JP6640604B2 - Treatment tool - Google Patents

Description

  The present invention relates to a treatment tool which is used by being inserted into a forceps port of an endoscope, and in particular, is used for pushing and spreading an adhesive sheet and attaching it to an affected part in a body.

  In endoscopy, if a lesion such as a tumor is found in a mucous membrane such as the esophagus, stomach, or duodenum, a procedure is performed to remove the lesion under an endoscope. Late bleeding or perforation may occur after days. For this reason, after excision of the affected part, a treatment for covering the affected part with an adhesive sheet is performed to prevent bleeding and perforation.

  A treatment tool for performing this type of treatment is proposed in, for example, Patent Document 1. The treatment tool disclosed in Patent Document 1 is inserted into a forceps channel (forceps port) of an endoscope, an inner sheath is inserted into an outer sheath, and a protective sheet (sticking sheet) is provided at a tip of the inner sheath. A first linear member attached in a roll shape and a second linear member inserted into the inner sheath are provided, and one end of the protection sheet is fixed to the second linear member. In the body, when the inner sheath, the first and second linear members, and the protective sheet are extruded with respect to the outer sheath, the distance between the first and second linear members is increased, so that the protective sheet is expanded. Can be spread. In this state, the second linear member is pulled with respect to the inner sheath to separate the protection sheet and the fixed portion of the second linear member, and the end of the protection sheet is aligned with the peripheral edge of the affected part and attached. wear. Further, the first linear member is moved, the roll-shaped protective sheet is pulled out to the end of the winding, the protective sheet is separated from the first linear member, and is attached to the affected part.

JP 2012-40135 A

  However, in the device described in Patent Document 1, a roll-shaped sticky sheet (protective sheet) is attached to the first linear member, and one end of the sticky sheet (protective sheet) is not fixed to the second linear member. However, the attachment of the attachment sheet to the treatment tool is complicated. In addition, it is necessary to separately operate the first and second linear members to unfold the roll-shaped sticky sheet while pulling it out, and the operation of sticking the sticky sheet is complicated.

  The present invention has been made in order to solve the above-mentioned problem, and provides a treatment tool that can easily attach a sticking sheet and that can spread the sticking sheet with a simple operation and stick it to an affected part. With the goal.

  The treatment tool according to the present invention is a treatment tool used for sticking an adhesive sheet to an affected part in a body, and has a handle operation unit for a hand-held operation on a proximal end side and the adhesive sheet on a distal end side. Comprising an operating portion, the operating portion comprises a head supporting the adhesive sheet from the inside, and a trunk supporting the peripheral portion of the portion of the adhesive sheet supported by the head from the inside, The trunk is composed of a support member for supporting the head and at least two flexible members arranged around the head, and each flexible member is supported on the head at its distal end, The proximal end is supported by a movable member that can advance and retreat with respect to the head, and by operating the handle operation unit, each flexible member expands outward with the advancement of the movable member and the head Is configured to overhang around the part That.

  An operation sheet of the treatment instrument is covered with an adhesive sheet, and inserted into a forceps port of the endoscope. In the body, the head of the operating part is brought into contact with the affected part via the sticking sheet, and the movable member is advanced with respect to the head by operating the handle operating part, whereby the flexibility of the trunk of the operating part is increased. Since the member bulges outward and protrudes around the head, the adhesive sheet covered by the operating part is pushed open and adhered to the affected part.

  According to the above configuration, it is possible to easily attach the adhesive sheet to the treatment instrument with a simple operation of merely putting the adhesive sheet on the operating portion of the treatment instrument. Further, with a simple operation of moving the movable member forward with respect to the head, the sticking sheet covered on the operating portion can be spread and attached to the affected part.

  In a preferred embodiment, each of the flexible members is supported by being inserted into a radial hole having a distal end side opening in the outer peripheral surface of the head.

  According to the above configuration, each of the distal ends of the flexible members is supported at an angle close to perpendicular to the outer peripheral surface of the head. The member can be reliably extended around the head. Further, it is preferable that the flexible member is formed of a shape memory alloy in which a linear shape is stored.

  In a further preferred embodiment, the head is composed of a pressing portion that supports the adhesive sheet from the inside and a main body portion that supports the respective distal ends of the flexible member, and the distal end surface of the pressing portion is flat. Or, the outer diameter of the main body is smaller than the outer diameter of the pressing portion.

  According to the above configuration, since the distal end surface of the pressing portion that supports the adhesive sheet from the inside is flat or hemispherical, when the head of the operating portion is brought into contact with the affected portion via the adhesive sheet in the body, the affected portion Can be prevented from being damaged. In addition, when transporting the forceps port of the endoscope while pressing the adhesive sheet covered with the operating unit with the treatment tool, the outer diameter of the head is set to prevent the head from breaking through the adhesive sheet. It is preferable to increase the size as much as possible within a range that allows passage through the forceps port of the endoscope with the attachment sheet placed thereon. The same is true to prevent harm to the affected area.

  On the other hand, when inserting the treatment tool with the adhesive sheet over the operating portion into the forceps port, the peripheral portion of the portion supported by the head of the adhesive sheet is supported on a flexible member supported around the main body. However, when the outer diameter of the main body is large, the peripheral portion of the adhesive sheet is further folded, so that there is a possibility that it cannot be inserted into the forceps port. For this reason, in order to convey a larger-sized adhesive sheet, it is preferable that the outer diameter of the main body in which the distal end side of the flexible member is supported on the head be as small as possible. According to the above configuration, since the outer diameter of the main body portion is smaller than the outer diameter of the pressing portion, the flexible member supporting the peripheral portion of the adhesive sheet is also reduced in the radial direction, and the folded portion of the adhesive sheet is pressed. Because it does not protrude from the outer peripheral surface of the part, it is possible to stably convey a larger size of the adhesive sheet without breaking through as compared to the case where the outer diameter of the main body part is equal to the outer diameter of the pressing part, and damage the affected part Instead, the head of the operating part can be brought into contact with the affected part in the body via the adhesive sheet.

  In a preferred embodiment, the body has an even number of flexible members, and the opposing flexible members are radially penetrating one wire into the outer peripheral surface of the head. It is formed by inserting it into a hole and folding it back.

  According to the above configuration, the opposing flexible members are formed by folding one wire into the through holes formed in the main body of the head. In this case, the number of times of passing the wire through the hole is only one, which makes the work easier. Further, when the opposing flexible members are formed of separate wires, holes for locking the distal ends of the wires at positions facing each other on the outer peripheral surface of the main body of the head are individually formed. However, in order to form a hole having a depth capable of securely locking the distal end of each wire, it is necessary to increase the outer diameter of the main body of the head accordingly. According to the above configuration, the opposing flexible members are formed by inserting a single wire into the through hole and folding the same, so that the flexible members are securely locked to the main body, and the The outer diameter of the main body can be made smaller, and the production at a lower cost is possible.

  It is preferable that the folded portion of the wire is fixed to the through hole or slidably supported by the through hole.

  Further, it is preferable that the flexible member is formed of a shape memory alloy in which a linear shape is stored.

In this embodiment, when the movable member is advanced with respect to the head, the wire rod will be rotated around the axis inside the through hole and twisted due to the restoring force of the flexible member that attempts to return to the linear shape. And
At this time, when the folded portion of the wire of the flexible member is fixed to the through hole, the folded portion of the wire cannot be twisted, and protrudes around the head while bending outward and expanding. . When the movable member further advances, the flexible member starts to bend while being curved by the restoring force of returning to a linear shape. When the flexible member is viewed from the distal end side of the head, the torsion of each flexible member is caused. The part that forms the shape of an ellipse and protrudes like a petal around the head. For this reason, the portion in contact with the adhesive sheet is increased, and the adhesive sheet can be reliably spread and adhered to the affected part.

  On the other hand, when the folded portion of the wire is slidably supported in the through-hole, when the movable member is advanced with respect to the head, the flexible member rotates around the inside of the through-hole and twists, When the flexible members are viewed from the distal end side of the head, the torsion portion of each flexible member forms an elliptical surface, and the elliptical surface forms a through-hole in the main body portion. While tilting to one side with respect to the penetrating direction, it curves largely outward and swells to protrude around the head. When the movable member further advances, the flexible member further pivots inside the through-hole, and protrudes farther to the distal end side than the distal end surface of the pressing portion of the head. For this reason, the sticking sheet can be pushed forward from the head and stuck to the affected part.

  In a further preferred embodiment, a plurality of the through holes are provided in the head, the wire is inserted into each of the through holes, and at least one of the wires has a folded portion fixed to the through hole, and the remaining The folded portion of the wire is supported slidably in the through hole.

  According to the above configuration, both the flexible member fixed to the through hole and the flexible member not fixed to the through hole but slidably supported in the through hole are provided. The adhesive sheet can be reliably spread and adhered to the affected part by the flexible member fixed to the hole, and the adhesive sheet can be slidably supported by the through hole so that the adhesive sheet is positioned forward of the head. And can be stuck to the affected area.

  At least one of the through holes to which the folded portion of the wire is fixed, and at least one of the through holes to which the folded portion of the wire is slidably supported, have the same penetration direction, and extend in the moving direction of the movable member. It is preferably formed along.

  In a preferred embodiment, the support member is constituted by a distal end portion of a guide shaft connecting the handle operation portion and a head of the operation portion, and the movable member is a movable cylinder that can advance and retreat on the guide shaft. In addition, a base end of each flexible member is connected to the movable cylinder.

  According to the above configuration, by advancing the movable cylinder along the guide shaft, the flexible member can be expanded outward and protrude around the head.

  In a preferred embodiment, the movable cylinder can move in and out of an outer cylinder provided outside the movable cylinder.

When the treatment tool without the outer cylinder is inserted to the vicinity of the affected part through the forceps port of the endoscope having a long and curved distal end, for example, it is movable with respect to the head of the operating part. Even when the tube is advanced, a large sliding resistance is generated between the inner wall surface of the forceps port and the movable tube at the curved portion of the forceps port, and the advancement of the movable tube is hindered. The forward movement is absorbed by the slack portion, and conversely, the flexible member may bulge outward while the guide shaft retreats toward the movable cylinder, and the head of the operating portion may separate from the affected part. . For this reason, the sticking sheet may fall off from the treatment tool while the flexible member is expanding, or the sticking position may be shifted.
On the other hand, in the present embodiment, the outer cylinder is provided outside the movable cylinder, and only the movable cylinder in the outer cylinder is advanced, so that no sliding resistance occurs between the inner wall surface of the forceps port and the movable cylinder. Thus, the movable cylinder can be reliably advanced. For this reason, the movable cylinder can be moved forward with respect to the head of the operating portion, and the sticking sheet can be securely stuck to the affected part.

  The support member includes a support rod that connects a head of the operating portion and a distal end of the fixed cylinder.The movable member is a movable rod that can advance and retreat in the fixed cylinder. The proximal end of the flexible member may be connected.

  According to the above configuration, by advancing the movable rod in the fixed cylinder, the flexible member can be expanded outward and protrude around the head.

  The movable cylinder, the guide shaft, the movable rod, the fixed cylinder, and the support rod may be made of a flexible material.

  According to the above configuration, since the movable cylinder, the guide shaft, the movable rod, the fixed cylinder, and the support rod are also flexible, the adhesive sheet is conveyed using the treatment tool even in the curved endoscope forceps port. It becomes possible. In particular, since the support member (the distal end portion of the guide shaft or the support rod) on the distal end side of the treatment tool is made of a flexible material, even when the length of the operating portion is lengthened, a curved endoscope is used. Because the treatment instrument can be inserted into the forceps port of the mirror and the attached sheet can be transported, a larger-sized attached sheet can be pushed and spread. Further, it also functions as a cushion when the treatment tool is pressed against the affected part.

  According to the present invention, since the flexible member of the trunk of the operating section bulges outward and protrudes around the head, the adhesive sheet covered on the operating section is pushed open and adhered to the affected part. In this way, the sticky sheet can be easily attached to the treatment tool by a simple operation of merely putting the sticky sheet on the operating portion of the treatment tool. Further, with a simple operation of moving the movable member forward with respect to the head, the sticking sheet covered on the operating portion can be spread and attached to the affected part.

It is a perspective view of a treatment implement concerning one embodiment of the present invention. It is a schematic perspective view which shows the front-end | tip part of a treatment tool. It is a perspective view of the head of an operation part. It is a schematic perspective view which shows the state which put the sticking sheet on the operation part. It is the front view which looked at the head from the tip side. It is a perspective view which shows the front-end | tip part of a movable cylinder. It is a figure explaining the deformation | transformation operation | movement of the flexible member by which the front-end | tip side was fixed to the head. (C) is a side view when the movable cylinder moves forward, (D) is a front view of the head of (C) viewed from the tip side, and (E) is the movable cylinder further advances. (F) is a front view of the head of (E) as viewed from the distal end side. It is sectional drawing of the principal part which shows operation | movement of a treatment tool, (A) is sectional drawing of the state which put the sticking sheet on the operation part, (B) is sectional drawing which shows the state in which the sticking sheet was expanded. It is the front view which looked at the head from the front-end | tip side, (A) is a front view in the case of two flexible members, (B) is a front view in the case of six flexible members. It is sectional drawing of the principal part which shows operation | movement of the treatment tool which concerns on other embodiment, (A) is sectional drawing of the state which put the sticking sheet on the operation part, (B) shows the state where the sticking sheet was spread. FIG. It is a figure explaining the deformation | transformation operation | movement of the flexible member which the front end side was slidably supported by the through-hole of the head, (A) is a side view when a movable cylinder moves forward, (B) is (A) ) Is a front view of the head viewed from the front end side, (C) is a side view when the movable barrel is at the further advanced position, and (D) is a front view of the head of (C) viewed from the front end side. . FIG. 12 is a cross-sectional view of a main part when the movable barrel according to the embodiment of FIG. 11 is at a retracted position. It is a perspective view of the head of the operation part concerning yet another embodiment. It is a perspective view of a treatment instrument concerning still another embodiment.

  Hereinafter, an embodiment of the treatment tool 10 of the present invention will be described with reference to the accompanying drawings.

  In the following description, in FIG. 1, the right side is the distal side in the longitudinal direction of the treatment tool 10, the direction opposite to the distal side is the proximal side, the forward direction indicates the direction toward the distal side, and the retreat direction. Indicates a direction opposite to the forward direction.

  The treatment instrument 10 of the present invention is inserted into a forceps port of an endoscope or a through-hole (not shown) of a trocar at the time of laparoscopic surgery. Used to attach. As the attachment sheet S, for example, an absorbent suture reinforcing material (NEOVERE (registered trademark)) which is a nonwoven fabric made of polyglycolic acid manufactured by Gunze Co., Ltd. can be used. In the following description, a case in which the endoscope is inserted into a forceps port of an endoscope will be described.

  As shown in FIG. 1, the treatment tool 10 includes a handle operation unit 20 for a hand-held operation on the base end side, an operation unit 30 on which the sticking sheet S is placed on the distal end side, and a handle operation unit 20 to the handle operation unit 20. It includes a guide shaft 40 that extends, and a movable cylinder 50 (movable member) that can advance and retreat on the guide shaft 40. The handle operation unit 20 is configured from the respective base ends of the guide shaft 40 and the movable barrel 50. By operating the handle operation unit 20, the movable barrel 50 can be moved forward and backward with respect to the guide shaft 40. If this operation can be realized, the shape and configuration of the handle operation unit 20 are not particularly limited. Further, a lock mechanism for fixing the guide shaft 40 and the movable barrel 50 to the handle operation unit 20 when the operation unit 30 is covered with the adhesive sheet S and inserted into the forceps port of the endoscope may be provided.

  The guide shaft 40 is not particularly limited as long as it has flexibility and moderate rigidity, and examples thereof include a metal wire formed of a single wire or a stranded wire. Examples of the metal material include stainless steel, tantalum, and a nickel-titanium alloy.

  As shown in FIGS. 2 and 4, the operating unit 30 supports the head 31 that supports the substantially central portion S1 of the adhesive sheet S from the inside and the peripheral portion S2 of the substantially central portion S1 of the adhesive sheet S from the inside. The body 32 includes a tip portion 40a (supporting member) of a guide shaft 40 that supports the head and four flexible members 321 (321A to 321D). In the present embodiment, the distal end portion 40a of the guide shaft 40 constitutes a support member. However, the guide shaft 40 and the support member may be constituted by separate members and connected to each other. Or different. Further, in the present embodiment, the inside of the substantially central portion S1 of the adhesive sheet is supported by the head 31, but any part of the adhesive sheet may be supported by the head 31.

As shown in FIGS. 3 and 5, the head 31 includes a cylindrical main body 311, and a cylindrical pressing section 312 provided at the tip of the main body 311 and having a larger diameter than the main body 311. A locking hole 311b for inserting the distal end portion 40a of the guide shaft 40 from the proximal end side is provided on the proximal end surface of the main body portion 311. The distal end portion 40a of the guide shaft 40 is fixed by bonding, welding, brazing, or the like. Fixed in the way.
In addition, the shape of the main body 311 and the pressing portion 312 of the head 31 is not limited to the column shape, and may be a polygonal column shape.

  The pressing part 312 supports the substantially central part S1 of the sticking sheet S from the inside when the sticking sheet S is put on the operating part 30, as shown in FIG. That is, when the sticking sheet S is inserted into the forceps port of the endoscope with the treatment tool 10, the sticking sheet S is pushed by the distal end surface 312 a of the pressing portion 312. When the sticking sheet S is stuck to the affected part P, the distal end surface 312a of the pressing part 312 is pressed against the affected part P via the sticking sheet S. For this reason, in order to prevent the pressing portion 312 from piercing the adhesive sheet S during transportation in the forceps port of the endoscope, and to prevent the affected portion P from being damaged when the pressing portion 312 is pressed against the affected portion P. For this purpose, as shown in FIG. 3, the distal end surface 312a is made flat, and a taper 312b is provided between the distal end surface 312a and the peripheral wall of the pressing portion 312. Note that the tip surface 312a may be hemispherical. The outer diameter of the pressing portion 312 is smaller than the inner diameter of the forceps port so that the treatment tool 10 covered with the adhesive sheet S can be inserted into the forceps port, but is preferably as large as possible. When the outer diameter of the main body 311 can be ensured, the pressing portion 312 is provided continuously to the main body 311 with the same diameter as the main body 311 and the pressing portion 312 supports the substantially central portion S1 of the adhesive sheet S. You may.

  As shown in FIGS. 3 and 5, two through holes 311 a are provided in the main body 311 in a direction substantially perpendicular to the axial direction of the main body 311 (the length direction of the treatment tool 10). Have been. The through-hole 311a extends along the radial direction of the main body 311. Both ends of each through-hole 311a are opened on the outer peripheral surface of the main body 311. Flexible members 321A to 321D are inserted into the respective through holes 311a. In this embodiment, a total of four flexible members 321A to 321D are formed by inserting two wires into the two through holes 311a and folding the wires. The two wires are fixed to the two through holes 311a by a fixing method such as adhesion, welding, brazing, or the like.

  Each of the flexible members 321A to 321D only needs to be flexible and have a rigidity to push and spread the adhesive sheet S, and examples thereof include a metal wire formed of a single wire or a stranded wire. Examples of the metal material include stainless steel, tantalum, and a nickel-titanium alloy. More preferably, it is formed of a shape memory alloy such as a nickel-titanium alloy stored in a linear shape. The cross-sectional shape in the direction perpendicular to the length direction of the flexible member 321 is not particularly limited, but may be a circle, an ellipse, a rectangle, or the like.

  Further, each of the flexible members 321A to 321D may be formed of one wire (four wires in total), and the distal ends of the flexible members 321A to 321D may be fixed to the through holes 311a of the main body 311. Alternatively, it may be fixed to a bottomed hole provided in the main body 311 and not penetrating. In the case where the number of flexible members is an even number as in the present embodiment, if the flexible member is formed by inserting a single wire into the through hole 311a and folding the same, the main body 311 can be formed. The flexible member is securely locked to the main body 311 by passing each wire through the through hole, so that the outer diameter of the main body 311 of the head 31 is made smaller. And production at a lower cost becomes possible.

In the present embodiment, the respective distal ends of the flexible members 321A to 321D are fixed to the head 31 perpendicular to the length direction of the treatment tool 10, but each flexible member is attached to the main body. The angle fixed to the portion 311 is not limited to the angle close to the direction perpendicular to the length direction of the treatment tool 10.
In addition, even when the flexible members 321A to 321D are fixed at positions other than perpendicular to the length direction of the treatment tool 10, two flexible wires 321A to 321D can be formed by folding one wire by providing a hole in a V-shape or the like. It may be a flexible member.

  Each of the flexible members 321A to 321D has a base end fixed to the movable barrel 50 and is deformed as the movable barrel 50 moves forward. The deformation operation of the flexible members 321A and 321B having the distal ends fixed to the head will be described with reference to FIGS. 7A to 7F. 7A to 7F, the illustration of the flexible members 321C and 321D and the attachment sheet S is omitted for simplification of description, but the flexible members 321C and 321D are also flexible. It deforms similarly to the sex members 321A and 321B.

As shown in FIGS. 7A and 7B, when the movable barrel 50 is at the retracted position, the distal ends of the flexible members 321A and 321B have an arc shape slightly bulging outward. .
As shown in FIGS. 7 (C) and 7 (D), when the movable cylinder 50 moves forward, the flexible members 321A and 321B largely curve outward and bulge, and project around the head 31. At this time, when the flexible members 321A and 321B project from the distal end side of the head 31, the flexible members 321A and 321B extend through the through holes of the main body 311. 7D, ie, the vertical direction in FIG. 7D.

  As shown in FIGS. 7 (E) and 7 (F), when the movable cylinder 50 further moves forward, the flexible members 321A and 321B return to the linear shape of the flexible members 321A and 321B by a restoring force. Begin to twist while bending. When the flexible members 321A and 321B are viewed from the distal end side of the head 31, the twisted portions of the flexible members 321A and 321B form an elliptical surface, and form a petal around the head 31. Overhang.

  As described above, when the movable barrel 50 is at the retracted position, each of the flexible members 321A to 321D has an arc shape slightly bulging outward. For this reason, the outer diameter of the main body 311 to which each of the flexible members 321A to 321D is fixed is made as small as possible, and the outer diameter of the operating part 30 when the sticking sheet S is put on the operating part 30 is reduced. It is preferable to make it easy to insert into the forceps port of the endoscope. Further, the outer diameter of the distal end of the main body 311 to which each of the flexible members 321A to 321D is fixed is smaller than the outer diameter of the base end of the main body 311 to which the distal end 40a of the guide shaft 40 is fixed. Alternatively, the outer diameter of the main body 311 may be changed.

  As shown in FIG. 5, in the present embodiment, four linear flexible members 321 </ b> A to 321 </ b> D are arranged around the head 31 at an equal angle (90 degrees). If S can be expanded, the arrangement in the circumferential direction is not limited to an equal angle.

  The movable cylinder 50 is guided on the guide shaft 40 and is capable of moving forward and backward with respect to the head 31 of the operating section 30. As shown in FIGS. 6, 8A and 8B, A main body 51 and a cylindrical distal end cap 52 attached to the distal end of the cylindrical main body 51 are provided. The base end 521 of the tip cap 52 is fitted and fixed in a hole 511 inside the cylinder body 51, and the tip 522 of the tip cap 52 projects from the cylinder body 51.

  The tube main body 51 has a hollow cylindrical shape, and the guide shaft 40 passes through the inside of the cylinder. The material of the tube main body 51 is not particularly limited as long as it has flexibility and moderate rigidity. Examples of the material of the tube main body 51 include a tightly wound coil such as stainless steel, and a resin such as polyethylene, polypropylene, and fluororesin (PTFE). Further, the surface of the tube main body 51 may be coated in order to enhance the slidability in the forceps port of the endoscope. In addition, as a material of the distal end cap 52, a metal such as stainless steel may be used, but a resin may be used.

  Holes 523 are formed in the distal end surface of the distal end portion 522 of the distal end cap 52 at equal intervals in the circumferential direction, and the proximal end portions of the flexible members 321A to 321D are inserted into the holes 523, for example, by bonding, welding, It is fixed by a fixing method such as brazing. The number of the holes 523 is the same as the number of the flexible members 321A to 321D, and the arrangement of the holes 523 in the circumferential direction corresponds to the opening position of the through hole 311a provided in the main body 311 of the head 31. . Thereby, as shown in FIG. 6, the four flexible members 321 </ b> A to 321 </ b> D are arranged along the length direction of the operation unit 30. The base ends of the flexible members 321A to 321D are fixed parallel to the length direction of the distal end cap 52, but may be fixed obliquely outward to the length direction.

  The hole 511 inside the cylinder main body 51 and the hole 524 inside the tip cap 52 communicate with each other, and the guide shaft 40 penetrates these holes 511 and 524. Therefore, the cylinder main body 51 and the tip cap 52 can slide on the guide shaft 40. A guide mechanism or the like for preventing the cylinder body 51 and the tip cap 52 from rotating in the radial direction of the guide shaft 40 when the cylinder body 51 and the tip cap 52 slide on the guide shaft 40 may be provided. .

  As described above, the guide shaft 40 has a distal end portion 40 a connected to the head portion 31 of the operating portion 30 and a proximal end portion connected to the handle operation portion 20. The guide shaft 40 guides the movable cylinder 50 to advance and retreat, and also functions as a support member that supports the head 31 of the operating unit 30 when the sticking sheet S is attached to the affected part P, and the head 31 contacts the affected part P. Support contact.

  In addition, a cylindrical spacer is provided to fill the space formed around the hole 511 in the cylinder main body 51 and the guide shaft 40, and the guide shaft 40 moves in the hole 511 of the cylinder main body 51 in the radial direction. May be prevented.

Next, a method of using the treatment tool 10 of the present invention will be described.
First, the sticking sheet S is put on the operating section 30 of the treatment instrument 10 (FIG. 4), the handle operation section 20 of the treatment instrument 10 is grasped, and inserted into the forceps port of the endoscope from the distal end side and inserted into the body. .

  Next, the treatment tool 10 is advanced until the head 31 of the operating section 30 comes into contact with the affected area P via the adhesive sheet S (FIGS. 7A, 7B, and 8A). In this state, when the movable cylinder 50 is advanced with respect to the head 31 of the operation unit 30 by operating the handle operation unit 20, the flexible members 321A to 321D expand outward and protrude around the head 31. Then, the adhesive sheet S is reliably spread out (FIGS. 7 (C), 7 (D), 8 (B)). Under this condition, it is also possible to press the adhesive sheet S against the affected area P with the flexible members 321A to 321D and adhere the sheet.

  Further, when the movable cylinder 50 is advanced with respect to the head 31 of the operation unit 30, the flexible members 321A to 321D are twisted while flexing, and the flexible members 321A to 321D are viewed from the distal end side of the head 31. At this time, the twisted portions of the flexible members 321A to 321D have an elliptical shape, a so-called petal shape, and spread around the head 31 (FIGS. 7E and 7F). Due to this twist, the portion where the flexible members 321A to 321D come into contact with the adhesive sheet S increases, and the adhesive sheet S can be pressed against the affected area P and attached in a more stable state.

  After the adhesive sheet S is pressed against the affected part, the treatment tool 10 is pulled to detach the operating portion 30 from the adhesive sheet S, thereby completing the attaching operation. With the flexible members 321 </ b> A to 321 </ b> D protruding around the head 31, the treatment tool 10 may be moved back and forth again to perform the pressing operation of the sticking sheet S by the operation unit 30. After that, the operating unit 30 is moved backward with respect to the head 31 by operating the handle operating unit 20 to bring the operating unit 30 into the state shown in FIG. 8A, and then the treatment tool 10 is moved from the forceps port of the endoscope. to recover.

  According to the present invention, it is possible to easily attach the adhesive sheet S to the treatment tool 10 with a simple operation of merely placing the adhesive sheet S on the operating section 30 of the treatment instrument 10. In addition, the sticking sheet S can be spread and the sticking sheet S can be stuck to the affected part P by a simple operation of moving the movable cylinder 50 forward with respect to the head 31.

  As mentioned above, although one Embodiment of this invention was described, this invention is not limited to the said Embodiment, A various change is possible unless it deviates from the meaning of this invention.

  For example, the number of flexible members 321A to 321D is not limited to four in the above embodiment, but may be two as shown in FIG. 9A, or as shown in FIG. 9B. The number may be six. In the case of two, each of the flexible members 321A and 321B is arranged around the head 31 at an interval of 180 degrees. In the case of six, the flexible members 321A to 321F are arranged around the head 31 at intervals of 60 degrees. That is, the number of the flexible members may be at least two or more, and may be an odd number as well as an even number. Further, the arrangement around the head 31 is not limited to an equal angle, but may be an uneven arrangement.

  FIG. 10 shows another embodiment of the present invention. The treatment tool 10 in the illustrated example includes a fixed cylinder 60 having a distal end connected to the head 31 of the operating section 30 via a support rod 61 (support member), and a movable rod (movable member) capable of moving back and forth in the fixed cylinder 60. ) 70, and the base ends of the fixed cylinder 60 and the movable rod 70 are connected to the handle operation unit 20 (not shown). By operating the handle operation unit 20, the movable lot 70 can be moved forward and backward with respect to the fixed cylinder 60.

  The support rod 61 is not particularly limited as long as it has flexibility and moderate rigidity, and examples thereof include a metal wire made of a single wire or a stranded wire. Examples of the metal material include stainless steel, tantalum, and a nickel-titanium alloy. More preferably, it is a shape memory alloy such as a nickel-titanium alloy, and more preferably, the shape memory is performed in a linear state. The flexibility of the support rod 61 allows the treatment instrument 10 to be inserted into the forceps port of the endoscope in a curved state even when the length of the operation section 30 is increased. . Also, it functions as a cushion when the head 31 is pressed against the affected part P.

  A locking hole 311b into which the distal end of the support rod 61 is inserted is formed in the base end surface of the main body 311 of the head 31 of the operating section 30. The distal end of the support rod 61 is inserted into the locking hole 311b and fixed by a fixing method such as bonding, welding, or brazing. As will be described later, the proximal end of the support rod 61 is connected to the distal end of the fixed cylinder 60.

  The fixed cylinder 60 includes a cylindrical main body 62 and a front end cap 63 for closing the front end of the main body 62. A locking hole 63c is formed in the distal end surface 63a of the distal end cap 63, and the base end of the support rod 61 is inserted and fixed by a fixing method such as adhesion, welding, or brazing. Around the support bar 61 of the distal end cap 63, a through hole 63b is formed in the length direction for slidably inserting the flexible members 321A to 321D. The number of the through holes 63b is the same as the number of the flexible members 321A to 321D, and is four in the present embodiment. Four through holes 63b are formed at equal intervals in the circumferential direction.

  The material of the fixed cylinder 60 is not particularly limited as long as it has flexibility and moderate rigidity. Examples of the material of the fixed cylinder 60 include a tightly wound coil such as stainless steel, a resin such as polyethylene, polypropylene, and fluororesin (PTFE). Further, as a material of the distal end cap 63, a metal such as stainless steel may be used, but a resin may be used.

  The proximal ends of the flexible members 321A to 321D are connected to the distal end of the movable rod 70 via a connecting body 71. The base end of each of the flexible members 321A to 321D is inserted into the hole 62a inside the fixed cylinder 60 through the through hole 63b of the front end cap 63, and is bonded, for example, to the front end of the connecting body 71 by adhesion, welding, or brazing. And so on.

  The movable rod 70 is not particularly limited as long as it has flexibility and moderate rigidity, and examples thereof include a metal wire formed of a single wire or a stranded wire. Examples of the metal material include stainless steel, tantalum, and a nickel-titanium alloy. Further, in the present embodiment, the handle operation unit 20 and the connecting body 71 are connected by one movable rod 70, but the movable rod 70 may be configured by connecting a plurality of members. The outer diameter may be the same or different.

  Other configurations are the same as those in the embodiment of FIGS. 1 to 8, and corresponding components are denoted by the same reference numerals and description thereof is omitted.

Next, a method of using the treatment tool 10 of the embodiment of FIG. 10 will be described.
First, the sticking sheet S is put on the operating part 30 of the treatment instrument 10, the handle operation part 20 of the treatment instrument 10 is grasped, and inserted into the forceps port of the endoscope from the distal end side to be inserted into the body.

  Next, the treatment tool 10 is advanced until the head 31 of the operating section 30 comes into contact with the affected area P via the adhesive sheet S (FIG. 10A). In this state, when the movable rod 70 is advanced with respect to the head 31 of the operation unit 30 by operating the handle operation unit 20 (FIG. 10B), the flexible member 321A of the body 32 of the operation unit 30 is provided. 321D bulges outward and protrudes around the head 31. Thereby, the sticking sheet S is spread. Under this condition, it is also possible to press the adhesive sheet S against the affected area P with the flexible members 321A to 321D and adhere the sheet.

  Further, when the movable rod 70 is advanced with respect to the head 31 of the operation section 30, the respective flexible members 321A to 321D are twisted as in the embodiment shown in FIGS. When the flexible members 321A to 321D are viewed from the tip end side of the head 31, the twisted portions of the flexible members 321A to 321D become elliptical shapes, so-called petal shapes, and spread around the head 31. . Due to this twist, the portion where the flexible members 321A to 321D come into contact with the adhesive sheet S increases, and the adhesive sheet S can be pressed against the affected area P in a more stable state.

  In this state, by pulling the treatment tool 10 and detaching the operating part 30 from the sticking sheet S, the sticking operation is completed. After that, the operating rod 30 is retracted with respect to the head 31 by operating the handle operating unit 20 to bring the operating unit 30 to the state shown in FIG. 10A, and then the treatment tool 10 is moved from the forceps port of the endoscope. to recover.

  According to the present invention, it is possible to easily attach the adhesive sheet S to the treatment tool simply by putting the adhesive sheet S on the operating portion 30 of the treatment tool 10. Further, the sticking sheet S can be spread and the sticking sheet S can be stuck to the affected area P by a simple operation of moving the movable rod 70 forward with respect to the head 31.

  11 and 12 show another embodiment of the present invention. In the treatment tool 10 of the illustrated example, in the treatment tool 10 shown in FIG. 3, two wires constituting the flexible members 321A to 321D are slidably supported without being fixed to the two through holes 311a. Things.

  Each of the flexible members 321A to 321D is deformed in accordance with the forward movement of the movable barrel 50. Hereinafter, the deforming operation of the flexible members 321A and 321B whose leading ends are slidably supported by the through holes in the head. Will be described with reference to FIGS. 11A to 11D. Although the flexible members 321C and 321D are deformed similarly to the flexible members 321A and 321B, the flexible members 321C are illustrated in FIGS. , 321D and the adhesive sheet S are not shown.

When the movable barrel 50 is at the retracted position, each of the flexible members 321A and 321B has an arc shape slightly bulging outward, similarly to the embodiment shown in FIGS. 7A and 7B. .
When the movable barrel 50 moves forward, as shown in FIGS. 11A and 11B, the flexible members 321A and 321B penetrate by the restoring force of returning to the linear shape of the flexible members 321A and 321B. The shaft is rotated and twisted inside the hole 311a. At this time, when the flexible members 321A and 321B are viewed from the tip end side of the head 31, the torsion portion forms an elliptical surface. The elliptical surface bulges greatly while tilting the through hole 311a of the main body 311 to one side (the left side in FIG. 11B) with respect to the direction in which the flexible members 321A and 321B penetrate. Overhang around the part 31.
When the movable cylinder 50 further moves forward, the flexible members 321A and 321B further rotate in the axial direction inside the through hole 311a and twist as shown in FIGS. 11C and 11D, and the head 31 is pressed. The portion 312 protrudes farther to the distal end side than the distal end surface 312a.

  Other configurations are the same as those in the embodiment of FIGS. 1 to 8, and corresponding components are denoted by the same reference numerals and description thereof is omitted.

  Next, a method of using the treatment tool 10 of the present invention will be described. As shown in FIG. 12, the treatment tool 10 of the present invention is used in a state where the affected part P is inclined in the oblique direction with respect to the length direction of the treatment tool 10, but is not limited thereto. .

First, the sticking sheet S is put on the operating section 30 of the treatment instrument 10 (FIG. 4), the handle operation section 20 of the treatment instrument 10 is grasped, and inserted into the forceps port of the endoscope from the distal end side and inserted into the body. .
Next, the treatment tool 10 is moved forward until the head 31 of the operating unit 30 contacts the affected part P via the adhesive sheet S or the head 31 of the operating unit 30 is located near the affected part P (FIG. 12). .

  In this state, when the movable cylinder 50 is advanced with respect to the head 31 of the operation unit 30 by operating the handle operation unit 20, the flexible members 321A to 321D of the body 32 of the operation unit 30 expand outward. Then, the sticking sheet S protrudes around the head 31 and is spread. Under this condition, it is also possible to press the adhesive sheet S against the affected area P with the flexible members 321A to 321D and adhere the sheet. For example, the attachment sheet S below the head 31 in FIG. 12 is pressed and attached to the affected part P by the flexible members 321A to 321D.

Further, when the movable cylinder 50 is advanced with respect to the head 31 of the operation section 30, the flexible members 321A to 321D are twisted, and as shown in FIGS. When viewed from the front end side, the twisted portion of each of the flexible members 321A to 321D has an elliptical shape, and protrudes farther to the front end side than the front end surface 312a of the pressing portion 312 of the head 31. With this protruding portion, the adhesive sheet S is attached to the affected part P further distally than the distal end surface 312a of the head 31. In FIG. 12, the adhesive sheet S above the head 31 is pressed and attached to the affected part P when the flexible member 321 </ b> A projects further distally than the distal end surface 312 a of the head 31.
In this state, by pulling the treatment tool 10 and detaching the operating part 30 from the sticking sheet S, the sticking operation is completed.

  According to the present invention, even when the head 31 of the operating unit 30 is separated from the affected part P in the body without coming into contact with the affected part P, the sticking sheet S is pushed forward from the head 31 and is moved to the affected part P. Can be pasted.

FIG. 13 shows another embodiment of the present invention.
In this embodiment, three through holes 311 c, 311 d penetrating through the main body 311 of the head 31 of the operating section 30 in a direction substantially perpendicular to the axial direction of the main body 311 (the length direction of the treatment instrument 10). 311 e (hereinafter, 311 c and 311 d are referred to as “first through holes” and 311 e is referred to as “second through holes”) are provided along the axial direction of the main body 311. The first through-holes 311c and 311d are provided to be orthogonal to each other, and the second through-hole 311e is provided in the same through-direction as the first through-hole 311c.

  Flexible members 321A to 321F are inserted into the first and second through holes 311c, 311d, and 311e. In the present embodiment, a total of six flexible members 321A to 321F are formed by inserting and folding three wires into the first and second through holes 311c, 311d, and 311e, respectively. The folded portions of the two wires passed through the first through holes 311c and 311d are respectively fixed to the main body 311 by a fixing method such as bonding, welding, or brazing to form flexible members 321A to 321D. I have. One wire rod passed through the second through hole 311e has a folded portion slidably supported by the second through hole 311e to form flexible members 321E and 321F.

  In the treatment tool 10 of the present embodiment, when the movable tube (not shown) is advanced with respect to the head 31, the flexible members 321A to 321D inserted into the first through holes 311c and 311d are shown in FIG. The same operation as in the embodiment is performed, and when the flexible members 321A to 321D are viewed from the distal end side of the head 31, the flexible members 321A to 321D expand in a cross shape. The flexible members 321E and 321F inserted into the second through-hole 311e perform the same operation as the embodiment shown in FIG. 11, and the flexible members 321E and 321F are viewed from the distal end side of the head 31. Sometimes it curves and swells while leaning to one side. That is, the flexible members 321E and 321F bulge outward between the crosses formed by the flexible members 321A to 321D. When the movable cylinder (not shown) is further advanced with respect to the head 31, each of the flexible members 321A to 321D spreads like a petal around the head, and the flexible members 321E and 321F have an elliptical twisted portion. , And protrude largely toward the distal end side from the distal end surface 312a of the pressing portion 312 of the head 31.

  Other configurations are the same as those in the embodiment of FIGS. 1 to 8, and corresponding configurations are denoted by the same reference numerals and description thereof will be omitted.

  According to the above configuration, the flexible members 321A to 321D fixed to the first through holes 311c and 311d and the flexible member 321E slidably supported without being fixed to the second through hole 311e. , 321F, when the movable cylinder (not shown) starts to move forward with respect to the head, the flexible members 321A to 321D perform the above-described cross-shaped bulging operation, so that the sticking sheet S is securely held. When the movable tube is further advanced with respect to the head, the flexible members 321E and 321F cause the flexible sheet 321E and 321F to move the adhesive sheet S closer to the distal end than the distal end surface 312a of the head 31. It can be extruded and attached to the affected area P.

  In the present embodiment, two first through holes 311c and 311d and one second through hole 311e are provided, but the number of the first through holes and the second through holes is not limited to this. The present invention is not limited thereto, and one or three or more first through holes may be provided, and two or more second through holes may be provided. Further, in the present embodiment, the second through hole 311e is opened in the same penetration direction as one of the first through holes 311c, but may be opened in any direction.

FIG. 14 shows another embodiment of the present invention.
In the present embodiment, the movable cylinder 50 can advance and retreat in an outer cylinder 80 provided outside the movable cylinder 50. The outer cylinder 80 is set to a length such that the distal end cap 52 of the movable cylinder 50 always projects from the distal end side even when the movable cylinder 50 moves forward and backward. In addition, the base end of the outer cylinder 80 is connected to a handle support section 81 which configures the handle operation section 20. The base end 53 of the movable cylinder 50 is accommodated in the handle support 81 so as to be able to advance and retreat, and the base end of the guide shaft 40 is connected to the base end of the handle support 81.

The handle support portion 81 is provided with a long hole 82 which is long in the moving direction of the movable cylinder 50. A claw portion 54 integral with the base end portion 53 of the movable cylinder 50 is slidably engaged with the long hole 82, and the claw portion 54 projects outside the handle support portion 81. The movable cylinder 50 moves inside the outer cylinder 80 by sliding the claw portion 54 along the elongated hole 82.
The material of the outer cylinder 80 is not limited, but is made of a resin such as polypropylene (PP) in the present embodiment. Further, by forming the cylinder main body 51 of the movable cylinder 50 from a fluorine resin (for example, PTFE), the sliding resistance when the movable cylinder 50 moves inside the outer cylinder 80 is reduced.
In the present embodiment, a material having good slidability is used for the cylinder body 51 of the movable cylinder 50. However, a material having good slidability may be used for the outer cylinder 80, or the cylinder body 51 and the outer cylinder 80 may be used. For both, a material having good slidability may be used.

  Other configurations are the same as those in the embodiment of FIGS. 1 to 8, and corresponding configurations are denoted by the same reference numerals and description thereof will be omitted.

  The treatment tool 10 of the present embodiment is particularly used by being inserted into a forceps port of an endoscope. By providing the outer cylinder 80 outside the movable cylinder 50, the inner wall surface of the forceps port contacts the outer cylinder 80 but does not contact the movable cylinder 50. For this reason, since the operation of sliding the claw portion 54 along the long hole 82 can be reliably transmitted to the operating portion 30 through the movable cylinder 50, the adhesive sheet S can be held while the position of the head 31 is fixed. Can be pasted on P. Accordingly, the sliding movement between the inner wall surface of the forceps port and the movable cylinder 50 prevents the movable cylinder 50 from moving forward, or conversely, the guide shaft 40 retreats toward the movable cylinder 50 and the head of the operating section 30 31 does not separate from the affected area P.

  As mentioned above, although one Embodiment of this invention was described, this invention is not limited to the said Embodiment, A various change is possible unless it deviates from the meaning of this invention.

Reference Signs List 10 treatment tool 20 handle operation unit 30 operating unit 31 head 311a through hole 311b locking hole 311c, 311d first through hole 311e second through hole 32 trunk unit 321 (321A to 321F) flexible member 40 guide shaft 40a Tip of guide shaft (support member)
50 movable cylinder 60 fixed cylinder 61 support rod (support member)
70 Movable rod 71 Connected body 80 Outer cylinder P Affected part S Adhering sheet S1 Substantially central part of adhering sheet S2 Peripheral part of approximately central part of adhering sheet

Claims (6)

A treatment tool used to attach the adhesive sheet to an affected area in the body,
A handle operation unit for hand-held operation on the base end side, and an operation unit on which the sticking sheet is covered on the distal end side,
The operating portion includes a head that supports the adhesive sheet from the inside, and a body that supports a peripheral portion of a portion of the adhesive sheet supported by the head from the inside, wherein the body is the head , And at least two flexible members arranged around the head, each flexible member having a distal end supported by the head and a proximal end facing the head. The flexible member is supported by a movable member that can advance and retreat with respect to the portion, and by operating the handle operation portion, each flexible member expands outward with the advancement of the movable member and surrounds the head. It is configured to overhang ,
The body has an even number of flexible members, and the opposing flexible members are folded by inserting one wire into a radial through-hole opening in the outer peripheral surface of the head. A plurality of the through-holes are provided in the head, the wire is inserted into each of the through-holes, and at least one of the wire has a folded portion fixed to the through-hole, and the remaining The treatment tool , wherein the wire member has a folded portion slidably supported by the through hole . The head is composed of a pressing portion that supports the affixing sheet from the inside and a main body portion where the respective distal ends of the flexible members are supported,
The distal end surface of the pressing portion is flat or hemispherical treatment instrument according to claim 1 outer diameter smaller than the outer diameter of the pressing portion of the main body portion. At least bracts of the through hole at least one folded portion of the wire material of the through hole folded portion of the wire is fixed is supported slidably, a penetration direction is the same, advancing and retracting of the movable member The treatment tool according to claim 1 , wherein the treatment tool is formed along a direction. The support member is constituted by a distal end portion of a guide shaft that connects the handle operation unit and the head of the operation unit, and the movable member is a movable cylinder that can advance and retreat on the guide shaft. The treatment tool according to any one of claims 1 to 3 , wherein a base end of each of the flexible members is connected. The treatment tool according to claim 4 , wherein the movable cylinder is capable of moving forward and backward in an outer cylinder provided outside the movable cylinder. The support member is constituted by a support rod that connects the head of the operating portion and a distal end of a fixed cylinder, and the movable member is a movable rod that can advance and retreat in the fixed cylinder, and a distal end of the movable rod. The treatment tool according to any one of claims 1 to 3 , wherein a base end of each of the flexible members is connected.