JP7190240B2 - Endoscopic treatment tool - Google Patents

Description

TECHNICAL FIELD The present invention relates to an endoscopic treatment instrument provided with a pair of treatment sections for treating living tissue remotely operated at a tip position to be inserted into a body cavity of a living body.

An endoscope system is widely used as a means for directly diagnosing and treating lesions in the body in a minimally invasive manner. A pair of remotely operated treatment parts are provided at the tip position to be inserted into the body cavity of the living body, and the pair of treatment parts are opened and closed to perform treatment such as removal of the affected part of the living tissue in the body cavity, sampling, excision, hemostasis, etc. The endoscopic treatment instrument includes a flexible sheath, an operation wire disposed in the sheath so as to be able to move back and forth, an operation portion provided at the rear end of the sheath for advancing and retracting the operation wire, and a distal end of the sheath. and a pair of treatment portions that are supported by the treatment portion support means and that open and close the operation wire by operating the operation portion in accordance with the forward/backward operation. Moreover, there is also a device further comprising a guide wire engaging means for guiding the pair of treatment portions along the guide wire.

The treatment portion supporting means has a tubular portion provided at the distal end portion of the sheath, and a pair of arms extending toward the distal end side from two opposing positions on the distal end surface of the tubular portion. The pair of treatment sections has, for example, a pair of members that intersect in an X shape. It is rotatably supported, and the rear end side portion is configured to open and close by receiving the forward/backward movement force of the operation wire, thereby opening and closing the pair of treatment portions to treat living tissue in the body cavity.

During treatment, the endoscopic treatment instrument protrudes the distal end of a guide wire, which is inserted into an endoscope channel previously inserted into a body cavity under fluoroscopy, from the distal end side opening of the endoscope to further extend into the body cavity. In a state in which a pair of treatment portions, which are distal side portions, are inserted to a position ahead of the affected area to be treated in the endoscope channel, the pair of treatment portions, which are the distal side portions, are in a closed state and are attached to a guide wire inserted in advance into the endoscope channel via a guide wire engaging means. It is engaged and guided and inserted into the endoscope channel, protrudes from the tip opening of the insertion section of the endoscope system, and is inserted into the affected area to be treated in the body cavity, without retracting the guide wire. , the sheath and the operating portion connected to the rear end portion of the operating wire which is operated to move back and forth within the sheath are operated to advance and retract the operating wire, and the pair of treatment portions are opened and closed to treat living tissue in the body cavity. It has become.

Japanese Patent Application Laid-Open No. 9-10220, FIG. 2002-119514, FIGS. 1, 2, and 9 2006-263159, FIGS. 12 and 13 Japanese Utility Model Publication No. 6-21449, Fig. 1

In this type of endoscopic treatment instrument, it is dependent on the engagement relationship between the guide wire and the guide wire engaging means to smoothly guide the pair of treatment parts to the affected part of the living tissue in the body cavity. Furthermore, it is also dependent on the engagement relationship between the guide wire and the guide wire engaging means that the pair of treatment parts occupy an appropriate position where they can be opened and closed so as to face the affected part of the living tissue in the body cavity so that the treatment can be performed well. there is

1 of Patent Document 1, FIGS. 1 and 2 of Patent Document 2, and FIG. 1 of Patent Document 3, a guide wire is engaged with one of a pair of treatment portions. Therefore, when the pair of treatment parts are opened and closed, the guide wire is shaken greatly and the pair of treatment parts is also shaken greatly, and the guide wire interferes with the treatment of the living tissue by the pair of treatment parts. .

9 of Patent Document 2 and FIG. 1 of Patent Document 4, respectively, the engagement position between the guide wire and the guide wire engaging means is from the opening and closing distal ends of the pair of treatment sections. Because of the large distance, it is difficult to smoothly guide the pair of treatment parts to the affected part of the living tissue in the body cavity. The treatment section interferes with the guide wire, causing the opening and closing directions of the pair of treatment sections to change direction, and the guide wire interferes with the treatment of the living tissue by the pair of treatment sections.

SUMMARY OF THE INVENTION The present invention has been made to solve such problems, and based on the engagement relationship between the guide wire and the guide wire engaging means, the guide wire can be inserted into the endoscope channel without tightness and can be easily inserted into the body cavity. Disclosed is an endoscopic treatment instrument that is easy to insert and that can avoid interference by a guide wire that causes a change in the direction of opening and closing when a pair of treatment parts are opened at a position corresponding to an affected part of a living tissue in a body cavity. intended to provide

In order to achieve the above object, an endoscopic treatment instrument according to the present invention includes a flexible sheath that is inserted into and removed from an endoscope channel, an operation wire that is arranged in the sheath so as to be able to move back and forth, An operation part connected to the rear end side of the operation wire and the sheath for advancing and retreating the operation wire, a tube part provided at the tip part of the sheath, and a pair of opposed arms extending from the tube part to the tip side. and a support shaft provided so that a middle portion overlaps between the pair of opposing arms and penetrates through the pair of arms. A pair of treatment sections for performing treatment on living tissue in a body cavity by opening and closing the distal end portion by receiving the advancing and retreating force of the operating wire and opening and closing the treatment section, and inserting the treatment section into the endoscope channel. and guidewire engaging means for guiding along the guidewire to be withdrawn.

The support shaft is formed to have a shaft hole penetrating through both ends thereof, and the guide wire engaging means has an engagement guide portion which engages so as to allow the guide wire to pass through the shaft hole of the support shaft. It is characterized in that it is configured to be supported by a provided support portion.

According to the present invention, based on the engagement relationship between the guide wire and the guide wire engaging means, the pair of treatment sections can be inserted into the body cavity without being tightly inserted into the endoscope channel and can be easily inserted into the body cavity. It is possible to provide an endoscopic treatment instrument that can avoid interference by a guide wire that causes a change in the opening/closing direction when opened at a position corresponding to an affected part of an internal body tissue.

BRIEF DESCRIPTION OF THE DRAWINGS It is a figure for demonstrating the endoscope system containing the treatment tool for endoscopes which concerns on Embodiment 1 of this invention. 1 is an overall view of an endoscopic treatment instrument according to Embodiment 1 of the present invention; FIG. FIG. 2 is a partially sectioned front view of the tip portion of the endoscopic treatment instrument according to Embodiment 1 of the present invention, excluding the guide wire. Fig. 2 is a front view of the distal end portion of the endoscopic treatment instrument according to Embodiment 1 of the present invention; Fig. 2 is a plan view of the distal end portion of the endoscopic treatment instrument according to Embodiment 1 of the present invention; 6(A) is a view taken along line VIa-VIa in FIG. 3, and FIG. 6B is a view taken along line VIb in FIG. FIGS. 7A and 7B are process diagrams for explaining treatment by a doctor using the endoscopic treatment instrument according to Embodiment 1 of the present invention. FIG. 7 is a configuration diagram of guide wire engaging means corresponding to FIG. 6(A), according to a modification of Embodiment 1 of the present invention. Fig. 9(A) is a partially sectioned front view excluding a guide wire, and Fig. 9(B) is a front view of a distal end portion of a treatment instrument for an endoscope according to Embodiment 2 of the present invention. is.

DESCRIPTION OF THE PREFERRED EMBODIMENTS An embodiment of an endoscopic treatment instrument according to the present invention will be described below with reference to the drawings. In the present embodiment, the side on which the pair of treatment sections are located is called the distal end side, and the side on which the operation section is located is called the rear end side.

[Embodiment 1]
[Endoscope system]
As shown in FIG. 1, an endoscope system 1 to which the endoscopic treatment instrument according to the first embodiment is applied includes an insertion section 2 for insertion into a body cavity of a living body, and a distal end of the insertion section 2 that can be moved up and down. An endoscope operation section 3 having a dial for bending operation in the left-right direction, and a treatment instrument introduction section 4 disposed between the insertion section 2 and the endoscope operation section 3. An endoscope channel 5 is formed longitudinally from the insertion portion 2 toward the distal end of the insertion portion 2. Within the endoscope channel 5, a pair of treatment portions 15, 16 and a sheath of an endoscope treatment instrument 10, which will be described later, are provided. 11 is configured to pass therethrough.

[Basic Configuration of Endoscopic Treatment Tool]
As shown in FIG. 2, the endoscopic treatment instrument 10 according to Embodiment 1 includes a flexible elongated sheath 11 that is inserted into and removed from an endoscope channel 5, and a sheath 11 that is disposed in the sheath 11 so as to be advanceable and retractable. an operating wire 12, an operating portion 13 for moving the operating wire 12 forward and backward, treatment portion supporting means 14 provided at the distal end portion of the sheath 11, and rotatably supported by the treatment portion supporting means 14 via a support shaft 18. Also, a pair of treatment portions 15 and 16 which are connected to the operation wire 12 and perform treatment of the living tissue in the body cavity by opening and closing the distal end portions 15c and 16c through the forward/backward operation of the operation wire 12 by the operation portion 13; and guide wire engaging means 20 shown in FIGS. The endoscopic treatment instrument 10 has a hydrophilic coating on the outer surface of the portion to be inserted into the body cavity from the sheath 11 to the guide wire engaging means 20 .

The sheath 11 is an elongated cylindrical body having flexibility and moderate stiffness (bending resistance). Preferably, the length is 500-2000 mm. The sheath 11 may be composed of a coil sheath and a flexible resin jacket that covers the outer surface of the coil sheath. It may consist of only

The operation wire 12 is arranged loosely in the sheath 11 so as to be able to move forward and backward, and is made of a torque wire that is conductive and has high rotational followability. For example, the operation wire 12 may be made entirely of stainless steel, or may be made of stainless steel on the rear end side and Nitinol (nickel-titanium alloy) on the front end side, both of which are connected by a stainless steel pipe.

The operating portion 13 moves the operating wire 12 by relatively sliding (advancing and retreating) a slider 13 a attached to the proximal end of the operating wire 12 and an operating portion main body 13 b attached to the proximal end of the sheath 11 . can be moved in the longitudinal direction, and the operation wire 12 is moved to the distal end side by moving the slider 13a leftward in the figure (to the distal end side).

The operation part 13 is connected to the operation wire 12 and the rear end side of the sheath 11 and is configured to operate the operation wire 12 to advance and retreat.

The treatment portion supporting means 14 is formed by processing a small-diameter stainless steel tube, for example, and faces a cylindrical portion 14a provided at the distal end portion of the sheath 11 and a distal end surface of the cylindrical portion 14a formed by slitting. and a pair of arm portions 14b extending toward the distal end side from two positions where the arm portions 14b are located. The cylindrical portion 14a is fitted over the distal end portion of the sheath 11 and fixed to each other by brazing, soldering, adhesion or crimping.

The pair of treatment portions 15 and 16 are made of stainless steel or nitinol (nickel-titanium alloy) and are formed into a pair of cup-shaped biopsy forceps that are overlapped in an X shape. It is rotatably supported by a support shaft 18 which is provided so as to pass through the pair of arms 14b. The rear end portions 15b and 16b of the pair of treatment portions 15 and 16 are pin-connected to a pair of opening/closing operation links 15d and 16d, and the pair of opening/closing operation links 15d and 16d are connected to a forward/retreat transmission link 17. , and the forward/retreat transmission link 17 is connected and fixed to the distal end portion of the operation wire 12 .

The pair of treatment sections 15 and 16 rotate about a support shaft 18, and when the operation wire 12 is moved to the distal end side, the pair of opening and closing links 15d and 16d are adjusted to the leg opening angle. is increased, the rear end portions 15b and 16b receive the advancing and retreating force of the operation wire 12 and are opened, and the distal end portions 15c and 16c are opened. Then, when the operation wire 12 is moved to the rear end side, the pair of opening/closing operation links 15d and 16d are operated so as to decrease the leg opening angle, so that the rear end side portions 15b and 16b move the operation wire 12 forward and backward. As the operating force is received, the leg opening angle is reduced, and the distal end portions 15c and 16c are closed. Therefore, by advancing and retreating the operation wire 12, the distal end portions 15c and 16c of the pair of treatment portions 15 and 16 are opened and closed to perform treatment such as excision of living tissue in the body cavity or collection of a sample. .

A guide wire engaging means 20, which will be described later, is provided to engage and guide the endoscopic treatment instrument 10 along the guide wire 30 that is inserted into and removed from the endoscope channel 5. As shown in FIG.

[Characteristic Configuration of Endoscopic Treatment Tool]
A characteristic configuration of Embodiment 1 is that the support shaft 18 has a shaft hole 19 as shown in FIGS. The guide wire engaging means 20 includes an engaging guide portion 20a that engages so that the guide wire 30 is inserted thereinto, and an engaging guide portion 20a that is irremovably provided in the shaft hole 19 of the support shaft 18 and is connected to support the engaging guide portion 20a. and a support portion 20b.

As shown in FIGS. 4, 5, and 6A, the guide wire engaging means 20 of Embodiment 1 has an engaging guide portion 20a and a support portion 20b made of a wire such as a fishing line, a resin filament, or a flexible material. The engaging guide portion 20a is a loop portion formed by bending the intermediate portion of the flexible wire into a loop shape, and the support portion 20b is the wire. It is a straight portion on both sides inserted into the shaft hole 19 of the support shaft 18 except for the loop portion so as not to escape. The structure in which the support portions 20b, which are straight portions on both sides of the wire, cannot escape into the shaft hole 19 of the support shaft 18 may be adhesion, brazing, soldering, or the like, depending on the material of the wire. In particular, when the wire is a fishing line or a resin filament, straight portions on both sides of the wire are made to protrude greatly from the shaft hole 19 of the support shaft 18 and are melted by applying a soldering iron to form a block-like shaft hole escape prevention portion. may be formed.

In addition to the engagement guide portion 20a, the guide wire engagement means 20 of the first embodiment includes an auxiliary engagement guide portion 21 as shown in FIGS. 4, 5 and 6B. provided for. The auxiliary engagement guide portion 21 is located on the same axis as the engagement guide portion 20a with respect to the sheath 11 and is located on the rear end side of the engagement guide portion 20a, and is engaged with the guide wire 30 so that the guide wire 30 is inserted therethrough. is configured to

FIGS. 7A and 7B are process diagrams for explaining treatment by a doctor using the endoscopic treatment instrument 10 of Embodiment 1. FIG.

First, for example, when there is an affected part in the bile duct 43, the insertion portion 2 of the endoscope system shown in FIG. , the distal opening of the insertion section 2 is opposed to the vicinity of the papilla 42, and then the guide wire 30 is inserted into the endoscope channel and protruded from the distal opening of the insertion section 2 into the bile duct. 43, and to a desired position beyond the position where the affected part 44 exists.

Next, the sheath 11 is engaged and guided by the guide wire 30 through the guide wire engaging means 20, is passed through the endoscope channel, is advanced into the bile duct 43, and is advanced to a position adjacent to the affected area 44. Let Subsequently, as shown in FIG. 7B, the operation wire 12 is advanced without retracting the guide wire 30 into the endoscope channel. The affected part in the body cavity is taken into the pair of treatment parts 15 and 16 by opening and closing the parts 15 and 16 .

Next, the pair of treatment portions 15 and 16 are opened and closed by retracting the operation wire to take in a part or all of the cells of the affected area into the pair of treatment portions 15 and 16, and the sheath 11 is pulled out to remove the pair of treatment portions 15. , 16 is taken out of the body. Since the guide wire 30 has not been pulled out, the endoscopic treatment instrument 10 is engaged and guided with the guide wire 30 via the guide wire engaging means 20, and is inserted through the endoscope channel, thereby connecting the pair of treatment portions 15, 16 can be positioned near the affected part of the body.

According to the first embodiment, the guide wire engaging means 20 includes the engaging guide portion 20a engaged so that the guide wire 30 is inserted thereinto, and the engaging guide portion 20a which is irremovably provided in the shaft hole 19 of the support shaft 18. a support portion 20b coupled to support portion 20a and guided in engagement with guidewire 30; Therefore, if the distance from the engagement position between the guide wire engaging means 20 and the guide wire 30 to the opening/closing distal ends of the pair of treatment portions 15 and 16 is short and the outer diameter of the cylindrical portion 14a of the treatment portion supporting means is large, First, the side edges of the closed surfaces of the pair of treatment sections 15 and 16 are kept in the vicinity of the guide wire 30 . The auxiliary engagement guide portion 21 complements the state in which the side edges of the closed surfaces of the pair of treatment portions 15 and 16 are maintained along the vicinity of the guide wire 30 . Based on such an engaging relationship between the guide wire 30 and the guide wire engaging means 20, the pair of treatment parts 15, 16 and the treatment part supporting means 14 are inserted into the endoscope channel 5 without being tight, and are inserted into the body cavity. The pair of treatment sections 15 and 16 can be smoothly guided to an appropriate position facing the affected area of the living tissue in the body cavity, and the pair of treatment sections 15 and 16 can be inserted into the body cavity. When opening at the position corresponding to the affected part of the living tissue, it is possible to avoid interference by the guide wire, which causes a change in the direction of opening and closing.

[Modification of Embodiment 1]
FIG. 8 shows a modification of the guide wire engaging means 20 of the first embodiment. In the guide wire engaging means 20A according to the modification, the engagement guide portion 20c is ring-shaped or short cylindrical, and the support portion 20d is a shaft extending in the centrifugal direction from one end of the outer peripheral surface of the engagement guide portion 20c. It is inserted through the shaft hole of the support shaft 18 so as not to escape.

[Embodiment 2]
[Basic configuration]
The configuration of the endoscope system is the same as that of the first embodiment, so the illustration and description are omitted. The basic configuration of the endoscopic treatment instrument differs in the following points. As shown in FIGS. 9(A) and 9(B), the endoscope treatment instrument of Embodiment 2 has a pair of treatment portions 15A and 16A which are connected to the opening/closing operation links 15d and 16d shown in FIG. 17 does not exist, and two operating wires 12A and 12B are passed through the sheath 11A. The two operating wires 12A, 12B protrude between the arm portions 14c of the treatment portion support means 14A provided at the distal end of the sheath 11A, gradually widen the distance, and extend the rear ends of the pair of treatment portions 15A, 16A. It is connected to the rear ends of the side portions 15d and 16d. Therefore, the pair of treatment sections 15A and 16A are configured such that the two operation wires 12A and 12B advance and retreat integrally, thereby causing expansion and contraction of the spread angles of the distal ends of the two operation wires 12A and 12B. A part opens and closes.

The pair of treatment portions 15A and 16A of the second embodiment are incision scissors instead of the biopsy forceps of the first embodiment. The incision scissors may be electrode blades, and in this case, the two operation wires 12A and 12B are insulated from each other so as not to cause an electrical short circuit. The sheath 11A is composed of a conductive coil sheath wound with a stainless steel wire or the like, and an insulating and flexible resin sheath covering the outer surface of the coil sheath. The inner surface of the coil sheath is also insulated.

[Characteristic Configuration of Endoscopic Treatment Tool]
A characteristic configuration of the second embodiment is that a guide wire engaging means 20B is provided in the shaft hole of the support shaft 18A, and an auxiliary engaging guide portion 21B is provided on the outer surface of the treatment portion supporting means 14A. The guidewire engaging means 20B is the same as the guidewire engaging means 20 according to the first embodiment or the guidewire engaging means 20A according to the modification of the first embodiment. The auxiliary engagement guide portion 21B is the same as the auxiliary engagement guide portion 21 according to the first embodiment.

The effects of the guide wire engaging means 20B of the second embodiment are the same as those of the first embodiment.

Advantageous Effects of Invention According to the present invention, when a pair of treatment sections are opened at a position corresponding to an affected part of a body tissue in a body cavity, it is possible to avoid interference caused by a guide wire that causes a change in the opening/closing direction. , is useful for an endoscopic treatment instrument provided with a pair of treatment parts for treating living tissue remotely operated at a distal end position to be inserted into a body cavity of a living body.

Reference Signs List 1 endoscope system 5 endoscope channel 10 endoscope treatment instrument 11 sheath 12, 12A, 12B operation wire 13 operation section 14, 14A treatment section support means 14a tube section 14b, 14c arm section 15, 15A, 16, 16A treatment portion 15a, 16a intermediate portion 15b, 15d, 16b, 16d rear end side portion 15c, 16c tip side portion 15d, 16d opening/closing operation link 17 advance/retreat transmission link 18, 18A support shaft 19 shaft hole 20, 20A, 20B guide Wire engaging means 20a, 20c Engagement guide portions 20b, 20d Support portions 21, 21B Auxiliary engagement guide portions 30 Guide wire

Claims (4)

a flexible sheath that is inserted into and removed from a channel of an endoscope;
an operation wire disposed in the sheath so as to be able to move back and forth;
an operation unit connected to the operation wire and the rear end side of the sheath for advancing and retracting the operation wire;
treatment portion support means having a tubular portion provided at the distal end portion of the sheath and a pair of opposed arms extending from the tubular portion toward the distal end;
The intermediate portion is rotatably supported by a support shaft that overlaps between the pair of opposed arms and penetrates through the pair of opposed arms, and the rear end portion receives the forward/backward movement force of the operation wire. a pair of treatment parts for treating a living tissue in a body cavity by opening and closing a tip side portion by receiving and opening and closing the treatment parts;
guide wire engaging means for guiding the treatment portion along a guide wire that is inserted into and removed from a channel of the endoscope;
An endoscopic treatment instrument comprising
The support shaft is formed with a shaft hole passing through both ends,
The guide wire engaging means is configured such that an engaging guide portion engaged so that the guide wire is inserted is supported by a support portion provided within a shaft hole of a support shaft.
An endoscopic treatment instrument characterized by: In the guide wire engaging means, the engaging guide portion is a loop portion formed by bending a middle portion of a flexible wire into a loop shape, and the support portion is a straight line on both sides excluding the loop portion of the wire. 2. The endoscopic treatment instrument according to claim 1, wherein the straight portions on both sides are joined together and inserted into the shaft hole of the support shaft so as not to escape. The guide wire engaging means is characterized in that the engagement guide portion is ring-shaped or cylindrical, and the support portion is a shaft portion that is inserted into the shaft hole of the support shaft so as not to escape. The endoscopic treatment tool according to claim 1 . an auxiliary engagement guide portion located on the same axis as the engagement guide portion with respect to the sheath and on the rear end side of the engagement guide portion and engaged with the guide wire so that the guide wire is inserted; 2. The endoscopic treatment instrument according to claim 1, which is provided on the outer surface of the cylindrical portion.

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