JP5191364B2 - Endoscopic treatment tool - Google Patents

Description

  The present invention relates to an endoscope treatment tool.

  An endoscope treatment tool for performing a treatment such as cutting a living tissue with a high-frequency current through a treatment tool insertion channel of an endoscope, such as a so-called high-frequency cutting tool for an endoscope. The high-frequency electrode, which is a distal treatment member, is disposed at the distal end of the flexible sheath so as to be able to advance and retreat in the axial direction of the flexible sheath and to be rotatable around the axial line, and in the axial direction within the flexible sheath. There are many configurations in which the distal end of an operation wire that is inserted and disposed so as to be able to advance and retreat and rotate in the direction around the axis is connected to the rear end side of the distal treatment member.

However, in order to prevent the distal treatment member from shaking when performing an incision treatment or the like, a rotation restricting mechanism capable of arbitrarily restricting the distal treatment member from rotating in the direction around the axis with respect to the flexible sheath. It is desirable to provide (for example, Patent Document 1).
JP2004-261372

  Patent Document 1 discloses a configuration in which rotation of the distal treatment member is regulated using frictional resistance (FIG. 2 and the like), and a multi-groove that engages with a protrusion provided near the distal end of the operation wire. There is described a member (FIG. 10 and the like) in which rotation is regulated by forming it in a direction parallel to the axis on the inner peripheral part of a member arranged in the distal end of the flexible sheath.

  However, in the invention described in Patent Document 1, rotation restriction is performed only when the distal treatment member is protruded from the distal end of the flexible sheath to the maximum extent. The incision depth cannot be adjusted appropriately when it becomes deep.

  Further, a member (stopper member) for restricting rotation is fixed to the distal end of the flexible sheath, and a member (stopper receiving portion) provided on the operation wire side is provided from the rear in order to obtain a rotation restricting state. Strongly pressed against it.

  However, in the case of a high-frequency treatment instrument, since a flexible sheath is formed of a tetrafluoroethylene resin tube or the like that is difficult to obtain a large adhesive strength, if the stopper member is pushed from behind with a strong force, the flexible sheath The stopper member may fall off from the distal end of the sheath.

  The present invention can easily perform the rotation regulation and release of the distal treatment member at an arbitrary protruding length to perform the treatment safely, and further, the distal end portion has excellent durability without fear of the member dropping off. It aims at providing the treatment tool for endoscopes.

  In order to achieve the above object, an endoscope treatment tool according to the present invention has a distal treatment member disposed at the distal end of a flexible sheath so as to be movable forward and backward in the axial direction of the flexible sheath and rotatable in a direction around the axial line. The distal end of the operation wire, which is disposed and inserted in the flexible sheath so as to be movable forward and backward in the axial direction and rotatably in the direction around the axial line, is connected to the rear end side of the distal treatment member. In an endoscope treatment instrument provided with a rotation restricting mechanism for restricting rotation of the flexible sheath in the direction around the axis, the rotation restricting mechanism is provided with a rotation stopper provided at the distal end of the flexible sheath. And an anti-rotation engaging portion provided on the distal end side of the operation wire so as to be freely disengageable with respect to the anti-rotation portion, and capable of moving forward and backward in the axial direction with respect to the flexible sheath and in the direction around the axis A flexible sheath that is freely rotatable is a flexible sheath. When the manipulation wire is pulled relatively to the flexible sheath from the proximal end side, the rotation stopper engaging portion engages with the rotation stopper portion and the distal treatment member of the flexible sheath is engaged. When the rotation is restricted and the operation wire is pushed from the proximal end side to the distal end side with respect to the flexible sheath, the anti-rotation engaging portion is detached from the anti-rotation portion and the distal treatment member is axial with respect to the flexible sheath. When the operation wire is moved back and forth in the axial direction from the base end side with respect to the outer tube, the projection length of the distal treatment member changes from the distal end of the outer tube.

  In addition, an operation unit is provided that can move the operation wire forward and backward in the axial direction from the proximal end side and rotate in the direction around the axial line with respect to the flexible sheath, and the proximal end portion of the outer tube is the other member. On the other hand, it may be arranged on the operation unit side so that it can be moved forward and backward in the axial direction alone. Then, a screw mechanism that can finely move the proximal end portion of the outer tube in the axial direction independently with respect to other members may be provided at the proximal end portion of the outer tube.

  Further, the anti-rotation portion and the anti-rotation engagement portion may be tapered surfaces formed on both sides so as to come into contact with each other, and are engaged via an O-ring-like member formed of an elastic material. It may be a combination. Alternatively, the anti-rotation portion and the anti-rotation engagement portion may be engaged with the concave portion of the wavy surface formed on one side in a state where the convex portion formed on the other side is fitted.

  In addition, when the distal treatment member protrudes from the distal end of the mantle tube, a concave portion that elastically presses against the outer circumferential surface of the flexible sheath may be formed in the mantle tube.

  According to the present invention, the rotation restricting mechanism includes a rotation stopping portion provided at the distal end of the flexible sheath, and a rotation stopping engagement provided on the distal end side of the operation wire so as to be detachable from the rotation stopping portion. The distal treatment member is prevented from rotating with respect to the flexible sheath when the operation wire is pulled relatively to the flexible sheath from the proximal end side. The rotation of the distal treatment member and the release of the distal treatment member are controlled by the flexible sheath that is movable in the axial direction and rotatable in the direction around the axis. It can be easily performed at an arbitrary protruding length with respect to the above, and can be treated safely, and further, there is no risk of dropping of the members constituting the rotation stop portion, rotation stop engagement portion, etc. at the tip portion, and excellent durability is achieved. Can be obtained.

  A distal treatment member is disposed at the distal end of the flexible sheath so as to be movable forward and backward in the axial direction of the flexible sheath and rotatable around the axial line, and is movable forward and backward in the axial direction and around the axial line in the flexible sheath. Rotation for restricting rotation of the distal treatment member relative to the flexible sheath in the direction around the axis while the distal end of the operation wire inserted in a freely rotating manner is connected to the rear end side of the distal treatment member In the endoscope treatment instrument provided with the restriction mechanism, the rotation restriction mechanism includes a rotation stopper provided at the distal end of the flexible sheath, and a distal end side of the operation wire that is detachable from the rotation stopper. And a flexible outer tube that is movable in the axial direction with respect to the flexible sheath and that is rotatable in the direction around the axis is fitted on the flexible sheath. , Whether the operation wire is proximal to the flexible sheath When a relatively pulling operation is performed, the anti-rotation engaging portion engages with the anti-rotation portion and the rotation of the distal treatment member relative to the flexible sheath is restricted, and the operation wire is moved from the proximal end side to the flexible sheath. When the distal end is pushed, the anti-rotation engaging part is detached from the anti-rotation part, and the distal treatment member can rotate about the axis with respect to the flexible sheath. When it is advanced and retracted in the axial direction from the side, the protruding length of the distal treatment member from the distal end of the outer tube changes.

Embodiments of the present invention will be described below with reference to the drawings.
FIG. 2 is a side cross-sectional view of the distal end portion of the endoscope treatment tool according to the first embodiment in which the present invention is applied to an endoscope high-frequency treatment tool, and is not shown. An outer tube 1 to be inserted into and removed from the insertion channel is fitted on a flexible sheath 2 so as to be movable forward and backward in the axial direction and rotatable in the direction around the axial line.

  Both the outer tube 1 and the flexible sheath 2 are electrically insulating flexible tubes such as a tetrafluoroethylene resin tube and are formed to a length of about 1 to 2 m. The outer diameter of the outer tube 1 Is about 2 to 2.5 mm.

  In the distal end of the outer tube 1 where the distal end of the flexible sheath 2 is located, a conductive metal distal treatment member 3 formed in a hook shape with the distal end bent sideward is forward from the distal end of the outer tube 1. It is arranged so that it can be sunk freely. The distal treatment member 3 is disposed so as to be movable forward and backward in the axial direction with respect to the flexible sheath 2 and rotatable in the direction around the axial line.

  At the axial position of the flexible sheath 2, an operation wire 4 made of a conductive metal is inserted and disposed so as to be movable forward and backward in the axial direction and rotatable in the direction around the axial line. A sheath-shaped sheath distal end cap 5 is fixed, and the rear end of the distal treatment member 3 and the distal end of the operation wire 4 are connected via a substantially cylindrical connecting tubular member 6.

  FIG. 3 is an exploded view of the connecting portion. The connecting tail portion 3a of the distal treatment member 3 is inserted into the through hole 6h formed at the axial position of the connecting cylindrical member 6 from the front, and the operation wire is connected from the rear. 4 are inserted and fixed integrally and connected by soldering or brazing.

  The outer surface of the connecting cylindrical member 6 is formed with a diameter that is thicker at the front end than the rear, and the boundary portion is a tapered outer peripheral surface 6a that gradually narrows toward the rear. The flexible sheath 2 and the operation wire 4 are connected to each other. When moved relatively in the axial direction, the taper outer peripheral surface 6a comes into contact with the taper inner peripheral surface 5a formed at the tip inner peripheral portion of the sheath tip cap 5 at the same taper angle as the taper outer peripheral surface 6a. Disengage.

  When the tapered outer peripheral surface 6a of the connecting tubular member 6 is engaged with the tapered inner peripheral surface 5a of the sheath tip cap 5, the connecting tubular member 6 is sheathed by the frictional resistance generated at the press contact portion. The distal end cap 5 cannot be rotated, and the rotation of the distal treatment member 3 relative to the flexible sheath 2 in the direction around the axis is restricted.

  In this way, a rotation restricting mechanism for restricting the distal treatment member 3 from rotating in the direction around the axis relative to the flexible sheath 2 is provided with a taper inner peripheral surface 5 a (rotation stop) formed on the sheath distal end cap 5. Part) and a tapered outer peripheral surface 6a (rotation stop engaging part) formed on the connecting tubular member 6. Hereinafter, they are referred to as “rotation stop portion 5a” and “rotation stop engagement portion 6a”.

  With such a configuration, when the operation wire 4 is pulled in the axial direction from the proximal end side with respect to the flexible sheath 2, as shown in FIG. 2, the anti-rotation engagement portion 6a becomes the anti-rotation portion 5a. And the rotation of the distal treatment member 3 relative to the flexible sheath 2 is restricted.

  At this time, when the connecting tubular member 6 comes into contact with the sheath distal end cap 5 that is not necessarily fixed to the flexible sheath 2 with sufficient force, the force in the direction in which the connecting tubular member 6 is pushed into the flexible sheath 2. Therefore, there is no fear that the sheath tip die 5 is dropped from the tip of the flexible sheath 2.

  As shown in FIG. 4, when the operation wire 4 is pushed against the flexible sheath 2 from the proximal end side to the distal end side, the anti-rotation engagement portion 6a is detached from the anti-rotation portion 5a forward. The distal treatment member 3 can rotate in the direction around the axis of the flexible sheath 2. Therefore, by rotating the operation wire 4 from the proximal end side, the direction of the distal treatment member 3 can be arbitrarily adjusted in a direction suitable for treatment.

  As shown in FIG. 1, when the operation wire 4 is pulled from the proximal end side to the flexible sheath 2 with the distal treatment member 3 protruding forward from the distal end of the outer tube 1 ( Or, when the flexible sheath 2 is pushed from the proximal end side with respect to the operation wire 4), the anti-rotation portion 5 a and the anti-rotation engagement portion 6 a are engaged, and the flexible sheath 2 is The rotation of the distal treatment member 3 is restricted, and the distal treatment member 3 can perform the incision treatment stably.

  Further, when the operation wire 4 is moved forward and backward in the axial direction from the proximal end side with respect to the outer tube 1, the protruding length of the distal treatment member 3 from the distal end of the outer tube 1 changes, so that the distal end used for the incision treatment The protrusion length of the treatment member 3 can be easily adjusted to an optimal state.

  FIG. 5 shows an example of the operation unit 10 used in such an endoscopic treatment tool, and a slide operation member 13 is slidably arranged along a slit 12 formed in the operation unit main body 11. The proximal end of the operation wire 4 is connected to the slide operation member 13.

  Therefore, when the slide operation member 13 is slid, the operation wire 4 advances and retreats in the axial direction. Reference numeral 14 denotes a connection terminal to which a high-frequency power cord (not shown) is connected, and a high-frequency current can be supplied to the distal treatment member 3 through the operation wire 4.

  The sheath base end cap 2A connected and fixed to the base end of the flexible sheath 2 is connected to the rotation holding ring 2B via the luer lock connection portion 9, and the rotation holding ring 2B is axially connected to the tip of the operation portion main body 11. It is connected so as to be rotatable in the circumferential direction but not in the axial direction.

  As a result, the flexible sheath 2 does not move in the axial direction with respect to the operation portion main body 11, and if the rotation holding ring 2B is held and the operation portion main body 11 is rotated in the direction around the axis, the flexible sheath 2 2, the operation wire 4 rotates in the direction around the axis.

  The outer tube base end cap 1A connected and fixed to the proximal end of the outer tube 1 is fitted to the sheath base end cap 2A so as to be rotatable in the axial direction and movable in the axial direction. Therefore, the proximal end portion of the outer tube 1 is independent of the other members and can be rotated around the axis relative to the other members independently, and can advance and retreat in the axial direction.

  As shown in FIG. 6, by providing a screw mechanism N for screwing the sheath base end cap 2A and the outer tube base end cap 1A, the base end portion of the outer tube 1 can be independently attached to other members. It is possible to finely adjust the protruding amount of the distal treatment member 3 from the distal end of the outer tube 1 by finely moving in the axial direction.

  In that case, if the base end of the outer tube 1 is connected to a free rotation connecting member 1B that is rotatable in the axial direction with respect to the outer tube base end cap 1A, the outer tube 1 rotates together with the outer tube base end cap 1A. This is preferable.

  7, 8, and 9 show the distal end portion of the endoscope treatment instrument according to the second embodiment of the present invention. FIG. 7 shows a state in which the distal treatment member 3 is immersed in the outer tube 1. 8 is a state in which the distal treatment member 3 is protruded from the distal end of the outer tube 1 in a state where the rotation of the distal treatment member 3 is restricted, and FIG. 9 is an exploded view from the distal end of the outer tube 1 in a state in which the distal treatment member 3 is rotatable around the axis. The protruding state is shown.

  In this embodiment, when the distal treatment member 3 protrudes from the distal end of the outer tube 1, a recess 1 a that is elastically pressed against the outer peripheral surface of the flexible sheath 2 is formed near the distal end of the outer tube 1. ing.

  As a result, the distal treatment member 3 does not swing within the outer tube 1, so that the posture of the distal treatment member 3 protruding from the outer tube 1 can be stabilized. Other configurations and operational effects are the same as those of the first embodiment. In addition, such a recessed part 1a is employable also in the following each Example.

  10, 11 and 12 show the distal end portion of the endoscope treatment instrument according to the third embodiment of the present invention. FIG. 10 shows a state in which the distal treatment member 3 is immersed in the outer tube 1. 11 shows a state in which the distal treatment member 3 protrudes from the distal end of the outer tube 1 in a state where the rotation of the distal treatment member 3 is restricted, and FIG. 12 shows an operation from the distal end of the outer tube 1 in a state in which the distal treatment member 3 is rotatable around the axis. The protruding state is shown.

  In this embodiment, the O-ring-shaped member 7 formed of an elastic material is formed by the distal end surface (rotation preventing portion) of the sheath distal end cap 5 and the rear end surface (rotation preventing engaging portion) of the connecting tubular member 6. ) And is engaged in and disengaged.

  Both the distal end surface (rotation stop portion) of the sheath distal end cap 5 and the rear end surface (rotation stop engagement portion) of the connecting tubular member 6 are perpendicular to the axis, and an O-ring member 7 therebetween. Rotation of the connecting tubular member 6 with respect to the sheath distal end cap 5 is regulated by frictional resistance generated by being sandwiched in a pressed state.

  FIGS. 13 and 14 show the distal end portions of the endoscope treatment tools of the fourth and fifth embodiments of the present invention, and both of the outer tube 1 with the distal treatment member 3 being restricted in rotation. The state which protruded from the front-end | tip is shown.

  In the fourth and fifth embodiments, the rotation stop portion 5a is a waved surface in which a plurality of recesses are formed at a constant period on the tip surface portion of the sheath tip cap 5, and the rotation stop engagement portion 6a is a sheath It is formed with a convex portion that engages with the concave portion on the tip cap 5 side.

  In the fourth embodiment shown in FIG. 13, the anti-rotation engaging portion 6a is a pin-like member fixed to the connecting tubular member 6. In the fifth embodiment shown in FIG. The engaging portion 6 a is a convex portion formed to protrude from the base portion itself of the distal treatment member 3. Even if configured as described above, the same effects as those of the first embodiment can be obtained.

  In addition, this invention is not limited to the said Example, For example, you may apply this invention to the various treatment tools for endoscopes which do not use a high frequency current.

FIG. 3 is a side cross-sectional view of the distal end portion of the endoscope treatment tool according to the first embodiment of the present invention in a state where the distal treatment member protrudes forward in a rotation restricted state. FIG. 3 is a side cross-sectional view of the distal end portion of the endoscope treatment tool according to the first embodiment of the present invention in a state where the distal treatment member is immersed in the outer tube. It is a partial exploded perspective view of the tip part of the treatment tool for endoscopes of the 1st example of the present invention. FIG. 3 is a side cross-sectional view of the distal end portion of the endoscope treatment tool according to the first embodiment of the present invention in a state where the distal treatment member protrudes forward without rotation restriction. It is side surface sectional drawing of the operation part of the treatment tool for endoscopes of 1st Example of this invention. It is side surface sectional drawing of the partial modification of the operation part of the treatment tool for endoscopes of 1st Example of this invention. FIG. 10 is a side cross-sectional view of the distal end portion of the endoscope treatment tool according to the second embodiment of the present invention in a state where the distal treatment member is immersed in the outer tube. FIG. 10 is a side cross-sectional view of the distal end portion of the endoscope treatment tool according to the second embodiment of the present invention in a state where the distal treatment member protrudes forward in a rotation restricted state. In the endoscope treatment tool of the second embodiment of the present invention, it is a side cross-sectional view of the distal end portion in a state in which the distal treatment member protrudes forward without rotation restriction. FIG. 10 is a side cross-sectional view of the distal end portion of the endoscope treatment tool according to the third embodiment of the present invention in a state where the distal treatment member is immersed in the outer tube. In the endoscope treatment tool according to the third embodiment of the present invention, it is a side cross-sectional view of the distal end portion in a state where the distal treatment member protrudes forward in a rotation restricted state. In the endoscope treatment tool of the third embodiment of the present invention, it is a side cross-sectional view of the distal end portion in a state where the distal treatment member protrudes forward without rotation restriction. In the endoscope treatment tool of the 4th example of the present invention, it is a side sectional view of the tip part in the state where the tip treatment member protrudes ahead in the rotation regulation state. In the endoscope treatment tool according to the fifth embodiment of the present invention, it is a side cross-sectional view of the distal end portion in a state where the distal treatment member protrudes forward in a rotation restricted state.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Outer tube 1a Recessed part 2 Flexible sheath 3 Tip treatment member 4 Operation wire 5 Sheath tip cap (rotation restriction mechanism)
5a Anti-rotation part 6 Cylindrical member for connection (rotation restricting mechanism)
6a Anti-rotation engaging part 7 O-ring shaped member 10 Operation part N Screw mechanism

Claims (7)

A distal treatment member is disposed at the distal end of the flexible sheath so as to be movable forward and backward in the axial direction of the flexible sheath and rotatable in the direction around the axial line, and is movable forward and backward in the axial direction in the flexible sheath. A distal end of an operation wire that is rotatably inserted in the direction around the axis is connected to the rear end side of the distal treatment member, and the distal treatment member rotates in the direction around the axis with respect to the flexible sheath. In an endoscopic treatment tool provided with a rotation restricting mechanism for restricting,
The rotation restricting mechanism includes a rotation stopping portion provided at the distal end of the flexible sheath, and a rotation stopping engaging portion provided on the distal end side of the operation wire so as to be freely disengageable with respect to the rotation stopping portion. As well as
A flexible mantle tube that is movable forward and backward in the axial direction with respect to the flexible sheath and rotatable in the direction around the axial line is fitted on the flexible sheath,
When the operation wire is relatively pulled from the proximal end side with respect to the flexible sheath, the anti-rotation engaging portion engages with the anti-rotation portion and the distal treatment member with respect to the flexible sheath Rotation is restricted,
When the operation wire is pushed from the proximal end side to the distal end side with respect to the flexible sheath, the anti-rotation engaging portion is detached from the anti-rotation portion, and the distal treatment member is moved against the flexible sheath. Can rotate around the axis,
A treatment instrument for an endoscope, wherein when the operation wire is moved back and forth in the axial direction from the proximal end side with respect to the outer tube, the protruding length of the distal treatment member from the distal end of the outer tube changes.   An operation portion is provided for the flexible sheath so that the operation wire can be advanced and retracted in the axial direction from the proximal end side and rotated in the direction around the axial line. The endoscopic treatment tool according to claim 1, which is disposed on the operation unit side so that the member can be independently advanced and retracted in the axial direction.   The treatment instrument for an endoscope according to claim 2, wherein a screw mechanism capable of finely moving the proximal end portion of the outer tube in the axial direction independently with respect to another member is provided at the proximal end portion of the outer tube.   The endoscope treatment tool according to any one of claims 1 to 3, wherein the rotation stop portion and the rotation stop engagement portion are tapered surfaces formed on both sides so as to contact each other.   The endoscope according to any one of claims 1 to 3, wherein the rotation stop portion and the rotation stop engagement portion are engaged via an O-ring-shaped member formed of a resilient material. Treatment tool.   The said rotation stop part and the said rotation stop engagement part engage with the state in which the convex part formed in the other was fitted with respect to the concave part of the wavy surface formed in one side. The endoscopic treatment tool according to Item.   7. The outer tube according to claim 1, wherein a recess is formed in the outer tube so as to be elastically pressed against the outer peripheral surface of the flexible sheath when the distal treatment member protrudes from the distal end of the outer tube. The endoscopic treatment tool according to item 4.

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