JP2016131803A - Treatment instrument - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a treatment instrument capable of easily holding a recovery loop provided on a stent.SOLUTION: A treatment instrument 1 includes a first forceps piece 21 and a second forceps piece 22, where at least one of them is rotationally turned about a rotational axis. The second forceps piece 22 includes a hook part projecting towards the first forceps piece 21, at a tip end thereof. When viewing a grip part from the axial direction of the rotational axis, the thickness of the first forceps piece 21 gradually decreases towards the tip end of the first forceps piece 21, and, in the natural state, the first forceps piece 21 projects diametrically outward a sheath 10. When the grip part is closed by an operation of an operation part 30, an extension direction of the grip part and a longitudinal axis L cross with each other at the tip side with respect to the rotational axis so as to form an acute angle.SELECTED DRAWING: Figure 2

Description

  The present invention relates to a treatment tool for recovering a stent placed in the body.

For stenosis of the body lumen, for example, esophageal stenosis, malignant stenosis due to esophageal cancer, anastomotic stenosis occurring in the anastomosis after surgery, and mucosa by endoscopic submucosal dissection (ESD) There is benign stenosis such as scar stenosis occurring at the excision site. Regardless of benign or malignant, when stenosis occurs, the esophagus is blocked, making swallowing difficult.
Conventionally, a substantially cylindrical stent (for example, refer to Patent Document 1) formed of a metal such as stainless steel has been used for the purpose of expanding the narrowed portion of the lumen in the body.

Since the stent described in Patent Document 1 is a self-expanding type that expands radially outward, the stenotic site can be expanded by placing the stent in the esophagus.
At least one end of the stent is provided with a stent recovery loop. When retrieving the stent, the loop is gripped and pulled. When the loop is pulled, the stent is reduced in diameter and can be removed.

Japanese Patent No. 5008660

  Usually, when the stent is recovered, the recovery loop is gripped using gripping forceps. However, the tissue in the lumen where the end of the stent is disposed is often normal tissue, and the tissue in this portion is constantly stimulated because pressure from the stent is applied. As a result, the cells proliferate and the tissue volume may increase (hyperplasia). As a result, the recovery loop may be buried in the hyperplastic tissue, and may be difficult to grasp with the grasping forceps.

  The present invention has been made in view of such problems, and an object of the present invention is to provide a treatment instrument that can easily grasp a recovery loop provided on a stent.

  A treatment tool according to a first aspect of the present invention is a treatment tool for collecting a stent placed in a body, and includes a sheath having a longitudinal axis, a distal end side of the sheath, and a first forceps piece. A second forceps piece disposed opposite to the first forceps piece, and a gripping part supported by a rotating shaft, and an operation part for operating the gripping part, At least one of the first forceps piece and the second forceps piece rotates around the rotation axis, and the collar portion protrudes toward the first forceps piece at the tip of the second forceps piece When the grip portion is viewed from the axial direction of the pivot shaft, the thickness of the first forceps piece decreases toward the tip of the first forceps piece, and the first forceps piece is in a natural state. When the forceps piece protrudes outward in the radial direction of the sheath and the grip portion is closed by the operation of the operation portion Wherein the extending direction of the grip portion and the longitudinal axis intersect at an acute angle at the tip side of the rotating shaft.

  A main body provided on the distal end side of the sheath is further provided, the rotating shaft is provided in the main body, and one of the first forceps piece and the second forceps piece is fixed to the main body. May be.

  The main body further includes a main body provided on the distal end side of the sheath, the rotating shaft is provided on the main body, the first end is fixed to the main body, and the second end is the second end. There may be a biasing member that is fixed to the proximal end side of the one forceps piece and biases the first forceps piece.

  The hook part may protrude from the gripping surface of the first forceps piece when the gripping part in the closed state is viewed from the axial direction.

The first forceps piece is a needle-like member, a plurality of the second forceps pieces are arranged at intervals in the axial direction, and the needle-like member is Between the second gripping pieces.
The length of the first forceps piece in the extending direction may be longer than the length of the second forceps piece in the extending direction.

  According to the treatment instrument of each aspect described above, it is possible to easily grasp the collection loop provided on the stent.

1 is an overall view showing a treatment tool according to a first embodiment of the present invention. 1 is an overall view showing a treatment tool according to a first embodiment of the present invention. It is a figure which shows operation | movement of the treatment tool of 1st Embodiment of this invention. It is a figure which shows operation | movement of the treatment tool of 1st Embodiment of this invention. It is a perspective view which shows the holding part of the treatment tool of FIG. It is the schematic which shows one form at the time of use of the treatment tool of FIG. It is the schematic which shows one form at the time of use of the treatment tool of FIG. It is the schematic which shows one form at the time of use of the treatment tool of FIG. It is the schematic which shows one form at the time of use of the treatment tool of FIG. It is the schematic which shows one form at the time of use of the treatment tool of FIG. It is the schematic which shows one form at the time of use of the treatment tool of FIG. It is a figure which shows operation | movement of the treatment tool of 2nd Embodiment of this invention. It is a figure which shows operation | movement of the treatment tool of 2nd Embodiment of this invention. It is the schematic which shows one form at the time of use of the treatment tool of FIG. It is the schematic which shows one form at the time of use of the treatment tool of FIG. It is a figure which shows the state by which the treatment tool of 3rd Embodiment of this invention was penetrated by the channel. It is a figure which shows the state which the treatment tool of 3rd Embodiment of this invention protruded from the channel. It is a figure which shows the holding part of the treatment tool of the 1st modification of this invention. It is a figure which shows the holding part of the treatment tool of the 1st modification of this invention. It is a figure which shows the holding part of the treatment tool of the 2nd modification of this invention. It is a figure which shows the holding part of the treatment tool of the 2nd modification of this invention.

[First Embodiment]
A treatment tool according to a first embodiment of the present invention will be described with reference to FIGS.
The treatment tool 1 of the present invention is a treatment tool for collecting a stent placed in the body, for example, the esophagus. As shown in FIG. 1, the treatment instrument 1 includes a sheath 10 having a longitudinal axis L, a gripping part 20 provided on the distal end side of the sheath 10, and an operation part 30 for operating the gripping part 20.

  For example, as shown in FIG. 1, the sheath 10 is configured by winding a coil in the longitudinal axis L direction without a gap. The sheath 10 has flexibility, and can be easily changed in shape in accordance with the change in shape of the insertion portion of the endoscope apparatus while being inserted into the channel of the endoscope apparatus.

The treatment instrument 1 includes a cover member (main body portion) 25 at the distal end of the sheath 10. The gripping part 20 has a first forceps piece 21 and a second forceps piece 22 arranged to face the first forceps piece 21. A rotation shaft 23 that supports the first forceps piece 21 and the first forceps piece 21 is provided on the cover member 25. The base end of the first forceps piece 21 is fixed to the cover member 25.
The first forceps piece 21 protrudes outward in the radial direction of the sheath 10 in a natural state when the grip portion 20 is viewed from the direction of the axis C of the rotation shaft 23. That is, the tip of the first forceps piece 21 is located outside the outer diameter of the sheath 10. The natural state indicates a state in which no external force is applied to the grip portion 20.
As shown in FIG. 5, the first forceps piece 21 has a wedge shape. That is, the wedge shape has a triangular prism shape, and the first forceps piece 21 is arranged so that the height direction of the triangular prism is parallel to the axis C. When the grasping portion 20 is viewed from the direction of the axis C of the rotation shaft 23, the thickness t of the first forceps piece 21 decreases toward the tip, and the first forceps piece 21 is the tip of the first forceps piece 21. Pointed towards. The length of the first forceps piece 21 in the width direction along the axis C direction is constant toward the tip.
Further, the gripping surface 21 a of the first forceps piece 21 faces the second forceps piece 22.

The second forceps piece 22 is rotatably supported on the rotation shaft 23. The distal end portion 22 a of the second forceps piece 22 is provided with a collar portion 24 that protrudes toward the first forceps piece 21. The collar portion 24 has a pointed shape toward the first forceps piece 21.
In addition, the first forceps piece 21 and the second forceps piece 22 have a length in the extending direction of the first forceps piece 21 longer than a length in the extending direction of the second forceps piece 22. It is configured.

As shown in FIGS. 1 and 2, the operation unit 30 includes an operation unit main body 31 connected to the proximal end portion of the sheath 10 and a slider 32 attached to the operation unit main body 31.
The slider 32 and the second forceps piece 22 are connected by an operation wire W. As shown in FIGS. 3 and 4, a connecting member 26 is provided at the distal end portion of the operation wire W. The proximal end portion of the second forceps piece 22 is coupled to the distal end portion of the operation wire via the coupling member 26. The second forceps piece 22 is rotatably supported on the rotating shaft 27 of the connecting member 26, and the operation wire W is rotatably supported on the rotating shaft 28 of the connecting member 26.
Accordingly, by moving the slider 32 forward and backward with respect to the operation unit main body, the second forceps piece 22 rotates about the rotation shaft 23 and the gripping unit 20 can be opened and closed. When the slider 32 is advanced to open the grip 20 at the maximum, the second forceps piece 22 is positioned on the longitudinal axis L.

In addition, as shown in FIG. 2, a line segment connecting the axis C of the rotating shaft 23 and the contact portion P between the second forceps piece 22 and the first forceps piece 21 in a state where the grip portion 20 is closed. The extending direction L <b> 1 intersects the longitudinal axis L so as to form an acute angle on the tip side of the rotation shaft 23. That is, the angle α formed by the extending direction L1 and the longitudinal axis L on the tip side of the rotation shaft 23 is an acute angle.
In a normal treatment tool (gripping forceps), the first forceps piece 21 and the second forceps piece 22 are closed on the longitudinal axis L. In the treatment tool 1 of this embodiment, the first forceps piece 21 and the second forceps piece 21 are closed. The second forceps piece 22 is closed at a position displaced from the longitudinal axis L.

Next, a method for recovering a stent placed in the esophagus using the treatment tool of the present embodiment will be described.
The user inserts the endoscope device 201 into the esophagus E and observes the inside of the esophagus E. When the stent 100 is confirmed, the treatment tool 1 is inserted into the endoscope apparatus 201 and protruded from the channel 202. Note that the treatment instrument 1 may be inserted into the channel 202 before the endoscope apparatus 201 is inserted into the esophagus E.
As shown in FIG. 6, a stent recovery loop 101 is provided at the end 100 a of the stent 100. Usually, since the operator can visually recognize the loop 101 with the endoscope apparatus 201, the operator grasps the loop 101 with the treatment tool 1 and pulls the loop 101 toward the endoscope apparatus 201 side. Thereby, as shown in FIG. 7, the stent 100 is reduced in diameter and is extracted from the esophagus E.

However, when the cells of the esophagus E proliferate and the volume of the tissue increases (hyperplasia), the recovery loop 101 may be buried in the hyperplastic tissue. In such a case, as shown in FIG. 8, the loop 101 is buried in the overlying inner wall Ea of the esophagus E.
In this case, the user advances the slider 32 to bring the first forceps piece 21 into the inner wall Ea with the gripping portion 20 opened as shown in FIG. After the entered first forceps piece 21 is hooked on the loop 101, the endoscope device 201 is operated to move the treatment tool 1 away from the inner wall Ea, and the loop 101 is lifted as shown in FIG. . Next, when the slider 32 is retracted, the second forceps piece 22 rotates toward the first forceps piece 21 as shown in FIG. Thereby, it is gripped by the gripping part 20 so that the loop 101 does not come off. In this state, as shown in FIG. 11, when the entire treatment tool 1 is retracted and pulled with respect to the stent 100, the diameter of the stent 100 can be reduced and removed from the esophagus E.

According to the treatment instrument 1 of the present embodiment, when the grip portion 20 is closed, the extending direction L1 of the grip portion 20 and the longitudinal axis L intersect so as to form an acute angle on the distal end side with respect to the rotation shaft 23. Therefore, the first forceps piece 41 can be easily entered from the vertical direction with respect to the inner wall Ea of the esophagus E. Further, since the second forceps piece 22 protrudes outward in the radial direction of the sheath 10, it is easy to enter the inner wall Ea. In addition, even when the second forceps piece 22 enters the inner wall Ea of the esophagus E from the tangential direction, the loop 101 hooked on the second forceps piece 22 can be easily grasped. Thereby, the stent 100 can be easily recovered.
In addition, since the grasping portion 20 is opened and closed by one operation wire W, the treatment instrument 1 of the present embodiment can be opened and closed with a simple configuration, and the stent 100 can be recovered.

[Second Embodiment]
A second embodiment of the present invention will be described with reference to FIGS.
The treatment tool 40 of the present embodiment is different from the first embodiment in the configuration in which the first forceps piece is movable and the second forceps piece is fixed.
In the following description, the same components as those described above are denoted by the same reference numerals, and redundant description is omitted.

  The treatment instrument 40 includes a grasping portion 43 having a first forceps piece 41 and a second forceps piece 42 instead of the grasping portion 20. In the treatment tool 40, as shown in FIG. 12, the positions of the two forceps pieces 41 and 42 in a state where the grip portion 43 is closed are the same as in the first embodiment. That is, the extending direction L2 of the line connecting the axis C of the rotation shaft 23 and the contact portion P between the second forceps piece 42 and the first forceps piece 41 is closer to the distal end than the rotation shaft 23. It intersects with the longitudinal axis L so as to form an acute angle. In the present embodiment, the first forceps piece 41 is rotatably supported by the rotation shaft 23, and the second forceps piece 42 is fixed to the cover member 25. When the grip 43 is opened as shown in FIG. 13, the tip of the first forceps piece 41 located on the lower side is further outward in the radial direction than the tip of the first forceps piece 21 of the first embodiment. Located in.

  In the treatment instrument 40, when the slider 32 of the operation unit 30 is advanced, only the first forceps piece 41 moves in a direction away from the second forceps piece 42, and the gripping part 43 opens and closes.

Next, a method for recovering a stent placed in the esophagus using the treatment tool of the present embodiment will be described.
When the loop 101 of the stent 100 is buried in the overlying inner wall Ea of the esophagus E, the slider 32 is advanced to bring the grip 43 into an open state as shown in FIG. The forceps piece 41 is caused to enter the inner wall Ea, and the loop 101 is hooked on the tip of the first forceps piece 41. Next, when the slider 32 is retracted, as shown in FIG. 15, the first forceps piece 41 rotates toward the second forceps piece 42, so that the grip portion 43 is closed while lifting the loop 101.

According to the treatment instrument 40 of the present embodiment, when the grip portion 43 is closed, the extending direction L2 of the grip portion 43 and the longitudinal axis L are more distal than the rotation shaft 23, as in the first embodiment. The stent 100 can be easily recovered because it intersects at an acute angle on the side.
Further, since the first forceps piece 41 is located further radially outward than the tip of the first forceps piece 21 of the first embodiment in a state where the grip portion 43 is open, It is easy to allow the first forceps piece 41 to enter from the direction perpendicular to the inner wall Ea.
Further, since the loop hooked on the first forceps piece 41 can be lifted by the operation of closing the grip portion 43, the loop 101 can be easily pulled out from the inner wall Ea.

[Third Embodiment]
A second embodiment of the present invention will be described with reference to FIGS.
The treatment tool 50 of the present embodiment is different from the first embodiment in the configuration in which the first forceps piece is fixed via a spring member (biasing member).

  The treatment instrument 50 includes a grasping portion 53 having a first forceps piece 51 and a second forceps piece 52. As shown in FIGS. 16 and 17, the first forceps piece 51 is fixed to the cover member 25 via a spring member 55. That is, the first end 55 a of the spring member 55 is fixed to the cover member 25, and the second end 55 b of the spring member 55 is fixed to the base end portion of the first forceps piece 51. Since the first forceps piece 51 is urged by the spring member 55, the first forceps piece 51 is always urged in a direction away from the second forceps piece 52.

Next, the operation | movement at the time of collect | recovering the stent indwelled in the esophagus using the treatment tool of this embodiment is demonstrated.
When the treatment instrument 50 is inserted into the channel 202, the first forceps piece 51 is brought close to the second forceps piece 52 and is inserted without protruding outward in the radial direction of the sheath 10. As shown in FIG. 16, although the first forceps piece 51 is opened by the spring member 55 to the position where it hits the inner wall 202a of the channel 202, the treatment instrument 50 advances in the channel 202 without the first forceps piece 51 being caught. can do.
When the stent 100 is confirmed, the treatment tool 1 is protruded from the channel 202. At this time, the first forceps piece 51 moves in a direction away from the second forceps piece 52 as shown in FIG. As a result, as in the first embodiment, the first forceps piece 51 enters the inner wall Ea, and the loop 101 of the stent 100 is hooked on the first forceps piece 51 and lifted. By the operation of the operation unit 30, the second forceps piece 52 rotates toward the first forceps piece 51 as indicated by a two-dot chain line, and the gripping portion 53 is closed. Thereby, the treatment tool 50 is pulled toward the endoscope apparatus 201 side, and the stent 100 is removed.

According to the treatment instrument 50 of the present embodiment, the first forceps piece 51 is not directly fixed to the cover member 25 but is fixed via the spring member 55, so that the first forceps are caused by the inner wall 202 a of the channel 202. The piece 51 approaches the second forceps piece 52. Accordingly, the amount of the first forceps piece 51 protruding outward in the radial direction of the sheath 10 can be suppressed, so that the treatment instrument 50 can be advanced while suppressing damage to the inner wall 202a of the channel 202. .
Further, it is not necessary to make the grip portion 53 excessively small with respect to the inner diameter of the channel 202.

[First Modification]
A treatment instrument 60 according to a first modification of the present invention will be described with reference to FIGS. 18 and 19.
Since the treatment tool 60 of the present modification is different from the treatment tool 1 of the first embodiment only in the configuration of the grip portion 63, this point will be described.
In the treatment instrument 60, as shown in FIG. 18, a slit 65 is formed from the central portion of the tip of the first forceps piece 61 toward the rotation shaft 23. As shown in FIG. 19, when the grip portion 63 in a closed state is viewed from the axis C, the collar portion 64 protrudes from the grip surface 61 a of the first forceps piece 61.

According to the first modified example, when the loop 101 of the stent 100 is gripped by the grip portion 63, the loop 101 is pulled into the slit 65, so that the loop 101 can be reliably held.
In addition, although the slit 65 of this modification is penetrated and formed to the back surface opposite to the holding surface 61a, it may be formed to be opened halfway.
Moreover, the hole may be provided in the location which the collar part 64 contacts of the holding surface 61a. The hole may be penetrated to the back surface opposite to the gripping surface 61a, or may be opened halfway. Thereby, when the grip part 63 is closed, the collar part 64 is inserted into the hole, so that the loop 101 can be reliably held as in the first modification.
In the first modified example, as in the first embodiment, even if the first forceps piece 61 is fixed to the cover member 25, the second forceps piece 62 is covered as in the second embodiment. It may be fixed to the member 25. Further, similarly to the third embodiment, the first forceps piece 61 may be fixed to the cover member 25 via the spring member 55. That is, the structure of the gripping part 63 can be combined with the above embodiments.

[Second Modification]
A treatment tool 70 according to a second modification of the present invention will be described with reference to FIGS.
Since the treatment tool 70 of the present modification is different from the treatment tool 1 of the first embodiment only in the configuration of the grip portion 73, this point will be described.
As shown in FIG. 20, the gripping portion 73 has two second forceps pieces 71 and one first forceps piece 72. The two second forceps pieces 71 are arranged at intervals and are configured to move integrally by pulling the operation wire W. The first forceps piece 72 is a needle-like member that is pointed toward the tip. In the needle-like member 72, the length in the width direction along the axis C of the rotating shaft 23 is reduced toward the tip in addition to the thickness direction.
When the gripping portion 73 is closed, the needle-like member 72 is positioned between the two second forceps pieces 71 as shown in FIG.

According to the second modification, when the loop 101 of the stent 100 is gripped by the grip portion 73, the loop 101 is pulled between the two second forceps pieces 71, so that the loop 101 can be reliably held. It becomes possible.
Further, since the needle-like member 72 is pointed toward the tip, it is easy to pick up the loop 101.
In the second modified example, as in the first embodiment, even if the first forceps piece 72 is fixed to the cover member 25, the second forceps piece 71 is covered as in the second embodiment. It may be fixed to the member 25. Further, similarly to the third embodiment, the first forceps piece 72 may be fixed to the cover member 25 via the spring member 55. That is, the configuration of the gripping portion 73 can be combined with the above embodiments.

  As mentioned above, although preferable embodiment of this invention was described, this invention is not limited to these embodiment. Additions, omissions, substitutions, and other modifications can be made without departing from the spirit of the present invention. The present invention is not limited by the above description, but only by the scope of the appended claims.

E Esophageal (Body)
L Longitudinal axis L1, L2 Extension direction 1, 40, 50, 60, 70 Treatment instrument 10 Sheath 20, 43, 53, 63, 73 Grasping part 21, 41, 51, 61, 72 First forceps piece 22, 42 , 52, 62, 71 Second forceps piece 24 buttock part 25 cover member (main body part)
30 Operating section 55 Spring member (biasing member)
61a Gripping surface

Claims (6)

A treatment tool for collecting a stent placed in the body,
A sheath having a longitudinal axis;
A gripping portion provided on the distal end side of the sheath, having a first forceps piece and a second forceps piece arranged to face the first forceps piece, and supported by a rotating shaft;
An operation unit for operating the gripping unit;
With
At least one of the first forceps piece and the second forceps piece rotates about the rotation axis;
A hook that protrudes toward the first forceps piece is provided at the tip of the second forceps piece;
When viewing the grip portion from the axial direction of the pivot shaft,
The thickness of the first forceps piece decreases toward the tip of the first forceps piece;
In a natural state, the first forceps piece protrudes radially outward of the sheath,
The treatment tool, wherein when the grip portion is closed by operation of the operation portion, the extending direction of the grip portion and the longitudinal axis intersect so as to form an acute angle on the distal end side with respect to the rotation shaft. A main body provided on the distal end side of the sheath;
The rotating shaft is provided in the main body,
The treatment tool according to claim 1, wherein one of the first forceps piece and the second forceps piece is fixed to the main body portion. A main body provided on the distal end side of the sheath;
The rotating shaft is provided in the main body,
The grip portion includes a biasing member having a first end fixed to the main body portion, a second end fixed to a proximal end side of the first forceps piece, and biasing the first forceps piece. Item 2. The treatment tool according to Item 1. The treatment tool according to claim 1, wherein when the grip portion in the closed state is viewed from the axial direction, the collar portion protrudes from the grip surface of the first forceps piece. The first forceps piece is a needle-like member;
A plurality of the second forceps pieces are arranged at intervals in the axial direction,
The treatment tool according to claim 1, wherein the needle-like member is positioned between the plurality of second forceps pieces when the grip portion is closed. The treatment tool according to claim 1, wherein a length of the first forceps piece in the extending direction is longer than a length of the second forceps piece in the extending direction.

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