JP2021175496A - Endoscope snare - Google Patents

Abstract

To provide a convenient endoscope snare.SOLUTION: An endoscope snare 1 includes: a tube-shaped sheath 10 with flexibility; an operation wire 20 inserted freely retractably in the sheath 10; and a loop-shaped snare loop 30 whose both ends are formed by a snare wire 31 connected to an end side of the operation wire 20. An end of the sheath 10 is provided with a hard-to-deform part 11 which is harder to plastically deformation and to elastically deform than the other parts.SELECTED DRAWING: Figure 1

Description

The present invention relates to an endoscopic snare that is inserted and used in an endoscope.

Conventionally, an endoscopic snare is known as an endoscopic treatment tool that is inserted through the forceps opening of an endoscope to excise a lesion such as a polyp. This endoscopic snare has a snare loop composed of a loop-shaped (ring-shaped) snare wire at the tip of an operation wire inserted into a tubular sheath, and the lesion is squeezed by this snare loop. It is excised (tightened) (see, for example, Patent Document 1).

Treatment with this endoscopic snare includes so-called hot snare (hot polypectomy) in which a high-frequency current is passed through the snare loop to cauterize the lesion, and so-called mechanical excision of the lesion using only the strangulation force of the snare loop. There are two types of cold snare (cold polypectomy). At present, hot snares are the mainstream, but recently, cold snares, in which the tissues around the lesion are not affected by heat, are gradually being applied.

In excision of a lesion by a snare loop, after surrounding the lesion with a snare loop, the sheath is moved forward to accommodate the proximal end side of the snare loop in the sheath, and the size of the loop outside the sheath is gradually increased. It is done by narrowing down (making it smaller). Therefore, when the lesion is squeezed, a force is applied to the tip of the sheath in the direction of expanding the opening by the snare loop, and a large force is applied to the tip of the sheath, especially in the cold snare that mechanically excises the lesion. Will join.

JP-A-2018-57418

However, since the sheath of an endoscope snare is required to have flexibility for bending together with the endoscope and slidability for smoothly advancing and retreating the inserted operating wire and snare wire, it is usually made of polytetra. It is composed of a fluororesin such as fluoroethylene (PTFE). For this reason, in the conventional endoscopic snare, the tip of the sheath may be greatly deformed in a state of being expanded at the time of strangulation. In such a case, it becomes difficult to appropriately narrow down the size of the snare loop, so that the sharpness of the snare loop may be deteriorated and the treatment may be hindered.

In view of such circumstances, the present invention intends to provide an easy-to-use endoscope snare.

The endoscopic snare of the present invention is formed by a flexible tubular sheath, an operation wire that is freely inserted into the sheath, and a snare wire whose both ends are connected to the tip end side of the operation wire. A loop-shaped wire loop is provided, and the tip end portion of the sheath is provided with a deformable portion that is less likely to be plastically deformed than other portions and elastically deformed more than other portions.

According to the present invention, it is possible to prevent the tip of the sheath from being greatly deformed to a state of being expanded during strangulation and the sharpness of the snare loop from being deteriorated. It is not necessary to make adjustments such as increasing the amount of operation and the amount of operation, and it is possible to prevent the occurrence of problems such as camera shake due to such adjustments. As a result, the user can perform strangulation and excision of the lesion with high accuracy and safety. That is, according to the present invention, it is possible to realize a snare for an endoscope that is easy to use.

Further, in the present invention, it is preferable that the difficult-to-deform portion is configured by arranging a cylindrical reinforced sheath at the tip end portion of the sheath.

According to this, by arranging the reinforced sheath so as to be in direct contact with the snare wire, it is possible to inexpensively form a difficult-to-deform portion and prevent deterioration of sharpness due to compression deformation of the sheath. Further, by making the inner diameter of the reinforced sheath smaller than the inner diameter of the sheath, the snare loop can be narrowed down to a smaller width, so that the sharpness of the snare loop can be further improved.

Further, in the present invention, it is preferable that the sheath has a locking portion formed in a shape that locks with the reinforced sheath by partially deforming or breaking the sheath.

According to this, it is possible to prevent a problem such as the reinforced sheath falling off from the sheath while forming the difficult-to-deform portion at low cost.

Further, in the present invention, it is preferable that the reinforced sheath has a spirally continuous convex portion on a surface facing the inner peripheral surface or the outer peripheral surface of the sheath.

According to this, the reinforced sheath can be arranged on the sheath while forming the locking portion at low cost by the same procedure as the self-tapping screw.

Further, the endoscopic snare of the present invention includes a connecting member for connecting the operation wire and the snare wire, and the connecting member is more basic than the reinforced sheath in a state where the snare loop protrudes most from the sheath. It is preferably located on the end side.

According to this, it is possible to prevent a problem that the connecting member is caught in the reinforced sheath while the hard-to-deform portion is constructed at low cost.

Further, in the present invention, the axial length of the hard-to-deform portion is preferably 1 times or more the outer diameter of the snare wire and 10 times or less the outer diameter of the sheath.

According to this, the hard-to-deform portion can be stably brought into contact with the snare wire to receive the force, and the flexibility of the sheath can be prevented from being hindered by the hard-to-deform portion.

According to the snare for an endoscope of the present invention, an excellent effect of good usability can be obtained.

It is an external view of the snare for an endoscope which concerns on one Embodiment of this invention. It is sectional drawing which showed the tip part of the sheath enlarged. It is a figure which showed the detail of the shape of a snare loop. It is a figure which showed the action of a snare loop. It is a figure which showed the action of a snare loop. It is sectional drawing which showed the other structural example of a reinforced sheath. It is sectional drawing which showed the example of the case where the sheath is provided with the locking portion which locks with the reinforced sheath. It is sectional drawing which showed the example of the case where the sheath is provided with the locking portion which locks with the reinforced sheath. It is sectional drawing which showed the other structural example of a snare loop.

Hereinafter, embodiments of the present invention will be described with reference to the accompanying drawings. FIG. 1 is an external view of an endoscope snare 1 according to an embodiment of the present invention. As shown in FIG. 1, the endoscope snare 1 includes a sheath 10 that is inserted through the forceps opening of the endoscope and inserted into the forceps channel, and an operation wire 20 that is inserted into the sheath so as to be able to move forward and backward. A snare loop 30 connected to the tip end side of the operation wire 20, a connecting member 40 connecting the operation wire 20 and the snare loop 30, and a handle 50 to which the sheath 10 and the base end portion of the operation wire 20 are connected are provided. ing.

The sheath 10 is a tubular member having flexibility, and the tip portion is introduced into the vicinity of the lesion portion in the living body through the forceps channel of the endoscope. The sheath 10 is required to have flexibility of appropriately bending together with the endoscope and slidability (low friction) for smoothly advancing and retreating the operation wire 20 inserted therein.

Therefore, in the present embodiment, the sheath 10 is made of polytetrafluoroethylene (PTFE), which is a kind of fluororesin having appropriate flexibility and slidability. Further, in the present embodiment, the tip portion of the sheath 10 is provided with the difficult-to-deform portion 11 configured to be more difficult to deform than the other portion (the portion on the proximal end side) of the sheath 10. Is being strengthened. The details of the difficult-to-deform portion 11 will be described later.

In this embodiment, the outer diameter D1 (see FIG. 2) of the sheath 10 is set to about 2.5 mm, the inner diameter D2 (see FIG. 2) is set to about 1.5 mm, and the total length (length in the axial direction) is set to about 2350 mm. However, each dimension is not limited to this, and an appropriate dimension can be adopted according to the type and application of the endoscope used together. Further, as the material of the sheath 10, a fluororesin other than PTFE and various other resins can be adopted.

The operation wire 20 is for connecting the handle 50 and the snare loop 30 to operate the snare loop 30 protruding from the sheath 10 and being housed in the sheath 10. In the present embodiment, the operation wire 20 is composed of a stranded wire obtained by twisting a strand of SUS304, which is a kind of stainless steel, but the operation wire is made of a stranded wire of other metals such as various stainless steels and various titanium alloys. 20 may be configured, or the operating wire 20 may be configured from a single wire of various metals.

Further, in the present embodiment, the outer diameter of the operation wire 20 is set to about 0.8 mm, but the outer diameter of the operation wire 20 is not limited to this, and depends on the inner diameter D2 of the sheath 10 and the like. An appropriate outer diameter can be adopted. The outer diameter of the operating wire 20 which is a stranded wire is the diameter of the circumscribed circle in the cross section.

The snare loop 30 is formed by folding back a snare wire 31 made of a stranded wire obtained by twisting a wire of SUS304 on the tip side to form a loop, and is for strangling and excising a lesion portion. In the present embodiment, the snare loop 30 is configured in a hexagonal shape, and can be accommodated in the sheath 10 by elastically deforming so as to push open the bent portion, and elastically deformed when protruding from the sheath 10. It can be expanded to the original hexagonal shape by the restoring force.

Further, in the present embodiment, the outer diameter of the snare wire 31 is set to about 0.35 mm, which is slightly smaller than 1/2 of the outer diameter of the operation wire 20, but the outer diameter of the snare wire 31 is not limited to this. Instead, an appropriate outer diameter can be adopted according to the inner diameter D2 of the sheath 10, the outer diameter of the operation wire 20, and the like. Here, the outer diameter of the snare wire 31 which is a stranded wire is the diameter of the circumscribed circle in the cross section like the operation wire 20.

In the present embodiment, by devising the configuration of the snare loop 30, even when the snare loop 30 is housed in the sheath 10 and the size of the loop is narrowed down, the entire snare loop 30 outside the sheath 10 is substantially the same. It is designed to be located on a flat surface. Details of the configuration of the snare loop 30 will be described later.

The connecting member 40 is composed of a cylindrical member made of SUS304, and connects the tip end portion of the operation wire 20 and both end portions of the snare wire 31 (that is, the base end portion of the snare loop 30). In the present embodiment, the tip of the operation wire 20 is inserted into the connecting member 40 from the base end side and crimped, and both ends of the snare wire 31 are inserted into the connecting member 40 from the tip side and crimped. The wire 20 and the snare loop 30 are connected.

The connecting member 40 may connect the operation wire 20 and the snare wire 31 by brazing, or may connect the operation wire 20 and the snare wire 31 by using caulking and brazing together. ..

The handle 50 is for a user such as a doctor to grasp and advance / retreat the snare loop 30 with respect to the sheath 10 (protrusion to the outside of the sheath 10 and accommodation in the sheath 10). The handle 50 includes a main body 51 to which the sheath 10 is connected and a slider 52 to which the operation wire 20 is connected. The main body 51 and the slider 52 are made of polycarbonate (PC) in this embodiment.

The main body 51 has a U-shaped cross section, and is provided with a groove 51a that continuously accommodates the operation wire 20 in the axial direction. A cap 51b that closes the groove 51a is fitted to the tip end side of the main body 51, and the base end portion of the sheath 10 is connected to the cap 51b in a state of being covered with a protective tube 51c. The protective tube 51c is made of polyvinyl chloride (PVC) in the present embodiment, and covers the base end side of the sheath 10 over a predetermined range to prevent the sheath 10 from breaking or the like. ..

The slider 52 is loosely fitted on the outer circumference of the main body 51, and is relatively movable in the axial direction with respect to the main body 51. As described above, since the sheath 10 is connected to the main body 51 and the operation wire 20 is connected to the slider 52, the operation wire 20 is moved to the sheath 10 by moving the slider 52 relative to the main body 51. It is possible to change the amount of protrusion of the snare loop 30 from the sheath 10 by relatively advancing and retreating.

Although detailed illustration is omitted, the operation wire 20 is connected to the slider 52 in a state of being inserted into the tubular support member 52a made of SUS304. The support member 52a has a length such that the tip portion slightly protrudes from the cap 51b toward the tip end side in a state where the slider 52 is located at the most proximal end side of the movable range, and the operation wire 20 in the groove 51a. This is for preventing the slider 52 and the operating wire 20 from bending and allowing the slider 52 and the operating wire 20 to move forward and backward smoothly.

Further, a cylindrical stopper member 53 made of PTFE is arranged between the slider 52 and the cap 51b in the groove 51a, and the support member 52a is inserted into the stopper member 53. That is, when the stopper member 53 is pushed by the slider 52 and comes into contact with the cap 51b, the position on the most tip side of the movable range of the slider 52 is set, and the maximum protrusion amount of the snare loop 30 is set. It has become like. Note that FIG. 1 shows a state in which the slider 52 is located on the most tip side of the movable range and the snare loop 30 is most projected.

A ring 51d for the user to insert a thumb is provided on the base end side (rear end side) of the main body 51. Further, the slider 52 is provided with two rings 52b for inserting, for example, the index finger and the middle finger of the user on both sides in the direction orthogonal to the axial direction of the main body 51. As a result, the handle 50 can be operated with one hand. The ring 51d comes into contact with the slider 52 to set the position on the most proximal end side of the movable range, and also functions as a stopper for the slider 52 to come off.

Further, the slider 52 is provided with an electrode 54 electrically connected to the operation wire 20 via the support member 52a. That is, the endoscope snare 1 of the present embodiment is configured to be capable of performing both a hot snare and a cold snare, and when performing a hot snare, a high-frequency power supply is connected to the electrode 54. ..

FIG. 2 is an enlarged cross-sectional view of the tip of the sheath 10, and shows the state of the snare loop 30 at the time of strangulation by a chain double-dashed line. As shown in FIG. 2, the hard-to-deform portion 11 arranges a cylindrical reinforced sheath 12 made of a material that is harder to deform than PTFE in the sheath 10 (the outer peripheral surface of the reinforced sheath 12 is inside the sheath 10). It is configured by fitting it on the peripheral surface). In this embodiment, the reinforced sheath 12 is made of polyetheretherketone (PEEK). Since PEEK is less likely to be plastically deformed or elastically deformed than PTFE, the tip portion of the sheath 10 can be made less likely to be deformed by arranging the reinforced sheath 12 made of PEEK.

In the excision of the lesion portion by the snare loop 30, after surrounding the lesion portion with the snare loop 30, the sheath 10 is moved forward to accommodate the proximal end side of the snare loop 30 in the sheath 10, and the outside of the sheath 10 is accommodated. This is done by gradually reducing (decreasing) the size of the loop. Therefore, when the lesion is squeezed, as shown in FIG. 2, a force is applied to the tip of the sheath 10 in the direction of expanding the opening by the snare loop 30, and in particular, the cold snare that mechanically excises the lesion. In, a large force is applied to the tip of the sheath 10.

At this time, if the tip of the sheath 10 is deformed, particularly plastically deformed and greatly deformed, the amount of narrowing down of the snare loop 30 outside the sheath 10 with respect to the operating amount of the handle 50 (the relative movement amount of the main body 51 and the slider 52) is reduced. It will be. Further, since a force for deforming the sheath 10 is required in addition to the force required for excising the lesion portion, the operating force of the handle 50 (the force required for the relative movement of the main body 51 and the slider 52) is increased.

That is, if the tip of the sheath 10 is deformed, the sharpness of the snare loop 30 deteriorates. However, in the present embodiment, the reinforced sheath 12 is arranged at the tip of the sheath 10 to provide the difficult-to-deform portion 11. , Prevents such troubles. As a result, in the present embodiment, the sharpness of the snare loop 30 is maintained even when, for example, a plurality of lesions are sequentially squeezed and excised by one treatment. Therefore, the user does not need to make adjustments such as increasing the operating force and the amount of operation in response to the deterioration of sharpness, and the occurrence of problems such as camera shake due to such adjustments is prevented. It is possible to perform strangulation and excision with high accuracy and safety. That is, the endoscopic snare 1 of the present embodiment is very easy to use when strangulation and excision of a lesion.

The material of the reinforced sheath 12 may be one that is less likely to be plastically deformed and elastically deformed than the material of the sheath 10. Specifically, the material of the reinforced sheath 12 may have a higher tensile yield stress and tensile elastic modulus than the material of the sheath 10, and more preferably a material having a higher compressive yield stress and compressive elastic modulus. ..

Other materials for the reinforced sheath 12 include, for example, acrylonitrile-butadiene-styrene copolymer synthetic resin (ABS), polyvinyl chloride (PVC), polycarbonate (PC), polyphenylene sulfide (PPS), polysulfone (PSU), and the like. Polysulfone terephthalate (PET), phenol resin (PF), epoxy resin (EP) and the like can be adopted. Further, as the material of the reinforced sheath 12, a material obtained by adding glass fiber or the like to various resins or a fiber reinforced resin (FRP) may be adopted, or a metal such as stainless steel or a titanium alloy may be adopted.

Each dimension of the reinforced sheath 12 is not particularly limited, but in the present embodiment, the outer diameter D3 of the reinforced sheath 12 is set to about 1.66 mm, which is slightly larger than the inner diameter D2 (about 1.5 mm) of the sheath 10. By setting, the reinforced sheath 12 can be fixed by press fitting, thereby improving productivity and reducing cost. In recent years, disposable medical devices have been promoted in order to improve safety against various infectious diseases and reduce the burden of cleaning and disinfection in medical institutions. It is possible to make it an inexpensive disposable product. The outer diameter D1 of the sheath 10 in the difficult-to-deform portion 11 is increased by about 0.1 mm due to the press-fitting of the reinforced sheath 12, but the change in the outer diameter D1 is not shown in FIG.

Further, in the present embodiment, the inner diameter D4 of the reinforced sheath 12 is set to 1.26 mm, which is about 3.6 times the outer diameter of the snare wire 31, so that the two snare wires 31 housed in the sheath 10 are smooth. Relative movement is possible, and the appropriate bending of the snare wire 31, which will be described later, is not hindered.

Further, in the present embodiment, by setting the axial length (that is, the axial length of the reinforced sheath 12) L1 of the difficult-to-deform portion 11 to about 5 mm, the flexibility of the sheath 10 is increased by the reinforced sheath 12. I try not to be disturbed. In order not to impair the flexibility of the sheath 10, the axial length L1 of the difficult-to-deform portion 11 is preferably 10 times or less the outer diameter of the sheath 10, and more preferably 5 times or less. , 2.5 times or less is most preferable.

Further, the lower limit of the axial length L1 of the difficult-to-deform portion 11 is determined by the strength of the material of the difficult-to-deform portion 11 and the radial dimension, and the dimension in which the difficult-to-deform portion 11 is not broken according to the assumed stress. However, in order to stably contact the snare wire 31 and receive the force, the axial length L1 of the difficult-to-deform portion 11 is preferably 1 times or more the outer diameter of the snare wire 31 and 5 times or more. If it is, it is more preferable, and it is most preferable that it is 10 times or more.

Further, the reinforced sheath 12 may be fixed to the sheath 10 by an adhesive, welding or the like. Further, the hard-to-deform portion 11 may be configured by arranging the reinforced sheath 12 so as to cover the outer periphery of the sheath 10. Further, in the present embodiment, the reinforced sheath 12 is arranged so that the tip of the sheath 10 and the tip of the reinforced sheath 12 coincide with each other, but the tip of the sheath 10 and the tip of the reinforced sheath 12 do not have to coincide with each other. ..

By arranging the reinforced sheath 12 in the sheath 10, the reinforced sheath 12 can be brought into direct contact with the snare wire 31, so that deterioration of sharpness due to compression deformation (crushing) of the sheath 10 can be prevented. .. Further, since the inner diameter of the tip portion of the sheath 10 is reduced by the reinforced sheath 12, the snare loop 30 can be narrowed down to a smaller width, and the sharpness of the snare loop 30 can be improved. Further, when the reinforced sheath 12 is arranged so as to cover the outer periphery of the sheath 10, a problem such as being caught at the outlet of the forceps channel may occur, but in the present embodiment, such a problem does not occur. ing.

FIG. 3 is a diagram showing details of the shape of the snare loop 30. In FIG. 3, the snare loop 30 is shown in the most protruding state, and the sheath 10 is shown in cross section. In the snare loop 30, both ends of one snare wire 31 are connected to the operation wire 20 via a connecting member 40, and the snare loop 30 is bent at a plurality of locations to form a hexagonal surrounding portion 30a that surrounds the lesion portion. It is configured.

Specifically, the snare loop 30 includes a pair of extending portions 32 extending from the connecting member 40 in the axial direction of the substantially operating wire 20, and a pair bent toward the outside of the snare loop 30 at the tip of the extending portion 32. 1st inwardly convex bent portion 33, a pair of first outer convex bent portions 34 bent toward the inside of the snare loop 30 at a position on the tip side of the first inwardly convex bent portion 33, and a first outer convex bent portion. A pair of second outer convex bent portions 35 bent toward the inside of the snare loop 30 at a position closer to the tip side than the portion 34, and toward the outside of the snare loop 30 at a position closer to the tip side than the second outer convex bent portion 35. It includes a pair of second inwardly convex bent portions 36 that are bent and bent, and a tip folded portion 37 that is folded back at the most advanced position of the snare loop 30.

In the present embodiment, the length L2 of the extension portion 32 (the length of the snare wire 31 from the tip of the connecting member 40 to the first inward convex bend 33) is set to about 28 mm, and the length L2 is set to about 28 mm from the first inward convex bend 33. The length L3 of the snare wire 31 up to the first outer convex bent portion 34 is set to about 28 mm, and the length L4 of the snare wire 31 from the first outer convex bent portion 34 to the second outer convex bent portion 35 is set to about 17 mm. Then, the length L5 of the snare wire 31 from the second outer convex bent portion 35 to the second inner convex bent portion 36 is set to about 16 mm, and the length of the snare wire 31 from the second inner convex bent portion 36 to the tip folded portion 37 is set. The L6 is set to about 1.8 mm.

Further, in the present embodiment, the opening angle on the base end side of the surrounding portion 30a (the opening angle of the portion from the pair of first inner convex bent portions 33 to the first outer convex bent portion 34) θ1 is set to about 54 °. , The opening angle on the tip side of the surrounding portion 30a (the opening angle of the pair of the second outer convex bent portions 35 to the second inner convex bent portion 36) θ2 is set to about 95 °. Further, the bending angle θ3 in the first inner convex bending portion 33 is set to about 153 °, the bending angle θ4 in the first outer convex bending portion 34 is set to about 150 °, and the bending angle in the second outer convex bending portion 35. θ5 is set to about 135 °. Although the reference numerals are omitted, the bending angle at the second inwardly convex bent portion 36 is set to about 150 °, and the bending angle at the tip folded portion 37 is set to about 30 °.

As a result, the length of the surrounding portion 30a in the longitudinal direction (the axial distance of the operation wire 20 between the first inwardly convex bent portion 33 and the second inwardly convex bent portion 36) L7 becomes about 53 mm, and the surrounding portion 30a The length in the width direction (distance between the pair of first outer convex bent portions 34) L8 is about 25 mm, and the distance L9 between the pair of second outer convex bent portions 35 is about 23 mm. Further, the axial distance L10 of the operation wire 20 between the second inwardly convex bent portion 36 and the tip folded portion 37 is about 1.7 mm. The lengths or distances L2 to L10 are all the lengths or distances between the centers of the snare wires 31.

Further, as shown in FIG. 3, in the present embodiment, substantially the entire extension portion 32 remains housed in the sheath 10 even when the snare loop 30 is in the most protruding state.

4A and 4B and 5A and 5B are diagrams showing the action of the snare loop 30. In addition, in FIGS. 4A and 4B and 5A and B, the sheath 10 is shown in cross section, and the snare wire 31 is shown in one actual battle for easy understanding. In addition, the states of the snare loop 30 shown in FIGS. 4A and B and 5A and B are not always accurate, and some parts are exaggerated.

In the present embodiment, the length L2 of the extending portion 32 and the length L3 from the first inner convex bent portion 33 to the first outer convex bent portion 34 are set longer than before, so that the snare loop 30 is set during the treatment. Is kept on substantially the same plane.

As described above, the snare wire 31 and the operation wire 20 are composed of stranded wires obtained by twisting the strands of SUS304, and since the snare wire 31 has a smaller diameter than the operation wire 20, the directions of the ends of both are different from each other. It is difficult to accurately align and connect the wires, and the connecting portion (connecting member 40) with the operating wire 20 may be connected in an inclined state or in a twisted state. In such a case, not only the snare loop 30 deviates significantly from the same plane, but also the snare loop 30 may warp in an unexpected direction immediately before strangulation, which may hinder the treatment.

In the present embodiment, by setting the length L2 of the extending portion 32 to about 28 mm, an appropriate bending of the snare wire 31 in the extending portion 32 is allowed as shown in FIG. 4A, whereby the connecting member 40 The inclination and twist in the above do not affect the tip side of the first inwardly convex bent portion 33. That is, the extending portion 32 bends based on the inclination or twist of the connecting member 40 to absorb these, and the portion on the tip side of the first inward convex bent portion 33 maintains an appropriate shape, and the snare loop 30 Are located on substantially the same plane.

Further, in the present embodiment, even when the snare loop 30 is in the most protruding state, substantially the entire extension portion 32 is accommodated in the sheath 10, so that the extension portion 32 is always loosely restrained and supported. I have to. Further, by providing the reinforced sheath 12 and reducing the inner diameter of the tip portion of the sheath 10, the restraint at the tip portion of the sheath 10 is strengthened so that the two snare wires 31 are appropriately aligned. As a result, the snare loop 30 is more reliably maintained in an appropriate shape.

After surrounding the lesion with the surrounding portion 30a, when the sheath 10 is moved relative to the snare loop 30 toward the tip side, the first inwardly convex bent portion 33 is accommodated in the sheath 10 so as to be expanded. The Rukoto. Then, as shown in FIG. 4B, due to the restoring force of the elastic deformation of the snare wire 31, the pair of first inward convex bending portions 33 overcome each other and the snare loop 30 intersects with each other.

Specifically, the convex side of the first inward convex bent portion 33 abuts on the inner surface of the sheath 10, and the first intersecting portion 30b is on the base end side of the first inward convex bent portion 33 (that is, in the extending portion 32). At the same time, the second intersection 30c is generated on the tip end side of the first inwardly convexly bent portion 33 (that is, between the first inwardly convexly bent portion 33 and the first outerly convexly bent portion 34). Further, a tip contact portion 30d that contacts the inner peripheral surface of the sheath 10 tip portion is generated on the tip side of the second intersection 30c. At this time, the snare wire 31 in the vicinity of the first inwardly convex bent portion 33 is twisted due to the intersection, but in the present embodiment, the extending portion 32 is appropriately bent to cause a large twist. It is designed not to occur.

Specifically, the snare loop 30 is tilted by bending so that the first contact portion 30e in which the snare loop 30 abuts on the inner peripheral surface of the sheath 10 is generated on the proximal end side of the first intersection 30b. The twist and twist are absorbed, and the first contact portion 30e is supported by the sheath 10, so that the binding force that regulates the inclination and twist is strengthened, so that the first intersection 30b and the second intersection 30c are generated. Due to this, a large twist does not occur.

Further, in the conventional snare loop, the twist of the connecting portion and the twist caused by the intersection may act synergistically, but in the present embodiment, the first contact portion 30e makes the connecting member 40 and the first contact first. By increasing the binding force between the portions 30e, the twist of the connecting portion does not affect the vicinity of the first inwardly convex bent portion 33.

When the sheath 10 is further moved relative to the snare loop 30 from the state of FIG. 4B, the pair of first outer convex bent portions 34 approach the tip of the sheath 10 while reducing the distance between them. I will go. At this time, if the twist caused by the intersection in the vicinity of the first inner convex bent portion 33 affects the first outer convex bent portion 34, for example, both of the pair of first outer convex bent portions 34 are convex on the back side of the drawing. In this case, the portion on the tip side of the first outer convex bent portion 34 is in a state of being warped toward the front side in the drawing.

In the present embodiment, in addition to the prevention of warping based on the reduction of twisting in the vicinity of the first inwardly convexly bent portion 33 by the extending portion 32, the length from the first inwardly convexly bent portion 33 to the first outerly convexly bent portion 34 is further extended. By setting the L3 to about 28 mm, which is the same as the extension portion 32, as shown in FIG. 5A, an appropriate deflection is generated even between the first inner convex bending portion 33 and the first outer convex bending portion 34. , The above-mentioned twisting and warping caused by the above-mentioned twisting in the vicinity of the first outer convex bending portion 34 are prevented from occurring.

Specifically, a gentle S-shaped bending occurs to the extent that a second contact portion 30f in which the snare loop 30 contacts the inner peripheral surface of the sheath 10 is generated on the base end side of the tip contact portion 30d. , The inclination and twist of the snare loop 30 are absorbed, and the second contact portion 30f is supported by the sheath 10 to strengthen the binding force, so that the twist in the vicinity of the first outer convex bent portion 34 is reduced. It has become. As a result, even when the second outer convex bent portion 35 is close to the tip of the sheath 10, the warp as described above does not occur.

In the example shown in FIG. 5A, the third intersection 30g is generated on the tip side of the second intersection 30c, the fourth intersection 30h is generated on the tip side of the third intersection 30g, and the second intersection 30h is generated. The case where the second contact portion 30f is generated between the 30c and the third intersection 30g is shown, but depending on the state of the snare loop 30, bending occurs in which the third intersection 30g and the fourth intersection 30h do not occur. In some cases.

When the sheath 10 is further moved to the tip side from the state of FIG. 5A relative to the snare loop 30, the first outer convex bent portion 34 is housed in the sheath 10 as shown in FIG. 5B. Also at this time, in the present embodiment, in addition to the binding force by the second contact portion 30f, for example, the snare loop 30 abuts on the inner peripheral surface of the sheath 10 between the third intersection 30g and the fourth intersection 30h. A third contact portion 30i is generated, so that the binding force between the first inner convex bent portion 33 and the tip contact portion 30d is strengthened, whereby the first outer convex bent portion 34 of the first outer convex bent portion 34. Twisting in the vicinity is reduced.

The first contact portion 30e is at least 1 at any portion on the proximal end side of the extension portion 32 with respect to the first intersection portion 30b when the first inwardly curved portion 33 is housed in the sheath 10. It suffices if it occurs in a place. That is, the extension portion 32 has a length that allows any portion to be bent so as to abut on the inner peripheral surface of the sheath 10 when the first inwardly convex bent portion 33 is housed in the sheath 10. It suffices if it is set.

Further, at least one of the second contact portion 30f and the third contact portion 30i may be formed by the time immediately before the first outer convex bent portion 34 is accommodated in the sheath 10, and further, as described above. , The third intersection 30g and the fourth intersection 30h may not occur depending on how the first inner convex bending portion 33 and the first outer convex bending portion 34 are bent. That is, between the first inner convex bent portion 33 and the first outer convex bent portion 34, the first outer convex bent portion 34 is housed in the sheath 10 and then the first outer convex bent portion 34 is housed in the sheath 10. It suffices that the length is set so that any of the portions can be bent so as to come into contact with the inner peripheral surface of the sheath 10 by the time immediately before the sheath 10.

As described above, in the present embodiment, the snare loop 30 is most projected in the state where the snare loop 30 is most projected by appropriately bending between the extending portion 32 and the first inner convex bent portion 33 and the first outer convex bent portion 34. Not only are the snare loops 30 located on substantially the same plane, but also when the size of the snare loop 30 outside the sheath 10 is reduced, the snare loop 30 is maintained on the substantially same plane without warping or the like. It has become like.

Further, in the present embodiment, it is not necessary to use a special connection method for connecting the operation wire 20 and the snare loop 30, or to perform high-precision positioning or the like at the time of connection, so that the manufacturing cost increases. There is no such thing. That is, the endoscopic snare 1 of the present embodiment is an inexpensive disposable product, but is very easy to use when strangulation and excision of a lesion.

The length L2 of the extending portion 32 is not particularly limited, but is preferably 30 times or more, preferably 50 times or more, the outer diameter of the snare wire 31 in order to generate appropriate bending. If there is, it is more preferable, and it is most preferable that it is 70 times or more. Further, the snare wire 31 having a diameter smaller than that of the operation wire 20 is more easily stretched than the operation wire 20 at the time of strangulation, and the lengthening of the extending portion 32 increases the elongation amount of the snare wire 31 at the time of strangulation. Therefore, in order to reduce the amount of elongation of the snare wire 31 during strangulation and convey an appropriate feeling of operation to the handle 50, the length of the extending portion 32 must be 200 times or less the outer diameter of the snare wire 31. It is preferable that it is 150 times or less, more preferably 100 times or less, and most preferably 100 times or less.

Further, the length L3 from the first inner convex bent portion 33 to the first outer convex bent portion 34 is not particularly limited, but in order to generate an appropriate deflection, the outer diameter of the snare wire 31 is 20. It is preferably twice or more, more preferably 40 times or more, and most preferably 60 times or more. Further, in order to form the surrounding portion 30a having an easy-to-use size and shape, the length L3 from the first inner convex bent portion 33 to the first outer convex bent portion 34 is 150 times or less the outer diameter of the snare wire 31. It is preferably 130 times or less, more preferably 100 times or less, and most preferably 100 times or less.

By setting the length L3 from the first inner convex bent portion 33 to the first outer convex bent portion 34 to be relatively long, the length L8 in the width direction of the surrounding portion 30a is set to a size that is easy to use. Also, it is possible to set the bending angle θ3 in the first inner convex bending portion 33 and the bending angle θ4 in the first outer convex bending portion 34 to be relatively large. As a result, the restoring force of elastic deformation when the first inward convex bending portion 33 and the first outer convex bending portion 34 are housed in the sheath 10 is reduced to enable smooth operation, and the first inward convex bending portion 34 is enabled. It is possible to reduce the occurrence of twisting when the vicinity of the portion 33 and the first outer convex bent portion 34 intersect.

Further, in the present embodiment, even when the snare loop 30 is most protruding from the sheath 10, substantially the entire extension portion 32 is housed in the sheath 10, but in the state where the snare loop 30 is most protruding. A part or all of the extending portion 32 may protrude from the sheath 10. However, in this case, since the amount of operation of the handle 50 during strangulation becomes large, from the viewpoint of operability, the extension portion 32 is the extension portion 32 in a state where the snare loop 30 protrudes most from the sheath 10. It is preferable that 1/2 or more of the length L2 is housed in the sheath 10, more preferably 2/3 or more is housed in the sheath 10, and 3/4 or more is housed in the sheath 10. More preferred.

Even when the snare loop 30 is most protruding from the sheath 10, at least a part of the extending portion 32 is accommodated in the sheath 10, and the connecting member 40 is located closer to the proximal end side than the reinforced sheath 12 ( By not reaching the position of the reinforced sheath 12), it is possible to prevent the reinforced sheath 12 and the connecting member 40 from being caught.

Further, in a state where the snare loop 30 protrudes most from the sheath 10, the first inwardly convex bent portion 33 may be accommodated in the sheath 10 together with the extending portion 32. By doing so, it is possible to generate a binding force by the first contact portion 30e in the initial state of the snare loop 30 without requiring the user's operation when strangling. Therefore, the snare loop 30 being treated can be more stably maintained on substantially the same plane, and the operability of the endoscopic snare 1 can be improved. In this case, the first inwardly convex bent portion 33 may be located at the difficult-to-deform portion 11, or may be located at the proximal end side of the difficult-to-deform portion 11 as shown in FIG. 4B. good.

Further, in the present embodiment, the inner diameter D2 of the sheath 10 is set to about 4.3 times the outer diameter of the snare wire 31, and the inner diameter D4 of the reinforced sheath 12 is set to about 3.6 times the outer diameter of the snare wire 31. However, the inner diameter D2 of the sheath 10 and the inner diameter D4 of the reinforced sheath 12 may be set to other dimensions. However, in order to appropriately bend and restrain the extending portion 32 appropriately, the inner diameter D2 of the sheath 10 and the inner diameter D4 of the reinforced sheath 12 are 2.5 times or more and 8 times or less the outer diameter of the snare wire 31. It is preferable, it is more preferably 3 times or more and 6 times or less, and most preferably 3.5 times or more and 5 times or less.

6A to 6C are cross-sectional views showing another configuration example of the reinforced sheath 12. The reinforced sheath 12 may have a flange portion 12a as shown in FIG. 6A. In this case, it is possible to reliably prevent the position of the reinforced sheath 12 from being pushed by the snare wire 31 during strangulation and shifting to the proximal end side of the sheath 10. Further, as shown in FIG. 6B, the reinforced sheath 12 is formed in a bottomed cylindrical shape having a bottom portion 12c provided with a through hole 12b, and the tubular portion 12d is arranged so as to cover the outer peripheral surface of the sheath 10. It may be a thing. Also in this case, it is possible to reliably prevent the position of the reinforced sheath 12 from shifting during strangulation. Further, as shown in FIG. 6C, the reinforced sheath 12 may be formed in a ring shape or a cylindrical shape, and may be adhered or welded to the tip surface of the sheath 10.

Although not shown, the hard-to-deform portion 11 is not limited to the one formed by arranging the reinforced sheath 12 of another member at the tip of the sheath 10, for example, glass fiber or the like at the tip of the sheath 10. By partially mixing the additive of the above, it may be configured so that it is less likely to be plastically deformed and elastically deformed than other parts.

7A and 7B and 8A and 8B are cross-sectional views showing an example of a case where the sheath 10 is provided with a locking portion 13 for locking the reinforced sheath 12. By providing the locking portion 13 on the sheath 10 and preventing the reinforced sheath 12 from falling off from the sheath 10 by the locking portion 13, the usability of the endoscopic snare 1 can be further improved.

7A and 7B show a case where the locking portion 13 is formed by arranging the reinforced sheath 12 in the sheath 10 and then heating the tip portion of the sheath 10 to plastically deform it. In this example, first, as shown in FIG. 7A, the reinforced sheath 12 is arranged at a position slightly inserted into the proximal end side from the distal end in the sheath 10. Then, for example, the mold 100 heated by high-frequency induction heating is brought into axial contact with the tip of the sheath 10 and pressed to partially plastically deform the tip side of the sheath 10 with respect to the reinforced sheath 12.

The mold 100 is configured to be in contact with the tip end surface of the sheath 10 and the tip end side of the outer peripheral surface, and the sheath 10 pressed and heated by the mold 100 is crushed in the axial direction, and the inner peripheral surface is the axial center. It will be plastically deformed so as to bulge to the side. When the tip of the sheath 10 is appropriately deformed, the mold 100 is separated from the sheath 10 to cool the sheath 10 as shown in FIG. 7B.

As a result, the tip portion of the sheath 10 is provided with a locking portion 13 formed so as to bulge toward the axial center side. By locking the reinforced sheath 12 with the locking portion 13, the movement of the sheath 10 toward the tip end side is restricted, so that the reinforced sheath 12 is prevented from falling off from the sheath 10.

In this way, after the reinforced sheath 12 is placed at the tip of the sheath 10, the locking portion 13 is formed by partially plastically deforming the sheath 10, which is easier than a method such as adhesion or welding. Moreover, it is possible to prevent the reinforced sheath 12 from falling off at low cost. Further, when the end face treatment of the sheath 10 such as chamfering or rounding is performed, the locking portion 13 can be formed at the same time.

When forming the locking portion 13, a pin having an appropriate outer diameter is inserted into the sheath 10 and the reinforced sheath 12 to limit the amount of protrusion of the locking portion 13 (inner diameter of the locking portion 13). You may. Further, frictional heat or the like may be used to heat the sheath 10, or the sheath 10 may be plastically deformed only by pressing force without heating. Further, after forming the locking portion 13, the reinforced sheath 12 may be arranged by press fitting or the like.

8A and 8B show a case where the locking portion 13 is formed by partially plastically or elastically deforming the sheath 10 by the reinforced sheath 12. In this example, the reinforced sheath 12 has a flange portion 12a and a spirally continuous (thread-shaped) convex portion 12e on the outer peripheral surface of the portion inserted into the sheath 10. The outer diameter at the apex of the convex portion 12e is set to be slightly larger than the inner diameter of the sheath 10.

That is, the reinforced sheath 12 of this example is configured in the same manner as the self-tapping screw. Specifically, in the reinforced sheath 12 of this example, the convex portion 12e partially plastically deforms or elastically deforms the sheath 10 by being screwed into the tip of the sheath 10 (inserted while rotating around the axis). It is configured to form a locking portion 13 which is a spiral groove.

As a result, the reinforced sheath 12 is prevented from falling off from the sheath 10 because the convex portion 12e and the locking portion 13 are locked to restrict the movement of the sheath 10 toward the tip end side.

In this way, a spirally continuous convex portion 12e is provided on the surface of the reinforced sheath 12 facing the inner peripheral surface of the sheath 10, and the sheath 10 is partially deformed by the convex portion 12e to form the locking portion 13. By doing so, it is possible to prevent the reinforced sheath 12 from falling off easily and inexpensively as compared with a method such as adhesion or welding.

The apex of the convex portion 12e may be sharply formed, and the sheath 10 may be partially broken to form the locking portion 13. Further, the convex portion 12e may have one row (one) or two or more rows (plurality). Further, the reinforced sheath 12 may be configured to cover the outer peripheral surface of the sheath 10, and the convex portion 12e may be provided on the surface facing the outer peripheral surface of the sheath 10. Further, the flange portion 12a may be omitted.

Further, in this example, the tip side tapered portion 12f that gradually expands the diameter toward the tip side is provided on the tip end side of the inner peripheral surface of the reinforced sheath 12, and the diameter is gradually expanded toward the rear end side on the rear end side. Although the slidability of the snare wire 31 is improved by providing the end side tapered portion 12g, the front end side tapered portion 12f and the rear end side tapered portion 12g may be omitted. Further, instead of the front end side tapered portion 12f and the rear end side tapered portion 12g, an appropriate rounded portion may be provided.

Further, although not shown, the convex portion 12e may be intermittently continuous in a spiral shape. Further, the shape and arrangement of the convex portion 12e may be any shape and arrangement as long as the sheath 10 can be appropriately deformed or broken to form the locking portion 13.

9A and 9B are cross-sectional views showing another configuration example of the snare loop 30. The snare loop 30 may not include the second outer convex bend 35 as shown in FIG. 9A, for example, or the first outer convex bend 34 and the second as shown in FIG. 9B, for example. It may not be provided with the outer convex bent portion 35.

Although not shown, the shape of the surrounding portion 30a of the snare loop 30 is not particularly limited, and may be another shape such as a quadrangular shape or a seven-sided shape. Further, for example, in the example shown in FIG. 9B, the surrounding portion 30a may be configured to have an asymmetrical shape, such as providing the first outer convex bent portion 34 and the second outer convex bent portion 35 only on the right side of the drawing. Further, in the present embodiment, the shape on the tip side of the second inward convex bent portion 36 is formed in a V shape, but it may be formed in a U shape, for example. Needless to say, the size of the snare loop 30 is not particularly limited.

Although the embodiment of the present invention has been described above, the snare drum for an endoscope of the present invention is not limited to the above-described embodiment, and various modifications are made without departing from the gist of the present invention. Of course you can get it. For example, the structure of the handle 50 is not limited to that shown in the above-described embodiment, and other known structures can be adopted. Further, the snare loop 30 can adopt various known configurations.

Moreover, the actions and effects shown in the above-described embodiments are merely a list of the most suitable actions and effects arising from the present invention, and the actions and effects according to the present invention are not limited thereto.

1 Endoscopic snare 10 Sheath 11 Hard-to-deform part 12 Reinforced sheath 12e Convex part 13 Locking part 20 Operation wire 30 Snare loop 31 Snare wire 40 Connection member D1 Outer diameter of sheath L1 Axial length of hard-to-deform part

Claims (6)

With a flexible tubular sheath,
An operation wire that is freely inserted into the sheath and
A loop-shaped snare loop formed by a snare wire whose both ends are connected to the tip end side of the operation wire.
An endoscopic snare characterized in that a tip portion of the sheath is provided with a deformable portion that is less likely to be plastically deformed than other portions and is less likely to be elastically deformed than other portions. In the endoscopic snare according to claim 1.
The difficult-to-deform portion is a snare for an endoscope, which is configured by arranging a tubular reinforced sheath at the tip of the sheath. In the endoscopic snare according to claim 2.
The sheath is an endoscopic snare having a locking portion formed in a shape that locks with the reinforced sheath by partially deforming or breaking the sheath. In the endoscopic snare according to claim 3.
The reinforced sheath is a snare for an endoscope, which has a spirally continuous convex portion on a surface facing the inner peripheral surface or the outer peripheral surface of the sheath. In the endoscopic snare according to any one of claims 2 to 4.
A connecting member for connecting the operation wire and the snare wire is provided.
The connecting member is a snare for an endoscope, characterized in that the snare loop is located closer to the proximal end side than the reinforced sheath in a state where the snare loop protrudes most from the sheath. In the endoscopic snare according to any one of claims 1 to 5.
A snare for an endoscope, wherein the length of the difficult-to-deform portion in the axial direction is 1 times or more the outer diameter of the snare wire and 10 times or less the outer diameter of the sheath.

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