JP4838945B2 - Endoscopic treatment tool and operation part of endoscope 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 for treating a living tissue in a transendoscopic manner.
[0002]
[Prior art]
In general, there is an endoscope treatment tool having a configuration disclosed in, for example, Japanese Patent Application Laid-Open No. 63-97154. As shown in FIG. 25, this conventional treatment instrument b includes an elongate sheath c inserted into the endoscope, and a high-frequency knife a inserted into the sheath c and protruding from the tip, and the rear end of the sheath c The operation unit connected to the high-frequency knife a is fixed to.
When the biological tissue is incised using the treatment tool b, it is performed as follows.
First, the treatment tool b is inserted into the body from the distal end, and the operation unit is operated while observing through the endoscope so that the high-frequency knife a protrudes from the distal end of the sheath c and abuts on the target biological tissue. In this state, the switch is operated to pass a high-frequency current through the high-frequency knife a to cut the living tissue. After the incision is completed, the operation unit is operated, the high-frequency knife a is stored in the sheath c, the treatment tool b is removed from the body, and the treatment is completed.
[0003]
Moreover, there exists a thing of the structure currently disclosed by Japanese Utility Model Laid-Open No. 54-166092 as an endoscopic treatment tool. As shown in FIG. 26, this conventional treatment instrument d includes a sheath e that is inserted through an endoscope, a puncture needle g that is fixed to the distal end of the sheath e, and a puncture needle g that is inserted through the distal end portion. And a tissue fixing portion operating portion in which the tissue fixing portion f is disposed. A puncture needle operating portion connected to the puncture needle g is fixed to the rear end of the sheath e.
[0004]
When an incision is made using the treatment tool d, it is performed as follows.
First, the treatment instrument d is inserted into the body from the distal end, and while observing through the endoscope, the puncture needle operation unit is operated to puncture the target biological tissue. In this state, the tissue fixing unit operating unit is operated to project the tissue fixing unit f from the tip of the puncture needle g. The tissue fixing portion f is caught by the living tissue, and at this time, the living tissue is lifted by pulling the treatment tool d toward the hand side. Next, an appropriate high-frequency knife is inserted into the body, and a high-frequency incision is made on the living tissue suspended by the treatment instrument d. After the incision is completed, the treatment tool d is removed from the body and the treatment is terminated.
[0005]
[Problems to be solved by the invention]
In the treatment instrument described in the above-mentioned JP-A-63-97154 and JP-A-54-166092, the treatment is performed without fixing the biological tissue, so that the target site is particularly a biological tissue that is easy to move. May be difficult to treat in a short time.
The present invention has been made based on such circumstances, and an object thereof is to provide an endoscopic treatment tool having excellent operability.
[0006]
[Means for Solving the Problems]
According to a first aspect of the present invention, there is provided a first sheath formed of at least one forceps member that is provided at the distal end of the sheath, the distal end portion of which is inserted into the body, and is operable to grasp a living tissue in the body. 1 treatment means, an operation means for operating the first treatment means, and a movable slider provided at a proximal end portion located outside the body of the sheath, and the action means by moving the slider A first operation section for operating the first treatment section, a second treatment means disposed on the sheath and treating the biological tissue grasped by the first treatment means, and a proximal end side located outside the body of the sheath, The second operating unit that operates the second treatment means and the slider that moves in a direction in which the biological tissue in the body is grasped by the first treatment means return the slider in an operation state in which the slider is moved to the grasping position. Comprising an engaging means for preventing movement Kino, and a releasing operation means for performing an operation to release the engagement with the slider by the engaging means, The engaging means includes a ratchet provided on the operation unit main body, a latch provided on the slider and capable of engaging and releasing with the ratchet, and a direction in which the latch is engaged with the ratchet. An elastic member for biasing, and the slider is provided with a second slider that is movable in the moving direction of the slider and is different from the slider, and the second slider is a living tissue by the first treatment means. When the slider is moved in the direction of gripping, the latch that moves together with the slider is operated from the engaged state to the released state against the ratchet against the urging force of the elastic member. Having an operation pin Is a treatment tool for endoscopes.
[0007]
According to a second aspect of the present invention, there is provided an elongated sheath having a distal end portion inserted into the body, and at least one forceps member which is provided at a distal end of the sheath and is operable to grasp a living tissue in the body. 1 treatment means, an operation means for operating the first treatment means, and a movable slider provided at a proximal end portion located outside the body of the sheath, and the action means by moving the slider A first operation section for operating the first treatment section, a second treatment means disposed on the sheath and treating the biological tissue grasped by the first treatment means, and a proximal end side located outside the body of the sheath, The second operating unit that operates the second treatment means and the slider that moves in a direction in which the biological tissue in the body is grasped by the first treatment means return the slider in an operation state in which the slider is moved to the grasping position. Engaging means for preventing the movement of the slider, and release operation means for performing an operation of releasing the engagement with the slider by the engagement means. The engagement means includes a ratchet provided on the operation portion main body. A latch provided on the slider and capable of engaging with and releasing from the ratchet, and an elastic member for biasing the latch in a direction to engage the ratchet. A second slider that is movable in the moving direction of the slider and is separate from the slider is provided, and the second slider moves with the slider when moving the slider in a direction in which the first treatment means grips the living tissue. An operating pin that moves together to operate the latch engaged with the ratchet from the engaged state to the released state against the ratchet against the biasing force of the elastic member is provided. The operating pin releases the latch engaged with the ratchet when the second slider is moved in the direction opposite to the direction in which the slider is moved when the living tissue is grasped by the first treatment means. Operate to state It is characterized by that.
According to a third aspect of the present invention, in the endoscope treatment tool according to the first or second aspect, the second treatment means is a high-frequency knife.
According to a fourth aspect of the present invention, in the endoscope treatment instrument according to the first or second aspect, the second treatment means is a puncture needle.
According to a fifth aspect of the present invention, in the endoscope treatment instrument according to the fourth aspect, the puncture needle is hollow, and the puncture needle can be inserted through the third treatment means.
The invention according to claim 6 is the endoscope treatment instrument according to claim 5, wherein the third treatment means is a suture thread.
According to a seventh aspect of the present invention, in the endoscope treatment tool according to the sixth aspect, the suture is provided with a tissue fixing member.
The invention according to claim 8 is the endoscope treatment instrument according to any one of claims 1 to 7, wherein the forceps member is provided with a space for projecting the second treatment means in a state where the forceps member is closed. It is characterized by that.
A ninth aspect of the present invention is the endoscope treatment instrument according to any one of the first to eighth aspects, wherein the restricting portion for restricting the protruding length of the second treatment means includes a distal end cover and a sheath of the treatment instrument. , And provided in at least one of the inner tubes.
A tenth aspect of the present invention is the endoscope treatment instrument according to any one of the first to ninth aspects, wherein a hollow distal end cover is fixed to the distal end of the sheath.
The invention according to claim 11 is the endoscope treatment instrument according to any one of claims 1 to 10, wherein an inner tube is provided in the sheath.
According to a twelfth aspect of the present invention, in the endoscope treatment instrument according to any one of the first to eleventh aspects, the forceps member is a pair of forceps members.
According to a thirteenth aspect of the present invention, in the endoscope treatment instrument according to the twelfth aspect, the pair of forceps members have a gripping surface that comes into contact with the tissue, and the second treatment means advances and retreats with respect to the sheath. The axial direction in which the second treatment means is freely arranged and crosses either one of the pair of gripping surfaces and an intermediate surface connecting the pair of gripping surfaces.
[0008]
DETAILED DESCRIPTION OF THE INVENTION
<First Embodiment>
(Constitution)
1 to 9 show an endoscopic treatment tool according to a first embodiment of the present invention.
As shown in FIG. 1, the endoscope treatment tool 4 of the present embodiment includes an insertion portion 3 that can be inserted into the forceps channel 56 (FIG. 9) of the endoscope 1 from the distal end, and a proximal end of the insertion portion 3. The first operation unit 11 and the second operation unit 7 are respectively fixed to the unit. The endoscope treatment tool 4 is inserted into the forceps channel 56 of the endoscope 1 through the treatment tool operation auxiliary tool 6 fastened to the endoscope 1.
[0009]
As shown in FIGS. 2 and 3, the insertion portion 3 has a forceps member 14 as a first processing means and a high-frequency knife 13 as a second processing means arranged at the distal end portion. A sheath 2 in which an inner tube 15 to be inserted is disposed inside, and a hollow distal end cover 17 that is disposed at the distal end of the sheath 2 and that penetrates the distal end portion of the inner tube 15 are provided. A pair of arm portions 14a of the forceps member 14 is attached to the distal end cover 17 so that an intermediate portion thereof is freely rotatable. A first operation wire 16 extending from the first operation unit 11 is connected to a base end portion of each arm portion 14 a of the forceps member 14, and a second end extending from the second operation unit 7 is connected to a base end portion of the high-frequency knife 13. An operation wire 19 is connected.
[0010]
The sheath 2 of the present embodiment is formed of a coil sheath having irregularities on the inner and outer surfaces of a metal wire (for example, made of stainless steel) having a round cross section, and is made of a polymer resin (for example, polyamide, high density / low). (Density polyethylene, polyester, polytetrafluoroethylene, tetrafluoroethylene-perfluoroalkyl vinyl ether copolymer, tetrafluoroethylene-hexafluoropropylene copolymer, etc.) may be coated. Even if a force acts in a direction in which the sheath 2 is compressed from the distal end portion and the proximal end portion of the sheath 2, the sheath 2 is formed in a structure that does not buckle.
[0011]
On the other hand, the sheath 2 is formed by, for example, crushing a metal wire (such as stainless steel) having a round cross section to make the wire cross section rectangular, and tightly winding the wire having such a rectangular cross section so that the inner and outer surfaces are not curved. A coil sheath formed in the above may be used. In this case, since the inner surface is formed in a smooth curved shape, the operation of the first operation wire 16 is easy. Further, when compared with a coil sheath formed of a wire having a round cross section, a coil sheath having a larger inner diameter can be realized by using the same wire strand diameter. Thereby, the operation of the first operation wire 16 is further facilitated.
[0012]
Further, the sheath 2 may be formed of, for example, a tube sheath formed of the above-described polymer resin. In this case, since the inner and outer surfaces of the sheath 2 are slippery, the insertion / removal operation of the endoscope 1 to / from the forceps channel and the operation of the first operation wire 16 are facilitated. Such a sheath 2 made of polymer resin may be embossed on the outer surface, and this embossing reduces the contact area with the inner surface of the forceps channel of the endoscope 1 and reduces the frictional resistance. The insertion and removal of the treatment instrument 4 can be facilitated.
[0013]
The sheath 2 can also be formed by, for example, a double tube sheath in which a wall portion is formed in a double structure of an inner layer and an outer layer, and a reinforcing member is interposed or embedded therebetween. In this case, the inner layer and the outer layer can be formed of the above-described polymer resin. Thereby, even when a force for compressing the sheath 2 along the axial direction is applied to the distal end portion and the proximal end portion of the sheath 2, the compression resistance is excellent as compared with the tube sheath in which the reinforcing member is not embedded. The sheath 2 does not buckle.
[0014]
Such a sheath 2 is formed to have an outer diameter that can be inserted into the forceps channel of the endoscope 1. The wall thickness of the sheath 2 is set according to the rigidity of the material, and in the case of the metal sheath 2, it can be formed to be approximately 0.2 to 0.5 mm. In the case of a sheath made of polymer resin, the wall thickness is about 0.3 to 0.6 mm, and by embedding a reinforcing member, the wall thickness can be reduced and the inner diameter of the sheath 2 can be increased. There is an advantage.
[0015]
The inner tube 15 disposed inside the sheath 2 can be formed by, for example, the above-described polymer resin tube. In this case, the inner and outer surfaces of the inner tube 15 are formed into a smooth curved surface that is easy to slide. Therefore, the insertion / removal of the high frequency knife 13 and the operation of the second operation wire 19 are facilitated. In addition, a projection 15 a against which a stopper 18 (described later) abuts is provided on the inner surface of the inner tube 15 on the distal end side. The protrusion 15a may be formed integrally with the inner tube 15 or may be formed of a separate member.
[0016]
The inner tube 15 made of the polymer resin may be embossed on the inner surface, and by performing such embossing, the contact area between the high-frequency knife 13 and the second operation wire 19 inserted into the inner tube 15 is reduced. Therefore, the operation of the high-frequency knife 13 and the second operation wire 19 is facilitated.
[0017]
Further, the inner tube 15 may be formed of a coiled tube having irregularities on the inner and outer surfaces, in which a metal wire (such as stainless steel) having a round cross section is tightly wound, for example, at the distal end and the proximal end. Even if a force in the direction of compressing the inner tube 15, that is, an axial force is applied, the inner tube 15 does not buckle.
[0018]
On the other hand, the inner tube 15 is a curved surface having a concave and convex inner and outer surfaces by, for example, crushing a metal wire (such as stainless steel) having a round cross section to make the wire cross section rectangular, and winding the wire having such a rectangular cross section tightly. You may form with the coiled tube formed in the shape. In this case, since the inner surface is formed into a smooth curved surface, the operation of the second operation wire 19 inserted into the inside is easy. In addition, a coil tube having a large inner diameter can be realized even when the same wire diameter is used as compared with a coil tube formed of a wire having a round cross section. Thereby, the insertion / removal of the high frequency knife 13 as the second treatment means or the operation of the second operation wire 19 is further facilitated.
[0019]
The inner tube 15 can also be formed, for example, by a double wall tube in which a wall portion is formed in a double structure of an inner layer and an outer layer, and a reinforcing member is interposed or embedded between them. In this case, the inner layer and the outer layer can be formed of the above-described polymer resin. Thereby, even when a force that compresses the inner tube 15 in the axial direction is applied to the distal end portion and the proximal end portion of the inner tube 15, the compression resistance is higher than that of the double wall tube in which the reinforcing member is not embedded. The inner tube 15 is not buckled.
[0020]
Such an inner tube 15 is formed to have an outer diameter that can be inserted into the sheath 2. The wall thickness of the inner tube 15 is set according to the rigidity of the material, and in the case of a metal inner tube, it can be formed to be approximately 0.1 to 0.5 mm. In the case of a polymer resin tube, the wall thickness is about 0.1 to 0.6 mm. By embedding a reinforcing member, the wall thickness can be reduced and the inner diameter of the inner tube 15 can be increased. There is an advantage that you can.
[0021]
The high-frequency knife 13 as the second processing means is connected to the distal end portion of the second operation wire 19 via the stopper 18.
The high-frequency knife 13 is preferably formed of a metal (such as stainless steel) wire having a round cross section and having a good conductivity, and has an outer diameter of approximately 0.2 to 2.0 mm. The high-frequency knife 13 may be formed in a spatula shape with, for example, a metal having good conductivity. In this case, the width is approximately 0.2 mm to 2.0 mm, and the thickness is approximately 0.3 to 2 mm. It is preferably 0 mm.
[0022]
The stopper 18 that connects the high-frequency knife 13 and the second operation wire 19 is formed in, for example, a metal pipe shape, and has an outer diameter formed to a size that can be accommodated in the inner tube 15, and the high-frequency knife 13 and the second operation wire 19. And an inner diameter formed so as to allow the operation wire 19 to be inserted.
[0023]
The second operation wire 19 of the present embodiment is formed of, for example, a metal wire having a round cross section in which the stopper 18 is disposed at the tip, and the outer diameter is about 0.2 to about the extent that the outer tube can be accommodated in the inner tube 15. 2.0 mm. When the second operation wire 19 is slid toward the distal end side in the inner tube 15, the stopper 18 provided at the distal end contacts the protruding portion 15 a that protrudes from the inner surface on the distal end side of the inner tube 15. Touch. This restricts the tip of the second operation wire 19 from sliding beyond the protrusion 15a in the tip direction.
[0024]
The second operation wire 19 may be coated with the above-described polymer resin. In this case, the slidability of the second operation wire 19 can be improved. In this case, the thickness of the coating layer is preferably about 0.05 to 0.3 mm. Further, the second operation wire 19 may be inserted into the above-described thin tube made of polymer resin. Also in this case, the slidability of the second operation wire 19 can be improved. The thickness of such a thin tube is preferably about 0.05 to 0.3 mm.
[0025]
The tip cover 17 attached to the tip of the sheath 2 is formed of a hollow metal part. The outer surface of the tip cover 17 is electrically insulated by, for example, ceramic coating. In the present embodiment, the distal end cover 17 is formed to have an inner diameter of, for example, approximately 2.0 to 5.0 mm so that the inner tube 15 can be inserted, and the outer diameter is formed to be approximately the same as that of the sheath 2. . Moreover, it is preferable that the thickness of the ceramic coating formed on the outer surface of the tip cover 17 is approximately 0.05 to 0.2 mm.
[0026]
The tip cover 17 may be coated with the above-described polymer resin, and the thickness of the coating layer in this case is preferably approximately 0.05 to 0.2 mm. When the coating layer is formed of such a polymer resin, it has good slipperiness and facilitates insertion / removal of the treatment instrument 4. Further, the tip cover 17 may be entirely formed of the above-described polymer resin, and in this case, insulation and productivity can be improved.
[0027]
The distal end cover 17 of the present embodiment has recesses 17a formed on both sides on the distal end side, and the arm portion 14a of the forceps member 14 is attached to the recesses 17a. The forceps member 14 is formed as a metal part having a length of approximately 3 to 30 mm, and an uneven shape suitable for grasping a living tissue is formed on the mutually facing inner surfaces of each arm portion 14a. is there. The outer surface is electrically insulated by a ceramic coating layer having a thickness of approximately 0.05 to 0.2 mm, for example.
[0028]
Further, the forceps member 14 may be coated with the above-described polymer resin. In this case, good slidability is obtained, and the treatment instrument 4 can be easily inserted and removed. In this case, the thickness of the coating layer is preferably about 0.05 to 0.2 mm. Furthermore, the forceps member 14 may be formed of the above-described polymer resin, and in this case, insulation and productivity can be improved.
[0029]
In the present embodiment, the first operation wire 16 connected to each arm portion 14a of the forceps member 14 is formed of, for example, a metal wire having a round cross section, and has an outer diameter that can be accommodated in the sheath 2. It is formed to 0.2 to 2.0 mm.
The first operation wire 16 may be covered with the above-described polymer resin, and in this case, the slidability of the first operation wire 16 can be improved. In this case, the thickness of the coating layer is preferably about 0.05 to 0.3 mm. Moreover, the 1st operation wire 16 may be penetrated in the thin tube formed with the above-mentioned polymer resin, and can improve slidability also in this case. The thickness of the thin tube is preferably about 0.05 to 0.3 mm.
[0030]
As shown in FIG. 4, the first operation portion 11 for operating the first operation wire 16 is attached to the proximal end portion of the sheath 2 and has an operation portion main body 21 engraved with a ratchet, and the operation portion main body 21. A ring 29 attached to the base end portion of the operation portion main body 21 so as to be rotatable about the axis of the operation portion main body 21, and an operation portion that is connected to the base end portion of the first operation wire 16 and slides on the operation portion main body 21. Engaging means 12. The operating portion engaging means 12 is fixed to the proximal end portion of the operating wire 16 connected to the forceps member 14, and slides on the first slider 28 that slides on the operating portion main body. The first slider 28 is provided with a coil spring 22 and a latch 24 urged by the coil spring 22 in a direction to engage the ratchet. A pin 25 is provided, and when the second slider 26 moves on the first slider 28 in the direction of the tip, the latch 24 moves against the biasing force of the coil spring 22 to engage with the ratchet. It can be canceled.
[0031]
The operation unit main body 21 is formed of, for example, the above-described rod-shaped member made of a polymer resin, and a ratchet is engraved on at least one surface thereof. Further, a cleaning port 20 is formed at the distal end portion close to the sheath 2, and a claw for rotatably mounting the ring 29 is disposed at the proximal end portion on the opposite side. The outer diameter of the operation portion main body 21 is formed to be large enough to be accommodated in the first slider 28, and the diameter is formed to be approximately 5 to 20 mm.
[0032]
The operation portion main body 21 may be formed of a separate member made of metal such as stainless steel or brass in the ratchet portion, and in this case, wear of the ratchet can be prevented.
[0033]
The ring 29 of the present embodiment is formed of the above-described ring-shaped member made of a polymer resin, and is provided with a notch for freely attaching to the operation unit main body 21.
[0034]
The first slider 28 slidable on the operation unit main body 21 is a cylindrical member in which the proximal side, that is, the base end of the first operation wire 16 is fixed. In the present embodiment, the first slider 28 is formed of the above-described polymer resin. It is. A projection 27 is provided at the base end portion of the operation portion main body 21 so as to abut against the second slider 26 and restrict the sliding of the second slider 26. The inner diameter of the first slider 28 is formed to be about 5 to 20 mm so that the operation portion main body 21 is inserted, and the outer diameter is formed to be inserted into the second slider 26 and formed at the base end portion. The outer diameter of the protrusion 27 is formed larger than the inner diameter dimension of the second slider 26.
[0035]
The latch 24 that engages with the ratchet of the operation unit main body 21 is formed of an L-shaped member made of a metal material such as brass or stainless steel that is rotatably attached to the first slider 28 by a latch shaft 23. The latch 24 has at least one locking claw on the surface of the leg portion that contacts the ratchet on the operation unit main body 21, and is biased by the coil spring 22 so that the locking claw is engaged with the ratchet. Has been. The coil spring 22 is formed of a metal coil having one end in contact with the other leg of the latch 24 of the first slider 28, and the outer diameter of this coil is within the mounting hole of the first slider 28. It is formed to be about 3 to 10 mm that can be inserted.
[0036]
The coil spring 22 may be an elastic member made of the above-described polymer resin. In this case, as long as the leg portion of the latch 24 can be urged, it can be formed not only as a coil shape but also as an elastic member having an appropriate shape. Such an elastic member can be manufactured at low cost.
[0037]
The second slider 26 is preferably formed in a cylindrical shape from the above-described polymer resin, and is fixed on the first slider 28 so as to be slidable in the axial direction over a predetermined range and not to rotate. The inner diameter of the second slider 26 can be about 5 to 50 mm so that the first slider 28 can be inserted. Further, the second slider 26 includes a pin 25 on a surface portion that abuts on the latch 24.
[0038]
The pin 25 of this embodiment is formed in a round pin shape with an outer diameter of a cylindrical outer shape of approximately 8 to 10 mm by the above-described polymer resin, and is mounted at a position where it abuts on the latch 24 on the second slider 26. . The pin 25 may be formed of the above-described metal, and in that case, wear can be prevented.
[0039]
On the other hand, as shown in FIG. 1, the second operation portion 7 for operating the second operation wire 19 includes a second operation portion main body 8 fixed to the proximal end portion of the sheath 2 and a second operation portion main body 8. The second ring 10 is attached to the base end portion of the second operation wire so as to be rotatable about the axis, and the slider 9 is connected to the second operation wire 19 and slides on the second operation portion main body 8.
[0040]
The second operation section main body 8 is a rod-shaped member made of, for example, the above-described polymer resin, and has a cleaning port at a distal end portion close to the sheath 2 and a claw for attaching the second ring 10 to a proximal end portion. Is attached. The outer diameter of the operation portion main body 8 is such that it can be accommodated in the slider 9, and the diameter is approximately 5 to 20 mm. The second ring 10 is a ring-shaped member made of the above-described polymer resin, and is provided with a notch for freely attaching to the second operation portion main body 8.
[0041]
The slider 9 that slides on the second operation portion main body 8 is formed in a cylindrical shape from the above-described polymer resin, and has an inner diameter of about 5 to 20 mm to which the second operation portion main body 8 is inserted.
[0042]
5 to 9 show an operation assisting tool 6 for fixing the treatment instrument 4 to the endoscope 1 and a base portion 55 of the endoscope 1 to which the operation assisting tool 6 is attached.
As shown in FIGS. 5 to 8, the operation assisting tool 6 includes a base 31, an endoscope connecting portion 30 provided at the distal end portion of the base 31 on the scope contact surface side, and an O-ring on the outer peripheral portion. A substantially cylindrical main body 41 formed with a groove for disposing 37 and inserted into the base 31; a base cover 32 fixed to the base 31 with a screw 38 and rotatably holding the main body 41 in the base 31; A rotary handle 33 having a tapered inner peripheral surface that slides on the main body 41 and on which a fastener 40 described later slides, and a handle stopper that is fixed to the base end portion of the main body 41 and restricts the sliding position of the handle 33 34, a tube 39 fixedly disposed in the axial hole of the main body 41, for example, and a radial inner hole of the main body 41, and the tapered inner peripheral surface of the rotary handle 33 and the tube 39. Both sides And abutment to Teiketsuko 40, composed of the insertion hole closed forceps valve 35. When the sheath 2 is not inserted.
[0043]
As shown in FIG. 8, the endoscope connecting portion 30 includes a fitting hole 43 provided at the tip of the base 31, a packing 36 fitted to the inner bottom portion of the fitting hole 48, The sliding member 45 is guided on the base 31 by a sliding guide formed on the periphery of the fitting hole 48. The fitting hole portion 43 accommodates the protruding portion 52 protruding from the base 54 of the base portion 55 shown in FIG. 9 and the tip flange portion 52 thereof, and seals the flange portion 52 by contacting the packing 36. be able to. The slide member 45 includes guide grooves 48 and 49 through which slide guides formed in the base 31 are inserted, and an engagement hole 46 and a large-diameter hole 50 formed between the guide grooves. The engaging hole portion 46 can be inserted through the protruding portion 51 of the base portion 55 and has a smaller diameter than the flange portion 52, while the large diameter hole portion 50 can be inserted through the flange portion 52 of the base portion 55. FIG. 8 shows the dimensions aligned with the fitting hole 43 of the base 31. The large-diameter hole portion 50 and the engagement hole portion 46 communicate with each other, and the projecting portion 51 of the base portion 55 is connected to the engagement hole portion 46 by moving the slide member 45 along the guide grooves 48 and 49. It arrange | positions at one side with the large diameter hole part 50. FIG.
[0044]
When the operation assisting tool 6 is attached to the cap 55 of the endoscope 1 shown in FIG. 9 via the endoscope connecting portion 30, the flange portion 52 of the cap 55 is attached to the packing 36 in the fitting hole 43. Are moved along the sliding guides of the base member 31 while sliding the guide grooves 48 and 49 of the slide member 45 to align the small diameter hole portion 46 with the fitting hole portion 43 of the base 31. Thereby, the collar part 52 is latched by the slide member 45, and the operation assisting tool 6 is attached to the base part 55. The operation assisting tool 6 prevents air from flowing into the forceps channel 56 from the outside of the endoscope 1 through the fitting hole portion 43 of the base 31 and the through hole 53 of the base portion 55. When removing the operation assisting tool 6, the slide member 45 is slid to the position shown in FIG. 8 and the large-diameter hole 50 is aligned with the fitting hole 48. Thereby, engagement with the collar part 52 of the nozzle | cap | die part 55 can be cancelled | released.
[0045]
The base 31 of the operation assisting tool 6 can be formed of, for example, the above-described cylindrical member made of polymer resin, has a screw hole into which the screw 38 is screwed, and has an inner diameter of approximately 3 into which the main body 41 can be inserted. It is ˜20 mm and the outer diameter is about 5 to 40 mm.
[0046]
The base cover 32 that rotatably holds the main body 41 on the base 31 is formed of, for example, a cylindrical member made of the above-described polymer resin, and the screw 38 is inserted into a position aligned with the screw hole of the base 31. With holes to do. The base cover 32 preferably has an inner diameter of approximately 3 to 20 mm into which the main body 41 can be inserted and an outer diameter of approximately 5 to 40 mm.
[0047]
These screws 38 are formed with a male screw at the cylindrical tip, and are shorter than the total dimension of the thickness of the base cover 32 and the thickness of the base 31 by, for example, the above-described metal material or polymer material. Formed.
[0048]
The slide member 45 of the endoscope connection portion 30 is formed from the above-described polymer resin plate-like member that is slidably provided on the base 31. Moreover, the main body 41 is formed by the above-mentioned polymer resin cylindrical member inserted into the base 31, and has an outer diameter of 3 to 20 mm that can be inserted into the base. The O-ring 37 press-fitted into the circumferential groove of the main body 41 is an elastic member made of, for example, the above-described polymer resin or silicon resin.
[0049]
The rotary handle 33 slidably provided on the main body 41 is formed in a ring shape having an inner diameter enough to allow the main body 41 to be inserted by the above-described polymer resin, and an inner peripheral surface for operating the fastener 40. The length of the tapered portion formed in a part of the shaft is longer than the outer diameter of the fastener 40 in the axial direction. The tube 39 disposed in the main body 41 is formed as a cylindrical elastic member made of, for example, the above-described polymer resin or silicon, and has an inner diameter of approximately 1.2 to 6.0 mm to which the treatment instrument 4 can be inserted. Have
[0050]
The fastener 40 is a cylindrical member made of, for example, the above-described polymer resin that is inserted into a hole opened on the main body 41 and contacts the rotary handle 33 and the tube 39, and is provided on the inner peripheral surface of the rotary handle 33. Slide along the tapered portion. As shown in FIG. 6, when the fastener 40 is disposed at the position where the inner diameter of the tapered portion of the handle 33 is the largest, the inner end portion is disposed substantially on the same surface as the inner peripheral surface of the main body 41. Therefore, the tube 39 is not pressed. On the other hand, the inner end portion of the fastener 40 protrudes inward from the inner peripheral surface of the main body 41 when the taper-shaped portion of the rotary handle 33 is disposed at the position having the smallest inner diameter, and presses the tube 39 to be elastic. By deforming, the treatment instrument 4 inserted inside the tube 39 is fixed. The outer diameter of the fastener 40 is preferably about 1 to 10 mm.
[0051]
Further, the forceps plug 35 attached to the base end portion of the main body 41 is a member made of a suitable material such as silicon or rubber, for example, in the same manner as a forceps plug generally used for an endoscope forceps opening. It may be.
[0052]
(Function)
10 to 12 show the action of the above-described treatment instrument 4 when treating a living tissue, FIG. 10 shows a state where the living tissue is gripped, FIG. 11 shows a state where a high-frequency knife is used, and FIG. The state in which all layers are incised is shown.
[0053]
When treating a living tissue, first, the endoscope connecting portion 30 provided in the treatment tool operation assisting tool 6 shown in FIGS. 5 to 8 is brought into contact with the base portion 55 of the endoscope 1 shown in FIG. The slide member 45 is slid to fix the treatment instrument operation assisting tool 6 to the endoscope 1. At this time, the endoscope connecting portion 30 provided in the treatment instrument operation assisting tool 6 is arranged so that the large-diameter hole portion 50 of the slide member 45 faces the fitting hole portion 43 of the base 31 and is coaxial. . In this state, the large-diameter hole 50 of the slide member 45 and the fitting hole 43 of the base 31 are placed on the base 55 of the endoscope 1, and the tip of the base 31 is brought into contact with the pedestal 54.
[0054]
Subsequently, the slide member 45 is slid along the guide direction between the slide guides 42 and 44 of the base 31 and the guide grooves 48 and 49 of the slide member 45, and the engagement hole 46 and the fitting hole of the slide member 45 are fitted. The part 43 is positioned coaxially. At this time, with the flange portion 52 of the base portion 55 inserted into the fitting hole portion 43 of the base 31, the engagement hole portion 46 of the slide member 45 is engaged with the protrusion portion 51 of the base portion 55. To do. Thereby, the endoscope connecting portion 30 of the treatment instrument operation assisting tool 6 is reliably fixed to the base portion 55 of the endoscope 1.
[0055]
Further, when the engagement hole 46 of the slide member 45 is engaged with the protrusion 51 of the base 55 as described above, the flange 52 is held in pressure contact with the packing 36 in the fitting hole 43. The At this time, the packing 36 receives a pressing force from the side of the flange 52 and presses the base 31, so that the air flow from the outside to the forceps channel 56 through the fitting hole 43 and the through hole 53 is blocked.
[0056]
Next, the treatment tool 4 is inserted into the endoscope 1 through the treatment tool operation assisting tool 6, the distal end portion of the treatment tool 4 is positioned in the vicinity of the target portion, and the first operation unit 11 shown in FIG. The second slider 26 is pushed forward. As a result, the pin 25 protruding from the second slider 26 pushes in the latch 24 provided in the first slider 28. The latch 24 rotates about the latch shaft 23, and the latching claw is released from the ratchet formed in the operation portion main body 21, and the engagement between the first slider 28 and the operation portion main body 21 is released. 4B, the second slider 26 is pushed together with the first slider 28 toward the distal end of the operation unit main body 21. As shown in FIG. When the first operation wire 16 coupled to the first slider 28 is also pushed, the forceps member 14 connected to the distal end portion of the first operation wire 16 is opened.
[0057]
When it is difficult to grasp the target site of the living tissue, the rotary handle 33 of the treatment tool operation assisting tool 6 is pulled, and the fastener 40 is pushed inward by the tapered inner peripheral surface of the rotary handle 33. By squeezing the tube 39 in contact with the end, the sheath 2 inserted into the tube 39 is fastened. This state is shown in FIG.
When the rotary handle 33 is rotated in this state, the rotational force is transmitted to the sheath 2 through the tube 39, and the forceps member 14 attached to the distal end of the sheath 2 is rotated together with the sheath 2 so that each arm of the forceps member 14 is rotated. The direction of the portion 14a can be adjusted to the target site.
[0058]
After the forceps member 14 is arranged in the direction corresponding to the target site, the second slider 26 is pulled, whereby the first slider 28 that contacts the second slider 26 and the first operation wire 16 connected to the first slider 28 are connected. Is pulled, each arm portion 14a of the forceps member 14 connected to the tip of the first operation wire 16 is closed, and the forceps member 14 holds the target portion as shown in FIG. At this time, the latch 24 biased by the coil spring 22 in the first slider 28 is engaged with a ratchet provided in the operation unit main body 21, whereby the operation unit main body 21 and the first slider 28 are fixed, and forceps The member 14 is held in a state where the living tissue is gripped. Thereby, even if the external force which pulls the 2nd slider 26 stops acting, the forceps member 14 does not open.
[0059]
When the second slider 26 is in contact with the protrusion 27 provided at the base end portion of the first slider 28, the pin 25 provided in the second slider 26, the latch 24 provided in the first slider 28, and Is approximately 0.5 mm or more apart. For this reason, even if the second slider 26 is slid, the latch 24 does not immediately release the engagement with the ratchet, and the pin 25 provided on the second slider 26 and the latch 24 do not contact each other. The operator can be alerted by the feeling of operation transmitted to the hand when touched and the sound generated at that time.
[0060]
When the slider 9 (FIG. 1) provided in the second operation unit 7 is pushed out with the forceps member 14 closed, the second operation wire 19 connected to the slider 9 is pushed out and connected to the tip of the second operation wire 19. The formed high frequency knife 13 protrudes. At this time, as shown in FIG. 3, the stopper 18 fixed to the base end of the high-frequency knife 13 comes into contact with the protrusion 15 a provided on the inner surface of the inner tube 15, and regulates the protruding length of the high-frequency knife 13. . In this state, as shown in FIG. 13, the target site is incised with the high-frequency knife 13, and after the incision is completed, the treatment tool 4 is removed from the endoscope 1 to complete the treatment.
[0061]
(effect)
According to the above-described embodiment, by grasping and treating the target portion of the living tissue with the grasping forceps 14 provided in the treatment tool 4, the approach to the target portion of the high-frequency knife 13 is facilitated, and the operability is improved. An excellent treatment tool is formed.
Further, by providing the operation unit engaging means 12 in the first operation unit 11, even when the operation unit 11 is released, the gripping state of the forceps member 14 can be maintained, and the operability is improved. In addition, when the grasping state of the forceps member 14 is released, no special button operation is required, and it can be released simply by sliding the second slider 26 in the distal direction, thereby forming a treatment instrument with extremely excellent operability. Is done.
Furthermore, when the forceps member 14 needs to be rotated, the sheath 2 is fastened to the main body 41 with the fastener 40 of the treatment tool operation assisting tool 6 and the forceps member 14 is reliably rotated by only operating the rotary handle 33. Therefore, a treatment tool with excellent operability is formed.
[0062]
Second Embodiment
Next, a second embodiment of the present invention will be described with reference to FIGS. Note that in the various embodiments described below, the same reference numerals are given to the same configurations as those in the first embodiment, and detailed descriptions thereof are omitted.
[0063]
(Constitution)
13 and 14 show the distal end portion of the endoscope treatment tool according to the present embodiment, respectively. The endoscope treatment tool 4 according to the present embodiment includes an insertion portion 3, a first operation portion 11, and a second operation portion 7 as in the first embodiment.
[0064]
The insertion portion 3 includes a sheath 2 having an inner tube 15, a hollow tip cover 17 that is positioned at the tip of the sheath 2 and passes through the tip of the inner tube 15, and a pair of arm portions 14 a on the tip cover 17. The forceps member 14 is rotatably fixed and includes a first operation wire 16 connected to a proximal end portion of the forceps member 14.
[0065]
A puncture needle 59 is inserted into the inner tube 15 so as to freely advance and retreat, and a second operation wire 19 formed of a thin tubular member having a hollow structure is connected to the proximal end portion of the puncture needle 59. Further, a suture thread 58 having a tissue fixing means 57 at its distal end is inserted through the puncture needle 59 so as to freely advance and retract.
[0066]
The puncture needle 59 is formed of a pipe-shaped member made of a suitable metal material such as a Ni-Ti alloy or stainless steel, which is coupled to the distal end portion of the second operation wire and is freely inserted into and retracted into the inner tube 15. Yes, its tip is cut at a sharp angle. The puncture needle 59 in this embodiment has an outer diameter of approximately 0.5 to 3.0 mm so that it can be inserted into the inner sheath, and an inner diameter of approximately 0.3 to 2 that allows the tissue fixing means 57 to be inserted. .5mm.
[0067]
The tissue fixing means 57 is connected to the distal end portion of the suture thread 58 and is inserted into the puncture needle 59 with the suture thread 58 so as to freely advance and retreat, for example, a rod-shaped member made of a metal material such as stainless steel or the aforementioned polymer resin. The outer diameter is formed to be about 0.3 to 2.5 mm so as to be inserted through the puncture needle.
[0068]
The distal end portion of the suture thread 58 is connected to the tissue fixing means 57, the proximal end portion protrudes from the second operation portion 7 (FIG. 1), and is inserted into the puncture needle 59 together with the tissue fixing means 57 so as to freely advance and retract. The suture thread 58 is formed of a thread-like member made of, for example, silk or nylon, and has an outer diameter of about 0.2 to 2.0 mm that can be inserted into the puncture needle.
[0069]
(Function)
FIGS. 15 to 19 show the operation of the treatment tool 4 of the second embodiment when treating a living tissue, FIG. 15 shows a state in which a target site is gripped by the forceps member 14, and FIG. 16 shows the purpose of the puncture needle 59. FIG. 17 shows a state where the tissue fixing means 57 is left in the living body, FIG. 18 shows a state where the target site is incised with a high-frequency needle scalpel, and FIG. 19 shows a case where the entire layer is punctured. The state where the fixing means is indwelled is shown.
[0070]
When treating a living tissue, first, similarly to the above-described embodiment, the endoscope connection part 30 provided in the treatment tool operation assisting tool 6 is brought into contact with the endoscope 1 and the endoscope connection part 30 is The slide member 45 is slid to fix the treatment instrument operation assisting tool 6 to the endoscope 1. In addition, it is preferable to use what has two channels for forceps for the endoscope 1 which penetrates the treatment tool 4 of this embodiment.
[0071]
Next, the treatment tool 4 is inserted into the endoscope 1 through the treatment tool operation assisting tool 6, the distal end portion of the treatment tool 4 is disposed in the vicinity of the target site, and the second slider 26 of the first operation unit 11 is moved forward. Extrude into. As a result, the pin 25 provided on the second slider 26 pushes the latch 24 provided on the first slider 28, rotates the latch 24 about the latch shaft 23, and is provided on the operation portion main body 21. Disengage the locking claw from the ratchet. As a result, the second slider 26 is pushed together with the first slider 28 in the distal direction. When the first slider 28 pushes out the first operation wire 16 connected to the distal end portion thereof, the forceps member 14 connected to the distal end of the first operation wire 16 is opened.
[0072]
When it is difficult to grasp the target site of the living tissue, the fastener 40 is pushed inward in the radial direction by pulling the rotary handle 33 of the treatment tool operation assisting tool 6. As a result, the tube 39 in contact with the distal end portion of the fastener 40 is crushed, and the sheath 2 inserted into the tube 39 is fastened.
[0073]
When the rotary handle 33 is rotated in this state, the rotational force is transmitted to the sheath 2 through the tube 39, and the forceps member 14 attached to the distal end portion of the sheath 2 is rotated together with the sheath 2. The direction of the arm portion 14a can be adjusted to the target site.
[0074]
After the forceps member 14 is arranged in a direction corresponding to the target site, the second slider 26 is pulled, so that the first slider 28 that contacts the second slider 26 and the first operation wire 16 connected to the first slider are moved. Each arm portion 14a of the forceps member 14 that is pulled and connected to the distal end of the first operation wire 16 is closed, and the forceps member 14 holds the target site as shown in FIG. At this time, since the latch 24 biased by the coil spring 22 meshes with the 21 ratchet provided on the operation portion main body 21, the forceps member 14 opens even if an external force pulling the second slider 26 does not act. There is nothing.
[0075]
When the slider 9 (FIG. 1) provided in the second operation unit 7 is pushed out in this state, the second operation wire 19 connected to the slider 9 is pushed out, and as shown in FIG. A puncture needle 59 connected to the tip of 19 is projected into the living body.
[0076]
After the puncture needle 59 is punctured to the target site, the suture thread 58 is drawn forward, whereby the tissue fixing means 57 connected to the distal end of the suture thread 58 can be placed in the living body as shown in FIG. .
[0077]
Next, the second slider 26 is pushed forward, the forceps member 14 is opened, and when it is confirmed that the target site is detached from the forceps member 14, the second slider 26 is pulled, the forceps member 14 is lightly closed, and the treatment instrument 4 is removed. When pulled, the required living tissue can be pulled from the living body as shown in FIG.
[0078]
In this state, as shown in FIG. 18, a high-frequency needle scalpel is inserted from the other forceps channel of the endoscope 1 to incise the target site. After the incision is completed, the treatment is completed by removing the treatment tool 4 from the endoscope 1.
[0079]
(effect)
According to the second embodiment, the grasping forceps 14 provided in the treatment instrument 4 grasps and treats the target portion of the living tissue, thereby facilitating the approach of the puncture needle 59 to the target portion. A treatment tool with excellent properties is formed.
[0080]
Since the first operation unit 11 includes the operation unit engaging means 12, even when the operation unit 11 is released, the gripping state of the forceps member 14 can be maintained, and the operability is improved. Further, when releasing the grasping state of the forceps member 14, a special button operation is not required and the second slider 26 can be released simply by sliding in the distal direction. It is formed.
[0081]
Further, when the forceps member 14 needs to be rotated, the sheath 2 is fastened to the main body 41 with the fastener 40 of the treatment tool operation assisting tool 6 and the rotation handle 33 is operated, so that the forceps member 14 is reliably rotated. Thus, a treatment tool with excellent operability is formed.
[0082]
<Example 3>
Next, a third embodiment of the present invention will be described with reference to FIGS.
(Constitution)
FIG. 20 shows the entirety of the treatment tool operation assisting tool 6 according to the present embodiment, and FIGS. 21 and 22 show a state where the treatment tool operation assisting tool 6 is contracted and extended, respectively.
[0083]
The treatment tool operation assisting tool 6 in the present embodiment is substantially the same as in the first embodiment, but the main body 41 inserted into the base 31 is axially moved by the base cover 32 fixed to the base 31 with screws 38. It is slidably fixed to the circumferential direction.
The length of the base cover 32 is preferably about 20 to 300 mm, which is about the same as the amount of movement for moving the treatment instrument 4 back and forth during the treatment. The length of the main body 41 held by the base cover 32 is preferably about 20 to 300 mm so as to fit in the base cover 32.
[0084]
(Function)
The treatment tool operation assisting tool 6 according to the present embodiment can operate the treatment tool 4 not only by rotating the rotary handle 33 but also by moving it forward and backward.
[0085]
(effect)
When it is necessary to rotate or advance or retract the forceps member 14, the sheath 2 is fastened by the fastener 40 of the treatment instrument operation assisting tool 6, the main body 41 is rotated via the rotary handle 33, or the main body together with the rotary handle 33 is used. The operability is improved because the forceps member 14 can be reliably operated simply by moving the 41 forward and backward with respect to the base cover 32.
[0086]
<Example 4>
FIG. 23 shows a fourth embodiment of the present invention.
(Constitution)
FIG. 23 shows the distal end portion of the forceps member 14 in which the insertion groove of the second treatment means is formed. The forceps member 14 of the present embodiment is substantially the same as the forceps member of the first embodiment described above, but a groove through which the second treatment means can be inserted into the contact surfaces of the arm portions 14a of the forceps member 14 facing each other. Is formed. In the present embodiment, the second treatment means is formed of a high-frequency knife 13 having a circular cross section, and the insertion groove of the second treatment means formed in the forceps member 14 is substantially zero enough to allow the high-frequency knife 13 to be inserted. It is formed to a depth of 2 to 3 mm.
[0087]
(Function)
When a living tissue is treated through the forceps member 14, the target portion of the living tissue is treated by projecting the high-frequency knife 13 as the second treatment means with the forceps member 14 closed.
(effect)
According to the present embodiment, even when the forceps member 14 is closed, the second treatment means that is, for example, the high-frequency knife 13 can be protruded, and the operability is improved.
[0088]
<Example 5>
FIG. 24 shows a fifth embodiment of the present invention.
(Constitution)
In this embodiment, in addition to the third example, an operation unit fixing unit 60 for fixing the operation unit 11 of the endoscope treatment tool 4 is provided on the rotary handle 33 of the treatment tool operation assisting tool 6. Is.
[0089]
(Function)
In the present embodiment, by fixing the operation unit 11 of the endoscope treatment tool 4 to the treatment tool operation assisting tool 6, both the operation through the operation unit 11 and the operation through the assisting tool 6 are mutually performed. This can be done in close proximity.
(effect)
Therefore, according to the present embodiment, there is no need to operate the treatment instrument 4 in cooperation with an assistant, and even one person can operate the treatment instrument 4 quickly and reliably, improving operability.
[0090]
It should be noted that the present invention is not limited to the above-described embodiments, and it is obvious that various embodiments can be appropriately combined, and at least the following features can be obtained.
<Appendix>
1. An elongated sheath inserted into the body, at least one forceps member for gripping a living tissue operably provided at the distal end of the sheath, an operating means for operating the forceps member, and a proximal end of the operating means An endoscope treatment instrument comprising a first operation section, wherein the endoscope has a second operation means in the sheath and a second operation section for operating the second treatment means. Mirror treatment tool.
1-4, FIG. 13 and FIG. 14 are provided with grasping forceps coaxially with the treatment means in the endoscopic treatment tool according to the structure of the above-mentioned item 1, and the target living tissue with the grasping forceps. The treatment can be performed while grasping and fixing the device, and the treatment can be performed on the target portion in a short time, so that the procedure can be simplified.
2. 2. The endoscope treatment tool according to item 1, wherein the second treatment means is a high-frequency knife.
3. 2. The endoscope treatment tool according to item 1, wherein the treatment tool is a second treatment means and a puncture needle.
4). 4. The endoscopic treatment tool according to the item 3, wherein the puncture needle is hollow and the third treatment means can be inserted.
5). 5. The endoscope treatment tool according to item 4, wherein the third treatment means is a suture thread.
6). 6. The endoscope treatment tool according to 5 above, wherein a tissue fixing member is provided at a distal end of the suture thread.
7). 7. The endoscope treatment tool according to any one of 1 to 6 above, wherein a space for projecting the second treatment means is provided in the forceps with the forceps member closed.
8). 8. The endoscope treatment tool according to any one of the above items 1 to 7, wherein a restriction material for restricting the protruding length of the second treatment means is provided in at least one of the tip cover, the sheath, and the inner tube.
9. 9. The endoscope treatment tool according to any one of 1 to 8 above, wherein a hollow distal end cover is fixed to the distal end of the sheath.
10. The endoscopic treatment tool according to any one of claims 1 to 9, wherein an inner tube is provided in the sheath.
11. The endoscopic treatment tool according to any one of claims 1 to 10, wherein the forceps member is a pair of forceps members.
[0091]
The following items 12 to 16 relate to the operation portion of the endoscope treatment tool that pushes and pulls the operation wire of the transendoscopic treatment tool, and in particular, the operation slide member to which the operation wire is connected. The present invention relates to an operation portion of an endoscope treatment tool including a ratchet mechanism for engaging with a predetermined position of an operation portion main body.
Generally, there is a configuration disclosed in, for example, Japanese Utility Model Laid-Open No. 5-5105 as an operation unit of an endoscope treatment tool. As shown in FIG. 27, the operation portion h includes an operation portion main body k in which a ratchet is engraved, a second slider i that slides on the operation portion main body, and an operation button j provided with a locking claw. Is done.
Next, an operation for sliding the operation unit h will be described.
When the operation portion h is operated in the first direction, the operation portion h is brought into an engaged state by the locking claw and the ratchet provided in the operation button j. When moving in the second direction opposite to the first direction, the operating portion h can be moved by releasing the engaged state by pressing the operation button j.
In the configuration described in Japanese Utility Model Laid-Open No. 5-5105, when the operation unit i is slid in the second direction, the second slide must be slid while pressing the release button. The operation was complicated, such as having to.
[0092]
The following 12 to 16 items are intended to provide an endoscopic treatment tool excellent in operability.
The treatment instrument for an endoscope is a treatment instrument operation unit including a control unit main body and a second slider movably provided with respect to the operation unit main body, and the second direction of the second slider without external force being applied to the slider. An operating portion having an engaging means for preventing movement, wherein the engaging means has a releasing means for releasing the engagement when an external force for moving in the second direction is applied to the slider.
In the endoscope treatment tool having the operation means having the above-described configuration shown in FIG. 4, when being slid in the first direction, the engagement means is securely engaged by the engagement means, but the second direction When sliding the second slider, if the second slider is slid without any special operation, the engaging means is automatically released and the second slider can be slid in the second direction. The operability is improved, such as one-handed work without the need for work.
[0093]
12 An external force is applied to the slider in the treatment instrument operation portion including the operation portion main body and a slider that is slidable with respect to the operation portion main body in the first direction sliding in the proximal direction and the second direction sliding in the distal direction. Having engagement means for preventing the slider from moving in the second direction without being applied, and the engagement means has release means for releasing the engagement when an external force is applied to the slider in the second direction. An operation unit characterized by.
13. 13. The treatment instrument operation part according to the item 12, wherein the engagement means includes an operation part main body in which a ratchet is engraved, and a rat 9 which is fixed on the slider so as to be freely disengageable from the ratchet.
14 14. The treatment instrument operation section according to any one of items 12 to 13, further comprising a second slider slidably provided on the slider, wherein the release means is provided on the second slider.
15. A pin is provided on the second slider, the second slider slides in the second direction, the pin operates the latch to release the engaging means, and the slider operates together with the second slider. The treatment instrument operation part of the said 12-14.
16. When the second slider is at the sliding limit in the first direction on the slider, the pin provided on the second slider and the latch provided on the slider are separated by 0.5 mm or more. The treatment tool operation part of 12-15.
[0094]
The following items 17 to 25 relate to an operation assistance tool for an endoscope treatment tool.
In general, there is an endoscope treatment tool having a configuration disclosed in, for example, Japanese Patent Laid-Open No. 5-31120. As shown in FIG. 28, the treatment instrument m includes an elongate sheath n inserted into the body, a forceps member l that can be opened and closed provided at the distal end of the sheath n, and a rear end of the sheath n. It is comprised from the operation part o provided in the end side and opening / closing the said forceps member l via the operation wire.
Next, a description will be given of an operation for gripping a living tissue by rotating the forceps member l and aligning the position using the treatment tool m having the above-described configuration.
The treatment tool m is inserted into the endoscope, and the operation part o is rotated under the endoscope observation, whereby the forceps member l is rotated and the position of the forceps member l is adjusted to the living tissue. Next, by operating the operation unit o, the forceps member l is opened and closed to grip the living tissue.
In the configuration shown in Japanese Patent Laid-Open No. 5-31120, when the forceps member of the treatment instrument is rotated, the sheath is twisted between the endoscope forceps plug and the operation portion even if the operation portion is rotated, Rotation followability is poor, and rotation is also generated, making it difficult to rotate to the target angle, making operation complicated.
The following items 17 to 25 are intended to provide a treatment tool operation assisting tool that improves operability.
This treatment tool operation assistance tool is an auxiliary tool for fixing an endoscope treatment tool to an endoscope forceps opening, and is provided with a main body having a hollow duct through which the treatment tool can be inserted, and the main body. It is characterized by comprising an endoscope connecting portion fastened to the endoscope and a treatment instrument fixing means provided rotatably with respect to the main body.
The treatment tool operation assisting tool having the above-described configuration shown in FIGS. 6 and 7 is obtained by fastening the operation assisting handle and the endoscope treatment tool by the treatment instrument fixing means and rotating the operation assisting handle. Rotation loss due to torsion occurring in the sheath can be prevented, and the endoscope treatment instrument can be operated, improving operability.
[0095]
17. An auxiliary tool for fixing an endoscope treatment tool to an endoscope forceps opening, and a main body having a hollow duct through which the treatment tool can be inserted, and an endoscope fastened to an endoscope provided in the main body A treatment tool operation assisting tool comprising a endoscope connection part and a treatment tool fixing means provided rotatably with respect to the main body.
18. 18. The treatment instrument operation assisting tool according to the above 17, wherein the treatment instrument fixing means has a rotating ring.
19. 19. The treatment instrument operation assisting tool according to any one of the items 17 to 18, wherein the endoscope connecting portion is an engaging means for a forceps opening of the endoscope.
20. The treatment instrument operation assisting tool according to any one of claims 17 to 19, wherein the treatment instrument fixing means is an elastic member and a pressing member for deforming the elastic member.
21. Item 21. The treatment instrument operation assisting tool according to Item 20, wherein the elastic member is a hollow tube.
22. The treatment tool operation assisting device according to any one of the items 20 to 21, wherein the pressing member is a pin member that can be protruded and retracted inside the main body.
23. An operating member having a tapered surface that contacts the pressing member is provided on the main body for moving the pressing member from a first position where the pressing member presses the elastic member to a second position separated from the elastic member. The treatment tool operation assisting tool according to 20 to 22 above.
24. 21. The treatment instrument operation assisting tool according to the item 20, wherein the rotating ring and the operating member are integrally provided.
25. 25. The treatment tool operation assisting tool according to the above 17 to 24, wherein the treatment tool fixing means is capable of moving in the axial direction with respect to the main body.
[0096]
The following items 26 and 27 relate to the operation unit fixing tool of the endoscope treatment tool.
In general, there is an endoscope treatment tool having a configuration disclosed in, for example, Japanese Patent Laid-Open No. 5-31120. As shown in FIG. 28, the treatment instrument m includes an elongate sheath n inserted into the body, a forceps member l that can be opened and closed provided at the distal end of the sheath n, and a rear end of the sheath n. It is comprised from the operation part o provided in the end side and opening / closing the said forceps member l via the operation wire.
Next, an operation for grasping a living tissue using the treatment tool m having the above-described configuration will be described.
The surgeon inserts the treatment tool m into the endoscope, the operator operates the advancement / retraction of the forceps member l while observing the endoscope, and the assistant operates the rotation to bring the forceps member l closer to the target site. After that, the assistant operates the operation unit o to open and close the forceps member l and grasp the living tissue.
In the configuration shown in Japanese Patent Laid-Open No. 5-31120, when using a treatment tool, at least one assistant is attached in addition to the surgeon, and the operation of the scope and the advancement / retraction of the treatment tool are performed by the surgeon and the treatment tool. It is usually necessary for an assistant to perform operations such as opening and closing and rotation of the treatment instrument. Also, when using a treatment tool, the operator and assistant often often collaborate with each other, making the use of the treatment tool complicated.
[0097]
In the following 26 and 27, one surgeon can easily perform operations such as advancement / retraction, rotation, opening and closing of the treatment tool together with the operation of the scope, and it can be expected to simplify the procedure, and the assistant is not necessarily Since it does not need to be fixed, it will lead to a reduction in labor costs at the facility, aiming to reduce the cost of the procedure.
The operation unit fixing tool is an auxiliary tool that fixes the operation unit of the endoscope and the endoscope treatment tool, and includes an endoscope locking unit that locks the endoscope and the auxiliary tool body, and an endoscope. And an operation unit fixing unit that fixes the operation unit of the mirror treatment instrument to the auxiliary instrument body.
The above-described operation unit fixing tool shown in FIG. 26 eliminates the need to operate the treatment tool in cooperation with an assistant by fixing the operation unit of the endoscope treatment tool to the operation unit fixing tool. improves.
[0098]
26. An auxiliary tool for fixing an endoscope and an operation part of the endoscope treatment tool, an endoscope locking part for locking the endoscope and the auxiliary tool body, and an operation part of the endoscope treatment tool An operation unit fixing tool, comprising: an operation unit fixing unit that fixes the device to the auxiliary tool body.
27. 26. The treatment tool operation assistance tool according to any one of the items 17 to 25, further comprising an operation part fixing unit that fixes an operation part of the endoscope treatment tool to the auxiliary tool.
[0099]
【The invention's effect】
According to the present invention, the grasping forceps are provided coaxially with the treatment means, the treatment can be performed while grasping and fixing the target biological tissue with the grasping forceps, and the treatment to the target site can be performed in a short time. And the procedure can be simplified.
[Brief description of the drawings]
FIG. 1 is an overall view of an endoscope treatment tool according to a first embodiment of the present invention.
FIG. 2 is an external view of a distal end portion of the treatment instrument shown in FIG.
3 is a cross-sectional view of the distal end portion of the treatment instrument shown in FIG.
4 shows a first operation portion of the treatment instrument of FIG. 1, in which (A) is a sectional view of a state in which a latch of the operation portion engaging means is engaged, and (B) is a state in which the latch engagement is released. Sectional drawing.
FIG. 5 is an external view of the treatment tool operation aid shown in FIG. 1;
6 is a cross-sectional view showing a state where the treatment tool operation assisting tool shown in FIG. 6 has opened the treatment tool.
7 is a cross-sectional view showing a state where the treatment tool operation assisting tool shown in FIG. 6 has fastened the treatment tool.
8 is a schematic perspective view of a distal end portion of the treatment instrument operation assisting instrument shown in FIG. 6. FIG.
FIG. 9 is an explanatory diagram of a cap portion of an endoscope to which the treatment tool operation assisting tool shown in FIG. 6 is attached.
10 is an explanatory view showing a state in which a living tissue is grasped using the treatment instrument shown in FIG. 1. FIG.
11 is an explanatory diagram of a state where a high-frequency knife is used from the state shown in FIG.
12 is an explanatory view showing a state in which all layers are incised using the treatment instrument shown in FIG. 1. FIG.
FIG. 13 is an explanatory view of the distal end portion of the treatment tool according to the second embodiment.
14 is a cross-sectional view of the treatment instrument of FIG. 13 in a state in which the tissue fixing means is retracted into the puncture needle.
FIG. 15 is an explanatory diagram of a state where a target site of a living tissue is grasped by a treatment tool according to a second embodiment.
16 is an explanatory view showing a state where a puncture needle is punctured with the treatment instrument shown in FIG.
17 is an explanatory view showing a state in which the tissue fixing means is indwelling with the treatment instrument shown in FIG. 15. FIG.
18 is an explanatory view showing a state in which an incision is made with a high-frequency needle scalpel while pulling a target site with the treatment instrument shown in FIG. 15;
FIG. 19 is an explanatory view showing a state in which all layers are punctured with the treatment instrument shown in FIG. 15 and the tissue fixing means is indwelled.
FIG. 20 is an external view of a treatment tool operation aid according to a third embodiment.
21 is a cross-sectional view of the treatment tool operation assisting tool shown in FIG.
22 is a cross-sectional view of the treatment tool operation assisting tool shown in FIG. 20 in an extended state.
FIGS. 23A and 23B show a treatment tool according to a fourth embodiment, in which FIG. 23A is a side view of a distal end portion thereof, and FIG. 23B is a sectional view taken along line BB in FIG.
FIG. 24 is an explanatory view of a treatment tool according to a fifth embodiment.
FIG. 25 is a cross-sectional view of a conventional endoscope treatment tool.
FIG. 26 is a cross-sectional view of an endoscope treatment tool according to another conventional example.
FIG. 27 is an explanatory diagram of an operation unit provided in a conventional endoscope treatment tool.
FIG. 28 is an explanatory view of an endoscope treatment tool according to still another conventional example.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 ... Endoscope, 2 ... Sheath, 4 ... Treatment tool, 11 ... 1st operation part, 7 ... 2nd operation part, 13 ... High frequency knife, 14 ... Forceps member.

Claims (13)

An elongate sheath whose distal end portion is inserted into the body;
A first treatment means provided at the distal end of the sheath and operable by a movement for grasping a living tissue in the body and formed of at least one forceps member;
Operating means for operating the first treatment means;
A first operating portion that has a movable slider provided at a proximal end portion located outside the body of the sheath, and operates the operating means by moving the slider;
A second treatment means disposed on the sheath and treating the biological tissue grasped by the first treatment means;
A second operating portion that is provided on the proximal end side located outside the body of the sheath and operates the second treatment means;
Engagement means for preventing movement of the slider in the returning direction in an operation state in which the slider is moved to a grasping position with the slider moving in a direction of grasping the living tissue in the body by the first treatment means;
Release operation means for performing an operation of releasing the engagement with the slider by the engagement means;
Comprising
The engagement means includes a ratchet provided on the operation unit main body,
A latch provided on the slider and capable of engaging and releasing with the ratchet; an elastic member for biasing the latch in a direction to engage the ratchet;
Including
The slider is provided with a second slider that is movable in the moving direction of the slider and is different from the slider. The second slider moves the slider in a direction in which the first treatment means grips the living tissue. An operation pin is provided that moves together with the slider and engages the ratchet from the engaged state to the released state against the ratchet against the urging force of the elastic member. Endoscopic treatment tool. An elongate sheath whose distal end portion is inserted into the body;
A first treatment means provided at the distal end of the sheath and operable by a movement for grasping a living tissue in the body and formed of at least one forceps member;
Operating means for operating the first treatment means;
A first operating portion that has a movable slider provided at a proximal end portion located outside the body of the sheath, and operates the operating means by moving the slider;
A second treatment means disposed on the sheath and treating the biological tissue grasped by the first treatment means;
A second operating portion that is provided on the proximal end side located outside the body of the sheath and operates the second treatment means;
Engagement means for preventing movement of the slider in the returning direction in an operation state in which the slider is moved to a grasping position with the slider moving in a direction of grasping the living tissue in the body by the first treatment means;
Release operation means for performing an operation of releasing the engagement with the slider by the engagement means;
Comprising
The engagement means includes a ratchet provided on the operation unit main body,
A latch provided on the slider and capable of engaging and releasing with the ratchet; an elastic member for biasing the latch in a direction to engage the ratchet;
Including
The slider is provided with a second slider that is movable in the moving direction of the slider and is different from the slider. The second slider moves the slider in a direction in which the first treatment means grips the living tissue. move together with the slider when, only set the operating pin for operating the release state from the engaged state the latch to engage with the ratchet relative to the ratchet against the urging force of the elastic member, the operation pin, When the second slider is moved in a direction opposite to the direction in which the slider is moved when grasping the living tissue with the first treatment means, the latch engaged with the ratchet is operated to be released. An endoscopic treatment tool.   The endoscope treatment tool according to claim 1 or 2, wherein the second treatment means is a high-frequency knife.   The endoscope treatment instrument according to claim 1 or 2, wherein the second treatment means is a puncture needle.   The treatment instrument for an endoscope according to claim 4, wherein the puncture needle is hollow, and the puncture needle can be inserted through the third treatment means.   The endoscopic treatment tool according to claim 5, wherein the third treatment means is a suture.   The endoscope treatment tool according to claim 6, wherein a tissue fixing member is provided on the suture thread.   The endoscopic treatment tool according to any one of claims 1 to 7, wherein a space for projecting the second treatment means in a state in which the forceps member is closed is provided in the forceps member.   The restriction part for restricting the protruding length of the second treatment means is provided in at least one of the distal end cover, the sheath, and the inner tube of the treatment instrument. Endoscopic treatment tool.   The endoscope treatment tool according to any one of claims 1 to 9, wherein a hollow distal end cover is fixed to the distal end of the sheath.   The endoscopic treatment tool according to claim 1, further comprising an inner tube in the sheath.   The endoscopic treatment instrument according to any one of claims 1 to 11, wherein the forceps member is a pair of forceps members.   The pair of forceps members has a gripping surface that comes into contact with the tissue, the second treatment means is disposed so as to be able to advance and retreat with respect to the sheath, and an axial direction in which the second treatment means advances and retreats is a pair of gripping surfaces. The endoscopic treatment tool according to claim 12, which intersects with any one of intermediate surfaces connecting the pair of gripping surfaces.

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