JP3250621B2 - Endoscope treatment tool - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a treatment instrument for an endoscope, which is used particularly when performing strip biopsy.

[0002]

2. Description of the Related Art In general, an endoscope injector such as that disclosed in Japanese Utility Model Publication No. 51-53672 has been known as a type of endoscope treatment tool. FIG. 6A shows a schematic configuration of the endoscope syringe 1, and 2 is a flexible outer tube. An inner tube 3 is inserted into the outer tube 2 so as to be able to advance and retreat.

[0003] Further, an injection needle 4,
At the proximal end, a syringe mounting base 5 is provided. A syringe 6 is attached to the base 5.

[0004] When the syringe 1 for an endoscope is used, the outer tube 2 is inserted into the body cavity transendoscopically with the injection needle 4 housed inside the outer tube 2, It is guided to the vicinity of the target part. In this state, the injection needle 4 is pushed out of the outer tube 2 by pushing the inner tube 3 against the outer tube 2.
And puncture the target site. Further, in this state, a physiological saline or the like is injected into a target site by using a syringe 6 previously attached to the base 5.

[0005] As another treatment tool for an endoscope, Japanese Patent Publication No.
2. Description of the Related Art A high-frequency excision tool as disclosed in Japanese Patent Application Laid-Open No. 1-25380 is known. FIG. 6B shows a schematic configuration of a main part of the high frequency cutting tool 11. In this embodiment, an incision portion 14 in which a metal wire is formed into an elliptical shape is connected to the tip of an operation wire 13 which is inserted into a flexible outer tube 12 so as to be able to advance and retreat.

When the high-frequency resection tool 11 is used, the outer tube 12 is inserted endoscopically into the body cavity with the incision 14 housed in the outer tube 12, and the vicinity of the target site is Led to. In this state, the incision 14 is
More protruding and expanding.

Subsequently, after the incised portion 14 is spread over the raised lesion, a high-frequency current is applied while the metal wire of the incised portion 14 is tightened, thereby performing a high-frequency incision at the lesion. Has become.

[0008]

In recent years, there has been a growing demand for excision of small lesions formed in a body cavity using a high-frequency excision tool 11 as disclosed in Japanese Patent Publication No. 61-25380. However, many of such small lesions do not have a bulge. Therefore, such a lesion without a bulge is provided on the incision 14 of the high-frequency resection tool 11 as disclosed in JP-B-61-25380. There is a problem that the incision cannot be made and the incision cannot be made.

[0009] Then, a physiological saline is injected into the non-elevated lesion site using an endoscope syringe 1 as disclosed in Japanese Utility Model Publication No. 51-53672, so that the lesion site is raised in advance. In recent years, a technique of so-called strip biopsy in which the incision 14 of the high-frequency excision tool 11 is applied to the raised portion to perform high-frequency incision has been developed in recent years.

[0010] However, in the endoscope treatment tool of the above-mentioned conventional configuration, the endoscope syringe 1 is inserted into the forceps channel of the endoscope first, the physiological saline is injected into the lesion site, and then the endoscope is temporarily injected. The syringe 1 is withdrawn from the forceps channel of the mirror, and then the high-frequency incision tool 11 is inserted into the forceps channel of the endoscope.
In this case, there is a problem that it takes time to remove a small lesion formed in the body cavity, since a troublesome operation of performing high-frequency incision by re-inserting is required.

Furthermore, since a small lesion formed in the body cavity is to be treated here, there is a possibility that the lesion may be lost during the operation of inserting and removing the treatment tool into the forceps channel of the endoscope. .

SUMMARY OF THE INVENTION The present invention has been made in view of the above circumstances, and can simplify the operation of excision of a small non-elevated lesion formed in a body cavity, thereby improving the operation efficiency. Inside, plus a flexible sheath
Tool consisting of injection needle and metal wire in limited space
By inserting a thin metal wire into the cutting tool when inserting
The cutting tool can be reduced in diameter, as well as the diameter
It is an object to provide an endoscope treatment instrument that can be Nau complement the reduction in strength of the cutter caused by.

[0013]

According to the present invention, a flexible sheath having a first conduit and a second conduit formed therein is inserted into the first conduit so as to be able to advance and retreat. Injection needle at the tip,
A flexible tube provided with a fluid supply portion at a proximal end thereof, and the flexible tube is inserted into the second conduit so as to be able to advance and retreat independently of the flexible tube, and an incision portion is formed at a distal end. ; and a cutter made of metallic wire, the metallic wire
The first tube is turned into two by folding back at the tip.
Parallel to the direction in which the road and the second conduit are lined up
In the state, up to the treatment tool operation unit at hand,
It is an endoscope treatment tool that is inserted .

[0014]

[Action] A treatment tool can be advanced and retracted inside a single flexible sheath.
A flexible tube having a first conduit and a second conduit that are inserted into the first conduit and having an injection needle inserted into the first conduit;
The cutting tool formed with the incision made of the metal wire inserted into the second conduit is independently advanced and retracted,
By omitting the operation of inserting and removing the treatment tool into and from the forceps channel of the endoscope, the operation of excision of a small non-elevated lesion in a body cavity is simplified . In addition, make an incision
By folding the formed metal wire at the tip, it becomes two wires.
The direction substantially perpendicular to the direction in which the first pipeline and the second pipeline are arranged.
In the second pipeline in a state where the
By being guided to the treatment instrument operation section, it is inserted into the second conduit.
In addition to reducing the diameter of the metal wire to be
The reduction in strength caused by reducing the diameter of the
It is supplemented by using two metal wires to be inserted into the pipeline.
Thus, the required strength is maintained .

[0015]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS One embodiment of the present invention will be described below with reference to FIGS. FIG. 1 shows a state in which a treatment tool 22 for an endoscope is inserted into a forceps channel of the endoscope 21. The endoscope 21 has an operation section 23 on the hand side and an insertion section 2 formed by a flexible tube connected to the operation section 23.
4 are provided. A distal end configuration portion 26 is connected to the insertion portion 24 via a bending portion 25 for bending operation.

The operation unit 23 on the hand side is provided with a forceps insertion mouthpiece 27 together with a bending operation knob, an air / water supply button, a suction button, and an eyepiece. One end of a not-shown forceps channel disposed in the endoscope 21 is connected to the forceps insertion mouthpiece portion 27. The other end of the forceps channel is connected to a forceps port 28 formed in the distal end component 26.

The endoscope treatment tool 22 includes an endoscope 21.
Flexible sheath 29 inserted into forceps channel in
Is provided. The sheath 29 is a tube having electrical insulation and sufficient flexibility to be inserted into the forceps channel of the endoscope 21.

Further, FIG.
As shown in (A) and (B), two conduits 29a and 29b having a substantially half-moon-shaped cross section are formed. In this case, the two pipelines separated by the partition wall 29c have slightly different sizes, and the first pipeline 29 shown on the upper side in FIG.
A is set so that the area of “a” is larger than that of the lower second pipe 29b.

The first pipe 29a having a large pipe area is provided.
A flexible tube 30 is inserted therein so as to be able to advance and retreat by hand operation. A distal end of the tube 30 is connected to a fluid injection needle 31 as shown in FIG. 3, and a proximal end of the tube 30 is connected to a base (fluid supply unit) 39 through which an injector can be removed as shown in FIG. I have. This constitutes an injection needle that enables the injection of physiological saline into the body cavity tissue.

Further, the second pipe 29 having a small pipe area is provided.
A high frequency cutting tool 32 is placed in the tube 3b by hand.
It is inserted so that it can advance and retreat independently of 0. The high-frequency excision tool 32 is provided with a metallic wire 33 bent at its tip into two. The distal end of the wire 33 is bent into a substantially elliptical shape, and an incision 34 is formed.

After the wire 33 is bent at the distal end, the wire 33 is guided as it is through the second conduit 29b of the sheath 29 to the proximal side, and is passed to the treatment instrument operating section 35 at the proximal side of the sheath 29. It is detachably fixed to a slider 36 slidably mounted via an operation pipe (not shown).

Further, the main body 35a of the treatment instrument operating portion 35 is provided with a branch portion 35b projecting laterally and a guide portion 35c extending in the longitudinal direction. The slider 36 is attached to the guide portion 35c so as to be slidable in the longitudinal direction. Thus, by moving the slider 36 relatively to the operation section main body 35a, the incision section 34 can be operated to protrude and retract from the distal end of the sheath 29. When the incision 34 protrudes from the distal end of the sheath 29, the incision 34 is expanded into a substantially elliptical shape by bending the distal end of the wire 33.
The incision portion 3 is pulled into the sheath 29 and operated.
4 is to be closed.

Further, the branch portion 3 of the treatment instrument operating portion main body 35a
5b is protruded from the side, and the treatment instrument operating portion main body 3
The advancing / retreating operation of the fluid injection needle 31 can be performed on the side of 5a.

Further, a length adjusting mechanism L for adjusting the length of the first conduit 29a is attached to the tip of the branch portion 35b as shown in FIG. This length adjusting mechanism L has an internal conduit 3 of a branch portion 35b connected to the first conduit 29a.
Male screw-in member 40 screwed into the edge of 7
Is provided.

An operation pipe 38 is attached to the screw member 40.
Is formed. Further, a large-diameter rotary operation portion 41 for screwing the screwing member 40 is provided at a distal end portion of the screwing member 40.
A concave portion 41a connected to the distal end portion of the insertion hole 40a is formed on the distal end surface of the rotary operation portion 41. further,
An O-ring 42 for sealing a joint portion with the operation pipe 38 is attached to the concave portion 41 a via a fixing tool 43.

The screwing member 40 can adjust the screwing amount. In this case, the screw member 4
A fixing nut 44 is screwed on the outer peripheral surface of the “0”. Then, by adjusting the screwing amount of the screwing member 40, when the fluid injection needle 31 is pushed out, the position of the tip of the base 39 abutting on the rotation operating portion 41 of the screwing member 40 is adjusted, and the fluid injection needle 31 is adjusted. The maximum amount of protrusion is adjusted. Further, by screwing the fixing nut 44 in the direction of the branch portion 35b, the position of the screwing member 40 is fixed.

The length of the flexible tube 30 is such that when the fluid injection needle 31 is protruded to the maximum as shown in FIG. 3, the entire fluid injection needle 31 completely projects from the first conduit 29a of the sheath 29. It is set to a length that does not.

Next, the operation of the above configuration will be described.
First, the flexible tube 30 for injection is placed in the first conduit 29a of the sheath 29, and the high-frequency cutting tool 3 is placed in the second conduit 29b.
Insert 2. Further, the slider 3 of the treatment instrument operation section 35
6 and the base 39 are pulled toward the user, and the incision 34 at the distal end of the cutting tool 32 and the fluid injection needle 31 at the distal end of the tube 30 are housed in the sheath 29. The endoscopic treatment tool 22 is inserted into the inside.

Further, the slider 36 is moved in the distal direction with the distal end portion of the sheath 29 of the endoscope treatment tool 22 being guided to the vicinity of the lesion site Q of the living tissue P. This allows
As shown in FIG. 5A, the incision 34 at the distal end of the cutting tool 32 is protruded from the distal end of the sheath 29, and the incision 34 is arranged at the lesion site Q.

Subsequently, in this state, the base 39 attached with the syringe is pushed forward to pierce the fluid injection needle 31 into the lesion site Q of the living tissue P, and physiological saline is injected with the syringe. By this operation, as shown in FIG. 5 (B), the lesion site Q ′ of the living tissue P is raised, and the raised lesion site Q ′ is inserted into the incision portion 34, so that the lesion site Q ′ is An incision 34 is made.

Next, the base 39 is pulled toward the user, and the fluid injection needle 31 is stored in the first conduit 29a of the sheath 29.
Thereafter, the incision 34 is closed by pulling the slider 36 toward the hand, and the lesioned part Q ′ is tightly bound by the incision 34. Further, at the same time, a high frequency power supply device (not shown) connected to the slider 36 allows a high frequency to flow through the incision 34,
The lesion site Q 'is incised.

Prior to the above procedure, the amount of screwing of the screwing member 40 of the length adjusting mechanism L into the branch portion 35b is adjusted in advance to adjust the protruding length of the fluid injection needle 31 from the sheath 29 on the desk. , A desired protrusion amount.

Therefore, in the above configuration, the fluid injection needle 3 is inserted into the first conduit 29a of the single flexible sheath 29.
1 is inserted, and the cutting tools 32 are inserted into the second conduit 29b so that they can be independently advanced and retracted, so that they do not protrude in the body cavity. When performing a strip biopsy operation for resecting a small lesion site Q, it is possible to omit the operation of inserting and removing the treatment tool into the forceps channel of the endoscope 21 which is conventionally required. Therefore, the operation of resecting a small unaffected portion Q in the body cavity can be simplified as compared with the related art.

Further, since the loss of the lesion site Q can be prevented at the same time when the treatment tool 22 is inserted and removed, a reliable treatment can be performed. In this case, the living tissue P in the human body constantly moves, and the lesion site Q is located in a place where it is difficult to observe. Therefore, it is practically effective to prevent the loss site Q from being lost.

Further, the length of the needle for projecting the fluid injection needle 31 can be adjusted by the length adjusting mechanism L attached to the proximal end of the branch portion 35b of the treatment instrument operating section 35, so that it can cope with various situations of the lesion site Q. Thus, the treatment tool 22 can be used in an optimal state.

Further, since the entire needle 31 can be prevented from completely coming out of the sheath 29 at the time of the operation of projecting the fluid injection needle 31, the needle 31 can be inserted into the living tissue P when the fluid injection needle 31 is punctured into the living tissue P. There is no fear that the tube 30 leading to the puncture will be broken, and a reliable puncturing operation can be performed.

Since the operating pipe 38 is urged in a sealed state by the O-ring 42, the fluid injection needle 31
Can be prevented from inadvertently protruding, and the reliability of the operation can be increased.

Further, the high-frequency excision device 32 shares the incision portion 34 and the wire 33 and extends to the treatment tool operation portion 35 side at hand with two wires, so that a narrow conduit in the sheath 29 is provided. In particular, it can be inserted into the second conduit 29b having a substantially half-moon-shaped cross section as in this embodiment. In this case, since the two wires 33 are inserted in parallel in the second conduit 29b, it is possible to prevent the buckling of the wire 33 of the high-frequency excision tool 32 as compared with the case where one operation wire is used. Can be. Further, a metal wire forming the incision 34
By turning back 33 at the tip, it becomes two and the first tube
A direction substantially perpendicular to the direction in which the path 29a and the second pipe 29b are arranged
In a state where they are arranged in parallel to each other,
To the treatment instrument operating section 35 on the side of the
9b, the diameter of the metal wire 33 to be inserted is reduced.
At this time, the diameter of the metal wire 33 itself must be reduced.
That allows the strength reduction caused by the wire to pass through the second conduit 29b
Required by supplementing with two wires 33
Strength can be maintained. It should be noted that the present invention is not limited to the above-described embodiment, and it goes without saying that various modifications can be made without departing from the spirit of the present invention.

[0039]

According to the present invention, within a single flexible sheath
A first conduit and a second conduit through which a treatment instrument is inserted so as to be able to advance and retreat.
Of the conduit to form a flexible tube with an inserted injection needle with the first conduit, the ablation instrument incision made from the inserted metal wire in the second conduit is formed And independently operated to retract the treatment instrument into and out of the forceps channel of the endoscope, so that the work to resect small non-raised lesions formed in the body cavity was performed. It can be simplified, and the work efficiency can be improved. In addition, the metal wire forming the incision
The first pipe is turned into two by folding back at the tip.
And in a direction substantially perpendicular to the direction in which the second pipeline is arranged
To the treatment tool operation unit at hand.
A metal wire inserted into the second conduit by guiding
And the metal wire itself at this time.
The decrease in strength caused by the increase in diameter is inserted into the second conduit.
Metal wire to make up for it.
The required strength can be maintained. This allows the flexible shell
From the injection needle and metal wire to the limited space inside the source
Thin the metal wire of the cutting tool when inserting the cutting tool
By doing so, the diameter of the cutting tool can be reduced,
To compensate for the decrease in strength of the cutting tool caused by the reduction in diameter
Can be. As a result, the overall size of the endoscope treatment tool has been reduced.
And prevent the strength of the cutting tool from decreasing
It has an excellent effect that it can also

[Brief description of the drawings]

FIG. 1 is a perspective view showing a state in which a treatment tool according to an embodiment of the present invention is inserted into a channel of an endoscope.

FIG. 2 is a perspective view showing a state in which a fluid injection needle and an incision portion of a cutting tool are protruded from a distal end portion of a sheath, and FIG. 2B is a cross-sectional view of the sheath. Area view.

FIG. 3 is a longitudinal sectional view showing a connection state between a distal end of a flexible tube and a fluid injection needle.

FIG. 4 is a longitudinal sectional view showing a mechanism for adjusting a length of a proximal end of a flexible tube.

FIG. 5 is a side view showing a use state of the treatment tool, in which (A) shows a state in which a fluid injection needle is punctured into a living tissue;
(B) is a side view showing a state in which an incision of a resection tool is applied to a lesion site raised by injection of physiological saline.

6A and 6B show a conventional example, wherein FIG. 6A is a side view showing a cross section of a main part of an endoscope tool syringe, and FIG. 6B is a longitudinal sectional view of a main part showing an incision portion of a cutting tool.

[Explanation of symbols]

29 ... sheath, 29a ... first conduit, 29b ... second conduit, 30 ... flexible tube, 31 ... fluid injection needle, 32 ...
High-frequency cutting tool, 33: wire, 34: incision section, 39: base (fluid supply section).

Continuation of the front page (56) References JP-A-57-119734 (JP, A) JP-A-3-162845 (JP, A) JP-A-63-163803 (JP, U) JP-A-1-165011 (JP) , U) Fully open 1979-45316 (JP, U) Fully open 50-22694 (JP, U) Fully open 1979-87689 (JP, U) Fully open 1986-26508 (JP, U) 51-53672 (JP, Y1) (58) Fields investigated (Int. Cl. ⁷ , DB name) A61B 17/28 310 A61B 17/22 320 A61B 17/32 330 A61B 1/00 300 A61B 1/00 334

Claims (1)

(57) [Claims] 1. A flexible sheath having a first conduit and a second conduit formed therein, and a flexible sheath inserted through the first conduit so as to be able to advance and retreat, a needle at a distal end, and a proximal end. And a flexible tube provided with a fluid supply portion, respectively, and a metal tube which is inserted into the second conduit so as to be able to advance and retreat independently of the flexible tube, and has an incision at the end. A cutting tool made of a wire , and the metal wire is turned back at the tip to become two wires.
And a direction substantially perpendicular to the direction in which the first pipeline and the second pipeline are arranged.
In the state of being paralleled in the direction, up to the treatment tool operation part on the hand side,
An endoscope treatment tool, which is inserted into the second conduit .