JPH03231654A - Treatment device for endoscope - Google Patents

Abstract

PURPOSE:To reduce the diameter of a sheath by preventing a liquid leak at the time of liquid feed or an air leak at the time of suction by hermetically covering the sheath part coming out of the channel port part of an endoscope. CONSTITUTION:Bellows 10 constitutes a freely expansible cover means hermetically covering a sheath 2 and a rubber plug 13 hermetically connected to the cap part of the insertion port part 12 of the treatment device inserting channel of an endoscope in a freely detachable manner is provided to the other end of the bellows 10. When a contrast medium is fed, the bellows 10 is extended to fit the leading end rubber plug 13 in the cap part of the insertion port part of the endoscope 11 to connect the same to the cap part in a liquidtight manner and, therefore, the exposed part of the sheath 2 coming out of the insertion port part 12 of the endoscope 11 is perfectly covered with the bellows 10. As a result, a liquid leak is eliminated at the time of liquid feed and a liquid can be certainly fed out. Further, even when the liquid in the gall bladder 15 is absorbed, the open air is not sucked from the part of the sheath 2 and the lowering of suction force can be prevented.

Description

DETAILED DESCRIPTION OF THE INVENTION [Field of Industrial Application] The present invention relates to an endoscopic treatment instrument that is inserted endoscopically into a body cavity, for example, for crushing a stone formed within the body cavity. .

[Prior Art] Stones occurring in organs such as the biliary tract or bladder cause pain and various adverse biological effects on the patient. In particular, enlarged stones cause great pain to patients.

Therefore, for this treatment, a stone crushing device has been provided which is inserted endoscopically into a body cavity and crushes a stone formed in the body cavity to expel or remove it from the body. As this calculus crushing device, for example, JP-A-61
As shown in Japanese Utility Model Publication No. 181453 and Japanese Utility Model Publication No. 62-14812, etc., a calculus grasping basket made of a plurality of elastic wires is provided at the tip of an operating wire inserted into a flexible sheath. , After grasping the stone in this basket, pull the operating wire toward the proximal side to reduce the size.
It is designed to crush stones.

In this type of lithotripter, the flexible sheath consists of a tightly wound coil (spring body) so that the traction force from the operating wire is sufficiently transmitted to the distal basket during lithotripsy. .

By the way, when using this stone crushing device,
Before lithotripsy, X-ray fluoroscopy is performed to confirm the presence and condition of the stone. For this purpose, it is necessary to inject a contrast medium.

However, since the flexible sheath consists of a tightly wound coil (spring body), when the liquid is sent through it, it leaks through the gaps between the strands of the coil (spring body) and cannot be sent to the tip.

Furthermore, when a stone crushing device is introduced into a body cavity through a channel of an endoscope and used, a suction operation is performed through the channel of the endoscope. However, when a flexible sheath is constructed from a tightly wound coil (spring body), outside air is sucked through the sheath through the gaps between the wires rather than inside the body, reducing the suction ability.

For this reason, the conventional stone crushing device (Japanese Patent Laid-Open No. 61-1814
53 and Utility Model Publication No. 62-14812), a double structure is used in which a tube is provided in addition to a tightly wound coil.

[Problem 8 to be solved by the invention] However, if the sheath of the stone crushing device is made to have a double structure of a tightly wound coil and a tube, it inevitably becomes thick. Moreover, in order to smoothly insert and remove the calculus grasping basket from the tip of the sheath, the inner diameter has to be adjusted to a certain level! Therefore, the overall outer diameter becomes even larger.

As described above, the sheath of the conventional lithotripter becomes thick. This also requires increasing the inner diameter of the endoscope channel, making the endoscope thicker and causing more pain to the patient.

By the way, as in Utility Model Application Publication No. 63-197443,
There is a known structure in which a sleeve is wrapped around the proximal side of a sheath made of a tightly wound coil, and the sleeve is inserted into a channel of an endoscope. However, with this structure, depending on the amount of insertion of the endoscope into the channel and the length of the sleeve, the sleeve may come off and come off from the channel opening of the endoscope. In this case, fluid leakage and a decrease in suction occur. It is an object of the present invention to provide a treatment tool for an endoscope, which can prevent leakage during liquid feeding and decrease in suction ability (leakage) during suction with an endoscope.

[Means and effects for solving the problems] In order to solve the above problems, the endoscopic treatment instrument of the present invention has a sheath made of a coil, in which an operating wire having a treatment member at its tip is slidably inserted. An operating section for sliding the operating wire is provided on the proximal side of the sheath, and a retractable cover is attached at one end near the proximal side of the sheath and sealingly envelops the sheath. Provide packaging means,
The other end of the enveloping means is provided with a connecting means that is sealingly connected to the mouth of the channel of the endoscope, and is provided with an injection means for feeding fluid into at least one of the enveloping means and the sheath. It is.

Thus, when this endoscopic treatment instrument is assembled to an endoscope and the sheath portion is inserted into the channel, the sheath portion protruding from the channel opening of the endoscope is hermetically encapsulated. This makes it possible to prevent liquid leakage from this portion during liquid feeding and air leakage during suction with an endoscope.

Therefore, the sheath of the endoscopic treatment instrument can be made smaller in diameter,
Leakage during liquid delivery and decrease in suction ability when suctioning with an endoscope (
leakage).

[Embodiment] FIGS. 1 to 7 show a first embodiment of the present invention. As shown in FIG. 1, the calculus crushing device 1 of this embodiment has a sheath 2 made of a coil (spring) of tightly wound wire.
The sheath 2 has a plurality of wire relief grooves 3 at its tip.
A distal tip 4 made of a cylindrical hard member with a cylindrical shape formed on the edge of the distal opening is attached. A cap 6 having an injection port body 5 is attached to the rear end of the sheath 2 in a liquid-tight manner. The interior of the sheath 2 communicates with the cap 6. As shown in FIG. 4, this cap 6 consists of a first member 6a on the front end side and a second member 6b on the rear end side, and the first member 6a and the second member 6b are
They are connected by screws 7. The inlet body 5 is integrally formed with the first member 6a. Further, a flange 8 is formed at the distal end of the first member 6a, into which the rear end of the sheath 2 is fitted and fixed.

Furthermore, one end of a bellows 10 that is covered with the sheath 2 and expands and contracts in the axial direction of the sheath 2 is fitted and fixed to the flange 8 . The bellows 10 is made of a material that does not leak, and is configured to expand and contract in the axial direction of the sheath 2. In other words, the bellows 10 constitutes a telescopic covering means for sealingly covering the sheath 2.

As shown in FIG. 5, the other end of the bellows 10 is provided with a rubber stopper 13 that is removably connected in a sealed manner to the base of the insertion port 12 in the treatment instrument insertion channel of the endoscope 11. ing. The rubber stopper 13 constitutes a connection means that is removably connected in a sealed manner to the insertion opening 12 in the treatment instrument insertion channel of the endoscope 11. Rubber stopper 1
3 is pressed to the outer periphery of the base portion of the insertion opening portion 12 using an elastic material, and is formed in a shape that fits into a circumferential groove 15 formed on the outer periphery of the base portion.

An operating wire 16 is slidably inserted into the sheath 2. As shown in FIG. 1, a calculus grasping basket 17 is provided at the tip of the operating wire 16. This basket 17 binds both front and rear end portions of a plurality of elastic wires 17a with binding tips 18a and 18b, respectively. A plurality of bent portions 19 are formed in the middle of each elastic wire 17a, and the elastic wire 17a is formed into a basket shape that can be opened and closed and expanded and contracted in the axial direction of the operating wire 16.

Further, a straight rod-shaped coupling member 21 is provided at the base end of the operating wire 16.
The tip is fixed. As shown in FIG. 4, the coupling member 21 is formed with a through hole 22 that passes through the first member 6a and the second member 6b of the base 6, and the coupling member 21 is slid into the through hole 22. It passes freely. An O-ring 23 is inserted between the first member 6a and the second member 6b. This O-ring 23 maintains a liquid-tightness of the portion through which the coupling member 21 is inserted. Further, the sheath 2 and the injection port 5 communicate with each other via the through hole 22 thereof.

On the other hand, an operating section 25 for slidingly operating the operating wire 16 is detachably connected to the base 6. The operating section 25 is configured as shown in FIG.

That is, it has a main body 26, and a grip portion 27 for the operator to grasp is integrally formed on the distal end side of the main body 26. An insertion hole 28 coaxially extends through the main body 26 and the grip portion 27 and extends through both. A ring body 29 is provided at the tip of the grip portion 27 coaxially with the insertion hole 28 . This ring body 2
A set screw 30 is screwed into 9 so that it moves forward and backward in that direction.

Then, the end of the second member 6b of the base 6 is fitted into the ring body 29, and the set screw 30 is screwed in, and the tip of the set screw 30 is formed on the outer peripheral surface of the second member 6b. If you engage with the Tamizosan rumor,
The cap 6 can be connected to the operating portion 25 thereof.

A rack body 31 is slidably inserted into the insertion hole 28 of the operating section 25. The rack body 31 is shown in FIGS.
As shown in the figure, the cross-sectional shape is circular, and a rack 32 is formed on the outer surface of one radial end over almost the entire length in the axial direction. In addition, a guide groove 33 that is open in the radial direction is formed in a portion of the rack 32 excluding both ends in the axial direction, and a through hole 34 that communicates with the guide groove 33 is bored in both ends in the axial direction. It is set up.

The base end portion of the coupling member 21 protruding from the second member 6b of the base 6 connected to the operating portion 25 is connected to the through hole 3.
4 and the guide groove 33, and its end protrudes from the base end of the rack body 31. In addition, the rack body 3
1 is screwed onto the main body 26 of the operating section 25 and is prevented from rotating by a guide screw 35 that engages with a guide groove 33.

At the base end of the rack body 31 is a grip portion 3 that is slidable.
6 are connected. A mounting hole 37 is formed in the grip portion 36 so as to be coaxial with the coupling member 21 inserted into the operating portion 25 . The end of the coupling member 21, on which the flat portion 21a is formed, is inserted into the attachment hole 37. Furthermore, a storage hole 38 is formed in the grip portion 36 in the radial direction, intersecting with the mounting hole 37 . The storage hole 38 has three engagement holes penetrating in the radial direction in the middle of the axial direction, and is biased in the protruding direction by a fixing rod 41 having a button 40 attached to the upper end and a spring 42. ing. Therefore, the fixing rod 41 is pushed against the spring 42 and the engagement hole 39 is opened.
While facing the mounting hole 37, insert the end of the coupling member 21 into the mounting hole 37, position the flat part 21a at the engagement hole 39, and then press the fixing rod 4]. When released, the flat portion 21a and the fixing rod 41 engage with each other, thereby fixing the coupling member 21 to the grip portion 36.

Therefore, the operating wire 16 can be moved forward and backward by the grip portion 36 via the coupling member 21.

As shown in FIG.
It is rotatably supported by 4. A first gear 45 is provided at one end of this first support shaft 43, and a handle 46 is provided at the other end. Further, as shown in FIG. 3, the main body 26 is rotatably supported by a second support shaft 47 whose axis is parallel to the first support shaft 43 or by a bearing 48 . A second gear 49 that meshes with the first gear 45 and has more teeth than the first gear 45 is attached to one end of the second support shaft 47 .

A housing portion 50 that is open to the guide groove 33 is formed in a portion of the main body 26 corresponding to the middle portion of the second support shaft 47 . A third gear 51 fitted to the second support shaft 47 is provided in this housing portion 50, and this third gear 51
meshes with the rack 32. Therefore, when the handle 46 is rotated, this rotation causes the first and second gears 4 to rotate.
Since the speed is reduced by 5° 49 and transmitted to the third gear 51, the rack body 31 can be moved forward and backward by the third gear 51, and the operating wire 16 can be interlocked therewith via the coupling member 21.

Next, the operation of crushing a stone 15a in a body cavity, for example, in the gallbladder 15 using the stone crushing device 1 configured as described above will be described.

First, as shown in FIG. 6, the endoscope 11 is inserted through the biological channel that reaches the patient's bile a15. Then, by operating the connecting member 21 of the stone crushing device 1 and contracting the basket 17 into the sheath 2, the sheath 2 is inserted into the endoscope 11.
Insert it into the channel. When the sheath 2 protrudes from the tip of the endoscope 11, push the coupling member 21 forward,
Expand the basket 17.

Then, as shown in FIG.
It fits into the mouthpiece part of and connects liquid-tightly. When performing contrast imaging, a syringe barrel 53 containing, for example, a contrast agent 52 is attached to the injection port body 5, and the contrast agent 52 is injected as described later.

Then, by performing contrast imaging, the stone 23 is reliably taken into the basket 17. If the stone 15a is small, the stone crushing device 1 is pulled out together with the endoscope 11 and collected.

In addition, if the stone 15a is too large to be removed from the gallbladder 15, the connecting member 21 is pulled to move the operation wire 16 backward, and the basket 17 is applied to the hard distal tip 4 at the distal end of the sheath 2 to reduce the size of the stone. As a result, the stone 15a is crushed. In addition, in cases where the connecting member 21 cannot be broken by pulling it by hand, the connecting member 21
1 by hand, the connecting member 21 is retracted via the rack body 31 by connecting the operating part 25 to the base 6 and rotating the handle 46 of the operating part 25. In this way, the stone 15a can be reliably and powerfully crushed.

In other words, if the stone 15a is crushed using the operating section 25,
Since the rotational force of the handle 46 can be transmitted to the coupling member 21 in a gentle manner and its traction force is amplified, the calculus 15a can be gradually crushed with a small amount of force.

By the way, as mentioned above, when delivering a contrast agent, etc.,
As shown in FIG. 5, the bellows member 10 is stretched and the rubber stopper 13 at the tip is fitted into the base of the insertion port body 12 of the endoscope 11 for a liquid-tight connection, so that the sheath 2 is connected to the endoscope. 1], the exposed portion protruding from the mouth of the insertion port body 12 is completely covered by the bellows member 10. Therefore, there is no leakage during liquid feeding, and the liquid can be fed reliably.

Further, even when absorbing liquid or the like in the gallbladder 15 as necessary, the outside air is not sucked through the sheath 2, and a decrease in the suction force can be prevented.

Furthermore, since the bellows member 10 can be expanded and contracted to freely adjust its length, leakage can be prevented regardless of the length of the portion of the sheath 2 protruding from the insertion port body 12.

FIGS. 8 and 9 show a second embodiment of the present invention.

In this second embodiment, instead of the bellows member 10 as the enveloping means in the first embodiment described above, a first
A slider receiver 55 having a built-in O-ring 54 is provided. Furthermore, a first slider 57 is slidably fitted into the slider receiver 55. The first slider 57 has a plurality of recesses 56 arranged in the axial direction on its outer peripheral surface into which the first O-rings 54 are fitted. The first slider 57 has a second O-ring 58 built into its inner surface, and inside the first slider 57, a plurality of four parts 56 into which the second O-rings 58 are fitted are provided on the outer periphery in the axial direction. A second slider 59 formed side by side is slidably fitted therein. A rubber plug 13 is provided at the tip of the second slider 59. Thus, the slider receiver 55, the first slider 57, and the second slider 59 are slidably fitted into each other in a fluid-tight manner, and they constitute enclosing means that can be expanded and contracted as a whole in the axial direction. are doing.

Therefore, in order to use this, the sheath 2 must be attached to the endoscope 1.
1, when feeding the liquid, slide the first slider 57 and the second slider 59 according to the length of the sheath 2 protruding from the insertion port body 12 of the endoscope 11. Fully stretch the first and second O-rings 54. in appropriate positions.
58 is fitted into the recess 56 and fixed. Furthermore, the rubber stopper 13 is fitted into the insertion port body 12 and is engaged therewith. As a result, the exposed portion of the sheath 2 protruding from the insertion port body 12 of the endoscope 11 is connected to the slider receiver 55 and the first slider 57.
It is completely encapsulated by the second slider 59, and the liquid does not leak during liquid feeding.

Further, although liquid and the like in the gallbladder 15 may be absorbed as necessary, a decrease in suction force can be prevented without sucking outside air from the sheath 2 portion. Further, since this expandable enveloping means can be expanded and contracted to freely adjust its length, leakage can be prevented regardless of the length of the portion of the sheath 2 protruding from the insertion port body 12. Other effects are the same as those of the first embodiment described above.

FIGS. 10 and 11 show a third embodiment of the present invention. In this third embodiment, the through hole 6 of a forceps plug 61 connected to the insertion port body 12 of the endoscope 11 is used instead of the rubber plug 13 at the end of the bellows member 10 of the first embodiment.
2 is provided.

Therefore, when using this embodiment, the endoscope 1
The forceps plug 61 in the insertion port body 12 of No. 1 is fitted and attached, and when feeding liquid, the bellows member 10 is stretched and the insertion part 63 is inserted into the through hole 62 of the forceps plug 61 to connect in a sealed state. This provides the connection state described above and allows use in the manner described in the first embodiment.

FIG. 12 shows a fourth embodiment of the present invention. In this fourth embodiment, the bellows member 10 of the first embodiment has a length that covers the entire sheath 2 when expanded. In this way, the sheath 2 can be completely covered and can be handled hygienically. The inside of the sheath 2 can also be cleaned before and after use. Other effects are similar to those of the first embodiment.

Furthermore, three grasping claws 62 are provided at the tip of the operating wire 16 as a treatment section, and are opened and closed by pushing and pulling the operating wire 16.

Note that the present invention is not limited to the above-mentioned embodiments, and various modifications are possible.

[Effects of the Invention] As explained above, according to the endoscopic treatment instrument of the present invention,
When this is assembled into an endoscope and the sheath portion is inserted into the channel, the sheath portion protruding from the channel opening of the endoscope is hermetically encapsulated. This encapsulation can prevent liquid leakage during liquid feeding and air leakage during suction with an endoscope. Therefore, the diameter of the sheath of the endoscopic treatment tool can be reduced, and leakage during liquid feeding and reduction in suction ability (leakage) during suction with the endoscope can be prevented. Further, the sheath of the endoscopic treatment instrument can be made smaller in diameter.

[Brief explanation of drawings]

1 to 7 show a first embodiment of the present invention, in which FIG. 1 is a side sectional view of the stone crushing device, FIG. 2 is a sectional view taken along the line ■-■ in FIG. 1, and FIG. Figure 3 is a sectional view taken along the line ■-■ in Figure 1, Figures 4 and 5 are side sectional views showing the procedure for attaching the bellows material covering the sheath, and Figures 6 and 7 are views in use. The perspective view, FIGS. 8 and 9 show a second embodiment of the present invention, and the side sectional view and FIGS. Embodiment 3 is shown, and FIG. 12 is a side sectional view showing the procedure for installing the bellows member covering the sheath, and FIG.
FIG. 3 is a side cross-sectional view showing a sheath and a bellows member covering the sheath. DESCRIPTION OF SYMBOLS 1... Stone crushing device, 2... Sheath, 1o... Bellows member, 13... Rubber stopper, 16... Operation wire, 2
5...Operation unit.

Claims (1)

[Claims] A sheath made of a coil, an operating wire slidably inserted into the sheath, a treatment member provided at the tip of the operating wire, and an operation provided on the proximal side of the sheath for sliding the operating wire. a retractable enveloping means having one end attached near the proximal portion of the sheath and sealingly enveloping the sheath; 1. A treatment instrument for an endoscope, comprising: a connection means that is sealingly connected to the sheath; and an injection means that sends a fluid into at least one of the enveloping means and the sheath.