JPH0546426Y2 - - Google Patents

Description

[Detailed description of the invention] [Industrial application field] The present invention is applicable to endoscopic treatment tools such as basket forceps that are inserted into body cavities to grasp foreign objects, and high-frequency snares that are used to remove polyps inside body cavities. Regarding.

[Prior Art] Basket forceps are known for grasping foreign bodies such as stones generated in body cavities such as the biliary tract or the bladder. This general basket forceps is constructed as shown in FIGS. 4 and 5. That is,
The basket forceps is provided with an operating section 2 on the proximal side of a flexible sheath 1. To explain the operating section 2, a proximal body 3 is connected to the proximal end of the sheath 1. This hand portion main body 3 is provided with a liquid feeding port 4 that communicates with the sheath 1. A slider shaft portion 5 is provided on the hand portion main body 3 so as to protrude rearward. A first finger hook 6 is provided at the end of the shaft 5 on the proximal side. A slider 8 having two second finger hooks 7, 7 is provided on the shaft portion 5 so as to be slidable in the axial direction thereof. A proximal end of an operating wire 9 inserted into the sheath 1 so as to be freely advanced and retracted is connected to the slider 8.

By moving the slider 8 back and forth, the operating wire 9 can be moved back and forth within the sheath 1. Therefore, the shaft portion 5 is provided with a guide groove 5a through which the operating wire 9 is passed.

A grasping basket portion 10 is provided at the tip of the operating wire 9. As shown in FIG. 5, in this gripping basket part 10, the rear end portions of a plurality of elastic wires 11 are fastened to the tip end of the operating wire 9 by a binding member 12. As shown in FIG. The tip of each elastic wire 11 is bound by a tip 13. In the middle part of each elastic wire 11, there are two bending points 14, 14 bent outward.
is formed. A side portion 14a between these bent portions 14, 14 is parallel to the central axis of the basket portion 10.

By moving the operating wire 9 back and forth using an operating device (not shown), the basket portion 10 is inserted into and removed from the opening at the distal end of the flexible sheath 1.

When using the basket forceps, the sheath 1 of the basket forceps is inserted into the body cavity through a channel tube or the like of an endoscope that has been previously introduced into the body cavity. When the basket portion 10 is protruded from the distal end of the flexible sheath 1 in the body cavity, each elastic wire 11 deforms by its own elastic force, expanding the basket portion 10 so that foreign matter can be taken in. do. Next, the foreign object is grasped by pulling the operating wire 9 and drawing the basket portion 10 into the distal end of the sheath 1 to contract it.

By the way, the shape of the basket portion 10 in the general basket forceps shown in FIG.
4 is less than 2, and moreover, the number of adjacent bending points 14
The side portion 14a in between is parallel to the direction in which the operating wire 9 moves forward and backward. Therefore, the elastic wire 11 of the basket portion 10 is easily crushed by receiving force from the outside. In particular, in a narrow lumen, the basket portion 10 does not expand sufficiently, making it difficult to grasp foreign objects such as stones.

On the other hand, the shapes of the basket portions of this type of basket forceps include those shown in Japanese Utility Model Publication No. 9601/1982 and those shown in Japanese Patent Application Laid-open No. 197443/1983.

The former has a shape in which the length between the bending point closest to the user's hand in the elastic wire and the binding member is increased to increase the overall length of the basket portion. The latter provides three bending points on each elastic wire,
The length of the bending point closest to the user's hand and the binding member are shortened to shorten the overall length of the basket portion.

The shape of the basket portion in the former Utility Model Publication No. 61-9601 has a long length from the bending point located closest to the user's hand to the binding member. For this reason, the part of the basket portion that expands to the maximum is far away from the distal end of the sheath. Furthermore, in a shallow lumen region, the distal tip comes into contact with the body cavity wall, making it difficult to bring the maximum expanded portion close to the target foreign object, making it difficult to use it to grasp a foreign object. Furthermore, even if the proximal portion of the basket portion is only slightly accommodated within the sheath, the basket portion closes to a small size.

Furthermore, in the latter one disclosed in Japanese Patent Application Laid-Open No. 63-197443, the length from the bending point on the hand side to the binding member is short, so the basket portion does not expand greatly. Therefore, large foreign objects cannot be gripped by the basket portion. Particularly in a narrow portion such as a lumen, the pressure from the surroundings is large, making it difficult to expand the tube sufficiently and making it difficult to grasp a foreign object.

The one shown in Figure 6 is a general high-frequency snare 15.
shows. This high frequency snare 15 has a flexible sheath 1
The operating wire 9 is inserted into the inside so that it can move forward and backward. A loop wire portion 18 is attached to the tip of the operating wire 9. This loop wire portion 18 has one elastic wire bent into two at the middle thereof, and two bending points 19, 19 bent outward are formed in the middle of both sides thereof. Further, a portion of the side 19a between these bending points 19, 19 is parallel to the central axis of the loop wire portion 18.

When operating this high-frequency snare, by advancing the operating wire 9 and protruding the loop wire section 18 from the distal opening of the sheath 1, the loop wire section 18 is expanded by the elastic force of the elastic wire. Put the polyp inside. Then, by retracting the operating wire 9, the loop wire section 18 is drawn into the distal end of the sheath 1, and while tightening the neck of the polyp, a high frequency current is applied to the loop wire section 18 through the operating wire 9. Remove polyps.

In this high-frequency snare as well, the loop wire portion 18 has approximately the same shape as the basket portion in the above-mentioned general basket forceps, and has a bending point 1.
9,19 is small and its adjacent bending point 19,1
Since the side portion 19a between the loop wire portions 9 is parallel to the advancing and retreating direction of the operating wire 9, the elastic wire of the loop wire portion 18 is likely to be crushed by receiving force from the outside. Particularly in a narrow lumen, the loop wire portion 18 does not expand sufficiently, making it difficult to grasp foreign objects such as stones.

[Problem to be solved by the invention] The purpose of the invention is to reliably widen the elastic wire part of the treatment part even in shallow or narrow body cavities by protruding the treatment part from the sheath. An object of the present invention is to provide an endoscopic treatment tool that can perform the following tasks.

[Means and effects for solving the problem] In order to solve the above problem, the present invention has a treatment section provided at the tip of the operating wire inserted through the sheath so as to be able to be taken in and out from the tip of the sheath as follows. did. That is, it has a plurality of elastic wire parts extending from the distal end to the proximal end, and the distal end and the proximal end of each elastic wire part are tied together, and the elastic wire parts are connected from the distal end to the proximal end of each elastic wire part. First to fifth bending points are formed in the middle part, the first bending point at the most distal end and the fifth bending point at the rearmost end are bent inward, and the second to fourth bending points are formed by bending inward. The points are bent outward, and the elastic wire portion between the fifth bending point and the proximal binding portion of each elastic wire portion is formed gently with respect to the central axis of the treatment section, and the sheath When the treatment section is protruded from the treatment section, all sides between the bending points are inclined at an angle with respect to the central axis, and the treatment section has a substantially octagonal shape.

However, according to the treatment section with such a configuration,
When the treatment section is protruded from the distal end of the sheath, the first and fifth bending points bent inwardly ensure that the second to fourth bending points bent outwardly move outwardly. Expand to.

[Example] FIG. 1 shows a basket forceps according to a first example of the present invention. This basket forceps is provided with an operating section 2 at the proximal end of a flexible sheath 1. To explain the operating section 2, a proximal body 3 is connected to the proximal end of the sheath 1. This hand portion main body 3 is provided with a liquid feeding port 4 that communicates with the sheath 1. A slider shaft portion 5 is provided on the hand portion main body 3 so as to protrude rearward. A first finger hook 6 is provided at the end of the shaft 5 on the proximal side. The shaft portion 5 includes
Slider 8 having two second finger hooks 7, 7
is provided so as to be slidable in its axial direction. A proximal end of an operating wire 9 inserted into the sheath 1 so as to be freely advanced and retracted is connected to the slider 8.

By moving the slider 8 back and forth, the operating wire 9 can be moved back and forth within the sheath 1. The shaft portion 5 has a guide groove 5a for passing the operating wire 9.
is provided.

A basket portion 20 serving as a treatment portion is provided at the tip of the operating wire 9. This basket portion 20 is attached to the tip of the operating wire 9 inserted through the sheath 1. The basket portion 20 is constituted by a plurality of elastic wires 21, and in this embodiment, four elastic wires 21 in upper and lower and left and right pairs. The base ends of these elastic wires 21 are bundled together with the tip of the operating wire 9 by a binding member 22 serving as a proximal binding portion and connected to the tip of the operating wire 9. Further, the tip of each elastic wire 21 is bound by a tip 23. Note that the operating wire 9 is formed by bundling extended portions of the plurality of elastic wires 21 on the proximal end side.

The elastic wire 21 has first to fifth bending points (bending portions) 24a to 24e formed at certain intervals in order from the tip on the distal tip 23 side to the base end on the binding member 22 side. There is. Each elastic wire 21 is opened by these first to fifth bending points 24a to 24e, and the basket portion 2
0 as a whole has a habit of expanding into a basket shape.

Furthermore, the first bending point 24a at the most distal end and the fifth bending point 24e at the rearmost end are bent toward the inside of the basket portion 20. Second bending point 24b~
The fourth bending point 24d is bent toward the outside of the basket portion 20. Then, the bending point 24
The first to fourth sides 25a between each of a to 24e
25d are all not parallel to the forward and backward movement direction of the operating wire 9, that is, the central axis of the basket portion 20, but are inclined. Moreover, the fifth bending point 2
The side 25e between the binding member 4e and the binding member 22 is gently curved at a gentle inclination angle with respect to the central axis. Furthermore, the first to fourth sides 25a
25d are approximately the same length, and when the basket portion 20 is expanded, each side of the pair of elastic wires 21 on the same plane forms a substantially regular octagon. In addition, if the portion between the fifth bending points 24e is included, the shape becomes a substantially regular 9-gon.

A case will be described in which a foreign object in a body cavity, for example, a bile duct stone, is grasped and recovered using an endoscopic treatment instrument having the basket portion 20 configured as described above. By operating the operating section 2, the operating wire 9 is retracted and the basket section 20 is housed within the sheath 1. Then, in this state, the distal end of the sheath 1 is pushed into the body cavity through an insertion channel of an endoscope (not shown) that has been previously introduced into the body cavity. That is, the distal end of the sheath 1 protruding from the distal opening of the insertion channel is inserted into the common bile duct from the duodenal papilla.

Next, when the slider 8 of the operating section 2 is moved forward relative to the shaft section 5, the basket section 20 protrudes from the distal end of the sheath 1 and expands. That is, since the elastic wire 21 constituting the basket portion 20 has a habit of expanding into a basket shape, it expands into a basket shape by itself due to its own elastic force. Stones can be taken in from the gaps between the elastic wires 21 which are spread out in a basket shape in this manner.

Next, in the operating section 2, when the slider 8 is pulled toward the proximal side and the operating wire 9 is retreated, the proximal side portion of the basket section 20 is drawn into the inside of the distal end of the sheath 1. Therefore, the basket section 20 is reduced in size. Therefore, the stone is grasped inside the reduced basket portion 20, and can be extracted from the body cavity alone or together with an endoscope and recovered outside the body.

In this case, a side 25a between each of the first to fifth bending points 24a to 24e in each elastic wire 21
25d are all inclined at a certain angle with respect to the advancing and retreating direction of the basket portion 20, so that the basket portion 20 is difficult to collapse in the expanded state. Further, a fifth bending point 24 facing inward of the basket portion 20 is provided at the rear end side portion of the elastic wire 21.
Because of the provision of e, the overall length of the basket portion 20 is shortened, making it easy to bring the basket portion 20 close to the target site even in a shallow lumen. Furthermore, since the elastic wire 21 expands between the fifth bending point 24e and the binding member 22, even a stone larger than the basket portion 20 can be grasped.

FIG. 2 shows a second embodiment of the present invention. This example is a basket forceps for crushing stones. The sheath 26 has a flexible inner cylinder 27
The sheath 26 has a double structure including a sturdy outer tube 28 for preventing buckling, and a hard tip tube portion 29 is provided at the tip of the sheath 26. A plurality of crushing teeth 29a are formed at the tip edge of the tip tube portion 29. An operating wire 9 is inserted into the sheath 26, and a basket portion 30 for crushing stones is connected to the distal end of the operating wire 9.
This basket section 30 has basically the same configuration as the basket section 20 of the first embodiment described above, but is located in front of the first bending point 24a of the elastic wire 21, that is, near the rear end of the distal tip 23. An enlarged portion (point) 31 is provided at. This expanded portion 31
Length L ₁ of the side 32 between and the first bending point 24a
is approximately 1/2 of the length _L2 of each of the first to fourth sides 25a to 25d.

According to the basket forceps for stone crushing constructed in this manner, after grasping a stone within the bile duct, the operation wire 9 is pulled and the elastic wire 21 of the basket portion 30 compresses and crushes the stone. Furthermore, the same effects as in the first embodiment can be obtained.

Furthermore, according to the second embodiment, since the expansion point 31 is provided for expanding the elastic wire 21 from the position of the rear end portion of the distal tip 23, it is possible to expand the elastic wire 21 even more, and The amount of operating force needed to project the basket portion 30 from the sheath 1 can be reduced.

FIG. 3 shows a third embodiment of the present invention. This embodiment relates to a high frequency snare. The high frequency snare 40 has a sheath 1 made of an electrically insulating material. The distal end of the sheath 1 is cut obliquely to form an inclined distal edge 1a in order to improve insertability. Further, by tilting the distal end edge 1a of the sheath 1, it is possible to provide directionality when protruding a snare loop 42, which will be described later.

An operating section 2 is attached to the proximal end of the sheath 1.
The operation unit 2 is constructed in the same manner as in the first embodiment described above, and further includes a plug 41 on the slider 8 for electrical connection to the conductive operation wire 9.

Further, a snare loop 42 serving as a treatment section is directly connected to the tip of the operating wire 9 using a binding member 22. The snare loop 42 consists of a pair of elastic wire parts 43a and 43b formed from a single elastic wire. That is, a single conductive elastic wire is bent in the middle to form a pair of elastic wire portions 43a and 43b on each side. Each end of the pair of elastic wire parts 43a, 43b is bound with the binding member 22 and connected to the operating wire 9 with the bent part 44 at the tip.

First to fifth bending points 24a to 24e similar to those of the first embodiment described above are formed in the pair of elastic wire portions 43a and 43b. Furthermore, the sides 25a to 25d between the first to fifth bending points 24a to 24e are also arranged in the forward and backward directions of the basket portion 20, that is, as in the first embodiment.
They are all inclined at a certain angle with respect to the central axis of the snare loop 42.

The side 25e between the fifth bending point 24e and the binding member 22 is gently inclined with respect to the central axis of the snare loop 42 and is gently curved. Further, the first to fourth sides 25a to 2
5d have substantially the same length, and the snare loop portion 42 forms a substantially regular octagonal ring when expanded.

Therefore, when the high-frequency snare 40 configured as described above is used to remove tissue in a body cavity, such as a polyp, the snare loop portion 42 is housed in the sheath 1, and the sheath 1 is inserted into the endoscope. Insert into the body cavity through the insertion channel. Then, when the snare loop portion 42 is protruded from the distal end of the sheath 1 by advancing the operating wire 9 under observation with an endoscope, the snare loop portion 42
The elastic wire portions 43a and 43b expand by their own elastic restoring force. Then, a polyp is placed inside the snare loop portion 42. After that, by retracting the operating wire 9, the snare loop portion 4
2 into the inside of the sheath 1 and tighten the neck of the polyp. A high-frequency generator connected to the plug 41 of the operating section 2 via a cord (not shown) supplies a high-frequency current to the snare loop section 42 through the operating wire 9 . This causes the polyp to be cauterized and removed. According to the high frequency snare 40 configured in this way, the same effects as in the first embodiment can be obtained.

It should be noted that the present invention is not limited to the embodiments described above, and various modifications can be made without changing the gist of the invention.

[Effects of the invention] As explained above, the endoscopic treatment instrument of the present invention has five bending points in the plurality of elastic wire parts constituting the treatment section, and the sides between the bending points. are all inclined at angles with respect to the advancing and retreating direction of the treatment section, so that the treatment section made up of the plurality of elastic wire sections is less likely to be crushed by compression from the outside. Furthermore, the overall length of the treatment section is shortened, making it easier to bring the treatment section closer to the target site even in a shallow body cavity. Furthermore, even if the treatment section consisting of a plurality of elastic wire sections is slightly pulled into the sheath, it will not be reduced in size. Furthermore, since the elastic wire expands between the fifth bending point on the proximal side and the binding member, the elastic wire expands considerably and has the excellent effect of being able to easily grasp even a large stone.

[Brief explanation of the drawing]

FIG. 1 is a side view of an endoscopic treatment device according to a first embodiment of the present invention, and FIG. 2 is a side view of an endoscopic treatment device according to a second embodiment of the present invention. FIG. 3 is a partially cutaway side sectional view showing the vicinity of the distal end of the instrument; FIG. 3 is a partially cutaway side view of the endoscopic treatment instrument according to the third embodiment of the present invention; FIG. FIG. 5 is a side view of a conventional endoscopic treatment instrument; FIG. 5 is a longitudinal cross-sectional view of the vicinity of the distal end of the conventional endoscopic treatment instrument; FIG. 6 is a distal end of a conventional endoscopic high-frequency snare. It is a vertical cross-sectional view of the vicinity. 1... Sheath, 9... Operation wire, 20, 30
... Basket part (treatment part), 21 ... Elastic wire part, 22 ... Binding member (proximal side binding part), 24
a to 24e...first to fifth bending points, 25a to 2
5d... Side, 26... Sheath, 30... Basket part (treatment part), 40... Snare loop part (treatment part), 42... Snare loop part 42, 43a, 4
3b...Elastic wire section.

Claims (1)

[Scope of utility model registration request] A treatment section configured to be expandable and retractable is connected to the tip of an operating wire that is inserted into the sheath so as to be freely advanced and retracted using an elastic wire having multiple bending points, and the treatment section is inserted and removed from the tip of the sheath. The endoscopic treatment instrument has a plurality of elastic wire sections extending from the distal end to the proximal end, and the distal end and the proximal end of each elastic wire section are tied together to form a treatment section. , first to fifth bending points are formed in the middle part of each of the elastic wire parts from the distal end to the base end on the proximal side, and the first bending point at the most distal end and the fifth bending point at the rearmost end are located on the inner side. The second to fourth bending points are formed by bending outward, and the elastic wire portion between the fifth bending point and the proximal binding portion of each elastic wire portion is Formed gently with respect to the central axis of the section,
and in a state in which the treatment section is protruded from the sheath, all sides between the bending points are inclined at an angle with respect to the central axis, and the shape of the treatment section is approximately octagonal. Treatment instruments for endoscopes.