JP2017012670A - Treatment instrument - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a treatment instrument capable of being easily inserted when the treatment instrument is re-inserted into a bile duct.SOLUTION: A treatment instrument 1, which is extended in a longitudinal direction to be inserted into the body cavity along the longitudinal direction, includes a first balloon 15 which is provided at a tip to maintain a position within the body cavity, and a second balloon 16 which is provided to be freely movable along the longitudinal direction between the tip and a base end and which can be expanded and contracted.SELECTED DRAWING: Figure 5

Description

  The present invention relates to a treatment instrument that approaches a bile duct or a common bile duct (hereinafter collectively referred to as a bile duct) through a lumen in a body cavity, particularly a duodenal papilla.

  In recent years, endoscopic examinations or treatments for biliary diseases such as biliary tract cancer, cholelithiasis, or common bile duct stones are becoming widespread in the medical field. These are less invasive than conventional surgical treatments and have advantages such as less burden on the subject.

  As an example of these treatment methods, for example, in Japanese Patent Laid-Open No. 2014-223107 (Patent Document 1), a treatment instrument including a contractible member such as a balloon or a basket is inserted into a bile duct via an endoscope. A method for removing gallstones accumulated in the bile duct using the treatment tool is shown.

  Specifically, Patent Document 1 aims at facilitating insertion of a treatment tool as described above into the bile duct via the duodenal papilla when the treatment tool is inserted into the bile duct via an endoscope. The method of inserting the treatment instrument into the bile duct after fixing the distal end of the endoscope around the duodenal papilla using a predetermined balloon is shown.

JP, 2014-223107, A

  By the way, in the above-described gallstone extraction method, it is necessary to repeat the extraction procedure a plurality of times when the amount of gallstones in the bile duct is large.

  Also, in this type of cholelithectomy, once the gallstone has been removed, it was necessary to insert the endoscope or treatment tool into the bile duct again in order to confirm the presence or absence of stones in the bile duct .

  Here, when inserting the endoscope or treatment instrument into the bile duct requires a certain amount of labor and time, repeatedly inserting these endoscope or treatment instrument into the bile duct is a factor that increases the time required for treatment. It was with me.

  This invention is made | formed in view of the said situation, and it aims at providing the treatment tool which can be easily reinserted in a bile duct.

  A treatment instrument according to one aspect of the present invention is a treatment instrument that extends in a longitudinal direction and is inserted into a body cavity along the longitudinal direction. A treatment member capable of expansion and contraction, which is movably provided along the longitudinal direction between the ends.

  ADVANTAGE OF THE INVENTION According to this invention, the treatment tool which can be easily reinserted in a bile duct can be provided.

It is the principal part external appearance perspective view which showed the treatment tool which concerns on one Embodiment of this invention. It is the principal part external appearance perspective view which showed the mode at the time of inserting the treatment tool which concerns on the said embodiment into an endoscope. FIG. 6 is a cross-sectional view of the main part in the longitudinal direction of the treatment instrument showing a state in which the distal end part of the treatment instrument is housed in the distal end configuration part of the endoscope when the treatment instrument according to the embodiment is inserted into the endoscope. . A cross-sectional view of the main part in the longitudinal direction of the treatment instrument, showing a state in which the second shaft portion of the treatment instrument protrudes from the distal end configuration part of the endoscope when the treatment instrument according to the embodiment is inserted into the endoscope. It is. When the treatment tool according to this embodiment is inserted through an endoscope, the cross-sectional view of the main part in the longitudinal direction of the treatment tool shows a state in which the first shaft portion further protrudes from the second shaft portion of the treatment tool. . It is principal part sectional drawing which showed the state which expanded the 1st balloon, the 2nd balloon, and the 3rd balloon when the treatment tool and endoscope which concern on the said embodiment were inserted in a bile duct. It is the principal part enlarged view which showed the mode at the time of inserting the front-end | tip part structure part of the endoscope which accommodated the treatment tool which concerns on the said embodiment toward a bile duct via the duodenal papilla. After inserting the distal end configuration part of the endoscope through which the treatment tool according to the embodiment is inserted into the bile duct via the duodenal papilla, the first shaft part and the second shaft part are extended, and the first balloon and the first balloon It is the principal part enlarged view which showed the mode at the time of expanding 2 balloons. The state at the time of extracting the 2nd balloon from the tip part constituent part and the 2nd balloon of the endoscope which were inserted in the bile duct in the state where the position of the first balloon of the treatment instrument according to the embodiment is maintained in the bile duct is shown. FIG.

Embodiments of the present invention will be described below with reference to the drawings.
Moreover, this invention is not limited by this embodiment. Furthermore, the same code | symbol is attached | subjected to the same part in description of drawing. Furthermore, the drawings are schematic, and it should be noted that the relationship between the thickness and width of each member, the ratio of each member, and the like are different from the actual situation. Moreover, the part from which a mutual dimension and ratio differ also in between drawings.

  FIG. 1 is an external perspective view showing a main part of a treatment tool according to an embodiment of the present invention, and FIG. 2 is a diagram showing a state when the treatment tool according to the embodiment is inserted through an endoscope. FIG.

<Schematic configuration of treatment tool>
As shown in FIG. 1, a treatment tool 1 according to the present embodiment is a treatment tool for removing gallstones accumulated in a bile duct via a duodenal papilla, and includes two balloon catheters, that is, a small-diameter shaft. The first balloon catheter 3 has a second balloon catheter 4 having a large-diameter shaft (details will be described later).

  Further, as shown in FIG. 2, in the treatment instrument 1, the second balloon catheter 4 is directly inserted into a channel tube in an endoscope 2 that can be inserted into the bile duct from the duodenum through the duodenal papilla. It has become so.

  In FIG. 2, the second balloon catheter 4 in the treatment instrument 1 is inserted into the channel tube 29 (see FIG. 3; described in detail later) in the endoscope 2 from the distal end thereof. 2 shows a state in which part of the distal ends of the second balloon catheter 4 and the first balloon catheter 3 project from the distal end surface of the endoscope 2.

  Returning to FIG. 1, the treatment instrument 1 of the present embodiment includes two balloon catheters as described above, that is, the first balloon catheter 3 having a first shaft having a small diameter, and the first balloon catheter 3 in the first balloon catheter 3. And a second balloon catheter 4 having a large-diameter second shaft 12 having a lumen line through which the first shaft 11 can be inserted.

  In addition, in order to place the first shaft 11 at a fixed position in the bile duct after the first shaft 11 and the second shaft 12 are inserted into the bile duct at the distal end portion of the first shaft 11 in the first balloon catheter 3. The first balloon 15 is provided.

  Furthermore, a second balloon 16 for collecting gallstones after the second shaft 12 is inserted into the bile duct is provided at the distal end portion of the second shaft 12 in the second balloon catheter 4, and the second shaft 12 is provided. A third balloon 17 for fixing the second shaft 12 in the distal end constituting portion 21 is provided on the proximal end side of the second balloon 16 in FIG.

  On the other hand, a flange-shaped first shaft flange portion 13 is disposed on the first shaft base end portion 11b which is a base end portion of the first shaft 11, and the first balloon 15 is provided on the first shaft flange portion 13. A first fluid insertion port 36 is provided for flowing in fluid for expansion / contraction.

  Further, a second fluid insertion port 35 and a third fluid for inflowing a fluid for expanding and contracting the second balloon 16 and the third balloon 17 respectively on one side surface in the vicinity of the proximal end portion of the second shaft 12. An insertion port 34 is provided.

  The internal configuration of the treatment instrument 1 including the first shaft 11 and the first balloon 15 in the first balloon catheter 3 and the second shaft 12 and the second balloon 16 in the second balloon catheter 4 will be described in detail later. .

<Configuration of endoscope>
As shown in FIG. 2, the endoscope 2 with which the treatment instrument 1 of the present embodiment is engaged assumes a so-called biliaryscope in the present embodiment, and the body cavity of the subject (the bile duct in the present embodiment is used). A long and flexible insertion portion 20 to be inserted), an operation portion 24 connected to the proximal end portion of the insertion portion 20, and a base portion extending from a side portion of the operation portion 24. And a universal cord 25 provided with a connector portion not to be provided.

  The insertion portion 20 is connected to the distal end side portion 21 incorporating the imaging portion, the bending portion 22 formed of, for example, fluororubber and bendable in two directions, and the proximal end side of the bending portion 22 in order from the distal end side. For example, it has the flexible long flexible pipe part 23 formed of the fluororesin.

  The distal end component 21 is formed using, for example, polysulfone and the like, and illumination light transmitted via a light guide (not shown) that forms a light guide path of light generated by the light source device is used as an object on the distal end surface. An illumination lens window 41 for emitting light toward the object and an observation window 42 for observing the object are provided.

  On the upper surface of the operation unit 24, bending operation knobs 6a and 26b for changing the bending direction of the bending unit 22 by hand operation are overlapped, and various switches 27 for remotely adjusting the light amount of the light source device and the like are provided. ing. On the other hand, a forceps port 28 for inserting various treatment tools such as the treatment tool 1 of the present embodiment is disposed on the lower side surface of the operation unit 24.

<Detailed configuration of treatment instrument and engaging endoscope>
Hereinafter, the configuration of the treatment instrument 1 will be described in detail with reference to FIGS.
3 to 5 are cross-sectional views of the main part in the longitudinal direction showing the state in which the treatment instrument 1 of the present embodiment is inserted into the channel tube 29 of the endoscope 2, but FIG. 4 shows a state in which the distal end portions (the distal end portions of the first shaft 11 in the first balloon catheter 3 and the second shaft 12 in the second balloon catheter 4) are accommodated in the distal end constituting portion 21 of the endoscope 2. FIG. FIG. 5 shows a state in which the second shaft 12 in the treatment instrument 1 protrudes from the distal end constituting portion 21 of the endoscope 2, and FIG. 5 shows a state in which the first shaft 11 further protrudes from the second shaft 12 in the treatment instrument 1. Show.

  FIG. 6 shows a state in which the first balloon 15, the second balloon 16, and the third balloon 17 are expanded when the treatment instrument 1 and the endoscope 2 according to the embodiment are inserted into the bile duct. FIG.

  3 to 5, only the peripheral members at both end portions of the channel tube 29 are shown for the endoscope 2, that is, the distal end portion (channel distal end side opening portion 29a) of the channel tube 29 is disposed. The cross-sections of the distal end constituting portion 21 and the forceps opening portion 28 where the proximal end portion (channel proximal end side opening portion 29b) of the channel tube 29 is disposed are shown.

  As described above, the channel tube 29 starts from the channel proximal end opening 29b in the forceps port portion 28 provided in the operation portion 24 of the endoscope 2, and the flexible tube portion 23 in the insertion portion 20, It extends through the inside of the bending portion 22 to the channel tip side opening portion 29 a formed at the tip portion of the tip component portion 21.

  As described above, the illumination lens window 41 and the observation window 42 are disposed on the distal end surface of the distal end configuration portion 21, while the distal end configuration portion 21 includes the distal end portion of the light guide that transmits illumination light and the An illumination unit provided at the tip of the light guide, an imaging optical system, an imaging unit, and the like are provided. However, in FIG. 3 to FIG. 5, only the illumination lens window 41 provided in front of the illumination unit and the observation window 42 provided in front of the imaging optical system are shown, and each of the above-described components is shown. The illustration is omitted for.

<Configuration of second balloon catheter 4>
As described above, the treatment instrument 1 of the present embodiment is configured by two balloon catheters, the first balloon catheter 3 and the second balloon catheter 4. First, the treatment tool 1 is directly inserted into the channel tube 29 in the endoscope 2. The second balloon catheter 4 will be described.

  As shown in FIGS. 3 to 5, the second balloon catheter 4 is a catheter that can be inserted into the channel tube 29 in the endoscope 2, and has a plurality of lumen conduits that extend in the lengthwise direction therein. The second shaft 12 that forms the shape, the second balloon 16 that can be expanded and contracted disposed at the tip of the second shaft 12, and the location where the second balloon 16 is disposed on the second shaft 12. And a third balloon 17 that can be expanded and contracted disposed on the end side.

  The second shaft 12 is a lumen line extending through the length direction, and forms a main lumen 18 through which the first shaft 11 in the first balloon catheter 3 can be inserted, and a second A second fluid insertion lumen 32 that allows a fluid for expanding and contracting the balloon 16 to be inserted, and a third fluid insertion lumen 33 that allows a fluid for expanding and contracting the third balloon 17 to be inserted, respectively. Form inside.

  As shown in FIG. 5, the distal end side of the main lumen 18 is opened at the distal end portion 12a of the second shaft to form a lumen proximal end opening portion 18a. On the other hand, the base end side of the main lumen 18 is opened at a second shaft flange portion 12b formed at the base end portion of the second shaft 12, thereby forming a lumen base end side opening portion 18b.

  The second balloon 16 is an expandable / shrinkable balloon for extracting gallstones accumulated in the bile duct, and is disposed so as to wind the outer peripheral surface at the distal end portion of the second shaft 12. Here, the distal end portion of the second balloon 16 is fixed in a liquid-tight manner, for example, by adhesion, fusion, or the like, over the entire circumference of the outer peripheral surface of the second shaft 12.

  A predetermined fluid is injected into one side surface of the second shaft 12 in the second balloon 16 at a portion where the second balloon 16 is disposed on the second shaft 12. A second balloon hole 32a is formed for this purpose.

  The second fluid insertion lumen 32 extends in the length direction in parallel with the main lumen 18 in the second shaft 12, and the tip side of the second fluid insertion lumen 32 faces the second balloon 16. After being bent toward one side, the second balloon hole portion 32a communicates with the second balloon hole portion 32a. The proximal end side of the second fluid insertion lumen 32 is bent toward one side surface in the vicinity of the proximal end portion of the second shaft 12, and communicates with the opening of the second fluid insertion port 35.

  Here, as the fluid inserted into the second fluid insertion lumen 32, for example, a liquid such as water or physiological saline, or a gas such as air or an inert gas is used in the present embodiment. By injecting or sucking these fluids from the fluid insertion port 35, the second balloon 16 can be expanded and contracted. FIG. 6 shows a state where the second balloon 16 is expanded.

  In the present embodiment, the second balloon 16 serves as a treatment member for removing the gallstone after the second shaft 12 is inserted into the bile duct.

  On the other hand, the third balloon 17 is a balloon that can be expanded and contracted so as to be wound around the outer peripheral surface on the proximal side from the location of the second balloon 16 on the second shaft 12. When the gallstone is extracted by the second balloon 16, the third balloon 17 is expanded to play a role of holding the second shaft 12 in the channel tube 29 in the distal end constituting portion 21. ing.

  Further, a predetermined fluid is injected into one side surface of the second shaft 12 in the third balloon 17 at a portion where the third balloon 17 is disposed on the second shaft 12. A third balloon hole 33a for this purpose is formed.

  The third fluid insertion lumen 33 extends in the length direction in the second shaft 12 in parallel with the main lumen 18, and the distal end of the third fluid insertion lumen 33 faces the third balloon 17. After being bent toward one side, the third balloon hole 33a communicates with the third balloon hole 33a.

  The proximal end side of the third fluid insertion lumen 33 is bent toward one side surface in the vicinity of the proximal end portion of the second shaft 12 and communicates with the opening of the third fluid insertion port 34.

  Here, in the present embodiment, the fluid inserted through the second fluid insertion lumen 32 and the third fluid insertion lumen 33 is, for example, a liquid such as water or physiological saline, or a gas such as air or an inert gas. The second balloon 16 or the third balloon 17 can be expanded or contracted by injecting or sucking these fluids from the second fluid insertion port 35 or the third fluid insertion port 34. It has become.

  The second shaft 12 is made of, for example, a fluororesin such as polytetrafluoroethylene, a polyamide resin such as nylon 11 or nylon 12, or a polyamide elastomer, a polyolefin such as polypropylene or polyethylene, a polyester such as polyethylene terephthalate, a polyurethane, a chloride, A flexible polymer material such as vinyl or a combination of one or more of these materials is used.

  In addition, the outer diameter of the second shaft 12 is usually preferably about 0.7 to 3.0 mm so as to have appropriate insertability, rigidity, and flexibility, and the length of the second shaft 12 extends to the target location in the living body. As long as it is necessary and sufficient to arrange the two balloons 16, it is usually preferably 50 to 250 cm, more preferably 180 to 200 cm.

  The constituent materials of the second balloon 16 and the third balloon 17 are, for example, natural rubber / synthetic rubber, silicone resin, polyamide resin such as nylon 11 or nylon 12, polyamide elastomer, polyolefin such as polypropylene or polyethylene, polyethylene A polymer containing at least one of polymer materials such as polyester such as terephthalate and polyurethane can be used.

  Furthermore, as for the dimensions of the second balloon 16 and the third balloon 17, for example, the maximum diameter of the cross section in the direction perpendicular to the axial direction is preferably φ3 to 30 mm, and more preferably φ10 to 20 mm.

  Although details will be described later, the expansion force when the second balloon 16 is expanded is set to be smaller than the expansion force when the first balloon 15 is expanded. Desirably, the first balloon 15 is set to be smaller than the dimension at the time of expansion.

<Configuration of first balloon catheter 3>
Next, of the two balloon catheters in the treatment instrument 1 of the present embodiment, the first balloon catheter 3 will be described.

  As shown in FIGS. 3 to 5, the first balloon catheter 3 is a catheter that can be slidably inserted into the main lumen 18 in the second balloon catheter 4, and extends in the length direction inside. A first shaft 11 that forms a lumen conduit, and a first balloon 15 that is disposed at the tip of the first shaft 11 and that can be expanded and contracted are provided.

  The first shaft 11 can be inserted into the main lumen 18 from the lumen proximal end opening 18b opened in the second shaft flange portion 12b, and extends in the length direction inside. A first fluid insertion lumen 31 is formed.

  The first balloon 15 is a balloon for placing the first shaft 11 at a fixed position in the bile duct, and is disposed so as to wind the outer peripheral surface at the distal end portion of the first shaft 11. Here, the distal end portion of the first balloon 15 is fixed in a liquid-tight manner, for example, by adhesion, fusion, or the like, over the entire outer periphery of the first shaft 11.

  In addition, a predetermined fluid is injected into one side surface of the first shaft 11 in the first balloon 15 at a portion where the first balloon 15 is disposed on the first shaft 11. A first balloon hole 31a is formed for this purpose.

  The first fluid insertion lumen 31 extends in the length direction in the first shaft 11, and the distal end side thereof is bent toward one side surface of the first shaft 11 that faces the first balloon 15. After that, it communicates with the first balloon hole 31a.

  Further, the proximal end side of the first fluid insertion lumen 31 is bent toward one side surface at the first shaft flange portion 13 disposed at the proximal end portion 11b of the first shaft 11, and the first fluid insertion port is formed. The 36 openings communicate with each other.

  Here, the first balloon 15 is expanded to maintain the position in the bile duct, and thereby serves as a fixing member for indwelling the first shaft 11 at a fixed position in the bile duct.

  As in the above, the fluid to be inserted into the first fluid insertion lumen 31 is, for example, a liquid such as water or physiological saline, or a gas such as air or an inert gas. By injecting or sucking these fluids from the first fluid insertion port 36, the first balloon 15 can be expanded and contracted.

  The first shaft 11 is made of, for example, a fluorine resin such as polytetrafluoroethylene, a polyamide resin such as nylon 11 or nylon 12, or a polyamide elastomer, a polyolefin such as polypropylene or polyethylene, a polyester such as polyethylene terephthalate, a polyurethane, a chloride, A flexible polymer material such as vinyl or a combination of one or more of these materials is used.

  Furthermore, the outer diameter of the first shaft 11 is usually preferably about 0.7 to 3.0 mm so as to have appropriate insertion property, rigidity, and flexibility, and the length of the first shaft 11 extends to the target location in the living body. As long as it is necessary and sufficient to dispose the balloon 15, it is usually preferably 50 to 250 cm, more preferably 180 to 200 cm.

  As the constituent material of the first balloon 15, as described above, for example, natural rubber / synthetic rubber, silicone resin, polyamide resin such as nylon 11 or nylon 12, polyamide elastomer, polyolefin such as polypropylene or polyethylene, polyethylene terephthalate, etc. Among them, polymers containing at least one kind of polymer materials such as polyester and polyurethane can be used.

  Furthermore, in the present embodiment, the expansion force when the first balloon 15 is expanded is set to be larger than the expansion force when the second balloon 16 is expanded. Therefore, the dimension of the first balloon 15 when expanded is the second balloon 15. It is desirable to set the dimension larger than 16 expanded dimensions. For example, the maximum diameter of the cross section in the direction perpendicular to the axial direction is preferably φ3 to 30 mm, and more preferably φ10 to 20 mm.

<Operation of this embodiment>
Next, with reference to FIGS. 7 to 9 in addition to FIGS. 3 to 6 described above, an operation at the time of gallstone extraction by the treatment tool 1 of the present embodiment will be described.

  First, as shown in FIG. 7, the operator inserts the insertion portion 20 of the endoscope 2 toward the duodenum 101 of the subject, and then inserts the distal end constituting portion 21 of the insertion portion 20 through the duodenal papilla 103. Is inserted into the bile duct 102.

  At this time, a known technique, for example, a treatment tool such as an electric knife is inserted from the forceps opening portion 28 toward the channel tube 29, and the duodenal papilla 103 is incised with high frequency using the electric knife. The distal end component 21 may be guided into the bile duct 102 via the duodenal papilla 103.

  Note that, as shown in FIG. 7, it is assumed that a gallstone 51 is present in front of the distal end component 21 in the bile duct 102 at this time.

  In the state shown in FIG. 7, the operator inserts the second shaft 12 of the second balloon catheter 4 from the forceps opening portion 28 toward the channel tube 29, and subsequently the lumen proximal end opening portion of the second balloon catheter 4. The first shaft 11 of the first balloon catheter 3 is inserted from 18b.

  At this time, the second balloon 16 and the third balloon 17 in the second balloon catheter 4 and the first balloon 15 in the first balloon catheter 3 are in a deflated state.

  The surgeon inserts the second shaft 12 and the first shaft 11 into the channel tube 29, and positions the distal end portions of the first shaft 11 and the second shaft 12 at the position of the channel distal end side opening portion 29 a in the distal end configuration portion 21. 3 in a state where it has reached (state of FIG. 3).

  The post-operator operates the second shaft 12 (and the first shaft 11) by operating the vicinity of the second shaft flange portion 12b of the second shaft 12 while observing the inside of the bile duct 102 in the imaging unit of the endoscope 2. ) Protrudes from the tip surface of the tip component 21 (state of FIG. 4), and further, the tip of the first shaft 11 is set to the tip of the second shaft 12 while observing the gallstone 51 in the bile duct 102. It protrudes from 12a (state of FIG. 5).

  Then, the surgeon arranges the first balloon 15 on the first shaft 11 and the second balloon 16 on the second shaft 12 at an optimal position for quarrying the gallstone 51, and then the first balloon 15 and the first balloon 15. 2 The balloon 16 is expanded.

  That is, the predetermined fluid described above is inserted through the first fluid insertion port 36 and the second fluid insertion port 35, and the fluid is supplied from the first balloon hole portion 31a and the second balloon hole portion 32a, respectively. The first balloon 15 and the second balloon 16 are expanded by being injected toward the first balloon 15 and the second balloon 16 (expanded state as shown in FIGS. 6 and 8).

  Here, in the present embodiment, as described above, the expansion force when the first balloon 15 is expanded is larger than the expansion force when the second balloon 16 is expanded, for example, as shown in FIG. The first balloon 15 is set so as to press the bile duct wall 100 more strongly than the second balloon 16.

  The expansion force when the first balloon 15 is expanded is not affected by the movement of the second balloon 16, which will be described later, and the first shaft 11 can be placed and fixed at a predetermined position in the bile duct 102. It has become a force.

  The second balloon 16 is expanded at a position in front of the gallstone 51 so as to be suitable for quarrying the gallstone 51.

  When the state shown in FIG. 8 is reached, that is, the first balloon 15 is in a state of pressing the bile duct wall 100 from its inner wall surface with a relatively strong expansion force at an appropriate position in the bile duct 102, and When the second balloon 16 reaches the expanded state at an optimal position for quarrying the gallstone 51, the operator expands the third balloon 17, and connects the second shaft 12 to the channel tube in the distal end component 21. 29 (state shown in FIG. 6).

  The surgeon adjusts the expansion force of the second balloon 16 and keeps the second shaft 12 held in the channel tube 29 in the distal end component 21 until the state shown in FIG. The endoscope 2 is pulled out from the bile duct 102.

  Since the second shaft 12 is integrated with the endoscope 2 as described above, the gallstone 51 is scraped from the bile duct 102 to the duodenum 101 by the expanded second balloon 16 (FIG. 9). State shown in).

  At this time, as described above, the expansion force when the first balloon 15 is expanded is at least a force that is not affected by the scraping action of the gallstone 51 by the second balloon 16 in the present embodiment. The first balloon 15 is left in a predetermined position in the bile duct 102 (state shown in FIG. 9).

  Here, as described above, when the amount of gallstones in the bile duct is large, there is a possibility that gallstones may remain in one excision procedure, and in order to confirm the residual state of gallstones, After extraction, it is necessary to insert an endoscope or a treatment instrument into the bile duct again.

  The treatment tool of the present embodiment can accurately cope with such a situation, that is, after the second balloon 16 (and the distal end component portion 21) is once moved into the duodenum 101, it is directed toward the bile duct 102 again. It can be easily inserted.

  Specifically, in the present embodiment, as shown in FIG. 9, the first shaft 11 is placed in a state of being extended at a predetermined position in the bile duct 102 by the expansion action of the first balloon 15. By guiding the first shaft 11, the second shaft 12 and the distal end constituting portion 21 of the endoscope 2 can be easily inserted into the bile duct 102.

  As described above, according to the treatment instrument 1 of the present embodiment, the second shaft 12 (and the distal end constituting portion 21 of the endoscope 2) on which the second balloon 16 for gallstone extraction is disposed is used for gallstone extraction. Even after being moved into the duodenum 101, the second shaft 12 (and the distal end constituting portion 21) can be easily inserted toward the bile duct 102.

  The present invention is not limited to the embodiment described above, and various modifications and changes are possible, and these are also within the technical scope of the present invention.

  The endoscope 2 with which the treatment tool 1 of the present embodiment is engaged is assumed to be a so-called biliary mirror in the present embodiment. For example, it can be applied to a urinary endoscope or a duodenoscope.

  Moreover, in the treatment tool 1 of the present embodiment, the second balloon catheter 4 is provided as a configuration that serves to extract gallstones from the bile duct. However, the treatment tool of the present invention is not limited thereto, and for example, the bile duct A so-called basket catheter may be employed in place of the second balloon catheter 4 as a configuration for taking out the gallstone from the inside, and this case is also included in the technical scope of the present invention.

1: Treatment tool 2: Endoscope 3: First balloon catheter 4: Second balloon catheter 11: First shaft 12: Second shaft 13: First shaft flange portion 15: First balloon 16: Second balloon 17: Third balloon 18: Main lumen 20: Insertion portion 21: Tip configuration portion 22: Bending portion 23: Flexible tube portion 31: First fluid insertion lumen 32: Second fluid insertion lumen 33: Third fluid insertion lumen

Claims (8)

In a treatment instrument that extends in the longitudinal direction and is inserted into a body cavity along the longitudinal direction,
A fixing member provided at the distal end portion and holding a position in the body cavity;
A treatment member capable of expanding and contracting provided movably along the longitudinal direction between a distal end and a proximal end;
A treatment instrument comprising:   The treatment instrument according to claim 1, wherein the treatment tool can be inserted into a channel of an endoscope inserted into a subject.   The treatment tool according to claim 1, wherein the fixing member is expanded to maintain a position in a body cavity.   The treatment tool according to claim 3, wherein an expansion force of the fixing member is set larger than an expansion force of the treatment member.   The treatment instrument according to claim 1, wherein the fixing member is a balloon that can be expanded and contracted.   The treatment instrument according to claim 1, wherein the treatment member is a balloon that can be expanded and contracted.   The treatment instrument according to claim 1, wherein the treatment member is a basket that can be expanded and contracted.   The said fixing member is arrange | positioned at the front-end | tip of the elongate guide member, The said treatment member is arrange | positioned so that a movement outside the said guide member is possible, The Claim 1 characterized by the above-mentioned. Treatment tool.

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