JP3936031B2 - Endoscopic endoscope treatment tool - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a distal expansion / contraction endoscope treatment instrument in which a distal expansion / contraction portion formed by bending an elastic wire is expanded / contracted by being taken in and out from the distal end of a sheath.
[0002]
[Prior art]
There are many different sizes of polyps and foreign objects that are subject to transendoscopic treatment with a high-frequency snare or a basket-type recovery tool. Therefore, in general, several types of treatment devices for distal expansion / contraction type endoscopes such as a high-frequency snare and a basket-type collection device are prepared with different sizes of the distal expansion / contraction part, and the lumen of the organ is widened. It is selectively used according to the size of the object to be treated.
[0003]
[Problems to be solved by the invention]
The operation stroke required for the distal expansion / contraction-type endoscope treatment tool varies depending on the size of the distal expansion / contraction part. When the distal expansion / contraction part is large, a long operation stroke is required, and the distal expansion / contraction part is small. In some cases, shorter operation strokes are easier to use.
[0004]
The length of the operation stroke of such a treatment tool is generally determined by the operation portion of the treatment tool. However, since there are so many types of endoscope treatment tools, if the operating portion is changed only by the difference in the size of the tip inflated / deflated portion, it will not be able to be collected for manufacturing management.
[0005]
Therefore, even if the size of the tip expansion / contraction part is different, it is a fact that a common operation part has to be used, and a long operation stroke is given to what requires a short operation stroke. However, it was difficult to use because it was difficult to perform delicate operations.
[0006]
In addition, if the amount is drawn too much, stress concentration may occur near the root of the sheath when a large operating force is applied while holding a polyp or calculus, causing the sheath to buckle, and biliary, bronchial, urine When a treatment tool having a large stroke is used on an organ with a narrow lumen such as a tube, there is a risk of damaging the mucosal surface or gripping an unnecessary part.
[0007]
Therefore, the present invention provides an easy-to-use tip expansion / contraction-type endoscope that allows the operation stroke to correspond to the size of the tip expansion / contraction portion while using a common operation portion for treatment instruments having different sizes of the tip expansion / contraction portion. It aims at providing the treatment tool for mirrors.
[0008]
[Means for Solving the Problems]
In order to achieve the above object, the distal expansion / contraction endoscope treatment tool of the present invention has an end portion of a distal expansion / contraction portion formed by bending one or a plurality of elastic wires in the sheath in the axial direction. The operation wire is connected to the distal end of an operation wire that is inserted in a freely reciprocating manner, and a wire driving member connected to the proximal end of the operation wire is advanced and retracted in an operation portion connected to the proximal end of the sheath. In the distal expansion / contraction endoscope treatment tool in which the distal end expansion / contraction part moves in and out of the distal end of the sheath and thereby the distal end expansion / contraction part expands / contracts in the sheath. A proximal end portion and a proximal end portion of the operation wire are detachably connected to the operation portion and the wire driving member, and the proximal end of the sheath is in the middle of the advance / retreat range of the wire driving member. Abuts the drive member And said that there was Unishi.
[0009]
The distal expansion / contraction endoscope treatment tool of the present invention is inserted through the end of the distal expansion / contraction portion formed by bending one or a plurality of elastic wires into the sheath so as to be able to advance and retract in the axial direction. The operation wire is advanced and retracted in the sheath by operating the wire drive member connected to the distal end of the operation wire and the proximal end of the operation wire in the operation portion connected to the proximal end of the sheath. In the distal expansion / contraction endoscope treatment tool in which the distal expansion / contraction portion enters and exits from the distal end of the sheath, and thereby the distal expansion / contraction portion expands and contracts, the proximal end portion of the sheath is It is characterized in that it can be fixed to the operation unit at a plurality of different positions while being moved in the direction.
[0010]
Note that a cylindrical member may be fitted and fixed to the outer periphery of the proximal end portion of the sheath, and the cylindrical member may be detachably connected to the operation portion. The shaped member may be connected and fixed to the operation unit by being pressed by a manual screw screwed into the operation unit.
[0011]
And the groove | channel for engaging the front-end | tip of the said manual screw may be formed in the outer peripheral surface of the said cylindrical member, and even if the said groove | channel is shifted in the axial direction of the said sheath, and plural may be formed. Good.
[0012]
The tip expansion / contraction portion may be formed in a loop shape by bending one or a plurality of elastic wires, and the tip expansion / contraction portion is formed by bending the ends of the plurality of elastic wires in a claw shape. It may be.
[0013]
DETAILED DESCRIPTION OF THE INVENTION
Embodiments of the present invention will be described with reference to the drawings.
FIG. 3 shows the overall configuration of the distal expansion / contraction endoscope treatment tool according to the first embodiment of the present invention. For example, the sheath 1 is made of a flexible tube made of tetrafluoroethylene resin. A proximal end portion of a distal end expansion / contraction portion 3 formed in a loop shape by bending one or a plurality of elastic wires is connected to the distal end of the operation wire 2 inserted so as to be movable forward and backward in the axial direction.
[0014]
As the tip expansion / contraction part 3, for example, a single wire or a stranded wire made of stainless steel wire is used, and the distal end expansion / contraction part 3 is moved in and out of the distal end of the sheath 1 by operating the operation wire 2 forward and backward. The expansion / contraction part 3 expands and contracts.
[0015]
The base end of the sheath 1 is connected and fixed to the operation unit 10. Reference numeral 12 denotes a sheath fixing screw that can be pinched with a fingertip and manually tightened or loosened, and the base end portion of the sheath 1 is pressed and fixed to the operation portion main body 11 by the sheath fixing screw 12.
[0016]
Reference numeral 13 denotes a bend preventing tube provided so as to surround the outer surface of the proximal end portion of the sheath 1 in order to prevent the vicinity of the proximal end portion of the sheath 1 from being suddenly bent and broken.
[0017]
Reference numeral 14 denotes a wire driving member for driving the distal expansion / contraction portion 3 to advance and retract in the axial direction, and is attached to the operation portion main body 11 so as to be able to advance and retract in the extension direction of the axis of the proximal end portion of the sheath 1.
[0018]
Therefore, an operator's finger is put on the first finger hook 15 formed at the end of the operation section main body 11 and the second finger hook 16 connected to the wire drive member 14 to move the wire drive member 14 forward and backward. As a result, the operation wire 2 moves in the axial direction within the sheath 1, and the distal expansion / contraction portion 3 enters and exits from the distal end of the sheath 1.
[0019]
FIG. 1 shows an operation portion 10 portion, and the base end portion of the sheath 1 is not directly connected to the operation portion main body 11, but a metal or plastic tube is provided on the outer periphery of the base end portion of the sheath 1. A base end cap 21 is bonded and fixed, and the base cap 21 is detachably pressed and fixed to the operation portion main body 11 by a sheath fixing screw 12. A circumferential groove is formed in a portion of the outer peripheral surface of the base end cap 21 where the distal end of the sheath fixing screw 12 is pressed to prevent the base end cap 21 from coming off.
[0020]
As shown in FIG. 2 showing the II-II cross section, the operation unit main body 11 is formed with a slit 22 that is long in the axial direction, and the wire drive member 14 to which the end of the operation wire 2 is connected, The slot 22 is loosely fitted.
[0021]
However, a metal pipe 23 is fitted and fixed in the vicinity of the proximal end portion of the operation wire 2 to prevent buckling, and a manual wire fixing screw 24 passed through the wire driving member 14 from the second finger hook 16 portion. Thus, the metal pipe 23 is detachably pressed and fixed to the wire driving member 14. A circumferential groove is formed in the outer peripheral surface of the metal pipe 23 where the tip of the wire fixing screw 24 is pressed to prevent the metal pipe 23 from coming off.
[0022]
A second finger hook 16 provided so as to surround the operation unit main body 11 is fixed to the wire driving member 14 by a fixing screw 25. As a result, the second finger hook 16 and the wire driving member 14 are integrated with each other in the slit 22 in the axial direction of the operation portion main body 11 (that is, the axial direction of the proximal end portion of the sheath 1 and the operation wire 2). It is free to advance and retreat.
[0023]
The sheath 1 has a proximal end protruding into the slit 22, and when the second finger hook 16 is moved forward, the wire driving member 14 comes into contact with the end surface 1 a of the sheath 1, and the end surface 1 a of the sheath 1 is This is a stopper that regulates the amount of movement of the finger hook 16, that is, the operation stroke L of the operation wire 2.
[0024]
Therefore, the operation stroke L of the operation wire 2 can be appropriately set by setting the protrusion length e of the end surface 1a of the sheath 1 from the end surface of the base end cap 21 to an appropriate amount.
[0025]
The protruding length e of the sheath 1 is determined when the proximal end cap 21 is bonded to the sheath 1. Therefore, in the case where the distal end expansion / contraction portion 3 is large and the operation stroke L needs to be lengthened, the base end cap 21 is bonded so that the protruding length e of the sheath 1 is short, and conversely the distal end expansion / contraction portion 3. Is small and the operation stroke L is preferably shorter, the base end cap 21 is bonded in a state where the protruding length e of the sheath 1 is long.
[0026]
Then, by loosening the sheath fixing screw 12 and the wire fixing screw 24, both the sheath 1 and the operation wire 2 can be detached from the operation unit 10 and replaced, and therefore, a plurality of tip expansion / contraction types with different operation strokes L are provided. Each of the endoscope treatment tools can be used with an appropriate operation stroke using one operation unit 10.
[0027]
FIG. 4 shows the operation unit 10 according to the second embodiment of the present invention, and the anti-bending tube 13 is also used as the base end cap 21. The folding tube 13 is bonded and fixed to the outer periphery of the proximal end portion of the sheath 1, and a circumferential groove 28 for contacting the tip of the sheath fixing screw 12 is positioned on the outer circumferential surface of the folding tube 13 in the axial direction. It is formed in three places by shifting.
[0028]
Therefore, by selecting the connection and fixing position of the sheath 1 with respect to the operation portion main body 11 from three positions, the amount of projection of the end surface 1a of the sheath 1 into the slit 22 changes, and the operation stroke L can be changed.
[0029]
Since the sheath fixing screw 12 can be arbitrarily loosened and retightened manually, the operation stroke L can be changed at any time. Therefore, the operation stroke L of one distal expansion / contraction endoscope treatment tool can be changed before and during use to make it easy to use.
[0030]
In this embodiment, the base end portion of the operation wire 2 is folded 180 ° and fitted into the wire drive member 14 so that it cannot be easily detached from the wire drive member 14. The wire driving member 14 is also elastically deformed and fitted to the second finger hook 16 so that it cannot be easily removed.
[0031]
FIG. 5 shows the procedures (1), (2), and (3) for binding a small polyp 101 using a high-frequency snare as a treatment instrument for a tip expansion / contraction type endoscope. A snare having a small tip expansion / contraction part 3 is preferably used with a short operation stroke.
[0032]
FIG. 6 shows a state in which a small polyp 101 is to be bound with a high-frequency snare having a slightly larger tip expansion / contraction part 3, and the tip expansion / contraction part 3 is too large compared to the polyp 101, so that it can be easily bound. Can not.
[0033]
FIG. 7 shows the steps (1) and (2) for binding the medium-sized polyp 101 with a high-frequency snare. In such a case, the medium-sized tip expansion / contraction part 3 is shown. You need a snare with
[0034]
FIG. 8 shows the steps (1) and (2) for binding a larger-sized polyp 101 with a high-frequency snare. In such a case, a snare having a larger-sized tip expansion / contraction part 3 is shown. I need.
[0035]
The shape of the tip expansion / contraction part 3 of the high-frequency snare used as described above may be a hexagonal shape as shown in FIG. 9 or an oval shape as shown in FIG. You may use things, such as a square.
[0036]
FIG. 11 shows the tip portion of a hexagonal type high-frequency snare used in the present invention. By setting the stroke L in the operation unit 10 to a medium level, as shown in (1), the tip expansion / contraction is shown. The expansion diameter of the part 3 can be set to about 20 mm, and a moderate polyp can be bound.
[0037]
Then, as shown in (2), by setting the stroke L in the operation part 10 to be long, the diameter of the expansion of the tip expansion / contraction part 3 can be set to about 25 to 30 mm and a large polyp can be bound.
[0038]
Further, as shown in (3), by setting the stroke L in the operation portion 10 to be short, the diameter of the expansion of the tip expansion / contraction portion 3 can be reduced to about 10 mm, and a small polyp can be bound. (4) shows a state in which the operation wire 2 is fully drawn into the sheath 1.
[0039]
FIG. 12 shows the tip of an oval type high-frequency snare used in the present invention, and the operation related to the operation stroke is the same as that of the hexagonal type snare shown in FIG.
[0040]
FIG. 13 shows a tip portion of an octagonal type high-frequency snare used in the present invention, and the operation related to the operation stroke is the same as that of the hexagonal type snare shown in FIG.
[0041]
In FIG. 14, an endoscope foreign matter collecting tool in which the distal end expansion / contraction portion 3 is formed in a hook shape with three or four or more elastic wires is inserted into the biliary tract 100 or the like via the endoscope 50. The state which is going to discharge the gallstone 200 is shown.
[0042]
As shown in FIG. 14, the size of the gallstone 200 is various, and it is necessary to change the size of the bulging of the tip inflating / contracting portion 3 accordingly, but if the operation unit 10 shown in FIG. 4 is used, By changing the position of the circumferential groove 28 to be engaged with the sheath fixing screw 12 during use and appropriately selecting the operation stroke L, the bulging amount of the distal expansion / contraction portion 3 is adjusted to the size of each gallstone 200. Can do. Such usage is not limited to the recovery of the gallstone 200 but can also be applied to the case of recovering foreign matter from the inside of the intestine, stomach, or the like.
[0043]
FIG. 15 shows a tip portion of a four-claw gripping tool used in the present invention, and (1) shows a state in which the operation stroke L is lengthened so that the tip inflating / contracting portion 3 is greatly opened, (2) shows a state in which the operation stroke L is shortened to limit the opening size of the tip expansion / contraction part 3 to be small.
[0044]
【The invention's effect】
According to the present invention, the proximal end portion of the sheath and the proximal end portion of the operation wire are detachably connected to the operation portion and the wire driving member, and the proximal end of the sheath is in the middle of the advance / retreat range of the wire driving member. By making contact with the wire drive member, the operation stroke can be made to correspond to the size of the tip expansion / contraction part by using an operation part common to treatment instruments having different sizes of the tip expansion / contraction part.
[0045]
In addition, since the proximal end portion of the sheath can be fixed at a plurality of different positions while being moved in the axial direction relative to the operation portion, the operation stroke of one treatment instrument can be changed to change the distal expansion / contraction portion. The size of the expansion / contraction can be set to a size corresponding to the treatment object.
[Brief description of the drawings]
FIG. 1 is a side partial cross-sectional view of an operation unit according to a first embodiment of the present invention.
FIG. 2 is a II-II cross-sectional view of the operation unit according to the first embodiment of the present invention.
FIG. 3 is a side view of the high-frequency snare according to the first embodiment of the present invention.
FIG. 4 is a side sectional view of an operation unit according to a second embodiment of the present invention.
FIG. 5 is a schematic diagram of a usage state of a tip portion of a high-frequency snare to which the present invention is applied.
FIG. 6 is a schematic view of a usage state of a tip portion of a high-frequency snare to which the present invention is applied.
FIG. 7 is a schematic view of a usage state of a tip portion of a high-frequency snare to which the present invention is applied.
FIG. 8 is a schematic view of a usage state of a tip portion of a high-frequency snare to which the present invention is applied.
FIG. 9 is a side sectional view of a tip portion of a high-frequency snare to which the present invention is applied.
FIG. 10 is a side sectional view of a tip portion of a high-frequency snare to which the present invention is applied.
FIG. 11 is a side cross-sectional view of the distal end portion of the hexagonal type high-frequency snare to which the present invention is applied in a state where the operation stroke is changed.
FIG. 12 is a side cross-sectional view of the tip portion of the oval type high-frequency snare to which the present invention is applied in a state where the operation stroke is changed.
FIG. 13 is a side cross-sectional view of the tip portion of the octagonal type high-frequency snare to which the present invention is applied in a state where the operation stroke is changed.
FIG. 14 is a schematic view of a use state of a basket type gripping tool to which the present invention is applied.
FIG. 15 is a side cross-sectional view of the distal end portion in a state where the operation stroke of the four-nail gripping tool to which the present invention is applied is changed.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 Sheath 2 Operation wire 3 Tip expansion / contraction part 10 Operation part 11 Operation part main body 12 Sheath fixing screw 14 Wire drive member 22 Slot 24 Wire fixing screw

Claims (8)

The end of the distal expansion / contraction part formed by bending one or a plurality of elastic wires is connected to the distal end of an operation wire that is inserted in the sheath so as to be movable in the axial direction, and the proximal end of the operation wire is connected The operation wire is advanced and retracted in the operation portion connected to the proximal end of the sheath, so that the operation wire advances and retreats in the sheath, and the distal expansion / contraction portion enters and exits from the distal end of the sheath. In the distal expansion / contraction-type endoscope treatment instrument in which the distal expansion / contraction part expands and contracts,
The base end portion of the sheath and the base end portion of the operation wire are detachably connected to the operation portion and the wire drive member, and the base end of the sheath is in the middle of the advance / retreat range of the wire drive member. And a distal expansion / contraction type endoscope treatment tool, wherein the distal end expansion / contraction type endoscope is in contact with the wire driving member. The end of the distal expansion / contraction part formed by bending one or a plurality of elastic wires is connected to the distal end of an operation wire that is inserted in the sheath so as to be movable in the axial direction, and the proximal end of the operation wire is connected The operation wire is advanced and retracted in the operation portion connected to the proximal end of the sheath, so that the operation wire advances and retreats in the sheath, and the distal expansion / contraction portion enters and exits from the distal end of the sheath. In the distal expansion / contraction-type endoscope treatment instrument in which the distal expansion / contraction part expands and contracts,
The proximal end portion of the sheath can be fixed to the operation portion at a plurality of different positions while being moved in the axial direction, and the proximal end of the sheath is driven in the middle of the advance / retreat range of the wire drive member. A distal expansion / contraction endoscope treatment tool characterized by being in contact with a member . The distal end expansion / contraction type internal view according to claim 1 or 2, wherein a cylindrical member is fitted and fixed to an outer periphery of a proximal end portion of the sheath, and the cylindrical member is detachably connected to the operation portion. Mirror treatment tool. The treatment instrument for a distal expansion / contraction endoscope according to claim 3, wherein the cylindrical member is pressed and connected to the operation portion by a manual screw screwed into the operation portion. The treatment instrument for distal expansion / contraction endoscopes according to claim 4, wherein a groove for engaging the distal end of the manual screw is formed on an outer peripheral surface of the cylindrical member. The treatment instrument for a distal expansion / contraction endoscope according to claim 5, wherein a plurality of the grooves are formed by shifting the position in the axial direction of the sheath. The treatment instrument for a distal expansion / contraction endoscope according to any one of claims 1 to 6, wherein the distal expansion / contraction portion is formed in a loop shape by bending one or a plurality of elastic wires. The distal expansion / contraction-type endoscope treatment tool according to any one of claims 1 to 6, wherein the distal expansion / contraction portion is formed by bending the distal ends of a plurality of elastic wires into a nail shape.

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