JP6084135B2 - Treatment tool - Google Patents

Description

  The present invention relates to a treatment instrument that is inserted into a forceps port of an endoscope and used for attaching a covering material to an affected part in the body.

  Conventionally, when a lesioned part such as a tumor is found in a mucosal part in the body such as the esophagus, stomach, and duodenum by endoscopy, a treatment for peeling the lesioned mucous membrane from the muscle layer is performed under the endoscope. With this procedure, delayed bleeding or perforation may occur several days after the procedure. Therefore, a treatment for preventing bleeding and perforation is performed by covering the affected part with a covering material after the treatment. In performing this preventive treatment, since there is no dedicated treatment tool, for example, a treatment tool for an endoscope for other uses as disclosed in Patent Document 1 is used, and a covering material is applied to the affected part. It is attached.

  The endoscope treatment tool disclosed in Patent Document 1 is inserted into a forceps port of an endoscope, and a pair of forceps disposed at the distal end of the sheath by advancing and retracting a wire inserted into the sheath. The cup opens and closes like a bowl. When a covering material is attached to an affected area using this treatment tool, the following operations are performed.

  First, a pair of forceps cups is opened by performing a wire advance / retreat operation. Then, the wire is advanced and retracted while the covering material is inserted between the pair of forceps cups to close the pair of forceps cups. Thereby, the edge part of a coating | covering material is inserted | pinched between a pair of forceps cups, and it will be in the state by which the coating | covering material was hold | maintained at the forceps cup.

  Next, the treatment instrument is inserted into the body through the forceps port of the endoscope until the forceps cup reaches the vicinity of the affected part.

  And after the forceps cup reaches the vicinity of the affected area, the covering material of the portion not held by the forceps cup is spread by the operation of the endoscope tip and the back and forth operation of the treatment tool by the insertion operation to the forceps port, Placed in the affected area.

  Next, the forceps cup is opened by advancing and retracting the wire. Thereby, the sandwiching of the covering material by the forceps cup is released, and the covering material is separated from the forceps cup. Furthermore, the covering material is affixed to the affected part while pressing the covering material against the affected part on the surface of the forceps cup.

  In recent years, a treatment tool for applying a covering material to an affected area has been studied. For example, Patent Document 2 discloses a treatment that is inserted into a forceps port of an endoscope and a protective sheet for hemostasis is applied to the affected area. Ingredients have been proposed.

  In this treatment tool, the protective sheet is attached to the first linear member fixed to the inner sheath in a roll shape, and one end of the protective sheet is fixed to the second linear member that passes through the inner sheath. It is inserted into the outer sheath. In this treatment tool, after projecting the inner sheath relative to the outer sheath in accordance with the affected area, when the second linear member is pulled, one end of the protective sheet is separated from the second linear member, The protective sheet attached to the first linear member is attached to the affected area while being pulled out.

JP 2009-125418 A JP2012-040135A

  However, in the treatment tool for other purposes as described in Patent Document 1, the covering material is simply sandwiched between the pair of forceps cups, and the work of attaching the covering material is easy, but the holding device is held by the forceps cup. It is not easy to spread the portion of the covering material that is not, and the size of the covering material that can be expanded is as small as about 5 mm × 10 mm square. Further, when the covering material is wetted by body fluid, it becomes more difficult to spread the covering material.

  In the treatment tool described in Patent Document 2, since the covering material (protective sheet) is attached in a roll shape, a covering material having a large size can be attached to the affected area. However, the operation for attaching the covering material to the treatment instrument is not easy. Moreover, since it is a structure which draws out a roll-shaped coating | covering material only with the adhesive force of an affected part and a coating | covering material, there exists a possibility that it cannot stick well.

  The present invention has been made to solve the above-described problems, and an object of the present invention is to provide a treatment instrument that is inserted into a forceps port of an endoscope and used to attach a covering material to an affected part in the body. It is an object of the present invention to provide a treatment tool capable of easily spreading a covering material and capable of spreading a covering material having a large size.

  A treatment instrument according to the present invention is a treatment instrument used for attaching a covering material to an affected part in a body, and includes a cylinder, at least one wall projecting from an end surface of one end of the cylinder, A wire that is inserted into the cylinder so as to be able to advance and retract freely, a connection support member that is connected and fixed to the tip of the wire, and one end of which is rotatably supported by the wall body, and the covering material is disposed. A first blade portion and a second blade portion having a covering material arrangement surface, one end of which is rotatably supported by the connection support member, and the other end of which is rotatably supported by the other end of the first blade portion. A first transmission member that is rotatably supported by one end of the connection support member, and a second transmission member that is rotatably supported by the other end of the second blade portion. When the wire is advanced and retracted, the connection support member, the first transmission member, and the second transmission member are operated. Through member, the first blade portion and the second blade portion is configured to rotate about a position that is axially supported by the wall.

  Preferably, when the wire is moved to one end side in the axial direction of the cylindrical body, the covering material arrangement surfaces of the first blade portion and the second blade portion are parallel to the axial direction of the cylindrical body. When the wire is moved to the other end side in the axial direction of the cylindrical body, the covering material arrangement surfaces of the first blade portion and the second blade portion are the first blade portion and The covering material arrangement surface of the second blade portion extends on a straight line perpendicular to the axial direction of the cylindrical body in the vicinity of the tip of the wall body.

  Preferably, the wire is moved to one end side in the axial direction of the cylindrical body so that the covering material arrangement surfaces of the first blade portion and the second blade portion are parallel to the axial direction of the cylindrical body. In this state, the tip shape formed by the first blade portion and the second blade portion forms an arc shape.

  Preferably, the wall body includes a pair of first wall body and second wall body projecting so as to face each other from an end surface on one end side of the cylindrical body, and the wire is disposed on one axial end side of the cylindrical body. In a state where the covering material arrangement surfaces of the first blade portion and the second blade portion are moved and are in a state parallel to the axial direction of the cylindrical body, the cross section of the treatment instrument is the first wall. A circular outline is constituted by the body, the second wall body, the first blade portion, and the second blade portion.

  Preferably, one end or a part of the covering material is sandwiched between the first blade part and the cylindrical body or the first wall body, and the other end or a part of the covering material is the second blade. The covering material is held on the covering material arrangement surface by being sandwiched between the portion and the cylindrical body or the second wall body.

  According to the treatment instrument of the present invention, the covering material arrangement surfaces of the first blade portion and the second blade portion are on a straight line orthogonal to the axial direction of the tube body by a simple operation of moving the wire to one end side of the tube body. The covering material arranged on the covering material arrangement surface can be expanded.

  In addition, when the length or width of the covering material arrangement surface is increased, a covering material having a large size can be arranged on the covering material arrangement surface, so that the covering material having a large size can be widened. Even when a part of the covering material is sandwiched between the first blade portion and the second blade portion and the cylindrical body, the covering material having a large size can be expanded.

It is a perspective view which shows the treatment tool which concerns on embodiment of this invention. It is a perspective view which shows the treatment tool which concerns on embodiment of this invention. It is a schematic plan view which shows the treatment tool which concerns on embodiment of this invention. It is a schematic side view which shows the treatment tool which concerns on embodiment of this invention. It is a perspective view which shows the structure of the blade | wing part used for the treatment tool which concerns on embodiment of this invention. It is a cross-sectional view which shows the state which cut | disconnected the treatment tool which concerns on embodiment of this invention. It is a schematic side view for demonstrating the usage method of the treatment tool which concerns on embodiment of this invention. It is a schematic side view for demonstrating the usage method of the treatment tool which concerns on embodiment of this invention.

  Embodiments of the present invention will be described below with reference to the drawings. FIG.1 and FIG.2 is a perspective view which shows the front-end | tip part of the treatment tool 1 which concerns on embodiment of this invention. FIG. 3 is a schematic plan view showing the treatment instrument 1 in the state of FIG. 3A shows a state where the treatment tool 1 is viewed from the upper side in FIG. 1, and FIG. 3B shows a state where the treatment tool 1 is viewed from the lower side in FIG. FIG. 4 is a side view showing the treatment instrument 1 in the state of FIG. In FIG.4 (b), the below-mentioned blade board part 7a is abbreviate | omitted, and the between the below-mentioned 1st wall body 3 and the 2nd wall body 4 is shown.

  The treatment tool 1 according to the present embodiment is inserted into a forceps port of an endoscope, and is used for attaching a sheet-shaped covering material H to an affected part K (FIG. 8 described later) in the body. As the covering material H, for example, a suture reinforcing felt of polyglycolic acid (Neoval (registered trademark)) manufactured by Gunze Corporation can be used.

  The treatment instrument 1 includes a cylindrical body 2, a first wall body 3, a second wall body 4, a wire 5, a connection support member 6 (FIGS. 2 to 4), a first blade portion 7, and a second body. The wing | blade part 8, the 1st transmission member 9, and the 2nd transmission member 10 (FIG. 3, FIG. 4) are provided.

  The cylindrical body 2 includes a hollow flexible sheath 11 made of a tightly wound coil, and a metal body 12 connected and fixed to one end of the flexible sheath 11 by welding or the like. The 1st wall body 3 and the 2nd wall body 4 protrude. The metal body 12 includes a through hole 12a extending in the axial direction, and the wire 5 is inserted into the through hole 12a so as to be able to advance and retreat. The inner diameter of the through-hole 12a is formed to be slightly larger than the outer diameter of the wire 5, and the advance / retreat of the wire 5 is guided by inserting the wire 5 through the through-hole 12a. The first wall body 3 and the second wall body 4 protrude so as to face each other from the end face of one end of the cylindrical body 2, and one end 12 b (FIG. 2) of the through hole 12 a is connected to the first wall body 3 and the second wall body 2. An opening is made between the wall 4 and the wall 4.

  The through hole 2a of the cylindrical body 2 is formed by connecting the hole 11a of the flexible sheath 11 and the hole 12a of the metal body 12, and the wire 5 is inserted through the entire length of the through hole 2a. The other end of the flexible sheath 11 (the other end of the cylindrical body 2) is connected to an operation portion (not shown) for moving the wire 5 forward and backward. The wire 5 can be moved to one end side in the axial direction of the body 2 (the left side in FIGS. 1 and 2 and the upper side in FIG. 3) and the other end side (the right side in FIGS. 1 and 2 and the lower side in FIG. 3). it can.

  The connection support member 6 is a metal that is connected and fixed to the tip of the wire 5 extending from the one end 12 b of the through hole 12 a by welding or the like, and is located between the first wall body 3 and the second wall body 4.

  One end of the first blade portion 7 or the second blade portion 8 is rotatably supported by the first wall body 3 and the second wall body 4 via the first pin 20. Both ends of the first pin 20 are supported by the first wall body 3 and the second wall body 4, and pass between the first wall body 3 and the second wall body 4.

  The first transmission member 9 is a plate material that transmits the force applied to the wire 5 to the first blade portion 7. The second transmission member 10 is a plate material that transmits the force applied to the wire 5 to the second blade portion 8.

  One ends of the first transmission member 9 and the second transmission member 10 are rotatably supported by the connection support member 6 via the second pin 21. The second pin 21 penetrates the connection support member 6, and a portion of the second pin 21 extending to the first wall 3 side is passed through a hole formed in the first transmission member 9, The portion of the second pin 21 extending toward the two-wall body 4 is passed through a hole formed in the second transmission member 10.

  The other end of the first transmission member 9 is rotatably connected to the other end of the first blade portion 7 via the third pin 22. The other end of the second transmission member 10 is rotatably connected to the other end of the second blade portion 8 via a fourth pin 23 (FIGS. 3B and 4B).

  FIG. 5 is a perspective view showing the structure of the first blade portion 7 and the second blade portion 8. The first blade portion 7 includes a blade plate portion 7a and a base portion 7b. The vane portion 7a includes a covering material arrangement surface 70 on which the covering material H is arranged. The base portion 7 b protrudes from the side surface 71 of the blade plate portion 7 a on the opposite side of the covering material arrangement surface 70. The base portion 7b includes a thick portion 7c and a thin portion 7d, and a step surface 72 is formed at the boundary between the thick portion 7c and the thin portion 7d. The step surface 72 has a height equivalent to the thickness of the first transmission member 9, and the first transmission member 9 is disposed in a space lateral to the step surface 72. The thick portion 7c is a portion corresponding to one end of the first blade portion 7 described above, and includes a hole 7e through which the first pin 20 is passed. The thin portion 7d is a portion corresponding to the other end of the first blade portion 7 described above, and includes a hole 7f through which the third pin 22 is passed.

  The code | symbol in () in FIG. 5 has shown the structure with which the 2nd blade | wing part 8 is provided. The second blade portion 8 includes a blade plate portion 8a and a base portion 8b. The vane plate portion 8a includes a covering material arrangement surface 80 on which the covering material H is arranged. The base portion 8 b protrudes from the side surface 81 of the blade plate portion 8 a on the opposite side of the covering material arrangement surface 80. The base 8b includes a thick portion 8c and a thin portion 8d, and a step surface 82 is formed at the boundary between the thick portion 8c and the thin portion 8d. The step surface 82 has a height equivalent to the thickness of the second transmission member 10, and the second transmission member 10 is disposed in a space lateral to the step surface 82. The thick part 8c is a part corresponding to one end of the second blade part 8 described above, and includes a hole 8e through which the first pin 20 is passed. The thin portion 8d is a portion corresponding to the other end of the second blade portion 8 described above, and includes a hole 8f through which the fourth pin 23 is passed.

  In the treatment instrument 1 described above, when the wire 5 is pulled by the retraction operation of the operation unit and the wire 5 is moved to the other end side in the axial direction of the cylindrical body 2, the tensile force applied to the wire 5 is connected and supported. It is transmitted to the first blade portion 7 through the member 6 and the first transmission member 9, and is transmitted to the second blade portion 8 through the connection support member 6 and the second transmission member 10. Then, by this tensile force, the first blade portion 7 and the second blade portion 8 (hereinafter abbreviated as the blade portions 7 and 8), the first wall body 3 and the second wall body 4 (hereinafter referred to as wall bodies 3 and 4). Rotate around a position (position of the first pin 20) pivotally supported. At this time, the rotation of the first blade portion 7 occurs counterclockwise as viewed from the first wall 3 side (upper side in FIG. 1), and the rotation of the second blade portion 8 is the same side (first wall body 3). This occurs clockwise as viewed from the side. As a result, as shown in FIG. 1 and FIG. 3, the blade portions 7 and 8 (specifically, the blade plate portions 7 a and 8 a) are arranged along the side edges of the wall bodies 3 and 4, and the covering material arrangement of the blade portions 7 and 8 is arranged. The surfaces 70 and 80 are in a state parallel to the axial direction of the cylindrical body 2. In this state, the tip shape formed by the blade portions 7 and 8 forms an arc shape. As shown in FIG. 4B, the base portion 7b and the base portion 8b are located between the first wall body 3 and the second wall body 4, and the thick wall portion 7c and the thick wall portion 8c are The thin portion 7d and the thin portion 8d overlap vertically. Further, as shown in FIG. 3A, the third pin 22 is at a position closer to one side with respect to the straight line T1 connecting the first pin 20 and the second pin 21, and FIG. As shown in FIG. 4, the fourth pin 23 is located on the other side with respect to the straight line T1. Further, as shown in FIG. 3, slight gaps S <b> 1 and S <b> 2 are generated between the first blade portion 7 and the cylindrical body 2, or between the second blade portion 8 and the cylindrical body 2. The width of the gaps S1 and S2 is, for example, 0.5 mm.

  FIG. 6 is a cross-sectional view showing a state in which the treatment instrument 1 is cut in a direction orthogonal to the axial direction of the cylindrical body 2. As described above, in the state (the state shown in FIGS. 1, 3, and 4) in which the covering material arrangement surfaces 70 and 80 of the blade portions 7 and 8 are in a state parallel to the axial direction of the cylindrical body 2. As shown in FIG. 6, the cross section of the treatment instrument 1 has a circular outline formed by the wall bodies 3 and 4 and the blade portions 7 and 8.

  1, 3, and 4, when the wire 5 is pressed toward the one end side in the axial direction of the cylindrical body 2 by pressing the operation part forward, the wire 5 5 is transmitted to the first blade portion 7 via the connection support member 6 and the first transmission member 9, and the second blade portion 8 is transmitted via the connection support member 6 and the second transmission member 10. Is transmitted to. And by this pressing force, the blade | wing parts 7 and 8 rotate centering on the position (position of the 1st pin 20) pivotally supported by the wall bodies 3 and 4. FIG. At this time, because the third pin 22 was at a position closer to one side with respect to the straight line T1 (FIG. 3A), the first blade portion 7 is on the first wall 3 side (FIG. 1). Rotate clockwise as viewed from above. In addition, since the fourth pin 23 was at a position closer to the other side with respect to the straight line T1 (FIG. 3B), the second blade portion 8 is on the first wall 3 side (the lower side in FIG. 1). ) Rotate counterclockwise.

  FIG. 2 shows a state in which the wire 5 is moved to one end side of the cylindrical body 2 until the connection support member 6 reaches the vicinity of the first pin 20 by the forward operation of the operation portion. In this state, the covering material arrangement surfaces 70 and 80 of the blade portions 7 and 8 extend on a straight line perpendicular to the axial direction of the cylindrical body 2 in the vicinity of the tips of the wall bodies 3 and 4.

  Next, the operation of attaching the covering material H to the affected area K using the treatment tool 1 will be described.

  First, the covering material H is attached to the treatment instrument 1. At this time, as shown in FIG. 7A, the wire 5 is slightly moved to one end side of the cylindrical body 2 by the forward operation of the operation portion, and the blade portions 7 and 8 are rotated by a minute angle, thereby The parts 7 and 8 are separated from the wall bodies 3 and 4.

  Then, as shown in FIG. 7B, the covering material H is disposed on the covering material arrangement surfaces 70 and 80 of the blade portions 7 and 8. At this time, one end Ha and the other end Hb of the covering material H are extended from the ends of the covering material arrangement surfaces 70 and 80 and wound around the ends of the covering material arrangement surfaces 70 and 80.

  Next, as shown in FIG. 7C, the wire 5 is moved to the other end side of the cylindrical body 2 by the backward operation of the operation portion, and the blade portions 7 and 8 are rotated in the opposite direction to FIG. By doing so, the covering material arrangement surfaces 70 and 80 of the blade portions 7 and 8 are brought into a state parallel to the axial direction of the cylindrical body 2. Thereby, one end Ha of the covering material H is sandwiched between S1 (see FIG. 3) between the first blade portion 7 and the cylindrical body 2, and the other end Hb of the covering material H is connected to the second blade portion 8 and the cylindrical body 2. The covering material H is held on the covering material arrangement surfaces 70 and 80 by being sandwiched between S2 (see FIG. 3). In addition, the width of S1 between the 1st blade | wing part 7 and the cylinder 2 and the width | variety of S2 between the 2nd blade | wing part 8 and the cylinder 2 can be set arbitrarily, and enlarge these widths of S1 and S2. Thus, the thicker covering material H can be sandwiched. In addition, the covering material H can be sandwiched between the first blade portion 7 and the first wall body 3 or between the second blade portion 8 and the second wall body 4, and this is done. Thereby, the part of the coating | covering material H other than one end Ha and the other end Hb can also be inserted | pinched. Alternatively, a part of the covering material H may be sandwiched between the blades 7 and 8 and the cylindrical body 2 and the end of the covering material H may be disposed along the outside of the flexible sheath 11.

  Then, as shown in FIG. 8A, the treatment tool 1 is inserted into the body through the forceps port of the endoscope until the distal end of the treatment tool 1 contacts the affected part K. Note that, as described above, the user can move the wire 5 to one end side and the other end side in the axial direction of the cylindrical body 2 by an advance / retreat operation of the operation unit.

  Next, as shown in FIG. 8 (b), the wire 5 is moved to one end side of the cylindrical body by the forward operation of the operation portion, and the blade portions 7 and 8 are rotated, so that the covering material arrangement surfaces 70 and 80 are rotated. It extends on a straight line perpendicular to the axial direction of the cylindrical body 2. As a result, the covering material H is spread along the affected area K and pressed against the affected area K. As a result, the covering material H is affixed to the affected part K.

  After the covering material H is attached to the affected part K, as shown in FIG. 8C, the wire 5 is moved to the other end side of the cylindrical body 2 by the retreating operation of the operation part. By rotating the blade portions 7 and 8 in the opposite direction, the covering material arrangement surfaces 70 and 80 are made parallel to the axial direction of the cylindrical body 2. As a result, the covering material H is separated from the covering material arrangement surfaces 70 and 80. Then, all the operations are completed by pulling out the treatment instrument 1 from the body.

  According to the treatment tool 1 of the present embodiment, the wire 5 is moved to one end side of the cylindrical body 2 and the covering material H is arranged on the covering material arrangement surfaces 70 and 80 of the blade portions 7 and 8 by a simple operation. The covering material H can be attached to the treatment instrument 1. For this reason, the covering material H can be easily attached to the treatment instrument 1.

  Further, the covering material arrangement surfaces 70 and 80 are extended on a straight line perpendicular to the axial direction of the cylinder 2 by a simple operation of moving the wire 5 to one end side of the cylinder 2, so that the covering material arrangement surfaces 70 and 80 are formed. The disposed covering material H can be expanded.

  In addition, when the length and width of the covering material arrangement surfaces 70 and 80 are increased, the covering material H having a large size can be arranged on the covering material arranging surfaces 70 and 80, so that the covering material H having a large size can be widened. it can.

  Further, by moving the wire 5 to the other end side of the cylindrical body 2 so that the covering material arrangement surfaces 70 and 80 are in a state parallel to the axial direction of the cylindrical body 2, as shown in FIG. The profile of one cross section can be made circular. Therefore, by inserting the wire 5 to the other end side of the cylindrical body 2 before inserting the treatment instrument 1 into the body (corresponding to the step of FIG. 7C), the treatment instrument 1 can be smoothly obtained. Can be inserted into the body (corresponding to the step of FIG. 8A). In addition, since the forceps port of the endoscope is also circular, a larger covering material H can be expanded by making maximum use of the cross-sectional area of the forceps port.

  Further, by moving the wire 5 to the other end side of the cylindrical body 2 so that the covering material arrangement surfaces 70 and 80 are parallel to the axial direction of the cylindrical body 2, as shown in FIG. , 8 form an arc shape. For this reason, even if the front-end | tip part of the treatment tool 1 is made to contact the affected part K at the process of FIG. For this reason, the coating | covering material H can be affixed on the affected part K safely.

  In addition, this invention is not limited to the said embodiment, A various change is possible.

  For example, only one of the first wall body 3 and the second wall body 4 may be provided in the treatment instrument 1. In this case, the first pin 20 is cantilevered on one wall body, and one end of the first blade portion 7 or the second blade portion 8 is rotatable on one wall body via the first pin 20. It is pivotally supported.

  Moreover, in the said embodiment, when the wire 5 is moved to the one end side of the cylinder 2, the coating | covering material arrangement | positioning surfaces 70 and 80 of the blade | wing parts 7 and 8 are on the straight line orthogonal to the axial direction of the cylinder 2. FIG. Although the example (FIG. 2) which becomes extended was shown, the coating | covering material arrangement | positioning surfaces 70 and 80 may extend on the straight line which cross | intersects at angles other than 90 degree | times with respect to the axial direction of the cylinder 2. .

DESCRIPTION OF SYMBOLS 1 Treatment tool 2 Tubular body 3 1st wall body 4 2nd wall body 5 Wire 6 Connection support member 7 1st blade | wing part 8 2nd blade | wing part 9 1st transmission member 10 2nd transmission member 70 The covering material of 1st blade | wing part Arrangement surface 80 Covering material arrangement surface of second blade part

Claims (5)

A treatment tool used to apply a covering material to an affected area in the body,
A cylinder,
At least one wall projecting from an end surface of one end of the cylindrical body;
A wire inserted into the cylinder so as to freely advance and retract; and
A connection support member connected and fixed to the tip of the wire;
A first blade portion and a second blade portion provided with a covering material arrangement surface on which one end is rotatably supported by the wall body, and the covering material is arranged;
A first transmission member having one end rotatably supported by the connection support member and the other end rotatably supported by the other end of the first blade portion;
A second transmission member having one end rotatably supported by the connection support member and the other end rotatably supported by the other end of the second blade portion;
When the wire is advanced and retracted, the first blade portion and the second blade portion are pivotally supported by the wall body via the connection support member, the first transmission member, and the second transmission member. A treatment instrument configured to rotate around a position to be rotated. When the wire is moved to one end side in the axial direction of the cylindrical body, the covering material arrangement surfaces of the first blade portion and the second blade portion are in a state parallel to the axial direction of the cylindrical body. ,
When the wire is moved to the other end side in the axial direction of the cylindrical body, the covering material arrangement surfaces of the first blade portion and the second blade portion are the first blade portion and the second blade. The treatment tool according to claim 1, wherein the covering material arrangement surface of the portion extends on a straight line perpendicular to the axial direction of the cylindrical body in the vicinity of the distal end of the wall body.   In a state where the wire is moved to one end side in the axial direction of the cylindrical body, and the covering material arrangement surfaces of the first blade portion and the second blade portion are parallel to the axial direction of the cylindrical body The treatment instrument according to claim 1, wherein a tip shape formed by the first blade portion and the second blade portion is an arc shape. As the wall body, a pair of first wall body and second wall body projecting so as to face each other from the end face on one end side of the cylindrical body,
In a state where the wire is moved to one end side in the axial direction of the cylindrical body, and the covering material arrangement surfaces of the first blade portion and the second blade portion are parallel to the axial direction of the cylindrical body The cross-section of the treatment instrument is such that a circular contour is formed by the first wall body, the second wall body, the first blade portion, and the second blade portion. The treatment tool according to any one of the above.   One end or a part of the covering material is sandwiched between the first blade portion and the cylindrical body, or between the first blade portion and the first wall body, and the other end or one of the covering materials. When the portion is sandwiched between the second blade portion and the cylindrical body or between the second blade portion and the second wall body, the covering material is held on the covering material arrangement surface. The treatment tool according to any one of claims 1 to 4.

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