JPH07299078A - Electrotomy device for endoscope - Google Patents

Abstract

PURPOSE:To easily confirm a marking to be the standard for the insertion of a sheath, improve the positioning property in a cutting position, and perform a safe and efficient treatment. CONSTITUTION:In an electric cutting device for endoscope in which a conductive wire 5 is inserted into a sheath 4 having electric insulating property, and the wire 5 is exposed to the outer wall surface of the sheath 4 from a pair of wire leading ports 6a, 6b near a sheath top end part 22 to form a knife part 7, a plurality of markings 23 are provided on the outer surface of the sheath top end part 22. Of the markings 23, at least one marking situated between the wire leading ports 6a, 6b of the sheath top end part 22 is the marking 23 recognizable from the other markings 23.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an electric incision for an endoscope which is inserted endoscopically into a body cavity to electrically incise a living tissue, in particular, a lumen outlet such as a duodenal papilla. Regarding the device.

[0002]

2. Description of the Related Art An incision device for electrically incising a living tissue in a body cavity is known. This is, for example, Japanese Patent Laid-Open No. 5-68.
High frequency incision instrument for endoscope shown in Japanese Patent No. 685, USP
A medical sphincter cutting blade shown in No. 5024617, etc., a conductive wire is inserted into a sheath having electrical insulation properties, and the wire is attached to a sheath outer wall surface from a pair of wire outlets near the distal end of the sheath. It is an exposed structure.

Then, by pulling the wire, the distal end portion of the sheath is curved and the exposed wire portion is stretched to form a knife portion.
The knife portion is brought into contact with the living tissue to electrically incise the living tissue.

Such an incision device is, for example, in the duodenum, when the outlet of the bile duct that carries bile to the duodenum is narrowed by a tumor or a stone, a papillosphincterotomy (hereinafter referred to as EST) is performed to incise the sphincter muscle at the end of the bile duct. It is used and incisions are generally made with high frequency currents.

[0005] When performing EST, generally, first, the endoscope is inserted into the duodenum, and then an incision device is inserted into the endoscope channel, and when the incision device projects from the distal end of the endoscope,
The incision device is inserted from the duodenal papilla into the bile duct by operating the endoscope and advancing and retracting the incision device. Next, the wire of the incision device is pulled to bend the tip of the sheath, and a high-frequency current is passed through the knife with the knife stretched to incise the sphincter.

At this time, it is generally desirable to incise the sphincter at the tip of the knife for the following reasons. 1. By making an incision near the tip of the knife, the contact area between the knife and the sphincter muscle is reduced, and the current density of the high frequency current at the knife portion is increased, so that the incision can be made efficiently in a short time.

2. By making an incision near the tip of the knife,
Prevents overcutting of the sphincter. Here, in order to make an incision at the knife tip while observing with an endoscope, it is necessary to position the incision device in advance in the bile duct before incision.For that reason, currently, the marking on the outer circumference of the sheath is used as a guide. Incision is performed by controlling the depth of insertion of the sheath into the bile duct.

[0008]

However, Japanese Unexamined Patent Publication No.
In the incision device disclosed in Japanese Patent No. 68685, 6 are placed at equal intervals between a pair of wire lead-out ports at the distal end of the sheath.
Two markings are provided. EST using this device
In order to perform the incision at the tip portion of the knife as described above, one of the six markings is selected in advance when the sheath is positioned in the bile duct. It is necessary to insert the sheath from the nipple into the bile duct using the marking position as a guide. At this time, since the widths of the respective markings are all the same, it is difficult to distinguish one selected marking from other markings when positioning the sheath, and it is difficult to position the sheath.

On the other hand, in the incision device disclosed in US Pat. No. 5,024,617, a narrow width 1 is provided in the vicinity of about 1/3 from the knife tip between a pair of wire outlets at the sheath tip.
Marking, two narrow markings in the vicinity of about 2/3, intermediate width marking between the tip of the sheath and the wire outlet on the tip side, wide from the wire outlet on the rear end side to the sheath rear end Has markings.

When the sheath is positioned in the bile duct in the same manner as described above, the sheath is inserted from the papilla into the bile duct using the marking position in the vicinity of about 1/3 from the knife tip as a guide. Since one marking in the vicinity has a different marking width from the intermediate width marking or the wide marking, they can be distinguished from each other, but since the two markings in the vicinity of 2/3 have the same width, respectively. As in Japanese Patent Laid-Open No. 5-68685, it was not easy to distinguish the marking in the vicinity of 1/3 selected when positioning the sheath from other markings, and positioning of the sheath was difficult.

The present invention has been made in view of the above circumstances, and an object thereof is to be a guide for inserting a sheath provided on the outer circumference of a sheath when a living tissue is incised by a tip portion of a knife. It is an object of the present invention to provide an electric incision device for an endoscope, in which the marking can be easily recognized, the positioning property at the incision position is improved, and, for example, EST can be performed safely and efficiently.

[0012]

In order to achieve the above-mentioned object, the present invention inserts a conductive wire into a sheath having electrical insulation properties, and inserts the wire from a pair of wire outlets near the distal end of the sheath. In an electric incision device for an endoscope, which is exposed on an outer wall surface to form a knife portion, a plurality of markings are provided on the sheath distal end portion, and among the markings, a marking located between a pair of wire outlets of the sheath distal end portion. At least one of the markings is a marking distinguishable from other markings.

[0013]

When the sheath is positioned in the bile duct to dissect the papillary sphincter at the knife tip when performing EST, for example, the marking provided between the pair of wire outlets at the tip of the sheath is used as a guide. After inserting an incision device into the bile duct, electrically dissect the papillary sphincter.

[0014]

Embodiments of the present invention will be described below with reference to the drawings. 1 to 12 show a first embodiment, and FIG. 1 is an enlarged view showing the entire configuration and a main part of an electric incision device for an endoscope. In the figure, 1 is a living tissue in a body cavity using high frequency current,
In particular, an incision is made in the duodenal papillary sphincter (so-called ES
T) An electric incision device for an endoscope. This incision device 1 is
It is composed of an insertion section 2 to be inserted into a treatment instrument insertion channel of an endoscope (not shown) and an operation section 3 for an operator to operate the incision device 1.

First, the insertion portion 2 of the incision device 1 will be described. As shown in FIG. 2, a conductive wire 5 is inserted into a sheath 4 having electrical insulation properties, and a pair of wires near the tip of the sheath 4 is inserted. The knife portion 7 is formed by exposing the outer wall surface of the sheath 4 through the outlet ports 6a and 6b.

The sheath 4 is made of a thermoplastic resin, especially PT.
The wire lumen 4a is made of a flexible tube made of fluorocarbon resin such as FE and FEP, and the conductive wire 5 is inserted therethrough, and a sufficient inner diameter that does not interfere with movement of fluid in the lumen or insertion of a guide wire. And a multi-purpose lumen 4b having the above, and more preferably, a multi-lumen tube having four lightening lumens 4c for allowing the sheath 4 to have flexibility.

The conductive wire 5 is a flexible wire made of metal, particularly stainless steel, and at its tip portion 5a, of a pipe made of metal, particularly stainless steel, gold, silver or platinum. It is inserted into the cavity and fixed by means of a fixing agent (especially soldering, brazing, bonding) or welding (especially laser welding, plasma welding).

Here, the pipe 8 may be made of a non-metal material such as tungsten, and is preferably made of a material having high radiopacity such as gold, silver, platinum or tungsten. good.

The pipe 8 has an outer diameter slightly larger than the inner diameter of the wire lumen 4a of the sheath 4,
It is fixed in the wire lumen 4a further on the tip side than the pair of wire lead-out ports 6a, 6b by means such as press fitting or adhesion.

Further, a bent portion 5b is provided in the vicinity of the connecting portion of the pipe 8 of the conductive wire 5 in a direction substantially perpendicular to the longitudinal axis of the sheath 4. Further, the sheath 4
The inside of the multipurpose lumen 4b at the tip of the multipurpose lumen 4b has an outer diameter slightly larger than the inner diameter of the multipurpose lumen 4b, and is made of a material having high radiopacity, particularly gold, silver, platinum or tungsten. The transparent pipe 9 is press-fitted or fixed by means such as adhesion. Here, the pipe 9 may be made of stainless steel or brass.

By forming the bent portion 5b on the conductive wire 5, the fixing force between the sheath 4 and the pipe 8 can be improved when the conductive wire 5 to be described later is activated.

At the most distal end of the sheath 4, there is a small diameter portion 4d having an outer diameter D ₂ smaller than the outer diameter D ₁ of the intermediate portion of the sheath 4, and the thin diameter portion 4d heats the sheath 4. Then, it is formed by narrowing it down in the die. By forming the small-diameter portion 4d, the insertability of the sheath 4 into the bile duct can be improved.

Next, the operation portion 3 of the incision device 1 will be described. As shown in FIG. 3, the distal end portion 4e of the sheath 4 is shown.
Is fixed to the branch portion 10, and the end portion 5c of the conductive wire 5 is connected to the intermediate member 11 fixed to the branch portion 10, the slider 13 movable in the longitudinal direction with respect to the operation portion main body 12, the operation pipe 14, It is fixed via the plug 15.

As shown in FIGS. 4 and 5, the branch portion 10 has a sheath end portion 4e, a connecting pipe 16 and a piece 1.
7, an operation pipe insertion lumen 18, a branch multipurpose lumen 19, a base 20, and an operation portion main body connection portion 21.

As shown in FIG. 6, the sheath end portion 4e has a side hole 4f at a position slightly distal to the end thereof, and opens toward the multipurpose lumen 4b of the sheath 4.

On the other hand, the connecting pipe 16 has an outer diameter slightly larger than the inner diameter of the multipurpose lumen 4b.
In addition, the pipe is made of metal, particularly stainless steel, having a sufficient inner diameter that does not interfere with the movement of the fluid or the insertion of the guide wire, and from the side hole 4f of the sheath end portion 4e into the multipurpose lumen 4b. It is fixed by means such as press fitting or adhesion.

The piece 17 has an inner diameter substantially the same as the outer diameter of the sheath 4, and is made of thermoplastic resin, particularly ABS, PP, E.
It is obtained by injection molding a crystalline resin such as VA, and is attached to the outermost end of the sheath end 4e.

In this state, as shown in FIG. 4, the sheath end portion 4e, the connection pipe 16 and the piece 17 are set in an injection molding die (not shown), and the operation pipe insertion lumen 18 is surrounded so as to surround them. , Branch multipurpose lumen 1
Approximately Y including 9, base 20 and operation unit main body connection unit 21
Integrally molded into a letter shape by an injection molding method, and the branch portion 10
Is formed. Here, as the resin used for this injection molding, a thermoplastic resin, particularly a crystalline resin such as ABS, PP, EVA, etc. is used, and it is desirable to use the same resin as that of the piece 17.

Here, the piece 17 uses the same resin as that used in the injection molding of the branch portion 10 while preventing the sheath end portion 4e from moving from the initial set position by the flow of the resin during the injection molding of the branch portion 10. Therefore, during injection molding, piece 1
7 and the resin in the branching portion 10 can be made to have a fusion property, and mutual fixing force can be strengthened.

On the other hand, by making the lumen of the connecting pipe 16 press-fitted and fixed in the side hole 4f of the sheath distal end 4e so as to keep a tight seal, as a part of the branch multipurpose lumen 19 of the branch 10, Prevents the fluid from leaking to the outside of the multi-purpose branch lumen 19 when a liquid is flown from it, and the contact area between the sheath end portion 4e and the resin used in the injection molding of the branch portion 10 by the integration of the connection pipe 16 As a result, the fixing force between the resin and the sheath 4 including the connection pipe 16 can be strengthened. Further, as shown in FIG. 5, the mouthpiece 20 has a luer taper portion 20a therein for detachably connecting an injection cylinder and the like.

In addition, a multipurpose lumen 4a of the sheath 4,
By forming the multi-purpose multi-purpose lumen 19 so as to be substantially linear, it is possible to improve the movement of the fluid in the lumen and the insertability of the guide wire.

Further, as shown in FIG. 4, the operating portion main body connecting portion 21 includes an inner cavity portion 21a into which the distal end portions of the intermediate member 11 and the operating portion main body 12 are inserted, and slits 21b opened on both side surfaces, In addition to these slits 21b, it has a substantially rectangular hole 21c opened on both side surfaces.

As shown in FIG. 3, the operation pipe 14 is a hollow pipe made of metal, particularly stainless steel, having conductivity, and its tip is located in the operation pipe insertion lumen 18 of the branch portion 10. It is possible to move back and forth in the operation pipe insertion lumen 18. Further, the conductive wire 5 is inserted into the inner cavity of the operation pipe 14, and the conductive wire 5 and the plug 15 are integrally fixed via the operation pipe 14 at the rear end of the operation pipe 14. .

The slider 13 is, as shown in FIG.
It is obtained by injection molding a thermoplastic resin, particularly a crystalline resin such as ABS, PP, EVA, etc.
a and the operation portion main body 12 are inserted, and two slide grooves 13 are provided over the entire length of the slider 13 in the longitudinal direction.
b, two slits 13c and 13d which are passages for mounting the plug 15 on the slider 13, and the slit 13c has a narrow portion 13 narrower than the width of the slit 13c.
e and has a center hole 13 on the longitudinal axis of the slider 13.
have f.

On the other hand, the plug 15 is electrically conductive and is made of metal, particularly stainless steel or brass, and has a substantially columnar shape. A cord (not shown) for connecting the high frequency ablation device (not shown) to the incision device 1 is provided. Connection part 15b for connecting with
And a hole 15c perpendicular to the longitudinal axis of the plug 15 and a narrow portion 13 on the slit 13c of the slider 13 near the center.
It has a small diameter portion 15d having an outer diameter slightly larger than the width of e.

The operation pipe 14 into which the conductive wire 5 is inserted is inserted into the hole 15c at the rear end thereof, and the conductive wire 5 and the plug 15 are in contact with each other so as to be electrically conductive. It is fixed by means such as caulking and welding.

As shown in FIGS. 7 and 8, the plug 1
5 is fixed to the slider 13, and the fixing method is to first insert the operation pipe 14 and the end of the conductive wire 5 into the center hole 13f of the slider 13, and then insert the plug 15 around the longitudinal axis of the operation pipe 14. The plug 15 is rotated to guide the plug 15 into the two slits 13c and 13d, and the slider 1
3, the small-diameter portion 15d of the plug 15 is forcedly passed through the narrow portion 13e, and the end portions 13 of the slits 13c and 13d are
This is performed by abutting the plug 15 on the c'and 13d '.

As shown in FIGS. 3 and 9, the operating portion main body 12 is made of thermoplastic resin, particularly ABS, PP, EV.
It is obtained by injection molding a crystalline resin such as A, and has a finger hook 12a, a central slit 12b, two arms 12c, and a protrusion 12d at the tip of each arm.

The intermediate member 11 is obtained by injection-molding a material similar to that of the operation portion main body 12, and has a center opening 11
a, has two arms 11b and two side openings 11c. The connection between the branch portion 10, the intermediate member 11, and the operation portion main body 12 is performed by first inserting the two arms 12c of the operation portion main body 12 into the two side openings 11c of the intermediate member, and then in this state. The two slits 21b are expanded by being inserted into the inner cavity 21a of the operation part main body connection part 21 of 10, and the two projections 12d of the operation part main body 12 are fitted into the holes 21c of the operation part main body connection part 21 when further pushed. Combined, slit 21b
Return to their original shape, and each is fixed.

Further, the two arms 12c of the operation section main body 12
Are respectively inserted into the two slide grooves 13b of the slider 13, and the operation portion main body 12 and the slider 13 can slide in the longitudinal direction.

When the high frequency current is applied, the operation section main body 12
Operation pipe 14 located inside the central slit 12b of the
It is desirable that the slit width of the central slit 12b be 3 mm or less so that a finger, a metal piece, or the like does not come into contact with the outside.

Further, as shown in FIG.
Marking 23 on the distal end of the
Is provided. The marking 23 will be described. The pair of wire lead-out ports 6 in the sheath distal end portion 22.
Out of a and 6b, the sheath 4 of the wire lead-out port 6a on the tip side
A black tip marking 23a with a width of 1 mm is provided on the outer circumference, and a green back end marking 23b with a width of 10 mm is provided on the outer circumference of the sheath 4 from the wire outlet 6b on the rear end side toward the rear end of the sheath 4. There is.

Further, a black central marking 23c with a width of 1 mm is provided on the outer circumference of the sheath 4 located in the middle of the pair of wire lead-out ports 6a and 6b, and further the pair of wire lead-out ports 6a and 6b from the tip wire lead-out port 6a. A red 1/3 marking 23d having a width of 1 mm is provided on the outer circumference of the sheath 4 located at a length of 1/3 L of the length L between them.

The material of these markings 23 is a dispersion type ink whose main component is FEP, and the pigments used are generally red iron oxide (carbon) and carbon (black) which are harmless to the human body. ing.

These markings 23 are applied to the sheath 4 with the respective marking materials, and then this portion is heated at a temperature not lower than the melting point of FEP, particularly not lower than the melting point of PTFE, so that the marking materials are heat-welded to the sheath 4. Formed.

Next, the operation of the electric incision device 1 for an endoscope configured as described above will be described. As shown in FIG. 10, an endoscope 102 previously inserted into the duodenum 101.
The incision device 1 is inserted into the treatment tool insertion channel (not shown), and the distal end portion of the incision device 1 is projected from the distal end opening of the endoscope 102.

Next, the distal end of the incision device 1 is inserted from the papilla 103 into the bile duct 104 by bending the endoscope 102, operating the treatment instrument raising device, or pushing and pulling the incision device 1. Next, if necessary, the base 20 of the branching unit 10
An injection cylinder (not shown) is attached to, and the contrast agent is sent into the bile duct 104 through the branch multi-purpose lumen 19 and the multi-purpose lumen 4b of the sheath 4 to perform imaging in the bile duct 104. Next, the position of the X-ray opaque pipe 9 at the distal end portion of the sheath 4 is confirmed under fluoroscopy, and it is confirmed whether or not the sheath distal end portion 22 is securely inserted into the bile duct 104. Alternatively, when the bile duct 104 is filled with a contrast agent,
Since the portion of the sheath 4 is not imaged under fluoroscopy, the position of the sheath distal end portion 22 is detected by confirming the position of the silhouette of the sheath 4.

Here, regardless of the presence or absence of the X-ray opaque pipe 9 in the incision device 1, the sheath distal end portion 22 is usually inserted deeper into the papilla 103 than the desired incision position.
This is because when the position of the sheath distal end portion 22 is confirmed under fluoroscopy and the insertion length of the sheath distal end portion 22 is short, the position of the sheath distal end portion 22 is inside the bile duct 104 or inside the pancreatic duct 105. This is because it is difficult to determine if it is in the store.

When it is confirmed that the sheath distal end portion 22 has entered the bile duct 104, the sheath 4 is then cut to make a desired incision position, that is, the distal end portion of the knife portion 7.
Was pulled back from the bile duct 104, and it was confirmed that the central marking 23c came out of the teat 103. Then, the 1/3 marking 23d provided on the outer periphery of the sheath 4 corresponding to the tip portion of the knife portion 7 just came out of the teat 103. By the way, the sheath 4 is positioned.

Next, when the slider 13 of the operating portion 3 is moved to the rear end side with respect to the operating portion main body 12, the conductive wire 5 is pulled and the distal end portion of the sheath 4 is curved, resulting in an arcuate shape. The knife part 7 is formed.

As another method, when the slider 13 of the operating portion 3 is moved to the distal end side with respect to the operating portion main body 12, as shown in FIG. 11, the conductive wire 5 is pushed and the distal end of the sheath 4 is pushed. The conductive wire 5 is extruded from the portion to form the arc-shaped knife portion 7. After the knife portion 7 is formed in an arc shape or an arc shape, a high frequency current is applied to the knife portion 7 to incise the papillary sphincter. After the incision is completed, the slider 13 is returned to the original position and is pulled out from the treatment instrument insertion channel of the endoscope 102.

In order to make an incision at the tip of the knife portion 7, another method for positioning the sheath 4 shown in FIG. 12 may be adopted. When it is confirmed that the sheath distal end portion 22 has entered the bile duct 104, the sheath 4 is pulled back from the bile duct 104, and after confirming that the rear end marking 23b has come out of the papilla 103, then, it corresponds to the central portion of the knife portion 7. When the central marking 23c provided on the outer circumference of the sheath 4 slightly protrudes from the teat 103, the sheath 4 is positioned. Thereafter, the papillary sphincter is incised as described above.

By the way, when the incision device 1 is inserted into the bile duct 104, or when another treatment tool is inserted into the bile duct 104 and other treatment is performed after the EST has been performed by the incision device 1. Depending on the situation, a guide wire can be used together. When using a guide wire together, sheath 4
Using the multipurpose lumen 4b, the guide wire can be easily put in and taken out from the tip opening portion of the multipurpose lumen 4b or the mouthpiece 20 of the branch portion 10.

According to this embodiment, the sheath 4 is attached to the bile duct 10.
1/3 marking 23d located between the pair of wire lead-out ports 6a and 6b in the sheath distal end portion 22 is used as a standard marking for positioning inside
Since the marking 23d is different in color and / or width from the other markings 23a to 23c, the other marking 2
3a to 23c can be easily distinguished, and the positioning property of the sheath 4 at a desired incision position is improved.

Before the sheath 4 is pulled back from the bile duct 104 and the 1/3 marking 23d is positioned on the teat 103, it is possible to confirm that the central marking 23c has come out of the teat 103. It is possible to detect in advance that the / 3 marking 23d comes out, and it is possible to prevent the sheath 4 from being pulled out too much.

On the other hand, when the center marking 23c located between the pair of wire lead-out ports 6a and 6b in the sheath tip portion 22 is used as a standard marking for positioning the sheath 4 in the bile duct 104, the center marking 23 is also present.
dc Since the color and / or width is different from the other markings 23a, 23b, 23d, the other markings 23a, 23b,
23b and 23d can be easily distinguished, and the positioning property of the sheath 4 at a desired incision position is improved.

Before the sheath 4 is pulled back from the bile duct 104 and the central marking 23c is positioned on the nipple 103, it is possible to confirm that the trailing end marking 23b has come out of the nipple 103, so that the operator will soon make a central marking. 23c can be detected in advance and the sheath 4
Can be prevented from being pulled out too much.

When the knife portion 7 is not completely projected from the tip of the endoscope 102 and a high frequency current is applied to the knife portion 7 to incise the papillary sphincter, a high frequency current is emitted from the tip of the endoscope 102. There is a risk of electric shock due to leakage of high frequency current to the endoscopist or patient. Therefore, it is necessary to confirm that the knife portion 7 completely projects from the tip of the endoscope 102 before the high-frequency current is applied.

According to this embodiment, the wire lead-out port 6b on the rear end side of the sheath distal end portion 22 is directed toward the rear end of the sheath 4 and the rear end marking 23b of 10 mm width provided on the outer periphery of the sheath 4 is viewed. By confirming in the field of view of the mirror 102, it can be confirmed that the knife portion 7 is completely projected from the tip of the endoscope 102, and this rear end marking 23b.
Since it is a 10 mm wide marking, it can be easily confirmed in the field of view and a safe incision can be made.

FIG. 13 shows a second embodiment. The same components as those of the first embodiment are designated by the same reference numerals and the description thereof will be omitted.
A marking 24 is provided on the distal end portion of the sheath 4, that is, the sheath distal end portion 22. The marking 24 will be described. Of the pair of wire lead-out ports 6a and 6b at the tip of the sheath 4, the wire lead-out port 6a on the tip side is provided.
1 mm wide black tip marking 24a is provided on the outer periphery of the sheath 4, and 10 mm wide black trailing end marking 24b is provided on the outer periphery of the sheath 4 from the wire lead-out port 6b on the rear end side toward the rear end of the sheath 4. Has been. Further, a black central marking 24c with a width of 1 mm is provided on the outer circumference of the sheath 4 located in the middle of the pair of wire outlets 6a and 6b, and further 10 mm from a position of 8 mm from the tip wire outlet 6a toward the rear end. 2m on the outer circumference of the sheath 4 up to the position
A black identification marking 24d having a width of m is provided.

With this configuration, the identification marking 24d located between the pair of wire outlets 6a and 6b in the sheath distal end portion 22 has a marking width different from that of the other markings, so that the markings can be easily distinguished from the other markings. The positioning of the sheath 4 at the position is improved.

According to the above-mentioned embodiment of the present invention, the following constitution can be obtained. (1) An electric incision for an endoscope in which a conductive wire is inserted into an electrically insulating sheath and the wire is exposed from a pair of wire outlets near the distal end of the sheath to the outer wall surface of the sheath to form a knife portion. In the device, a plurality of markings are provided on the sheath distal end, and at least one of the markings located between the pair of wire lead-out ports of the sheath distal end is distinguishable from other markings. An electric incision device for an endoscope.

(2) An endoscope in which a conductive wire is inserted into an electrically insulating sheath and the wire is exposed from the pair of wire outlets near the distal end of the sheath to the outer wall surface of the sheath to form a knife portion. An electric incision device for medical use, wherein an identification marking is provided between the pair of wire lead-out ports, and an identification marking is provided between the tip of the wire lead-out port and the central portion of the pair of wire lead-out ports. Electric incision device for mirrors.

(3) The electric dissection device for an endoscope according to item (1) or (2), wherein the identification marking is different from other marking colors. (4) The electric dissection device for an endoscope according to item (1) or (2), wherein the identification marking is different from other marking widths. (5) The electric dissection device for an endoscope according to item (1) or (2), wherein the identification marking is different from other marking colors and other marking widths. (6) A 1 mm wide black tip marking, a 10 mm wide black rear end marking, a 1 mm wide black center marking and a 1 mm wide red identification marking are provided on the outer circumference of the sheath distal end portion. The electric incision device for an endoscope according to the item (1) or (2).

(7) 1 m on the outer circumference of the sheath tip.
m width black front marking, 10 mm width black rear marking, 1 mm width black central marking and 2
An electric incision device for an endoscope according to item (1) or (2), characterized in that a black identification marking having a width of mm is provided.

(8) The main material of the marking material is F
An electric dissection device for an endoscope according to item (1) or (2), which is a dispersion type ink of EP, in which the pigments are red iron oxide (red) and carbon (black) that are harmless to the human body. .

(9) The marking is characterized in that after the marking material is applied to the sheath, this portion is heated at a temperature higher than the melting point of FEP to heat-weld the marking material to the sheath (1) or ( The electric incision device for an endoscope according to the item 2). (10) The electric incision device for an endoscope according to the item (1) or (2), wherein the sheath is a flexible tube made of fluorocarbon resin. (11) In the item (1) or (2), the sheath is a flexible porous tube having at least a wire lumen through which the conductive wire is inserted and a multipurpose lumen. Electric incision device for endoscopes. (12) The electric incision device for an endoscope according to item (1) or (2), wherein the conductive wire is a flexible wire made of metal such as stainless steel. (13) The electric incision device for an endoscope according to item (1) or (2), wherein an X-ray opaque pipe is press-fitted into the sheath distal end portion.

Further, in the endoscopic electric incision device disclosed in the above-mentioned Japanese Patent Laid-Open No. 5-68685, the pair of wire outlets near the distal end of the sheath are both oblique with respect to the longitudinal axis of the sheath. It is inclined. This inclined outlet port is usually opened in a circular shape by using a tool such as a needle or a drill having almost the same diameter as the outlet port. However, when the outlet is formed by such a method, it takes time to set the tool at an angle inclined with respect to the sheath, and there is a problem that it is difficult to manufacture.

14 to 17 show a third embodiment and a fourth embodiment in which the above-mentioned problems are solved. The same components as those in the first embodiment are designated by the same reference numerals and their description is omitted. To do.
First, the basic structure will be described. A conductive wire 5 is inserted into a sheath 4 having electrical insulation properties, and the wire 5 is inserted into a pair of wire outlets 6a and 6b near the sheath tip 22.
In the electric incision device for an endoscope, which is exposed from the outer wall surface of the sheath 4 to form the knife portion 7, a pair of wire lead-out ports 6
At least one of a and 6b is formed substantially at right angles to the longitudinal axis of the sheath 4, and when the wire lead-out ports 6a and 6b are formed, the wire lead-out port 6a,
Since 6b is substantially perpendicular to the longitudinal axis of the sheath 4, the tool for opening the wire outlets 6a and 6b does not need to be positioned diagonally.

FIG. 14 shows a specific construction of the third embodiment, in which the pair of wire lead-out ports 6a, 6b in the lancing device 1 is shown.
Are formed substantially at right angles to the longitudinal axis of the sheath 4, and are formed in a slit shape toward the wire lumen 4a of the sheath 4.

The pair of outlets 6a and 6b are formed by the method shown in FIG. First, the thin plate 25 having a width smaller than the inner diameter of the wire lumen 4a is inserted into the wire lumen 4a of the sheath 4, and then the cutter 26 is moved from the outer peripheral surface of the sheath 4 toward the wire lumen 4a.
Then, the cutter 26 is pressed almost perpendicularly to the longitudinal axis of the plate until the cutter 26 abuts against the thin plate 25 to form a slit shape. The thin plate 25 is preferably made of a hard material, particularly metal such as stainless steel.

As described above, since the wire lead-out ports 6a and 6b are not slanted and are substantially perpendicular to the longitudinal axis of the sheath 4, the manufacture is easy and the wire can be provided in a short time. Since the thin plate 25 is inserted into the wire lumen 4a at the time of manufacture, there is an effect that it is possible to prevent penetration to other lumens when the wire lead-out ports 6a and 6b are formed.

FIG. 16 shows a specific construction of the fourth embodiment, in which the pair of wire lead-out ports 6a, 6b in the lancing device 1 is shown.
Are formed substantially at right angles to the longitudinal axis of the sheath 4 and are formed in a circular shape toward the wire lumen 4a of the sheath 4. The pair of outlets 6a and 6b are formed by the method shown in FIG.

First, a thin plate 25 having a width smaller than the inner diameter of the wire lumen 4a is attached to the wire lumen 4a of the sheath 4.
Then, the drill 27 is directed from the outer peripheral surface of the sheath 4 toward the wire lumen 4a so as to be substantially perpendicular to the longitudinal axis of the sheath 4, and the drill 27 is rotated until the drill 27 hits the thin plate 25. Circular wire outlet 6
a and 6b are formed.

According to this embodiment, in addition to the effect of the third embodiment, since the wire outlets 6a and 6b are circular, the EST
At this time, when the conductive wire 5 is pushed and pulled, the slidability between the conductive wire 5 and the wire outlets 6a and 6b is good.

Therefore, when the wire lead-out ports 6a and 6b are formed, the wire lead-out ports 6a and 6b are substantially perpendicular to the longitudinal axis of the sheath 4, so that the wire lead-out ports 6a and 6b are formed.
There is an effect that it is not necessary to position the tool for opening a and 6b obliquely.

According to the above-mentioned embodiment, the following constitution can be obtained. (1) An electric incision for an endoscope in which a conductive wire is inserted into an electrically insulating sheath and the wire is exposed from the pair of wire outlets near the distal end of the sheath to the outer wall surface of the sheath to form a knife portion. In the device, at least one of a pair of wire lead-out ports is formed orthogonal to an axis in the longitudinal direction of the sheath, and an electric incision device for an endoscope.

(2) An endoscope in which a conductive wire is inserted into an electrically insulating sheath and the wire is exposed from a pair of wire outlets near the distal end of the sheath to the outer wall surface of the sheath to form a knife portion. The electric incision device for endoscopes, wherein at least one of the pair of wire lead-out ports is formed in a slit shape orthogonal to the axis of the sheath longitudinal direction.

(3) The wire lead-out port has a slit shape formed by applying a cutter from the outer peripheral surface of the sheath substantially perpendicularly to the longitudinal axis of the sheath (1).
Alternatively, the electric incision device for an endoscope according to (2). (4) The electric incision for an endoscope according to (1), wherein the wire outlet is a circular shape formed by applying a drill from the outer peripheral surface of the sheath substantially perpendicularly to the longitudinal axis of the sheath. apparatus. 18 and 19 show a fifth embodiment, in which the incision device 1 includes a conductive wire 29 in a sheath 28 having one inner cavity 28a and having an electrically insulating property, and a pair of wires near the tip of the sheath 28. From the outlet 30a, 30b, the sheath 28
The knife portion 31 is formed by being exposed on the outer wall surface of the.

The tip of the conductive wire 29 is fixed to a fixing member 32 made of metal, particularly stainless steel, and this fixing member 32 is inside the sheath inner cavity 28a located on the tip side of the tip side wire lead-out port 30a. And is fixed to the sheath 28. Further, at the distal end of the sheath 28, the small diameter portion 28b
And the inner diameter of the small-diameter portion 28b is
The outer diameter is smaller than 2.

Wire lead-out ports 30a, 3 of this incision device 1
0b is formed in a slit shape substantially perpendicular to the longitudinal axis of the sheath 28 as in the third embodiment. Therefore, when the conductive wire 29 is pulled to the rear end side by remote control with an operation part (not shown), the sheath 28 is curved and the knife part 31 is formed in an arc shape as shown in (a) of FIG. . Further, when the conductive wire 29 is pushed out to the tip side,
As shown in (b) of the figure, the knife portion 31 projects in an arc shape, and the knife portion 31 can be brought into contact with the papillary sphincter muscle by any one of the above-mentioned methods, and an incision can be made by a high-frequency current.

An incision device for electrically incising a living tissue in a body cavity is also known, for example, in DE2657256. In this incision device, a conductive wire is inserted into a sheath having electrical insulation properties, the wire is exposed from the pair of wire outlets near the distal end of the sheath to the outer wall surface of the sheath, and the wire is pulled to pull the sheath. The tip portion of the is bent and the exposed wire portion is stretched to form a knife portion, and the knife portion is brought into contact with the living tissue to electrically incise the living tissue.

Such an incision device is, for example, a papillary sphincterotomy (hereinafter referred to as EST) for incising the sphincter at the end of the bile duct when the outlet of the bile duct that carries bile to the duodenum is narrowed due to a tumor or stone in the duodenum. The incision is generally performed by a high frequency current.

Here, when the incision device is inserted into the bile duct from the papilla, it is confirmed under fluoroscopy that the sheath tip is surely inserted into the bile duct, and the sheath tip position is within the bile duct. You need to check where it is located.

The lancing device shown in DE 2657256 is commonly used as a manufacturer of such devices.
There are several other product groups that differ in the length of the knife part and the length from the sheath tip to the knife tip, but each product group may have different lengths from the sheath tip to the X-ray opaque member. There are many. For example, the user may move X from the sheath tip.
If you have multiple incision devices with different lengths up to the radiopaque member, check the sheath tip position under X-ray fluoroscopy as described above.
It was necessary to grasp the entire length from the tip of the sheath to the X-ray opaque member, and it was difficult for the user to grasp all of them, and I felt a problem.

FIG. 20 and FIG. 21 are for solving the above-mentioned problems, and a user who has a plurality of product groups can easily select which product to use and see the tip of the sheath under fluoroscopy. It is possible to provide a product group of incision devices capable of estimating and confirming the position.

20 and 21 show a specific structure of the incision device, and the same components as those in the first embodiment are designated by the same reference numerals and the description thereof will be omitted. Compared with the incision device 1 shown in FIG. 2, this incision device has a wire lead-out port 6b on the rear end side of the electric incision device for an endoscope which has a structure and external dimensions particularly between the product groups.
From the tip to the tip of the wire lead-out port 6a from the tip of the sheath 4 and the relative position of the X-ray opaque pipe 9 and the pipe 8 is different. Length, pair of wire outlets 6a, 6b
Only the distance between them differs.

Further, as shown in FIG. 21, as shown in FIGS.
8. The incision device 1 shown in FIG. 8 and FIG. 19 have certain common points, and the distances from the distal end surface of the sheath 4 to the X-ray opaque members (9, 32) are all equal.

Like these incision device products, the user usually has several products having different specifications. When the user cannot confirm the position of the tip of the sheath (4, 28) under the fluoroscopy without being able to confirm it with the endoscope when using these product groups, the sheath (4, 28) under the fluoroscopy. )
The distal end position of the sheath (4, 28) is predicted from the position of the X-ray opaque member (9, 32) which can be observed under fluoroscopy instead. Therefore, for each type of product group, sheath (4, 2
It is necessary to know in advance the distance from the tip of 8) to the X-ray opaque member (9, 32).

Therefore, no matter which product of the product group the user has, the distance from the tip of the sheath (4, 28) to the X-ray opaque member (9, 32) is equal. It is not necessary to grasp the above distances for all products, and the sheath tip position can be easily estimated and confirmed under fluoroscopy.

According to the above-mentioned embodiment, the following constitution can be obtained. (1) A conductive wire is inserted into a sheath having electrical insulation properties, and the wire is exposed from the pair of wire outlets near the distal end of the sheath to the outer wall surface of the sheath to form a knife and near the distal end of the sheath. In the electric incision device for an endoscope having an X-ray opaque member arranged in a lumen that is built in, a product group of various types of the electric incision device for an endoscope,
An electric incision device for an endoscope, wherein the distance from the tip of the sheath to the radiopaque member is constant.

(2) An endoscope in which the structure, appearance, and dimensions of the product group of the electric incision device for an endoscope are different from each other only in the tip portion of the electric incision device for an endoscope, and other parts are almost the same. Electric incision device.

(3) In the product group of the electric incision device for endoscopes, the structure, appearance, and dimensions are different only from the wire lead-out port on the rear end side of the electric incision device for endoscope to the tip portion, and other parts. Are almost the same electric incision device for endoscopes.

According to the above construction, in each type of product group, it is not necessary to know in advance the distance from the sheath tip to the X-ray opaque member, and which product of the product group the user has Even if is used, since the distance from the tip of the sheath to the X-ray opaque member is the same, the position of the tip of the sheath can be easily estimated and confirmed under X-ray fluoroscopy.

[0095]

As described above, according to the present invention, a plurality of markings are provided on the sheath tip, and at least one of the markings located between the pair of wire lead-out ports of the sheath tip is provided. , By making the marking distinguishable from other markings, for example, E
In order to incise the papillary sphincter at the knife tip when performing ST, when positioning the sheath in the papilla, insert the incision device into the papilla using the marking provided on the sheath tip as a guide, Can be dissected.

Therefore, it is possible to easily recognize the marking that should be used as a guide for inserting the sheath, improve the positioning property at the incision position, and perform the safe and efficient treatment.

[Brief description of drawings]

1A and 1B show a first embodiment of the present invention, in which FIG. 1A is an overall view of an electric incision device for an endoscope, and FIG.

2A and 2B show the distal end portion of the sheath according to the embodiment, FIG. 2A is a longitudinal side view, and FIG. 2B is a sectional view taken along line BB.

3A and 3B show an operating portion of the embodiment, wherein FIG. 3A is a partially sectional side view, and FIG. 3B is an enlarged sectional view of a C portion.

4A and 4B show a branch portion of the embodiment, FIG. 4A is a vertical side view, FIG. 4B is a view in the direction of D, and FIG. 4C is a view in the direction of E.

5 is an enlarged cross-sectional view of the F portion of FIG. 4 showing the operating portion of the embodiment.

6A and 6B show the sheath distal end portion of the embodiment, in which FIG. 6A is a side view and FIG. 6B is a sectional view taken along the line G-G.

7A and 7B show a slider of the same embodiment, in which FIG. 7A is a partially sectional front view, FIG. 7B is a side view, and FIG. 7C is a rear view.
(D) is a sectional view taken along the line H-H, and (e) is a sectional view taken along the line I-I.

FIG. 8 is a perspective view of the slider according to the embodiment.

FIG. 9 is an exploded perspective view of a branch portion, an intermediate member, and an operation portion main body of the embodiment.

FIG. 10 is an operation explanatory view of the same embodiment.

FIG. 11 is an operation explanatory view of the same embodiment.

FIG. 12 is an operation explanatory view of the same embodiment.

FIG. 13 is a side view of the distal end portion of the sheath showing the second embodiment of the present invention.

14A and 14B show a third embodiment of the present invention, in which FIG. 14A is a longitudinal side view of a sheath, and FIG. 14B is a sectional view taken along line JJ and KK.

15A and 15B show a manufacturing method of the example, in which FIG. 15A is a longitudinal side view of a sheath, and FIG. 15B is a sectional view taken along line LL.

16A and 16B show a fourth embodiment of the present invention, FIG. 16A is a longitudinal side view of a sheath, and FIG. 16B is a sectional view taken along line MM and NN.

FIG. 17 shows a manufacturing method of the embodiment, (a) is a longitudinal side view of the sheath, and (b) is a sectional view taken along line OO.

FIG. 18 shows a fifth embodiment of the present invention, (a) is a longitudinal sectional side view of the sheath, and (b) is a sectional view taken along the lines PP and QQ.

FIG. 19 is an explanatory view of the operation of the embodiment.

FIG. 20 is a vertical cross-sectional side view showing another embodiment of the sheath distal end portion.

FIG. 21 is a side view of the embodiment.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Incision device 4 ... Sheath 5 ... Conductive wire 6a, 6b ... Wire lead-out port 7 ... Knife part 22 ... Sheath tip part 23 ... Marking

Claims (1)

[Claims] 1. An endoscope in which a conductive wire is inserted into an electrically insulating sheath and the wire is exposed from a pair of wire outlets near the distal end portion of the sheath to the outer wall surface of the sheath to form a knife portion. In the electric incision device, a plurality of markings are provided on the sheath distal end, and at least one of the markings located between the pair of wire outlets of the sheath distal end is a marking that is distinguishable from other markings. An electric incision device for an endoscope, characterized in that