JP2019107182A - Basket-type treatment instrument for endoscope - Google Patents

Abstract

To provide a treatment instrument for endoscopes capable of preventing deformation of basket wires in stone disintegration.SOLUTION: The basket-type treatment instrument for endoscopes is disclosed, where a distal metal fitting 20 provided at a distal end of a long tubular flexible sheath 2 comprises: a circular ring portion 20a fitted to the distal end of the flexible sheath 2; and a plurality of projections 25 projecting upward the circular ring portion 20a. The plurality of projections 25 equivalent to at least the number of basket wires 8 are provided, and the width and height of notches formed between the projections is at least equal to or more than the radius of the basket wire.SELECTED DRAWING: Figure 2A

Description

  The present invention relates to a treatment tool for a basket type endoscope apparatus provided with a treatment portion which is inserted into a body cavity and which crushes and breaks foreign bodies such as calculi in the body cavity with a basket formed of a plurality of elastic wires. The present invention relates to a treatment tool for a basket type endoscope apparatus that can prevent the

  Generally, for recovery or crushing of foreign bodies such as calculi in a body cavity, a basket grasping tool having a flexible sheath in which a basket-like expandable and contractible basket portion is accommodated in a cylinder is inserted into an endoscope channel and inserted into a body cavity. The procedure is performed by bringing the basket portion out of the tip of the flexible sheath and capturing a calculus etc. by bringing it close to foreign matter such as calculus. This basket grasping tool attaches an expandable and contractible basket portion to the tip of the operation wire inserted into the flexible sheath, and protrudes from the tip of the flexible sheath from the state where the basket portion is positioned in the tip of the flexible sheath The stones are expanded by being taken up into the basket portion, and the operation wire is pulled and contracted by the operation portion to crush or grip and pull out the stones and the like. As a document in which the technique regarding such a basket holding tool was described, the following patent document 1 is mentioned.

  In this patent document 1, an endoscope is removed from the body while leaving a basket wire of a calculus breaking apparatus and a quarrying basket insulator in the body, and a coil sheath is covered on the basket wire under X-ray radioscopy. The technology of rolling up and crushing is described.

Japanese Patent Application Laid-Open No. 2002-11016

  Although the treatment tool for an endoscope apparatus described in the above-mentioned patent documents can crush calculi with a strong crush force and can insert the coil sheath rapidly, when the basket wire is rolled up and crushed. There was a possibility that the subject that the possibility that a basket wire might be deformed was large might be caused.

  In view of such a subject, an object of the present invention is to provide the treatment tool for endoscope apparatus which can prevent modification of the basket wire at the time of crushing a calculus.

  In order to achieve the above object, a treatment tool for an endoscope apparatus according to the present invention comprises a long cylindrical flexible sheath, an operation wire inserted into a cylinder of the flexible sheath so as to be movable back and forth, and A basket portion provided at the tip of the operation wire, and a basket portion formed to elastically reduce or expand the diameter of the plurality of basket wires, and an operation attached to the tip of the flexible sheath and provided with the basket portion A treatment tool for a basket type endoscope apparatus comprising a tip fitting through which a wire is inserted, wherein the tip fitting is made of a substantially cylindrical hard material, and an annular portion fitted to the tip of the flexible sheath; A first feature of the present invention is a plurality of projections protruding at equal intervals in the direction of the basket portion of the annular portion.

  Further, according to a second aspect of the present invention, in the treatment tool for a basket type endoscope apparatus according to the first aspect, the plurality of projections are provided at least for the number of basket wires. In the treatment tool for a basket type endoscope apparatus according to the second feature, the third feature is that the width and height of the notch formed between the protrusions are at least as large as the diameter of the basket wire, In the treatment tool for a basket type endoscope apparatus according to any one of the first to third features, the fourth feature is that the plurality of protrusions of the tip end fitting are formed to be curved toward the center of the cylinder, In the treatment tool for a basket type endoscope apparatus according to any one of the first to third features, a longitudinally elongated guide groove is axially cut at a position facing a notch formed between the protrusions of the tip end fitting. Installed, the axial direction of the end fitting According to a fifth aspect of the present invention, in the treatment tool for a basket type endoscope apparatus according to the fifth aspect, the longitudinally extending guide groove of the stopper is more flexible than the distal end side. The treatment device for a basket type endoscope apparatus according to the fifth or the sixth feature is characterized in that the width on the side of the flexible sheath is widely engraved, and the stopper is in the axial direction of the end fitting. A seventh feature of the present invention is the provision of an annular locking portion which fits in and defines a dimension projecting from the end fitting, as a seventh feature, for the basket type endoscope apparatus characterized in any of the above 5 to 7 In the treatment tool, an eighth feature is that the stopper is provided with a guide hole in which an end portion on the flexible sheath side of the vertically elongated guide groove is removed.

  A treatment tool for an endoscope apparatus according to the present invention is provided with a distal end fitting comprising a torus and a plurality of projections projecting at equal intervals in the direction of the basket of the torus at the distal end of the flexible sheath. The root portion of the wire can be released in the circumferential direction to prevent the force on the lower end side of the calculus from being applied to the basket wire, thereby preventing breakage or deformation of the basket wire.

BRIEF DESCRIPTION OF THE DRAWINGS The figure which shows the whole structure of the treatment tool for endoscope apparatuses by the Example of this invention. The figure which shows the tip metal fitting of the treatment tool for endoscope apparatuses by Example 1 of this invention. The figure for demonstrating the principle by Example 1 of this invention. The figure which shows the metal tip and stopper of the treatment tool for endoscope apparatuses by Example 2 of this invention. The figure which shows the tip metal fitting of the treatment tool for endoscope apparatuses by Example 3 of this invention. The figure which shows the stopper of the treatment tool for endoscope apparatuses by Example 4 and 6 of this invention. The figure which shows the stopper of the treatment tool for endoscope apparatuses by Example 5 of this invention. The figure for demonstrating the operation example of the treatment tool for endoscope apparatuses which applies this invention.

  Hereinafter, an embodiment of a treatment tool for an endoscope apparatus according to the present invention will be described in detail with reference to the drawings. First, an entire structure of a treatment tool for an endoscope apparatus according to an embodiment of the present invention will be described.

  The treatment tool for an endoscope apparatus according to the present embodiment is, as shown in FIG. 1, a long cylindrical flexible sheath 2 made of a resin, a coil or the like to which the operation unit 10 is attached at its rear end, and this flexible A distal end fitting 20 according to the present invention comprising an operation wire 3 inserted in a sheath 2 in a freely retractable manner and a hard metal material disposed at the distal end of the flexible sheath 2; and a tip of the operation wire 3 And a basket portion 4 for crushing foreign matter, which is a treatment portion which can be inserted into and withdrawn from the flexible sheath 2 by advancing and retracting the operation wire 3. The end fitting 20 in the drawing is illustrated so that the annular portion is a cross section as described later, and the wire penetrating portion 20b is not a cross section because it is a rear portion.

  The operation section 10 penetrates the operation pipe 12 of the grip section 14 attached to the rear end of the operation wire 3 via the operation pipe 12 and the grip section 14 attached to the operation wire 3, and the water supply port 13 is opened. And an operation unit main body 11 for moving the operation wire 3 relative to the flexible sheath 2 by advancing and retracting the grip unit 14. An inner end portion of the water supply port 13 is in communication with the in-cylinder space of the operation section main body 11, and an injection (not shown) or the like is attached thereto so that a drug solution or the like can be fed into the flexible sheath 2.

  The basket portion 4 includes a plurality of (four in this embodiment) basket wires 8 made of stranded wire, a tip 6 for fixing the tips of the basket wires 8 together, and a rear end of the basket wires 8. And a rear end tip 7 for collectively fixing them, and the treatment portion is formed so that the plurality of basket wires 8 elastically contract or expand at intervals.

  The basket portion 4 is self-biased so that each basket wire 8 is curved and bulges outward, and the basket wire 8 is disposed in a three-dimensionally symmetrical relationship with the central axis of the basket portion 4 as the center of symmetry. The diameter is reduced in the flexible sheath 2, and in a state where the flexible sheath 2 protrudes from the distal end of the flexible sheath 2, the flexible sheath 2 is configured to expand and expand in a self-biased manner to form a substantially bowl shape.

  The treatment tool for an endoscope apparatus, which is the basket holding tool according to the present embodiment configured as described above, is inserted into the body cavity of the patient through the channel of the endoscope apparatus previously inserted into the body cavity of the patient and is a recovery target This procedure is described with reference to FIG.

  As shown in FIG. 6 (a), the treatment of the treatment tool for a basket type endoscope apparatus is a flexible state in which the doctor pulls the operation wire and pulls in the basket portion at the tip to reduce the diameter. Step of inserting the sheath 2 into the bile duct 22 in the papilla 210 of the duodenum, and then pushing out the operation wire as shown in FIG. 6 (b) to open the basket portion 4 from the distal end of the flexible sheath 2 6 (c), and then pulling the operation wire into the flexible sheath 2 to capture the calculus 230 in the gap of the basket portion 4, and further FIG. As shown in (d), the process of crushing 230 by further drawing in the basket portion 4 into the flexible sheath 2 and sandwiching it between the end fitting of the distal end of the flexible sheath 2 and the basket portion 4 and tightening the calculus 230 Divide.

  Particularly, the end fitting 20 which is a feature of the present embodiment is attached to the end of the flexible sheath 2 and made of a substantially cylindrical hard metal material and fitted to the end of the flexible sheath 2 as shown in FIG. 2A. And a wire penetrating portion 20b comprising a plurality of projections 25 projecting toward the upper side (the direction toward the basket portion 4) of the annular portion 20a, and the rear end of the flexible sheath 2 A plurality of basket wires 8 extending from the tip 7 are configured to expand outward in the circumferential direction through the notches 26 which are gaps between the plurality of protrusions 25. That is, the end fitting 20 according to the present embodiment has an annular portion 20a fitted to the distal end of the flexible sheath 2 and a circumferential direction toward the upper side (direction toward the basket portion 4) of the annular portion 20a. It is constituted by the wire penetration part 20b which consists of a plurality of projected parts 25 which project at equal intervals, for example, removing the one end side of the metal annular ring at equal intervals and removing it, or manufacturing the metal annular ring It can be manufactured by spacing a plurality of projections at equal intervals and welding them.

  The notches 26 formed between the plurality of projections 25 and the plurality of projections 25 are provided at least as many as the number of the basket wires 8 in order to pass all the basket wires 8 constituting the basket portion 4. In the example, four basket wires 8 are provided. Further, the height of the projection 25 needs at least about the diameter of the basket wire 8 in order to expand the basket wire 8 and contact with the calculus as described later, and from twice the diameter of the basket wire 8 About three times is preferable, and the width is preferably equal to or more than the same diameter value of the basket wire 8.

  The distal end fitting 20 configured in this way is the lower end of the calculus 230 when the calculus 230 is pulled toward the distal end fitting 29 using the conventional annular tip fitting 29 as shown in FIG. 2B (a). When the side presses the basket wire 8 against the opening of the end fitting 29 with the force F, plastic deformation (permanent strain) occurs in the wire bending portion 8a of the plurality of basket wires 8 expanding from the annular opening of the end fitting 29. When it is tried to draw the basket portion 4 into the flexible sheath 2 after it is bent and the bending can not be performed without retracting the basket wire 8 during the crushing operation of the calculus 230 due to the bending, or after crushing the calculus 230 , That the basket wire 8 is cut, can not be deformed and drawn in, can be reopened even if it is drawn. In the end fitting 20 according to this embodiment, as shown in FIG. 2B (a), the root portion of the basket wire 8 is released in the circumferential direction and the lower end side of the calculus 230 is produced. The force F is not applied to the basket wire 8, so that breakage and deformation of the basket wire 8 can be prevented.

  That is, in the case of the annular tip fitting 29 according to the prior art, the force F on the lower side of the calculus 230 is strongly applied to the root of the basket wire 8 and deformed by a relatively large angle θ1 and strong at the opening of the tip fitting 29 Because the basket wire 8 is pressed and the wire diameter is stainless steel with a diameter of about 0.2 mm to 1.0 mm, plastic deformation (permanent strain) remains, which causes problems of cutting and deformation, whereas the present practice The end fitting 20 according to the example allows the root portion of the basket wire 8 to escape in the circumferential direction through the notch 26 and spreads the bending angle θ2 largely and prevents the force F from the calculus 230 from being applied to the basket wire 8 Therefore, breakage or deformation of the basket wire 8 can be prevented.

  In the treatment tool for an endoscope apparatus according to the present embodiment configured as described above, when the basket portion 4 is pushed out from the distal end side of the flexible sheath 2, the four basket wires 8 are rotated in accordance with the pushing operation. When fitting the four notches 26 of the metal fitting 20 and taking in the calculus 230 and tightening the calculus 230 to fracture the calculus 230, the root portion of the basket wire 8 is released circumferentially through the notches 26 and calculi 230 In order to prevent the force F from being applied, breakage or deformation of the basket wire 8 can be prevented.

  The width of the notch 26 formed by the plurality of projections 25 is preferably about 2.5 to 3 times the wire diameter in order to allow the basket wire 8 to rotate within the width of the notch 26, The height (depth) of the notch 26 is preferably about 1.5 times as large as the diameter of the basket wire 8 since the basket wire 8 is allowed to rotate and the strength is reduced if it is too long. For example, when the basket wire diameter Φ is 0.3 mm, the height (depth) of the notch 26 is preferably about 0.875 mm to 1.05 mm, and the width is preferably about 0.525 mm.

  Although the example of preventing breakage and deformation of the basket wire 8 with only the end fitting 20 has been described in the first embodiment described above, the present invention is not limited to this, and the force from the calculus is applied to the basket wire The embodiments described below will be described as means for preventing the

  As shown in FIG. 3, the treatment tool for an endoscope apparatus according to the second embodiment includes a tip fitting 20 similar to that of the first embodiment, and a stopper 90 fitted in the opening of the tip fitting 20. That is, in the treatment tool for an endoscope apparatus according to the present embodiment, a guide groove (longitudinal groove) 92 is cut in the axial direction at a position facing the notch portion 26 of the distal end fitting 20. A stopper 90 is provided for extending and fitting.

  The general structure of the stopper 90 is such that, in a shape provided with a conical portion at the end of a cylinder, an approximately semicircular guide groove 92 in which a part of the basket wire 8 is fitted at 90.degree. When viewed from the side, as shown in FIG. 3B, four semicircular guide grooves 92 are provided on four sides of a true circle.

  In the treatment tool for an endoscope apparatus according to the second embodiment, the stopper 90 is fitted in the direction of arrow A so that the guide groove 92 is positioned in the notch 26 of the upper end opening of the distal end fitting 20. Configured

  In the treatment tool for an endoscope apparatus configured in this manner, the basket wire 8 at the root portion of the basket portion 4 is fitted in the guide groove 92 in a state where the basket portion 4 is protruded from the end fitting 20 and the basket portion 4 is opened. The stopper 90 is fitted into the opening of the end fitting 20 so that the operation wire 3 is pulled in so that the basket portion 4 is narrowed, and a part of the narrowed basket portion 4 is from the end. The flexible sheath 2 in a projecting state is used by being inserted into the channel of the endoscope apparatus.

  The treatment tool for an endoscope apparatus according to the present embodiment pulls the operation wire 3 into the flexible sheath 2 to capture the calculus 230 in the gap of the basket portion 4, and the basket portion 4 into the flexible sheath 2. When it is further retracted, the acute end portion of the stopper 90 strikes the bottom of the calculus 230 to prevent the calculus 230 from strongly bending the basket wire 8 and to prevent breakage or deformation of the basket wire 8. In particular, in the treatment tool for an endoscope apparatus according to the present embodiment, the calculus 230 hits the basket wire 8 with only the end fitting 20 according to, for example, the shape of the calculus 230 (for example, longitudinal, oval, with a plurality of projections, and a polygon). In this case, it is possible to reduce the diameter of the basket portion 4 in a state in which the acute end portion of the stopper 90 supports the bottom of the calculus 230 to fracture the calculus and to prevent breakage or deformation of the basket wire 8. In particular, since the stopper 90 according to the present embodiment is formed to have an acute angle at the tip end, in the case of a hard calculus, it can be pierced to further facilitate the fracture.

  In the above-described first and second embodiments, an example is described in which the outer periphery of the end fitting 20 is a straight cylindrical shape that is linear in the axial direction, but the end fitting of the treatment tool for an endoscope apparatus according to the present invention For example, as shown in FIG. 4, the notch 26 above the right circular ring portion 20 a may be formed in a shape in which the tip is curved inward and narrowed. That is, the plurality of projections 25 may be formed to curve toward the center of the cylinder.

  In the treatment tool for an endoscope apparatus according to the present embodiment, in addition to the above-mentioned effects, the basket wire 8 is more easily expanded in the outer peripheral direction and the basket wire 8 is notched because the notch 26 is bent inwardly. The possibility of deviating from 26 can be reduced.

  Further, in the above-described second embodiment, an example is described in which the stopper 90 in which the approximately semicircular guide grooves 92 are cut in the axial direction in the four sides is applied linearly, but for the endoscope apparatus according to the present invention. The treatment tool is not limited to the shape of the embodiment, and as shown in FIG. 5A (a), the width of the bottom side is larger than that of the upper part of the guide groove 92 and inscribed to extend toward the center, The stopper 90 may be configured to be fitted to the opening of the end fitting. That is, in the treatment tool for an endoscope apparatus according to the present embodiment, the width on the flexible sheath (lower side) side of the guide groove (longitudinal groove) 92 of the stopper 90 may be cut wider than that on the distal end side. .

  In addition to the above-described effects, the treatment instrument for an endoscope apparatus according to the fourth embodiment improves the degree of freedom of the position of the basket wire 8 in the flexible sheath 2 passing from the flexible sheath 2 to the distal end fitting. The operability at the time of fitting the end fitting 20 to the tip fitting 20 is improved, and the insertion and removal of the basket wire 8 can be further facilitated.

  Although the examples in which the outer diameter of the stopper 90 is entirely contained in the inner diameter of the end fitting 20 have been described in the second and fourth embodiments described above, the present invention is not limited to these embodiments and is shown in FIG. As shown in FIG. 5 (b), the guide groove 92 has an annular locking portion 99 as shown in FIG. Including a semi-circular shape in four directions, including a fitting portion 90a that fits into the inner diameter of the end fitting 20, and a wire projecting portion that protrudes upward (tip direction) from the end fitting 20 and the fitting portion 90a 90b may be provided. That is, the treatment tool for an endoscope apparatus according to the present embodiment has a dimension in which the stopper 90 protrudes from the end fitting 20 by providing the annular locking portion 99 fitted to the end fitting 20 in the middle of the stopper 90 in the axial direction. It is possible to set the stopper projection size that the stopper 90 does not hit the basket wire 8 and hits the calculus 230 according to the shape of the calculus 230 (for example, longitudinal, oval, multi-protred, polygonal) . That is, regardless of the shape of the calculus 230, the calculus 230 can prevent the basket wire 8 from being strongly bent, and breakage or deformation of the basket wire 8 can be prevented.

  In addition to the effects described above, the treatment tool for an endoscope apparatus according to this embodiment adjusts the dimension of the distal end portion of the stopper 90 from the distal end of the flexible sheath 2 by adjusting the position where the annular locking portion 99 is provided. It can be set. In other words, it is possible to set the size of the ridge that reaches the calculus 230 from the tip of the end fitting 20 according to the position where the annular locking portion 99 is provided. The calculus can be easily broken up according to a square shape, large projections, etc., and can be captured in the basket portion 4.

  Further, the stopper 90 of the treatment tool for an endoscope apparatus according to the present invention is not limited to the above-described embodiment, and as shown in FIG. 5A (b), the lower end (sheath side) of the guide groove 92 of the stopper 90 A guide hole 95 may be provided by removing the. The stopper 90 according to the fifth embodiment can further facilitate taking in and out when the basket wire 8 is protruded from the flexible sheath 2 through the end fitting 20, in addition to the above-mentioned effects. Further, the stopper 90 according to the present invention may combine the fourth and fifth embodiments.

2 flexible sheath, 3 operation wire, 4 basket portion, 6 distal end tip, 7 rear end tip,
8 basket wire, 8a wire bending portion, 10 operation unit, 11 operation unit main body,
12 operation pipe, 13 water supply port, 14 grips, 20 tip fittings, 20a annular part,
29 tip fitting, 50 tip curve, 90 stopper, 90a fitting part,
90b wire protrusion, 92 guide groove, 99 annular locking portion, 210 papillary, 230 calculus

Claims (8)

An elongated cylindrical flexible sheath,
An operation wire which is rotatably inserted into the cylinder of the flexible sheath;
A basket portion provided at a tip end of the operation wire and formed to elastically reduce or expand the plurality of basket wires;
A tip fitting attached to the tip of the flexible sheath and passing through the operation wire provided with the basket portion;
A treatment instrument for a basket type endoscope apparatus comprising
The end fitting is made of a substantially cylindrical hard material, and includes an annular portion fitted to the distal end of the flexible sheath, and a plurality of projections projecting at equal intervals in the basket portion direction of the annular portion. A treatment tool for a basket type endoscope apparatus characterized in that   The treatment tool for a basket type endoscope apparatus according to claim 1, wherein the plurality of projections are provided at least as many as the number of basket wires.   The treatment tool for a basket type endoscope apparatus according to claim 2, wherein a width and a height of a notch formed between the projections are at least equal to or larger than a diameter of the basket wire.   The treatment tool for a basket type endoscope apparatus according to any one of claims 1 to 3, wherein the plurality of projections of the end fitting are formed to be curved toward the center of a cylinder.   A longitudinally extending guide groove is cut in the axial direction at a position facing the notch formed between the projections of the end fitting, and a stopper is provided to extend and fit in the axial direction of the end fitting. The treatment tool for a basket type endoscope apparatus according to any one of claims 1 to 3, which is characterized by the above.   The treatment instrument for a basket type endoscope apparatus according to claim 5, wherein the longitudinally extending guide groove of the stopper is formed with a wider width on the flexible sheath side than the distal end side.   The said stopper is provided in the circumferential direction the annular ring latching | locking part which fits in the axial direction of the said point metal fitting, and defines the dimension which protrudes from the point metal fitting. Treatment tool for basket type endoscope apparatus. The treatment for the basket type endoscope apparatus according to any one of claims 5 to 7, characterized in that the stopper is provided with a guide hole in which an end of the flexible sheath on the flexible sheath side is removed. Equipment.

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