JP7473691B2 - Endoscopic treatment tools - Google Patents

Description

The present invention relates to an endoscopic treatment tool.

Conventionally, endoscopic treatment tools for incision and dissection, such as high-frequency knives, have been used in endoscopic treatments such as endoscopic submucosal dissection (hereinafter sometimes abbreviated as "ESD"). Endoscopic treatment tools are capable of incising and dissecting biological tissues such as the mucosa and submucosa through an endoscope, and are configured to be able to deliver medicinal solutions, physiological saline, and the like from a water supply hole at the distal end.

In ESD procedures, an endoscopic local injection needle is inserted into a channel formed in the insertion section of an endoscope. An initial local injection is performed by feeding medicinal liquid or saline while the tip of the needle is punctured into a lesion formed in the lumen of the digestive tract, causing the lesion to bulge. The endoscopic local injection needle is then removed from the endoscope, and an endoscopic high-frequency treatment tool is inserted. The endoscopic high-frequency treatment tool is used to incise the area around the lesion, peel off the exposed submucosal layer, and resect the lesion. In addition, over time during the procedure, the medicinal liquid or saline injected into the submucosal layer leaks out, causing the bulging lesion to shrink. For this reason, additional local injection is performed by pressing the water supply port at the distal end against the submucosal layer and feeding water appropriately.

One such endoscopic treatment tool is known, for example, from Patent Document 1. In the endoscopic treatment tool of Patent Document 1, a conductive helical tube is disposed proximal to the high-frequency knife, and the helical tube functions as an electrode and a water supply conduit.

Chinese Patent Application Publication No. 111202485A

In the endoscopic treatment tool of Patent Document 1, in addition to factors such as the condition of the mucosa and submucosa (thickness of the mucosa, softness of the surface, etc.), if the water supply hole is not placed properly on the mucosa and submucosa, or if the water pressure of the saline solution or medicinal solution supplied from the water supply hole at the distal end is weak, the shape and size of the mucosa and submucosa when bulged may vary. As a result, the lesion does not bulge to the intended shape or size. In this case, the high-frequency treatment tool and the local injection needle are replaced each time local injection is performed, which increases the time of the procedure. To solve this problem, it is necessary to use a water supply pump with high pressure or high flow rate, or a water supply pump with high pressure and high flow rate. However, there are problems with the water supply pump being large and expensive.

In the endoscopic treatment tool of Patent Document 1, there is a water supply hole at the tip of the high-frequency knife, and the hole of the water supply hole is small. Therefore, if blood or mucus enters the water supply hole and adheres to it, and electricity is repeatedly applied, the adhesions burn and solidify, clogging the water supply pipe, making it impossible to supply medicinal liquid, saline solution, etc. forward. Therefore, if the blockage in the water supply pipe cannot be cleared, it is necessary to replace the high-frequency treatment tool with a new one, which increases the time of the procedure.

The present invention has been made in consideration of these problems, and aims to provide an endoscopic treatment tool that can deliver liquids such as medicinal solutions and saline solution with strong water force from the distal end of the treatment tool without using a high-performance water supply pump.

An endoscopic treatment instrument according to a first aspect of the present invention comprises a sheath, a tubular member extending freely back and forth within the sheath and having a first pipeline, and a conductive treatment section connected to the distal end of the tubular member and having a second pipeline capable of supplying a fluid and a water supply port , wherein the treatment section has a third pipeline located between the water supply port and the distal end of the tubular member, and the opening area of the third pipeline is smaller than the opening areas of the first pipeline and the second pipeline .

In the above-mentioned endoscopic treatment tool, the distal end of the third conduit may be located distal to the proximal end of the treatment section.

In the above-mentioned endoscopic treatment tool, the distal end of the third pipeline may be located proximal to the distal end of the second pipeline, and a step may be formed between the distal end of the third pipeline and the second pipeline.

In the above-mentioned endoscopic treatment tool, the step may be provided at the proximal end of the second pipeline.

In the above-mentioned endoscopic treatment tool, the third duct may be formed at the distal end of the tubular member.

In the above-mentioned endoscopic treatment tool, the distal end of the tubular member may be inserted into the second duct.

The above-mentioned endoscopic treatment tool may include a cylindrical body having the third duct, and the distal end of the cylindrical body may be inserted into the second duct of the treatment section.

In the above-mentioned endoscopic treatment tool, the third duct may be formed proximal to the second duct of the treatment section.

In the above-mentioned endoscopic treatment tool, an inclined surface may be formed between the proximal end of the third pipeline and the first pipeline.

In the above-mentioned endoscopic treatment tool, the sheath has an insulating tip at its distal end that is heat resistant and insulating, and the treatment portion may be a high-frequency knife that is inserted into the insulating tip and can be advanced and retreated relative to the sheath.

The above-mentioned endoscopic treatment tool may further include a cylindrical body having the third duct, and a connector connecting the cylindrical body and the high-frequency knife and formed of a conductive material, and the protruding position of the high-frequency knife relative to the sheath may be determined by abutting the connector and the insulating tip.

The above-mentioned endoscopic treatment tool may further include a connector that connects the tubular member and the high-frequency knife and is made of a conductive material, and the protruding position of the high-frequency knife relative to the sheath may be determined by abutting the connector and the insulating tip.

In the above-mentioned endoscopic treatment tool, the high-frequency knife may have an insulating distal end member in which the water supply port is formed, and an electrically conductive portion that is electrically conductive and is disposed at the proximal end of the distal end member, the outer edge of which is exposed on the proximal side of the distal end member.

In the above-mentioned endoscopic treatment tool, the treatment section may have a pair of forceps members and an axial member to which the pair of forceps members are provided on the distal side, and the second duct may be formed in the axial member.

With the above-mentioned endoscopic treatment tool, liquids such as medicinal solutions and saline can be delivered with strong water force from the distal end of the treatment section without using a high-performance water supply pump.

The present invention eliminates the need to replace the high-frequency treatment tool and injection needle each time a local injection is performed, preventing the procedure from taking too long. The present invention eliminates the need to use a water pump with high pressure or high flow rate, preventing the water pump from becoming too large and keeping costs down.

1 is an overall view of an endoscopic treatment tool according to a first embodiment of the present invention. 1 is a partial cross-sectional view of an endoscopic treatment tool according to a first embodiment of the present invention. 1 is a cross-sectional view of a main part of an endoscopic treatment tool according to a first embodiment of the present invention. 13 is a cross-sectional view of a main part of an endoscopic treatment tool according to a modified example. FIG. 13 is a cross-sectional view of a main part of an endoscopic treatment tool according to a modified example. FIG. 13 is a cross-sectional view of a main part of an endoscopic treatment tool according to a modified example. FIG. 13 is a cross-sectional view of a main part of an endoscopic treatment tool according to a modified example. FIG. 13 is a cross-sectional view of a main part of an endoscopic treatment tool according to a modified example. FIG. This is a view taken along line IX-IX in Figure 8. 10 is an overall view of an endoscopic treatment tool according to a second embodiment of the present invention. FIG. 6 is a cross-sectional view of a main part of an endoscopic treatment tool according to a second embodiment of the present invention. FIG. 13 is a cross-sectional view of a main part of an endoscopic treatment tool according to a modified example. FIG. 13 is a cross-sectional view of a main part of an endoscopic treatment tool according to a modified example. FIG. 13 is a cross-sectional view of a main part of an endoscopic treatment tool according to a modified example. FIG. 13 is a cross-sectional view of a main part of an endoscopic treatment tool according to a modified example. FIG.

First Embodiment
A first embodiment of an endoscopic treatment tool according to the present invention will be described below with reference to Figs. 1 to 3. Fig. 1 is an overall view of an endoscopic treatment tool 1 according to this embodiment. Fig. 2 is a cross-sectional view of a main portion of the endoscopic treatment tool 1. In Fig. 2, the distal end portion is illustrated enlarged compared to the proximal portion. The endoscopic treatment tool 1 is used by being inserted into a channel of an endoscope (not shown). As shown in Fig. 1, the endoscopic treatment tool 1 is provided with a treatment section 2 at its distal end portion and an operation section 4 at its proximal end portion.

The endoscopic treatment tool 1 has a sheath 10, an operating wire 3, a high-frequency knife 2 (hereinafter simply referred to as "knife"), and an operating section 4. The operating section 4 is provided at the proximal end of the soft sheath 10. The knife 2 is provided at the distal end of the operating wire 3, and the operating wire 3 is inserted inside the sheath 10. The knife 2 and the operating wire 3 are provided so as to be able to advance and retreat with respect to the sheath 10 in response to the operation of the operating section 4. The knife 2 is configured to be able to incise tissue, etc. by passing a high-frequency current through the operating section 4 and the operating wire 3. The endoscopic treatment tool 1 has a water supply pipeline formed from the operating section 4 side to the distal end of the knife 2. The endoscopic treatment tool 1 is configured so as to supply liquid to the water supply pipeline and to be able to supply water from the distal end of the knife 2.

The operation wire 3 is made of a conductive metal material such as stainless steel. A first duct 31 is formed over the entire length of the operation wire 3. The operation wire 3 is, for example, a tightly wound coil. The operation wire 3 is covered over the entire length with an insulating inner tube 6.

The sheath 10 is formed of an electrically insulating material such as tetrafluoroethylene. The outer diameter of the sheath 10 is set to a size that allows it to be inserted into a channel of an endoscope (not shown). A control wire 3 is inserted into the sheath 10. The control wire 3 can advance and retreat in a direction along the longitudinal axis C of the sheath 10. The sheath 10 and the control wire 3 form an insertion section that is inserted into the channel of the endoscope.

The insulating tip 8 is inserted into the distal opening of the sheath 10. The insulating tip 8 is fixed to the distal end of the sheath 10 by an adhesive (not shown) or the like. The insulating tip 8 is made of a material having heat resistance and insulating properties, such as ceramics or resin. The insulating tip 8 has an insertion hole 82 that communicates with the internal space of the sheath 10 and opens distally. A step 83 is formed on the distal side of the insertion hole 82 of the insulating tip 8, where the opening of the insertion hole 82 is enlarged in diameter. The insulating tip 8 has a recess 84 that is recessed from the distal end face to the proximal side. The outer diameter of the proximal part of the insulating tip 8 is large enough to be inserted into the distal end of the sheath 10. The distal end of the insulating tip 8 has a large diameter part 85 that is larger in diameter than the proximal part. The outer diameter of the large diameter part 85 is approximately equal to the outer diameter of the sheath 10. The outer periphery of the distal side of the large diameter part 85 has a curved surface.

As shown in Figure 2, the operating unit 4 is provided in the proximal portion of the sheath 10. The operating unit 4 includes an operating body 43 and a slider 44. The slider 44 is provided so as to be slidable along the longitudinal axis C relative to the operating body 43. By moving the slider 44 forward and backward relative to the operating body 43, operations such as moving the knife 2 forward and backward relative to the sheath 10 can be performed.

The operating body 43 is fixed to the proximal end of the sheath 10. The operating body 43 has a slit 431 formed along the longitudinal axis C. The slider 44 can slide along the slit 431 relative to the operating body 43. The proximal end of the operating body 43 is provided with a ring 432 for hanging a finger.

The slider 44 is provided with a ring 442 for hanging a finger. The slider 44 is equipped with an electrical connector 42. The electrical connector 42 is electrically connected to a high-frequency power supply device (not shown). The proximal end of the operating wire 3 is electrically connected to the electrical connector 42.

Figure 3 is a cross-sectional view along the longitudinal axis C of the distal end of the slider 44. The slider 44 is formed with an insertion hole 441 for the operation wire 3. The proximal end of the operation wire 3 is inserted into the insertion hole 441, and the proximal end of the operation wire 3 is fixed. Specifically, a pair of protrusions 443 for fixing the operation wire 3 is formed in the insertion hole 441. The protrusions 443 protrude from the inner surface of the insertion hole 441 in a direction perpendicular to the longitudinal axis C. The protrusions 443 are protrusions having an approximately cylindrical shape. The protrusions 443 protrude to such an extent that the outer circumferential surface of the proximal end of the operation wire 3 inserted into the insertion hole 441 comes into contact with the pair of protrusions 443.

3, the liquid feed nozzle 41 is provided on the slider 44. Although not shown, the liquid feed nozzle 41 is configured to allow a liquid feed means such as a syringe or a water feed tube extended from a water feed pump to be detachably attached. The liquid feed nozzle 41 has an injection port 411. The slider 44 has an injection path 412 that communicates between the liquid feed nozzle 41 and the insertion hole 441. The proximal end of the operation wire 3 is formed with an opening 33 for injecting liquid. The opening 33 is an opening that communicates with the inside and outside of the operation wire 3. The operation wire 3 is fixed to the insertion hole 441 at a position where the insertion hole 441 and the opening 33 face each other. As a result, the liquid feed port 411 is connected to the liquid feed pipe 31 of the operation wire 3. An O-ring 444 is attached to each convex portion 443. The O-ring 444 keeps the area between the operation wire 3 and the convex portion 443 watertight. The O-ring 444 prevents the liquid from leaking from the gap between the operation wire 3 and the convex portion 443 when the liquid is fed from the liquid feed nozzle 41 .

2, a cylindrical body 5 is fixed to the distal end of the operating wire 3. The cylindrical body 5 is, for example, a cylindrical member having electrical conductivity such as stainless steel. The cylindrical body 5 has a third duct 53 formed along the longitudinal axis C. The opening area of the third duct 53 is smaller than the opening area of the first duct 31 of the operating wire 3. The proximal end of the cylindrical body 5 and the distal end of the operating wire 3 are fixed by a welded portion 11. The distal end of the operating wire 3, the proximal end of the cylindrical body 5, and the welded portion 11 are covered by the distal end of the inner tube 6. As a result, the first duct 31 and the third duct 52 are connected watertightly. A spiral groove 54 is formed on the outer circumferential surface of the cylindrical body 5 at the middle portion in the longitudinal axis C direction.

The knife 2 is an electrode member. As shown in FIG. 2, the knife 2 is connected to the distal end of the operating wire 3 via the cylindrical body 5 and the connector 7. The knife 2 is formed of a conductive material such as stainless steel. The knife 2 is a tubular member extending along the longitudinal axis C. In other words, the knife 2 is a tubular electrode in which a second duct 22 is formed along the longitudinal axis C. The knife 2 has a large diameter portion 24 and a small diameter portion 25. The large diameter portion 24 is located at the distal end of the knife 2. The small diameter portion 25 is located in the region from the proximal end of the large diameter portion 24 to the proximal end 23 of the knife 2. A second duct 22 extending along the longitudinal axis C is formed inside the knife 2. The second duct 22 extends from the proximal end to the distal end of the knife 2 and opens at the proximal end and the distal end of the knife 2. The opening at the distal end of the knife 2 is a water supply port 21 through which liquid is supplied. The water supply port 21 opens at the large diameter portion 24. The large diameter portion 24 has a radial thickness greater than that of the small diameter portion 25 .

The small diameter portion 25 is inserted into the insertion hole 82 of the insulating tip 8. The outer diameter of the small diameter portion 25 is smaller than the inner diameter of the recess 84 distal to the step portion 83 in the insertion hole 82 of the insulating tip 8. In a direction perpendicular to the longitudinal axis C, the opening area of the recess 84 is larger than the area of the large diameter portion 24. The knife 2 is inserted into the insulating tip 8 so as to be able to advance and retract. When the knife 2 is retracted, the large diameter portion 24 enters the recess 84.

The distal end of the cylindrical body 5 is inserted into the second duct 22 of the knife 2. The cylindrical body 5 and the knife 2 are connected by a connector 7. The connector 7 is made of a metal material having electrical conductivity, such as stainless steel. The connector 7 is formed with an insertion hole 72 penetrating along the longitudinal axis C. A spiral groove 71 is formed on the inner peripheral surface of the insertion hole 72 at the proximal end of the connector 7. The inner peripheral surface of the distal end 721 of the insertion hole 72 of the connector 7 has an opening dimension that allows the small diameter portion 25 of the knife 2, which will be described later, to be inserted. The proximal end of the knife 2 is inserted into the distal end 721 of the insertion hole 72, and the knife 2 and the connector 7 are fixed.

The cylindrical body 5 is inserted into the insertion hole 72 from the proximal side of the connector 7, and the spiral grooves 54, 71 are screwed together. The distal end of the cylindrical body 5 protrudes distally beyond the distal end of the connector 7. When the connector 7 and the cylindrical body 5 are screwed together, the proximal end 23 of the knife 2 is inserted into the distal end 721 of the insertion hole 72. In this example, the connector 7 and the cylindrical body 5 are fixed together with a screw, but the method of joining the connector and the cylindrical body is not limited to screwing. For example, the connector and the cylindrical body may be joined together by adhesive or welding.

The knife 2 is connected to the electrical connector 42 through the connector 7, the tube 5, the welded portion 11, and the operating wire 3. As a result, electricity is passed through the knife 2 from the high-frequency power supply device connected to the electrical connector 42 through the operating wire 3, the welded portion 11, the connector 7, and the tube 5.

2, the opening area of the third conduit 53 of the cylinder 5 is smaller than the opening area of the first conduit 31 of the operating wire 3 and the second conduit 22 of the knife 2. Therefore, the flow path of the liquid from the operating wire 3 to the water supply port 21 of the knife 2 is once narrowed at the third conduit 53. As a result, the water pressure of the liquid supplied to the first conduit 31 of the operating wire 3 increases as it passes through the third conduit 53. The liquid with increased water pressure passes through the second conduit 22 and is supplied from the water supply port 21 of the knife 2. As a result, even if the water pressure of the liquid supplied to the first conduit 31 is low, the water force in the second conduit 22 can be increased, and water can be supplied from the water supply port 21 with increased water force.

Next, we will explain the operation of the endoscopic treatment tool 1. The endoscopic treatment tool 1 is operated by, for example, a user, such as a surgeon, inserting his or her fingers into the ring 432 of the operation body 31 and the ring 442 of the slider 44, and sliding the slider 44 with one hand in the direction along the longitudinal axis C relative to the operation body 43.

The operation wire 3 is moved distally relative to the sheath 10 by moving the slider 44 distally relative to the operation body 43. As a result, the knife 2 protrudes distally beyond the insulating tip 8. At this time, when the slider 44 is pushed distally, the distal end surface 74 of the connector 7 abuts against the proximal end 81 of the insulating tip 8, as shown in FIG. 2. As a result, the knife 2 is protruded to its maximum protruding position. In other words, the protruding position of the knife 2 is determined by the connector 7 abutting against the insulating tip 8. The state in which the connector 7 abuts against the insulating tip 8 and the knife 2 protrudes most distally is referred to as the protruding state.

In the protruding state, the distal portion of the small diameter section 25 of the knife 2 can be protruded distally beyond the sheath 10 through the insertion hole 82 of the insulating tip 8. A liquid such as physiological saline is supplied to the first duct 31 from the inlet 411 of the liquid supply nozzle 41. The liquid is supplied from the water supply port 21 to the distal side through the first duct 31 of the operating wire 3, the third duct 53 of the cylindrical body 5, and the second duct 22 of the knife 2.

By moving the slider 44 proximally relative to the operating body 43, the operating wire 3 is retracted proximally relative to the sheath 10. As a result, the large diameter portion 24 abuts against the recess 84 of the insulating tip 8. As a result, the small diameter portion 25 of the knife 2 is accommodated within the internal space 10S of the sheath 10, and the operating wire 3 is positioned in a stored state where it is stored proximally.

Next, we will explain the operation of the endoscopic treatment tool 1 related to this embodiment.

The distal portion of the sheath 10 of the endoscopic treatment tool 1 is protruded from the channel of the endoscope, and the knife 2 is opposed to, for example, the diseased mucosal portion that is the treatment target area within the body cavity.

A syringe or water supply tube (not shown) is attached to the inlet 411 of the liquid supply nozzle 41. The user presses the knife 2 against the mucous membrane of the affected area and supplies physiological saline stored in the syringe or water supply pump to the first duct 31 of the operating wire 3. At this time, the knife 2 may be in a protruding or retracted state. Physiological saline is supplied from the water supply port 21 to the distal side through the water supply pipe. In the endoscopic treatment tool 1, the liquid supplied to the first duct 31 passes through the third duct 53, and then is supplied from the water supply port 21 through the second duct 22. The third duct 52 has a smaller opening area of the water supply pipe than the first duct 31. Therefore, the liquid supplied to the first duct 31 has a stronger water force by passing through the third duct 53. Therefore, water can be supplied from the water supply port 21 with a strong water force. As a result, water is supplied while the water supply port 21 is pressed against the mucous membrane and submucosa of the affected area, causing the affected area to rise.

Next, a high-frequency current is passed through the knife 2 from a high-frequency power supply device (not shown) connected to the electrical connector 42 of the operating unit 4 via the electrical connector 42, the operating wire 3, and the connector 7.

Next, for example, when the knife 2 is moved laterally perpendicular to the longitudinal axis C, the mucosa (tissue) in contact with the knife 2 is incised. After the diseased mucosa portion is completely incised in the circumferential direction, the knife 2 is brought into contact with the incision made around the diseased mucosa portion, and the entire diseased mucosa portion is excised and peeled off.

When performing a procedure to incise a mucous membrane or coagulate a bleeding point, bodily fluids such as mucus and blood may enter the second duct 22 of the knife 2 from the water supply port 21 due to capillary action, etc. In this case, the mucus and blood that have adhered to the second duct 22 due to the incision or peeling with the knife 2 may be scorched by the heat of the high temperature of the knife 2. When the mucus and blood are scorched in the second duct 22, the water supply line of the second duct 22 becomes narrow, making it difficult to supply water. Therefore, water is supplied through the third duct 53 with strong water pressure, and the scorched adhesions in the second duct 22 are removed. As described above, the liquid with strong water pressure in the third duct 53 is supplied through the second duct 22 and from the water supply port 21. As a result, the scorched adhesions in the second duct 22 are peeled off from the inner surface of the second duct 22 by the liquid pressure and discharged from the water supply port 21.

As described above, the endoscopic treatment tool 1 according to this embodiment has a third conduit 53 between the first conduit 31 and the water supply port 21. The opening area of the third conduit 53 is smaller than the opening areas of the first conduit 31 and the second conduit 22. As a result, the liquid supplied to the first conduit 31 passes through the third conduit 53, thereby increasing the water pressure of the liquid, and water can be supplied from the water supply port 21 with increased water pressure. According to the endoscopic treatment tool 1, water can be supplied from the water supply port 21 with increased water pressure even if the output of the syringe or water supply pump supplying liquid to the first conduit 31 is small.

According to the endoscopic treatment tool 1 of this embodiment, by providing a third conduit 53, which has a smaller opening area than the first conduit 31 and the second conduit 22, between the distal end of the operating wire 3 and the water supply port 21, saline or medicinal solution can be supplied from the water supply port 21 with strong water pressure without using a high-performance water supply pump. As a result, local injection operations that supply water to the mucosa and submucosa to swell the lesion are facilitated, the need to replace treatment tools is eliminated, and the procedure time is shortened.

According to the endoscopic treatment tool 1, by supplying water with strong water pressure from the third conduit 53, it is possible to easily remove the scorched deposits in the second conduit 22. Therefore, it is possible to prevent the second conduit 22 from being clogged with the deposits.

The manner in which the third duct 53 is provided is not limited to the above-mentioned example. The endoscopic treatment tool may be, for example, the modified form shown in Figures 4 to 9. In the following description, the same parts as in the first embodiment are given the same reference numerals and their description is omitted, and only the differences are described.

The example shown in FIG. 4 is an example in which the configurations of the operation wire 3A, the connector 7A, and the cylindrical body 5A are different from those of the first embodiment. The operation wire 3A is a soft tube made of a conductive material. When the operation wire 3A is a tube, the first conduit 31 of the operation wire 3A can be kept watertight, so the inner tube 6 is not an essential configuration. In the first embodiment, an example was shown in which a part of the cylindrical body 5 protrudes proximally from the connector 7 and is connected to the operation wire 3. However, the third conduit 53A may be located between the distal end of the operation wire 3 and the water supply port 21. For example, as shown in FIG. 4, a third conduit 53A having a smaller opening area than the first conduit 31 and the second conduit 22 may be arranged by fitting the cylindrical body 5A into the proximal end of the second conduit 22 of the knife 2A.

In the first embodiment, an example was shown in which the cylindrical body 5 is fixed to the operating wire 3, the connector 7 is fixed to the proximal end of the knife 2, and the connector 7 is screwed to the cylindrical body 5 to connect the cylindrical body and the knife 2. The manner in which the operating wire 3 and the knife 2 are connected by the connector 7 is not limited to this example. For example, as shown in FIG. 4, the distal end of the operating wire 3A and the proximal end of the knife 2A may be inserted and fixed through the insertion hole 72 of the connector 7A. In this configuration example, the operating wire 3A and the knife 2A can be abutted against the connector 7A to conduct electricity. In this case, as shown in FIG. 4, the inner tube 6 of the first embodiment does not need to be provided. With this configuration, as in the first embodiment, the water pressure of the liquid can be increased in the third pipe 53A and water can be supplied from the water supply port 21 with strong water force.

The example shown in FIG. 5 is an example in which the configurations of the operating wire 3B, connector 7B, cylindrical body 5B, insulating tip 8B, and proximal end of the knife 2B are different from those of the first embodiment. The configurations of the operating wire 3B, connector 7B, and cylindrical body 5B are the same as those of the modified example shown in FIG. 4. The proximal end 26 of the knife 2B has a larger diameter than the small diameter portion 25. A step portion 27 is formed between the small diameter portion 25 and the proximal end 26. In a direction perpendicular to the longitudinal axis C, the thickness of the proximal end 26 is thicker than the thickness of the small diameter portion 25. The second duct 22 of the proximal end 26 is formed with a storage portion for the cylindrical body 5B. The opening area of the second duct 22 at the proximal end 26 is slightly larger than other areas, and is configured so that the cylindrical body 5B can be fitted inside.

A recess 821 recessed toward the distal side is formed at the proximal end of the insulating tip 8B. The recess 821 has an opening dimension larger than the insertion hole 82 of the insulating tip 8, and a step 822 is formed. In the example shown in FIG. 5, when the knife 2B is pushed out, the step 27 of the proximal end 26 of the knife 2B abuts against the step 822 of the recess 821 of the insulating tip 8B. As a result, the position where the knife 2 protrudes most relative to the sheath 10 is determined. The treatment tool of the modified example shown in FIG. 5 can supply liquid from the water supply port 21 with strong water pressure in the third pipeline 53B, as in the first embodiment.

The connector 7 and the cylinder 5 shown in the first embodiment are not essential components. As shown in FIG. 6, the second duct 22 and the third duct 53C may be formed continuously in the knife 2C. The knife 2C has a third duct 53C on the proximal end side of the second duct 22, the third duct 53C having a smaller opening area than the second duct 22 and the first duct 31 of the operating wire 3. In this case, the proximal end of the knife 2 and the distal end of the operating wire 3 may be fixed by a welded portion 11. The treatment tool of the modified example shown in FIG. 6 can supply liquid from the water supply port 21 in a state where the water force of the liquid is increased in the third duct 53C, as in the first embodiment.

In the example shown in FIG. 7, the third conduit 53D is formed integrally with the knife 2D, as in the modified example shown in FIG. 6. The configuration of the third conduit 53D is the same as that of the modified example shown in FIG. 6. An inclined surface 29 is formed between the proximal end of the third conduit 53D and the proximal end of the knife 2D. The inclined surface 29 is a tapered inclined surface that reduces in diameter from the proximal end of the knife 2D to the proximal end of the third conduit 53D. With this configuration, liquid can be smoothly sent from the first conduit 31 to the third conduit 53D, and pressure loss can be reduced. As in the first embodiment, the treatment tool of the modified example shown in FIG. 7 can send liquid from the water supply port 21 with the water force of the liquid being increased in the third conduit 53D.

In the first embodiment, an example having the first duct 31 inside the operation wire 3 is shown, but the first duct 31 may be provided separately from the operation wire. The first duct and the third duct are not limited to one duct each. As in the example shown in FIG. 8 and FIG. 9, a plurality of liquid supply tubes 9 may be provided independently of the operation wire 3. In the modified example shown in FIG. 8 and FIG. 9, three liquid supply tubes 9 are arranged around the operation wire 3. The distal end of the operation wire 3 is fixed to the connector 7E. The proximal end of the knife 2E is fixed to the connector 7E. As a result, the knife 2E is energized via the operation wire 3 and the connector 7E. A connection duct 73 is formed in the connector 7E. The connection ducts 73 are formed in the same number as the number of liquid supply tubes 9. The proximal end of each connection duct 73 is connected to each liquid supply tube 9. The connection ducts 73 are opened at three locations at the proximal end of the connector 7E at intervals in the circumferential direction of the connector 7E and are inclined toward the distal end of the connector 7E. The three connecting pipelines 73 join at the distal end of the connector 7E. The third pipeline 53E is formed distal to the joining portion of the three liquid supply tubes 9. The third pipeline 53E is formed at the connection portion between the connector 7E and the incision 2E. The opening area of the third pipeline 53E is smaller than the opening area of the joining portion of the connecting pipeline 73. With this configuration, as in the first embodiment, the diameter of the water supply pipeline is reduced in the third pipeline 53E, and water can be supplied from the water supply port 21 of the knife 2E with strong water pressure.

Second Embodiment
An endoscopic treatment tool 1F according to the second embodiment will be described with reference to Fig. 10 to Fig. 12. The endoscopic treatment tool is not limited to a high-frequency knife, and may be applied to an endoscopic treatment tool having functions of supplying water and passing electricity. As shown in Fig. 10, the endoscopic treatment tool 1F according to this embodiment has a treatment section in the form of forceps 2F. The configurations of the operation section 4, the sheath 10, the operation wire 3, and the inner tube 6 are the same as those of the first embodiment.

The forceps 2F has a pair of forceps members 211, 212, a pair of link members 213, 214, a plurality of pivot shafts 216, 217, 218, an axis member 215, a cover 228, and a stopper 227. The forceps 2F has a known link mechanism. The cover 228 and the stopper 227 are integrally formed. The stopper 227 has an insertion hole 229 penetrating in the longitudinal axis C direction. A second duct 22F is formed inside the axis member 215. The proximal end of the axis member 215 is fixed to the distal end of the operation wire 3. A cylindrical body 5F is inserted into the proximal end of the second duct 22F. The third duct 53F of the cylindrical body 5F is disposed on the distal side of the first duct 31 of the operation wire 3, and the second duct 22F is formed on the distal side of the third duct 53F.

The link members 213 and 214 are connected to the distal end of the shaft member 215 via the proximal pivot shaft 218. The pair of forceps members 211 and 212 are inserted through the distal pivot shaft 216, which is connected to the cover 228. The distal pivot shaft 216 is formed with a through hole 216F that penetrates along the longitudinal axis C. The through hole 216F has an opening area equivalent to that of the second conduit 22F inside the shaft member 215, and functions as an extension conduit of the second conduit 22F. Therefore, the distal end of the through hole 216F functions as the water supply port 21F.

The insulating tip 8F has an enlarged diameter portion 823 formed in the middle of the insertion hole 82 in the longitudinal axis C direction. The enlarged diameter portion 823 accommodates a stopper 227. The stopper 227 restricts the range of movement of the cover 228 in the longitudinal axis C direction relative to the insulating tip 8F.

When the operation wire 3 is advanced or retracted relative to the sheath 10, the shaft member 215 advances or retracts relative to the cover 228. A pair of forceps members 211, 212 are rotatably connected to the cover 228 by the distal rotation shaft 216. As a result, as shown in FIG. 11, as the operation wire 3 advances, the proximal rotation shaft 218 approaches the distal rotation shaft 216, and the pair of forceps members 211, 212 open. In this state, as in the first embodiment, liquid is supplied through the liquid supply nozzle 41. The liquid passes through the first pipeline 31, the third pipeline 53F, and the second pipeline 22F and is supplied from the distal end of the shaft member 215. The liquid supplied from the distal end of the shaft member 215 passes through the water supply port 21F provided at the distal end of the through hole 216F of the distal rotation shaft 216 and is supplied to the distal side between the pair of forceps members 211, 212 that are open. When the operating wire 3 is retracted, the proximal rotation shaft 218 moves proximally and separates from the distal rotation shaft 216, and the pair of forceps members 211, 212 close as shown in FIG.

According to the endoscopic treatment tool 1F of the second embodiment, similar to the first embodiment, liquid can be supplied from the water supply port 21F while the water pressure of the liquid is increased in the third pipeline 53F.

The cylindrical body of this embodiment is not limited to the above-mentioned configuration. For example, it may be in the modified form shown in Figures 12 and 13. In the example shown in Figure 12, the cylindrical body 5F is provided at the distal end of the shaft member 215. In the example shown in Figure 12, the third pipeline 53F is located on the distal end side of the shaft member 215. The distal end of the cylindrical body 5F protrudes distally beyond the distal end of the shaft member 215.

12, as in the second embodiment, water is supplied to the distal side between the pair of open forceps members 211, 212 through the water supply port 21F provided at the distal end of the through hole 216F with the water pressure increased in the third conduit 53F. By providing the third conduit 53F at the distal end of the shaft member 215, water can be supplied with the liquid pressure increased in the distal portion of the device.

The modified example shown in FIG. 13 is an example in which the cylindrical body 5G is longer than the cylindrical body 5F of the modified example shown in FIG. 12. As shown in FIG. 13, the long cylindrical body 5G may be protruded to the vicinity of the distal rotation axis 216. In this case, when the pair of forceps members 211, 212 are opened, the distal end of the cylindrical body 5G protrudes distally from the distal rotation axis 216. As a result, with the pair of forceps members 211, 212 open, water can be delivered with stronger water pressure on the more distal side. According to the modified example shown in FIG. 13, as in the second embodiment, water can be delivered from the water delivery port 21G with the liquid pressure in the third pipeline 53G being stronger.

In the above embodiment, examples of high-frequency knives 2A to 2E are shown as endoscopic treatment tools, but endoscopic treatment tools are not limited to the above examples. For example, endoscopic treatment tools exemplified in FIG. 14 and FIG. 15 may be used. In the high-frequency treatment tool 2G shown in FIG. 14 and FIG. 15, the configuration of the distal end is different from that of the high-frequency knives 2A to 2E described above. The large diameter portion 24G of the high-frequency treatment tool 2G has a distal end member 244 and a current-carrying portion 241. The distal end member 244 is disposed at the distal end of the large diameter portion 24G. The distal end member 244 is formed of an insulating spherical member such as zirconia or ceramics. The current-carrying portion 241 is provided at the proximal end of the distal end member 244. The current-carrying portion 241 is formed of a conductive metal material such as stainless steel, and has a circular proximal end portion 242 and a cylindrical portion 243. The cylindrical portion 243 protrudes distally from the proximal end portion 242. The cylindrical portion 243 is inserted and fixed in the distal end member 244. The distal end of the small diameter portion 25G is inserted and fixed in the cylindrical portion 243. The outer periphery (outer edge) 245 of the proximal end 242 of the current-carrying portion 241 is exposed along the outer periphery of the proximal end of the distal end member 244. A high-frequency current is applied to the current-carrying portion 241 through the operation wire 3G, the connector 7G, and the small diameter portion 25G. When current is applied, the outer periphery 245 of the proximal end 242 of the current-carrying portion 241 is configured to be in contact with tissue or the like to incise the tissue or the like. The cylindrical body 5G is inserted in the proximal end of the small diameter portion 25G. The liquid that has passed through the first pipeline 31 is sent in a state where the water pressure is increased in the third pipeline 53G, and is sent from the water supply port 21 through the second pipeline 22G.

In the above embodiment, an example was shown in which the fluid was saline solution, but the fluid is not limited to this and may be a medicinal solution, etc.

According to the above-mentioned endoscopic treatment tool 1, the liquid can be delivered from the water delivery port 21 with the liquid pressure increased in the third conduit 53. Therefore, even if the water delivery means connected to the liquid delivery nozzle 41 of the operation unit 4 is a low-pressure or low-flow syringe or a low-performance water delivery pump, the liquid can be delivered from the water delivery port 21 with strong water pressure. This eliminates the need to replace the high-frequency knife with the local injection needle to perform local injection, thereby shortening the treatment time.

Because water can be delivered at high pressure from the water supply port 21, if blood or mucous membrane gets into the second pipeline 22 of the knife 2, the matter that has adhered and become burnt due to repeated energization can be removed by delivering the fluid. As a result, clogging of the water supply pipeline due to burnt matter can be prevented.

Although each embodiment of the present invention has been described above, the technical scope of the present invention is not limited to the above-mentioned embodiments, and it is possible to change the combination of components in each embodiment, make various modifications to each component, or delete components without departing from the spirit of the present invention. The present invention is not limited by the above description, but is limited only by the scope of the attached claims.

It is possible to provide an endoscopic treatment tool that can deliver liquids such as medicinal solutions and saline using strong water force from the distal end of the treatment tool without using a high-performance water supply pump.

1, 1A Endoscopic treatment tool 2 High frequency knife (treatment part)
2F Forceps (treatment section)
3 Operation wire (tube member)
5 Cylinder 7 Connector 10 Sheath 411 Inlet (supply port)
31 First pipeline 22 Second pipeline 53 Third pipeline 21 Water supply port

Claims (15)

A sheath,
a tubular member extending freely within the sheath and having a first duct;
a conductive treatment unit connected to a distal end of the tubular member and having a second conduit and a water supply port capable of supplying a fluid;
Equipped with
the treatment section has a third pipeline located between the water supply port and the distal end of the tubular member,
The third pipeline has an opening area smaller than the opening areas of the first pipeline and the second pipeline . The endoscopic treatment tool according to claim 1 , wherein a distal end of the third conduit is located distal to a proximal end of the treatment section. the distal end of the third conduit is located proximal to the distal end of the second conduit;
The endoscopic treatment tool according to claim 1 , wherein a step is formed between the distal end of the third conduit and the second conduit. The endoscopic treatment tool according to claim 3 , wherein the step is provided at a proximal end of the second pipeline. The endoscopic treatment tool according to claim 1 , wherein the third channel is formed at a distal end of the tubular member. The endoscopic treatment tool according to claim 5 , wherein a distal end of the tubular member is inserted into the second channel. a cylinder having the third pipe,
The endoscopic treatment tool according to claim 1 , wherein a distal end of the cylindrical body is inserted into the second duct of the treatment section. The endoscopic treatment tool according to claim 1 , wherein the third channel is formed proximal to the second channel of the treatment section. The endoscopic treatment tool according to claim 1 , wherein an inclined surface is formed between a proximal end of the third conduit and the first conduit. The sheath has a heat-resistant and insulating tip at a distal end thereof,
The endoscopic treatment tool according to claim 1 , wherein the treatment portion is a high-frequency knife that is inserted into the insulating tip and is movable forward and backward relative to the sheath. A cylindrical body having the third pipe line;
a connector that connects the cylindrical body and the high-frequency knife and is made of a conductive material;
The connector and the insulating tip come into contact with each other, thereby determining a protruding position of the high-frequency knife relative to the sheath.
The endoscopic treatment tool according to claim 10. a connector that connects the tube member and the high-frequency knife and is made of a conductive material;
The connector and the insulating tip come into contact with each other, thereby determining a protruding position of the high-frequency knife relative to the sheath.
The endoscopic treatment tool according to claim 10. The high frequency knife is
a distal end member having insulating properties and in which the water supply port is formed;
The endoscopic treatment tool according to claim 10 , further comprising: a conductive portion that is disposed at a proximal end of the distal end member and has an outer edge portion exposed on a proximal side of the distal end member. The treatment section includes a pair of forceps members and a shaft member to which the pair of forceps members are provided on a distal side,
The endoscopic treatment tool according to claim 1 , wherein the second duct is formed in the shaft member. The treatment portion is a knife having a large diameter portion located at a distal end of the knife and a small diameter portion located in a region from the large diameter portion to a proximal end of the knife,
The second duct extends from the proximal end to the distal end of the knife, and the water supply port opens in the large diameter portion.
The endoscopic treatment tool according to claim 1 .

Images