JP7445604B2 - endoscopic treatment equipment - Google Patents

Description

The present invention relates to an endoscopic treatment tool used for purposes such as hemostasis, sampling and resection of body tissues, and injection of medicinal solutions into body tissues in surgeries and treatments using an endoscope.

Conventionally, in procedures using an endoscope such as endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR), it has been necessary to stop bleeding and remove the lesion by removing the lesion. Endoscopic treatment instruments such as clips for suturing, snares and knives for removing lesions, forceps for collecting internal tissues, and local injection needles for injecting medical solutions into internal tissues. is used.

For example, Patent Document 1 discloses an insertion tube in which operating wires are bundled in an inner cylinder and further includes an outer cylinder, and the distal end surface of the insertion tube can be accurately observed without damaging the tissue of the subject when inserted into the body. A medical endoscope device is described that allows the device to face the target area. Patent Document 2 discloses an endoscope having a tube in which a sample collection tool located at the tip of the endoscope is accommodated so as to be movable back and forth, and the tube has a sheath large diameter part and a sheath small diameter part. Treatment tools are listed. Patent Document 3 discloses that the materials of the outer tube and the inner tube are made to have a low coefficient of friction to prevent buckling of the endoscopic puncture needle attached to the tip of the treatment instrument and to smoothly protrude and retract from the tip of the outer tube. A puncture needle device for an endoscope is described. Patent Document 4 discloses that an endoscope treatment instrument can be moved forward and backward by providing a locking gear on the inside of an outer cylinder part and an engagement protrusion on the side surface of the inner cylinder part, which protrudes to the outside from the tip of the outer cylinder part. An endoscopic treatment instrument is described that allows the protrusion length to be changed in multiple stages.

Japanese Patent Application Publication No. 2016-83270 International Publication No. 2013/168498 JP2013-172842A Japanese Patent Application Publication No. 2000-37455

A treatment instrument such as a clip is attached to the distal end side of the endoscopic treatment instrument, and is inserted into the endoscope while being housed in the outer cylinder. The endoscopic treatment instruments such as those disclosed in Patent Documents 1 to 4 have a problem in that the position of the treatment instrument within the outer cylinder is unclear. If the position of the treatment instrument within the outer tube is not appropriate, the treatment instrument may not be able to protrude from the outer tube when inserted into the body through the treatment tool hole of the endoscope placed inside the body. Otherwise, the outer cylinder may protrude excessively from the treatment instrument hole, which may injure internal tissue.

The present invention has been made in view of the above-mentioned circumstances, and an object thereof is to provide an endoscopic treatment instrument and an operating method thereof that can restrict the position of the treatment instrument within the outer cylinder.

The present inventors have conducted extensive research to solve the above problems, and as a result, have completed the present invention. That is, the gist of the present invention is as follows.
[1] An outer cylinder having a distance direction, an inner cylinder disposed in the inner cavity of the outer cylinder, and an inner cylinder disposed in the inner cavity of the inner cylinder and having a connection part for a treatment instrument at a distal end. The outer cylinder has a small diameter portion where the inner diameter is small in a part of the distance direction, and the inner cylinder has a small diameter part where the inner diameter is small in a part of the distance direction. The outer cylinder has a large diameter part, which is a large part, and the outer cylinder can move in the distance direction with respect to the inner cylinder. An endoscopic treatment instrument characterized by being located proximal to the point with the largest outer diameter.
[2] Preferably, the outer cylinder is not fixed to any other member.
[3] The inner diameter of the small diameter portion is preferably larger than the outer diameter of the inner cylinder disposed inside the small diameter portion and smaller than the outer diameter of the large diameter portion.
[4] Preferably, the small diameter portion is located closer to the center of the outer cylinder in the distance direction, and the larger diameter portion is located closer to the center of the inner cylinder in the distance direction.
[5] It is preferable that the tapered portion is provided at least on one side of the small diameter portion distal to the midpoint in the distance direction and at least one of the large diameter portion proximal to the distance midpoint of the large diameter portion.
[6] It is preferable that the outer diameter of the outer cylinder in the portion where the small diameter portion exists is smaller than the outer diameter of the outer cylinder on the distal side of the small diameter portion.
[7] In the range of motion of the outer cylinder, the distal end of the small diameter portion is preferably located closer to the proximal side than the proximal end of the large diameter portion.
[8] It is preferable that the outer cylinder has a gripping part on the outer surface, and the gripping part is arranged on the proximal side of the midpoint of the outer cylinder in the distance direction.
[9] It is preferable that the gripping portion has a portion that is more convex than the outer surface of the outer cylinder.
[10] It is preferable that the handle is connected to the proximal end of the inner cylinder, and the handle has a receiving part that contacts the proximal end of the outer cylinder.
[11] Preferably, the receiving portion is disposed inside the handle.
[12] It is preferable that the inner tube has a handle connected to the proximal end of the inner tube, and that the inner tube is rotatably attached to the handle about the long axis of the inner tube as a rotation axis.
[13] The handle may be connected to the proximal end of the linear object, and the portion of the handle to which the linear object is connected may be movable in the far and near directions with respect to the handle body. preferable.
[14] In the range of motion of the outer cylinder relative to the inner cylinder, when the outer cylinder is placed at the most distal side in the range of movement relative to the inner cylinder, the distal end of the small diameter portion is placed in a position where it touches the proximal end of the large diameter portion. When the outer cylinder is placed at the most proximal side in the range of motion relative to the inner cylinder, it is preferable that the proximal end of the small diameter portion be placed in contact with the receiving portion.
[15] A method for operating the endoscopic treatment instrument according to any one of [1] to [14], comprising: moving the outer cylinder toward the proximal side; and connecting the treatment instrument to the connecting portion. , a step of moving the outer tube to the distal side and placing the treatment instrument in the inner cavity of the outer tube, a step of inserting the endoscopic treatment instrument into the endoscope and sending the treatment instrument to the target site, It is preferable to include the step of moving the cylinder to the proximal side and exposing the treatment instrument from the outer cylinder.

According to the endoscopic treatment instrument of the present invention, the small diameter portion of the outer tube and the large diameter portion of the inner tube limit the range of motion of the outer tube, which can move in the far and near directions with respect to the inner tube. , the position of the treatment instrument within the barrel can be restricted. Therefore, when inserting a treatment instrument into the body through the treatment instrument hole of an endoscope placed inside the body, the treatment instrument cannot protrude from the outer cylinder inside the body, and the treatment instrument of the endoscope cannot be inserted into the body. It is possible to prevent the outer cylinder from protruding excessively from the hole and damaging internal tissue.

1 is a plan view of the entire endoscopic treatment instrument according to an embodiment of the present invention. FIG. 2 is a schematic cross-sectional view of the endoscopic treatment tool shown in FIG. 1 taken in the far-to-near direction with the outer tube disposed at the most proximal side of the range of motion. FIG. 2 is a schematic cross-sectional view of the endoscopic treatment tool shown in FIG. 1 taken in the far-to-near direction with the outer tube disposed at the most distal side of the range of motion. FIG. 2 is a partially enlarged cross-sectional view of the endoscopic treatment instrument shown in FIG. 1 along the far and near direction. FIG. 7 is a partially enlarged cross-sectional view of an endoscopic treatment instrument in another embodiment of the present invention along the far-near direction. FIG. 3 is a schematic cross-sectional view of an endoscopic treatment tool in another embodiment of the present invention taken in a near-far direction. FIG. 4 is a schematic cross-sectional view of an endoscopic treatment instrument in another embodiment of the present invention taken in a near-far direction.

Hereinafter, the present invention will be explained in more detail based on the following embodiments. However, the present invention is not limited by the following embodiments, and modifications may be made as appropriate within the scope that fits the spirit of the above and below. Of course, additional implementations are also possible, and all of these are included within the technical scope of the present invention. In addition, in each drawing, hatching, member codes, etc. may be omitted for convenience, but in such cases, the specification and other drawings shall be referred to. Further, the dimensions of various members in the drawings are given priority to help understanding the features of the present invention, and therefore may differ from actual dimensions.

FIG. 1 is a plan view of the entire endoscopic treatment instrument according to an embodiment of the present invention, and FIGS. 2, 3, 6, and 7 are schematic cross-sectional views of the endoscopic treatment instrument along the far and near directions. 4 and 5 are partially enlarged cross-sectional views of the endoscopic treatment tool along the far and near direction.

As shown in FIGS. 1 to 3, the endoscopic treatment instrument 1 of the present invention includes an outer cylinder 10 having a near-far direction, an inner cylinder 20 disposed in the inner cavity of the outer cylinder 10, and an inner cylinder 20 disposed in the inner cavity of the outer cylinder 10. A linear object 30 is disposed in the inner cavity and has a connection part 31 with a treatment instrument at its distal end. The outer cylinder 10 has a small diameter portion 11 having a small inner diameter in a part of the distance direction, and the inner cylinder 20 has a large diameter part 21 having a large outer diameter in a part of the distance direction. have.

In the present invention, the proximal side refers to the user's proximal side with respect to the extending direction of the outer cylinder 10 and the inner cylinder 20, and the distal side refers to the side opposite to the proximal side, that is, the side to be treated. Further, the extending direction of the outer cylinder 10 and the inner cylinder 20 is referred to as a perspective direction. The radial direction refers to the radial direction of the outer cylinder 10 and the inner cylinder 20, and the inner direction in the radial direction refers to the direction toward the axial center of the outer cylinder 10 and the inner cylinder 20, and the outer direction in the radial direction refers to the inner direction. and points in the opposite direction. Note that in FIGS. 1 to 7, the right side of the figure is the proximal side, and the left side of the figure is the distal side.

The endoscopic treatment instrument 1 connects a treatment instrument to a connection portion 31 for treatment instruments in treatments using an endoscope such as ESD and EMR. The treatment instruments are used for excision of a lesion, hemostasis, suturing of a lesion, collection of internal tissue, injection of a medicinal solution into internal tissue, and the like. Specific examples of treatment instruments include clips for stopping bleeding and suturing lesions, local injection needles for injecting medicinal solutions into body tissues, forceps for collecting body tissues, and snares and knives for removing lesions. can be mentioned.

The outer cylinder 10 is movable in the distance direction with respect to the inner cylinder 20. That is, the outer cylinder 10 can be moved relative to the entire endoscopic treatment instrument 1, and the positional relationship between the outer cylinder 10 and the inner cylinder 20 can be changed. For example, it may be possible to move the outer cylinder 10 in the distance direction without moving the inner cylinder 20, or it may be possible to move the inner cylinder 20 in the distance direction without moving the outer cylinder 10. good.

As shown in FIG. 2, in the endoscopic treatment instrument 1 of the present invention, in the range of motion of the outer cylinder 10, the part with the smallest inner diameter of the small diameter part 11 of the outer cylinder 10 is the same as that of the large diameter part 21 of the inner cylinder 20. It is characterized by being located on the proximal side of the point with the largest outer diameter. In the endoscopic treatment instrument 1, the part with the smallest inner diameter of the small diameter part 11 of the outer cylinder 10 is located on the proximal side of the part with the largest outer diameter of the large diameter part 21 of the inner cylinder 20. The range of motion of the outer tube 10 in the far and near direction with respect to the treatment instrument 1 can be controlled, and the position of the connection part 31 with the treatment instrument within the outer tube 10 can be restricted. As a result, when the treatment instrument is inserted into the body through the treatment instrument hole of the endoscope placed inside the body, the treatment instrument cannot protrude from the outer tube 10 inside the body, and the endoscope cannot be inserted into the body. It is possible to prevent the outer tube 10 from protruding excessively from the treatment instrument hole and damaging the internal tissue. The range of motion of the outer cylinder 10 is such that one end of the range of motion is the contact area between the large diameter part 21 and the small diameter part 11, and the other end of the range of movement is the contact area between the proximal end of the outer cylinder 10 and the handle 50. determined by something.

The outer cylinder 10 has a perspective direction, and has a lumen extending in the perspective direction. Further, an inner cylinder 20 is arranged in the inner cavity of the outer cylinder 10. Furthermore, the outer tube 10 can have a connecting portion 31 disposed in the inner cavity. Since the connecting portion 31 can be placed in the inner cavity of the outer tube 10, at least a portion of the treatment instrument connected to the connecting portion 31 can be placed inside the outer tube 10. Therefore, the outer tube 10 is preferably not fixed to any other member, so that the treatment instrument can be transported from the forceps port of the endoscope to the vicinity of the treatment target site through the forceps channel. It is possible to prevent damage to the forceps opening in the endoscope, the forceps channel, and body tissues other than the treatment target area.

The inner cylinder 20 has a perspective direction, and has a lumen extending in the perspective direction. A linear object 30 is disposed in the inner cavity of the inner cylinder 20, and it is preferable that the linear object 30 is movable in the directions of distance and distance with respect to the inner cylinder 20. Since the linear object 30 is movable in the distance direction with respect to the inner tube 20, the treatment instrument connected to the connecting portion 31 can be easily operated. Specifically, when the treatment instrument is a clip, by moving the linear object 30 in the distance direction with respect to the inner cylinder 20, the clip can be opened and closed, and the degree of opening and closing of the clip can be adjusted. When the treatment instrument is forceps, by moving the linear object 30 in the distance direction with respect to the inner cylinder 20, it is possible to open and close the forceps cup and adjust the degree of opening and closing of the forceps cup, similarly to a clip. . When the treatment instrument is a snare, the size and degree of expansion of the annular portion of the snare can be adjusted by moving the linear object 30 in the distance direction with respect to the inner cylinder 20.

The outer cylinder 10 and the inner cylinder 20 are, for example, coil-shaped cylinders in which metal wire or plate material is spirally wound, or a plurality of short cylindrical joint pieces made of metal or synthetic resin that are connected in the axial direction. It can include a cylindrical body made rotatable by a cylindrical body, a cylindrical body made of synthetic resin, and the like.

Examples of the metal that constitutes the outer cylinder 10 and the inner cylinder 20 include stainless steel such as SUS304 and SUS316, platinum, nickel, cobalt, chromium, titanium, tungsten, gold, Ni-Ti alloy, Co-Cr alloy, or these. A combination of these can be mentioned. The metal constituting the outer cylinder 10 and the inner cylinder 20 is preferably a Ni--Ti alloy. Since the metal constituting the outer cylinder 10 and the inner cylinder 20 is a Ni-Ti alloy, the outer cylinder 10 and the inner cylinder 20 can have excellent shape memory and high elasticity.

Examples of the resin constituting the outer cylinder 10 and the inner cylinder 20 include polyamide resins such as nylon, polyolefin resins such as polyethylene and polypropylene, polyester resins such as polyethylene terephthalate (PET), and polyether ether ketone (PEEK). aromatic polyetherketone resins, polyimide resins, polytetrafluoroethylene (PTFE), tetrafluoroethylene-perfluoroalkyl vinyl ether copolymers (PFA), ethylene-tetrafluoroethylene copolymers (ETFE), etc. Examples include synthetic resins such as fluororesins.

The material constituting the outer cylinder 10 is preferably, for example, a fluororesin, and more preferably PTFE. Since the material constituting the outer cylinder 10 is a fluororesin, the slidability with the inner cylinder 20 disposed in the inner cavity of the outer cylinder 10 is increased, and the movement of the outer cylinder 10 in the distance direction with respect to the inner cylinder 20 is improved. becomes easier to do. Further, it is preferable that the material forming the inner cylinder 20 is different from the material forming the outer cylinder 10. For example, when the material forming the outer cylinder 10 is a fluororesin, the material forming the inner cylinder 20 is different from the material forming the outer cylinder 10. The material is preferably a polyolefin resin, more preferably polyethylene. Since the material constituting the inner tube 20 is different from the material constituting the outer tube 10, the slidability with the outer tube 10 can be improved, and the movement of the outer tube 10 and the inner tube 20 in the distance direction can be improved. becomes easier.

The material constituting the outer cylinder 10 is preferably transparent or translucent. Since the material constituting the outer cylinder 10 is transparent or semi-transparent, the positional relationship between the inner cylinder 20 and the outer cylinder 10 arranged in the inner cavity of the outer cylinder 10 can be visually confirmed, and the inner The operability of the endoscopic treatment instrument 1 can be improved.

The inner cylinder 20 may be a metal coiled cylinder. Since the inner cylinder 20 is a coiled metal cylinder, the inner cylinder 20 can have a good balance between rigidity and flexibility, and the endoscopic treatment tool 1 can be used as a forceps opening of an endoscope. It becomes easier to insert the tube from the tube to the treatment target site, and it also becomes easier to move the outer tube 10 and the inner tube 20 in the distance direction, and to move the inner tube 20 and the linear object 30 in the distance direction.

The lengths of the outer tube 10 and the inner tube 20 in the far and near directions are determined by considering the distance from the forceps opening of the endoscope to the treatment target site, etc. An appropriate length can be selected depending on the size. The lengths of the outer tube 10 and the inner tube 20 in the far and near directions can be, for example, 1000 mm or more and 3000 mm or less.

The length of the inner tube 20 in the distance direction is preferably longer than the length of the outer tube 10 in the distance direction. Since the length of the inner tube 20 in the distance direction is longer than the length of the outer tube 10 in the distance direction, it becomes easier to move the outer tube 10 in the distance direction with respect to the inner tube 20, and the outer tube 10 is not excessively protruded in the body. This can prevent damage to body tissues other than the treatment target site. The length of the inner tube 20 in the distance direction is preferably 1.2 times or less, more preferably 1.1 times or less, and 1.05 times the length of the outer tube 10 in the distance direction. It is more preferable that it is the following. By setting the upper limit of the ratio of the length of the inner cylinder 20 in the distance direction and the length of the outer cylinder 10 in the distance direction in the above range, the inner cylinder 20 and the connecting portion 31 can be sufficiently fitted into the inner cavity of the outer cylinder 10. can be accommodated in As a result, it is possible to make it difficult for the treatment instrument to damage the forceps opening in the endoscope, the inside of the forceps channel, and body tissues other than the treatment target site until the treatment instrument is transported to the treatment target site.

The sizes of the outer tube 10 and the inner tube 20 can be appropriately selected depending on the size of the forceps hole of the endoscope, the connecting portion 31, and the sizes of other members of the endoscopic treatment instrument 1. For example, the thickness of the outer tube 10 and the inner tube 20 is preferably 100 μm or more, more preferably 150 μm or more, and even more preferably 200 μm or more. By setting the lower limit of the thickness of the outer cylinder 10 and the inner cylinder 20 within the above range, the rigidity of the outer cylinder 10 and the inner cylinder 20 can be made appropriate, and the distance of the outer cylinder 10 with respect to the inner cylinder 20 can be adjusted. It becomes easier to move in the direction. Further, the thickness of the outer tube 10 and the inner tube 20 is preferably 500 μm or less, more preferably 400 μm or less, and even more preferably 300 μm or less. By setting the upper limit of the thickness of the outer tube 10 and the inner tube 20 within the above range, the flexibility of the outer tube 10 and the inner tube 20 can be increased, allowing for easy access from the forceps port of the endoscope to the treatment target area. It becomes easy to send the endoscopic treatment instrument 1.

The outer cylinder 10 has a small diameter portion 11 having a small inner diameter in a partial section in the distance direction. That is, the inner diameter of the small diameter portion 11 is smaller than the inner diameter of the portion of the outer cylinder 10 that is not the small diameter portion 11 . Since the outer cylinder 10 has the small diameter part 11 and the inner cylinder 20 has the large diameter part 21, when the outer cylinder 10 is moved distally with respect to the inner cylinder 20, the small diameter part 11 and the large diameter part 21, the range of movement of the outer tube 10 toward the distal side can be restricted. The outer diameter of the section of the outer cylinder 10 where the small diameter section 11 is provided may be the same as or different from the section where the small diameter section 11 is not provided.

As a method for forming the small diameter portion 11 in the outer cylinder 10, for example, a cylindrical member is inserted into the inner cavity of the outer cylinder 10 at an arbitrary location of the outer cylinder 10, and the outer cylinder 10 and the cylinder are bonded together using an adhesive or the like. The outer cylinder 10 is made of heat-shrinkable resin, and the diameter of the outer cylinder 10 is reduced by applying heat to any part of the outer cylinder 10. The cylindrical member is placed over any part of the outer cylinder 10. Examples of methods include reducing the diameter of the outer cylinder 10 by caulking or the like. Among these, it is preferable to form the small diameter portion 11 by heating the outer cylinder 10 to reduce its diameter. By forming the small diameter portion 11 by heating and reducing the diameter of the outer cylinder 10, it is possible to easily form the small diameter portion 11 in the outer cylinder 10, which improves the production efficiency of the endoscopic treatment instrument 1. increases.

The inner cylinder 20 has a large-diameter portion 21 having a large outer diameter in a partial section in the near-far direction. That is, the outer diameter of the large diameter portion 21 is larger than the outer diameter of the portion of the inner cylinder 20 that is not the large diameter portion 21 . As mentioned above, when the outer cylinder 10 having the small diameter part 11 is moved distally with respect to the inner cylinder 20 having the large diameter part 21, the small diameter part 11 and the large diameter part 21 come into contact with each other. The range of movement of the outer cylinder 10 toward the distal side can be restricted.

As a method for forming the large diameter portion 21 in the inner cylinder 20, for example, a cylindrical member is placed on an arbitrary location of the inner cylinder 20, and the inner cylinder 20 and the cylindrical member are fixed using an adhesive or the like. Insert the inner cylinder 20 into the inner cavity of the cylindrical member, caulk the cylindrical member, etc. to bring the inner cylinder 20 and the cylindrical member into close contact, cover the inner cylinder 20 with a heat shrink tube and heat it to heat shrink the inner cylinder 20. Examples include methods such as bringing tubes into close contact with each other. Among these, it is preferable to form the large diameter portion 21 by covering the inner cylinder 20 with a cylindrical member and fixing the inner cylinder 20 and the cylindrical member using an adhesive or the like. By forming the large diameter portion 21 by covering the inner tube 20 with a cylindrical member and fixing the inner tube 20 and the cylindrical member, the large diameter portion 21 can be easily formed, and the endoscope treatment instrument 1 can be easily formed. Production efficiency can be increased.

The linear object 30 has a far-to-near direction, and has a connecting portion 31 at its distal end. The linear object 30 may have a cylindrical shape with a lumen extending in the far and near directions, but is preferably solid. Since the linear object 30 is solid, the rigidity can be increased without excessively increasing the outer diameter of the linear object 30, and the outer diameter of the endoscopic treatment instrument 1 can be reduced and the endoscope The insertability of the treatment instrument 1 can be improved.

The materials constituting the linear object 30 include metal wires such as stainless steel and carbon steel, polyamide resins such as nylon, polyolefin resins such as PP and PE, polyester resins such as PET, and aromatic polyester resins such as PEEK. Examples include synthetic resin fibers such as ether ketone resins, polyimide resins, and fluororesins such as PTFE, PFA, and ETFE. Among these, the material constituting the linear object 30 is preferably a stainless steel wire. Since the material constituting the linear object 30 is a stainless steel wire, biocompatibility can be improved while providing the necessary strength.

Although not shown, the linear object 30 may have a coating layer on the surface thereof. Since the linear object 30 has a coating layer, it is possible to reduce the friction between the linear object 30 and the inner cylinder 20 to improve sliding properties, and to increase the strength of the linear object 30. It becomes possible. Examples of the coating layer include fluororesins such as PTFE, PFA, ETFE, and tetrafluoroethylene/hexafluoropropylene copolymer (FEP).

As a method for forming the coating layer on the linear object 30, for example, the material for forming the coating layer may be coated on the linear object 30, such as a dipping method, a spray method, a fluidized bed method, a kneader coater method, etc. Can be used.

Similar to the lengths of the outer tube 10 and the inner tube 20, the length of the linear object 30 in the distance direction is determined by taking into consideration the distance from the forceps opening of the endoscope to the treatment target site. An appropriate length can be selected depending on the length of the inner cylinder 20 in the far and near directions. The length of the linear object 30 in the far and near directions can be, for example, 1000 mm or more and 3000 mm or less.

The length of the linear object 30 in the distance direction is preferably longer than both the length of the outer tube 10 in the distance direction and the length of the inner tube 20 in the distance direction. Since the length of the linear object 30 in the distance direction is longer than both the length of the outer tube 10 in the distance direction and the length of the inner tube 20 in the distance direction, movement of the outer tube 10 in the distance direction with respect to the inner tube 20 is prevented. It is easier to perform the treatment, and it is possible to prevent the outer cylinder 10 from protruding excessively inside the body and damaging body tissues other than the treatment target area. Note that the length of the linear object 30 in the perspective direction can be set according to the range of motion of the slider 52, and is preferably 1.15 times or less the length of the inner tube 20 in the perspective direction, for example. It is more preferably 1.1 times or less, and even more preferably 1.05 times or less. By setting the upper limit of the ratio of the length of the linear object 30 in the distance direction and the length of the inner cylinder 20 in the distance direction, the linear object 30 can be easily moved in the distance direction, and the connecting portion 31 It becomes easy to operate the treatment instrument connected to the

The outer diameter of the linear object 30 is preferably 100 μm or more, more preferably 200 μm or more, and even more preferably 300 μm or more. By setting the lower limit of the outer diameter of the linear object 30 within the above range, the rigidity of the linear object 30 can be increased, and the insertability of the endoscopic treatment instrument 1 can be improved. The outer diameter of the linear object 30 is preferably 0.8 times or less, more preferably 0.5 times or less, and preferably 0.15 times or more the inner diameter of the inner cylinder 20. , more preferably 0.3 times or more. In other words, the outer diameter of the linear object 30 is preferably within the range of 0.8 to 0.15 times the inner diameter of the inner cylinder 20, and preferably within the range of 0.5 to 0.3 times. is more preferable. By setting the upper limit of the outer diameter of the linear object 30 within the above range, the outer diameter of the linear object 30 can be reduced while maintaining its rigidity, and the endoscopic treatment instrument 1 can be made smaller in diameter. Can be done. The outer diameter of the linear object 30 may be the same or different over its entire length. For example, a portion of the linear object 30 disposed inside the handle 50 or a proximal portion thereof can be made thicker for reinforcement. A tube can be placed on the outer surface of the linear object 30 as a reinforcing member.

The connecting portion 31 is provided at the distal end of the linear object 30. The connecting portion 31 is a part for connecting a treatment instrument to the endoscopic treatment instrument 1. The connecting portion 31 may be a part of the linear object 30 or may be a separate component for connecting a treatment instrument to the distal end of the linear object 30. Since the connecting portion 31 is provided at the distal end of the linear object 30, it becomes easy to connect the treatment instrument to the linear object 30 and to remove the treatment instrument from the linear object 30, thereby facilitating endoscopic treatment. Treatment using tool 1 is easy to perform, and treatment time can also be shortened.

When the connecting portion 31 is a separate member from the linear object 30 disposed at the distal end of the linear object 30, a material constituting the separate component for connecting the treatment instrument, which is the connecting portion 31. Examples include metals such as stainless steel and carbon steel, polyamide resins such as nylon, polyolefin resins such as PP and PE, polyester resins such as PET, aromatic polyetherketone resins such as PEEK, and polyimide resins. Examples include synthetic resins such as resins and fluororesins such as PTFE, PFA, and ETFE. Among these, it is preferable that the material configuring the separate component for connecting the treatment instrument is the same as the material configuring the linear object 30. When the connecting portion 31 is a separate member from the linear object 30, the material of the connecting portion 31 and the material constituting the linear object 30 are the same, so that the connection between the connecting portion 31 and the linear object 30 is strengthened. can be taken as a thing. Therefore, the connecting portion 31 can be made difficult to come off from the linear object 30, and the durability of the endoscopic treatment instrument 1 can be increased.

When the connecting portion 31 is a separate component from the linear object 30 disposed at the distal end of the linear object 30, the method for fixing the separate component for connecting the treatment instrument to the linear object 30 is as follows. For example, mechanical fixation using connecting members such as screws, caulking, fitting, press-fitting, welding using laser or heat, bonding using adhesive or tape, etc. can be used. Among these, it is preferable that the connecting portion 31, which is a separate component for connecting a treatment instrument, is fixed to the linear object 30 by welding. Since a separate part for connecting the treatment instrument is fixed to the linear object 30 by welding, the bonding strength between the connecting part 31 and the linear object 30 can be easily increased, and the endoscopic treatment instrument 1 can reduce the possibility of damage.

The outer diameter of the connecting portion 31 is preferably smaller than the inner diameter of the inner cylinder 20. That is, it is preferable that the connecting part 31 can be arranged in the inner cavity of the inner cylinder 20. Since the outer diameter of the connecting part 31 is smaller than the inner diameter of the inner cylinder 20, the connecting part 31 is inserted into the inner cavity of the inner cylinder 20 when the endoscopic treatment instrument 1 is sent from the forceps port of the endoscope to the treatment target site. can be stored in. As a result, the connecting part 31 is housed in the inner cavity of the outer cylinder 10, and the connecting part 31 and the treatment instrument are prevented from damaging the forceps opening in the endoscope, the forceps channel, and body tissues other than the treatment target area. can. In order to arrange the treatment instrument within the outer cylinder 10, the outer diameter of the connecting portion 31 is preferably smaller than the inner diameter of the outer cylinder 10.

As shown in FIGS. 4 and 5, the inner diameter of the small diameter part 11 of the outer cylinder 10 is larger than the outer diameter of the inner cylinder 20 disposed inside the small diameter part 11, and the large diameter part 21 of the inner cylinder 20 It is preferable that the diameter is smaller than the outer diameter of. In the endoscopic treatment instrument 1, the inner diameter of the small diameter part 11 of the outer cylinder 10 is larger than the outer diameter of the inner cylinder 20 disposed inside the small diameter part 11, and the outer diameter of the large diameter part 21 of the inner cylinder 20 is By being smaller than the diameter, it is possible to prevent the outer cylinder 10 from moving excessively to the distal side without hindering the movement of the outer cylinder 10 in the distance direction with respect to the inner cylinder 20. Therefore, the position of the treatment instrument within the outer tube 10 is restricted to an appropriate position, and the treatment instrument cannot be made to protrude from the outer tube 10 inside the body, and the outer tube 10 may not be allowed to protrude excessively from the endoscope. It can prevent damage to body tissues.

The inner diameter of the small diameter portion 11 of the outer cylinder 10 is preferably 1.05 times or more, more preferably 1.1 times or more, the outer diameter of the inner cylinder 20 disposed inside the small diameter portion 11. It is preferably 1.2 times or more, and more preferably 1.2 times or more. By setting the lower limit of the ratio of the inner diameter of the small diameter portion 11 to the outer diameter of the inner tube 20 disposed inside the small diameter portion 11 within the above range, the distance direction of the outer tube 10 with respect to the inner tube 20 can be adjusted. can be moved smoothly, and treatment using the endoscopic treatment instrument 1 can be performed easily. Further, the inner diameter of the small diameter portion 11 is preferably 1.2 times or less, more preferably 1.1 times or less, the outer diameter of the inner cylinder 20 disposed inside the small diameter portion 11. More preferably, it is 1.05 times or less. By setting the upper limit of the ratio of the inner diameter of the small diameter portion 11 to the outer diameter of the inner tube 20 disposed inside the small diameter portion 11 within the above range, the outer diameter of the outer tube 10 can be prevented from becoming excessively large. This allows the endoscopic treatment instrument 1 to have good insertability.

The inner diameter of the small diameter portion 11 is preferably 0.9 times or less, more preferably 0.85 times or less, and even more preferably 0.8 times or less than the outer diameter of the large diameter portion 21. By setting the upper limit of the ratio of the inner diameter of the small diameter portion 11 to the outer diameter of the large diameter portion 21 within the above range, the small diameter portion 11 of the outer tube 10 can be distally beyond the large diameter portion 21 of the inner tube 20. It is possible to prevent the outer cylinder 10 from moving to the side, and to prevent the outer cylinder 10 from protruding too much inside the body, thereby preventing damage to body tissues and the like. Further, the inner diameter of the small diameter portion 11 is preferably 0.5 times or more, more preferably 0.6 times or more, and still more preferably 0.7 times or more the outer diameter of the large diameter portion 21. preferable. By setting the lower limit of the ratio of the inner diameter of the small diameter portion 11 to the outer diameter of the large diameter portion 21 within the above range, the small diameter portion 11 of the outer cylinder 10 has sufficient flexibility, and the endoscopic treatment instrument Even if the transport path is curved when transporting the outer cylinder 10 to the vicinity of the treatment target site, the outer cylinder 10 can be smoothly moved in the distance direction with respect to the inner cylinder 20.

The small diameter portion 11 may be provided at any location in the distance direction of the outer tube 10, but is preferably located closer to the midpoint of the outer tube 10 in the distance direction. Since the small diameter portion 11 is located on the proximal side of the midpoint of the outer tube 10 in the distance direction, it becomes easy to form the small diameter portion 11 in the outer tube 10, making it easier to manufacture the endoscopic treatment instrument 1. . Further, it becomes easy to form a taper portion 12 of the small diameter portion 11, which will be described later, in the small diameter portion 11.

The small diameter portion 11 is preferably located on the proximal side of the midpoint of the outer cylinder 10 in the distance direction, but is located closer than the midpoint between the midpoint of the outer cylinder 10 in the distance direction and the proximal end of the outer cylinder 10. It is more preferable that it be on the proximal end of the outer cylinder 10, and even more preferable that it be on the proximal end of the outer cylinder 10. By locating the small diameter portion 11 on the proximal side of the midpoint between the distance direction midpoint of the outer tube 10 and the proximal end of the outer tube 10, forming the small diameter portion 11 on the outer tube 10 is made easier. Therefore, the manufacturing efficiency of the endoscopic treatment instrument 1 can be improved.

The large diameter portion 21 may be provided at any location in the distance direction of the inner tube 20, but is preferably located closer to the midpoint of the inner tube 20 in the distance direction. By locating the large diameter part 21 on the proximal side of the midpoint of the inner cylinder 20 in the far-to-near direction, the large diameter part 21 can be easily formed in the inner cylinder 20, and the endoscopic treatment instrument 1 can be manufactured easily. Can be done. It also has the effect of making it easier to form the taper portion 22 of the large diameter portion 21, which will be described later.

The large diameter portion 21 is preferably located closer to the midpoint of the inner cylinder 20 in the distance direction, but is closer to the midpoint between the midpoint of the inner cylinder 20 in the distance direction and the proximal end of the inner cylinder 20. More preferably, it is on the proximal side. Since the large diameter portion 21 is located on the proximal side of the midpoint between the distance direction midpoint of the inner cylinder 20 and the proximal end of the inner cylinder 20, it is easy to form the large diameter portion 21 in the inner cylinder 20. Therefore, it becomes possible to increase the efficiency in manufacturing the endoscopic treatment instrument 1.

As shown in FIGS. 5 and 6, at least one of the distal side of the small-diameter portion 11 of the outer cylinder 10 from the midpoint P1 in the far-to-near direction, and the proximal side of the large-diameter portion 21 from the midpoint P2 of the large-diameter portion 21 in the far-to-near direction. It is preferable that the tapered portions 12 and 22 be provided. The endoscopic treatment instrument 1 has a tapered portion 12 on at least one of the side distal to the midpoint P1 of the small diameter portion 11 of the outer tube 10 in the far and near directions and the side proximal to the midpoint P2 of the large diameter portion 21 in the far and near directions. , 22, when the outer cylinder 10 is moved in the distance direction with respect to the inner cylinder 20 and the small diameter part 11 and the large diameter part 21 come into contact, the small diameter part 11 and the large diameter part 21 are It can prevent damage. For example, it is preferable that the tapered portion 12 provided on the distal side of the small diameter portion 11 of the outer cylinder 10 is a taper such that the inner diameter of the outer cylinder 10 increases toward the distal side. In this case, the inner diameter of the distal end of the tapered portion 12 may be the same size as the inner diameter of the outer cylinder 10 in which the tapered portion 12 and the small diameter portion 11 are not provided, or may be different. The range of motion of the outer cylinder 10 may be determined by the end of the large diameter part 21 of the inner cylinder 20 coming into contact with the middle part of the tapered part 12.

As shown in FIGS. 5 and 6, the small diameter part 11 has a tapered part 12 distal to the midpoint P1 of the small diameter part 11 in the far-to-near direction, and the outer cylinder 10 has a movable range with respect to the inner cylinder 20. It is preferable that the surface of the tapered portion 12 of the small diameter portion 11 be in contact with the surface of the large diameter portion 21 of the inner cylinder 20 when disposed at the most distal side. Further, the large diameter portion 21 has a tapered portion 22 on the proximal side of the midpoint P2 of the large diameter portion 21 in the far-to-near direction. When arranged, it is preferable that the surface of the tapered portion 22 of the large diameter portion 21 be in contact with the surface of the small diameter portion 11 of the outer cylinder 10 . In the endoscopic treatment instrument 1, when the outer cylinder 10 is disposed at the most distal side in the range of motion relative to the inner cylinder 20, the surface of the tapered part 12 of the small diameter part 11 comes into contact with the surface of the large diameter part 21 of the inner cylinder 20, By the surface of the tapered portion 22 of the large diameter portion 21 coming into contact with the surface of the small diameter portion 11 of the outer tube 10, the outer tube 10 and the inner tube 20 are fixed to each other, and the distal end 10a of the outer tube 10 is moved too far. It is possible to more effectively prevent movement toward the position side.

It is preferable to have tapered portions 12, 22 on at least one side distal to the midpoint P1 of the small diameter portion 11 in the distance direction and proximal to the midpoint P2 of the large diameter portion 21 in the distance direction. However, the tapered portions 12 and 22 may be provided both on the distal side of the small diameter portion 11 from the midpoint P1 in the far-to-near direction and on the proximal side from the midpoint P2 in the far-to-near direction of the large diameter portion 21. More preferred. That is, the tapered part 12 is distal to the midpoint P1 of the small diameter part 11 in the far-to-near direction, and the tapered part 22 is provided to the proximal side of the midpoint P2 of the large-diameter part 21 in the far-to-near direction. It is more preferable that In the endoscopic treatment instrument 1, tapered portions 12, 22 are provided both on the distal side of the small diameter portion 11 from the midpoint P1 in the far and near directions and on the proximal side of the large diameter portion 21 from the midpoint P2 in the far and near directions. By having this, when the outer cylinder 10 is placed at the most distal side in its range of motion, the tapered part 12 of the small diameter part 11 and the tapered part 22 of the large diameter part 21 come into contact with each other, so that the outer cylinder 10 and the inner tube 20 can be more firmly fixed, and excessive movement of the distal end 10a of the outer tube 10 toward the distal side can be further prevented.

When the outer tube 10 is transparent or translucent, the small diameter portion 11 is preferably colored and is preferably visible from the outside of the outer tube 10. That is, the color of the small diameter portion 11 is preferably different from the color of the outer cylinder 10. The expression that the colors are different from each other means that the color of the small diameter portion 11 and the color of the outer tube 10 are different in at least one of hue, lightness, and saturation defined in JIS Z8721. Since the small diameter portion 11 is visible from the outside of the outer cylinder 10, the range of motion of the outer cylinder 10 can be visually confirmed.

It is preferable that the outer cylinder 10 is not fixed to other members. Since the outer cylinder 10 is not fixed to other members, when performing a treatment using the endoscopic treatment instrument 1, it is difficult to store the treatment instrument in the endoscopic treatment instrument 1 or to prevent the endoscopic treatment instrument 1 from being stored in the endoscopic treatment instrument 1. To improve the operability of the endoscopic treatment instrument 1, since the exposure from the endoscope treatment instrument 1 is performed by moving the outer cylinder 10 disposed on the outermost surface in the radial direction of the endoscopic treatment instrument 1 in the distance direction. Can be done.

When the outer cylinder 10 is not fixed to another member, it is preferable that the inner cylinder 20 is fixed to another member. Examples of the member for fixing the inner tube 20 include the handle 50 of the endoscopic treatment instrument 1, as shown in FIGS. 1 to 3. In the endoscopic treatment instrument 1, the outer tube 10 is not fixed to other members, and the inner tube 20 is fixed to other members, so that the outer tube 10 cannot be moved in the distance direction with respect to the inner tube 20. It is easy to carry out, and it becomes easy to store and expose the treatment instrument in the endoscopic treatment instrument 1. Note that details of the handle 50 will be described later.

As shown in FIG. 5, it is preferable that the outer diameter of the outer tube 10 in the portion where the small diameter portion 11 is present is smaller than the outer diameter of the outer tube 10 on the distal side of the small diameter portion 11. . In the outer diameter of the outer tube 10 in the portion where the small diameter portion 11 exists, there is a portion smaller than the outer diameter of the outer tube 10 on the distal side of the small diameter portion 11. It becomes easier to draw the endoscopic treatment instrument 1 into the lumen of another object, and it is possible to prevent the length of the endoscopic treatment instrument 1 from becoming excessively long in the far and near directions.

It is more preferable that the entire outer diameter of the outer tube 10 in the portion where the small diameter portion 11 is present is smaller than the outer diameter of the outer tube 10 on the distal side of the small diameter portion 11. Furthermore, the outer diameter of the outer tube 10 from the portion where the small diameter portion 11 exists to the proximal end of the outer tube 10 is smaller than the outer diameter of the outer tube 10 distal to the small diameter portion 11. preferable. Since the outer diameter of the entire outer tube 10 in the portion where the small diameter portion 11 exists is smaller than the outer diameter of the outer tube 10 on the distal side of the small diameter portion 11, the proximal end of the outer tube 10 The outer diameter can be reduced, making it easier to draw the outer cylinder 10 into another object such as the handle 50.

As shown in FIGS. 2, 3, and 7, in the range of motion of the outer cylinder 10, the distal end 11a of the small diameter portion 11 is preferably located closer to the proximal end 21b of the large diameter portion 21. . In the movable range of the outer cylinder 10, the distal end 11a of the small diameter part 11 is located closer to the proximal side than the proximal end 21b of the large diameter part 21, so that the small diameter part 11 of the outer cylinder 10 is closer to the large diameter of the inner cylinder 20. It can be made difficult to move beyond the portion 21 to the distal side, and the range of movement of the outer cylinder 10 in the far and near directions can be further restricted.

As shown in FIGS. 1 and 7, the outer tube 10 preferably has a grip portion 40 on the outer surface. Since the outer tube 10 has the grip portion 40 on the outer surface, it becomes easy to sufficiently grip the outer tube 10 when moving the outer tube 10 in the distance direction relative to the inner tube 20, and the endoscope It becomes possible to improve the operability of the treatment instrument 1.

It is preferable that the grip portion 40 is disposed closer to the proximal side than the midpoint of the outer cylinder 10 in the far and near directions. By arranging the gripping part 40 on the proximal side of the midpoint of the outer cylinder 10 in the distance direction, the outer cylinder 10 can be gripped more easily, and the connecting part 31 and the treatment instrument can be inserted into the inner cavity of the outer cylinder 10. This makes it easier to store the image.

The material constituting the grip portion 40 is, for example, synthetic resin such as polyamide resin, polyolefin resin, polyester resin, aromatic polyether ketone resin, polyimide resin, or fluorine resin, stainless steel, carbon steel, etc. Examples include metals. It is preferable that the material constituting the grip portion 40 is the same material as the material constituting the outer cylinder 10. Since the material constituting the gripping part 40 is the same material as the material constituting the outer cylinder 10, it becomes easy to firmly fix the gripping part 40 to the outer cylinder 10, and the gripping part 40 can be prevented from coming off from the outer cylinder 10.

It is preferable that the color of the grip portion 40 is different from the color of the outer cylinder 10. The expression that the colors are different from each other means that the color of the grip portion 40 and the color of the outer tube 10 are different in at least one of hue, lightness, and saturation defined in JIS Z8721. Since the color of the gripping part 40 is different from the color of the outer tube 10, the visibility of the gripping part 40 is increased, and the endoscopic treatment instrument 1 can be easily operated. Moreover, when the outer cylinder 10 is transparent or semitransparent, it is preferable that the grip part 40 is opaque. Since the grip portion 40 is opaque, the visibility of the grip portion 40 can be further improved. The color of the grip portion 40 may be, for example, opaque black.

Examples of methods for fixing the grip part 40 to the outer cylinder 10 include bonding with adhesive, fixation by heat welding, mechanical fixation by fitting, press-fitting, caulking, etc. of the grip part 40 to the outer cylinder 10, etc. . Among the methods for fixing the grip portion 40 to the outer tube 10, fixing using an adhesive is preferred. Since the gripping part 40 is fixed to the outer cylinder 10 using adhesive, the gripping part 40 can be easily and firmly fixed to the outer cylinder 10.

It is preferable that the grip portion 40 has a portion that is more convex than the outer surface of the outer cylinder 10. Since the grip portion 40 has a portion that is more convex than the outer surface of the outer cylinder 10, the grip portion 40 can be easily gripped when the outer cylinder 10 is moved in the distance direction with respect to the inner cylinder 20. The outer cylinder 10 can be easily moved in the far and near directions.

Although the number of gripping parts 40 may be one, it is preferable that there is a plurality of gripping parts 40. By having a plurality of gripping parts 40, it becomes easier to grip the outer cylinder 10. The number of gripping parts 40 is preferably five or less, more preferably three or less, and even more preferably two.

It is preferable that the endoscopic treatment instrument 1 has a handle 50 connected to the proximal end of the inner cylinder 20. The handle 50 is a member that is held by the user when operating the endoscopic treatment instrument 1. Since the endoscopic treatment instrument 1 has the handle 50, the operation of the endoscopic treatment instrument 1 becomes easy.

Preferably, the handle 50 has a receiving portion 51 that contacts the proximal end of the barrel 10. Since the handle 50 has the receiving portion 51 that contacts the proximal end of the outer cylinder 10, the outer cylinder 10 does not move excessively to the proximal side when the outer cylinder 10 moves in the distance direction with respect to the inner cylinder 20. It is possible to prevent this and improve the operability of the endoscopic treatment instrument 1. By providing the receiving portion 51 on the handle 50, the range of movement of the outer tube 10 toward the proximal side can be restricted by the receiving portion 51. Further, when the large diameter portion at the point where the small diameter portion 11 and the large diameter portion 21 that limit the range of movement of the outer cylinder 10 toward the distal side contact is defined as the first large diameter portion, the first large diameter portion of the inner cylinder 20 A second large diameter part is provided in the inner cylinder 20 on the proximal side of the diameter part, and the range of motion of the proximal side of the outer cylinder 10 is limited by the location where the small diameter part 11 and the second large diameter part come into contact. Can be done.

The receiving portion 51 may be located at the distal end of the handle 50, as shown in FIGS. 2 and 3, but is preferably located inside the handle 50, as shown in FIG. . By disposing the receiving portion 51 inside the handle 50, when connecting a treatment instrument to the connecting portion 31 or when exposing the treatment instrument from the outer tube 10 in order to operate the treatment instrument, the outer tube can be easily removed. When moving the outer tube 10 proximally with respect to the inner tube 20, the proximal side of the outer tube 10 can be stored within the handle 50. Therefore, it is possible to prevent the length of the endoscopic treatment instrument 1 from becoming excessively long in the far and near directions, and to make the endoscopic treatment instrument 1 easy to operate.

When the endoscopic treatment instrument 1 is provided with a handle 50 and the handle 50 is connected to the proximal end of the inner cylinder 20, the inner cylinder 20 is connected to the handle 50 with the long axis of the inner cylinder 20 as the rotation axis. Preferably, it is rotatably mounted. The inner cylinder 20 is rotatably attached to the handle 50 with the long axis of the inner cylinder 20 as the rotation axis, so that when the endoscopic treatment instrument 1 is rotated within the forceps hole of the endoscope, Even when the endoscopic treatment instrument 1 is twisted or twisted, operability can be ensured. Particularly, when the linear object 30 is attached to the handle 50 so as to be movable in the distance direction but not rotated independently, and the inner cylinder 20 is attached to the handle so as to be rotatable and not movable in the distance direction. The endoscopic treatment instrument 1 can ensure operability and has a high ability to follow the movement of the handle 50. In this case, it is preferable that the linear object 30 rotates in accordance with the rotation of the handle 50.

The handle 50 may have a slider 52 connected to the proximal end of the linear object 30 and movable in the far and near directions. Since the handle 50 has the slider 52, the linear object 30 can be moved in the far and near directions when connecting a treatment instrument to the connection section 31 or when operating a treatment instrument connected to the connection section 31. This makes it possible to improve the operability of the endoscopic treatment instrument 1.

As shown in FIG. 3, when the outer tube 10 is placed at the most distal side in the range of motion relative to the inner tube 20, the distal end 11a of the small diameter portion 11 is placed in a position in contact with the proximal end 21b of the large diameter portion 21. It is preferable that By arranging the outer cylinder 10 at the most distal side, the distal end 11a of the small diameter part 11 is placed in contact with the proximal end 21b of the large diameter part 21, so that the distal end of the outer cylinder 10 is The range of motion may be limited by the small diameter portion 11 and the large diameter portion 21, and the outer tube 10 may move distally more than necessary, and the treatment instrument may not be able to protrude from the outer tube 10 inside the body. It is possible to prevent the outer cylinder 10 from protruding and damaging internal tissues.

As shown in FIG. 2, when the outer tube 10 is placed at the most proximal side in the movable range with respect to the inner tube 20, it is preferable that the proximal end 11b of the small diameter portion 11 be placed in a position in contact with the receiving portion 51. When the outer cylinder 10 is disposed on the most proximal side, the proximal end 11b of the small diameter portion 11 is placed in a position in contact with the receiving portion 51, so that the range of motion of the proximal side of the outer cylinder 10 is limited to the small diameter portion 11 and the receiving portion. 51 can be restricted. Therefore, it is possible to prevent the outer cylinder 10 from moving excessively toward the proximal side and making it difficult to accommodate the treatment instrument connected to the connecting portion 31 in the outer cylinder 10.

The method of operating the endoscopic treatment instrument 1 of the present invention includes a step of moving the outer tube 10 to the proximal side, a step of connecting the treatment instrument to the connecting portion 31, and a step of moving the outer tube 10 to the distal side. , a step of placing the treatment instrument in the inner cavity of the outer tube 10, a step of inserting the endoscopic treatment instrument 1 into the endoscope and sending the treatment instrument to the target site, and a step of moving the outer tube 10 to the proximal side. , and a step of exposing the treatment instrument from the outer cylinder 10.

First, in order to make it easier to specify the position of a target site such as a lesion, a step of scattering a dye on the target site or a step of marking the area around the target site may be performed. Marking can be performed, for example, by cauterizing the area around the target site using a high-frequency instrument. Furthermore, when a lesion is to be excised, a step may be performed in which saline or hyaluronic acid is injected between the muscular layer and the submucosa of the lesion to raise the lesion. By performing the step of elevating the lesion, the lesion can be easily excised.

First, the outer cylinder 10 is moved to the proximal side, and the inner cylinder 20 is exposed from the outer cylinder 10. At this time, it is preferable to move the linear object 30 to the distal side and expose the connecting part 31 from the inner cylinder 20. By exposing the connecting portion 31 from the inner tube 20, the process of attaching a treatment instrument to the connecting portion 31 becomes easier.

Next, a treatment instrument is connected to the connecting portion 31. Treatment instruments include snares, knives, clips, forceps, local injection needles, etc., and are selected depending on the treatment to be performed. After connecting the treatment instrument to the connecting portion 31, the outer cylinder 10 is moved to the distal side and the treatment instrument is placed in the inner cavity of the outer cylinder 10. By arranging the treatment instrument in the inner cavity of the outer tube 10 after connecting the treatment instrument to the connection part 31, the treatment instrument can be attached to the forceps opening in the endoscope or the forceps until the treatment instrument is transported to the target site. It is possible to prevent damage to body tissues, etc. inside the channel and other than the target site.

Then, the endoscopic treatment instrument 1 is inserted into the endoscope, and the treatment instrument is sent to the target site. Specifically, the distal end of the endoscopic treatment instrument 1 is inserted into the forceps channel through the forceps port of the endoscope, and the treatment instrument is conveyed to the target site through the forceps channel. At this time, the operator moves the endoscopic treatment tool 1 while observing the position and situation of the target region using the image obtained from the endoscope.

After the treatment instrument is transported to the target site, the outer tube 10 is moved proximally to expose the treatment instrument from the outer tube 10. By exposing the treatment instrument from the outer tube 10 after conveying the treatment instrument to the target site, the treatment instrument is stored in the outer tube 10 until the treatment instrument is conveyed to the target site, so that the endoscope is not exposed. This prevents damage to the forceps mouth, the inside of the forceps channel, and body tissues other than the target site, and after the treatment instrument reaches the target site, the treatment instrument is exposed from the outer cylinder 10, so that the operation of the treatment instrument is not hindered. Thereafter, the treatment instrument is operated by moving the linear object 30 toward the proximal side as necessary.

As described above, the endoscopic treatment instrument of the present invention includes an outer cylinder having a far-to-near direction, an inner cylinder disposed in the inner cavity of the outer cylinder, and an inner cylinder disposed in the inner cavity of the inner cylinder. A linear object having a connection part with a treatment instrument at the end, the outer cylinder has a small diameter part where the inner diameter is small in a part of the distance direction, and the inner cylinder has a small diameter part where the inner diameter is small in a part of the distance direction. , the outer cylinder has a large diameter part where the outer diameter is large in a part of the distance direction, and the outer cylinder is movable in the distance direction with respect to the inner cylinder, and in the range of movement of the outer cylinder, the small diameter part The part with the smallest inner diameter is located on the proximal side of the part with the largest outer diameter of the large diameter part. Since the endoscopic treatment instrument of the present invention has such a configuration, the small diameter part of the outer cylinder and the large diameter part of the inner cylinder can move in the direction of distance with respect to the inner cylinder. In order to limit the area, the position of the treatment instrument within the outer cylinder can be restricted, and when inserting the treatment instrument into the body through the treatment instrument hole of the endoscope placed inside the body, it is possible to limit the position of the treatment instrument within the body. It is possible to prevent the outer cylinder from being able to protrude from the cylinder and from causing damage to body tissues by excessively protruding the outer cylinder from the treatment tool hole of the endoscope inside the body.

This application claims the benefit of priority based on Japanese Patent Application No. 2018-219669 filed on November 22, 2018. The entire contents of the specification of Japanese Patent Application No. 2018-219669 filed on November 22, 2018 are incorporated by reference into this application.

1: Endoscope treatment instrument 10: Outer tube 10a: Distal end of outer tube 11: Small diameter portion 11a: Distal end of small diameter portion 11b: Proximal end of small diameter portion 12: Tapered portion of small diameter portion 20: Inner tube 20a: Distal end of inner cylinder 21: Large diameter portion 21b: Proximal end of large diameter portion 22: Tapered portion of large diameter portion 30: Linear object 31: Connection portion 40: Grip portion 50: Handle 51: Receiving portion 52: Slider P1: Midpoint of the small diameter section in the perspective direction P2: Midpoint of the large diameter section in the perspective direction

Claims (14)

an outer cylinder having a perspective direction;
an inner cylinder disposed in the inner cavity of the outer cylinder;
a linear object that is disposed in the lumen of the inner cylinder and has a connection part with a treatment instrument at its distal end;
a handle connected to the proximal end of the inner cylinder ;
The outer cylinder has a small diameter portion where the inner diameter is small in a part of the distance direction,
The inner cylinder has a large diameter portion having a large outer diameter in a part of the distance direction,
The outer cylinder is movable in a distance direction with respect to the inner cylinder,
In the range of motion of the outer cylinder, the part of the small diameter part with the smallest inner diameter is located on the proximal side of the part with the largest outer diameter of the large diameter part,
An endoscopic treatment instrument characterized in that an outer diameter of the outer tube at a portion where the small diameter portion is present is smaller than an outer diameter of the outer tube distal to the small diameter portion. . an outer cylinder having a perspective direction;
an inner cylinder disposed in the inner cavity of the outer cylinder;
a linear object that is disposed in the lumen of the inner cylinder and has a connection part with a treatment instrument at its distal end;
a handle connected to the proximal end of the inner cylinder ;
The outer cylinder has a small diameter portion where the inner diameter is small in a part of the distance direction,
The inner cylinder has a large diameter portion having a large outer diameter in a part of the distance direction,
The outer cylinder is movable in a distance direction with respect to the inner cylinder,
In the range of motion of the outer cylinder, the part of the small diameter part with the smallest inner diameter is located on the proximal side of the part with the largest outer diameter of the large diameter part,
The handle has a receiving portion that contacts the proximal end of the outer cylinder,
The endoscopic treatment instrument is characterized in that the receiving portion is disposed inside the handle . The endoscopic treatment instrument according to claim 1 or 2 , wherein the outer cylinder is not fixed to any other member. The inner diameter of the small diameter portion is larger than the outer diameter of the inner cylinder disposed inside the small diameter portion and smaller than the outer diameter of the large diameter portion. endoscopic treatment instruments. The small diameter portion is located on the proximal side of the midpoint of the outer cylinder in the far and near direction,
The endoscopic treatment instrument according to any one of claims 1 to 4 , wherein the large diameter portion is located on the proximal side of the midpoint of the inner cylinder in the far and near directions. Any one of claims 1 to 5 , further comprising a tapered portion distal to the midpoint of the small diameter portion in the distance direction and at least one of the tapered portion proximal to the midpoint of the large diameter portion in the distance direction. The endoscopic treatment instrument according to item 1. The endoscopic treatment instrument according to any one of claims 1 to 6, wherein the distal end of the small diameter portion is located closer to the proximal side than the proximal end of the large diameter portion in the range of motion of the outer cylinder. . The outer cylinder has a grip portion on the outer surface,
The endoscopic treatment instrument according to any one of claims 1 to 7, wherein the gripping portion is disposed proximal to a midpoint of the outer tube in a far-to-near direction. The endoscopic treatment instrument according to claim 8, wherein the gripping portion has a portion that is more convex than the outer surface of the outer tube. The endoscopic treatment instrument according to claim 1 , wherein the handle has a receiving portion that contacts the proximal end of the outer tube. The endoscopic treatment instrument according to claim 10, wherein the receiving portion is arranged inside the handle. The endoscopic treatment instrument according to any one of claims 1 to 11, wherein the inner cylinder is rotatably attached to the handle with a long axis of the inner cylinder as a rotation axis. a slider connected to the proximal end of the linear object;
The endoscopic treatment instrument according to any one of claims 1 to 12, wherein a portion of the slider to which the linear object is connected is movable in a direction toward and away from the handle . In the range of motion of the outer cylinder with respect to the inner cylinder, when the outer cylinder is disposed at the most distal side in the range of movement with respect to the inner cylinder, the distal end of the small diameter part is in contact with the proximal end of the large diameter part. 12. Any one of claims 2, 10 and 11, wherein when the outer cylinder is placed at the most proximal side in the movable range with respect to the inner cylinder, the proximal end of the small diameter part is placed in contact with the receiving part. The endoscopic treatment instrument according to item (1) .

Images