JP6462396B2 - Endoscopic treatment tool - Google Patents

Description

  The present invention relates to an endoscope treatment tool. More specifically, the present invention relates to an endoscope treatment tool for excising a lesion in a body cavity.

  Various types of endoscopic treatment tools are used to remove lesions in body cavities such as polyps. A lesion such as a polyp is recovered from the body cavity after being excised with a predetermined treatment tool in the body cavity. Patent Documents 1 and 2 disclose a polyp recovery treatment tool prepared separately from a polyp excision treatment tool by using a polyp excision treatment tool inserted from an endoscope forceps port or the like. An endoscope apparatus that is recovered in is disclosed.

  In the endoscope apparatus described in Patent Documents 1 and 2, the recovery treatment tool 100 shown in FIG. 14 is inserted into an endoscope or an insertion pipe provided outside the endoscope. It is configured. The recovery treatment tool 100 includes a recovery net 101 such as a flexible polyp, an annular ring 102 made of an extremely thin thread that is passed through the opening end side of the recovery net 101, and one end of the annular ring 102. And the other end of the extra fine thread 103 is passed through the extra fine thread 103, the other end of the extra fine thread 103 being slidably attached to the extra fine thread 103. A first sheath 105 having a smaller diameter than the tool 104, and a second sheath 107 having a diameter larger than that of the first sheath 105 and the net stopper 104 and having a snare 106 separated from the tip inside. And. As shown in FIG. 14, the first sheath 105 is disposed in the second sheath 107, and the snare 106 from which the tip is separated is passed through the opening end side of the recovery net 101, and the recovery net 101 Is held in an open state.

  The recovery treatment tool 100 described in Patent Documents 1 and 2 does not have a function of excising the polyp itself, and a polyp excision treatment tool provided separately from the recovery treatment tool 100 or the like. The polyp is excised, and the treatment tool 100 for collection is used when the polyp is collected after the polyp is excised. The polyp is collected by cutting the polyp with a treatment tool for polyp excision, etc., putting the polyp in the collection net 101, and then simultaneously pulling the end portion 108 of the ultrathin thread 103 and the snare 106, At that time, the net stopper 104 is caught at the entrance end of the first sheath 105, the opening end of the recovery net 101 is narrowed, and the snare 106 from which the tip is separated is configured to come out of the annular ring 102. Yes.

  The recovery treatment tool of Patent Documents 1 and 2 described above can recover a polyp, but the removal of the polyp is performed by a treatment tool for polyp excision inserted from the forceps opening of the endoscope. A lesion such as a polyp cannot be excised.

  On the other hand, Patent Document 3 discloses a high-frequency snare 200 that excises and collects a lesion such as a polyp. As shown in FIG. 15, the high-frequency snare 200 includes a snare wire 201 made of a conductive wire and having a loop portion formed at the tip thereof, and a sheath tube 202 capable of moving the snare wire 201 forward and backward. . A net portion 203 is connected and fixed to the loop portion of the snare wire 201. The snare wire 201 is formed of a conductive material capable of passing a high-frequency current, and the sheath tube 202 and the net part 203 other than the snare wire 201 are formed of an insulating material or an insulator covering the insulating material, A heat-resistant material that is not damaged by the heat when flowing is used.

JP 2004-166876 A JP 2010-213796 A JP-A-10-137260

  However, in the case of the structure as in Patent Document 3, the materials for the snare wire 201 and the net portion 203 are limited, and the selection range of the materials is very narrow. Further, in the snare wire 201 of Patent Document 3, the removal of the polyp depends on the high-frequency current, and the polyp cannot be removed only by physically sandwiching the polyp.

  In some cases, a cold snare that does not depend on a high-frequency current is used for polyp excision. However, when used in a structure such as Patent Document 3, the net portion 203 interferes with the polyp excision, and the shape of the polyp. If it becomes a mountain-shaped thing close to flat, there is also a problem that it is difficult to grab a polyp only with a snare.

  Therefore, in view of such problems, the present invention aims to provide an endoscopic treatment tool that can stably hold a lesion such as a polyp and can reliably perform excision of the lesion. .

  The present invention is an endoscopic treatment tool for resecting a lesion in a body cavity, wherein the endoscopic treatment tool includes a sheath, an operation wire inserted into the sheath, and the operation wire. An operating portion that operates in a longitudinal direction of the sheath; a loop portion that is provided on a distal end side of the operating wire; and a distal end member that protrudes and protrudes from an opening on the distal end side of the sheath by the operation of the operating portion; Along the loop portion, the loop member is attached to the tip member so as to be detachable from the tip member. When the tip member projects from the tip side opening and the loop portion expands, the loop portion expands. When the strangling member is operated to the proximal end side of the sheath, the strangling member is detached from the distal end member, and the loop of the strangling member is Phase against the loop in the loop section To reduced, characterized in that it is configured to cut by strangulation the lesion.

  Further, it is preferable that the squeezing member and the tip member are attached by a fragile portion configured to be detached from the tip member when the squeezing member is pulled. .

  In addition, the tip member is attached to the loop part, and includes a recovery part that can recover the excised lesion part, and the strangulation member is detachably attached to the loop part or the recovery part. preferable.

  In addition, it is preferable that the strangulation member is attached to the tip member so as to form a plurality of loops along the loop portion of the tip member, and a plurality of lesions can be removed.

  Moreover, it is preferable that a plurality of the strangling members are provided.

  Moreover, it is preferable that the cutting blade which excises the said lesion part is formed in the front-end | tip part of the said sheath.

  Further, a detention snare attached to the tip member so as to be detachable from the tip member is further provided on the distal end side of the tip member, and the detention snare and the tip member are operated to the proximal end side. It is preferable that the indwelling snare is attached by a second fragile portion configured to be detached from the tip member.

  The endoscope treatment tool further includes a second sheath that can be inserted through the sheath, and the indwelling snare extends from the ligation loop portion to the proximal side, and a ligation loop portion that ligates a lesioned portion, A connecting portion that connects the ligating loop portion and the tip member; and a stopper that prevents the loop from spreading when the connecting portion is inserted and the loop of the ligating loop portion becomes small. When the wire is operated to the proximal end side, the connecting portion is pulled to the proximal end side together with the distal end member, the stopper comes into contact with the distal end of the sheath, and the stopper is relative to the connecting portion. When the operation wire is further operated to the proximal side after the lesioned part is ligated by the ligation loop part after the movement of the ligation loop part is reduced to the distal end side, the second fragile Part of the connecting part End side is separated from the distal end member, it is preferable that the detention snare is released from the tip member.

  According to the endoscopic treatment tool of the present invention, a lesion such as a polyp can be stably held, and the lesion can be reliably excised.

1 is an overall view showing a state in which an endoscope treatment tool according to an embodiment of the present invention is inserted into an endoscope. It is a figure which shows the state by which the treatment tool for endoscopes of one Embodiment of this invention was inserted in the insertion conduit provided in the auxiliary tool attached to the front-end | tip of an endoscope. It is the figure which showed the front end side of the treatment tool for endoscopes of one Embodiment of this invention, and was seen from the opening part side of the collection | recovery part provided in the endoscope treatment tool. It is a perspective view of the treatment tool for endoscopes of Drawing 3a. It is a side view of the treatment tool for endoscopes of Drawing 3a. FIG. 3B is a perspective view showing a state where the strut member is pulled in the endoscope treatment tool shown in FIG. 3B. It is the schematic which shows an example of the loop formation method of a strut member. It is the schematic which shows the other attachment method between a front-end | tip member and a strut member. It is a figure explaining the use condition of the treatment tool for endoscopes of one Embodiment of this invention, and has shown the state which moved the treatment tool for endoscopes to the vicinity of a lesioned part. It is a figure explaining the use condition of the treatment tool for endoscopes of one Embodiment of this invention, and has shown the state which covered the treatment tool for endoscopes on the lesioned part. It is a figure explaining the use condition of the treatment tool for endoscopes of one embodiment of the present invention, and shows the state where the lesion part was strangled by the strangulation member. It is a figure explaining the use condition of the treatment tool for endoscopes of one embodiment of the present invention, and shows the state where the lesion part was excised with the strangulation member. (A) is a figure showing other embodiments provided with a plurality of strut members, (b) shows a loop of one strut member among a plurality of strut members of (a) becomes small. FIG. It is the schematic which shows the modification with which the some strut member was connected. (A) is the schematic which shows an example of operation of the plurality of strut members of FIG. 9, (b) is that the loop of one strut member of the plurality of strut members of (a) is small. It is a figure which shows the state which became. (A) is a figure which shows the treatment tool for endoscopes of further another embodiment by which the cutting blade was formed in the sheath, (b) covered the lesioned part with the treatment tool for endoscopes of (a). It is a figure which shows a state, (c) is a figure which shows the state from which the lesioned part was excised by the strangulation member and the cutting blade. It is the schematic which shows other embodiment with which the indwelling snare was provided in the front end side of the front-end | tip member. FIG. 13 is a diagram showing a state where an indwelling snare is housed in a second sheath in the embodiment of FIG. 12. It is a figure which shows the state which made the indwelling snare protrude from the front-end | tip of a 2nd sheath from the state of FIG. 13a. In the state of FIG. 13b, it is a figure which shows the state which passed the polyp through the loop of the detention snare. It is a figure which shows the state which restrict | squeezed the loop of the detention snare from the state of FIG. 13c, and ligated the polyp. It is a figure which shows the state which operated the operation wire to the base end side from the state of FIG. 13d, and the indwelling snare removed from the front-end | tip member. It is a figure which shows the state before squeezing the polyp which made the tip member protrude from the sheath from the state of FIG. 13e. It is a perspective view which shows the treatment tool for collection | recovery which collects the conventional polyp. It is a figure which shows the conventional high frequency snare.

  Hereinafter, an endoscope treatment tool of the present invention will be described in detail with reference to the drawings. The endoscopic treatment tool of the embodiment described below is merely an example, and the endoscopic treatment tool of the present invention is not limited to the embodiment described in the drawings.

  As shown in FIG. 1, an endoscope treatment tool 1 (hereinafter simply referred to as a treatment tool 1) of this embodiment is inserted into a body cavity from outside the body, such as a forceps opening of an endoscope E, and the like. It is configured to excise a lesion such as a polyp. In FIG. 1, the treatment instrument 1 is inserted into the forceps opening of the endoscope E and is configured to remove the lesion while observing the lesion with a lens on the distal end side of the endoscope E. In addition to the forceps opening of the endoscope E, the treatment tool 1 may be used by being inserted into an auxiliary tool (see, for example, FIG. 2) having an insertion conduit C attached to the distal end of the endoscope E. As an auxiliary tool having the insertion pipe C, for example, as shown in FIG. 2, a tip cap Ca made of a transparent annular resin material attached to the tip of the endoscope E, and a tip cap Ca are attached. A tube-shaped insertion line C is provided, and the insertion line C having a slit S formed from the distal end to the proximal end of the insertion line C can be used.

  As shown in FIG. 1 and FIGS. 3 a to 3 c, the treatment instrument 1 of the present embodiment includes a sheath 2, an operation wire 31 inserted into the sheath 2 (see FIG. 3 c), and an operation wire 31 connected to the sheath 2. A distal end member that has an operation portion 4 (see FIG. 1) operated in the longitudinal direction and a loop portion L provided on the distal end side of the operation wire 31, and protrudes and retracts from the distal end side opening 2 a of the sheath 2 by the operation of the operation portion 4. 32 and a thread-like strangling member 5 attached to the tip member 32 along the loop portion L of the tip member 32 so as to be detachable from the tip member 32. Moreover, in this embodiment, as FIG. 1 and FIG. 3 a-3 c show, the collection | recovery part 6 which can collect | recover the lesioned part excised with the treatment tool 1 is provided. In the embodiment described below, the recovery unit 6 is provided. However, when the purpose is only excision of a lesioned part, it is not necessary to provide the recovery unit 6.

  In the present embodiment, the sheath 2 is inserted into the forceps port of the endoscope E, the insertion conduit C shown in FIG. The sheath 2 is a flexible tubular member that extends from the proximal side, which is the proximal side of the practitioner, to the distal end side of the endoscope E and has an insertion path formed therein. When the operation wire 31 and the thread-like strangling member 5 (a linear portion 52 (see FIG. 3c) described later) are inserted into the sheath 2 and the operation wire 31 and the linear portion 52 are operated on the proximal end side In addition, the operation force on the proximal end side is transmitted to the distal end side of the endoscope E. 1 and FIGS. 3 a to 3 c, the distal end member 32, the strangling member 5 attached to the distal end member 32 (a loop-shaped strangling portion 51 described later) and the recovery portion 6 protrude from the distal end side opening 2 a of the sheath 2. Although shown, the distal end member 32, the strangulation member 5 and the recovery part 6 are accommodated in the sheath 2 when the treatment instrument 1 is inserted into the endoscope E or the insertion conduit C from the proximal end opening. State. Thereby, insertion of the treatment tool 1 to the endoscope E or the insertion conduit C can be facilitated. In the embodiment shown in FIGS. 1 and 2, the sheath 2 is inserted into the forceps port of the endoscope E or the insertion conduit C. However, the forceps port of the endoscope E or the insertion tube is shown. The path C itself may function as a sheath.

  The treatment instrument 1 is configured such that the distal end member 32 protrudes and retracts from the distal end side opening 2 a on the distal end side of the sheath 2. The tip member 32 has elasticity so that it can be deformed between a state accommodated in the sheath 2 and a state of protruding from the sheath 2 and expanding. Specifically, when the distal end member 32 is accommodated in the sheath 2, the distal end member 32 is compressed and elongated, and when the distal end member 32 protrudes from the distal end side opening 2 a of the sheath 2, the loop portion L expands due to the elasticity of the distal end member 32. Thus, a loop having a size capable of passing a lesion such as a polyp is formed.

  The tip member 32 (the recovery portion 6 of the tip member 32) holds the thread-like strangulation member 5 before excising the lesion, as shown in FIGS. As will be described later, the thread-like strangling member 5 is attached to the distal end member 32 and is held in a shape corresponding to the shape of the distal end member 32 that is deformed when the sheath 2 protrudes and retracts. When the distal end member 32 is accommodated in the sheath 2 before excising the lesioned part, the strangulation member 5 is also accommodated in the sheath 2 together with the distal end member 32, and the distal end member 32 is opened on the distal end side of the sheath 2. When projecting from 2a and the loop portion L expands, the strangling member 5 also forms a loop as the loop portion L expands, as shown in FIGS. The details of the strut member 5 will be described later.

  The shape of the loop of the loop portion L is shown as a substantially elliptical shape or an egg shape in the present embodiment, but it is sufficient that it has a generally loop shape such as a circle or a polygon, and is limited to the shape shown in the figure. Is not to be done. The tip member 32 including the loop portion L is not particularly limited as long as it is a material having elasticity. However, the tip member 32 has rigidity and shape retainability capable of holding the strangling member 5 and the recovery portion 6 in an expanded state. For example, a tip member 32 made of metal or synthetic resin can be used. Here, the loop of the loop portion L does not need to be a completely unbroken loop, and the loop portion L may have a break as long as it can emerge from the distal end side opening 2a of the sheath 2. .

  An operation wire 31 inserted into the sheath 2 extends on the proximal end side (lower side in FIG. 3A) of the loop portion L of the distal end member 32, and the proximal end side of the operation wire 31 is connected to the operation portion 4. Yes. The operation wire 31 transmits a push-pull operation to the proximal end side and the distal end side within the sheath 2 to the distal end member 32 by the operation of the operation unit 4. The operation wire 31 only needs to be provided on the proximal end side of the distal end member 32 so that the push / pull operation can be transmitted to the distal end member 32. Even if the operation wire 31 and the distal end member 32 are provided integrally, It may be provided as a body. The material of the operation wire 31 is not particularly limited, and has a predetermined rigidity so that the distal end member 32 can be projected and retracted from the distal end side opening 2 a of the sheath 2. Can be transmitted to the tip member 32.

  The operation unit 4 operates the tip member 32 as described above. In the present embodiment, the operation unit 4 includes an operation unit main body 41 and an operation rod 42 slidably provided on the operation unit main body 41, as shown in FIG. In the present embodiment, the operation unit main body 41 is shown as an elongated member having an elongated slide groove to which the proximal end of the sheath 2 is connected, and a finger hook ring is provided at the free end of the operation unit main body 41. It has been. The operating rod 42 engages with the slide groove of the operation unit main body 41 and is provided so as to be movable along the slide groove. The operating rod 42 extends in a direction orthogonal to the direction in which the slide groove is formed, and finger hook rings are provided at both ends of the operating rod 42. The proximal end of the operation wire 31 is coupled to the operation rod 42, and the distal end member is operated by operating the operation wire 31 with respect to the sheath 2 by sliding the operation rod 42 with respect to the operation portion main body 41. 32 can be operated. The structure of the operation unit 4 is not particularly limited as long as the operation wire 31 and the tip member 32 can be operated, and other known operation structures can be used.

  The collection unit 6 is provided when a treatment unit 1 collects a lesion such as a polyp excised by a strangulation member 5 described later. The shape and structure of the collecting unit 6 are not particularly limited as long as the collecting unit 6 can collect a lesion such as a polyp. However, in the present embodiment, the collecting unit 6 is a net shape attached to the loop portion L. It is shown as a recovery part. The recovery unit 6 is accommodated in the sheath 2 together with the loop portion L before excision of the lesioned part. When the lesioned part is excised, the operation unit 4 is operated from the state accommodated in the sheath 2 so that the recovery unit 6 is recovered. The portion 6 protrudes together with the loop portion L from the distal end side opening 2 a of the sheath 2. In addition, after removing a lesion such as a polyp and collecting it in the collecting unit 6, at least a part or most (or all) of the loop L is accommodated in the sheath 2, thereby opening the loop L Is narrowed, and the opening of the recovery part 6 is also narrowed, so that the excised lesion part is prevented from falling off from the recovery part 6.

  Next, the thread-like strut member 5 will be described. The strangling member 5 forms a loop separately from the loop portion L of the distal end member 32, and the strangling member 5 reduces the loop relative to the loop portion L by an operation on the proximal end side of the sheath 2 by a practitioner or the like. Stroke the affected area, such as a polyp. The strangulation member 5 may excise the lesioned part only by strangulation, or may be cut with a cutting blade while grasping the lesioned part with the strangulation member 5 after squeezing, as will be described later. The thread-like strangling member 5 is an elongated member such as a thread, a string, or a wire, for example, and the material of the strangling member 5 is a flexible material that can be deformed following the deformation of the distal end member 32, and the lesion It is preferable that the strangling member 5 has such rigidity that the strangling member 5 is not broken when the part is wrung. For example, polyamide, such as nylon, resin threads such as polyester, polypropylene, etc., cotton, silk, synthetic fiber, and the like are used. The thinness of the thread-like strangling member 5 is not particularly limited, but it is preferable to use a thin strangling member 5 in order to facilitate excision of the lesion, for example, a diameter of 0.1 to 1 mm, more preferably 0. A strangling member 5 of 3 to 0.5 mm can be used. Further, the strangulation member 5 may be formed of a conductive material so that a high-frequency current can be applied. However, the strangulation member 5 is a lesion caused by tightening of a lesion portion by the strangulation member 5 or a lesion by the strangulation member 5. It is preferable to excise the lesioned part by so-called cold polypectomy, in which the lesioned part is excised by tightening the part and cutting blade. The removal of the lesion by cold polypectomy does not burn the lesion by heat, but physically removes the lesion, reducing the risk of bleeding in the body cavity due to inflammation after a while after the operation. be able to. As will be described later, the treatment tool 1 of the present embodiment is suitable for excision of a lesion by cold polypectomy without using a high-frequency current.

  In the present embodiment, as shown in FIGS. 3a to 3c, the strangulation member 5 is inserted into the sheath 2 with a loop-shaped strangulation portion 51 that strangles the lesion, and from the distal end side of the sheath 2 to the proximal end And a linear portion 52 extending to the side, and the lesioned portion is excised by reducing the size of the loop of the loop strangulated portion 51. In the present embodiment, as shown in FIG. 1, a second operation portion 7 for operating the thread-like strangling member 5 is provided on the proximal end side of the linear portion 52, and the second operation portion 7 is By pulling, the linear portion 52 is pulled, and the loop of the loop-shaped strangling portion 51 is reduced as shown in FIG. In the present embodiment, the second operation portion 7 is shown as a finger ring as shown in FIG. 1, but the linear portion 52 of the strut member 5 can be pulled to the proximal end side. If possible, the structure is not particularly limited. In addition, in the present embodiment, the second operation unit 7 is shown as separate members that are physically separated from the operation unit 4 (first operation unit) and the second operation unit 7. For example, the operation unit 4 and the second operation unit 7 may be physically integrated as one device.

  3a, 3b, FIG. 4 and the like, the strangling member 5 extends from the proximal end side of the sheath 2 to the distal end side along the loop portion L of the distal end member 32 in FIG. After being folded back into a loop shape, the sheath 2 enters the sheath 2 again and extends from the distal end side to the proximal end side of the sheath 2. However, the method of forming the loop is not particularly limited as long as the strut member 5 is configured so that the loop of the strut member 5 becomes small when operated to the proximal end side. For example, a small ring R is formed at one end of one linear strut member 5 as shown in FIG. 5 (in FIG. 5, the loop portion L and the recovery portion 6 are omitted). The strangling member 5 is formed in a loop through the ring R, and then the strangling member 5 is extended from the distal end side to the proximal end side of the sheath 2, and the strangling member 5 is pulled toward the proximal end side of the sheath 2. You may comprise so that the loop of the strut member 5 may be made small by operating.

  The thread-like strangling member 5 is detachably attached to the tip member 32 along the loop portion L of the tip member 32. The strangling member 5 is provided along the loop portion L as long as the strangling member 5 is routed in a shape corresponding to the loop outline of the loop portion L, and the strangling member is slightly separated from the loop portion L. 5 may be routed. As shown in FIGS. 3a to 3c, the attachment position of the squeezing member 5 to the distal end member 32 is attached to the recovery unit 6, but may be attached to the loop portion L. The strangling member 5 may be indirectly attached to the collection portion 6 or the loop portion L via another member. In this embodiment, as shown in FIGS. 3 b and 3 c, the collection unit 6 shown as a collection net includes a lesion part collection site 61 that spreads in a bag shape from which a lesion part is collected, and a lesion part sandwiching the loop part L. A strangling member attaching part 62 provided on the opposite side of the part collecting part 61 is provided, and the strangling member 5 is attached to the strangling member attaching part 62. As shown in FIGS. 3 b and 3 c, the squeezing member attaching portion 62 is provided along the loop portion L in a band shape and in an annular shape. The strangling member attaching portion 62 is not necessarily required to be formed in an annular shape as long as the strangling member 5 can be attached so as to form a loop along the loop portion L. For example, as shown in FIG. 6 (illustration is omitted with respect to the collection unit 6), the strut member attaching portion 62 is a plurality of strut member attaching portions 62a spaced apart in the loop forming direction of the loop portion L. In addition, since the line connecting the plurality of strut member attachment portions 62a has a shape along the loop portion L, the strut member 5 can spread along the loop portion L.

  The detachable attachment between the tip member 32 and the wrinkle member 5 is performed by forming a fragile portion F (see FIGS. 3a to 3c, etc.) at the attachment portion between the tip member 32 and the wrinkle member 5. Is called. Before the squeezing member 5 is pulled, the fragile portion F remains connected between the tip member 32 and the squeezing member 5 depending on the movement of the tip member 32 into and out of the sheath 2 (squeezing member 5). The member 5 is in a state in which the strangling member 5 is not detached and the strangling member 5 is separated from the tip member 32 when the strangling member 5 is pulled. In this embodiment, the fragile portion F is a mesh portion of the collection portion 6 shown as a collection net, as shown in FIGS. 3a to 3c, and the struts that are partially sewn and passed through the mesh portion. This mesh portion is configured to be broken when the member 5 is pulled. With this configuration, when the squeezing member 5 is pulled, the fragile portion F of the squeezing member attaching portion 62 of the collecting portion 6 is torn, and the squeezing member 5 is detached from the tip member 32. In this case, even if the strangulation member attachment site 62 is torn, the lesion site collection site 61 is not torn, so that the lesion site collection is not affected.

  The fragile portion F is not limited to that shown in the present embodiment, and for example, the mesh of the collection portion 6 is configured to be unwound rather than torn by pulling the strangling member 5. Alternatively, the adhesive member may be released by joining the tip member 32 and the strangling member 5 as a whole or in a dotted manner with an adhesive and pulling the strangling member 5. In addition, the weak part F may be formed by heat-sealing in a dot shape. The fragile portion F is provided on the collecting portion 6 side in the present embodiment, but may be provided on the loop portion L side, or may be small separately from the collecting portion 6 and the loop portion L as shown in FIG. The ring-shaped strangling member mounting portion 62a is easily cut to form a weakened portion F, and a plurality of the weakened portions F are provided apart in the loop forming direction of the loop portion L. You may comprise so that it may be torn when it is pulled.

  On the other hand, the strangling member 5 is attached to the distal end member 32 so that the strangling member 5 does not separate from the distal end member 32 when the distal end member 32 protrudes from the sheath 2. For this reason, when the distal end member 32 exits from the distal end side opening 2 a of the sheath 2, the strangulation member 5 expands in accordance with the expansion of the distal end member 32 to form a loop, and the loop of the strangulation member 5 forms a lesioned portion. It can be set to a size that can be enclosed. Therefore, the thread-like strangling member 5 has a shape that is not stable because the sheath 2 and the strangling member 5 are joined when the distal end member 32 is protruded from within the sheath 2. In addition, a loop having a size capable of enclosing a lesion such as a polyp can be easily formed.

  After the lesion is surrounded by the loop of the strangulation member 5, the lesion can be excised by the strangulation member 5. Specifically, when the strangulation member 5 is operated to the proximal end side of the sheath 2 after the lesion part such as a polyp is surrounded by the loop of the strangulation member 5, the strangulation member 5 squeezes in the fragile portion F. The joining (the state where it does not detach) between the scissors member 5 and the tip member 32 is released, and the strut member 5 is detached from the tip member 32. When the strangulation member 5 is further operated toward the proximal end side of the sheath 2, the loop of the strangulation member 5 becomes relatively small with respect to the loop of the loop portion L as shown in FIG. Can be excised by strangling. At this time, the distal end member 32 is not directly involved in excision of a lesion such as a polyp, but by operating the distal end member 32 to the proximal end side, the size of the loop portion L of the distal end member 32 is reduced, and the polyp It is possible to grip a lesioned part. As a result, the lesion part such as a polyp is gripped by the loop part L that has become smaller, and the lesion part such as a polyp is stabilized by two points of the root part of the lesion part and the part gripped by the loop part L, and the stable lesion The part is squeezed by reducing the loop of the squeezing member 5 between the two points. Therefore, it is possible to avoid a situation in which the lesion part during strangulation becomes unstable and the force when squeezing cannot be transmitted and the lesion part cannot be excised well, and the lesion part is stabilized and excised. Can be performed reliably.

  Moreover, since the treatment tool 1 of the present embodiment can use the strangulation member 5 whose shape is not stable due to the above-described configuration, the selection range of the material of the strangulation member 5 is widened, and the high-frequency current is used for excision of the lesioned part. It is suitable for excision of a lesion by cold polypectomy. When the strangulation member 5 is used as a cold snare that does not use high-frequency current, the lesion is not burned out, so the risk of inflammation such as burns due to heat can be greatly reduced, and after a while. The risk of bleeding in the body cavity afterwards can be reduced. In this embodiment, the lesioned part can be stably excised in this way, and post-operative inflammation, bleeding, etc. can be suppressed.

  Next, an operation up to excision / recovery of a lesioned part (hereinafter referred to as a polyp P) using the treatment tool 1 of the present embodiment will be described in detail with reference to FIGS. In addition, the following description is an example to the last and this invention is not limited to the following content. 7a to 7d, the left side view is a view of the collection unit 6 seen from the side, the right side view is a view of the collection unit 6 from the opening side, and in the right side view, the loop portion L is shown. In order to make the strangling member 5 visible, the collection unit 6 is not shown.

  First, after inserting the endoscope E into the body cavity and discovering the polyp P by the endoscope E, in order to remove the polyp P, as shown in FIG. The treatment instrument 1 is inserted into the insertion line C attached to the endoscope E. When the treatment instrument 1 is inserted into the endoscope E or the insertion conduit C, the distal end member 32 (the loop portion L and the collection portion 6) is in a state of being accommodated in the sheath 2, and the strangulation member 5 is It is accommodated in the sheath 2 together with the tip member 32. When the distal end of the sheath 2 is fed to the distal end side of the endoscope E, the distal end member 32 and the strangling member 5 are protruded from the distal end side opening 2a of the sheath 2 in order to cut the polyp P (FIGS. 1 and 7a). reference). Specifically, by operating the operation unit 4, the operation wire 31 is pushed toward the distal end side with respect to the sheath 2, thereby causing the distal end member 32 to protrude from the distal end side opening 2 a of the sheath 2. This state is the state shown in FIG. 7a.

  When the distal end member 32 protrudes from the distal end side opening 2a of the sheath 2, the loop portion L of the distal end member 32 compressed in the sheath 2 spreads as shown in the right side of FIG. 7a and is attached to the loop portion L. The collecting unit 6 is also widened. Further, the loop-shaped strangling portion 51 of the thread-shaped strangling member 5 joined via the recovery portion 6 and the fragile portion F may surround the polyp P as the loop portion L and the recovery portion 6 expand. It spreads to form a loop of the size possible. Thus, even when the thread-like strangling member 5 whose shape is not stable is used, the distal end member 32 and the strangling member 5 are joined via the fragile portion F, so that the distal end member 32 becomes the distal end of the sheath 2. The strangling member 5 can be easily spread by deformation when protruding from the side opening 2a.

  Next, the treatment portion 1 in a state where the loop portion L and the strangulation member 5 are expanded is moved toward the polyp P, and the polyp P is surrounded by the loop portion L and the strangulation member 5. After surrounding the polyp P, if necessary, the operation unit 4 is operated to pull the operation wire 31 to the proximal end side, and as shown in the right side of FIG. A direction perpendicular to the longitudinal direction (left and right direction in the right side of FIG. 7B) is deformed so as to be narrowed, and the polyp P is sandwiched. By this operation, there are two points (two places), a part P1 sandwiched and held by the loop portion L (see the left figure in FIG. 7b) and a root part P2 of the polyp P (see the left figure in FIG. 7b). ), The polyp P is held, and the region between the polyp P sites P1 and P2 is stabilized.

  In a state where the polyp P is stable, the second operation portion 7 is pulled toward the proximal end side. When the second operating portion 7 is pulled, the linear portion 52 of the strangling member 5 is pulled, and the loop-shaped strangling portion 51 also receives a force toward the proximal end side. When the loop-shaped strangling portion 51 receives a predetermined force toward the proximal end side, the joining between the loop-shaped strangling portion 51 and the fragile portion F of the strangling member attaching portion 62 is released. That is, by pulling the loop-shaped strangling portion 51, the net (fragile portion F) in which the loop-shaped strangling portion 51 is knitted is broken, and the loop of the loop-shaped strangling portion 51 is as shown in FIG. While being smaller than the loop of the loop portion L, the outer peripheral portion of the polyp P is squeezed.

  When the outer periphery of the polyp P is squeezed by the loop-like squeezing part 51 of the squeezing member 5 and the second operation part 7 is further pulled, the loop of the loop-like squeezing part 51 becomes even smaller. The polyp P is excised by the loop of the loop-shaped strangulation portion 51 that is smaller than the outer peripheral portion of the polyp P. At the time of excision of the loop-shaped strangulation portion 51, both sides of the portion of the polyp P that is strangled by the loop-shaped strangulation portion 51 are the portion P1 sandwiched by the loop portion L and the root portion of the polyp P as described above. It is held stably by P2. In a state where the polyp P is stably held, the loop-shaped strangulation portion 51 can move independently of the loop portion L and the size of the loop can be reduced. The force applied to the polyp P by the squeezing of the collar portion 51 is difficult to escape, and the polyp P can be easily excised.

  When the excision of the polyp P is completed, the polyp P is recovered as it is by the recovery unit 6, as shown in FIG. 7d. The squeezing member 5 used for squeezing the polyp P passes through the sheath 2 from the base end side of the sheath 2 by pulling the second operation portion 7 as it is from the state of FIG. Can be removed to the outside. The collection unit 6 that collects the polyp P operates the operation unit 4 to pull the loop part L into the sheath 2 in order to prevent the polyp P from dropping from the collection unit 6. Close the opening of L. The polyp P recovered by the recovery unit 6 moves along the slit S formed in the insertion pipe C shown in FIG. 2 to the base end side together with the recovery unit 6, and is recovered outside the body. Thus, the treatment instrument 1 provided with the collection unit 6 can collect the polyp P simultaneously with the cutting. And even if the weak part F provided in the collection part 6 is torn by the strangulation member 5, the lesion part collection part 61 of the collection part 6 is not torn, so that the polyp P is also reliably collected. Can do.

  Next, a modification of the above embodiment will be described. The following modifications are shown merely as examples, and the present invention is not limited to the following modifications. In the following modified examples, description of common matters will be omitted, and differences will be mainly described.

  In the embodiment described above, the one using the strangulation member 5 that cuts the lesion portion only once is shown. However, in order to be able to remove a plurality of lesion portions, the strangulation member 5 is a loop portion of the tip member 32. The tip member 32 may be attached so as to form a plurality of loops along L.

  For example, as shown in FIGS. 8A and 8B, a plurality of strut members 5 are attached along the loop portion L to the tip member 32 (for example, the strut member attachment portion 62 of the collection portion 6). In FIGS. 8A and 8B, the loop portion L and the recovery portion 6 are indicated by a two-dot chain line in order to make the strut member 5 easily visible. 8 (a) and 8 (b), three strut members 5 are attached, but the number of strut members 5 is not particularly limited. As shown in FIG. 8 (a), the plurality of strangulation members 5a, 5b, and 5c are strangulated member attachment sites 62 (on the opposite side of the lesion site collection site 61 across the loop portion L) (see FIG. 8). 3b), are arranged concentrically and are detachably attached via the fragile portion F. Each of the strangulation members 5a, 5b, 5c can be operated independently, and one strangulation member is used for one lesioned part. After one lesion is excised with one of the plurality of strangulation members 5 and collected in the collection unit 6, it may be taken out of the body each time the lesion is excised or collected, or the plurality of lesions After being collected in the collection unit 6, it may be taken out of the body. In addition, when comprised so that the weak part F may be torn (the strangling member attaching part 62a of the collection | recovery part 6 is torn), as shown in FIG.8 (b), it is preferable to make it detach | leave from the outer strangling member 5a. By doing so, the remaining strangling members 5b and 5c are attached to the strut member attaching portion 62a by being torn from the side farther from the loop portion L of the strut member attaching portion 62a of the recovery portion 6. The fragile portion F that has been broken by the strangling member 5a does not affect the mounting state of the other strangling members 5b, 5c.

  Further, the plurality of loops formed by the strangling member 5 may be connected to each other by a thread-like connecting portion 53 as shown in the schematic diagram of FIG. In this modification, a plurality of loops 5d, 5e, and 5f are connected by a thread-like connecting portion 53, and the plurality of loops 5d, 5e, and 5f are sequentially pulled from the tip member 32 by pulling and operating one linear portion 52. It is configured to detach and resect the lesion. Specifically, the plurality of loops 5d, 5e, and 5f are shown in FIG. 8 (a) on the strangulation member attaching portion 62 provided on the opposite side of the lesion portion collecting portion 61 across the loop portion L. It arrange | positions concentrically in the state similar to arrangement | positioning, and each is attached through the weak part F so that separation | detachment is possible. When the linear portion 52 is pulled, one of the plurality of loops 5d, 5e, and 5f is detached from the strangulation member attaching portion 62, the loop is reduced, and the lesion is excised. When another lesion is to be excised, the linear portion 52 is further pulled to disengage the second loop from the strut member attachment site 62, the loop is made smaller, and the lesion is excised. In this case, for example, in order to adjust the pulling operation by the second operation unit 7 that operates the linear part 52, a stopping unit that stops the pulling operation of the linear part 52 by a predetermined operation amount can be provided. More specifically, for example, as shown in FIGS. 10A and 10B, operation means such as a dial D is provided on the proximal end side of the sheath 2 and the linear portion 52 is wound up. When the linear portion 52 is wound by a predetermined amount, the rotation of the dial D is stopped to prevent the linear portion 52 from being pulled excessively, and after the lesion portion is excised by one loop, the next lesion It is possible to prevent the next loop from detaching from the strut member mounting portion 62 until the portion is cut off.

  As still another modification, as shown in FIGS. 11A to 11C, a cutting blade 2 c for excising a lesioned part can be formed at the distal end of the sheath 2. The cutting blade 2 c is used for cutting the lesioned part that has been squeezed by the squeezing member 5. More specifically, as shown in FIGS. 11A to 11C, the cutting blade 2 c forms a notch portion 21 in which the outer peripheral portion of the sheath 2 is partially cut out at the distal end of the sheath 2. The cutting blade 2c is attached in the cutout portion 21 so as not to protrude to the end face and the outer peripheral side of the sheath 2. In this modified example, as shown in FIG. 11B, after the polyp P is surrounded by the strangulation member 5, the strangulation member 5 draws it toward the end face side of the sheath 2 while strangling the lesioned portion. 11 (c), the polyp P drawn toward the end face side of the sheath 2 is cut by the cutting blade 2c. With this configuration, it becomes possible to excise a lesion such as a polyp P more easily. 11A to 11C, the cutting blade 2c is formed in the cutout portion 21 of the sheath 2, but the polyp P is applied by the strangling member 5 without providing the cutting blade 2c. The polyp P may be cut into the notch 21 while squeezing and the polyp P may be excised.

  As still another modification, an indwelling snare 8 can be provided on the distal end side of the distal end member 32 as shown in FIGS. 12 and 13a to 13f. The indwelling snare 8 is used to block the blood flow by ligating the base of the polyp in order to prevent bleeding from the part removed after the polyp is removed, for example, when the diameter of the polyp is large. In this modification, as shown in FIG. 12, the endoscope treatment tool 1 has a second sheath 9 that can be inserted through the sheath 2 and has an inner diameter larger than the outer diameter of the sheath 2, and an indwelling snare 8. Is configured to be able to appear and retract from the distal end side of the second sheath 9. The indwelling snare 8 is formed of a material having a predetermined elasticity or shape retaining property so that it can be accommodated in the second sheath 9 and can form a loop when protruding from the distal end side of the second sheath 9. ing. The material of the indwelling snare 8 is not particularly limited as long as the indwelling snare 8 can be accommodated in the second sheath 9 and can form a loop when protruding from the distal end side of the second sheath 9. In addition to the material used for the drawn strut member 5, a material used as a known indwelling snare can be used.

  As shown in FIG. 12, the indwelling snare 8 includes a ligation loop portion 81 that ligates a lesioned portion, and a connection portion 82 that extends from the ligation loop portion 81 to the proximal end side and connects the ligation loop portion 81 and the distal end member 32. And a stopper 83 that prevents the loop from spreading when the connection portion 82 is inserted and the loop of the ligation loop portion 81 becomes small. As will be described later, when the operation wire 31 is operated to the proximal end side, the connecting portion 82 is pulled to the proximal end side together with the distal end member 32, the stopper 83 comes into contact with the distal end of the sheath 2, and the stopper 83 is The loop of the ligation loop portion 81 is made smaller by moving toward the distal end side relative to the connection portion 82. The proximal end side of the stopper 83 is sized so as not to enter the sheath 2 but to enter the second sheath 9. Specifically, the width of the proximal end side of the stopper 83 ( (Diameter) is larger than the inner diameter of the sheath 2 and smaller than the inner diameter of the second sheath 9.

  As shown in FIG. 12, the indwelling snare 8 is attached to the tip member 32 by the second fragile portion F <b> 2, and the indwelling snare 8 can be detached from the tip member 32. The second weakened portion F2 has such a structure or bonding strength that the indwelling snare 8 is detached from the distal end member 32 after the distal end member 32 is operated to the proximal end side and the indwelling snare 8 ligates the polyp P. Thereby, before excising the lesion part such as polyp P, the lesion part can be ligated by the indwelling snare 8, and after the lesion part is ligated, the indwelling snare 8 is detached from the distal end member 32 by the second fragile part F2. Since it becomes easy to perform, treatment efficiency improves. The second fragile portion F2 can be the same as the fragile portion F described above. For example, the proximal end side of the connection portion 82 is attached to the mesh of the collection portion 6 of the distal end member 32, and the distal end member 32 is the proximal end. When the polyp P is ligated (or after ligation), the mesh of the collection unit 6 can be broken or unraveled. Further, the proximal end side of the connecting portion 82 and the distal end member 32 may be joined with an adhesive, or may be joined by thermal fusion. Further, a hook-shaped locking portion (not shown) can be provided at the base end of the connecting portion 82 so that the locking portion can be locked to the mesh of the collection portion 6, and the detention snare 8 is necessary. Sometimes, the indwelling snare 8 may be attached to the endoscope treatment tool 1 shown in FIG. 3a or FIG. 8 (a) before use.

  Next, the operation of this modification will be described with reference to FIGS. In FIGS. 13a to 13e, the strangling member 5 is omitted for easy understanding, and the tip member 32 is also shown in a simplified manner.

  When the distal end of the endoscope treatment tool 1 is moved to the position of the polyp P before the polyp P is excised, the indwelling snare 8 is accommodated in the second sheath 9 as shown in FIG. It is the state that was done. When the distal end of the endoscope treatment tool 1 is moved to the vicinity of the polyp P, the indwelling snare 8 protrudes from the distal end side of the second sheath 9 as shown in FIG. 13b. The indwelling snare 8 moves the sheath 2 to the distal end side with respect to the second sheath 9, so that the indwelling snare 8 protrudes from the distal end side of the second sheath 9, and the ligation loop portion 81 of the indwelling snare 8 expands. Next, as shown in FIG. 13c, after passing the polyp P through the loop of the ligation loop portion 81, the polyp P is ligated as shown in FIG. 13d. The ligation of the polyp P is performed by operating the operation wire 31 to the proximal end side with respect to the sheath 2. When the operation wire 31 is operated to the proximal end side, the connecting portion 82 of the indwelling snare 8 is pulled toward the proximal end side as shown in FIG. 13d, and the stopper 83 stops at the distal end side of the sheath 2, so The loop of the loop part 81 becomes small and the polyp P is ligated. After the polyp P is ligated by the ligation loop portion 81, as shown in FIG. 13E, when the operation wire 31 is further operated to the proximal end side, the recovery portion 6 of the distal end member 32 is broken and the second In the fragile portion F <b> 2, the proximal end side of the connection portion 82 is detached from the distal end member 32, and the indwelling snare 8 is detached from the distal end member 32.

  Thereafter, after the indwelling snare 8 is detached and separated, as shown in FIG. 13f, the tip member 32 is protruded from the sheath 2, and the polyp P is squeezed as described in FIGS. 7a to 7d. P excision is completed. As described above, in this modification, for example, when the stem of the polyp P is thick, when the polyp P needs to be ligated after the polyp P is ligated, the indwelling snare 8 is provided on the distal end side of the distal end member 32. Since it is provided, the ligation by the indwelling snare 8 of the polyp P and the squeezing by the squeezing member 5 of the polyp P can be performed without removing the endoscope treatment tool 1 from the body, and the treatment efficiency is improved. improves. In addition, since the indwelling snare 8 is attached to the distal end member 32 by the second fragile portion F2 and can be detached from the distal end member 32, the indwelling snare 8 to which the polyp P is ligated can be easily removed, and the treatment time can be shortened. This can reduce the burden on the patient.

  Moreover, although the indwelling snare shown in FIGS. 12 to 13f described above was provided on the distal end side of the strangulation member, a modification of the endoscopic treatment tool using the indwelling snare shown in FIGS. 12 to 13f. As an example, for example, one strangling member out of a plurality of constricting members arranged concentrically as shown in FIGS. 8 to 10 may be used as an indwelling snare. For example, among the plurality of constricting members and the detention snare arranged concentrically, the detention snare is positioned on the innermost periphery, and the detention snare and the plurality of strangulation members are connected by the second fragile portion. . As described with reference to FIGS. 12 to 13f, after the polyp is surrounded by the detention snare, the loop of the detention snare is made small to ligate the polyp, and then the polyp is squeezed by the squeezing member. Can be excised. The indwelling snare and the strangling member are configured to be detachable by the second fragile portion. For example, the second fragile portion makes the connecting portion of the indwelling snare and the strangling member thinner than the other portions. Therefore, the indwelling snare can be easily detached. Even in this case, similarly to the embodiment shown in FIGS. 12 to 13f, the ligation by the indwelling snare of the polyp and the strangulation by the strangling member of the polyp can be performed without removing the endoscope treatment tool from the body. This can be done and the treatment efficiency is improved. Furthermore, since the indwelling snare and the strangling member are arranged concentrically, after the polyp is ligated, the polyp can be strung with the strangling member as it is, and the treatment efficiency is further improved. In addition, since the indwelling snare is attached to the distal end member by the second weakened part and can be detached from the distal end member, the indwelling snare ligated with the polyp can be easily removed, and the treatment time can be shortened. Can be reduced.

  Note that the above-described embodiments and modifications are not limited to the illustrated aspects, and each embodiment and modification can be modified within a range in which the above-described object can be achieved. What combined the modification is also contained in this invention.

DESCRIPTION OF SYMBOLS 1 Endoscopic treatment tool 2 Sheath 2a Sheath front end opening 2c Cutting blade 21 Notch 31 Operation wire 32 End member 4 Operation part 41 Operation part main body 42 Operation rod 5, 5a, 5b, 5c Constriction member 51 Loop shape Strangulation part 52 Linear part 53 Connection part 5d, 5e, 5f Loop 6 Collection part 61 Lesion part collection part 62, 62a Constriction member attachment part 7 Second operation part 8 Indwelling snare 81 Ligation loop part 82 Connection part 83 Stop Tool 9 Second sheath C Insertion channel Ca Tip cap D Dial E Endoscope F Fragile part F2 Second weak part L Loop part P Polyp P1 Polyp root part P2 Polyp root part R Ring S Slit

Claims (6)

An endoscopic treatment tool for excising a lesion in a body cavity, wherein the endoscopic treatment tool comprises:
Sheath,
An operation wire inserted through the sheath;
An operation unit for operating the operation wire in the longitudinal direction of the sheath;
A distal end member having a loop portion provided on the distal end side of the operation wire, and protruding and retracting from the distal end side opening of the sheath by operation of the operation portion;
Along with the loop part of the tip member, the loop part is spread when the tip part is attached to the tip member so as to be detachable from the tip member, and the tip part projects from the tip side opening and the loop part spreads. A thread-like strangulation member that forms a loop along with, and cuts off the lesion by cold polypectomy ,
The distal end member is attached to the loop portion, and includes a recovery portion capable of recovering the excised lesion.
The recovery portion is provided in a ring shape along the loop portion, and the wrinkle member mounting portion is attached in a ring shape along the loop portion,
The squeezing member attaching part has a plurality of weak parts provided annularly spaced in the loop forming direction of the loop part, and the squeezing member is the plurality of fragile parts of the squeezing member attaching part. Is attached annularly along the loop portion,
When the squeezing member is operated to the proximal end side of the sheath, the squeezing member is detached from the plurality of weakened portions arranged in a ring-like manner, and the loop of the squeezing member becomes the loop portion. An endoscopic treatment tool that is relatively small with respect to the loop of the endoscope and is configured to squeeze and excise the lesion. An endoscopic treatment tool for excising a lesion in a body cavity, wherein the endoscopic treatment tool comprises:
A sheath,
An operation wire inserted through the sheath;
An operation unit for operating the operation wire in the longitudinal direction of the sheath;
A distal end member having a loop portion provided on the distal end side of the operation wire, and protruding and retracting from the distal end side opening of the sheath by operation of the operation portion;
Along with the loop part of the tip member, the loop part is spread when the tip part is attached to the tip member so as to be detachable from the tip member, and the tip part projects from the tip side opening and the loop part spreads. And a thread-like strangling member that forms a loop with the
When the squeezing member is operated to the proximal end side of the sheath, the squeezing member is detached from the distal end member, and the loop of the squeezing member becomes relatively small with respect to the loop of the loop portion. , Configured to strangulate and excise the lesion,
The strangulation member, wherein attached to the distal end member so as to form a plurality of loops along the loop portion of the tip member, an endoscopic treatment instrument is capable of removing multiple lesions. The endoscope treatment tool according to claim 2, wherein a plurality of the strangulation members are provided. An endoscopic treatment tool for excising a lesion in a body cavity, wherein the endoscopic treatment tool comprises:
A sheath,
An operation wire inserted through the sheath;
An operation unit for operating the operation wire in the longitudinal direction of the sheath;
A distal end member having a loop portion provided on the distal end side of the operation wire, and protruding and retracting from the distal end side opening of the sheath by operation of the operation portion;
Along with the loop part of the tip member, the loop part is spread when the tip part is attached to the tip member so as to be detachable from the tip member, and the tip part projects from the tip side opening and the loop part spreads. And a thread-like strangling member that forms a loop with the
When the squeezing member is operated to the proximal end side of the sheath, the squeezing member is detached from the distal end member, and the loop of the squeezing member becomes relatively small with respect to the loop of the loop portion. , Configured to strangulate and excise the lesion,
A cutting blade for excising the lesion is formed at the distal end of the sheath ,
At the distal end portion of the sheath, a cutout portion in which the outer peripheral portion of the sheath is partially cut away is formed,
The cut in portion, the cutting blade endoscope treatment tool Ru Tei mounted so as not to protrude on an end face and an outer peripheral side of the sheath. An endoscopic treatment tool for excising a lesion in a body cavity, wherein the endoscopic treatment tool comprises:
A sheath,
An operation wire inserted through the sheath;
An operation unit for operating the operation wire in the longitudinal direction of the sheath;
A distal end member having a loop portion provided on the distal end side of the operation wire, and protruding and retracting from the distal end side opening of the sheath by operation of the operation portion;
Along with the loop part of the tip member, the loop part is spread when the tip part is attached to the tip member so as to be detachable from the tip member, and the tip part projects from the tip side opening and the loop part spreads. And a thread-like strangling member that forms a loop with the
When the squeezing member is operated to the proximal end side of the sheath, the squeezing member is detached from the distal end member, and the loop of the squeezing member becomes relatively small with respect to the loop of the loop portion. , Configured to strangulate and excise the lesion,
When the distal end of the distal end member is further provided with an indwelling snare attached to the distal end member so as to be detachable from the distal end member, and the indwelling snare and the distal end member are operated to the proximal end side in the detention snare second endoscope treatment tool that is attached by weakened portion configured to disengaged from the distal end member. The endoscopic treatment tool further includes a second sheath that can be inserted through the sheath,
The indwelling snare ligates a lesioned part, a ligation loop part extends from the ligation loop part to a proximal end side, a connection part that connects the ligation loop part and the distal end member, and the connection part is inserted, With a stopper that prevents the loop from spreading when the loop of the ligation loop portion becomes small,
When the operation wire is operated to the proximal end side, the connection portion is pulled toward the proximal end side together with the distal end member, the stopper comes into contact with the distal end of the sheath, and the stopper is against the connection portion. When the operation wire is further operated to the proximal end side after the lesioned part is ligated by the ligation loop part, the first ligation loop part is moved to the distal end side relatively, and then the first ligation loop part is ligated. The endoscopic treatment tool according to claim 5 , wherein the proximal end side of the connecting portion is detached from the distal end member and the indwelling snare is detached from the distal end member in the two fragile portions.

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