JP3947790B2 - Endoscopic treatment tool - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to an endoscope treatment tool.
[0002]
[Prior art]
Endoscopic mucosal resection (EMR) that has been performed in recent years includes a hooking knife in which a high-frequency electrode having a distal end bent in an L-shape is attached to the distal end of a flexible sheath as a distal treatment member. A so-called high-frequency treatment instrument is used.
[0003]
The hooking knife having such an L-shaped tip treatment member has directionality when the tip is pressed against the affected part to make an incision, so that the tip treatment member is arbitrarily rotated around the axis of the flexible sheath. It is desirable to be able to
[0004]
As described above, as an endoscopic treatment tool in which the distal treatment member can be rotated around the axis, a pin protruding laterally from the base of the distal treatment member is used as the distal end of the flexible sheath. The tip treatment member is rotated around the axis by engaging with a spiral groove formed on the inner peripheral surface of the cylindrical body and moving the tip treatment member in the axial direction by remote control from the hand side. (Japanese Utility Model Publication No. 52-40616) and the like, in which the distal end portion of the flexible sheath itself rotates around the axis by a similar configuration (Japanese Patent Laid-Open No. 5-192348).
[0005]
[Problems to be solved by the invention]
However, since the structure in which the pin projecting laterally from the rotated member is engaged with the spiral groove formed on the inner peripheral surface of the cylindrical body is complicated and large, the treatment for the endoscope It is not practical for use in tools, and if the distal end portion of the flexible sheath itself is rotated, it may not work reliably due to interference with the endoscope side.
[0006]
Accordingly, an object of the present invention is to provide an endoscopic treatment instrument that can reliably rotate a distal treatment member around an axis by an operation from the hand side, with a configuration that is simple, thin, and downsized. To do.
[0007]
[Means for Solving the Problems]
In order to achieve the above object, an endoscopic treatment instrument according to the present invention is an endoscopic treatment instrument in which a distal treatment member is disposed at the distal end of a flexible sheath, in the distal opening of the flexible sheath. A spiral member is arranged so as to be rotatable around the axis, the proximal end of the distal treatment member is connected to the spiral member, and an advance / retreat force transmitting member for applying an advance / retreat force in the axial direction to the spiral member is flexible. The engaging member that is inserted and disposed in the sheath and engages with the spiral member to convert the forward and backward movement of the spiral member in the axial direction into a rotational motion around the axis is fixed to the distal end opening of the flexible sheath. By providing a force to advance and retract in the axial direction by the advance / retreat force transmitting member on the spiral member, the spiral member rotates around the axis so that the distal treatment member rotates integrally therewith. is there.
[0008]
The spiral member may be one in which a spiral groove is formed on the outer peripheral surface of a cylindrical or columnar member. Further, the spiral member may be one in which a spiral protrusion is formed on the outer peripheral surface of a cylindrical or columnar member, or a flat member is formed in a spiral shape. May be.
[0009]
Further, the distal treatment member may be formed in a size that does not protrude from the outer diameter of the flexible sheath when viewed from the front, and such a distal treatment member is straight forward from the distal end of the flexible sheath. It may be formed in a shape in which the tip of the rod-shaped body protruding in the direction is bent sideways.
[0010]
Alternatively, the proximal end of the distal treatment member may be attached eccentrically with respect to the spiral member, and the distal treatment member may be formed in a shape bent in a crank shape at an intermediate portion, and is flexible. You may form in the shape which bent the front-end | tip of the rod-shaped body which protruded toward diagonally forward from the front-end | tip of a sheath to the side.
[0011]
Note that the distal treatment member may be a high-frequency electrode through which a high-frequency current is passed.
[0012]
DETAILED DESCRIPTION OF THE INVENTION
Embodiments of the present invention will be described with reference to the drawings.
FIG. 2 shows the overall configuration of the endoscope treatment tool according to the first embodiment in which the present invention is applied to a hooking knife, which can be inserted into and removed from an endoscope treatment tool insertion channel (not shown). The flexible sheath 1 is formed of, for example, a tetrafluoroethylene resin tube or a super elastic alloy pipe.
[0013]
A high-frequency electrode 2 made of a conductive metal such as a stainless steel rod is disposed at the distal end of the flexible sheath 1 as a distal treatment member. The high-frequency electrode 2 is formed in an L shape that protrudes straight forward from the axial position of the distal end portion of the flexible sheath 1 and that the distal end portion 2a is bent to a substantially right side.
[0014]
In the flexible sheath 1, an operation wire 3 (advance / retraction force transmission member) that is advanced and retracted in the axial direction by the operation unit 10 from the proximal end side is inserted and arranged over the entire length. The operation wire 3 is made of a conductive material such as a stainless steel wire or a superelastic alloy wire, and also serves as a high-frequency current conductive wire for the high-frequency electrode 2.
[0015]
The configuration of the operation unit 10 connected to the proximal end (hand side) of the flexible sheath 1 is illustrated in detail in FIG. 3, and a first finger hook 11 a is attached to the rear end of the operation unit main body 11. The second finger hook 12 is slidably engaged with the slit portion formed in the intermediate portion of the operation portion main body 11.
[0016]
A power socket 13 is attached to the second finger hook 12. When the power socket 13 is tightened (screwed), the conductive rod 14 fixedly connected to the proximal end of the operation wire 3 is connected to the second finger hook 12. At the same time, the conductive rod 14 and the conductive terminal 13a of the power socket 13 are electrically connected.
[0017]
As a result, the operation wire 3 is advanced and retracted in the axial direction in the flexible sheath 1 by advancing and retracting the second finger hook 12, and a high-frequency power cord (not shown) is connected to the power socket 13 to thereby operate the operation wire. 3 can be energized with a high-frequency current.
[0018]
FIG. 4 shows in detail the configuration of the distal end portion of the endoscope treatment instrument of the first embodiment, and penetrates the central axis position of the spiral member 4 disposed in the distal end opening of the flexible sheath 1. The base end portion of the high-frequency electrode 2 and the distal end portion of the operation wire 3 are inserted and fixed from both sides in the hole thus drilled, and the high-frequency electrode 2 and the operation wire 3 are connected via the spiral member 4. It is in the state that was done.
[0019]
As shown in FIG. 5, which is a front view of the flexible sheath 1 as viewed from the distal end opening side, the high-frequency electrode 2 does not protrude from the outer diameter of the spiral member 4 when viewed from the front. Further, the tip portion 2 a is formed shorter than the radius of the spiral member 4.
[0020]
However, in this embodiment, this is done for the convenience of assembly and the like. However, in order to pass the treatment instrument insertion channel of the endoscope at the time of use, the distal end portion 2a is removed from the outer diameter of the flexible sheath 1. Any size that does not protrude is acceptable.
[0021]
The spiral member 4 is formed of an electrically insulating cylindrical or columnar member such as ceramics or plastic, for example, and the high frequency electrode 2 and the operation wire 3 are abutted between the end faces to be directly electrically connected. Has been. However, the spiral member 4 may be formed of a conductive material, and the high-frequency electrode 2 and the operation wire 3 may be electrically connected via the spiral member 4.
[0022]
A spiral groove 40 is formed on the outer peripheral surface of the spiral member 4 as shown in FIG. In order to increase the pitch of the spiral grooves 40, in this embodiment, the spiral grooves 40 are formed in two lines (that is, arranged in two rows).
[0023]
The spiral groove 40 is opened on the distal end side of the spiral member 4 (the distal end opening 41) so that the spiral groove 40 can be engaged with an engagement portion 50 described later. The rear end side of the spiral groove 40 is closed so as not to escape forward.
[0024]
An engaging member 5 made of an electrically insulating member such as ceramic or plastic is firmly fixed to the inner peripheral surface portion of the distal end opening of the flexible sheath 1, and the spiral groove of the spiral member 4 is fixed. A projecting engaging portion 50 that engages with 40 is formed to project inward from the engaging member 5. Since there are two spiral grooves 40 in this embodiment, a pair of engaging portions 50 are formed at symmetrical positions of 180 ° accordingly.
[0025]
The endoscope treatment tool configured as described above can energize the high-frequency electrode 2 through the operation wire 3 to perform transendoscopic mucosal resection and the like. If the operation part 10 is advanced or retracted from the operation part 10 side, a force to move the spiral member 4 in the axial direction is applied, and this is converted into a rotational motion by the engagement between the spiral groove 40 and the engagement part 50. Thus, the spiral member 4 rotates around the axis together with the high-frequency electrode 2.
[0026]
By adopting the configuration as described above, the distal end portion of the flexible sheath 1 can be made thin and small, and the hard portion can be manufactured at a low cost, while at the same time being smooth and fine with respect to the high-frequency electrode 2. Rotation adjustment operation can be performed.
[0027]
Further, since the spiral member 4 can be extracted forward from the engaging portion 50 and removed from the flexible sheath 1 together with the high-frequency electrode 2 and the operation wire 3, cleaning and assembly after use are easy.
[0028]
FIGS. 6 and 7 show the second and third embodiments of the present invention, in which the spiral groove 40 is made into a single groove for easier manufacture, and the tip opening 41 of the spiral groove 40 is provided. The taper is widened to facilitate engagement with the engaging portion 50.
[0029]
FIG. 8 shows a fourth embodiment of the present invention, in which a spiral ridge 42 is provided on the outer peripheral surface of a cylindrical or columnar member that is a material of the spiral member 4 to form a spiral groove 40. Formed.
[0030]
FIG. 9 is a cross-sectional view of a cross section perpendicular to the axis of the embodiment, and the engaging portion 50 is formed in a shape that matches the cross-sectional shape of the spiral groove 40 and extends in the axial direction of the spiral member 4. Is converted into a rotational motion around the axis.
[0031]
10 and 11 show a fifth embodiment of the present invention, in which the spiral member 4 is formed in a shape in which a flat plate material is spirally twisted, thereby forming a spiral groove 40. Has been. In the fourth and fifth embodiments, the spiral groove 40 is open on the front end side and closed on the rear end side.
[0032]
FIG. 12 shows a sixth embodiment of the present invention, in which the base end of the high-frequency electrode 2 is arranged at a position eccentric from the central axis position of the spiral member 4. By doing so, the length (X) of the distal end portion 2a of the high-frequency electrode 2 can be increased to be larger than half of the outer diameter (Y) of the spiral member 4 (that is, X> Y / 2). It is possible to easily hook the distal end portion 2a to the affected area when performing mucosal resection.
[0033]
FIGS. 13 and 14 show seventh and eighth embodiments for obtaining the same effect, in which the high-frequency electrode 2 is formed in a shape bent in a crank shape at an intermediate portion, and the high-frequency electrode 2 is This is an example in which the structure protrudes obliquely forward from the spiral member 4.
[0034]
The present invention is not limited to the above-described embodiments. For example, the present invention may be applied to a high-frequency treatment instrument for endoscopes other than a so-called hooking knife, and a mechanical endoscope that does not use a high-frequency current. It may be applied to a treatment tool.
[0035]
【The invention's effect】
According to the present invention, the spiral member is disposed in the distal end opening of the flexible sheath so as to be rotatable about the axis, the proximal end of the distal treatment member is connected to the spiral member, and is engaged with the spiral member. An engaging member that converts the axial movement of the helical member into the rotational movement around the axial line is fixedly provided at the distal end opening of the flexible sheath, and the helical member has a force to advance and retract in the axial direction. By operating, the spiral member rotates around the axis and the distal treatment member rotates integrally therewith, so that the distal treatment member can be reliably rotated around the axis by an operation from the hand side. In addition, it is thin and small, and can exhibit an excellent effect for transendoscopic use.
[Brief description of the drawings]
FIG. 1 is a partial perspective view of a distal end portion of an endoscope treatment tool according to a first embodiment of the present invention.
FIG. 2 is a side view showing the overall configuration of the endoscope treatment tool according to the first embodiment of the present invention.
FIG. 3 is a side sectional view of an operation unit of the endoscope treatment tool according to the first embodiment of the present invention.
FIG. 4 is a side sectional view of the distal end portion of the endoscope treatment tool according to the first embodiment of the present invention.
FIG. 5 is a front view of the distal end portion of the endoscope treatment tool according to the first embodiment of the present invention.
FIG. 6 is a partial perspective view of a distal end portion of an endoscope treatment tool according to a second embodiment of the present invention.
FIG. 7 is a partial side view of a distal end portion of an endoscope treatment tool according to a third embodiment of the present invention.
FIG. 8 is a partial side view of a distal end portion of an endoscope treatment tool according to a fourth embodiment of the present invention.
FIG. 9 is a cross-sectional view in a cross section perpendicular to the axis of the distal end portion of the endoscope treatment tool according to the fourth embodiment of the present invention.
FIG. 10 is a partial side view of a distal end portion of an endoscope treatment tool according to a fifth embodiment of the present invention.
FIG. 11 is a cross-sectional view in a cross section perpendicular to the axis of a distal end portion of an endoscope treatment tool according to a fifth embodiment of the present invention.
FIG. 12 is a side sectional view of a distal end portion of an endoscope treatment tool according to a sixth embodiment of the present invention.
FIG. 13 is a side sectional view of a distal end portion of an endoscope treatment tool according to a seventh embodiment of the present invention.
FIG. 14 is a side sectional view of a distal end portion of an endoscope treatment tool according to an eighth embodiment of the present invention.
[Explanation of symbols]
1 Flexible sheath 2 High-frequency electrode (tip treatment member)
2a Tip 3 Operation wire (advance / retraction force transmission member)
4 Helical member 5 Engaging member 10 Operation part 40 Spiral groove 50 Engaging part

Claims (11)

An endoscope treatment tool in which a distal treatment member is disposed at the distal end of a flexible sheath,
A helical member which spiral grooves are formed on the outer peripheral surface connecting the proximal end of the distal end treatment member to the helical member is placed rotatably on the axis around within the distal opening of the flexible sheath, the An advancing / retracting force transmitting member for applying an advancing / retreating force in the axial direction to the spiral member is inserted into the flexible sheath and engaged with the spiral groove to advance / retreat the spiral member in the axial direction. An engaging member for converting the operation into a rotational motion around the axis is fixedly provided at the distal end opening of the flexible sheath, and the force for advancing / retreating in the axial direction by the advance / retreat force transmitting member is applied to the spiral member. Thus, the spiral member rotates around the axis and the tip treatment member rotates integrally therewith .
The spiral groove is opened to the front end side of the spiral member, and the rear end side of the spiral groove is formed in a closed state so that the spiral member is extracted forward from the engagement member and the flexible member is formed. Endoscopic treatment instrument characterized in that it can be removed from the distal end of the sheath . The endoscopic treatment instrument according to claim 1, wherein the spiral member has a spiral groove formed on an outer peripheral surface of a cylindrical or columnar member. The endoscopic treatment tool according to claim 1, wherein the spiral member has a spiral projection formed on an outer peripheral surface of a cylindrical or columnar member. The endoscope treatment tool according to claim 1, wherein the spiral member is formed in a shape in which a flat plate member is spirally twisted. The endoscope treatment tool according to any one of claims 1 to 4, wherein the distal treatment member is formed in a size that does not protrude from the outer diameter of the flexible sheath when viewed from the front. The endoscope treatment tool according to claim 5, wherein the distal treatment member is formed in a shape in which a distal end of a rod-like body protruding straight forward from a distal end of the flexible sheath is bent sideways. The endoscope treatment tool according to claim 6, wherein a proximal end of the distal treatment member is eccentrically attached to the spiral member. The endoscopic treatment tool according to claim 6, wherein the distal treatment member is formed in a shape bent in a crank shape at an intermediate portion. The endoscope treatment instrument according to claim 6, wherein the distal treatment member is formed in a shape in which a distal end of a rod-like body protruding obliquely forward from the distal end of the flexible sheath is bent sideways. The endoscopic treatment tool according to any one of claims 1 to 9, wherein the distal treatment member is a high-frequency electrode through which a high-frequency current is passed. The endoscope treatment tool according to claim 10, wherein a high-frequency current is passed through the distal treatment member via the advance / retreat force transmission member.

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