JP5202234B2 - Endoscopic treatment tool - Google Patents

Description

  The present invention relates to an endoscope treatment tool used through a treatment tool insertion channel of an endoscope.

  Many endoscope treatment tools have a configuration in which a distal end treatment member elongated in the front-rear direction is disposed at the distal end position of a flexible sheath that is inserted into and removed from a treatment instrument insertion channel of an endoscope. Absent.

For example, in the case of an endoscopic grasping forceps or the like, a pair of forceps pieces arranged in a hook shape so as to be openable and closable forward is provided as a distal treatment member, and an open / close operation wire inserted through a flexible sheath is used. When the pulling operation is performed from the proximal end side of the flexible sheath, the pair of forceps pieces are closed, and when the pushing operation is performed, the pair is opened (for example, Patent Document 1).
JP-A-9-262239

  In order to grasp a large foreign object, a wide range of mucous membranes, etc. with the grasping forceps, it is necessary to make the forceps piece as long as possible. However, the length of the hard portion of the treatment tool inserted into and removed from the treatment tool insertion channel of the endoscope that is in a tortuous state is significantly limited (for example, about 15 mm), and if the distal treatment member is longer than that, the treatment tool insertion channel It becomes difficult to insert and remove.

  According to the present invention, the length of the distal treatment member can be formed so as to exceed the conventional common sense so that an excellent treatment function can be exerted, and the distal treatment member can be smoothly inserted into and removed from the treatment instrument insertion channel of the endoscope. An object of the present invention is to provide an endoscopic treatment tool.

  In order to achieve the above object, in the endoscope treatment instrument of the present invention, a distal end treatment member elongated in the front-rear direction is disposed at the distal end of a flexible sheath inserted into and removed from the treatment instrument insertion channel of the endoscope. In the endoscope treatment tool, the distal treatment member is formed of a plurality of divided pieces that are connected in series in the longitudinal direction, and the bendable portion is inserted into a through hole that is formed straight in the longitudinal direction over the plurality of divided pieces. And a non-bendable portion are inserted through a connecting wire formed by shifting the position in the longitudinal direction, and the connecting wire is advanced and retracted in the axial direction from the proximal end side of the flexible sheath, thereby connecting the connecting portions of the plurality of divided pieces. The state where the bendable portion of the connecting wire is positioned and the state where the unbendable portion is positioned are switched, and the distal treatment member is switched between a bendable state and a rigid state at the connecting portion between the plurality of divided pieces. It is what I did.

  The connecting wire is formed by alternately arranging a bendable portion in which a tightly wound coil pipe is covered with a flexible wire and a non-bendable portion in which a hard pipe is covered in series, and a plurality of pieces are separated from each other. When the tightly wound coil pipe is positioned at the connecting portion, the tip treatment member may be bent at the connecting portion between the plurality of divided pieces, and may be in a rigid state when the hard pipe is positioned.

  In addition, through holes may be formed in two rows in parallel with each divided piece, and a connecting wire may be inserted through each of them, and a spring that urges each connecting wire in the distal direction is formed on the most advanced divided piece. It may be provided. Moreover, each division | segmentation piece may mutually contact | abut, The circumference | surroundings of the contact surface may each be formed in the shape of a conical surface.

  Note that the distal treatment member is a pair of forceps pieces arranged in a hook shape so as to be opened and closed forward, and an opening / closing operation wire inserted into the flexible sheath is pulled from the proximal end side of the flexible sheath. Then, the pair of forceps pieces are closed, and when the opening / closing operation wire is pushed in, the pair of forceps pieces may be opened, in which case the pair of forceps pieces is opened in the opening direction. An opening spring for biasing may be provided in the vicinity of the opening / closing fulcrum of the pair of forceps pieces.

  In addition, a plurality of staples are detachably attached to one of the pair of forceps pieces, and the pair of forceps pieces are closed in a rigid state so that the one sandwiched between the pair of forceps pieces is stapled. You may enable it to sew with a needle.

  According to the present invention, the distal treatment member can be switched between a state where it can be bent and a rigid state at a connecting portion between a plurality of divided pieces, so that the entire length of the distal treatment member exceeds the conventional common sense. In this way, an excellent treatment function can be exhibited, and it can be smoothly inserted into and removed from the treatment instrument insertion channel of the endoscope.

  In an endoscope treatment instrument in which a distal end treatment member that is elongated in the front-rear direction is disposed at the distal end of a flexible sheath that is inserted into and removed from a treatment instrument insertion channel of an endoscope, the distal treatment member is connected in series in the longitudinal direction. A connecting wire formed of a plurality of divided pieces and having a bendable portion and a non-bendable portion shifted in the longitudinal direction in a through-hole formed straight in the longitudinal direction on the entire divided pieces. By inserting and retracting the connecting wire in the axial direction from the proximal end side of the flexible sheath, a state in which the bendable portion of the connecting wire is located in the connecting portion between the plurality of split pieces and a state in which the unbendable portion is located Are switched so that the distal treatment member can be switched between a bendable state and a rigid state at the connecting portion between the plurality of divided pieces.

Embodiments of the present invention will be described below with reference to the drawings.
FIG. 1 is a side sectional view of a distal end portion of an endoscopic treatment tool showing a first embodiment of the present invention in which the present invention is applied to a grasping forceps, and FIG. 2 is a plan sectional view. However, the cross-sectional positions are appropriately combined so that the configuration is clearly shown in one figure (the same applies to the following figures).

  A flexible sheath 1 inserted into and removed from a treatment instrument insertion channel of an endoscope (not shown) is formed of, for example, a tetrafluoroethylene resin tube having a diameter of about 2 mm and a length of about 1.5 to 2 m. ing.

  At the distal end of the flexible sheath 1, a pair of distal treatment members 2 that are elongated in the front-rear direction are disposed in a hook shape so as to be openable and closable forward. The distal treatment member 2 of this embodiment is a forceps piece for grasping a foreign substance, mucous membrane, and the like in the body. Hereinafter, it is referred to as “forceps piece 2”.

  The pair of forceps pieces 2 shown side by side in FIG. 1 are opened and closed in a hook shape separately from the upper side and the lower side. The forceps piece 2 ”and the forceps piece 2 shown on the lower side are referred to as“ lower forceps piece 2 ”.

  Each forceps piece 2 is formed of a plurality of divided pieces 2A... 2C connected in series in the longitudinal direction so that they are not separated by the connecting wire 3 that is advanced and retracted from the proximal end side of the flexible sheath 1. It is connected.

  In both the upper forceps piece 2 and the lower forceps piece 2, a plurality of divided pieces 2 </ b> A to 2 </ b> C connected in series are in contact with each other at the front and rear ends. As shown in FIG. 4 to be described later, the contact surface T is a plane portion having a smaller area than the sectional area of each of the divided pieces 2A... 2C, but the periphery of the contact surface T is a conical surface E. (That is, a shape forming one conical surface as a whole in a state where the divided pieces 2A... 2C on both the upper and lower sides are combined into one).

  In both the upper and lower forceps pieces 2, a pair of through-holes 4 are formed in parallel in the longitudinal direction in each divided piece 2 </ b> A... 2 </ b> C as shown in FIG. The wire 3 is inserted. A spring accommodating chamber 5 is formed with the diameter of the through hole 4 being expanded inside the most advanced segment 2A.

  FIG. 3 is an enlarged view of the most advanced divided piece 2A on the upper and lower sides and the second and third divided pieces 2B, 2B. FIG. 4 shows the upper side of the disassembled forceps piece 2. The 2nd, 3rd division | segmentation piece 2B, 2B and the connection wire 3 are shown. T and E are the above-mentioned contact surface and conical surface.

  As shown in FIG. 5 illustrating the VV cross section in FIG. 3, the connecting wire 3 inserted through the four through holes 4 in the vertical direction is allowed as shown in FIG. 3 and FIG. A flexible wire 3A drawn to the proximal end side of the flexible sheath 1 is covered with a straight hard pipe 3B made of, for example, stainless steel (fixed portion) and a thin metal wire with a fixed diameter. The portions (flexible portions) covered with the tightly wound coil pipe 3C that are tightly wound in (3) are alternately arranged in series.

  In each of the connecting wires 3 configured as described above, the arrangement pitch of the closely wound coil pipes 3C provided alternately with the hard pipes 3B substantially matches the length of the divided pieces 2B other than the front and rear ends.

  Therefore, when the connecting wire 3 advances and retreats in the axial direction within the through hole 4, a state (FIGS. 1 to 3) in which the closely wound coil pipe 3C is located in all the connecting portions between the adjacent divided pieces 2A. The state in which the pipe 3B is located (FIGS. 6 and 7) is switched.

  As shown in FIG. 3, the hard pipe 3B located in the through hole 4 formed in the most advanced divided piece 2A is disposed in the spring accommodating chamber 5 of the most advanced divided piece 2A. A hook-shaped spring receiver 3D for receiving one end of the compressed coil spring 6 is formed.

  The other end of the compression coil spring 6 is received at the rear end of the spring accommodating chamber 5. As a result, when the connecting wire 3 is pulled from the proximal end side, the compression coil spring 6 is compressed, and an urging force for returning the connecting wire 3 in the distal direction is applied from the compression coil spring 6 to the connecting wire 3.

  In the endoscope treatment tool configured as described above, when the connecting wire 3 is not pulled from the proximal end side, as shown in FIGS. 1 to 3, adjacent divided pieces 2A. The tightly wound coil pipe 3C is located at all of the connecting portions.

  Accordingly, each forceps piece 2 is not rigid and can be bent at the connecting portion between the adjacent divided pieces 2A... 2C. As a result, for example, when a force is applied from the outside in a situation where it is inserted into and removed from the treatment instrument insertion channel of the endoscope, the connecting portions of the adjacent divided pieces 2A... 2C are freely bent by the external force. Even the forceps piece 2 that is significantly longer than the conventional one can be smoothly inserted into and removed from the treatment instrument insertion channel of the endoscope.

  Since each forceps piece 2 is elastically returned to a straight state by the restoring force of the tightly wound coil pipe 3C that tries to maintain linearity, no external force is applied, such as after passing through the treatment instrument insertion channel. Then, the forceps piece 2 returns to the original straight state.

  When the four connecting wires 3 are pulled from the proximal end side, as shown in FIG. 6 and FIG. 7 which is a partially enlarged view thereof, the compression coil spring 6 at the distal end is simultaneously compressed and adjacent. The hard pipe 3B is positioned at the connecting portion between the divided pieces 2A... 2C, and the forceps pieces 2 on both the upper and lower sides are straightened.

  In this way, the forceps piece 2 can be switched between a state where it can be bent at a connecting portion between the adjacent divided pieces 2A... 2 can be formed to exert an excellent treatment function.

  As described above, the present invention capable of switching the distal treatment member 20 between the bendable state and the rigid state can be applied not only to the grasping forceps but also to various kinds of endoscope treatment tools. Shows an example in which the present invention is applied to a grasping forceps as described above.

  As shown in FIG. 6, a flexible opening / closing operation wire 8 made of, for example, a stranded wire is loosely inserted in the flexible sheath 1. 8 is connected and fixed to the front end of the opening / closing operation wire 8 on the rear end surface of the lever portion 2L extending rearward from the split piece 2C at the rear end of each of the upper and lower forceps pieces 2 shown alone in FIG. The front end surface of the drive block 9 is in contact.

  Reference numeral 10 denotes a rotation support shaft that rotatably connects the pair of lever portions 2L. The rotation support shaft 10 is passed through a shaft hole 2H formed in both lever portions 2L and serves as an opening / closing fulcrum of the forceps piece 2. The pair of lever portions 2L and the drive block 9 are housed in a cylindrical sheath tip cap 11 that is connected and fixed to the tip of the flexible sheath 1.

  And the opening spring 12 which urges | biases a pair of lever parts 2L to an opening direction is attached to the rotating shaft 10 part. A slit 11 a for imparting elasticity in the radial direction is formed in a portion near the distal end of the sheath distal end cap 11.

  As a result, when the opening / closing operation wire 8 is pushed in from the proximal end side, as shown in FIG. 9, the pair of lever portions 2L are pushed forward from the inside of the sheath distal end cap 11, and the pair of forceps pieces 2 are It becomes a state opened by the urging force of the opening spring 12 in a rigid state.

  Then, when the opening / closing operation wire 8 is pulled from the proximal end side of the flexible sheath 1, as shown in FIG. 6, the pair of lever portions 2L are drawn into the sheath distal end cap 11 (compression coil spring). 6), the pair of forceps pieces 2 are closed, and a large foreign object, mucous membrane or the like can be gripped between the pair of rigid forceps pieces 2.

  FIG. 10 shows an example of the operation unit 30 of such a grasping forceps. An operation in which the slide operation member 32 to which the proximal end of the opening / closing operation wire 8 is coupled is coupled to the proximal end of the flexible sheath 1. The opening / closing operation wire 8 can be driven forward and backward in the axial direction by an advance / retreat operation of the slide operation member 32 attached to the body 31.

  Further, a slide piece 33 to which the base ends of the four connecting wires 3 (flexible wires 3A) are connected is slidably engaged in a slit 34 formed in the operation unit body 31 in the longitudinal direction. The base end of the drive pin 35 protruding sideways is fixed to the slide piece 33.

  The drive pin 35 passes through a straight groove 36 formed straight in the direction parallel to the axis of the extension cylinder 32 a of the slide operation member 32, and is rotatable in the direction around the axis of the extension cylinder 32 a of the slide operation member 32. Is engaged with a cam groove 38 of a rotary operation ring 37 attached to the.

  As a result, when the slide operation member 32 is advanced / retracted, the four flexible wires 3A advance / retreat together with the opening / closing operation wire 8 in the axial direction, and when the rotation operation ring 37 is rotated, As the slide piece 33 advances and retreats in the slit 34, only the four flexible wires 3A advance and retreat in the axial direction.

  FIG. 11 is a side cross-sectional view of the distal end portion of an endoscopic treatment instrument showing an example in which the present invention is applied to a stapler-type suture instrument for suturing a bleeding site or incision site in the body endoscopically, FIG. 12 is a plan sectional view. 13 and 14 show the XIII-XIII cross section and the XIV-XIV cross section in FIG.

  Also in the second embodiment, the upper forceps piece 2 and the lower forceps piece 102 provided at the distal end of the flexible sheath 1 inserted into and removed from the treatment instrument insertion channel of the endoscope are respectively in the longitudinal direction. Are formed of a plurality of divided pieces 2A... 2C, 102A.

  And the connecting wire 3 similar to the 1st Example is penetrated by the through-hole formed in each division | segmentation piece 2A ... 2C, 102A ... 102C, and the connecting wire 3 is inserted from the base end side of the flexible sheath 1. FIG. When advanced and retracted in the axial direction, the upper forceps piece 2 and the lower forceps piece 102 can be bent at the connecting portions of the plurality of divided pieces 2A... 2C, 102A. Switching between a normal state and a rigid state.

  Accordingly, by making the forceps pieces 2 and 102 bendable at the connecting portions between the divided pieces 2A... 2C, 102A. It can be smoothly inserted into and removed from the treatment instrument insertion channel of the mirror.

  The split piece 2C at the rear end of the upper forceps piece 2 is formed with a lever portion 2L extending rearward, and is an opening / closing operation wire that is inserted and disposed in the flexible sheath 1 so as to be movable forward and backward in the axial direction. When 8 is advanced and retracted from the proximal end side of the flexible sheath 1, the upper forceps piece 2 opens and closes in a hook shape around the shaft hole 2H. The kind of opening spring as in the first embodiment is not provided.

  The split piece 102C at the rear end of the lower forceps piece 102 is fixedly connected straight to the distal end of the flexible sheath 1, and does not perform an opening / closing operation. However, as with the upper forceps piece 2, the pair of connecting wires 3 is inserted in the same manner as the upper forceps piece 2 (see FIG. 13) and can be switched between a bendable state and a rigid state. is there.

  A plurality of (for example, about 3 to 20) staple needles 20 are provided in the space in each divided piece 102B other than the front and rear ends of the lower forceps piece 102 formed thicker than the upper forceps piece 2. Is attached detachably toward the upper forceps piece 2 side.

  As shown in FIG. 15, each stapler needle 20 has a configuration in which two needle parts 21 formed in a substantially U shape are arranged in parallel and are partially fitted in the groove of the back seat 22. Yes, each with 4 needle tips.

  Returning to FIG. 11, a driving slider 23 for pushing up the stapler needle 20 to the upper forceps piece 2 side is slidably arranged in the front-rear direction on the most advanced divided piece 102 </ b> A of the lower forceps piece 102. . The rear end wall of the drive slider 23 is a slope that faces obliquely upward.

  The distal end of a staple operating wire 24 that is advanced and retracted from the proximal end side of the flexible sheath 1 is connected to the drive slider 23. When the staple operating wire 24 is pulled from the proximal end side, driving is thereby performed. The slider 23 slides backward. As a result, the back seat 22 pushed by the slope of the drive slider 23 rises, and the needle portion 21 attached to the back seat 22 is pushed up to the upper forceps piece 2 side.

  As shown in FIGS. 11 and 13, each of the split pieces 2 </ b> B other than the front and rear ends of the upper forceps piece 2 has a recess 25 for receiving the needle tip of each needle part 21 of the stapler needle 20. Are formed together.

  Accordingly, as indicated by an arrow A in FIG. 15, when the staple operating wire 24 is pulled from the proximal end side and the drive slider 23 slides backward, the staple needle 20 pushed up as indicated by the arrow B thereby. The tip part of each needle part 21 'is pressed against the depression 25 part of the upper forceps piece 2 to be deformed and closed.

  FIG. 16 shows a usage state of the second embodiment configured as described above, and all four connecting wires 3 are pulled from the proximal side as indicated by an arrow C, and the upper forceps Both the piece 2 and the lower forceps piece 102 are in a rigid state.

  Then, as shown by the arrow D, the opening / closing operation wire 8 is pushed in from the proximal end side to open the upper forceps piece 2, and the mucous membrane in the body between the upper forceps piece 2 and the lower forceps piece 102. The living tissue N can be sandwiched.

  Next, as shown by an arrow E in FIG. 17, the open / close operation wire 8 is pulled from the proximal end side, the upper forceps piece 2 is closed, and the living tissue N is tightened between the upper and lower forceps pieces 2, 102. When in the clamped state, the staple operating wire 24 is pulled from the proximal end side as indicated by an arrow A, whereby each staple needle 20 is pushed up by the drive slider 23, and the staple needle 20 is moved to the living tissue. It is deformed to a closed state at a position where N is penetrated, and the living tissue N is sutured by the staple needle 20 '.

  In addition, this invention is not limited to the said Example, It can apply to various treatment tools for endoscopes.

It is side surface sectional drawing of the front-end | tip part of the treatment tool for endoscopes of 1st Example of this invention. It is a plane sectional view of the tip part of the treatment tool for endoscopes of the 1st example of the present invention. It is an expanded side sectional view of the tip part of the treatment tool for endoscopes of the 1st example of the present invention. 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. 5 is a VV cross-sectional view of the endoscope treatment tool according to the first embodiment of the present invention in FIG. 3. It is side surface sectional drawing of the rigid state of the front-end | tip part of the treatment tool for endoscopes of 1st Example of this invention. It is an expanded side sectional view of the rigid state of the tip part of the treatment tool for endoscopes of the 1st example of the present invention. It is a single-piece | unit perspective view of the division piece of the rear end of the treatment tool for endoscopes of 1st Example of this invention. It is side surface sectional drawing of the state which the front-end | tip part of the treatment tool for endoscopes of the 1st Example of this invention opened. It is side surface sectional drawing which shows an example of the operation part of the treatment tool for endoscopes of 1st Example of this invention. It is side surface sectional drawing of the front-end | tip part of the treatment tool for endoscopes of the 2nd Example of this invention. It is plane sectional drawing of the front-end | tip part of the treatment tool for endoscopes of 2nd Example of this invention. It is XIII-XIII sectional drawing in FIG. 11 of the 2nd Example of this invention. It is XIV-XIV sectional drawing in FIG. 11 of the 2nd Example of this invention. It is a fragmentary perspective view of the 2nd Example of this invention. It is side surface sectional drawing of the front-end | tip part in the use condition of the treatment tool for endoscopes of 2nd Example of this invention. It is side surface sectional drawing of the front-end | tip part in the use condition of the treatment tool for endoscopes of 2nd Example of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Flexible sheath 2,102 Forceps piece (tip treatment member)
2A ... 2C, 102A ... 102C Split piece 3 Connecting wire 3A Flexible wire 3B Hard pipe (non-bendable part)
3C Coiled coiled pipe (flexible part)
4 Through-hole 6 Compression coil spring 8 Open / close operation wire 12 Opening spring 20 Stapler needle 21 Needle part 30 Operation part E Conical surface T Contact surface

Claims (8)

In an endoscope treatment instrument in which a distal end treatment member elongated in the front-rear direction is arranged at the distal end of a flexible sheath inserted into and removed from a treatment instrument insertion channel of an endoscope.
The distal treatment member is formed of a plurality of divided pieces connected in series in the longitudinal direction, and a bendable portion and a non-bendable portion are long in a through hole formed straight in the longitudinal direction over the plurality of divided pieces. A connecting wire formed by shifting the position in the direction is inserted, and the connecting wire is advanced and retracted in the axial direction from the proximal end side of the flexible sheath, whereby the connecting wire is connected to the connecting portion between the plurality of divided pieces. The state where the bendable part is located and the state where the non-bendable part are located are switched, so that the distal treatment member is switched between a bendable state and a rigid state at the connecting portion of the plurality of divided pieces. An endoscopic treatment tool characterized by comprising:   The connecting wire is configured by alternately arranging a bendable portion in which a tightly wound coil pipe is covered on a flexible wire and a non-bendable portion in which a hard pipe is covered in series, and the plurality of divided pieces are arranged between each other. 2. The inner portion according to claim 1, wherein when the tightly wound coil pipe is positioned at the connecting portion, the distal treatment member is in a state of being bent at the connecting portion between the plurality of divided pieces, and is in a rigid state when the hard pipe is positioned. Endoscopic treatment tool.   The endoscope treatment tool according to claim 1 or 2, wherein the through holes are formed in two rows in parallel with the divided pieces, and the connecting wire is inserted into each of the divided holes.   The treatment instrument for an endoscope according to any one of claims 1 to 3, wherein a spring for urging each of the connecting wire members in a distal direction is provided on the most advanced divided piece.   The endoscopic treatment tool according to any one of claims 1 to 4, wherein the divided pieces are in contact with each other, and each of the contact surfaces is formed in a conical shape.   The distal treatment member is a pair of forceps pieces that are disposed in a hook shape so as to be openable and closable forward, and an open / close operation wire inserted into the flexible sheath is pulled from the proximal end side of the flexible sheath. The pair of forceps pieces are closed when operated, and the pair of forceps pieces are opened when the open / close operation wire is pushed. Endoscopic treatment tool.   The endoscopic treatment tool according to claim 6, wherein an opening spring for urging the pair of forceps pieces in an opening direction is provided in the vicinity of an opening / closing fulcrum of the pair of forceps pieces.   A plurality of staples are detachably attached to one of the pair of forceps pieces, and the pair of forceps pieces are closed in a rigid state, thereby sandwiching the pair of forceps pieces between the pair of forceps pieces. The treatment instrument for an endoscope according to claim 6, which can be sutured with the stapler needle.

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