JP2018007829A - Sheath with cleaning tool and sheath device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a sheath with a cleaning tool and sheath device that can remove a foreign material attached to an endoscope treatment tool without taking the treatment tool out of an endoscope and can prevent the attachment of a foreign material inside a channel of the endoscope.SOLUTION: A sheath with a cleaning tool includes: a sheath 21 that is flexibly formed to have a long cylindrical shape of a length for enabling insertion/detachment to/from a treatment insertion channel 1a of an endoscope 1 and enables a treatment part 33 arranged at the distal end of the endoscope treatment tool 30 to be inserted to the cylindrical shape; and a sponge 21b arranged on an inner side close to the distal end of the sheath 21 so as to have contact with an outer peripheral surface of the treatment part 33.SELECTED DRAWING: Figure 3

Description

  The present invention relates to a sheath with a cleaning tool that is inserted into a channel of an endoscope and passes through a treatment portion disposed at a distal end of an endoscope treatment tool that treats an affected area, and a sheath device including the sheath. .

In general, an endoscope is widely used as a means for directly diagnosing or treating a lesion site in the body in a minimally invasive manner, and an endoscope having a treatment section for performing treatment within the field of view of the endoscope A treatment instrument is passed through the endoscope channel.
As this treatment tool, for example, a high-frequency treatment tool for endoscopes described in the following patent document can be cited.

JP 2016-87450 A

  The high-frequency treatment instrument for endoscope described in Patent Document 1 described above is a treatment instrument for endoscope for performing treatment such as excision of a lesion site in a body cavity or incision of a living tissue. , Passed through the channel of the endoscope, to treat the affected area within the field of view of the endoscope. The endoscope high-frequency treatment instrument includes a scissor-shaped treatment portion that is pivotally supported by a pivot shaft and is pivotally displaced between an open state and a closed state, and the operation wire is advanced and retracted. Thus, the heel piece is displaced between an open state and a closed state, and the living tissue is cauterized by applying a high frequency voltage to the blade portion provided on the heel piece.

In such a treatment tool, when a living tissue or the like is excised, a foreign substance such as a lesion adheres to the treatment portion at the distal end of the treatment instrument. It is not preferable because it may be difficult to cut off the field of view or to remove other parts. In each case, about 2 mm of the treatment tool is pulled out from the inside of the endoscope channel to remove the foreign matter adhering to the treatment part. I had to wipe it off with gauze by hand.
In addition, since the above-mentioned treatment tool is directly inserted into the channel of the endoscope, the tip of the endoscope treatment tool (such as a scissors) is scratched inside the channel or a foreign object is attached. There has been a problem that foreign matter adheres to the channel when it is pulled out from the channel.

  The present invention has been made in view of such a situation, and even if the treatment tool is not taken out of the endoscope, the foreign matter attached to the treatment tool can be removed, and the foreign matter adheres in the channel of the endoscope. It is an object of the present invention to provide a sheath with a cleaning tool and a sheath device that can prevent damage in the channel.

  In order to achieve the above object, the present invention is formed in a long cylindrical shape having a length to be inserted into and removed from a treatment instrument insertion channel of an endoscope, and the endoscope treatment instrument is formed in the tubular shape. A cleaning tool comprising: a sheath capable of inserting a treatment portion disposed at a distal end; and a cleaning tool disposed inside the vicinity of the distal end of the sheath so as to contact an outer peripheral surface of the treatment portion of the endoscope treatment tool. The first characteristic is that it is a sheath with attachment.

  In the sheath with a cleaning tool according to the first aspect of the present invention, the cleaning tool is a flexible sponge that is formed in a cylindrical shape having a hollow portion in the center near the central axis of the sheath. This is the second feature.

  Further, the present invention provides the sheath with the cleaning tool according to the first feature, wherein the cleaning tool has a plurality of bristles so that a hollow portion is formed in a central portion coaxial with the sheath toward the central axis of the sheath. A third feature is that the brush is raised.

  Further, the present invention is formed in a long cylindrical shape having a length to be inserted into and removed from the treatment instrument insertion channel of the endoscope, and is disposed at the distal end of the endoscope treatment instrument in the cylindrical shape. A sheath that can be inserted through the treatment section, a cleaning tool that is disposed inside the vicinity of the distal end of the sheath so as to contact the outer peripheral surface of the treatment section of the endoscope treatment tool, and the distal end is fixed to the distal end of the sheath A fourth feature is that the sheath device includes an operation wire arranged in a longitudinal direction of the sheath and an operation unit for pulling the operation wire to bend the sheath.

  In the sheath device according to the fourth aspect of the present invention, the cleaning tool is a flexible sponge that is formed in a cylindrical shape having a hollow portion in the center near the central axis of the sheath. Let's say fifth.

  In the sheath device according to the fourth aspect of the present invention, in the sheath device according to the fourth aspect, the cleaning tool is raised toward a central axis of the sheath, and a plurality of hairs are raised so that a hollow portion is formed at a central portion coaxial with the sheath. A sixth feature is that it is a brush.

  The sheath with a cleaning tool and the sheath device according to the present invention include a cleaning tool that contacts and cleans the treatment portion disposed at the distal end of the endoscope treatment tool in the vicinity of the distal end of the sheath. Since the endoscopic treatment tool can be cleaned in the sheath, it is not necessary to take out the endoscopic treatment tool for each treatment of the affected area and remove the foreign matter, and it is easy to treat a plurality of affected areas and the treatment time. Can be shortened. Further, since the endoscope treatment tool passes through the sheath device, the endoscope channel is hardly contaminated or damaged.

1 is an overall view showing an endoscope of the present invention. The whole sheath device of the present invention. The expanded sectional view of the sheath front-end | tip by 1st Example. The expanded sectional view of the sheath front-end | tip by 2nd Example. The figure explaining use of the sheath apparatus of this invention.

  Hereinafter, embodiments of the sheath with a cleaning tool and the sheath device according to the present invention will be described. First, an endoscope inserted through the sheath device according to the present embodiment will be described.

[Endoscope]
As shown in FIG. 1, an endoscope 1 to which a sheath 21 and a sheath device 20 according to the present embodiment are applied includes an insertion portion 11 for insertion into a body cavity of a living body, and a bending operation of the distal end of the insertion portion 11. An operation unit 10 having a dial for performing the operation, and an internal view that is a hole formed in the longitudinal direction from the treatment instrument introduction unit 12 disposed between the insertion unit 11 and the operation unit 10 toward the distal end of the insertion unit 11 A mirror channel 1a is formed.

[Endoscope treatment tool]
As shown in FIG. 5, the endoscope treatment tool 30 includes a pair of collars 33 a and 33 b that are disposed on the distal end side and pivotally displaced in an open state and a closed state by being pivotally supported by a link mechanism. Between the treatment part 33, the treatment tool operation part 30a (refer to FIG. 1) which is disposed on the proximal end side and can pull the treatment tool operation wire 32 to the proximal end side, and the treatment part 33 and the treatment tool operation part 30a. The treatment instrument sheath 31 is made of a flexible coil pipe 220 that is tightly wound with a metal such as a stainless steel wire, and is inserted through the treatment instrument sheath 31 and between the treatment section 33 and the treatment instrument operation section 30a. And a treatment instrument operating wire 32 corresponding to an operating means made of a conductive material.

  In the endoscope treatment instrument 30 according to the present embodiment, a distal end support frame 39 having two arm portions extending to the distal end side via a distal end cap 38 is connected to the distal end of the treatment instrument sheath 31, and between the arm portions. The rotary shaft 34 is pivotally supported by the crossing rotary shaft 34 to be pivotally displaced between the open state and the closed state, the blade surface extends from the rear end to the front end in a substantially straight line, and the front end is curved in the inner surface direction (closing direction). A pair of flanges 33a and 33b made of a conductive metal having a curved portion and a shaft 36a or 36b disposed on the rear end side of the pivot shaft 34 of the flanges 33a and 33b are attached to the distal end side so as to be freely rotatable. The pair of links 35a and 35b and the rear ends of the links 35a and 35b are pivotally supported (held) coaxially and rotatably, and are attached to a wire connecting member attached to the treatment instrument operation wire 32. Shaft 37 Equipped with a.

  The endoscope treatment tool 30 configured as described above opens the links 35a and 35b and moves the links 35a and 35b to the rear when the treatment tool operation wire 32 is moved in the left direction (front end side) in the figure. When the distal ends of the end-connected hook pieces 33a and 33b are opened around the rotation shaft 34 and the treatment instrument operation wire 32 is moved in the right direction (base end side) in the figure, the links 35a and 35b are closed and the hooks are closed. The tips of the pieces 33a and 33b are closed, and the affected part is incised.

  The endoscopic treatment tool 30 can be incised by cauterizing the living tissue in contact with the scissors piece 33a and 33b by applying a high-frequency current to the scissors pieces 33a and 33b through the treatment tool operation wire 32. However, the present invention is not limited to this. For example, an incision may be made by the shearing force of the sepal piece without using a high-frequency current. In the present embodiment, an example of opening and closing using the link mechanism including the links 35a and 35b has been shown. However, the opening and closing mechanism is not limited to that shown in the present embodiment, and may be opened and closed by another mechanism. May be.

[Sheath device]
As shown in FIG. 1, the sheath device 20 of the present embodiment is inserted through the treatment instrument sheath 31 of the endoscope treatment instrument 30 and the treatment portion 33 disposed at the distal end of the treatment instrument sheath 31. As shown in FIG. 2, it is inserted into an endoscope channel 1a formed in the endoscope 1 and has a long and flexible structure made of, for example, a resin. A hollow cylindrical sheath 21 having a bending portion 21a and an operation portion 22 for bending the bending portion 21a of the sheath 21 are provided.

2 and 3, in the sheath 21, a treatment instrument insertion hole 21f for inserting the endoscope treatment instrument 30 and an operation wire 21c for bending the distal end are inserted in the longitudinal direction. An operation wire insertion hole 21 d is formed, and an operation portion 22 for bending the sheath 21 is attached to the rear end of the sheath 21.
A sponge 21b, which is a cleaning tool that is a feature of the present embodiment, is attached to the inside of the hollow near the tip of the treatment instrument insertion hole 21f.

The sponge 21b is made of a soft material in which, for example, a synthetic resin such as polyethylene or polyurethane is foam-molded and has an infinite number of fine holes inside, and is formed in a cylindrical shape having a hollow portion in the central portion near the sheath 21 and the central axis Z. Since the inner diameter is in contact with the outer peripheral surface of the treatment portion 33 of the endoscope treatment tool 30, the inner diameter is formed to be the same as or slightly smaller than the outer diameter of the treatment portion 33 in the closed state. It is formed to have the same diameter as that of the inner diameter.
The sponge 21b may be any length as long as it is softer than the treatment portion 33 and harder than the lesion, and can cover at least the scissors 33b of the treatment portion 33.

The sponge 21b may be attached to the distal end side of the sheath 21. However, if the sponge 21b is not positioned at the curved portion at the distal end of the endoscope during use, the treatment portion 33 is affected by the pressure of the curved portion when the treatment portion 33 is cleaned. It is even better because it can be cleaned in a straight state. For example, since the bending portion of an endoscope is generally located about 50 mm from the distal end, when the sheath 21 is used by protruding 100 mm from the distal end portion of the endoscope, it is necessary to attach the sheath 21 within about 140 mm from the distal end of the sheath. When the sheath 21 is used at a position about 10 mm away from the distal end portion of the endoscope, the curved portion of the endoscope is arranged if attached to a position about 50 mm from the distal end of the sheath. It will be arranged on the tip side from the part.
That is, it is preferable to arbitrarily set the attachment position of the sponge 21b with respect to the sheath 21 according to the dimensional amount of the bending portion at the distal end of the insertion portion and the amount of protrusion from which the sheath 21 protrudes from the insertion portion 11.

  There are various methods of attaching the sponge 21b. For example, an adhesive is applied to the outside of the sponge 21b formed in a cylindrical shape, and the sponge 21b is bonded by heat, or the sponge 21b of the sheath 21 is disposed. For example, several holes may be formed in the place and bonded from the outside.

The operation portion 22 is formed with a hole 22b communicating with the treatment instrument insertion hole 21f of the sheath 21, and the treatment instrument 30 is inserted from the base end side (right side in the figure).
Further, by fixing the proximal end of the operation wire 21c whose distal end is fixed to the operation wire fixing tool 21e at the distal end of the sheath 21 to the pulley 22d, and turning the bending dial 22c interlocking with the pulley in the X or Y direction, One side of the wire 21c is pulled, and the bending portion 21a of the sheath 21 is bent toward the side where the pulled operation wire 21c is arranged.
In this embodiment, the upper and lower operation wires are two, but this is not restrictive. For example, one or four operation wires may be used, and the structure of the operation unit is not limited to this. You may make it operate by another mechanism.
Moreover, although the sponge 21b was formed in the cylinder shape which has a hollow part in the center, it is not restricted to this, For example, you may attach the sponge formed in the rectangular parallelepiped to the inside of the several sheath 21, etc.

[Description of operation]
Next, the use operation of the sheath with the cleaning tool and the sheath device configured as described above will be described with reference to FIG.

FIG. 5A is a view when treating an affected part (not shown), and the treatment tool insertion hole 21f of the sheath 21 passed through the channel 1b of the endoscope is used as the treatment part 33 of the treatment tool 30 for the endoscope and The treatment instrument sheath 31 passes and protrudes from the distal end of the sheath 21 to treat the affected part. If necessary, in addition to the bending operation of the endoscope 1, the bending operation of the sheath 21 is performed so that the treatment portion 33 of the endoscope treatment tool 30 reaches the affected area. If treatment such as incision of the affected part is performed by the treatment part 33, a lesion adheres to the sputum 33a or the like (not shown), and subsequent treatment becomes difficult. Therefore, as shown in FIG. The portion 33 is pulled into the sheath 21, and the rod piece 33a is moved back and forth in the longitudinal direction (XY direction in the figure) in the vicinity of the sponge 21b, so that the lesion attached to the rod piece 33a is brought into contact with the sponge 21b and scraped off. Can do. Thereafter, the treatment portion 33 is projected from the distal end of the sheath 21 to perform the treatment.
When the treatment is completed, the endoscope treatment tool 30 is pulled into the sheath 21 and pulled out, the sheath 21 is pulled out from the endoscope channel 1b, and the endoscope 1 is pulled out from the body.

Thus, since the sheath device 20 according to the present embodiment includes the sponge 21b as a cleaning tool in the sheath 21, the lesion attached to the collar piece 33a can be scraped off by the sponge 21b, and the treatment to which the lesion or the like has adhered is performed. It is not necessary to pull out and wipe the entire endoscope treatment tool 30 including the portion 33 from the endoscope, so that the treatment is easy and the treatment time can be shortened.
Further, since the treatment section 33 passes through the sheath device 20 according to the present embodiment and the treatment section 33 does not contact the channel 1a of the endoscope, the inside of the channel 1a is damaged or adhered to the collar piece 33a. It is possible to prevent contamination with damaged lesions.

  The sheath and the sheath device with the cleaning tool according to the present invention are not limited to the configuration in which the cleaning tool is a sponge as in the above-described embodiment, and a brush may be used as the cleaning tool.

As shown in FIG. 4, the sheath with the cleaning tool according to the second embodiment is a brush that is a cleaning tool that stands up toward the central axis Z of the sheath inside the vicinity of the distal end of the treatment tool insertion hole 21 f of the sheath 21. 40 is attached.
The brush 40 has a hollow portion formed coaxially with the sheath 21, and the hollow portion has a diameter that is the same as or slightly smaller than the outer diameter in a state where the treatment portion 33 of the endoscope treatment tool 30 is closed. The hair whose length is set (for example, about one third of the inner diameter of the sheath 21) is raised.
The bristles constituting the brush 40 include bristles (taper bristles) whose diameter gradually decreases toward the bristles, and bristles (straight bristles) having substantially the same outer diameter except for the rounded portion of the bristles, The material is made of a resin such as polyamide or polyethylene terephthalate.
Further, the hair constituting the brush 40 is softer than the hardness of the treatment portion 33 and harder than the lesion, and the raised region may be at least as long as it can cover the scissors 33b of the treatment portion 33.

The attachment position of the brush 40 may be in the vicinity of the distal end of the sheath 21 as in the first embodiment, but it is still more preferable if the brush 40 is not located at the bending portion of the endoscope distal end when the endoscope treatment tool 30 is used. good.
There are various methods for attaching the brush 40, and for example, the brush 40 can be attached by making an adhesive sheet-like member having a plurality of bristles raised into a cylindrical shape and sticking it inside the distal end of the sheath 21.
In addition, since it is the same as that of 1st Example about structures other than the brush 40, description is abbreviate | omitted.

The sheath device 20 according to the present embodiment includes the brush 40 as a cleaning tool in the sheath 21, and the brush 40 can scrape off the lesion attached to the collar piece 33a. It is not necessary to pull out and wipe the entire endoscope treatment tool 30 including the treatment 33 from the endoscope, so that the treatment is easy and the treatment time can be shortened.
In addition, since the treatment unit 33 passes through the sheath device 20 according to the present embodiment and the treatment unit 33 does not contact the channel 1a of the endoscope, the inside of the channel 1a of the endoscope is covered with the scissors 33a of the treatment unit 33 or the like. It can be prevented from being damaged or soiled by a lesion or the like attached to the flange 33a.

1 Endoscope, 20 sheath device, 21 sheath, 21b sponge,
21c operation wire, 22 operation section,
30 Endoscopic treatment tools, 40 brushes,

Claims (6)

A long cylindrical shape that is inserted into and removed from the treatment instrument insertion channel of the endoscope is formed with flexibility, and a treatment portion disposed at the distal end of the treatment instrument for endoscope is inserted into the tubular shape. A sheath that can
A cleaning tool disposed inside the vicinity of the distal end of the sheath so as to contact the outer peripheral surface of the treatment portion of the endoscope treatment tool;
A sheath with a cleaning tool, comprising:   The sheath with a cleaning tool according to claim 1, wherein the cleaning tool is a flexible sponge formed in a cylindrical shape having a hollow portion at a central portion in the vicinity of the central axis of the sheath.   2. The cleaning tool according to claim 1, wherein the cleaning tool is a brush in which a plurality of hairs are raised so that a hollow portion is formed at a central portion coaxial with the sheath toward a central axis of the sheath. Sheath with. A long cylindrical shape that is inserted into and removed from the treatment instrument insertion channel of the endoscope is formed with flexibility, and a treatment portion disposed at the distal end of the treatment instrument for endoscope is inserted into the tubular shape. A sheath that can
A cleaning tool disposed inside the vicinity of the distal end of the sheath so as to contact the outer peripheral surface of the treatment portion of the endoscope treatment tool;
An operation wire having a distal end fixed to the distal end of the sheath and disposed in a longitudinal direction of the sheath;
An operation unit for pulling the operation wire to bend the sheath;
A sheath device comprising:   The sheath device according to claim 4, wherein the cleaning tool is a flexible sponge that is formed in a cylindrical shape having a hollow portion at a central portion near the central axis of the sheath.   The sheath device according to claim 4, wherein the cleaning tool is a brush in which a plurality of bristles are raised so that a hollow portion is formed at a central portion coaxial with the sheath toward a central axis of the sheath. .

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