JP2019130037A - Operation device of medical treatment tool - Google Patents

Abstract

To provide an operation device for a medical treatment tool capable of improving operation ability.SOLUTION: An operation device 30 for a medical treatment tool is arranged in a proximal end of a catheter part 10 of a medical treatment tool comprising: the catheter part 10 having a tube 12 into which an operation wire 11 is slidably inserted; and a processing part 20 arranged on a distal end of the catheter part 10. The operation device comprises: a base member 31 to which the tube 12 is connected, and which has a rail part 31c in an almost linear state; and a slider member 32 to which the operation wire 11 is connected, and which is slidably attached to the base member 31 along the rail part 31c. The base member 31 has a first finger hook part 31a on a position closer to a proximal end side than to the slider member 32, and has a second finger hook part 31b on a position closer to a distal end side than to the slider member 32, and the slider member 32 has third and fourth finger hook parts 32a, 32b.SELECTED DRAWING: Figure 1

Description

  The present invention relates to an operating device for a medical treatment instrument for operating a treatment section inserted into the body from outside the body to perform various treatments in the body.

  For example, as an endoscopic treatment instrument for performing transluminal treatment using an endoscope, a wire having a distal end and a proximal end and a tube (sheath) through which the wire is slidably inserted And an operation of sliding a wire and a sheath relative to the proximal end of the catheter portion relative to the treatment portion (manipulator) for treatment inside the body at the distal end of the catheter portion. What is comprised by arrange | positioning a part (handle) is used (for example, refer patent document 1).

  As the handle, in Patent Document 1, a handle provided with a base member and a slider member slidably attached to the base member is used. The wire to be relatively slid is connected and fixed to the slider member and the sheath is connected to the base member. The base member integrally has a substantially annular ring portion at its proximal end, and the slider member integrally has a pair of substantially annular rings on both sides of the base member.

  Insert the thumb into the ring part of the base member, insert the index finger and the middle finger into the pair of ring parts of the slider member, and make them close to each other (sliding the slider member toward the proximal end with respect to the base member), or The tube and the wire can be relatively slid by operating so as to be separated (sliding the slider member toward the distal end with respect to the base member).

  However, in general, a gripping operation (an operation for bringing the index finger and the middle finger close to the thumb) is relatively easy to apply force, whereas an opening operation (an operation for separating the index finger and the middle finger from the thumb) is relatively easy. However, the conventional handle described in Patent Document 1 has a problem that it may be difficult to perform an opening operation depending on the configuration of the treatment unit.

Japanese Patent Laying-Open No. 2015-8858

  This invention is made | formed in view of such a point, and it aims at providing the operating device of the medical treatment instrument which can improve operativity.

In order to achieve the above object, an operating device for a medical treatment instrument according to the present invention comprises:
A catheter portion having a long body having a distal end and a proximal end, and a tubular body into which the long body is slidably inserted; and a treatment portion disposed at the distal end of the catheter portion. An operating device disposed at the proximal end of the catheter portion of a medical treatment instrument comprising:
One of the elongated body and the cylindrical body is connected, and a base member having a substantially linear rail portion;
The other of the elongated body and the cylindrical body is connected, and includes a slider member attached to the base member so as to be slidable along the rail portion,
The base member has a first finger hook portion on a proximal end side with respect to the slider member, and has a second finger hook portion on a distal end side with respect to the slider member,
The slider member has a third finger hook portion.

  In the operation device for a medical treatment instrument according to the present invention, the base member has a first finger hook portion on the proximal end side of the slider member, and a second finger hook portion on the distal end side of the slider member. have. For this reason, for example, while putting a thumb on the first finger hook portion, another single or plural fingers (for example, index finger or middle finger) are hooked on the third finger hook portion, and an operation of gripping them so as to be close to each other is performed. Thus, the slider member can be slid toward the proximal end side with respect to the base member. In addition, for example, the user places a thumb on the second finger-hanging portion and another single or a plurality of fingers (for example, index finger or middle finger) on the third finger-holding portion and performs an operation of gripping them close to each other. Thus, the slider member can be slid to the distal end side with respect to the base member. Therefore, since the operation in any direction can be performed by a gripping operation, the operability can be improved.

In the operating device for the medical treatment instrument according to the present invention,
The slider member further includes a fourth finger hook portion,
The third finger hook part and the fourth finger hook part are arranged so as to protrude sideways in opposite directions from the rail part,
The first finger hook part and the second finger hook part are arranged so as to protrude laterally in opposite directions from the rail part,
The first finger hook portion and the third finger hook portion are provided on one side of the rail portion, and the second finger hook portion and the fourth finger hook portion are provided on the other side of the rail portion. it can.

  By configuring in this way, for example, a thumb is hung on the first finger hanging portion, a middle finger is hung on the third finger hanging portion, a forefinger is hung on the fourth finger hanging portion, or a thumb is placed on the second finger hanging portion. In addition, the user can hold the middle finger on the fourth finger hanging portion and the index finger on the third finger hanging portion to perform the gripping operation with natural finger placement, thereby further improving the operability.

  In the operation device for a medical treatment instrument according to the present invention, the first finger hook portion, the second finger hook portion, and the third finger hook portion may each have a finger insertion through hole. In addition, the fourth finger hook portion may also have a through hole for inserting a finger. With this configuration, depending on the case, not only a gripping operation but also an opening operation can be performed. Therefore, it is possible to operate even when the hand is inverted by 180 ° with respect to the operating device. Can be increased.

FIG. 1 is a plan view showing an overall configuration of an endoscopic basket-type treatment instrument according to an embodiment of the present invention, and shows a state in which a basket portion is projected from a distal end of a catheter tube. FIG. 2 is a view showing a state in which the basket portion is retracted into the distal end of the catheter tube in the endoscopic basket-type treatment instrument shown in FIG. 1. FIG. 3 is a perspective view illustrating an example of a configuration of a basket portion of the endoscope basket-type treatment instrument illustrated in FIG. 1.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. In the present embodiment, as an example of a medical treatment instrument to which an operation device for a medical treatment instrument according to the present invention is applied, an endoscope basket-type treatment instrument inserted into the body using an endoscope will be described. To do. However, the present invention is arranged at the distal end of the catheter portion having a long body having a distal end and a proximal end, and a tubular body into which the long body is slidably inserted. The present invention can be widely applied to various medical treatment instruments having a treatment section.

  In addition to the basket-type treatment instrument for an endoscope, the present invention provides a clip device as described in Patent Document 1 for holding a body tissue with a clip to perform hemostasis, marking, etc., and a body tissue with a ligation snare. The present invention is also applicable to a ligating device for ligating, a stent delivery device for placing a stent in a body lumen, a forceps device, a high-frequency knife device, and the like. In addition, the present invention is not limited to an endoscopic treatment instrument that is used by being inserted into the body using an endoscope, and transcutaneously without using an endoscope or through a natural mouth of the body. The present invention is widely applicable to medical treatment instruments that are inserted into a lumen and used.

  The endoscopic basket-type treatment instrument according to the present embodiment is inserted into an endoscope channel (treatment instrument guide tube), inserted into the bile duct via the duodenum and duodenal papilla, and a calculus (gallstone) or the like is obtained. It is an instrument used to remove (capture / recover) or crush.

  As shown in FIG. 1, the basket-type treatment instrument 1 includes a long catheter portion 10 that is inserted into a body through an endoscope channel, a treatment portion 20 provided at a distal end of the catheter portion 10, And an operation unit (operation device) 30 that is provided at the proximal end of the catheter unit 10 and operates the treatment unit 20 inserted into the body outside the body.

  The catheter unit 10 has an operation wire 11 as an elongated body having a distal end and a proximal end and also has a distal end and a proximal end, and the operation wire 11 is slidably inserted (movable in the axial direction). And a catheter tube 12 as a long cylindrical body.

  The catheter tube 12 is a tube formed of a flexible material, and includes a distal end portion that is an end portion to be inserted into the body endoscopically and a proximal end portion that is disposed outside the body. And have. Although not particularly limited, the outer diameter of the catheter tube 12 is about 1.0 to 3.0 mm, the thickness of the catheter tube 12 is about 0.05 to 0.5 mm, and the length of the catheter tube 12 is , About 500-2500 mm. A metal short tube 12 a such as a stainless steel tube is fixed to the distal end of the catheter tube 12.

  The material of the catheter tube 12 is not particularly limited as long as it is a flexible material, but is preferably a polymer material, and particularly preferably a polyamide resin or a polyamide-based elastomer. The catheter tube 12 may be made of resin and reinforcing metal. Examples of the form in which the catheter tube 12 is reinforced with metal include a coil tube and a blade tube.

  The operation wire 11 transmits an operation force acting on the proximal end side thereof to a basket portion 21 which will be described later, and the basket portion 21 stored in a state of being folded and contracted in the catheter tube 12 is distal to the catheter tube 12. Rigidity that can be sent out from the end.

  A basket portion 21 is integrally provided as a treatment portion 20 at the distal end of the operation wire 11. When the operation portion 30 is operated from the proximal end side and the basket portion 21 is pulled inward from the opening at the distal end of the catheter tube 12, the basket portion 21 is contracted so that the basket is folded and accommodated in the catheter tube 12. It has become so. Further, when the basket portion 21 is pushed out of the opening of the distal end of the catheter tube 12 by the operation of the operation portion 30 from that state, the basket portion 21 is configured to expand to the shape before being pulled in due to its own shape restoring property. Has been.

  As shown in FIG. 3, the basket portion 21 is formed of four wires (wires) 22 a to 22 d, and the distal ends of the wires 22 a to 22 d are bound by a tip chip 23. Further, the proximal end portions of the wires 22a to 22d are bound at the binding portion 24 by a welding method such as silver soldering, and are bundled on the proximal end side with respect to the binding portion 24. ˜22d constitutes at least a part of the operation wire 11.

  The wires 22a to 22d constituting the basket portion 21 are inwardly folded into the wires 22a to 22d so that the wires 22a to 22d bulge out outwardly in the radial direction while protruding from the opening 12b at the distal end of the catheter tube 12. A bent portion 25 and an outward bent portion 26 are formed, and the entire wire 22a to 22d is formed in the basket-like basket portion 21. As a result, gallstones and the like can be captured in the basket portion 21 through the gaps between the wires 22a to 22d.

  The operation wire 11 may be constituted by extending the wires 22a to 22d constituting the basket portion 21 in the longitudinal direction, but may be constituted by a wire different from these wires 22a to 22d. The wires 22a to 22d and the operation wire 11 constituting the basket portion 21 can be made of metal wires having a wire diameter of 0.1 mm to 1.5 mm, for example. Examples of the material of these wires include nickel titanium alloy, stainless steel, gold, silver, platinum, nickel, iron, titanium, aluminum, tin, zinc, and tungsten. Further, the number of wires 22a to 22d for constituting the basket portion 21 is not particularly limited, but is preferably 2 to 10 wires.

  A joint pipe 13 made of a metal such as stainless steel is covered at a position corresponding to the operation portion 30 on the proximal end side of the operation wire 11, and the joint pipe 13 and the operation wire 11 are welded. It is joined by means such as. By connecting and fixing the operation wire 11 using the lock knob 32d and the slider member 32 at a position where the joining pipe 13 is provided, the operation wire 11 and the operation wire 11 are compared with the case where the joining pipe 13 is not provided. Connection and fixation with the slider member 32 can be made more reliable.

  An operation portion (handle) 30 as an operation device to which the present invention is applied is provided at the proximal end of the catheter portion 10. The operation unit 30 includes a base member 31 and a slider member 32.

  The base member 31 includes a first finger hook portion 31a, a second finger hook portion 31b, and a rail portion 31c. The rail portion 31c is a substantially strip-like portion having a substantially rectangular through hole so as to have a pair of substantially linear rails, and the first finger hook portion 31a is located on the proximal end side in the longitudinal direction of the rail portion 31c. However, the second finger hook portion 31b is integrally provided on the distal end side in the longitudinal direction of the rail portion 31c.

  The first finger hook portion 31a and the second finger hook portion 31b are disposed so as to protrude sideways in opposite directions. That is, the first finger hook portion 31a is provided so as to protrude from the side portion of the rail portion 31c to one side in the short direction (right side in FIG. 1), and the second finger hook portion 31b It is provided so as to protrude from the side portion 31c to the other side in the short direction (left side in FIG. 1). Each of the first finger hook portion 31a and the second finger hook portion 31b has a substantially circular through hole having a diameter that allows a human finger to be inserted and removed without hindrance. In addition, you may arrange | position the 1st finger hook part 31a and the 2nd finger hook part 31b so that it may protrude sideways in the same direction mutually.

  A luer lock type lock connector 33 is provided at the distal end of the base member 31 (rail portion 31c), and the proximal end of the catheter tube 12 can be attached to and detached from the lock connector 33 via the connector hub 34. Connection is fixed. The connector hub 34 has a side injection tube 34a, and a syringe (not shown) is connected to the side injection tube 34a so that a contrast agent or the like can be injected. It is discharged from the opening 12b at its distal end through the lumen of the catheter tube 12. Furthermore, an insertion hole through which the operation wire 11 (joining pipe 13) extending to the proximal end side of the lock connector 33 can pass through the distal end side and the proximal end side of the base member 31 (rail portion 31c). (Not shown) is provided, and the operation wire 11 (joining pipe 13) is bridged between these insertion holes, thereby forming a space between the pair of rails in the rail portion 31c (substantially rectangular through hole). The base member 31 protrudes from the proximal end side.

  A slider member 32 is attached to the base member 31 so as to be slidable along the rail portion 31c. The slider member 32 has a receiving portion 32c formed so as to hold the pair of rails of the rail portion 31c from the outside, and is slidable along the longitudinal direction of the rail portion 31c.

  A third finger hook portion 32a and a fourth finger hook portion 32b are integrally provided on both sides of the slider member 32 (receiving portion 32c). The third finger hook portion 32a and the fourth finger hook portion 32b are arranged so as to protrude sideways in opposite directions. That is, the third finger hook portion 32a is provided so as to protrude from the side portion of the receiving portion 32c to one side in the short direction of the rail portion 31c (right side in FIG. 1), and the fourth finger hook portion 32b is The rail portion 31c is provided so as to protrude from the side portion of the receiving portion 32c to the other side in the short side direction (left side in FIG. 1). Each of the third finger hook portion 32a and the fourth finger hook portion 32b has a substantially circular through hole having a diameter that allows a human finger to be inserted and removed without hindrance.

  A screw-type lock knob 32d for detachably connecting and fixing the operation wire 11 to the slider member 32 is provided at a substantially central portion of the receiving portion 32c of the slider member 32, and the lock knob 32d is screwed. Accordingly, the operation pipe 11 can be fixed to the slider member 32 by sandwiching or sandwiching the joining pipe 13 covered with the operation wire 11, and the slider of the operation wire 11 can be obtained by loosening the lock knob 32d. The fixing to the member 32 can be released.

  In this way, the slider member 32 is positioned between the position slid toward the distal end side (see FIG. 1) and the two positions slid toward the proximal end side (see FIG. 2) with respect to the base member 31. It can be slid as possible.

  When the slider member 32 is slid to the distal end side with respect to the base member 31, the operation wire 11 is slid to the distal end side with respect to the catheter tube 12, and the basket portion 21 is opened at the distal end of the catheter tube 12. It is pushed out from 12b and expands (see FIGS. 1 and 3). On the other hand, when the slider member 32 is slid toward the proximal end side with respect to the base member 31, the operation wire 11 is slid toward the proximal end side with respect to the catheter tube 12, and the basket portion 21 is attached to the catheter tube 12. It retracts from the opening 12b at the distal end and contracts (see FIG. 2).

  Next, as an example of a method of using the basket-type treatment instrument 1 for an endoscope according to the present embodiment, when the basket-type treatment instrument 1 is inserted into a bile duct through an endoscope channel, the gallstone is crushed. Is outlined.

  First, the endoscope used when inserting the basket-type treatment instrument 1 for endoscope into the body is inserted to the vicinity of the duodenal papilla inside the patient's duodenum. Next, the catheter tube 12 of the basket type treatment instrument for endoscope is inserted into the channel of the endoscope from the proximal end side of the endoscope. At this time, the basket portion 21 of the endoscope basket-type treatment instrument 1 is housed in the catheter tube 12.

  When the distal end side portion of the catheter tube 12 of the endoscopic basket-type treatment instrument 1 protrudes from the opening on the distal end side of the endoscope channel, the portion is inserted into the nipple. Then insert it into the bile duct. The nipple may be expanded in advance using a balloon catheter or the like as necessary. The catheter tube 12 is further inserted (advanced) to a certain position in the bile duct, and then, if necessary, a contrast medium is injected from the side injection tube 34a of the connector hub 34. After flowing into the bile duct from the opening 12b at the distal end, the inside of the bile duct is observed by X-ray fluoroscopy, the position of the gallstone or the like is grasped, and the position of the distal end of the catheter tube 12 is adjusted.

  Next, the operation unit 30 is operated, the slider member 32 is slid toward the distal end side with respect to the base member 31, and the operation wire 11 is fed to the distal end side, whereby the distal end of the catheter tube 12 is moved. The basket portion 21 is caused to jump out from the opening 12b (see FIG. 1). Thereby, since the basket part 21 is expanded, gallstones and the like are captured by the expanded basket part 21. Thereafter, the slider member 32 is slid toward the proximal end side with respect to the base member 31, the operation wire 11 is drawn into the catheter tube 12, and the basket portion 21 is drawn into the opening 12 b at the distal end of the catheter tube 12. While reducing the outer diameter of the basket portion 21, the gallstones are crushed.

  When removing gallstones or the like without crushing, the slide of the slider member 32 toward the proximal end side with respect to the base member 31 is stopped halfway, and the catheter part 10 is pulled out from the body, so that the basket part 21 can be pulled out. Captured gallstones and the like may be collected.

  In the basket-type treatment instrument 1 for an endoscope according to the present embodiment, the base member 31 is located closer to the proximal end side than the slider member 32 as the operation portion 30, farther than the first finger hook portion 31 a and the slider member 32. A second finger hook portion 31b is provided on the distal end side. The first finger hook portion 31a and the third finger hook portion 32a are provided on one side of the rail portion 31c, and the second finger hook portion 31b and the fourth finger hook portion 32b are provided on the other side of the rail portion 31c. ing.

  For this reason, when inserting each finger of the right hand from the rear side of the drawing toward the front side of the drawing in FIG. 2, the thumb is put on the first finger hanging portion 31a, the middle finger is put on the third finger hanging portion 32a, and the fourth finger is put on the fourth finger. The slider member 32 is attached to the base member 31 by performing an operation of placing an index finger on the finger hook portion 32b (hereinafter, for convenience, this finger placement is referred to as a first finger placement) and holding them close to each other. On the other hand, it can be slid to the proximal end side. When inserting each finger of the right hand from the rear side of the drawing to the front side of the drawing in FIG. 1, the thumb is put on the second finger hooking portion 31b, the middle finger is put on the fourth finger hooking portion 32b, and the third finger is put on. By placing an index finger on the hanging portion 32a (hereinafter, for convenience, this finger arrangement is referred to as a second finger arrangement), and holding the slider member 32 with respect to the base member 31 by gripping them close to each other. Can be slid to the distal end side. Therefore, since the operation in any direction can be performed by a gripping operation, the operability can be improved.

  In the present embodiment, the first finger hook portion 31a, the second finger hook portion 31b, the third finger hook portion 32a, and the fourth finger hook portion 32b each have through holes for inserting fingers. It is possible to perform not only the grip operation but also the opening operation, that is, the operation by the first finger placement and the operation by the second finger placement can be arbitrarily selected and performed as necessary. . Therefore, the operator can also perform an operation by inverting the hand by 180 ° according to the relationship between the position and posture of the operator and the operation unit 30 when performing the procedure. Can be increased, and the operability can be improved.

  Further, the lock connector 33 is provided so that the catheter tube 12 can be attached to and detached from the base member 31, and the operation knob 11 is attached to and detached from the slider member 32 by providing the lock knob 32d. If the gallstone is so large that it is difficult to be discharged out of the bile duct as it is, and the gallstone is found to be extremely firm, the catheter tube 12 (including the connector hub 34) by the lock connector 33 is found. ) Is released from the base 31, the operation knob 11 is released from the lock member 32, the operation member 30 is removed from the catheter 10, and another operation suitable for crushing hard gallstones is performed. Device (for example, wire driving device disclosed in Japanese Patent Laid-Open No. 2001-87273) The attached, crushing gallstones, captured in the basket portion 21, how can a used such, it is possible to flexibly cope with various demands. Further, the operation wire 11 can be protruded from the proximal end side of the base member 31 through a pair of rails in the substantially linear rail portion 31c so that each finger hook portion protrudes from the rail portion 31c. Since they are arranged, even when a long operation wire 11 is used, the operation portion 30 can be smoothly operated without interference between the finger hook portions and the operation wire 11. Therefore, it is possible to prepare for replacement with another operation device that requires a sufficiently long operation wire 11 for connection, and it is possible to flexibly respond to various requests.

  Note that the configuration of the basket portion 21 is not limited to that described above. For example, as disclosed in Japanese Patent Application Laid-Open No. 2005-21195, a basket portion configured by combining a plurality of wires formed in a substantially spiral shape. The basket portion may have other configurations.

  In the above-described embodiment, the catheter tube 12 is connected to the base member 31 and the operation wire 11 is connected to the slider member 32. Conversely, the catheter tube 12 is connected to the slider member 32 and the catheter tube 12 is connected to the slider member 32. The base member 31 may be connected.

  The embodiment described above is described for facilitating understanding of the present invention, and is not described for limiting the present invention. Therefore, each element disclosed in the embodiment described above is intended to include all design changes and equivalents belonging to the technical scope of the present invention.

1 ... Endoscopic basket-type treatment instrument (medical treatment instrument)
DESCRIPTION OF SYMBOLS 10 ... Catheter part 11 ... Operation wire 12 ... Catheter tube 12b ... Opening 20 ... Treatment part 21 ... Basket part 30 ... Operation part (operation apparatus)
31 ... Base member 31a ... First finger hook portion 31b ... Second finger hook portion 31c ... Rail portion 32 ... Slider member 32a ... Third finger hook portion 32b ... Fourth finger hook portion 32c ... Receiving portion 32d ... Lock knob 33 ... Lock connector 34 ... Connector hub

Claims (3)

A catheter portion having a long body having a distal end and a proximal end, and a tubular body into which the long body is slidably inserted; and a treatment portion disposed at the distal end of the catheter portion. An operating device disposed at the proximal end of the catheter portion of a medical treatment instrument comprising:
One of the elongated body and the cylindrical body is connected, and a base member having a substantially linear rail portion;
The other of the elongated body and the cylindrical body is connected, and includes a slider member attached to the base member so as to be slidable along the rail portion,
The base member has a first finger hook portion on a proximal end side with respect to the slider member, and has a second finger hook portion on a distal end side with respect to the slider member,
The slider member is an operating device for a medical treatment instrument having a third finger hook. The slider member further includes a fourth finger hook portion,
The third finger hook part and the fourth finger hook part are arranged so as to protrude sideways in opposite directions from the rail part,
The first finger hook part and the second finger hook part are arranged so as to protrude laterally in opposite directions from the rail part,
The first finger hook portion and the third finger hook portion are provided on one side of the rail portion, and the second finger hook portion and the fourth finger hook portion are provided on the other side of the rail portion. Item 3. A medical treatment instrument operating device according to Item 1.   The operation device for a medical treatment instrument according to claim 1 or 2, wherein the first finger hook portion, the second finger hook portion, and the third finger hook portion each have a through hole for inserting a finger.

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