JP4725997B2 - Endoscopic treatment tool - Google Patents

Description

  The present invention relates to an endoscope treatment tool.

  The endoscope treatment instrument is used by passing a flexible sheath through the endoscope treatment instrument guide tube, but the direction of the distal end portion protruding from the distal end of the treatment instrument guide tube into the body cannot be changed arbitrarily. In such a case, the flexible sheath is arbitrarily curved by a remote operation from the proximal side so that the direction of the distal end portion of the treatment instrument can be smoothly changed toward the target in such a case. Some have a curved portion that can be formed.

In an endoscopic treatment instrument in which a tubular member is used as a flexible sheath, a pair of wire passage holes are formed in the tubular member at intervals in the longitudinal direction so as to pass through the tubular member. In addition to a simple configuration (for example, Patent Document 1) in which the curved bending operation wire is disposed along the outer surface of the tubular member between a pair of wire passage holes, a flexible tube is used. There is a configuration in which the tube wall in the direction to be bent is formed flat between a pair of wire passage holes, or is thinly scraped off at a plurality of locations as a whole or at intervals (for example, Patent Documents 2 and 3). It was.
Japanese Utility Model Publication No. 61-7697 Japanese Utility Model Publication No. 61-6893 Japanese Utility Model Publication No. 64-4335

  However, in any case of the invention described in Patent Documents 1 to 3, when the bending operation wire is pulled from the hand side, the tubular member draws a large loop between the pair of wire passage holes. In other words, the direction of the distal end portion of the flexible sheath cannot be bent in a so-called small turning direction, so that the target may not be easily sniped in the body cavity. In addition, although patent document 1 describes that there exists a case (problem) that a tube-shaped member will be bent, since such an unscheduled bending phenomenon is unstable because a position and direction are not constant. It is difficult to use practically.

  Therefore, for example, it is conceivable to form a V-shaped cut in the tube-shaped member so that the tube-shaped member bends there. However, if the tube-shaped member is bent at the position where the tube-shaped member is bent, it is bent. Repeating the operation causes a crack at the bent position, and the tubular member becomes unusable after a short period of use. In this case, it is difficult to use practically.

  The present invention has been made to solve such a problem, and is practically capable of bending the distal end portion of the tubular member into a stable state over a long period of time with a small turn by remote control from the hand side. An object of the present invention is to provide an endoscope treatment tool having a high height.

  At least the vicinity of the distal end portion of the flexible sheath passed through the treatment instrument guide tube of the endoscope is formed of a tubular member, and a pair of wire passage holes are spaced apart in the longitudinal direction of the tubular member. The tube-shaped member is formed by pulling the bending operation wire from the proximal side, and the bending operation wire formed on the side surface and passed through the flexible sheath is exposed to the outer surface between the pair of wire passage holes. In the endoscope treatment instrument configured to bend between a pair of wire passage holes, a region sandwiched between the pair of wire passage holes of the tubular member is formed into a flattened flat portion. The pair of wire passage holes are configured to face both front and rear end positions of the flat portion of the flat portion, and the flat portion is in a direction approaching the state where the pair of wire passage holes face each other. Ri bent to form a crease portion was returned to its original straight condition to an intermediate position of the pair of wire passage holes after.

  Note that the tubular member may have a circular cross-sectional shape at a portion other than the flat portion. The flat portion may be formed by plastic deformation in a state where the tubular member is sandwiched in the radial direction and crushed flat, and a portion extending outward of the side surface of the flat portion of the tubular member is not flat. It may be scraped off so as to be aligned with the outer diameter of the part. However, it is preferable that the portion that spreads outward on the side surface of the flat portion of the tubular member is scraped off without being perforated.

  In addition, both front and rear end portions of the flat portion are formed in a slope shape between the flat surface and the non-flat portion, a wire passage hole is formed in the slope portion, and the flat surface is formed between the pair of wire passage holes. The bending operation wire along the outer surface may be disposed in a state where it can be accommodated in the region of the outer diameter of the non-flat portion of the tubular member. The distal end of the bending operation wire may be fixed to the distal end portion of the tubular member.

  In addition, a pair of wire passage holes are formed on each of the front and back surfaces of the flat part, and the bending operation wire along the outer surface on the front side of the flat part and the bending operation wire along the outer surface on the back side can be individually pulled from the hand side. It may be arranged as follows. Alternatively, a plurality of flat portions may be formed by changing the position in the longitudinal direction of the tubular member, and the same bending operation wire may be passed through the wire passage hole formed in each of the flat portions. The flat surfaces may be formed in the same direction so that the tubular member can be bent to a bending angle exceeding 180 ° in total by a plurality of flat portions. Alternatively, two flat portions are formed by changing the position and orientation in the longitudinal direction of the tubular member, and separate bending operation wires are arranged in the wire passage holes formed in the flat portions, and the two flat portions are The eccentric planes may be formed in directions different by 90 °.

  Moreover, the crease part may be formed by pulling the bending operation wire from the hand side. A high-frequency electrode may be disposed at the tip of the tubular member, and the high-frequency electrode may be energized via a bending operation wire. The high-frequency electrode is elongated in a direction perpendicular to the flat surface of the flat portion. It may be formed in a shape. Or the grasping forceps which opens and closes may be attached to the front-end | tip of a tubular member.

  Further, the flexible sheath may be fitted into the flexible mantle tube so as to be slidable in the axial direction, and the flexible sheath may be rotatable around the axis in the mantle tube. Good.

  According to the endoscope treatment tool of the present invention, the region sandwiched between the pair of wire passage holes of the tubular member is formed in the flattened flattened portion, and the pair of wire passage holes are formed in the flat portion. A pair of wires is formed by facing the front and rear end positions of the plane and bending the flat portion in a direction approaching the state in which the pair of wire passage holes face each other and then returning to the original straight state. By forming it in the middle position of the passage hole, the distal end portion of the tubular member can be bent in a stable state over a long period of time by a remote operation from the hand side, which is very practical.

Embodiments of the present invention will be specifically described below with reference to the drawings.
FIG. 2 shows the overall configuration of the endoscope treatment tool.
The flexible sheath is formed of a tube-like member 1A such as a fluororesin tube in the vicinity of the distal end, and the other portion such as a synthetic resin tube or a multi-strand coil containing a net tube having a circular cross section. In this way, the rotation follow-up sheath 1B having high rotation follow-up property is formed, and these are firmly joined and connected with an adhesive or the like.

  In the flexible sheaths 1A and 1B, for example, a flexible conductive bending operation wire 2 such as a stranded wire of a stainless steel thin wire is loosely passed over the entire length, and the flexible sheaths 1A and 1B It is mechanically and electrically connected to the high-frequency electrode 3 attached to the most advanced part. The flat member 4 crushed flat is formed on the tubular member 1A, and the bending operation wire 2 is exposed and arranged on the outer surface of the tubular member 1A.

  The outer sheath 6 made of a flexible tube such as a fluororesin tube having a slightly shorter length than the flexible sheaths 1A and 1B is loosely covered with the flexible sheaths 1A and 1B. The outer tube 6 is slidable in the axial direction with respect to the flexible sheaths 1A and 1B, and is rotatable around the axis. Reference numeral 7 denotes a knob fixed to the proximal end of the outer tube 6, and is movable with respect to any member other than the outer tube 6.

  An operation unit 10 that is held and operated by an operator by hand is connected to proximal ends of the flexible sheaths 1A and 1B, and the bending operation wire 2 is connected to a slide operation member 11 that is slidably disposed on the operation unit 10. The bending operation wire 2 is connected to the connection terminal 12 attached to the slide operation member 11 by connecting the rear end portions thereof. Therefore, a high frequency current can be applied to the high frequency electrode 3 via the bending operation wire 2 by connecting a high frequency power cord (not shown) to the connection terminal 12.

  FIG. 1 shows the distal end portion of the above-described endoscope treatment tool in detail. FIG. 3 is a cross-sectional view taken along the line AA. The flat portion 4 formed in the vicinity of the tip of the tube-shaped member 1A having a circular cross-sectional shape was crushed flat by strongly pinching the tube-shaped member 1A in the radial direction with, for example, a narrow pliers-like tool or the like. It is formed by plastic deformation to the state. In this case, it is not necessary to heat, but heating may be performed.

  When such a crushing process is performed, as shown in FIG. 3, the width of the flat portion 4 becomes larger than the outer diameter of the non-flat portion of the tubular member 1A, but it is within the treatment instrument guide tube of the endoscope. If there is no inconvenience to pass, it can be used as it is. In addition, as shown in FIG. 4, the flat portion 4 may be formed at a position displaced with respect to the central axis of the tubular member 1A. When inconvenience occurs in passing through the treatment instrument guide tube of the endoscope, as shown in FIG. 5, a state in which the outwardly spread portion of the flat portion 4 is aligned with the outer diameter of the non-flat portion It may be scraped off. However, it is better to scrape off that part so as not to perforate.

  As shown in FIG. 1, the front and rear end portions of the flat portion 4 are formed in a slant shape between the flat surface 4 a and the non-flat portion, and wire passing holes 5 and 5 through which the bending operation wire 2 passes are formed. Openings are formed in the slope portions of the front and rear ends. And the bending operation wire 2 is arrange | positioned in the state which follows the outer surface of the flat surface 4a between a pair of wire passage holes 5 and 5, and in this Example, the bending operation wire 2 is a non-flat part of the tubular member 1A. It is arranged in such a state that it can be accommodated in the region of the outer diameter dimension of Therefore, the bending operation wire 2 can smoothly pass through the treatment instrument guide tube of the endoscope without being caught.

  The high-frequency electrode 3 is tightly coupled so that the rear half portion thereof bites into the tip of the tubular member 1A and does not come out, and the front half portion is formed in an elongated shape perpendicular to the flat surface 4a of the flat portion 4. ing. However, in the present invention, the high frequency electrode 3 may have any other shape. The distal end of the bending operation wire 2 is firmly connected to the rear end portion of such a high-frequency electrode 3 by a low contact or the like.

  The flat portion 4 approaches the state in which the pair of wire passage holes 5 and 5 face each other at a substantially central position of the flat portion 4 corresponding to an intermediate position between the pair of wire passage holes 5 and 5 formed in the tubular member 1A. A crease 40 is formed that is bent in the direction and then returned to the original straight state. In FIG. 1, the bending operation is illustrated by a two-dot chain line. In this embodiment, the bending operation is performed on both sides of the axial direction of the tubular member 1A, but it may be bent only in the direction in which the bending operation wire 2 is exposed. In addition, in order to make it easy to understand, in each drawing, the fold portion 40 is shown in a slightly recessed state, but in reality, the fold portion 40 is in a straight state and its surrounding portions even when viewed with the naked eye In many cases, it cannot be distinguished.

  The folding part 40 is formed straight in a direction substantially perpendicular to the axial direction of the tubular member 1A when the flat surface 4a is viewed from the front, and the bending operation wire 2 is tight from the hand side (for example, It can also be formed by pulling (to a state where the pair of wire passage holes 5, 5 are in contact with each other). Therefore, in the case of a commercially available product or the like, the fold portion 40 is not attached at the time of shipment, and the fold portion 40 can be formed by the user pulling the bending operation wire 2. .

  As shown in FIG. 6, the endoscope treatment tool according to the embodiment configured as described above is passed through the treatment tool guide tube of the endoscope in a state where the outer tube 6 is entirely covered, and the distal end thereof is When guided to the vicinity of the target in the body cavity, as shown in FIG. 7, the outer tube 6 is retracted slightly backward, and then the bending operation wire 2 is pulled from the operation unit 10 side, thereby being indicated by an arrow B. As shown, the tubular member 1 </ b> A is bent at the flat portion 4 formed between the pair of wire passage holes 5 and 5.

  In such an operation, the flat portion 4 is formed between the pair of wire passage holes 5 and 5, and the fold portion 40 is formed at an intermediate position thereof, so that the tubular member 1A is It always bends in a stable direction at a stable position, and bends in a very small turn. And since the front-end | tip part of the high frequency electrode 3 is formed in the elongate shape in the orthogonal | vertical direction with respect to the flat surface 4a of the flat part 4, if the flat part 4 is bent, the bending direction will be the tip direction of the high frequency electrode 3. Since they coincide, the mucous membrane surface can be accurately incised. Further, as indicated by the arrow R, the flexible sheaths 1A and 1B can be rotated around the axis with respect to the outer tube 6 to adjust the direction of the high-frequency electrode 3.

  When the operation force for pulling the bending operation wire 2 from the operation unit 10 side is released, the tubular member 1A returns to a state close to the original straight by its own elasticity, and the endoscope treatment tool is treated by the endoscope. It can be extracted from the tool guide tube. Further, if the bending operation wire 2 is pushed in from the operation unit 10 side, as shown by an arrow C in FIG. 8, the tube-shaped member 1 </ b> A is straightened and slightly bent to the opposite side. It can also be made. The endoscope treatment tool operating in this way can be bent any number of times in a stable state because the tube-like member 1A is not easily damaged even if the bending at the flat portion 4 is repeated, and is very practical. high.

FIG. 9 shows a distal end portion of the endoscope treatment tool according to the second embodiment of the present invention.
In this embodiment, a pair of wire passage holes 5, 5 are formed on each of the front and back surfaces of the flat part 4, and two bending operation wires 2, 2 are provided, and one bending operation wire 2 is flat. The other bending operation wire 2 is arranged along the outer surface on the front side of the portion 4 and along the outer surface on the back side of the flat portion 4, and the two bending operation wires 2 and 2 can be individually pulled from the hand side. Are arranged as follows. In addition, since the operation part for performing such operation is well-known, the description is abbreviate | omitted. The flat part 4 is formed with a fold 40 similar to that of the first embodiment.

  By comprising in this way, the tubular member 1 can be bent and bent to a desired angle on both sides of the axial direction of the tubular member 1. In this embodiment, the flexible sheath is constituted by only the tubular member 1, and the rotation follow-up sheath 1B and the outer tube 6 are not provided. However, in the present invention, such a configuration may be adopted. . In the case of a treatment instrument provided with a curette or the like instead of the high-frequency electrode 3, the outer tube 6 is not necessary.

FIG. 10 shows the distal end portion of the endoscope treatment tool according to the third embodiment of the present invention.
In this embodiment, two flat portions 4 and 4 are formed by changing the position in the longitudinal direction of the tubular member 1, and the same bending operation wire 2 is passed through the wire passage holes 5 formed in each of the flat portions 4 and 4. ing. The flat surfaces 4 a and 4 a of the two flat portions 4 and 4 are formed in the same direction, and a fold portion 40 is formed in each flat portion 4 and 4. Note that three or more flat portions 4 may be formed in different positions in the longitudinal direction.

  Further, a gripping forceps 9 made of a leaf spring or a wire spring material that returns to its open state by its own elasticity is attached to the distal end of the tubular member 1 so as to be openable and closable by being elastically deformed, and is curved at its attachment portion 9a. The distal end of the operation wire 2 is connected and fixed, and the outer tube 6 similar to that of the first embodiment is loosely covered with the tubular member 1. However, the flexible sheath is composed only of the tubular member 1.

  With such a configuration, as shown in FIG. 11, if the outer tube 6 is pushed in until it is covered with the gripping forceps 9 at the tip, the gripping forceps 9 can be elastically deformed into a closed state, as shown in FIG. If the outer tube 6 is retracted backward and the bending operation wire 2 is pulled from the proximal side, the tubular member 1 is bent and bent by the flat portions 4 and 4 to change the direction of the grasping forceps 9. Thus, the grasping forceps 9 can be made to face the affected part P. If the outer tube 6 is pushed in as shown in FIG. 13, the grasping forceps 9 can be closed to hold the affected part P therebetween.

  In this way, a plurality of flat portions 4 and 4 are formed by changing the position in the longitudinal direction of the tubular member 1 so that the flat surfaces 4a and 4a face in the same direction, and wire passing holes formed in the flat portions 4 and 4 respectively. By making the same bending operation wire 2 pass through 5 ..., the tip of the tubular member 1 can be stably bent with a small bending length to a bending angle exceeding 180 ° in total as shown in FIG. The affected part P can be sniped from the back side with respect to the observation direction of the endoscope. Any treatment member may be disposed in place of the grasping forceps 9.

FIG. 15 shows the distal end portion of the endoscope treatment tool according to the fourth embodiment of the present invention.
In this embodiment, the two flat portions 4 and 4 are formed by changing the position and orientation in the longitudinal direction of the tubular member 1, and the folds 40 are formed in the flat portions 4 and 4. Separate bending operation wires 2 and 2 are passed through wire passage holes 5 formed in the portions 4 and 4. In this embodiment, the two flat portions 4 and 4 are formed in directions different from the flat surfaces 4a and 4a by 90 °, and the two bending operation wires 2 and 2 are separately pulled appropriately. Thus, the tip portion of the tubular member 1 can be directed in an arbitrary direction in a three-dimensional manner with a small turn.

1 is a side sectional view of a distal end portion of an endoscope treatment tool according to a first embodiment of the present invention. The side view which shows the whole structure of the treatment tool for endoscopes of the 1st Example of this invention. Sectional drawing cut | disconnected by the AA line shown by FIG. 1 of the treatment tool for endoscopes of 1st Example of this invention. Sectional drawing of the 1st modification of the state cut | disconnected by the AA line of the treatment tool for endoscopes of 1st Example of this invention. Sectional drawing of the 2nd modification of the state cut | disconnected by the AA line of the treatment tool for endoscopes of 1st Example of this invention. BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a side cross-sectional view showing a state where an outer tube of a distal end portion of an endoscope treatment tool according to a first embodiment of the present invention is entirely covered. Side surface sectional drawing which shows operation | movement of the front-end | tip part of the treatment tool for endoscopes of 1st Example of this invention. Side surface sectional drawing which shows operation | movement of the front-end | tip part of the treatment tool for endoscopes of 1st Example of this invention. Side surface sectional drawing of the front-end | tip part of the treatment tool for endoscopes of the 2nd Example of this invention. Side surface sectional drawing of the front-end | tip part of the treatment tool for endoscopes of the 3rd Example of this invention. Side surface sectional drawing of the state in which the outer tube of the front-end | tip part of the treatment tool for endoscopes of the 3rd Example of this invention was entirely covered. Side surface sectional drawing which shows operation | movement of the front-end | tip part of the treatment tool for endoscopes of the 3rd Example of this invention. Side surface sectional drawing which shows operation | movement of the front-end | tip part of the treatment tool for endoscopes of the 3rd Example of this invention. Side surface sectional drawing which shows operation | movement of the front-end | tip part of the treatment tool for endoscopes of the 3rd Example of this invention. Side surface sectional drawing of the front-end | tip part of the treatment tool for endoscopes of the 4th Example of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1,1A ... Tubular member 2 ... Bending operation wire 3 ... High frequency electrode 4 ... Flat part 4a ... Flat surface 5 ... Wire passage hole 6 ... Outer tube 9 ... Grasping forceps 40 ... Folding fold part

Claims (20)

At least the vicinity of the distal end portion of the flexible sheath passed through the treatment instrument guide tube of the endoscope is formed of a tubular member, and a pair of wire passage holes are spaced apart in the longitudinal direction of the tubular member to form the tubular shape. A bending operation wire formed on a side surface of the member and passed through the flexible sheath is disposed so as to be exposed on the outer surface between the pair of wire passage holes, and the bending operation wire is pulled from the proximal side. In the endoscope treatment tool configured to bend between the pair of wire passage holes by the tubular member,
An area sandwiched between the pair of wire passage holes of the tubular member is formed in a flattened flat part so that the pair of wire passage holes face front and rear end positions of the flat part of the flat part. And the folded portion that is bent back in the direction approaching the state in which the pair of wire passage holes face each other and then returned to the original straight state at the intermediate position of the pair of wire passage holes. An endoscopic treatment tool characterized by being formed.   The endoscope treatment tool according to claim 1, wherein the tubular member has a circular cross-sectional shape at a portion other than the flat portion.   The endoscopic treatment instrument according to claim 1 or 2, wherein the flat portion is formed by plastically deforming the tube-shaped member so as to be flattened by sandwiching the tubular member in a radial direction. Mirror treatment tool.   The endoscopic treatment tool according to claim 3, wherein a portion of the tubular member that is spread outwardly from the side surface of the flat portion is scraped off so as to be aligned with the outer diameter of the non-flat portion. Mirror treatment tool.   5. The endoscope treatment tool according to claim 4, wherein a portion of the tubular member that has spread outward from the side surface of the flat portion is scraped off without being perforated.   The endoscopic treatment instrument according to any one of claims 1 to 5, wherein both front and rear end portions of the flat portion are formed in a slope shape between the flat surface and the non-flat portion, and the slope portion thereof. An endoscopic treatment tool in which the wire passage hole is opened.   The endoscope treatment tool according to any one of claims 1 to 6, wherein the bending operation wire along the outer surface of the flat surface between the pair of wire passage holes is a non-flat portion of the tubular member. Endoscopic treatment tool arranged in a state that can be accommodated in the region of the outer diameter dimension of the endoscope.   The endoscope treatment tool according to any one of claims 1 to 7, wherein a distal end of the bending operation wire is fixed to a distal end portion of the tubular member.   The endoscope treatment tool according to any one of claims 1 to 8, wherein the pair of wire passage holes are formed in pairs on both front and back surfaces of the flat portion, and curved along an outer surface on the front side of the flat portion. A treatment instrument for an endoscope in which an operation wire and a bending operation wire along the outer surface on the back side are individually arranged to be pulled from the hand side.   The endoscope treatment tool according to any one of claims 1 to 9, wherein a plurality of flat portions are formed by changing positions in the longitudinal direction of the tubular member, and a wire passing through each of the flat portions is formed. Endoscopic treatment tool in which the same bending operation wire is passed through the hole.   The endoscopic treatment tool according to claim 10, wherein the plurality of flat portions are formed with the flat surfaces facing in the same direction.   The endoscope treatment tool according to claim 11, wherein the tubular member can be bent to a bending angle exceeding 180 ° in total by the plurality of flat portions.   The endoscopic treatment instrument according to any one of claims 1 to 9, wherein two flat portions are formed by changing the position and orientation in the longitudinal direction of the tubular member, and are formed in each of the two flat portions. An endoscopic treatment tool in which separate bending operation wires are arranged in the wire passage hole.   The endoscope treatment tool according to claim 13, wherein the two flat portions are formed in directions in which the flat surfaces are different from each other by 90 degrees.   The endoscope treatment tool according to any one of claims 1 to 14, wherein the fold portion is formed by pulling the bending operation wire from a hand side.   The endoscope treatment tool according to any one of claims 1 to 15, wherein a high-frequency electrode is disposed at a distal end of the tubular member, and the high-frequency electrode is energized via the bending operation wire. Endoscopic treatment tool.   17. The endoscope treatment tool according to claim 16, wherein the high-frequency electrode is formed in an elongated shape in a direction perpendicular to the flat surface of the flat portion.   The endoscopic treatment instrument according to any one of claims 1 to 15, wherein a grasping forceps that opens and closes is attached to a distal end of the tubular member.   The endoscopic treatment tool according to any one of claims 1 to 18, wherein the flexible sheath is inserted into a flexible mantle tube so as to be slidable in the axial direction. Ingredients.   The endoscopic treatment instrument according to claim 19, wherein the flexible sheath is also rotatable about an axis in the outer tube.

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