JP2021132745A - Treatment instrument and endoscope - Google Patents

Abstract

To provide a treatment instrument more multi-functional than conventional instruments.SOLUTION: A treatment instrument 100 to be used together with an endoscope comprises: a sheath 4; grip forceps 1 disposed on the tip side of the sheath 4; a rod-like electrode 2 which is disposed to be retractable relative to the grip forceps 1 to function as an electric knife; and an injection needle 3 disposed to be retractable relative to the rod-like electrode 2, within a through hole formed in the rod-like electrode 2 along the axial direction of the rod-like electrode 2.SELECTED DRAWING: Figure 1B

Description

The present invention relates to a treatment tool and an endoscope provided with the treatment tool.

Compared to open surgery, endoscopic surgery does not require or is very small, so it has the advantages of less burden on the body and no surgical scars, and may have spread to lymph nodes. EMR (endoscopic mucosal resection) and ESD (endoscopic submucosal dissection) are used for early gastric cancer and the like, which are considered to be small.
ESD is an operation to remove only the mucosa in the vicinity of the cancer in the case of early cancer in which the cancer is contained in the mucosa. The treatment tools used for this surgery are mainly 1. Electric scalpel (also called high frequency scalpel, high frequency knife, etc.) 2. Injection needle (also called local injection needle), 3. There are three forceps.
In the past, each treatment tool was replaced with respect to the treatment tool channel of the endoscope according to the progress of surgery, but this replacement work takes time and there is a problem that the work is interrupted. there were.
In response to such a problem, in Patent Document 1, an electric knife and an injection needle are used so that a series of operations including ridge (local note) of the lesion tissue, excision of the ridge, and hemostasis can be continuously performed. There is a description of the technology related to the integrally provided treatment tool.

Japanese Unexamined Patent Publication No. 2001-178740

In Patent Document 1, one treatment tool is provided with an electric knife and an injection needle, but forceps is another treatment tool.
That is, in order to use forceps instead of the electric knife and the injection needle, the treatment tools must be replaced according to the progress of the operation, but this replacement work takes time and the work is interrupted. There is a problem that it will end up.
For such problems, it is desired that one treatment tool has as many functions as possible.

In view of the above points, an object of the present invention is to provide a treatment tool having more functions than before.

(Structure 1)
A treatment tool used together with an endoscope, a sheath, a gripping forceps arranged on the tip side of the sheath, a rod-shaped electrode arranged so as to appear and disappear with respect to the gripping forceps and functioning as an electric knife, and the above. A treatment tool including an injection needle that is arranged so as to appear and disappear with respect to the rod-shaped electrode in a through hole formed in the rod-shaped electrode along the axial direction of the rod-shaped electrode.

(Structure 2)
The treatment tool according to configuration 1, wherein the gripping forceps includes a forceps electrode which is an electrode capable of stopping bleeding of a gripping object.

(Structure 3)
The treatment tool according to the configuration 1 or 2, wherein the rod-shaped electrode is arranged so as to appear and disappear with respect to the gripping forceps in a state where the gripping forceps are closed.

(Structure 4)
The treatment tool according to any one of configurations 1 to 3, wherein the rod-shaped electrode appears and disappears from a rod-shaped electrode insertion hole formed at the tip of the grasping forceps.

(Structure 5)
The treatment tool according to any one of configurations 1 to 4, further comprising a first driving member for moving the rod-shaped electrode forward and backward with respect to the grasping forceps.

(Structure 6)
With the rod-shaped electrode so that the center of the rod-shaped electrode and the center of the first driving member do not coincide with each other in the cross section perpendicular to the longitudinal axis direction of the sheath at the end portion on the base end side of the rod-shaped electrode. The treatment tool according to configuration 5, wherein the first driving member is arranged.

(Structure 7)
The treatment tool according to the configuration 5 or 6, further comprising a first intermediate connecting member for connecting the rod-shaped electrode and the first driving member to each other.

(Structure 8)
The treatment tool according to configuration 7, wherein the first intermediate connecting member has an outer diameter equal to or smaller than the inner diameter of the sheath.

(Structure 9)
The treatment tool according to the configuration 7 or 8, wherein the first intermediate connecting member is formed with a through hole communicating with the through hole formed in the rod-shaped electrode.

(Structure 10)
The treatment tool according to any one of configurations 7 to 9, wherein the first intermediate connecting member is a columnar member.

(Structure 11)
The treatment tool according to any one of configurations 7 to 10, further comprising a first base member fixed to the sheath on the proximal end side of the sheath with respect to the first intermediate connecting member inside the sheath.

(Structure 12)
The treatment tool according to any one of configurations 5 to 11, further comprising a first guide pipe through which the first driving member is inserted.

(Structure 13)
The treatment tool according to configuration 11, further comprising a first guide pipe through which the first driving member is inserted, and the first guide pipe being fixed to the first base member.

(Structure 14)
The treatment tool according to any one of configurations 1 to 13, further comprising a second driving member for driving the opening / closing operation of the grasping forceps and a second guide pipe for inserting the second driving member into the inside.

(Structure 15)
The treatment tool according to configuration 14, wherein a first base member fixed to the sheath is provided inside the sheath, and the second guide pipe is fixed to the first base member.

(Structure 16)
The treatment tool according to any one of configurations 1 to 15, wherein the injection needle has a curved portion.

(Structure 17)
The treatment tool according to any one of Configuration 11, Configuration 13, and Configuration 15, wherein the injection needle has a curved portion on the base end side of the sheath with respect to the first base member.

(Structure 18)
16. The treatment tool according to configuration 16 or 17, wherein the injection needle is made of a metal that elastically deforms.

(Structure 19)
Inside the sheath, a first base member fixed to the sheath is provided, a third guide pipe through which the injection needle is inserted is provided, and the third guide pipe is the first base member. The treatment tool according to configuration 18, which is fixed to the proximal end side.

(Structure 20)
The curved portion is formed by elastically deforming the injection needle inserted into the curved third guide pipe due to the curvature of the third guide pipe, according to the configuration 19. Treatment tool.

(Structure 21)
16. The treatment tool according to configuration 16 or 17, wherein the curved portion is formed by plastically deforming a part of the injection needle.

(Structure 22)
The injection needle tube, which is connected to the injection needle, is a flow path of the drug solution to the injection needle, and is a driving member for driving the injection needle so as to appear and disappear with respect to the rod-shaped electrode, is contained in the sheath. The treatment tool according to any one of configurations 1 to 21, which is provided eccentrically with respect to.

(Structure 23)
The treatment tool according to any one of Configuration 11, Configuration 13, Configuration 15, and Configuration 19, wherein an injection needle insertion hole for inserting the injection needle and defining the direction thereof is formed in the first base member.

(Structure 24)
The treatment tool according to configuration 23, wherein the injection needle insertion hole is located at a position substantially center of the sheath in a cross section perpendicular to the longitudinal axis direction of the sheath.

(Structure 25)
A second base member provided at the tip of the sheath and pivotally supporting the grasping forceps so as to be openable and closable is provided, and the second base member is provided along the base portion and the longitudinal direction of the sheath from the base portion. The treatment tool according to any one of configurations 1 to 24, comprising two support pieces standing upright and facing each other in the vicinity of the outer periphery of the base portion in a cross section orthogonal to the longitudinal axis direction of the sheath.

(Structure 26)
One of the two support pieces is provided with a first shaft member that pivotally supports the gripping forceps so that the gripping forceps can be opened and closed, and the other of the two support pieces is pivotally supported by the gripping forceps that can be opened and closed. The treatment tool according to configuration 25, wherein the shaft member of 2 is provided.

(Structure 27)
In the base portion, a rod-shaped electrode insertion portion for inserting the rod-shaped electrode so as to be able to advance and retreat, a second drive member insertion portion for inserting a second drive member for driving the opening / closing operation of the gripping forceps, and the inside of the sheath. The treatment tool according to configuration 25 or 26, wherein a fitting portion to be fitted and a fitting portion are formed.

(Structure 28)
A configuration 14 or a configuration 14 or a configuration 14 having a second base member provided at the tip of the sheath and axially supporting the grasping forceps so as to be openable and closable, and the second guide pipe is fixed to the second base member. The treatment tool according to 15.

(Structure 29)
The treatment tool according to any one of configurations 7 to 11, further comprising a guide member for guiding the advance / retreat movement of the first intermediate connecting member in the longitudinal axis direction of the sheath.

(Structure 30)
The treatment tool according to the configuration 29, wherein the guide member is a rod-shaped member, and an engaging groove for guiding the guide member is formed in the first intermediate connecting member.

(Structure 31)
Inside the sheath, a first base member fixed to the sheath on the base end side of the sheath with respect to the first intermediate connecting member is provided, and the guide member is fixed to the first base member. , The treatment tool according to configuration 29 or 30.

(Structure 32)
Any of configurations 29 to 31, which is provided at the tip of the sheath, includes a second base member that pivotally supports the gripping forceps so as to be openable and closable, and the guide member is fixed to the second base member. The treatment tool described in.

(Structure 33)
The gripping forceps include a first jaw and a second jaw, and each of the first jaw and the second jaw is opposite to the grip portion, the shaft support portion, and the shaft support portion. A first brim portion having a slit formed on the side is provided, and an engaging portion that slidably engages with the slit is further provided, and the engaging portion performs an opening / closing operation of the gripping forceps. The treatment tool according to any one of configurations 1 to 32, which is driven by a second driving member to be driven.

(Structure 34)
The treatment tool according to configuration 33, wherein each of the first jaw and the second jaw includes the first brim portion having the slit and the second brim portion not having the slit.

(Structure 35)
The treatment tool according to the configuration 34, wherein the rod-shaped electrode is arranged between the first brim portion and the second brim portion.

(Structure 36)
The treatment tool according to any one of configurations 33 to 35, wherein the shaft support is composed of a pin member and a pin hole.

(Structure 37)
The treatment tool according to any one of configurations 33 to 36, wherein the second driving member is connected and advances and retreats in the longitudinal axis direction of the sheath, and includes a second intermediate connecting member having the engaging portion.

(Structure 38)
The treatment tool according to the configuration 37, wherein the second intermediate connecting member is provided so as to be able to advance and retreat with respect to the rod-shaped electrode by inserting the rod-shaped electrode into the second intermediate connecting member.

(Structure 39)
It has a base and two support pieces that are erected from the base along the longitudinal axis direction of the sheath and face each other in the vicinity of the outer periphery of the base in a cross section orthogonal to the longitudinal axis direction of the sheath. A second base member that pivotally supports the first jaw and the second jaw so as to be openable and closable is provided at the tip of the sheath, the first brim portion is formed in a plate shape, and the two support pieces. The second intermediate connecting member is arranged between the two support pieces, and the plate-shaped first brim portion is arranged between the two support pieces and the second intermediate connecting member. 38. The treatment tool.

(Structure 40)
The surfaces of the two support pieces facing the second intermediate connecting member and the surfaces of the second intermediate connecting member facing the two support pieces are each formed in a substantially flat surface. , The treatment tool according to configuration 39.

(Structure 41)
The grasping forceps include a first jaw, a second jaw, and a forceps electrode which is an electrode capable of stopping bleeding of a gripping object. When the gripping forceps are closed, the forceps electrodes are arranged on a surface where the first jaw and the second jaw face each other, and the first jaw and the second jaw in a state where the gripping forceps are closed. The treatment tool according to any one of configurations 1 to 40, wherein an insulating portion is formed on the outer peripheral surface of the jaw.

(Structure 42)
The grasping forceps include a first jaw and a second jaw, and in the first jaw and the second jaw, the rod-shaped electrode insertion hole is formed when the grasping forceps is closed. The treatment tool according to configuration 4, which is composed of grooves formed on the respective surfaces of the forceps and the second jaws facing each other.

(Structure 43)
The treatment tool according to any one of configurations 1 to 42, which has a diameter-expanded portion at the tip of the rod-shaped electrode.

(Structure 44)
An endoscope comprising the treatment tool according to any one of configurations 1 to 43.

According to the treatment tool inserted into the endoscope or the like of the present invention and used, it is possible to provide a treatment tool having more functions than before.

A perspective view showing an outline of the treatment tool of the embodiment according to the present invention. Perspective view showing the tip of the treatment tool Perspective view showing a state in which the sheath portion near the tip of the treatment tool is removed. Perspective view showing a state in which the sheath portion near the tip of the treatment tool is removed. Perspective view showing a state in which the sheath portion near the tip of the treatment tool is removed. Perspective view showing the first base member Perspective view showing the first base member Rear view showing the first base member Front view showing the first base member Perspective view showing the second base member Perspective view showing the second base member Top view showing the second base member Side view showing the second base member Rear view showing the second base member Front view showing the second base member A perspective view showing an assembled state of the first base member, the second base member, and the guide member. Perspective view showing a rod-shaped electrode Perspective view showing the first intermediate connecting member Perspective view showing the first intermediate connecting member Rear view showing the first intermediate connecting member Front view showing the first intermediate connecting member A perspective view showing an assembled state of the first intermediate connecting member, the rod-shaped electrode, and the first driving member 16. A perspective view showing an assembled state of the first base member, the second base member, the guide member, the first intermediate connecting member, the rod-shaped electrode, and the first driving member. A perspective view showing an assembled state of the first base member, the second base member, the guide member, the first intermediate connecting member, the rod-shaped electrode, and the first driving member. Perspective view showing an injection needle and an injection needle tube Perspective view showing the positional relationship between the injection needle, the injection needle tube, and the rod-shaped electrode. Perspective view showing the positional relationship between the injection needle, the injection needle tube, and the rod-shaped electrode. Conceptual cross-sectional view of the portion of the sheath portion on the base end side of the first base member Another cross-sectional conceptual view of a portion of the sheath portion on the base end side of the first base member. The figure which shows the injection needle guide (third guide pipe) Perspective view showing jaws constituting gripping forceps Perspective view showing jaws constituting gripping forceps Bottom view showing the jaws that make up the gripping forceps An exploded perspective view of the jaws that make up the gripping forceps A perspective view showing an assembled state of the first jaw, the second jaw, and the second base member. Front view showing the assembled state of the first jaw, the second jaw, and the second base member. Front view showing the assembled state of the first jaw, the second jaw, and the second base member. Perspective view showing the second intermediate connecting member Perspective view showing the second intermediate connecting member Side view showing the second intermediate connecting member Front view showing the second intermediate connecting member A perspective view showing an assembled state of the second intermediate connecting member and the second driving member. Front view showing the assembled state of the second intermediate connecting member and the second driving member A perspective view showing a state in which the sheath portion, the second base member, and the guide member are excluded near the tip of the treatment tool. A perspective view showing a state in which the sheath portion, the second base member, and the guide member are excluded near the tip of the treatment tool. Top view showing a state in which the sheath portion is excluded near the tip of the treatment tool Perspective view showing the tip of the treatment tool of another aspect A perspective view showing an assembled state of the jaw and the second base member of the treatment tool of another aspect. An exploded perspective view of a jaw and a second base member of another aspect of the treatment tool. Perspective view showing the tip of the treatment tool of another aspect A perspective view showing an assembled state of the jaw and the second driving member of the treatment tool of another aspect. Perspective view showing the tip of the treatment tool of another aspect

Hereinafter, embodiments of the present invention will be specifically described with reference to the drawings. The following embodiment is an embodiment of the present invention, and does not limit the present invention to the scope thereof.

FIG. 1A is a perspective view showing an outline of a treatment tool according to an embodiment of the present invention.
As a basic embodiment of the treatment tool 100 of the present embodiment, an end effector such as a gripping forceps 1, a tubular sheath portion 4 including a driving member (wire or the like) for operating the end effector, and each drive are provided. It includes an operation unit 20 that operates the end effector by pulling a member (wire or the like).
FIG. 1B is a perspective view showing a tip portion of the treatment tool 100.
The treatment tool 100 of the present embodiment has a gripping forceps 1 as an end effector, a rod-shaped electrode 2 that is arranged so as to appear and disappear with respect to the gripping forceps 1 and functions as an electric knife, and a rod-shaped electrode along the axial direction of the rod-shaped electrode 2. An injection needle 3 that is arranged so as to appear and disappear with respect to the rod-shaped electrode 2 is provided in the through hole formed in 2. Although not particularly shown, the treatment tool 100 is used by being inserted into the treatment tool channel of the endoscope.
Hereinafter, unless a specific direction is mentioned, the direction along the longitudinal direction (axial direction) of the sheath portion 4 is defined as the "longitudinal axial direction", and the sheath portion 4 is inserted into the treatment tool channel of the endoscope. The one that is on the tip side is called the "tip side", and the opposite is called the "base end side". Further, the direction orthogonal to both the longitudinal axis direction and the opening / closing axis of the gripping forceps 1 is the vertical direction, the upper side in FIGS. 2A to 2C is referred to as "upper side", and the lower side in FIGS. 2A to 2C is referred to as "lower side".

2A to 2C are perspective views showing a state in which the sheath portion 4 is removed in the treatment tool 100, FIG. 2A is a state in which the gripping forceps 1 is opened in the hemostatic forceps mode, and FIG. 2B is a gripping forceps in the electric scalpel mode. 1 is closed and the rod-shaped electrode 2 is projected, and FIG. 2C is a diagram showing a state in which the grasping forceps 1 is closed and the injection needle 3 is projected in the injection needle mode.
The gripping forceps 1 is opened and closed by a second intermediate connecting member 6 that moves forward and backward in the longitudinal axis direction by a second driving member 14 that is slidably inserted in the second guide pipe 13. ..
The rod-shaped electrode 2 advances and retreats in the longitudinal axis direction by the first intermediate connecting member 7 that moves forward and backward in the longitudinal axis direction by the first drive member 16 that is slidably inserted in the first guide pipe 15. Operate. The rod-shaped electrode 2 can appear and disappear with respect to the gripping forceps 1 in both the open state and the closed state of the gripping forceps 1.
The injection needle 3 is connected to an injection needle tube 17 which serves as a flow path for a drug solution to the injection needle 3 and a driving member for driving the injection needle 3 so as to appear and disappear with respect to the rod-shaped electrode 2. As the injection needle tube 17 moves forward and backward in the longitudinal axis direction, the injection needle 3 also moves forward and backward in the longitudinal axis direction, and appears and disappears with respect to the rod-shaped electrode 2.
In the hemostatic forceps mode, the rod-shaped electrode 2 and the injection needle 3 can be pulled toward the proximal end side to a position where they do not interfere with grasping the living tissue with the grasping forceps.
The second driving member 14, the first driving member 16, and the injection needle tube 17 for driving each of the gripping forceps 1, the rod-shaped electrode 2, and the injection needle 3 are independently operated in the longitudinal axial direction by the operation of the operation unit 20. It is configured to move forward and backward. Therefore, the opening and closing of the gripping forceps 1, the advance / retreat of the rod-shaped electrode 2, and the advance / retreat of the injection needle 3 can be operated independently.

3A to 3D are views showing the first base member 8, FIGS. 3A and 3B are perspective views, FIG. 3C is a rear view (viewed from the base end side), and FIG. 3D is a front view (viewed from the tip side). Figure).
The first base member 8 is fixedly provided inside the sheath portion 4, and is arranged closer to the base end side than the second base member 5 and the first intermediate connecting member 7.
The first base member 8 is a columnar member whose basic embodiment is substantially the same as the inner diameter of the sheath portion 4.
The first base member 8 is formed with three through holes in the longitudinal axis direction, and a through hole 81 is formed in the center of a cross section perpendicular to the longitudinal axis direction, and a through hole 83 and a through hole 84 are provided at eccentric positions. It is formed. The through hole 84 has a shape in which a part of the side surface of the hole is opened because the outer circumference of the hole reaches the outer circumference of the first base member 8.
The through hole 81 formed in the center is an injection needle insertion hole for inserting the injection needle 3 so as to be able to move forward and backward and defining the direction thereof, and has an inner diameter slightly larger than the outer diameter of the injection needle 3. A counterbore 86 is formed from the back surface side (base end side) in the central portion of the first base member 8, and a through hole 81 is formed in the center thereof.
The through hole 83 formed at an eccentric position is a hole through which the first driving member 16 can be inserted and retreated, and has an inner diameter slightly larger than the outer diameter of the first driving member 16. .. The through hole 83 is formed on the same axis as the counterbore 85 formed from the back surface side (base end side). The inner diameter of the counterbore 85 is formed to be substantially the same as the outer diameter of the first guide pipe 15, and the first guide pipe 15 is attached to the counterbore 85.
The first guide pipe 15 is preferably formed of a metal coil tube. The metal coil tube is preferably a so-called tightly wound coil in which a metal wire is spirally wound without a gap. It is preferable to use a metal coil using a flat wire having a flat cross section so that the metal coil is less likely to shrink or buckle. Examples of the material include stainless steel wire. A resin tube or the like made of Teflon (registered trademark) resin or the like may be used instead of the metal coil tube. The same applies to the second guide pipe 13.
The through hole 84 formed at the eccentric position (upper side) is for holding or fixing the second guide pipe 13, and is formed with an inner diameter substantially the same as the outer diameter of the second guide pipe 13. Will be done.
Further, the first base member 8 is formed with a guide member fastening hole 82 on the lower side of the front side (tip side) thereof. The guide member fastening hole 82 is a hole into which the guide member 9 is inserted and fixed, and is formed with an inner diameter substantially the same as the outer diameter of the guide member 9.

4A to 4F are views showing the second base member 5, FIGS. 4A and 4B are perspective views, FIG. 4C is a top view (viewed from above), FIG. 4D is a side view, and FIG. 4E is a rear view (rear view). The view seen from the base end side) and FIG. 4F are front views (viewed from the tip end side).
The second base member 5 is a member provided at the tip end portion of the sheath portion 4 and pivotally supports the gripping forceps 1 so as to be openable and closable.
The second base member 5 includes a base 51, two support pieces 52 that are erected from the base 51 along the longitudinal axis direction and face each other in the vicinity of the outer periphery of the base 51 in a cross section orthogonal to the longitudinal axis direction. To be equipped with.
Holes 53 for fitting pin members 118 and 119 (see FIG. 12A), which serve as an opening / closing shaft of the gripping forceps 1, are formed in each of the two support pieces 52.
The base 51 includes a rod-shaped electrode insertion portion 512 for inserting the rod-shaped electrode 2 so as to be able to advance and retreat, and a second drive member insertion portion 513 for inserting a second drive member 14 for driving the opening / closing operation of the gripping forceps 1. , A fitting portion 511 that fits inside the sheath portion 4 is formed. Further, a guide member fastening hole 515 is formed on the lower side of the back surface side (base end side) of the base portion 51.
A counterbore 516 is formed from the front side (tip side) in the central portion of the base portion 51, and a rod-shaped electrode insertion portion 512 is formed in the center thereof. The rod-shaped electrode insertion portion 512 is formed so that the inner diameter thereof is larger than the outer diameter of the rod-shaped electrode 2 in order to allow the rod-shaped electrode 2 to be inserted and retracted. Further, the counterbore 516 is a recess for receiving the tubular portion 63 (see FIG. 13B) of the second intermediate connecting member 6, and the inner diameter thereof is formed to be larger than the outer diameter of the tubular portion 63.
The second drive member insertion portion 513, which is formed at an eccentric position in the cross section of the base portion 51 orthogonal to the longitudinal axis direction, allows the second drive member 14 to be inserted and retracted so as to be able to advance and retreat. It has an inner diameter slightly larger than the outer diameter. The second drive member insertion portion 513 is formed coaxially with the counterbore 514 formed from the back surface side (base end side). The inner diameter of the counterbore 514 is formed to be substantially the same as the outer diameter of the second guide pipe 13, and the second guide pipe 13 is attached to the counterbore 514.
The guide member fastening hole 515 is a hole into which the guide member 9 is inserted and fixed, and is formed with an inner diameter substantially the same as the outer diameter of the guide member 9.

FIG. 5 is a perspective view showing an assembled state of the first base member 8, the second base member 5, and the guide member 9.
The guide member 9 is a round bar-shaped member that guides the advancing / retreating operation of the first intermediate connecting member 7 in the longitudinal axis direction, and is a guide member fastening hole 82 of the first base member 8 and a second base member. Both ends thereof are inserted into and fixed to the guide member fastening hole 515 of 5.
FIG. 5 shows that the first base member 8 and the second base member 5 are fixed to the sheath portion 4, and the first base member 8 and the second base member 5 are connected to the guide member 9. The structure functions as a skeleton that holds each configuration.
The guide member 9 is preferably fixed to both the first base member 8 and the second base member 5. However, the guide member 9 can also be fixed to either the first base member 8 or the second base member 5. Further, the guide member 9 can be fixed to the sheath portion 4 without being fixed to either the first base member 8 or the second base member 5.

FIG. 6 is a perspective view showing the rod-shaped electrode 2.
The rod-shaped electrode 2 is a tubular member formed of an electric conductor and having a through hole 21 penetrating in the longitudinal axis direction. The rod-shaped electrode 2 preferably has a diameter-expanded portion 22 at the tip end portion. By having the diameter-expanded portion 22 at the tip of the rod-shaped electrode 2 of the present embodiment, it is possible to reduce the occurrence of excessive current concentration even when the diameter of the rod-shaped electrode 2 is formed to be small. In addition, there is also an effect that the tissue is easily caught because the tip of the rod-shaped electrode 2 has a slight bulge.
The through hole 21 is located at the center of the rod-shaped electrode 2 in a cross section orthogonal to the longitudinal axis direction, and therefore, the injection needle 3 inserted therein is arranged along the central axis of the rod-shaped electrode 2.

7A to 7D are views showing the first intermediate connecting member 7, FIGS. 7A and 7B are perspective views, FIG. 7C is a rear view (viewed from the base end side), and FIG. 7D is a front view (from the tip side). The figure I saw).
The first intermediate connecting member 7 connects the rod-shaped electrode 2 arranged near the center of the cross section of the sheath portion 4 and the first driving member 16 arranged eccentrically with respect to the rod-shaped electrode 2 to each other. It is a member that drives the rod-shaped electrode 2 by the first driving member 16.
The first intermediate connecting member 7 is a member that slides in the longitudinal axis direction inside the sheath portion 4, and the basic embodiment is a columnar member having an outer diameter smaller than the inner diameter of the sheath portion 4.
A mounting hole 71 to which the rod-shaped electrode 2 is mounted is formed at the center of the first intermediate connecting member 7 in the cross section perpendicular to the longitudinal axis direction. The mounting hole 71 is provided so as to penetrate the first intermediate connecting member 7, and is a through hole that communicates with the through hole 21 of the rod-shaped electrode 2 in a state where the rod-shaped electrode 2 is attached to the mounting hole 71.
The counterbore 75 and the through hole 73 formed in the first intermediate connecting member 7 are located at substantially the same position as the through hole 83 of the first base member 8 in the cross section perpendicular to the longitudinal axis direction. It is a fixed portion to which the driving member 16 of 1 is fixed.
The through hole 74 formed in the first intermediate connecting member 7 at a position substantially the same as the through hole 84 of the first base member 8 in the cross section perpendicular to the longitudinal axis direction is a second guide. The pipe 13 is slidably received, and is formed with an inner diameter slightly larger than the outer diameter of the second guide pipe 13.
The counterbore 75, the through hole 73, and the through hole 74 have a shape in which a part of the side surface of the hole is released because the outer circumference of the hole reaches the outer circumference of the first intermediate connecting member 7.
In the cross section perpendicular to the longitudinal axis direction of the first intermediate connecting member 7, an engaging groove 72 for guiding the guide member 9 is formed at a position substantially the same as the guide member fastening hole 82 of the first base member 8. Has been done. The engaging groove 72 slidably receives the guide member 9, and is formed with an inner diameter slightly larger than the outer diameter of the guide member 9.
The first intermediate connecting member 7 is arranged between the first base member 8 and the second base member 5.

FIG. 8 is a perspective view showing an assembled state of the first intermediate connecting member 7, the rod-shaped electrode 2, and the first driving member 16.
As shown in FIG. 8, the rod-shaped electrode 2 is fitted into the mounting hole 71 of the first intermediate connecting member 7, and both have an integral structure. Further, the first driving member 16 is arranged in the through hole 73 of the first intermediate connecting member 7, and the caulking 161 fixed to the tip of the first driving member 16 is the counterbore 75 of the first intermediate connecting member 7. Is fixed to. As a result, even if the first driving member 16 and the rod-shaped electrode 2 are not arranged in the same linear shape, the rod-shaped electrode 2 can be moved forward and backward by pushing and pulling the first driving member 16.
Since the first intermediate connecting member 7 is configured to engage with the guide member 9 which is a skeleton structure by the engaging groove 72, the occurrence of twisting operation of the first intermediate connecting member 7 due to the advancing / retreating operation is suppressed. Will be done.

9A and 9B are perspective views showing an assembled state of the first base member 8, the second base member 5, the guide member 9, the first intermediate connecting member 7, the rod-shaped electrode 2, and the first driving member 16. It shows a state in which the components of FIGS. 5 and 8 are combined. FIG. 9A shows a state in which the rod-shaped electrode 2 is in the retracted position, and FIG. 9B shows a state in which the rod-shaped electrode 2 is in the protruding position.
As can be understood from FIGS. 9A and 9B, the rod-shaped electrode 2 is inserted into the rod-shaped electrode insertion portion 512 of the second base member 5 so as to be able to advance and retreat, and the first intermediate connecting member 7 is inserted into the guide member 9. Is slidably arranged. The first guide pipe 15 is attached to the counterbore 85 of the first base member 8, and the first drive member 16 is inserted into the through hole 83 so as to be able to advance and retreat.
With the above configuration, the first intermediate connecting member 7 and the rod-shaped electrode 2 move forward and backward as the first driving member 16 in the first guide pipe 15 moves forward and backward.

FIG. 10A is a perspective view showing the injection needle 3 and the injection needle tube 17. 10B and 10C are perspective views showing the positional relationship between the injection needle 3, the injection needle tube 17, and the rod-shaped electrode 2. FIG. 10B is a state in which the injection needle 3 is in the retracted position with respect to the rod-shaped electrode 2, and FIG. The states in which the injection needle 3 is in the protruding position with respect to the rod-shaped electrode 2 are shown.
The injection needle 3 is composed of a metal pipe having a sharp tip, and is connected to an injection needle tube 17 through which a drug solution passes through the lumen thereof. The injection needle tube 17 passes through the lumen of the sheath portion 4 to the base end of the sheath portion 4. It is extended and is connected to a syringe (not shown) on the operation unit 20 side. The advancing / retreating operation of the injection needle 3 is realized by pushing / pulling the injection needle tube 17 at the base end of the sheath portion 4.
The injection needle 3 has a curved portion 31 on the proximal end side of the first base member 8. The tip of the injection needle 3 is arranged substantially in the center of the sheath portion in a cross section orthogonal to the longitudinal axis direction of the sheath portion 4, whereas the injection needle tube 17 is not in the center, so that the stroke of the needle advancing / retreating operation is performed. The base end side is partially bent to make it eccentric from the length required for the injection to absorb the misalignment.

FIG. 10D is a conceptual cross-sectional view of the sheath portion 4 on the proximal end side of the first base member 8.
The injection needle tube 17, the first guide pipe 15, and the second guide pipe 13 are housed inside the sheath portion 4. The outer diameter of the sheath portion 4 is limited by the diameter of the treatment tool channel of the flexible endoscope. The diameter of the treatment tool channel of the flexible endoscope is, for example, a minimum of 2.8 mm, and a clearance of, for example, about 0.3 mm is required for insertion through the channel. Therefore, the outer diameter of the sheath portion 4 is a maximum of 2. It is desirable to set it to about 5 mm. Under such restrictions, it is preferable that the injection needle tube 17, the first guide pipe 15, and the second guide pipe 13 each have a diameter as large as possible. By making the injection needle tube 17 as thick as possible, it becomes easy to maintain the transmission performance of the push-pull operation and the passing flow rate of the chemical solution. For the user, the time for injecting the desired amount of liquid can be shortened, and the resistance when pushing the syringe can be reduced. By making the first guide pipe 15 and the second guide pipe 13 as thick as possible, the opening and closing operation of the gripping forceps 1 transmitted by the first driving member 16 such as a wire and the second driving member 14, and the rod-shaped electrode 3 It becomes easier to maintain the performance of the advance / retreat operation of. From the viewpoint of arranging three parts having a circular cross section in the circular cross section and trying to make the diameter of each part as large as possible, it is preferable to adopt the arrangement as shown in FIG. 10D. The injection needle tube 17 needs to have a larger diameter than the injection needle 3 so that the injection needle 3 can be inserted into the lumen. When the injection needle 3 located at the center of the sheath portion 4 is directly connected to the injection needle tube 17, that is, when the injection needle tube 17 is arranged at the center, the arrangement is as shown in FIG. 10E, and the diameter of any member must be reduced. Does not fit in the sheath.
On the other hand, in the treatment tool 100 of the present embodiment, as shown in FIG. 10D, the injection needle tube 17 is provided eccentrically in the sheath portion 4 in a cross section orthogonal to the longitudinal axis direction, and the injection needle is provided. It has the effect of maximizing the diameters of the tube 17, the first guide pipe 15, and the second guide pipe 13. Further, since mutual pressure is suppressed, the frictional resistance can be reduced when the injection needle moves forward and backward.
As shown in FIG. 10D, the sheath portion 4 has a two-layer structure of a sheath outer skin 42 and a liner blade tube 41 having torque transmissibility. The liner blade tube 41 is formed by combining a tube made of a metal net with a crush prevention coil so that the entire sheath can be rotated. Since it is difficult to pinch the gripping forceps 1 unless the opening direction of the gripping forceps 1 matches the direction of the living tissue, the gripping forceps 1 can be rotated around the axis of the sheath. The sheath outer skin 42 is covered with an insulating outer skin such as a heat-shrinkable tube.

As described above, in the present embodiment, the injection needle tube 17 is provided eccentrically in the sheath portion 4, and the injection needle 3 is provided in the central portion of the sheath portion 4 on the tip side of the injection needle 3. , The misalignment occurs in the arrangement relationship between the injection needle tube 17 and the tip end side of the injection needle 3.
The injection needle 3 has a curved portion 31 in order to absorb the misalignment. In the present embodiment, the injection needle 3 is plastically deformed to form a curved portion 31 on the injection needle 3 (see FIG. 10A). Stainless steel is preferable as the material of the injection needle that can be plastically deformed.
On the other hand, the curved portion 31 may be formed by forming the injection needle with a metal that elastically deforms and elastically deforming (curving) the injection needle. As the elastically deformable metal, nickel-titanium alloy, stainless spring steel and the like are preferable. As described above, the through hole 81 of the first base member 8 through which the injection needle 3 is inserted is an injection needle insertion hole through which the injection needle 3 is inserted so as to be able to move forward and backward and its direction is defined. Therefore, by inserting the through hole 81 of the first base member 8, the injection needle 3 may be elastically deformed to form the curved portion 31. Further, as shown in FIG. 10F, an injection needle guide (third guide pipe) 18 which is fixed to the base end side of the first base member 8 and allows the injection needle 3 to be inserted therein may be provided. good. Since the injection needle guide 18 is curved, the curved portion 31 is formed by elastically deforming the injection needle 3 inserted in the injection needle guide 18. The first and second guide pipes and the injection needle are in close contact with each other in the vicinity of the base end side of the first base member 8, but by providing the injection needle guide 18, the first and second guide pipes can be brought into close contact with each other. It is possible to prevent contact with the needle that moves forward and backward, and prevent malfunction due to friction.

Further, when the arrangement is as shown in FIG. 10D for the above reason, the first driving member 16 for moving the rod-shaped electrode 2 forward and backward is also provided eccentrically with respect to the center of the sheath portion 4. On the other hand, the rod-shaped electrode 2 is also provided in the central portion, and misalignment also occurs in the arrangement relationship between the first driving member 16 and the rod-shaped electrode 2. That is, the center of the rod-shaped electrode 2 and the center of the first driving member 16 do not coincide with each other in the cross section perpendicular to the longitudinal axis direction at the end portion of the rod-shaped electrode 2 on the proximal end side.
The member for absorbing the misalignment is the first intermediate connecting member 7, and the rod-shaped electrode 2 arranged at the center by the first intermediate connecting member 7 and the first driving member arranged eccentrically. 16 are connected to each other.
The first driving member 16 does not have to extend to the position of the base end side end portion of the rod-shaped electrode 2. Also in this case, the tip of the first drive member 16 when the tip of the first drive member 16 is projected onto a surface orthogonal to the longitudinal axis direction of the sheath at the position of the base end side of the rod-shaped electrode 2. It is preferable that the center and the center of the base end side end portion of the rod-shaped electrode 2 on the plane orthogonal to the longitudinal axis direction of the sheath do not coincide with each other.
Make sure that the center of either the first drive member 16 and the rod-shaped electrode 2 and the other cross section (cross section orthogonal to the longitudinal axis of the sheath) do not overlap, or the cross section of the first drive member 16 and the rod-shaped electrode 2 The cross sections of the above may not overlap.

11A to 11D are views showing jaws constituting the gripping forceps 1, FIGS. 11A and 11B are perspective views, FIG. 11C is a bottom view (viewed from below), and FIG. 11D is an exploded perspective view.
The grasping forceps 1 is composed of a pair of jaws, a first jaw 11 and a second jaw 12, so that the biological tissue can be grasped and pressure is applied to the tissue as a hemostatic forceps. The jaw and the second jaw have the same configuration (hereinafter, the first jaw 11 and the second jaw 12 are simply referred to as "joe 11" without any particular distinction). In the present embodiment, the first jaw and the second jaw have the same configuration as an example, but the first jaw and the second jaw have different configurations as in another example shown later. It doesn't matter.
The jaw 11 has a grip portion 111, a shaft support portion composed of a pin member 118, 119 (see FIG. 12A) and a pin hole 112, and a slit 115 formed on the opposite side of the shaft support portion from the grip portion 111. It includes a first brim portion 113 having a first brim portion 113 and a second brim portion 114 having no slit.

The jaw 11 is made of a conductive member so that a high-frequency current can be applied to solidify the tissue, thereby forming the forceps electrode 116. The forceps electrode 116 is arranged on the gripping surface, which is the surface on which the jaws 11 face each other when the gripping forceps 1 is closed.
Further, an insulating portion 117 is formed on the outer peripheral surface of the jaw 11 when the gripping forceps 1 are closed. In the present embodiment, the same power source is used for the rod-shaped electrode 3 and the forceps electrode 116, and the current is concentrated on the rod-shaped electrode 3 when the rod-shaped electrode 3 is used. ) Is insulated. Further, by insulating the outside of the gripping forceps 1 (Jaw 11), it is possible to prevent unintended high-frequency cauterization / coagulation of the mucous membrane on the outside of the jaw 11 at the time of hemostasis or cauterization by the rod-shaped electrode 3.
As shown in FIG. 11D, the jaw 11 of the present embodiment has the above configuration formed by the jaw member 11A formed of a conductive member and the cover member 11B formed of an insulator. The insulating portion 117 may be configured by coating the outside of the jaw with an insulating material.
Grooves 120 that are semicircular in a cross-sectional view orthogonal to the longitudinal axis direction are formed on the gripping surfaces of the jaw member 11A and the cover member 11B along the longitudinal axis direction. The groove 120 forms a round hole penetrating along the longitudinal axis direction when the gripping forceps 1 is closed. The round hole formed by the groove 120 is a rod-shaped electrode insertion hole 1200 formed in the gripping forceps 1 so that the rod-shaped electrode 2 and the injection needle 3 can appear and disappear when the gripping forceps 1 is closed (see FIG. 12C). Is.
The gripping surface of the cover member 11B is formed with uneven portions to prevent slipping, thereby increasing the gripping force on the living tissue.

The first brim portion 113 and the second brim portion 114 are formed in a plate shape, and are provided substantially in parallel at both ends in the direction along the opening / closing axis of the gripping forceps 1. As shown in FIG. 11C, the second brim portion 114 is provided at a position offset inward by the thickness of the first brim portion 113. When combining the pair of jaws, the second brim portion 114 of one jaw is arranged so as to be in contact with the inside of the first brim portion 113 of the other jaw.
12A to 12C are views showing an assembled state of the pair of jaws and the second base member 5, FIG. 12A is a perspective view, and FIG. 12B is a front view (viewed from the tip side) with the gripping forceps open. ), FIG. 12C is a front view of the gripping forceps in a closed state.
A pair of jaws (first jaw 11 and second jaw 12) are aligned so that the positions of the pinholes 112 and the holes 53 formed in the support piece 52 of the second base member 5 are aligned with each other. , The arrangement is as shown in the figure, and the pin member 118 (first shaft member) and the pin member 119 (second shaft member), which serve as the opening / closing shaft of the gripping forceps 1, are pivotally supported.
As shown in FIG. 12B, the gripping forceps are configured to pivotally support a pair of jaws to the two support pieces 52 of the second base member 5 with the two divided shaft members. There is no shaft member or the like in the central portion of 1, and a space portion can be formed in the central portion of the gripping forceps 1. The pin member 118 and the pin member 119 may be fixed to the second base member 5 and slidably inserted into the pin holes 112 of the pair of jaws, or the pin member 118 and the pin member 119 may be slidably inserted. The 119 may be fixed to the pair of jaws (fixed without hindering the opening / closing operation of the forceps) and slidably inserted into the hole 53 of the second base member 5.
As shown in FIGS. 12B and 12C, in the gripping forceps 1, when the gripping forceps are opened and closed, the rod-shaped electrode insertion hole 1200 extends in the longitudinal axis direction to the rod-shaped electrode insertion portion 512 of the second base member 5. It is penetrated, and the rod-shaped electrode 2 and the injection needle 3 can appear and disappear in both the open state and the closed state of the grasping forceps. As can be understood from FIG. 12B, the rod-shaped electrode 2 is arranged at a position between the brim portions of the pair of jaws.

13A to 13D are views showing the second intermediate connecting member 6, FIGS. 13A and 13B are perspective views, FIG. 13C is a side view, and FIG. 13D is a front view (viewed from the tip side).
The second intermediate connecting member 6 includes an engaging portion (a pin member 67 fitted into the pin hole 64) that slidably engages with the slit 115 of the brim portion 113 of the jaw 11, and is a second driving member. It is a member that advances and retreats along the longitudinal axis direction by 14.
The second intermediate connecting member 6 has a shape in which the tip end side is thick and the base end side is thin. The tip portion 62, which is a thick portion on the tip side of the second intermediate connecting member 6, has a shape in which a cylinder is D-cut in two places on a surface perpendicular to the bottom surface, and the two D-cut surfaces are parallel. A pin hole 64 is formed on the D-cut surface of the second intermediate connecting member 6, and a protrusion (engagement portion) is formed by the pin member 67 fitted therein (see FIGS. 14A and 14B).
A counterbore 65 is formed from the tip side on the upper portion of the tip portion 62, and a through hole 66 is formed in the counterbore 65. The counterbore 65 and the through hole 66 are fixing portions to which the second driving member 14 is fixed.
The narrow portion on the proximal end side of the second intermediate connecting member forms a tubular portion 63 having a cylindrical shape extending in the longitudinal axis direction. The hole of the tubular portion 63 is formed as a through hole 61 penetrating to the tip portion 62. The through hole 61 is a hole through which the rod-shaped electrode 2 is inserted.

14A and 14B are views showing an assembled state of the second intermediate connecting member 6 and the second driving member 14, FIG. 14A is a perspective view, and FIG. 14B is a front view (viewed from the tip side). ..
The second drive member 14 is passed through the through hole 66, and the caulking 141 attached to the tip of the second drive member 14 is fixed to the counterbore 65, so that the second drive member 6 is driven second. The member 14 is attached. Further, by fitting the pin member 67 into the pin hole 64, an engaging portion that slidably engages with the slit 115 of the jaw 11 is formed.

15A and 15B are perspective views showing a state in which the sheath portion 4, the second base member 5 and the guide member 9 are excluded near the tip of the treatment tool 100, and FIG. 15A is a state in which the gripping forceps 1 are opened. FIG. 15B is a diagram showing a state in which the grasping forceps 1 are closed. FIG. 15C is a top view showing a state in which the second base member 5 is added to FIG. 15B.
As can be understood from the drawings of FIGS. 15A to 15C, the engaging portion of the second intermediate connecting member 6 (the pin member 67 fitted into the pin hole 64) is slid into the slit 115 of the jaw 11 (12). It is movably engaged, and the gripping forceps 1 is opened and closed by moving the second intermediate connecting member 6 back and forth.
The second intermediate connecting member 6 is inserted into the rod-shaped electrode 2 to move forward and backward along the rod-shaped electrode 2. Since the tubular portion 63 is formed in the second intermediate connecting member 6, the rod-shaped electrode 2 is inserted into the inside at a long distance in the longitudinal axis direction, thereby improving the stability of operation. .. The second driving member 14 for driving the second intermediate connecting member 6 is fixed to the upper part of the second intermediate connecting member 6, and the engaging portion (pin member 67) on which the force acts is the second. Since the drive member 14 is not on a straight line in the direction in which the force acts, a rotational torque is generated. On the other hand, the above configuration improves the stability of operation.

As shown in FIG. 15C, a second intermediate connecting member 6 is arranged between the two supporting pieces 52 of the second base member 5, and the two supporting pieces 52 and the second intermediate connecting member 6 are arranged. A first brim portion 113 of the jaw 11 (12) is arranged between them. Further, the surfaces of the two support pieces 52 facing the second intermediate connecting member 6 and the surfaces of the second intermediate connecting member 6 facing the two supporting pieces 52 are each substantially flat. It is formed. With this configuration, each member can be efficiently arranged in a limited space, and the structure in which each member slides and supports each other improves the stability of operation of each member. When the engaging portion (pin member 67) of the second intermediate connecting member 6 rubs against the slit 115 of the jaw 11 due to the advancing / retreating operation of the second intermediate connecting member 6, it is reversed from the two slits 115 of the pair of jaws. In order to receive the force in the direction, the second intermediate connecting member 6 tries to make an unnecessary rotational movement. On the other hand, the flat surfaces (D-cut surfaces) on both side surfaces of the second intermediate connecting member 6 hit the first brim portion 113, which is a plate-shaped member, so that the second intermediate connecting member 6 rotates about an axis in the longitudinal direction. It can be prevented.

In addition, preferable materials for constituting each member will be exemplified below.
Rod-shaped electrode: Stainless steel Injection needle: Stainless steel for plastic deformation, Nickel-titanium alloy and stainless spring steel for elastic deformation Second base member: Stainless steel, ceramic, plastic Second intermediate connecting member: Stainless steel, Ceramic, plastic pin member (engagement part): stainless steel material, ceramic, plastic First intermediate connection member: stainless steel material (need to conduct electricity)
First base member: stainless steel, ceramic, plastic Guide member: stainless steel, ceramic, plastic jaw: stainless steel Insulation: ceramic, fluororesin Pin member: stainless steel, ceramic, plastic Second guide pipe: coil For stainless steel and resin Teflon (registered trademark) resin, engineering plastic Second driving member: stainless rope, stainless wire, nickel-titanium alloy wire (need to conduct electricity)
First guide pipe: Stainless steel for coil, Teflon (registered trademark) resin for resin, engineering plastic First drive member: Stainless rope, stainless wire, nickel-titanium alloy wire (need to conduct electricity)
Injection needle Tube: Fluororesin, engineering plastic Injection needle guide: Stainless steel, plastic, nickel-titanium alloy Sheath sheath: Fluororesin, polyolefin, etc. Heat-shrinkable tube Liner blade tube: Stainless steel Caulking: Stainless steel (where energization is required) It is necessary to conduct electricity for caulking)

As described above, according to the treatment tool 100 of the present embodiment, the gripping forceps 1, the rod-shaped electrode 2, and the injection needle are contained in the extremely limited space of the treatment tool inserted into the treatment tool channel of the endoscope. 3 can be arranged extremely efficiently by an original configuration, and can provide a treatment tool having more functions than before.

In the present embodiment, a pair of jaws having the same configuration is provided to form a gripping forceps, but the present invention is not limited to this. For example, one jaw is fixed. It may be formed in such a way that only the other jaw performs the opening / closing operation. 16A to 16C show a treatment tool 100', which is an example of such a thing.
FIG. 16A is a perspective view showing the tip end portion of the treatment tool 100'. The treatment tool 100'is different from the treatment tool 100 of the embodiment in the second base member 5'and the jaw 11', and other configurations are the same as those of the treatment tool 100 of the embodiment. Therefore, only the second base member 5'and the jaw 11'will be described.
FIG. 16B is a perspective view showing an assembled state of the second base member 5'and the jaw 11', and FIG. 16C is an exploded perspective view.
The base 51 and the two support pieces 52 of the second base member 5'are basically the same as the second base member 5 of the treatment tool 100, but the jaw 55 is integrally formed at the tip portion. It is different in that it is. The jaw 55 is formed by being connected to the tip portions of the two support pieces 52, and a groove 551 having a semicircular shape in a cross-sectional view orthogonal to the longitudinal axis direction is formed along the longitudinal axis direction.
The jaw 11'does not have a second brim portion 114 with respect to the jaw 11 of the treatment tool 100, but has two brim portions 113'having the same configuration as the first brim portion 113. different.
The two pin holes 112'of the jaw 11' are pivotally supported by the pin members 118 and 119 of the support piece 52, and the two slits 115' are the engaging portions of the second intermediate connecting member 6 (same as the treatment tool 100). By engaging slidably with the configuration), the gripping forceps are opened and closed by the advancing / retreating motion of the second intermediate connecting member 6.
The jaw 11'has the same configuration as the groove 120 of the jaw 11 of the treatment tool 100, and penetrates along the longitudinal axis direction with the groove 551 of the jaw 55 when the grasping forceps are closed. A round hole (rod-shaped electrode insertion hole) is formed.

Further, in the treatment tool 100, as a mechanism for opening and closing the gripping forceps, a second intermediate connecting member 6 having an engaging portion that engages with a slit formed in the jaw is used as an example. The drive member 14 of 2 may be more directly connected to the jaw. 17A and 17B show a treatment tool 100 ″ which is an example of such a thing.
FIG. 17A is a perspective view showing the tip end portion of the treatment tool 100 ″. The treatment tool 100 ″ is different from the treatment tool 100 of the embodiment in the second base member 5 ″ and the jaw 11 ″, and does not have the second intermediate connecting member 6. Other configurations are basically the same as those of the treatment tool 100 of the embodiment. Therefore, only the second base member 5 ″ and the jaw 11 ″ will be described.
The base of the second base member 5 ″ and the two support pieces have basically the same concept as the second base member 5 of the treatment tool 100, but the jaw is integrally formed at the tip portion. The points and the arrangement positions of the pin members 118 ″ and 119 ″ are different. The jaw has the same concept as that described with reference to FIGS. 16A to 16C, and has a groove formed by being connected to the tips of two support pieces and having a semicircular shape in a cross-sectional view orthogonal to the longitudinal axis direction. It is formed along the longitudinal axis direction.
The positions of the pin members 118 ″ 119 ″ (that is, the opening / closing shaft of the gripping forceps) are offset below the center position in the vertical direction. Although the opening / closing torque of the gripping forceps is increased by such an arrangement, the pin member may be arranged at the same position as the treatment tool 100 of the embodiment.
FIG. 17B is a perspective view showing an assembled state of the jaw 11 ″ and the second drive member 14. The jaw 11 ″ is different from the jaw 11 of the treatment tool 100 in the configuration of the brim portion, and is the same as the jaw 11 of the treatment tool 100 except for the brim portion. The jaw 11 ″ has two brim portions 113 ″ provided substantially in parallel at both ends in the direction along the opening / closing axis of the grasping forceps. The two brim portions 113 ″ have the same configuration, have a pin hole for receiving the pin member 118 ″ 119 ″ on the lower side, and a connecting portion 19 for connecting the second drive member 14 on the upper side. Is attached. The second driving member 14 itself is the same as the second driving member 14 of the treatment tool 100.

Further, in the treatment tool 100, as an example, a rod-shaped electrode (and an injection needle) is arranged at a position substantially center of the sheath portion 4 in a cross section orthogonal to the longitudinal axis direction. It is not limited. For example, as shown in FIG. 18, the rod-shaped electrode (and the injection needle) may be arranged eccentrically (offset downward in this example).

100. .. .. Treatment tool 1. .. .. Gripping forceps 2. .. .. Rod-shaped electrode 21. .. .. Through hole 3. .. .. Injection needle 31. .. .. Curved part 4. .. .. Sheath part 5. .. .. Second base member 51. .. .. Base 511. .. .. Fitting part 512. .. .. Rod-shaped electrode insertion part 513. .. .. Second drive member insertion part 52. .. .. Support piece 6. .. .. Second intermediate connecting member 67. .. .. Pin member (engagement part)
7. .. .. First intermediate connecting member 71. .. .. Mounting hole (through hole)
72. .. .. Engagement groove 8. .. .. First base member 81. .. .. Through hole (injection needle insertion hole)
9. .. .. Guide member 11 (12). .. .. Joe 111. .. .. Grip 112. .. .. Pinhole 113. .. .. First brim 114. .. .. Second brim part 115. .. .. Slit 116. .. .. Forceps electrodes 118, 119. .. .. Pin member 120. .. .. Groove 13. .. .. Second guide pipe 14. .. .. Second drive member 15. .. .. First guide pipe 16. .. .. First drive member 17. .. .. Injection needle tube 18. .. .. Injection needle guide (third guide pipe)
20. .. .. Operation unit

Claims (44)

A treatment tool used with an endoscope
With the sheath
With the gripping forceps arranged on the tip side of the sheath,
A rod-shaped electrode that is arranged so as to appear and disappear with respect to the grasping forceps and functions as an electric knife,
An injection needle that is arranged so as to appear and disappear with respect to the rod-shaped electrode in a through hole formed in the rod-shaped electrode along the axial direction of the rod-shaped electrode.
Treatment tool equipped with. The treatment tool according to claim 1, wherein the gripping forceps includes a forceps electrode which is an electrode capable of stopping bleeding of a gripping object. The treatment tool according to claim 1 or 2, wherein the rod-shaped electrode is arranged so as to appear and disappear with respect to the gripping forceps in a state where the gripping forceps are closed. The treatment tool according to any one of claims 1 to 3, wherein the rod-shaped electrode appears and disappears from a rod-shaped electrode insertion hole formed at the tip of the grasping forceps. The treatment tool according to any one of claims 1 to 4, further comprising a first driving member for moving the rod-shaped electrode so as to move back and forth with respect to the grasping forceps. With the rod-shaped electrode so that the center of the rod-shaped electrode and the center of the first driving member do not coincide with each other in the cross section perpendicular to the longitudinal axis direction of the sheath at the end portion on the base end side of the rod-shaped electrode. The treatment tool according to claim 5, wherein the first driving member is arranged. The treatment tool according to claim 5 or 6, further comprising a first intermediate connecting member for connecting the rod-shaped electrode and the first driving member to each other. The treatment tool according to claim 7, wherein the first intermediate connecting member has an outer diameter equal to or smaller than the inner diameter of the sheath. The treatment tool according to claim 7 or 8, wherein the first intermediate connecting member is formed with a through hole communicating with the through hole formed in the rod-shaped electrode. The treatment tool according to any one of claims 7 to 9, wherein the first intermediate connecting member is a columnar member. The treatment tool according to any one of claims 7 to 10, further comprising a first base member fixed to the sheath on the proximal end side of the sheath with respect to the first intermediate connecting member inside the sheath. The treatment tool according to any one of claims 5 to 11, further comprising a first guide pipe through which the first driving member is inserted. A first guide pipe for inserting the first driving member into the inside is provided.
The treatment tool according to claim 11, wherein the first guide pipe is fixed to the first base member. The treatment tool according to any one of claims 1 to 13, further comprising a second driving member for driving the opening / closing operation of the grasping forceps and a second guide pipe for inserting the second driving member into the inside. The treatment tool according to claim 14, wherein a first base member fixed to the sheath is provided inside the sheath, and the second guide pipe is fixed to the first base member. The treatment tool according to any one of claims 1 to 15, wherein the injection needle has a curved portion. The treatment tool according to any one of claims 11, 13, and 15, wherein the injection needle has a curved portion on the base end side of the sheath with respect to the first base member. The treatment tool according to claim 16 or 17, wherein the injection needle is made of an elastically deformable metal. A first base member fixed to the sheath is provided inside the sheath.
A third guide pipe for inserting the injection needle inside is provided.
The treatment tool according to claim 18, wherein the third guide pipe is fixed to the proximal end side of the first base member. 19. The curved portion is formed by elastically deforming the injection needle inserted into the curved third guide pipe due to the curvature of the third guide pipe, according to claim 19. Treatment tool. The treatment tool according to claim 16 or 17, wherein the curved portion is formed by plastically deforming a part of the injection needle. The injection needle tube, which is connected to the injection needle, is a flow path of the drug solution to the injection needle, and is a driving member for driving the injection needle so as to appear and disappear with respect to the rod-shaped electrode, is contained in the sheath. The treatment tool according to any one of claims 1 to 21, which is provided eccentrically with respect to. 11. Treatment tool. The treatment tool according to claim 23, wherein the injection needle insertion hole is located at a position substantially center of the sheath in a cross section perpendicular to the longitudinal axis direction of the sheath. A second base member provided at the tip of the sheath and pivotally supporting the grasping forceps so as to be openable and closable is provided.
The second base member is erected from the base portion along the longitudinal axis direction of the sheath, and two base members are opposed to each other in the vicinity of the outer periphery of the base portion in a cross section orthogonal to the longitudinal axis direction of the sheath. The treatment tool according to any one of claims 1 to 24, comprising a support piece. One of the two support pieces is provided with a first shaft member that pivotally supports the gripping forceps so that the gripping forceps can be opened and closed, and the other of the two support pieces is pivotally supported by the gripping forceps that can be opened and closed. The treatment tool according to claim 25, wherein the shaft member of 2 is provided. In the base portion, a rod-shaped electrode insertion portion for inserting the rod-shaped electrode so as to be able to advance and retreat, a second drive member insertion portion for inserting a second drive member for driving the opening / closing operation of the gripping forceps, and the inside of the sheath. The treatment tool according to claim 25 or 26, wherein a fitting portion to be fitted and a fitting portion are formed. A second base member provided at the tip of the sheath and pivotally supporting the grasping forceps so as to be openable and closable is provided.
The treatment tool according to claim 14 or 15, wherein the second guide pipe is fixed to the second base member. The treatment tool according to any one of claims 7 to 11, further comprising a guide member for guiding the advance / retreat movement of the first intermediate connecting member in the longitudinal axis direction of the sheath. The treatment tool according to claim 29, wherein the guide member is a rod-shaped member, and an engaging groove for guiding the guide member is formed in the first intermediate connecting member. Inside the sheath, a first base member fixed to the sheath on the base end side of the sheath with respect to the first intermediate connecting member is provided, and the guide member is fixed to the first base member. , The treatment tool according to claim 29 or 30. A second base member provided at the tip of the sheath and pivotally supporting the grasping forceps so as to be openable and closable is provided.
The treatment tool according to any one of claims 29 to 31, wherein the guide member is fixed to the second base member. The grasping forceps include a first jaw and a second jaw.
Each of the first jaw and the second jaw includes a grip portion, a shaft support portion, and a first brim portion having a slit formed on the side opposite to the grip portion with respect to the shaft support portion. ,
13. The treatment tool described in any of them. 33. The treatment tool according to claim 33, wherein each of the first jaw and the second jaw includes the first brim portion having the slit and the second brim portion not having the slit. The treatment tool according to claim 34, wherein the rod-shaped electrode is arranged between the first brim portion and the second brim portion. The treatment tool according to any one of claims 33 to 35, wherein the shaft support portion is composed of a pin member and a pin hole. The treatment tool according to any one of claims 33 to 36, wherein the second driving member is connected and advances and retreats in the longitudinal axis direction of the sheath, and includes a second intermediate connecting member having the engaging portion. The treatment tool according to claim 37, wherein the second intermediate connecting member is provided so that the rod-shaped electrode is inserted into the second intermediate connecting member so that the second intermediate connecting member can move forward and backward with respect to the rod-shaped electrode. It has a base and two support pieces that are erected from the base along the longitudinal axis direction of the sheath and face each other in the vicinity of the outer periphery of the base in a cross section orthogonal to the longitudinal axis direction of the sheath. A second base member that pivotally supports the first jaw and the second jaw so as to be openable and closable is provided at the tip of the sheath.
The first brim portion is formed in a plate shape.
The second intermediate connecting member is arranged between the two support pieces, and the second intermediate connecting member is arranged.
The treatment tool according to claim 37 or 38, wherein the plate-shaped first brim portion is arranged between the two support pieces and the second intermediate connecting member. The surface of the two support pieces facing the second intermediate connecting member and the surface of the second intermediate connecting member facing the two support pieces are each formed in a substantially flat surface. The treatment tool according to claim 39. The grasping forceps include a first jaw, a second jaw, and a forceps electrode which is an electrode capable of stopping bleeding of a gripping object.
In the first jaw and the second jaw, the forceps electrode is arranged on a surface where the first jaw and the second jaw face each other when the grasping forceps are closed.
The treatment tool according to any one of claims 1 to 40, wherein an insulating portion is formed on the outer peripheral surfaces of the first jaw and the second jaw in a state where the grasping forceps are closed. The grasping forceps include a first jaw and a second jaw.
In the first jaw and the second jaw, the rod-shaped electrode insertion hole is formed by a groove formed on each of the surfaces of the first jaw and the second jaw facing each other when the grasping forceps are closed. The treatment tool according to claim 4, which is configured. The treatment tool according to any one of claims 1 to 42, which has a diameter-expanded portion at the tip of the rod-shaped electrode. An endoscope comprising the treatment tool according to any one of claims 1 to 43.

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