JP5538146B2 - Endoscopic treatment tool - Google Patents

Description

  The present invention relates to an endoscope treatment instrument that is used by being inserted into a treatment instrument guide tube (channel) of an endoscope so as to be able to advance and retract.

  In general, an endoscope treatment instrument is used by being inserted into a treatment instrument guide tube (channel) opened in a tube-like insertion portion constituting the endoscope. The treatment tool for endoscope has an operation wire connected to a treatment portion composed of a pair of treatment pieces such as a forceps cup for excision of an affected portion at the tip end inserted into a cylindrical sheath, and the operation wire is inserted into the treatment sheath. In general, the treatment portion is driven to open and close at the distal end of the sheath by advancing and retracting.

  As such an endoscopic treatment tool, for example, there is an endoscopic treatment tool as described in Patent Document 1 below. The endoscope treatment tool described in Patent Document 1 uses a general link mechanism to open and close the distal treatment section, and a slit (slit) in the distal end body provided at the distal end of the sheath. A substantially intermediate portion of the pair of forceps cups (treatment pieces) is rotatably supported by a support shaft that traverses the inside, and the sheath side end of the forceps cup is rotatably connected to one end of each link mechanism. . Since the other end of the link mechanism is connected and fixed to the operation wire, when the operation wire is pushed in and operated, the forceps cup rotates around the support shaft and the tips are separated from each other. When the tips are brought close to each other by pulling, the closed state is established.

In addition, the operation unit arranged on the hand side for operating the operation wire is generally slidable in the longitudinal direction with respect to the operation unit main body to which the proximal end of the sheath is coupled, and the operation unit main body. It consists of an attached slider. Since the base end of the operation wire is connected to the slider, the operation wire is moved forward and backward by sliding the slider in the longitudinal direction with respect to the operation unit body, and the above-described link mechanism and the like. Is configured to open and close the treatment section.
The operation of the insertion of the endoscope into the body and the positioning of the treatment is performed by the operator, and the endoscope treatment tool is generally operated by the assistant such as opening and closing the side of the operator according to the operator's instructions. Is.

JP 2007-130421 A

In this way, the endoscope treatment tool according to the prior art is operated by a person (assistant) different from the operator who operates the endoscope, so that the endoscope is placed in an anatomically bent organ. Even when the endoscope is rotated in the circumferential direction (around the axis) by the operator at the time of insertion, the operation unit side of the endoscopic treatment tool held by the assistant does not follow and rotate.
Therefore, the endoscope is bent and inserted into an anatomical luminal organ, and a rotation operation is performed in order to diagnose a desired position (affected part) at the time of examination. Since it is made of a hollow close-wound coil pipe such as a coil or a hollow plastic tube such as PTFE, the rotational followability is not good, and it is normally inserted through the inner wall of the treatment instrument guide tube of an endoscope with almost no gap. Because the frictional resistance is large due to contact with the inner wall of the treatment instrument guide tube, when the endoscope rotates, it is rotated together with the endoscope almost integrally with the distal end side, Since the assistant has on the operation unit side, it cannot rotate together with the rotation of the endoscope, and is in a twisted state.
The operation wire is a rope formed by closely twisting a stainless steel wire or the like, for example, seven steel wires, and has much higher followability than the sheath, and is loosely inserted into the sheath.
As described above, the endoscope treatment tool according to the prior art does not rotate on the operation unit side but rotates on the distal end side. At this time, on the proximal end side (operation unit side), the sheath and the operation tool are operated. When the endoscope is rotated, the wire is connected and fixed to the operation unit, and on the distal end side, the sheath and the distal body are connected and fixed, and the operation wire, the link mechanism, and the treatment piece are connected and fixed respectively. There is a difference between the rotational force transmitted to the link mechanism and the rotational force transmitted to the tip body. That is, as described above, the sheath is rotated together with the endoscope almost integrally on the distal end side, whereas the operation wire is loosely inserted into the sheath, so that it makes little contact with the inner wall of the sheath. In addition, since the frictional resistance is small, even if the endoscope is rotated (the operation unit remains unrotated), an attempt is made to maintain a state where the operation unit does not rotate even on the distal end side. Therefore, a difference in rotational force is generated between the sheath and the operation wire, and a phenomenon of kinking by the link mechanism or the support shaft occurs.

As described above, the endoscope treatment tool according to the related art has a connecting rod connected to the distal end of the operation wire 100 as shown in FIGS. 5 to 8 due to the difference in rotational force between the sheath and the operation wire. 101, the link mechanism 104, the forceps cup 102 connected to the link mechanism 104, and the distal end body 103 connected to the distal end side of the sheath are twisted, and the distal end provided on the distal end body 103 is inclined with respect to the distal end body 103. or contact with pressurized push the slit open to the, twisted so that occurs in each axis 105, 106 and 107. As described above, the link mechanism 104 and the forceps cup 102 come into contact with the distal end body 103, or the shafts 105, 106, and 107 are bent, and frictional resistance is generated at the contact portions, so that the operation wire is difficult to advance and retract. As a result, there is a problem that it becomes difficult to open and close the treatment piece. In particular, when trying to open the treatment piece, the operation wire is tortuous in the sheath, so the pushing force is difficult to be transmitted to the tip due to the resistance in the sheath, and in this state, it is advanced and retracted with a large force. When the operation is performed, stress concentrates on the hand side, and the operation wire at the connection portion with the operation unit may be damaged.

  An object of the present invention is to solve the above-described problems of the prior art, and to easily open and close the treatment section without disturbing the advancement / retraction operation of the operation wire even when the endoscope is rotated in the circumferential direction. It is an object of the present invention to provide an endoscopic treatment tool that can be used.

To achieve the above object, the present invention provides a flexible sheath that is passed through a treatment instrument guide tube of an endoscope, a distal end body that is connected to one end of the sheath, and a pivot shaft that is attached to the distal end body. A treatment part comprising a pair of treatment pieces that are pivotally supported by each other and rotated and displaced between an open state and a closed state, a flexible operation wire having a treatment part connected to one end and passed through the sheath at the other end a connecting rod for holding one end, is connected to the other ends of and sheath manipulation wire, the endoscope comprising an operation unit by advancing and retracting operation of the operation wire to displace the jaws to the open state and the closed state, the A treatment tool for a mirror, the operation wire has a hooking portion with a diameter larger than the diameter of the operation wire at one end, and the connecting rod has a hole for receiving the hooking portion and hooking the hooking portion inside to store. First member and the first after the hook is inserted By forming the second member connected to the treatment portion while closing the opening on the distal end side of the member, a holding portion that holds the hook portion rotatably with respect to the connecting rod is formed. The first member has a spherical shape larger than the operation wire diameter or a cylindrical shape fitted to the operation wire, and the first member extends from the bulging portion that bulges inside to hook the hook portion to the opening portion. In the case of a spherical hooking portion, the length is longer than the spherical diameter, and in the case of a cylindrical hooking portion, the length is longer than the entire length of the cylindrical shape .

  In the endoscope treatment tool according to the present invention, the connecting rod that holds one end of the operation wire has a holding portion that rotatably holds the one end of the operation wire with respect to the connecting rod. Even when trying to keep the operation wire not rotating on the distal end side when rotating in the circumferential direction, the force is not transmitted to the connecting rod, and from this, the treatment portion connected to the connecting rod is It is not pressed against the tip body provided at the sheath tip, and the support shaft and the link mechanism are not twisted. Therefore, the advance / retreat operation of the operation wire is not hindered by the frictional resistance, and the smooth advance / retreat operation and the opening / closing operation of the treatment piece are possible.

The figure which shows the whole treatment tool for endoscopes of this invention. The expanded partial sectional view which shows the treatment tool for endoscopes by the 1st Embodiment of this invention. The expanded partial sectional view which shows the treatment tool for endoscopes by the 2nd Embodiment of this invention. The expanded partial sectional view which shows the treatment tool for endoscopes by the 3rd Embodiment of this invention. The figure explaining the conventional treatment tool for endoscopes. XX sectional drawing of FIG. FIG. 6 is a cross-sectional view taken along line YY in FIG. 5. FIG. 6 is a sectional view taken along line ZZ in FIG. 5.

  Hereinafter, endoscope treatment tools according to a plurality of embodiments of the present invention will be described with reference to the drawings. In the following embodiments, an endoscopic forceps will be described as an example, but the present invention is not limited to this, and may be, for example, an endoscopic cage.

  An endoscope treatment tool according to a first embodiment of the present invention will be described. As shown in FIGS. 1 and 2, the endoscope treatment tool 1 according to the present embodiment is connected to a flexible sheath 2, an operation wire 3 inserted into the sheath 2, and a distal end of the sheath 2. The distal end body 4, the connecting rod 5 that holds the distal end of the operation wire 3, the treatment portion 6 that is connected to the distal end body 4 and the connection rod 5, and the operation portion that is provided on the proximal end side of the sheath 2 and the operation wire 3. 7.

  The sheath 2 is formed of a tightly wound coil pipe such as a stainless steel wire and is used by being inserted into a treatment instrument guide tube of an endoscope (not shown). The sheath 2 may be configured by covering an outer peripheral surface with an electrically insulating flexible tube such as a tetrafluoroethylene resin tube, or without using a coil pipe. Further, it may be composed of only a flexible tube such as a resin such as polyethylene or polyimide, and these are the same in other embodiments.

  A flexible operation wire 3 made of stainless steel or the like made of a single wire or a stranded wire is inserted into the sheath 2 so as to freely advance and retreat, and the diameter of the operation wire 3 is larger than the diameter of the operation wire 3. A spherical hook 3a having a diameter is formed. The hook portion 3a may be formed by heating and melting the end portion of the operation wire 3 by plasma discharge or laser irradiation and solidifying it, or welding the separately manufactured hook portion 3a to the end portion of the operation wire 3 or the like. May be formed. Note that the hooking portion 3a is not limited to a spherical shape, and may be any shape that can prevent the operation wire 3 and the hooking portion 3a from coming off from a connecting rod 5 described later.

The hook portion 3a of the operation wire 3 is held by a holding portion 5a formed at an end portion of a connecting rod 5 connected to a treatment portion 6 described later. The holding portion 5a is a hole having a rotatable inner diameter after the hook portion 3a is inserted, and after the end portion of the operation wire 3 and the hook portion 3a are fitted therein, a gap is provided in the vicinity of the opening portion. By forming the crimped caulking portion 5b, the hooking portion 3a is prevented from falling off from the holding portion 5a. As described above, the holding portion 5a holds the operation wire 3 and the hooking portion 3a via the gap so as to rotatably hold the operation wire 3 in the circumferential direction (A direction in FIG. 1).
In the present embodiment, the example in which the caulking process is performed has been described. However, the opening of the holding portion 5a is made of a resilient material and / or structure, and the hook portion 3a of the operation wire 3 is press-fitted into the opening. The hook portion 3a may not be detached from the holding portion 5a due to the elastic restoring force of the opening portion, and after the hook portion 3a is fitted into the holding portion 5a, the hook portion 3a is hooked on the end portion of the opening portion. You may make it connect the ring etc. which have the diameter which the part 3a does not fall out, and the diameter which the operation wire 3 can rotate.

  A treatment portion 6 is connected to the distal end of the connecting rod 5, and the treatment portion 6 can freely rotate on a pair of forceps cups 8 and 8 (treatment pieces) and the forceps cups 8 and 8 by slide shafts 10 and 10. Plate-like links 9 and 9 supported on the shaft. The links 9, 9 are pivotally supported on the connecting rod 5 by a support shaft 11, and the forceps cups 8, 8 are pivoted across a slit 4 a that opens toward the tip provided in the tip body 4. A substantially intermediate portion is pivotally supported by a shaft 12 so as to be rotatable. That is, when the connecting wire 5 and the support shaft 11 are pushed out by pushing out the operation wire 3, the forceps cups 8 and 8 are turned around the turning shaft 12, and the tips are separated from each other to be opened. When the connecting rod 5 and the support shaft 11 are pulled by pulling the operation wire 3, the tips of the forceps cups 8 and 8 are close to each other around the rotation shaft 12 and are closed. In the present embodiment, an example in which the plate-like links 9 and 9 are used has been described. However, the present invention is not limited to this. For example, the link wires are connected so as to be divided into two branches from the tip of the connecting rod 5. You may make it connect the front-end | tip of this to the position of the slide shaft 10 of forceps cups 8 and 8.

The operation unit 7 includes an operation unit main body 7a and a slider 7b that is slidably attached to the operation unit main body 7a. Although not shown, the operation portion main body 7a is formed with a groove in the axial direction over a predetermined length, and the slider 7b is fitted in the groove so as to be slidable in the axial direction. Further, the base end of the sheath 2 is fixed to the operation portion main body 7a, and the base end of the operation wire 3 inserted through the inside of the sheath 2 and the operation portion main body 7a is fixed to the slider 7b. The operation wire 3 can be advanced and retracted by operating the slider 7b in the axial direction with respect to the operation portion main body 7a.
Although not shown, a high frequency current can be applied to the treatment section 6 via the operation wire 3 by connecting a high frequency power source to the slider 7b.

  In the endoscope treatment tool according to the first embodiment, after the hooking portion 3a of the operation wire 3 is inserted into the holding portion 5a of the connecting rod 5, the caulking portion 5b near the opening of the connecting rod 5 is caulked. Therefore, the operation wire 3 is configured to be rotatable in the holding portion 5a and not fallen off. For this reason, even when an endoscope (not shown) is rotated in the circumferential direction (around the axis) and a rotational force in the circumferential direction (A direction in FIG. 1) is applied to the sheath 2 on the distal end side, the distal end side The difference between the rotational force of the sheath 2 and the rotational force of the operation wire 3 is not transmitted to the connecting rod 5. Therefore, even if the operation wire 3 keeps the state where the operation wire 3 does not rotate on the tip side as well as the operation portion 7 side, the hook portion 3a of the operation wire 3 and the holding portion 5a formed at the end of the connecting rod 5 are Since it rotates freely, the forceps cups 8 and 8 and the links 9 and 9 constituting the treatment portion 6 are not inclined and pressed against the distal end body 4, and the slide shaft 10, the support shaft 11, and the rotation shaft 12 are not pressed. No twisting occurs. Accordingly, the operation wire 3 can be smoothly advanced and retracted, and the forceps cups 8 and 8 can be easily opened and closed.

Next, an endoscope treatment tool according to a second embodiment of the present invention will be described with reference to FIG. The endoscope treatment tool according to this embodiment is the same as that of the first embodiment with respect to parts other than the connecting rod 13.
The connecting rod 13 according to the present embodiment has a diameter at which one end of the operation wire 3 cannot pass the hooking portion 3a of the operation wire 3 (smaller diameter than the hooking portion 3a), and a diameter through which the operation wire 3 can pass (operation wire). A first member 13a formed with a bulging portion that bulges inward so as to have a diameter larger than 3 and having an opening so as to fit the hook portion 3a only from the distal end side (treatment portion side); It is comprised from the 2nd member 13b inserted so that the opening part of the front end side of the 1 member 13a may be plugged up. And the hole formed by this 1st member 13a and the 2nd member 13b becomes the holding | maintenance part 13c which hold | maintains the hook part 3a, and holds the operation wire 3 and the hook part 3a rotatably.

  In the endoscope treatment tool according to the second embodiment, the operation wire 3 and the hooking portion 3a are inserted into the first member 13a of the connecting rod 13 so that the hooking portion 3a is located inside from the distal end side. By fitting the second member 13b into the opening on the distal end side of the first member 13a, the operation wire 3 and the hooking portion 3a are configured to be rotatable and not fall off. Therefore, as in the above-described embodiment, an endoscope (not shown) is rotated in the circumferential direction (around the axis), and a rotational force is applied to the sheath 2 in the circumferential direction (A direction in FIG. 1). However, the difference between the rotational force of the sheath 2 on the distal end side and the rotational force of the operation wire 3 is not transmitted to the connecting rod 13. Therefore, even if the operation wire 3 keeps the state where the operation wire 3 does not rotate on the tip side as well as the operation portion 7 side, the hook portion 3a of the operation wire 3 and the holding portion 5a formed at the end of the connecting rod 5 are Since it rotates freely, the forceps cups 8, 8 and the links 9, 9 constituting the treatment section 6 are not inclined and pressed against the distal end body 4, and the slide shaft 10, the support shaft 11, and the rotation shaft 12 are not pressed. There is no twisting. Accordingly, the operation wire 3 can be smoothly advanced and retracted, and the forceps cups 8 and 8 can be easily opened and closed.

  Next, an endoscope treatment tool according to a third embodiment of the present invention will be described with reference to FIG. The endoscope treatment tool according to the present embodiment is the same as that of the second embodiment with respect to portions other than the hooking portion 14 of the operation wire 3. The hook portion 14 of the present embodiment is formed by fitting a cylindrical tube portion formed in a diameter that does not fall off from the holding portion 13 c at the tip of the operation wire 3. Thus, in addition to the effect of the above-mentioned embodiment, by forming the hook part 14 by the cylinder part fitted to the front-end | tip of the operation wire 3, the operation wire 3 and the hook part 14 are made into the base end side (operation part side). It is possible to insert and assemble from the beginning, and the manufacture becomes easy.

  In each of the above-described embodiments, the example in which the hook portions 3a and 14 are held by the holding portions 5a and 13c by caulking, press-fitting, and fitting has been described. However, this connection structure is described in the above embodiment. However, the present invention is not limited to this, and any structure may be used as long as the operation wire 3 and the hooking portions 3a and 14 are rotatably connected. Various modifications can be made without departing from the gist of the present invention.

DESCRIPTION OF SYMBOLS 1 Endoscopic treatment tool 2 Sheath 3 Operation wire 3a, 14 Hook part 4 Tip body 5, 13 Connecting rod 5a, 13c Holding part 6 Treatment part 7 Operation part 8 Forceps cup (treatment piece)
12 Rotating shaft 13a First member 13b Second member

Claims (1)

A flexible sheath that is passed through the treatment instrument guide tube of the endoscope;
A tip body coupled to one end of the sheath;
A treatment section including a pair of treatment pieces that are pivotally supported by a pivot shaft attached to the distal end body and pivotally displaced between an open state and a closed state;
A connecting rod that holds one end of a flexible operation wire, the treatment portion being connected to one end and the other end being passed through the sheath;
An operation unit connected to the other end of the operation wire and the other end of the sheath, and moving the operation wire forward and backward to displace the treatment piece between the open state and the closed state ,
An endoscopic treatment instrument comprising:
The operation wire has a hooking portion having a diameter larger than the operation wire diameter at one end,
The connecting rod includes a first member having an opening in which the hook portion is inserted and the hook portion is hooked and accommodated therein, and an opening portion on a distal end side of the first member after the hook portion is inserted. And a second member connected to the treatment portion to form a holding portion that rotatably holds the hooking portion with respect to the connecting rod,
The hook portion is configured in a spherical shape with a diameter larger than the diameter of the operation wire or a cylindrical shape fitted to the operation wire,
The first member has a length from the bulging portion that bulges inward to hook the hook portion to the opening portion, and in the case of the spherical hook portion, the spherical diameter of the first member An endoscopic treatment instrument characterized by being longer than the overall length of the cylindrical shape in the case of the hook portion having the cylindrical shape .

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