JP4236290B2 - Endoscopic treatment tool - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to an endoscope treatment tool, and more particularly to an endoscope treatment tool characterized by a portion that is used by being conducted into a body cavity through a channel of the endoscope.
[0002]
[Prior art]
2. Description of the Related Art In recent years, an endoscope treatment tool that is inserted into an insertion channel of an endoscope has been widely used for observation therapy under an endoscope.
[0003]
This type of endoscopic treatment tool, for example, a biopsy forceps, is disclosed in Japanese Patent Application Laid-Open No. 61-247442, and is a coil-shaped penetrable device that is inserted through a treatment tool insertion channel of an endoscope. A flexible sheath, a pair of biopsy cups provided via a sleeve attached to the distal end of the flexible sheath, an operation wire connected to the rear end of the flexible sheath and inserted into the flexible sheath; It is formed by the operation part which operates a biopsy cup via an operation link. Any of these biopsy cups, operation links, sleeves, flexible sheaths, operation wires, etc. are made of metal such as stainless steel.
[0004]
When the biopsy forceps are used, an endoscope insertion portion is inserted into the lumen in advance, and then the biopsy forceps are inserted into the treatment instrument insertion channel of the endoscope so as to be within the field of view of the endoscope. After that, the distal end portion of the treatment tool is projected into the body cavity, guided to the affected area, and a pair of biopsy cups that are freely opened and closed at the distal end portion are opened and closed by the operation portion. The resulting affected tissue is bitten.
[0005]
By the way, as shown in Japanese Utility Model Publication No. 6-21449, when a biopsy forceps or the like is inserted into a narrow lumen, for example, a bile duct and a pancreatic duct, the treatment instrument insertion channel of the endoscope previously inserted into the body cavity After inserting a guide member, for example, a guide wire, the tip of the guide wire protrudes into the body cavity and is guided to a target site such as an affected part. Then, the affected part of the proximal side of the guide wire is passed through a through-hole provided in the sleeve of the biopsy forceps, and the biopsy forceps are subsequently inserted using the guide wire as a guide.
[0006]
In the above conventional endoscope treatment tool, when used in combination with a guide member, for example, a guide wire, the guide wire is inserted into the through hole provided in the sleeve of the distal treatment section of the endoscope treatment tool. It is supposed to be.
[0007]
[Problems to be solved by the invention]
However, since the sleeve has a hole through which the guide wire is inserted, the outer diameter of the distal end treatment portion of the endoscopic biopsy forceps is large, and it is particularly easy to insert a narrow pan lumen such as the main pancreatic duct. There is a problem that it is difficult.
[0008]
Further, since a guide wire having a small outer diameter is used particularly for a narrow portion of the lumen, the elastic force of the guide wire is small. When the guide wire is inserted into a through hole provided in the sleeve of the endoscope treatment tool, since there is a considerable distance from the through hole to the distal end of the treatment portion, the path of the guide wire and the endoscope It becomes difficult to match the insertion path of the distal end portion of the treatment instrument in a substantially parallel state, and the distal end portion of the treatment instrument for endoscope is inclined with respect to the insertion path of the guide wire. For this reason, when a branch point in the body cavity, for example, a bifurcation point of the bile duct and pancreatic duct, passes, a part of the endoscopic treatment tool is caught on the inner wall of the body cavity, which makes it difficult to guide to the target site. .
[0009]
Furthermore, if the insertion of the endoscopic treatment tool is forcibly performed, a part of the endoscopic treatment tool may be caught on the inner wall of the body cavity as described above, and the bile duct, liver, pancreas, etc. may be perforated. .
[0010]
Also, when inserting a forceps into a narrow lumen using a guide wire as a guide, the direction of the forceps must be in the same direction as the direction of the guide wire, and when the forceps are pressed, the tip of the forceps needs to advance in the direction of the guide wire.
[0011]
However, in the case of the above-mentioned Japanese Utility Model Publication No. 6-21449, when an external force is applied to the guide wire at the base end of the through hole, the direction of the guide wire becomes an unexpected direction, and the forceps is placed in a thin lumen containing the guide wire. There is a problem that it cannot be inserted into.
[0012]
The present invention has been made in view of the above circumstances, and can be safely and reliably guided to a site where insertion work is difficult such as in a narrow lumen or a complicated branching portion. It aims at providing the treatment tool for endoscopes which can aim at improvement.
[0013]
[Means for Solving the Problems]
The endoscope treatment tool of the present invention has at least one of a pair of movable members that can be opened and closed at the distal end treatment portion, and the treatment member is placed at the distal end of the pair of treatment members at a target site in a body cavity. A guide hole that is inserted into the body cavity in advance so as to be guided to the distal end of the treatment member is provided in the treatment member at the rear of the pair of treatment members. Other through-holes that are communicated with the through-holes and that allow the guide wire inserted through the through-holes into the treatment member to extend forward and backward in the proximal direction of the treatment member are provided. It is characterized by that.
[0015]
DETAILED DESCRIPTION OF THE INVENTION
Embodiments of the present invention will be described below with reference to the drawings.
[0016]
1 to 7 relate to a first embodiment of the present invention, FIG. 1 is a configuration diagram showing a configuration of an endoscopic biopsy forceps, and FIG. 2 is a view after the endoscopic biopsy forceps of FIG. FIG. 3 is an enlarged view showing a main part configuration of the distal end of the endoscopic biopsy forceps 1 of FIG. 1, and FIG. 4 is an endoscopic view of the endoscopic biopsy forceps of FIG. FIG. 5 is a configuration diagram showing a configuration of a first modification of the endoscopic biopsy forceps of FIG. 1, and FIG. 6 is an internal diagram of FIG. FIG. 7 is a block diagram showing the configuration of a third modification of the endoscopic biopsy forceps of FIG. 1. FIG. 7 is a block diagram showing the configuration of the third modification of the endoscopic biopsy forceps of FIG.
[0017]
(Constitution)
As shown in FIG. 1, a flexible sheath 2 is provided on the distal end side of the endoscopic biopsy forceps 1 that is the endoscope treatment tool of the first embodiment, for example. . An operation portion 3 is provided at the base end portion of the sheath 2. Further, a distal treatment section 4 is provided at the distal end of the sheath 2. The sheath 2 is composed of a densely wound coil 5 formed by densely winding a stainless steel wire, for example.
[0018]
As shown in FIG. 2, the rear end of the sheath 2 is connected to the operation portion main body 6 of the operation portion 3. The operation unit body 6 includes a shaft portion 7 and a finger ring 8 formed at the rear end portion of the shaft portion 7. Further, a slider 9 is loosely fitted to the shaft portion 7, and a rear end of an operation wire 10 formed by twisting is connected to the slider 9.
[0019]
Returning to FIG. 1, the distal treatment section 4 is provided with a pair of biopsy cups 11a and 11b. These biopsy cups 11 a and 11 b are pivotally supported by pins 13 on a sleeve 12 connected to the distal end of the sheath 2. The biopsy cups 11a and 11b can be opened and closed with a cup-shaped tip around the pin 13.
[0020]
Furthermore, as shown in FIG. 3, the base ends of the biopsy cups 11a and 11b are attached to one ends of the operation links 15a and 15b by pins 14a and 14b. The other ends of these operation links 15 a and 15 b are attached to the connecting member 17 by pins 16. A distal end of the operation wire 10 inserted into the sheath 2 is connected to the connecting member 17 and led out to the operation unit 3 side.
[0021]
Further, through holes 18a and 18b are formed in the biopsy cup 11b of the distal treatment section 4, and the through hole 18b is located rearward with respect to the long axis direction than the through hole 18a. In addition, these holes 18a, moth guide wire 19 for guiding the endoscopic biopsy forceps 1 of the main body 1a is adapted to be inserted retractably on the 18b.
[0022]
(Function)
FIG. 4 shows an example in which the main body 1a of the endoscopic biopsy forceps 1 is inserted into the endoscope 20 and actually used.
[0023]
When the endoscopic biopsy forceps 1 is used, a guide wire 19 is inserted into the channel 21 of the endoscope 20 previously inserted into the living body cavity before the main body 1a of the endoscopic biopsy forceps 1. . Then, the distal end portion of the guide wire 19 is projected into the body cavity and guided to the target site 25 of the main pancreatic duct 24, for example, the affected part. In this case, the guide wire 19 is thinner (for example, about 0.9 mm or less in diameter) than the outer diameter of a general treatment instrument (for example, the outer diameter is about 1.7 to 3 mm). For example, it can be inserted safely and surely into a portion where insertion work is difficult, such as in a thin lumen. Then, after guiding the guide wire 19 to the target site 25, the distal end portion 22 of the guide wire 19 is inserted into the through holes 18a and 18b provided in the biopsy cup 11b, and then the guide wire 19 is used as a guide. The main body 1 a of the endoscopic biopsy forceps 1 is inserted up to the target site 25.
[0024]
Furthermore, after inserting the main body 1a of the endoscopic biopsy forceps 1 into the target site 25, the slider 9 provided on the operation section main body 6 is slid, and the living tissue is opened and closed by opening and closing the biopsy cups 11a and 11b. Perform a biopsy, etc. At this time, it is also possible to perform a biopsy after the guide wire 19 is taken out of the body cavity while the main body 1a of the biopsy forceps 1 for endoscope is left at the target site 25.
[0025]
After the biopsy, the endoscope is left with the guide wire 19 left in the target site 25 so that a treatment tool or the like to be inserted next can be easily and quickly inserted into the target site 25. The main body 1 a of the biopsy forceps 1 is removed from the endoscope 20. It is also possible to remove the main body 1 a of the endoscopic biopsy forceps 1 together with the guide wire 19 from the endoscope 20.
[0026]
(effect)
As described above, in the present embodiment, the outer diameter of the distal treatment section 4 can be reduced, and the biopsy forceps 1 for endoscope is inserted using the guide wire 19 previously inserted into the target site as a guide. Can be made. Further, since the guide wire 19 can directly guide the biopsy cups 11a and 11b, a small opening, for example, a duodenal papilla, a complicated branch point, for example, biliary and pancreatic duct bifurcation, right and left hepatic duct bifurcation or bronchial bifurcation. Even in the case, the main body 1a of the endoscopic biopsy forceps 1 can be safely and surely inserted to the target site without the distal treatment section 4 of the endoscopic biopsy forceps 1 being caught by the body cavity wall. it can. Therefore, the main body 1a of the endoscopic biopsy forceps 1 can be guided more safely and reliably than before, so that the work efficiency of the insertion work of the main body 1a of the endoscopic biopsy forceps 1 is improved. be able to.
[0027]
Although the endoscopic biopsy forceps 1 is configured as shown in FIGS. 1 and 3, the present invention is not limited to this, and the first to third modifications shown in FIGS. 5 to 7 below are used. You may comprise.
[0028]
(First modification)
As shown in FIG. 5, the distal treatment section 4 of the main body 1 a of the endoscopic biopsy forceps 1 is a single-open type, and is fixed to the distal end of the sheath 2 and includes a base 32 having a pair of support pieces 31. The fixed biopsy cup 28 b provided between the support pieces 31 and fixed to the base 32, and the movable biopsy cup 28 a movable with respect to the base 32 may be formed.
[0029]
And in such a 1st modification, the arm part which is not illustrated protrudes in the base end of the said movable biopsy cup 28a, for example via the link mechanism which is not illustrated in the base end of this arm part. One end of an operation wire (not shown) is connected. Further, the middle part of the arm part is pivotally supported by the pin 29 so as to be rotatable with respect to the support piece 31. Further, the fixed biopsy cup 28b of the distal treatment section 4 is formed with through holes 30a and 30b. The through hole 30b is located behind the through hole 30a in the longitudinal direction, and further, the through holes 30a. , moth guide wire for guiding the main body 1a of the endoscope biopsy forceps 1 is adapted to be inserted retractably on the 30b. By configuring in this way, the same operation and effect as the first embodiment can be obtained.
[0030]
(Second modification)
Further, as shown in FIG. 6, a through hole 33a is formed on the contact surface of the biopsy cups 11a and 11b of the distal end treatment portion 4 of the main body 1a of the endoscope biopsy forceps, and the biopsy cup 11b is transparent. A hole 33b may be provided, and the through hole 33b may be configured to be positioned rearward with respect to the long axis direction than the through hole 33a. Furthermore, in the second modification, a guide wire 19 for guiding the main body 1a of the endoscopic biopsy forceps 1 is inserted into the through holes 33a and 33b so as to be freely advanced and retracted. The By configuring in this way, the same operation and effect as the first embodiment can be obtained.
[0031]
(Third Modification)
Furthermore, by applying the first modification to the second modification, as shown in FIG. 7, the distal treatment section 4 of the main body 1a of the endoscopic biopsy forceps 1 is a pair of one-open type biopsy. Even if the through hole 34a is provided on the contact surface of the test cups 28a and 28b and either one of the biopsy cups, for example, the fixed biopsy cup 28b is provided with the through hole 34b, the same as the first embodiment. Similar actions and effects can be obtained.
[0032]
8 and 9 relate to the second embodiment of the present invention, FIG. 8 is a configuration diagram showing the configuration of the endoscopic biopsy forceps, and FIG. 9 is a modification of the endoscopic biopsy forceps in FIG. It is a block diagram which shows the structure of an example.
[0033]
Since the second embodiment is almost the same as the first embodiment, only different points will be described, and the same components are denoted by the same reference numerals and description thereof will be omitted.
[0034]
(Configuration and action)
In the second embodiment, as shown in FIG. 8, the biopsy cup 11a of the distal treatment section 4 of the main body 1a of the biopsy forceps for endoscope has a through hole 35a, and the through hole 35b has a hole 11b. The through-hole 35b is located behind the through-hole 35a with respect to the long axis direction. Further, a guide wire 19 for guiding the main body 1a of the endoscopic biopsy forceps 1 is inserted into the through holes 35a and 35b so as to be able to advance and retract.
[0035]
As shown in FIG. 9, the distal treatment section 4 of the main body 1a of the biopsy forceps for endoscope as shown in the first modification of the first embodiment is a pair of one-open type biopsy. The through holes 35a and 35b may be provided in the test cups 28a and 28b, respectively.
[0036]
Other configurations and operations are the same as those in the first embodiment.
[0037]
(effect)
Therefore, in the present embodiment, in addition to the effects of the first embodiment, since the through-holes are provided in each of the pair of biopsy cups, the outer diameter of the biopsy cup can be further reduced. The endoscopic biopsy forceps 1 can be inserted more easily even in a narrow region.
[0038]
FIGS. 10 to 13 relate to a third embodiment of the present invention, FIG. 10 is a block diagram showing the configuration of an endoscopic biopsy forceps, and FIG. 11 is the distal end of the endoscopic biopsy forceps of FIG. FIG. 12 is an enlarged view showing a portion B of FIG. 10, and FIG. 13 is an enlarged view showing a portion C of FIG. 10.
[0039]
Since the third embodiment is almost the same as the first embodiment, only different points will be described, and the same components are denoted by the same reference numerals and description thereof will be omitted.
[0040]
(Constitution)
In the third embodiment, a lumen through which a guide wire can be inserted is provided in the insertion portion so that it can be inserted into the bile duct, pancreatic duct, etc. via the guide wire, thereby simplifying the treatment operation and shortening the treatment time. FIG.
[0041]
That is, in the biological forceps 50 of the third embodiment, as shown in FIG. 10, the tube 51 is provided with two lumens 52 and 53 from the front end side to the rear end side. As shown in FIG. 11 as viewed from the arrow A in FIG. 10, the biopsy cups 54 and 55 are provided on the distal end side in the lumen 52 of the two lumens, and the biopsy cups 54 and 55 are returned to FIG. 10. The link mechanism is formed by the fixing pin 56, the sliding pins 57 and 58, and the link 59. FIGS. 12 and 13 are enlarged views of portions B and C of FIG.
[0042]
This link mechanism can be remotely operated via the operation wire 65 by the slider 60 of the hand side operation unit. That is, when the biological forceps 50 is inserted into the endoscope and the mucous membrane or the like in the body cavity is biopsied, the distal end link mechanism is operated by the sliding operation of the slider 60 provided on the proximal side, and the biopsy cup 54, By performing the opening / closing operation 55, a biopsy of a tissue piece or the like can be performed.
[0043]
Further, a guide wire 61 can be inserted into the other lumen 53, and the distal end portion 62 to the branch portion 63 are provided along with the lumen 52, and penetrates from the branch portion 63 to the base 64. .
[0044]
(Function)
Next, the case where the biological forceps 50 of this Embodiment is used in combination with the guide wire 61 is demonstrated concretely.
[0045]
In general, it is considered extremely difficult to insert a treatment tool into a bile duct or pancreatic duct through an endoscope channel. For this reason, a technique of inserting a guide wire into the bile duct / pancreatic duct and inserting a treatment instrument along the guide wire has been generally performed (in addition, the bile duct / pancreatic duct or the like). Since endoscopes perform various diagnoses and treatments at the same time, many different types of treatment tools are often used, so that insertion and reinsertion are frequently repeated.
[0046]
For example, when the guide wire 61 has already been inserted into the bile duct or pancreatic duct, the guide wire 61 is inserted through the distal end portion 62 of the lumen 53 of the biological forceps 50, and the endoscope is placed along the guide wire 61 → The biological forceps 50 is inserted into the duodenal papilla → bile duct or pancreatic duct. After insertion, as shown above, a biopsy is performed by a sliding operation on the hand side.
[0047]
Then, after the biopsy, if the biological forceps 50 is removed while leaving the guide wire 61 in the bile duct or pancreatic duct, the treatment instrument can be quickly inserted when the next treatment is performed.
[0048]
(effect)
As described above, the bioforceps 50 according to the present embodiment can be easily inserted into the bile duct or pancreatic duct by using the guide wire 61. In addition, since two lumens 52 and 53 are provided side by side so that the biopsy part and the guide wire insertion part do not interfere with each other, a biopsy can be performed while the guide wire 61 remains in the body cavity. Time can be shortened.
[0049]
In addition, you may cut the front-end | tip part 62 diagonally with respect to a major axis direction. In this way, insertion into the bile duct or pancreatic duct from the duodenal papilla can be performed more easily.
[0050]
The present invention is not limited to the above embodiments. For example, in each of the above-described embodiments, the present invention is applied to the biopsy forceps. However, the present invention may be applied to a grasping forceps and the like, and may be variously modified without departing from the present invention. .
[0051]
[Appendix]
(Additional Item 1) In an endoscope treatment instrument having a pair of treatment members that can be opened and closed by moving at least one of them at the distal end of an insertion portion to be inserted into a body cavity.
An endoscope for an endoscope, characterized in that guide means for preventing a guide member for guiding the treatment member from the body cavity from being directed toward the treatment member at the distal end portion is provided. Treatment tool.
[0052]
(Additional Item 2) The endoscope treatment tool according to Additional Item 1, wherein the guide means is a through hole provided in the treatment member.
[0053]
(Additional Item 3) The through hole has first and second openings into which a guide member for guiding the treatment member to the affected part in the body cavity can be inserted and retracted. The endoscope treatment tool according to 2.
[0054]
(Additional Item 4) The endoscope treatment tool according to Additional Item 3, wherein the first and second openings are provided simultaneously in one of the pair of treatment members.
[0055]
(Additional Item 5) The treatment instrument for an endoscope according to Additional Item 3, wherein the first and second openings are provided in the pair of different treatment members, respectively.
[0056]
(Additional Item 6) The endoscope according to Additional Item 3, wherein, of the first and second openings, a distal end side opening of the treatment member is provided at a contact portion of the treatment member. Treatment tool.
[0057]
(Additional Item 7) The endoscope treatment tool according to Additional Item 1, wherein the guide means is a guide tube provided alongside the treatment tool from the vicinity of the treatment member to the vicinity of the proximal side.
[0058]
(Additional Item 8) The endoscope treatment tool according to Additional Item 7, wherein a distal end portion of the guide tube is formed obliquely with respect to the major axis direction.
[0059]
(Additional Item 9) In an endoscope treatment tool having a pair of treatment members that can be opened and closed by moving at least one of them at the distal end of an insertion portion to be inserted into a body cavity.
An internal view characterized in that the treatment member is provided with a through hole having first and second openings into which a guide member for guiding the treatment member to an affected part in the body cavity can be inserted and retracted. Mirror treatment tool.
[0060]
(Additional Item 10) The endoscope treatment instrument according to Additional Item 9, wherein the first and second openings are provided simultaneously in one of the pair of treatment members.
[0061]
(Additional Item 11) The endoscope treatment tool according to Additional Item 9, wherein the first and second openings are provided in the pair of different treatment members, respectively.
[0062]
【The invention's effect】
Above, according the way to the endoscopic treatment tool of the present invention described, safe, can be reliably induced against difficult sites inserting operation as and complex branching unit has a narrow lumen There is an effect that the work efficiency can be improved.
[Brief description of the drawings]
FIG. 1 is a configuration diagram showing a configuration of an endoscopic biopsy forceps according to a first embodiment of the present invention. FIG. 2 is a configuration showing a configuration of a rear end of the endoscopic biopsy forceps in FIG. FIG. 3 is an enlarged view showing the configuration of the main part of the distal end of the endoscopic biopsy forceps 1 in FIG. 1. FIG. 4 is an actual use of the endoscopic biopsy forceps in FIG. Explanatory drawing explaining the effect | action when it is carried out. FIG. 5 is a block diagram showing the configuration of the first modification of the endoscopic biopsy forceps in FIG. 1. FIG. 6 is the endoscopic biopsy forceps in FIG. FIG. 7 is a block diagram showing the configuration of a third modification of the endoscopic biopsy forceps of FIG. 1. FIG. 8 is a block diagram showing the configuration of the second modification of the second embodiment of the present invention. The block diagram which shows the structure of the biopsy forceps for endoscopes which concerns on a form [FIG. 9] The block diagram which shows the structure of the modification of the biopsy forceps for endoscopes of FIG. 8 [FIG. 10] 3rd implementation of this invention The block diagram which shows the structure of the biopsy forceps for endoscopes which concerns on the form of 11 is a block diagram showing the configuration of the distal end surface of the endoscopic biopsy forceps shown in FIG. 10. FIG. 12 is an enlarged view of portion B in FIG. 10. FIG. 13 is an enlarged view of portion C in FIG. Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 ... Endoscopic biopsy forceps 1a ... Main body 2 ... Sheath 3 ... Operation part 4 ... End treatment part 5 ... Close winding coil 6 ... Operation part main body 7 ... Shaft part 8 ... Finger ring 9 ... Slider 10 ... Operation wire 11a , 11b ... biopsy cup 12 ... sleeve 13, 14a, 14b, 16 ... pin 15 ... operation link 17 ... connecting member 18a, 18b ... through hole 19 ... guide wire 20 ... endoscope 21 ... channel 22 ... end 24 ... Main pancreatic duct 25 ... Target site

Claims (2)

The distal treatment section has at least one movable pair of treatment members that can be opened and closed,
A guide wire previously inserted into the body cavity in order to guide the treatment member to a target site in the body cavity can be inserted into the distal ends of the pair of treatment members so as to be able to advance and retract from the distal direction of the treatment member. Make a hole,
The guide wires that are communicated with the through-holes in the treatment member at the rear portions of the pair of treatment members and that are inserted from the through-holes into the treatment member are advanced and retracted in the proximal direction of the treatment member. Provided with other through holes that can be extended freely,
An endoscopic treatment tool characterized by the above. The endoscopic treatment tool according to claim 1, wherein the through hole is provided on a contact surface of the pair of treatment members.

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