JPH09262239A - Treating tool for endoscope - Google Patents

Abstract

PROBLEM TO BE SOLVED: To improve the operativity as a treating tool by making a given length part of a cord of an operation part from a connecting part be the first flexible part and connecting an angle part thereto. The operativity, for example, picking a body texture up to a desired height by a holding clamp in a body cavity inserted by using an inserting channel as a guiding means for the treating tool of an endoscope is improved by using the treating tool. SOLUTION: A clamp operating part 21 has a pair of holding nails 21a and 21b, the clamp operating part 21 is connected to a cord 22. The cord 22 is composed of a first flexible part 22a a given length from the top part connected to the clamp operating part of which is bendable in an optional direction, an angle part 22b capable of curving by remote controlling and a second flexible part 22c bendable in an optional direction. At the base part of the cord 22, an operating part 30 is mounted to connect, by operating the operating part 30, the clamp operating part 21 is driven as opening and closing motion and by this operation a diseased part is held, by curving the angle part 22b, thereby the first flexible part 22a is made swinging caused by the resistance of the first flexible part 22a on picking up the diseased part, a state picking the diseased part up right above is brought in.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an endoscopic treatment such as grasping forceps which is inserted into a body cavity or the like using an endoscope as a guide means and is used for performing mucosal resection or other treatments. It is about ingredients.

[0002]

2. Description of the Related Art An endoscope is inserted into a body cavity or the like, and performs examination / diagnosis of the inner wall and organs of the body cavity. The treatment used can also be applied. An example of this type of treatment is an operation for excision of early cancer. This treatment is performed when an endoscopic examination reveals a tumor in the mucous membrane or a position immediately below the mucous membrane. For example, a high-frequency snare is inserted through a high-frequency treatment tool, and the affected part is excised and collected. This is called a mucosal resection, and since there is no need to perform a laparotomy during the procedure, there are excellent advantages such that damage to the patient can be minimized and post-operative recovery is extremely fast.

Therefore, the mechanism for performing this mucosal resection will be described with reference to FIG. The instruments necessary for performing this mucosal resection are a high-frequency snare 2 and a grasping forceps 3 in addition to the endoscope 1. As is well known, the endoscope 1 has an insertion portion 10 to be inserted into a body cavity, and a distal end portion of the insertion portion 10 is a distal end body 10a, and the distal end body 10a has an illumination window at the distal end. 11 and an observation window 12 are provided, and two treatment instrument insertion channels 13 for inserting two treatment instruments of the high-frequency snare 2 and the grasping forceps 3 are provided.
a and 13b are provided. An angle portion 10b is connected to the distal end portion main body 10a.
By bending b in an appropriate direction, the distal end body 10a can be directed in a desired direction. Further, a flexible portion (not shown) is connected to the angle portion 10b.

The high frequency snare 2 has a structure in which a conductive wire 2b connected to a high frequency power source is inserted into the insulating tube 2a. The conductive wire 2b is formed so that the tip portion thereof spreads in a loop shape, and has a substantially linear shape when it is drawn into the insulating tube 2a, and protrudes from the insulating tube 2a by a predetermined length. When it is made to open, it will spread in the shape of a loop which was given a habit beforehand. Further, the grasping forceps 3 is formed by connecting a forceps operating portion 3b composed of a pair of grasping claws to the tip of a flexible cord 3a. Inside the cord 3a, the forceps operating portion 3b is opened and closed by remote operation. An operation wire for operating is inserted.

Next, a method of performing a mucosal resection using the above-described instrument will be described. First, the endoscope 1 is inserted to a required site in the body cavity, and the condition of the mucous membrane is examined through the observation window 12 under the illumination of the illumination light emitted from the illumination window 11. Then, when a tumor is found at a site of the mucous membrane based on a state such as a color tone of the mucous membrane, the high-frequency snare 2 is inserted through the treatment instrument insertion channel 13a, and the tumor is excised. However, since the tumor does not necessarily bulge from the mucous membrane, the high-frequency snare 2 can only surround the upper part of the affected area, and in order to perform resection,
The tissue part of the tumor must be pulled up.

[0006] In order to pull up a predetermined tissue portion,
The grasping forceps 3 is used. The grasping forceps 3 is provided in the insertion portion 1
The other treatment tool insertion channel 1 provided at 0
It is inserted and guided into the body cavity through 3b. Then, the forceps operating portion 3b of the grasping forceps 3 is positioned in the loop of the high-frequency snare 2, and the forceps operating portion 3b is opened and closed to grasp and pick up the tissue. As a result, when a high-frequency current is passed while displacing the conductive wire 2b of the high-frequency snare 2 in the direction in which the conductive wire 2b is drawn into the insulating tube 2a, the conductive wire 2b comes into contact with body tissue and Joule heat generated at the contact portion By the action of, the affected area is excised. Further, the gripping forceps 3 is held while the affected part excised in this way is gripped by the forceps operating portion 3b of the gripping forceps 3.
By extracting from the treatment instrument insertion channel 13b, the affected tissue can be collected.

[0007]

Here, in performing the above-mentioned mucosal resection, the site to be resected by the high-frequency snare 2 is the entire affected part, and it is necessary not to remove healthy cells other than the affected part. There must be. Obviously, it is not permissible to leave the affected part, and if healthy tissue cells are excised, there is a danger of perforation and bleeding. For this purpose, it is necessary to strictly adjust the amount of the mucous membrane portion picked up by the grasping forceps 3 and the position of the conductive wire 2b of the high-frequency snare 2. If the picked-up amount is small, the affected part may be left behind, and if the conductive wire 2b of the high-frequency snare 2 contacts a wide part of the picked-up mucous membrane, healthy tissue cells may be cut off.

By the way, since the axes of the treatment instrument insertion channels 13a and 13b in the insertion portion 1 are oriented in the same direction, the high-frequency snare 2 and the grasping forceps 3 are led out in parallel. Moreover, the forceps operating portion 3b of the grasping forceps 3 is
It is opened and closed at the front in the axial direction of. Therefore, in order to pick up the affected area with the grasping forceps 3 in a state where the affected area is surrounded by the conductive wire 2b of the high-frequency snare 2, the distal end main body in which the treatment instrument insertion channels 13a, 13b and the like in the insertion section 10 are opened. Angle part 10b connected to 10a
While appropriately bending the forceps, the forceps actuating portion 3b of the grasping forceps 3
Hold the affected area with. Then, the affected part grasped by the grasping forceps 3 is picked up, and the treatment instrument insertion channel 13a,
It is extremely difficult to pick up the diseased part to the required height because only the height dimension corresponding to the interval between 13b can be picked up and the cord 3a of the grasping forceps 3 is made of a flexible member. This is a troublesome work, requires skill, and makes picking up the affected area extremely troublesome.

The present invention has been made in view of the above points, and it is an object of the present invention to use a grasping forceps that is inserted into a body cavity or the like by using a treatment tool insertion channel of an endoscope as a guide means. It is to improve the operability of the treatment tool by, for example, easily picking up the needle to a desired height.

[0010]

In order to achieve the above-mentioned object, the present invention provides a long cord having a working portion connected to a distal end thereof, and a first length of the cord is a predetermined length from the connecting portion of the working portion. It is characterized in that it is not a soft portion, and that an angle portion is continuously provided to the first flexible portion and a second flexible portion is continuously provided to the angle portion.

Here, the treatment tool can be configured as grasping forceps. In this case, the actuation unit is a forceps actuation unit having a pair of gripping claws, and an operation wire for remotely operating the forceps actuation unit is inserted into the cord to which the forceps actuation unit is connected and the angle is set. In order to bend the part in a predetermined direction, the angle operation wire whose tip is connected to the connection part of the angle part and the first flexible part is inserted, and the operation wire and the angle operation wire are operated at the base end part of the cord. The operation unit for performing the operation is connected.

[0012]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS An embodiment of the present invention will be described below with reference to the drawings. In the following description, what is configured as the grasping forceps will be described, but the treatment tool of the present invention is not limited to the grasping forceps, and the point is that the distal end of the operating portion of the endoscope is inserted in the treatment instrument insertion channel of the endoscope. It can be applied to various kinds of treatment tools whose direction needs to be controlled.

First, FIGS. 1 and 2 show the overall structure of the grasping forceps. In the figure, reference numeral 20 denotes a grasping forceps, and the grasping forceps 20 has a forceps operating portion 21 including a pair of grasping claws 21a and 21b. Here, as shown in FIG. 3, one of the grasping claws 21a and 21b of the forceps actuating portion 21 has a convex central portion, and the other grasping claw 21a corresponds to that of the other grasping claw 21b. The part is concave. As a result, the contact area when gripping the affected area or the like is increased, and gripping can be reliably performed. The forceps actuating portion 21 is attached to a mounting member 22 that is provided so as to be connected to the tip of the cord 22. The mounting member 23 is a member in which a slit is formed on the front end side to form a fork, and the base end side is a tubular member. The mounting surface 23a facing each other by the slit on the front end side has a tubular portion. It is the slide surface 23b.

An opening / closing drive mechanism for opening / closing the forceps actuating portion 21 is provided on the mounting member 22. The opening / closing drive mechanism has a parallelogram link and a push piece 24 for driving the parallelogram link, and the push piece 24 slides along the slide surface portion 23b. In the parallelogram link, the grip claws 21a and 21b of the forceps actuating portion 21 are connected to link plate portions 25a and 25b, and both of these link plate portions 25a and 25b are attached to the attachment surface on the left and right sides of the attachment member 23. It is pivotally attached to a pivot pin 26 attached to 23a. On the other hand, a pair of link plates 28a and 28b are pivotally attached to the pusher piece 24 by pivot pins 27, and these link plates 28a and 28b are respectively linked plate portions 25a and 25a.
25b is pivotally attached by pivot pins 29a and 29b.

Therefore, when the pushing piece 24 is slid in the forward direction along the slide surface 23b, the link plate 28
As the angle between a and 28b opens, the angle of the link plate portions 25a and 25b pivotally attached to the link plates 28a and 28b and connected to the grip claws 21a and 21b increases, and the grip claw 21a is increased. , 21b will be opened. Further, when the pushing piece 24 is slid in the backward direction along the slide surface 23b, the parallelogram link of the opening / closing drive mechanism is displaced in the opposite direction to the above, and the grip claws 21a,
21b will be closed.

In order to open and close the forceps actuating portion 21 consisting of the gripping claws 21a and 21b, the base end portion of the cord 22 is provided with
The operation unit 30 is continuously provided. The distal end portion of the operation wire 31 is connected to the pushing piece 24, and the operation wire 31 is inserted into the cord 22 so that the operation portion 30
It has been extended to within. An annular operator 32 is provided on the outer surface of the operation unit 30.
A connecting rod 33 is connected to 2. The connecting rod 33 extends from the long hole 34 formed by a predetermined length in the axial direction of the operating portion 30 to the inside of the operating portion 30, and the operating wire 31 is connected to the distal end portion. . Therefore, when the manipulator 32 is moved in the axial direction of the manipulating section 30, the manipulating wire 31 is pushed and pulled so that the pushing piece 24 moves on the slide surface 2.
It will move along 3b.

The cord 22 has a first flexible portion 22a extending a predetermined length from the tip end side connected to the mounting member 23, and an angle portion 22b is connected to the first flexible portion 22a. . In addition, the angle portion 22b to the operation portion 30
Up to most of the length is the second flexible portion 22c. The first and second flexible portions 22a and 22c are the flexible shaft 3 in which a metal wire is wound in a close contact coil shape.
5, 36 has a flexible tubular structure having a shape-retaining property. Here, the first and second soft portions 22a and 22c may have substantially the same structure, and the two soft portions 22a may have a structure such that the second soft portion 22c is stiffer. , 22c can also be differentiated. On the other hand, the angle portion 22b has a large number of angle rings 37.
Are connected so as to be sequentially pivotable by using the left and right pivot pins 38, whereby the adjacent angle rings 37, 37 rotate vertically about the pivot pins 38, The entire angle portion 22b is curved in the vertical direction. Further, the first flexible portion 22a and the angle portion 22
The entire cord 22 up to b and the second flexible portion 22c is covered with an outer skin layer 39 made of a flexible tube.

The angle portion 22b is bent by remote control in the operation portion 30. For this purpose, an angle knob 40 is provided on the outer surface of the operation portion 30, and a rotation shaft 41 is connected to the angle knob 40. The rotation shaft 41 extends in the operation portion 30. It is connected to a pulley 42 provided in the operation portion 30.
The pulley 42 has a pair of angle operation wires 43.
The base ends of a and 43b are connected. The angle operation wires 43a and 43b are extended from the second flexible portion 22c into the angle portion 22b, and the most advanced angle ring 37 in the angle portion 22b (in FIG. 1, this angle ring is denoted by reference numeral 37F). Fixed).

Here, the angle operation wires 43a, 43
In the second flexible portion 22c, b is the contact coil 44, respectively.
a and 44b, and these contact coils 44 are inserted.
Although not shown, both ends of a and 44b are fixed to the angle ring at the most proximal end portion that configures the inside of the operation portion 30 and the angle portion 22b. Angle operation wires 43a, 4
In the angle portion 22b, 3b and 9 are respectively pivot pins 38 for pivotally supporting the adjacent angle rings 37, 37.
It is inserted while being positioned in a position where the phase of 0 ° is changed. These angle operation wires 43a and 43b
In order to position each of the angle rings 37, a cutting portion 37a is formed on each angle ring 37, and the angle operation wires 43a, 4
3b is inserted in this squeezing portion 37a.

The gripping forceps 20 is constructed as described above, and when the angle knob 40 is rotated, only the angle portion 22b of the cord 22 moves up and down as shown by the phantom line in FIG. It will bend in the direction. In this way, by providing the angled portion 22b that bends in the vertical direction in the middle of the cord 22 of the grasping forceps 20, the affected area can be effectively picked up, and treatment such as mucosal resection can be performed extremely easily and quickly. In addition, the treatment can be performed without leaving the affected area unremoved and without removing healthy cells other than the affected area. In this case, since the configuration other than the grasping forceps has no particular difference from that shown in FIG. 7, the same reference numerals are used for the same or equivalent members as those shown in FIG.

Then, as shown in FIG. 4, the high frequency snare 2 is inserted into the treatment instrument insertion channel 13a in the insertion portion 10 of the endoscope 1 and the high frequency snare 2 is inserted.
While protruding from the tip of 0 for a predetermined length, the conductive wire 2b is led out and expanded in a loop shape so as to cover the upper part of the affected area. In addition, the other treatment instrument insertion channel 13b
The grasping forceps 20 is inserted from the above, and the portions of the forceps actuating portion 21 and the cord 22 on the tip side are projected.

In this state, the insertion portion 10 is appropriately operated to
For example, the grasping forceps 20 is formed by bending the angle portion 10b that is connected to the distal end body 10a of the insertion portion 10 or the like.
The posture control is performed so that the grasping claws 21a and 21b of the forceps actuating unit 21 are directed toward the affected area. Then, the operator 32 provided on the operation unit 30 is operated to open and close the grip claws 21a and 21b to grip the affected part. When the affected part is grasped by the grasping forceps 20, the angle knob 40 in the operation part 30 is rotated to bend the angle part 22b in the cord 22 upward, that is, in a direction away from the inner wall of the body cavity, and the forceps actuating part 21. Try to wake up. As a result, the affected area will be picked up, and code 2
No. 1 in the portion on the tip side of the angle portion 22b in 2
Since the soft part 22a is provided, the first soft part 22a is in a swinging state due to resistance when picking up the affected part, and the forceps actuating part 21 faces downward as shown in FIG. The affected area will be pulled upward.

Therefore, the affected area is excised by operating the high frequency snare 2. This operation is performed on the insulating tube 2a
Is left as it is, and the conductive wire 2b inserted therein is pulled into the insulating tube 2a in the state where a high frequency current is applied. As a result, the conductive wire 2b comes into contact with the tissue of the affected area, and the Joule heat generated at that time excises the affected area.

Here, since the angled portion 22b of the cord 22 is curved and the forceps actuating portion 21 is raised, the affected portion is picked up. Therefore, by increasing the bending angle of the angled portion 22b, The affected area can be picked up to a desired height. Moreover, the first flexible portion 2 is provided between the angle portion 22b and the forceps operating portion 21.
Since 2a is interposed, the resistance when the internal tissue is picked up causes the first flexible portion 22a to shake its head in the direction opposite to the bending direction of the angled portion 22b, as if the affected portion were directly above. The gripping forceps 20 do not become an obstacle when the high frequency snare 2 is operated. Therefore, the affected area can be excised by operating the high-frequency snare 2 extremely accurately, and there is no inconvenience such as leaving the affected area or excising healthy tissue cells.

By the way, it is necessary to change the height at which the affected part is picked up according to the degree of spread of the affected part to be excised.
That is, when the area of the affected area is small, the height at which the grasping forceps 20 lifts the affected area is low to some extent, and when the affected area covers a wide area, it is necessary to pull it up greatly.
In order to properly deal with such a situation, the first flexible portion 22
The angle portion 22b is made sufficiently longer than a. Then, as shown in FIG. 6, when the grasping forceps 20 is inserted into the treatment instrument insertion channel 13b, only part of the angled portion 22b is protruded from the treatment instrument insertion channel 13b. As a result, the curved portion of the angle portion 22b is substantially limited to the length protruding from the treatment instrument insertion channel 13b, and the height at which the forceps operating portion 21 is raised by the angle portion 22b is raised. Can be adjusted. Therefore, when the affected area is small, as shown by the solid line in FIG.
By shortening the protruding length of b from the treatment instrument insertion channel 13b, the picked-up height of the affected part is lowered, and when the affected part covers a wide range, the angle part 22b is largely protruded from the treatment tool insertion channel 13b. Perform bending operation in the state.
This ensures that the conductive wire 2b of the high frequency snare 2 is brought into contact with the boundary between the affected area and the healthy tissue, and the excision can be performed.

[0026]

As described above, according to the present invention, the first flexible portion has a predetermined length from the connecting portion of the operating portion of the cord, and the angle portion is connected to the first flexible portion. Therefore, the operability as a treatment tool is remarkably good, such as easily picking up the internal tissue to a desired height with the grasping forceps that is inserted into the body cavity or the like using the treatment tool insertion channel of the endoscope as a guide means. It has the effect of becoming.

[Brief description of drawings]

FIG. 1 is an overall configuration diagram showing a major part of a grasping forceps as a treatment tool showing an embodiment of the present invention.

FIG. 2 is an external view of the grasping forceps of FIG.

FIG. 3 is a configuration explanatory view of a forceps operating portion of the grasping forceps.

FIG. 4 is an operation explanatory view showing a state where body tissue is picked up by using grasping forceps.

FIG. 5 is an operation explanatory view showing a state in which mucosal resection is performed.

FIG. 6 is an operation explanatory view of an angle portion in the cord of the grasping forceps.

FIG. 7 is an operation explanatory view showing a state of performing a mucosal resection using grasping forceps according to a conventional technique.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Endoscope 2 High frequency snare 20 Grasping forceps 21 Forceps operating part 21a, 21b Grasping claw 22 Code 22a 1st soft part 22b Angle part 22c 2nd soft part 30 Operating part 37,37F Angle ring 37a Cutting part 38 Pivot pin 40 Angle knob 43a, 43b Angle operation wire 44a, 44b Adhesion coil

Claims (2)

[Claims] 1. A long cord having an actuating portion connected to a tip thereof has a first flexible portion having a predetermined length from the connecting portion of the actuating portion, and an angle portion is connected to the first soft portion. Further, the endoscopic treatment tool is characterized in that a second flexible portion is connected to the angle portion. 2. The operating section is a forceps operating section having a pair of gripping claws, and an operating wire for remotely operating the forceps operating section is inserted into the cord and the angle section is predetermined. In order to bend in the direction of, the angle operation wire whose tip is connected to the connection portion of the angle portion and the first flexible portion is inserted, and the operation wire and the angle operation wire are operated at the base end portion of the cord. The endoscopic treatment tool according to claim 1, wherein an operation portion is connected.