JP6716453B2 - Endoscopic treatment tool - Google Patents

Description

TECHNICAL FIELD The present invention relates to a treatment tool for an endoscope for treating a body tissue by an operation outside the body using an endoscope.

A clip device as one of the treatment tools for an endoscope operates a clip connected to a distal end of a sheath that is passed through a treatment instrument guide tube of an endoscope from an operation section attached to a rear end of the sheath. Is a device used for indwelling the internal tissue while holding it for hemostasis, marking, and the like. Therefore, the clip is configured to be separable from the sheath, and in general, a connecting hook that is engageable with and disengageable from a connecting portion formed at the rear end portion of the clip is attached to the drive wire of the drive wire passed through the sheath. It is attached to the tip (distal end).

As the connecting hook, one having a shape in which the tip is bent inward by being biased by the elasticity of itself in a substantially V-shaped open toward the front and having a simple structure It is often used because the operation of connecting and disconnecting is surely performed and the performance is good. The base ends of the connecting hooks are integrated with each other and fixed to the tip of the drive wire (see, for example, Patent Document 1 below).

JP 2012-200518 A

By the way, the distal end of the endoscope is appropriately curved for the convenience of treatment, but if it is curved relatively large (curved so that the curvature becomes relatively small), it passes through this portion. In doing so, the sheath distal end portion in which the connection hook of the clip device is housed is also curved according to the curvature of the endoscope. At this time, as described above, in the related art, since the base end portion of the connecting hook is fixed to the distal end of the drive wire, the degree of freedom regarding the attitude of the connecting hook with respect to the drive wire is low, and depending on the degree of bending, the sheath may be changed. However, there is a problem in that the insertion work and the treatment may be hindered, and the connecting hook may be deformed or damaged at the fixing portion for the drive wire.

The present invention has been made in view of the above circumstances, and increases the degree of freedom regarding the posture of the connecting hook with respect to the drive wire, so that insertion work or treatment can be smoothly performed without causing deformation or damage. An object is to provide a treatment tool for an endoscope that can be used.

The treatment tool for an endoscope according to the present invention,
A tubular sheath,
A drive wire inserted through the sheath,
An operation unit provided at a proximal end of the sheath, for sliding the drive wire with respect to the sheath,
The drive wire is attached to the distal end of the drive wire, and is formed of an elastic body having a pair of arm portions arranged to open each other in a substantially V-shape toward the tip thereof. The distal end of the sheath by projecting from the distal end of the sheath and elastically opening the leg by sliding the sheath toward the distal end with respect to the drive wire. With an opening and closing part that is buried in the position end and closes the leg,
A first loose fit portion is integrally provided at the distal end of the drive wire,
A second loose fitting portion that is loosely fitted in the first loose fitting portion is integrally provided at a base end portion of the opening/closing portion,
The opening/closing portion is attached to the drive wire via the first loosely fitting portion and the second loosely fitting portion.

In the treatment tool for an endoscope according to the present invention, the opening/closing portion may be a connecting hook that releasably connects the clip for the endoscope that holds and holds the body tissue.

In the treatment tool for an endoscope according to the present invention,
The first loosely fitting portion has an annular portion formed in a substantially annular shape,
The second loosely fitting portion may be formed in a substantially U shape, and may have a U-shaped portion that is loosely fitted by being inserted into the annular portion.

According to the treatment tool for an endoscope of the present invention, the opening/closing portion is attached to the drive wire via the first loosely fitting portion and the second loosely fitting portion loosely fitted in the first loosely fitting portion. Therefore, the degree of freedom of the posture of the opening/closing part with respect to the drive wire can be increased. Therefore, even when the endoscope is relatively curved, there is an effect that the insertion work and the treatment can be smoothly performed without causing deformation or damage.

It is a figure which shows the whole structure of the treatment tool for endoscopes of embodiment of this invention. It is sectional drawing which followed the AA line of FIG. It is a figure which shows the structure of the distal end of the drive wire of the treatment tool for endoscopes of embodiment of this invention. It is a figure which shows the structure of the distal end of the drive wire of the treatment tool for endoscopes of embodiment of this invention. It is a figure which shows the state which attached the connection hook to the distal end of the drive wire of the treatment tool for endoscopes of embodiment of this invention. It is a figure which shows the state which attached the connection hook to the distal end of the drive wire of the treatment tool for endoscopes of embodiment of this invention. It is a top view which shows the structure of the clip of embodiment of this invention. It is a side view which shows the structure of the clip of embodiment of this invention. It is a figure which shows the state which made the connection hook of the treatment tool for endoscopes of embodiment of this invention project from the distal end of an inner sheath, and opened the connection hook. It is a figure which shows the state which accommodated the clip in the outer sheath by connecting the clip to the distal end of the inner sheath of the treatment tool for endoscopes of embodiment of this invention. It is a figure which shows the state which is inserting the treatment tool for endoscopes of embodiment of this invention into the treatment tool guide tube of the curved endoscope. It is a figure which shows the modification of the loop member of the treatment tool for endoscopes of embodiment of this invention. It is a figure which shows the other modification of the loop member of the treatment tool for endoscopes of embodiment of this invention.

Hereinafter, with reference to the drawings, as an embodiment of an endoscopic treatment tool according to the present invention, an endoscopic clip that performs hemostasis and the like is connected and conveyed into the body through an endoscope, and internal tissue A clip device for gripping (clipping) will be described.

However, the present invention is not limited to the clip device, and is made of an elastic body having a pair of arm portions arranged so as to open in a substantially V-shape toward the tip thereof, and the sheath is a drive wire. The distal end of the sheath is slid toward the distal end side of the drive wire by projecting from the distal end of the sheath and elastically opening the leg by sliding the proximal end side with respect to the drive wire. It can be widely applied to a treatment instrument for an endoscope including an opening/closing portion that is buried inside and closes a leg.

More specifically, for example, a snare ligating device having a connecting hook for connecting an indwelling snare to ligate body tissue as the opening/closing part, a forceps device having forceps for grasping body tissue as the opening/closing part, and a high-frequency electrode for opening/closing. The present invention can be applied to a bipolar type high frequency device or the like that includes

First, refer to FIG. 1 and FIG. The clip device 1 is configured to roughly include a connecting hook 11, an inner sheath (inner tube) 12, a drive wire 13, an outer sheath (outer tube) 14, a reinforcing coil 15, a slider 16, a base portion 17, and an operating portion 18. ing.

A tubular inner sheath 12 is also inserted through the tubular outer sheath 14, and a drive wire 13 is inserted through the inner sheath 12. The inner sheath 12 is slidable within the outer sheath 14, and the drive wire 13 is slidable within the inner sheath 12.

The outer sheath 14 is made of a flexible hollow tube, and a coil tube is used in this embodiment. As the coil tube, a flat wire coil tube formed by spirally winding a long flat plate made of metal (stainless steel) or the like can be used. However, a round wire coil tube or an inner flat coil tube may be used.

The inner sheath 12 is made of a flexible hollow tube, and a wire tube is used in this embodiment. The wire tube is a tube made of a hollow stranded wire formed by spirally twisting a plurality of wires (cables) made of metal (stainless steel) or the like so as to be hollow. As the inner sheath 12, a wire tube may be mainly used, and a coil tube may be used only on a part of the distal end side thereof.

The drive wire 13 is made of a flexible wire, and a wire rope is used in this embodiment. The wire rope is a rope composed of a twisted wire formed by spirally twisting a plurality of wires (cables) made of metal (stainless steel) or the like. However, as the drive wire 13, a wire tube similar to the inner sheath 12 may be used.

Such a coil tube or a wire tube made of a stranded wire is used as the outer sheath 14 and the inner sheath 12 when the clip device 1 is ultrasonically cleaned with a cleaning liquid, the cleaning liquid is sufficiently contained inside the tube. This is for the purpose of permeating into the inside of the container to allow good cleaning both inside and outside.

In addition, it is preferable that the outer sheath 14 and the inner sheath 12 are wound in opposite directions from the viewpoint of reducing sliding resistance between them. For example, when the outer sheath 14 is Z-wound, the inner sheath 12 is S-wound. When a wire rope or a wire tube made of a stranded wire is used as the drive wire 13, it is also preferable that the winding direction is opposite to the winding direction of the inner sheath 22.

As shown in FIGS. 5 and 6, the connecting hook 11 arranged at the distal end of the sheath of the clip device 1 includes a pair of arm portions made of an elastic body arranged in a substantially V-shape toward the distal end thereof. 11a, 11a, and in cooperation with the inner sheath 12, it is possible to take two states of an open leg (open) state and a closed leg (closed) state. Claw portions 11b and 11b are formed at the tip ends of the arm portions 11a and 11a of the connecting hook 11 by being bent inward (sides facing each other), and grip the connecting plate portion 21 of the clip 2 described later. Can be connected.

The base end portion of the connecting hook 11 is a U-shaped portion 11c which is formed in a substantially U-shape continuously with the base end portions of the pair of arm portions 11a, 11a. The arm portions 11a, 11a including the claw portions 11b, 11b and the U-shaped portion 11c can be formed by appropriately bending (plastically deforming) one elongated plate material made of an elastic body. The U-shaped portion 11c corresponds to the second loose fitting portion loosely fitted in the first loose fitting portion in the present invention. Although not particularly limited, the plate material of the connecting hook 11 has a plate thickness of about 0.20 to 0.24 mm and a width of about 0.6 mm. As the plate material, for example, stainless steel is used.

At the tip (distal end) of the drive wire 13 slidably inserted into the inner sheath 12, as shown in FIGS. 3 and 4, an annular portion (annular portion) formed in a substantially annular shape is formed. ) A loop member 19 having a bar-shaped portion 19b integrally formed with 19a and the annular portion 19a is integrally welded and fixed by laser welding or the like. Although the illustration of the fixing of the loop member 19 to the drive wire 13 is omitted, the distal end of the drive wire 13 is inserted from one end of the substantially cylindrical pipe member, and the rod-shaped portion of the loop member 19 is inserted from the other end. 19b may be inserted and each may be fixed to the pipe member by laser welding. The annular portion 19a has an outer diameter of about 1.2 mm and an inner diameter of about 0.8 to 1.0 mm. Although the cross section of the annular portion 19a is rectangular in this embodiment, it may be circular or semicircular. The annular portion 19a corresponds to the first loose fitting portion in which the second loose fitting portion is loosely fitted in the present invention.

The connecting hook 11 is inserted into the annular portion 19a and is arranged so that the U-shaped portion 11c is loosely fitted in the annular portion 19a, so that the connecting hook 11 is swingably attached to the distal end of the drive wire 13. .. By attaching the connecting hook 11 to the distal end of the drive wire 13 via such an annular portion 19a and the U-shaped portion 11c loosely fitted to the annular portion 19a, the connecting hook 11 can be formed as shown in FIG. In FIG. 6, it can freely rotate in the direction of arrow B and in the direction of arrow C in FIG.

Referring back to FIGS. 1 and 2, the vicinity of the proximal end (proximal end) side of the outer sheath 14 is inserted into the reinforcing coil 15 and integrally fixed to the reinforcing coil 15. The reinforcing coil 15 is integrally fixed to the slider 16, and the distal end side portion of the base portion 17 is inserted and arranged inside the slider 16. The slider 16 is slidable with respect to the base portion 17 so as to be positionable between a position moved toward the distal end (distal end) side and two positions moved toward the proximal end part (proximal end) side. Has become.

The operating portion 18 is slidably held by the base portion 17, and the inner sheath 12 is fixed to the base portion 17. The proximal end of the drive wire 13 is fixed to the operating portion 18.

Next, the medical clip 2 that holds the internal tissue using the clip device 1 will be described. As shown in FIGS. 7 and 8, the clip 2 has a connecting plate portion 21 bent into a substantially U shape. A pair of arm plate portions 22 are formed integrally with each of the U-shaped end portions of the connecting plate portion 21 so as to open (open legs) in a substantially C-shape toward the tip thereof. ing.

A claw portion 23 is integrally formed at the tip of each arm plate portion 22. The claw portion 23 is formed at the tip of the arm plate portion 22 by being bent toward the inside (that is, the closing direction). Each claw portion 23 has a notch (not shown) recessed in the middle portion of its tip.

The connecting plate portion 21, the pair of arm plate portions 22, and the pair of claw portions 23 that form the clip 2 are formed by bending (plastically deforming) a single thin and long elastic plate material. You can The plate thickness of the plate material forming the clip 2 is not particularly limited, but is preferably 0.10 to 0.30 mm. As the plate material, for example, stainless steel is used.

The arm plate portions 22 each have a base end portion 22a and a grip portion 22b, as shown in FIG. A penetrating portion 22c is formed in each of the grip portions 22b of each arm plate portion 22. These penetrating portions 22c are formed in order to reduce the weight without impairing the desired strength of the arm plate portion 22 (grasping portion 22b).

A tightening ring 24 is slidably fitted into the connecting plate portion 21. The tightening ring 24 is composed of a substantially cylindrical ring member. However, the tightening ring 24 may be configured by a spring formed by winding a wire rod into a coil. The tightening ring 24 has an inner guide hole through which the connecting plate 21 is inserted, and is movable (sliding) in the axial direction between the outer circumference of the connecting plate 21 and the outer circumference of the base end 22a of the arm plate 22. Is attached (externally fitted) to.

As shown in FIG. 7 or 8, when the tightening ring 24 is arranged toward the rear (connecting plate part 21 ), the arm plate part 22 is in a state of being opened (opened) by its own elasticity. Therefore, by moving (sliding) the tightening ring 24 to the position near the tip (base end portion 22a), the arm plate portion 22 can be closed (closed) as necessary.

Next, a method of using the clip device 1 described above will be described. First, as shown in FIG. 9, the slider 16 is slid to a position on the proximal end side with respect to the base portion 17 so that the distal end of the inner sheath 12 projects from the distal end of the outer sheath 14. It will be in a state of Further, the operating portion 18 is slid toward the proximal end side with respect to the base portion 17, the inner sheath 12 is retracted with respect to the drive wire 13, and the connecting hook 11 at the distal end of the drive wire 13 is moved away from the inner sheath 12. It is made to project from the base end, and the legs are opened in a substantially V shape by its own elasticity.

When the operating portion 18 is slid to the distal end side with respect to the base portion 17 from this state, the drive wire 13 is retracted with respect to the inner sheath 12, and the connecting hook 11 at the distal end of the drive wire 13 is moved to the inner side. while it enters the sheath 12, since閉脚gradually, and positioned such coupling hook 11 the connecting plate portion 21 of the clip 2 to grip, by buried in the inner sheath 12 completely by閉脚, The clip 2 can be connected to the distal end of the inner sheath 12.

Next, the slider 16 is slid to the position on the distal end side with respect to the base portion 17, and the distal end of the inner sheath 12 to which the clip 2 is connected is housed (embedded) in the outer sheath 14 together with the clip 2. ) Let me. In this state, the tightening ring 24 of the clip 2 remains positioned on the connecting plate portion 21, and the arm plate portion 22 is closed by the inner wall of the outer sheath 14.

Next, although not shown, the distal ends of the sheaths 12 and 14 of the clip device 1 to which the clip 2 is connected are positioned near an internal tissue to be treated such as hemostasis via an endoscope. .. After that, the outer sheath 14 is slid toward the proximal end side so that the clip 2 is projected from the distal end of the outer sheath 14. As a result, the arm plate portion 22 of the clip 2 is in a state of being opened due to its own elasticity (see FIG. 7).

The arm plate portion 22 is positioned in the vicinity of the site of the mucous membrane (body tissue) to be grasped with the legs open. Then, the inner sheath 12 is slid toward the distal end side with respect to the drive wire 13, so that the tightening ring 24 slides toward the distal end side of the arm plate portion 22. As a result, the arm plate portions 22 gradually close their legs (approaching each other), and the mucous membrane on one side and the mucous membrane on the other side are drawn together with the body tissue interposed therebetween.

By further sliding the inner sheath 12 toward the distal end side with respect to the drive wire 13, the tightening ring 24 moves to the grip portion 22b side of the arm plate portion 22, and the grip of the body tissue by the clip 2 is completed. In this state, by sliding the inner sheath 12 to the proximal end side with respect to the drive wire 13, the connecting hook 11 is pushed out from the distal end of the inner sheath 12 and opened as shown in FIG. The legs are released, and the grip (engagement) of the clip 2 by the connecting hook 11 is released, and the clipping of the clip 2 with respect to the internal tissue is completed.

According to the above-described embodiment, the connection hook 11 serving as the opening/closing portion serves as the ring wire portion 19a serving as the first wire fitting portion and the second wire fitting portion loosely fitted to the ring wire portion 19a with respect to the drive wire 13. Since the attachment hook 11 is attached via the U-shaped portion 11c, the connecting hook 11 can freely swing with respect to the drive wire 13 (that is, the degree of freedom of the posture with respect to the drive wire 13 is increased). Therefore, for example, as shown in FIG. 11, when passing through the treatment instrument guide tube 3 of the endoscope which is relatively largely curved, the distal end of the drive wire 13 and the distal end of the drive wire 13 are moved inside the inner sheath 12. Since the connecting hook 11 is bent without stress at the portions of the annular portion 19a and the U-shaped portion 11c, it is possible to prevent a large force from acting on this portion.

As a result, when the inner sheath 12 is inserted into the treatment instrument guide tube 3, the distal end portion of the inner sheath 12 in which the connecting hook 11 is housed and the vicinity thereof smoothly follow the bend of the treatment instrument guide tube 3. In addition, it is possible to reduce obstacles when the drive wire 13 is slid in the inner sheath 12, and the work can be smoothly performed. Further, it is possible to reduce deformation (plastic deformation), breakage, and the like in the connecting portion between the drive wire 13 and the connecting hook 11. The outer sheath 14 is not shown in FIG. 11.

In the above-described embodiment, the annular portion 19a is provided at the distal end of the drive wire 13 and the U-shaped portion 11c of the connecting hook 11 is loosely fitted in the annular portion 19a. However, on the contrary, An annular portion may be provided on the connecting hook 11 and a U-shaped portion may be provided on the drive wire 13.

Further, instead of the loop member 19 (see FIG. 3) having the annular portion 19a and the rod-shaped portion 19b, the annular portion 31a and the rod-shaped portion 31b are integrally formed as shown in FIG. As the loop member 31, or as shown in FIG. 13, a loop member 32 formed by integrally forming an annular portion 32a and a rod-shaped portion 32b may be adopted.

The embodiments described above are described to facilitate the understanding of the present invention, and are not described to limit the present invention. Therefore, each element disclosed in the above-described embodiment is intended to include all design changes and equivalents within the technical scope of the present invention.

Claims (3)

A tubular sheath,
A drive wire inserted through the sheath,
An operation unit provided at a proximal end of the sheath, for sliding the drive wire with respect to the sheath,
The drive wire is attached to the distal end of the drive wire, and is formed of an elastic body having a pair of arm portions arranged to open each other in a substantially V-shape toward the tip thereof. Te by sliding the near end side, and the open leg by its own elastic and protrudes from the distal end of the sheath by sliding the distal end side with respect to the sheath the drive wire, the sheath With an opening and closing part that is buried in the distal end and closes the leg,
The opening/closing part is for releasably connecting the member placed in the body,
A first loose fit portion is integrally provided at the distal end of the drive wire,
A second loose fitting portion that is loosely fitted in the first loose fitting portion is integrally provided at a base end portion of the opening/closing portion,
Attaching the opening/closing part to the drive wire via the first loosely fitting part and the second loosely fitting part ;
The first loosely fitting portion is a member having an annular portion formed in a substantially annular shape, and is provided by fixing a member other than the drive wire to the distal end of the drive wire. A treatment tool for an endoscope. The endoscopic treatment instrument according to claim 1, wherein the opening/closing part is a connecting hook that releasably connects an endoscopic clip that holds and holds in-vivo tissue. Second loosely fitting portion before SL is formed in a substantially U-shape, the endoscope according to claim 1 or 2, characterized in that it has a U-shaped portion which is loosely fitted by being inserted through the annulus Mirror treatment tool.

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