WO2015133432A1 - Treatment tool for endoscope - Google Patents

Treatment tool for endoscope Download PDF

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Publication number
WO2015133432A1
WO2015133432A1 PCT/JP2015/056076 JP2015056076W WO2015133432A1 WO 2015133432 A1 WO2015133432 A1 WO 2015133432A1 JP 2015056076 W JP2015056076 W JP 2015056076W WO 2015133432 A1 WO2015133432 A1 WO 2015133432A1
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WO
WIPO (PCT)
Prior art keywords
sheath
port
lumen
guide wire
opening edge
Prior art date
Application number
PCT/JP2015/056076
Other languages
French (fr)
Japanese (ja)
Inventor
康平 小国
小林　司
Original Assignee
オリンパス株式会社
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by オリンパス株式会社 filed Critical オリンパス株式会社
Priority to JP2015544662A priority Critical patent/JPWO2015133432A1/en
Publication of WO2015133432A1 publication Critical patent/WO2015133432A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00071—Insertion part of the endoscope body
    • A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
    • A61B1/00087—Tools
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00131—Accessories for endoscopes
    • A61B1/00133—Drive units for endoscopic tools inserted through or with the endoscope
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00131—Accessories for endoscopes
    • A61B1/0014—Fastening element for attaching accessories to the outside of an endoscope, e.g. clips, clamps or bands
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
    • A61B1/018—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/149—Probes or electrodes therefor bow shaped or with rotatable body at cantilever end, e.g. for resectoscopes, or coagulating rollers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1405—Electrodes having a specific shape
    • A61B2018/144—Wire

Definitions

  • the present invention relates to an endoscope treatment tool.
  • This application claims priority on March 4, 2014 based on Japanese Patent Application No. 2014-042052 for which it applied to Japan, and uses the content here.
  • Endoscopic sphincterotomy is known as a technique for incising the sphincter of the duodenal papilla while observing the duodenal papilla using an endoscopic device.
  • Patent Literature 1 to Patent Literature 4 disclose treatment instruments used in EST.
  • Patent Document 1 discloses a guide wire insertion tool provided with a funnel-shaped extension that communicates with the lumen of the catheter in order to easily insert the guide wire into the lumen of the catheter.
  • Patent Document 2 discloses a high-frequency knife capable of directing an incision portion of a knife wire in a desired direction by forming a guide arm portion on a knife wire and arranging the guide arm portion in a slit formed in a sheath. Has been.
  • Patent Document 3 EST can be safely performed by providing a non-insulated incision at the distal end portion of the high-frequency knife wire and an insulating portion that is insulated at a portion other than the incision.
  • a treatment tool is disclosed.
  • Patent Document 4 discloses a bile duct treatment catheter having a groove that communicates with the guide wire lumen from a position outside the catheter shaft and extends in the longitudinal direction of the shaft in order to easily exchange the guide wire. .
  • the present invention has been made in view of the above-described circumstances, and an object of the present invention is to provide an endoscopic treatment instrument that can be easily guided to a lumen even with a guide wire having a curved shape in the vicinity of a distal end. Is to provide.
  • an endoscope treatment tool is disposed at a proximal end of a sheath having a lumen extending in the longitudinal axis direction and having an inner diameter through which a guide wire can be inserted.
  • the proximal end portion of the sheath is formed in a substantially cylindrical shape having an insertable inner diameter, and has an open port that communicates from the inner peripheral surface to the outer peripheral surface.
  • the sheath is formed on the outer peripheral surface of the sheath so as to communicate the lumen and the outside of the sheath along the longitudinal axis direction of the sheath, and the opening width in the circumferential direction of the sheath is larger than the inner diameter of the lumen.
  • a slit formed so as to be smaller, and an inlet portion having a width larger than the opening width of the slit portion and communicating with the lumen and opened on an outer peripheral surface of the proximal end portion of the sheath And having said input
  • the inner peripheral edge of the port from the direction along the straight line perpendicular to the central axis of the lumen and the central axis of the sheath.
  • the sheath is fixed to the operation portion so that the opening edge portion of the inlet portion substantially coincides with the inner opening edge portion or is located outside the inner opening edge portion when projected onto the operation portion.
  • the port is further located outside the inner opening edge in the radial direction of the sheath, and the inner side.
  • An outer opening edge having an opening area larger than an opening area of the opening edge, and the inner opening edge and the outer opening edge are in a straight line perpendicular to the central axis of the lumen and the central axis of the sheath;
  • the outline of the outer opening edge may be located outside the inner opening edge when projected onto the inner peripheral surface of the port from the direction along.
  • the operation portion is connected to the port and extends in a radial direction with respect to the longitudinal axis of the port. You may have.
  • the distal portion of the guide wire has a curved shape having a restoring force to restore the curved shape.
  • the length of the opening of the port in the longitudinal direction of the sheath is equal to the maximum length of the tangential component at the tip of the curved portion of the distal portion of the guide wire or It may be set longer.
  • the guide wire has a restoring force for restoring to a shape in which a central axis of the guide wire is deflected.
  • a bending portion; and a distal portion provided on the distal side of the guide wire with respect to the bending portion, and the length of the opening of the port in the longitudinal direction of the sheath is the length of the guide wire It may be set equal to or longer than the length of the distal portion.
  • the bent portion has an obtuse angle or an acute angle with respect to the proximal side of the guide wire rather than the bent portion.
  • the distal portion may be bent so as to extend in the forming direction.
  • the port in the endoscope treatment tool according to the second aspect, has a tapered portion that connects the inner opening edge and the outer opening edge. May be.
  • the port has a length that is longer than the inner diameter of the lumen along the central axis direction of the lumen. You may open in the shape of a hole.
  • the endoscope treatment tool it is possible to easily guide a guide wire having a curved shape near the distal end to the lumen.
  • FIG. 1 is an overall view of an incision system including an endoscope treatment tool according to a first embodiment of the present invention. It is a top view of the treatment tool for endoscopes concerning a first embodiment of the present invention. It is sectional drawing in the III-III line of FIG. It is a top view which shows the distal end part of the sheath of the treatment tool for endoscopes which concerns on 1st embodiment of this invention. It is sectional drawing in the IV-IV line of FIG. It is a perspective view which shows a part of sheath in the treatment tool for endoscopes which concerns on 1st embodiment of this invention. It is a top view which shows a part of operation part of the treatment tool for endoscopes which concerns on 1st embodiment of this invention.
  • FIG. 1 It is a figure which shows one process at the time of use of the treatment tool for endoscopes which concerns on 1st embodiment of this invention. It is the figure which looked at the state by which the treatment tool for endoscopes concerning 1st embodiment of this invention was attached to the endoscope apparatus from the viewpoint of the operator of an endoscope apparatus. It is a figure which shows the usage condition of the treatment tool for endoscopes which concerns on 1st embodiment of this invention. It is a schematic diagram which shows the treatment tool for endoscopes reflected in the endoscopic image imaged using the endoscope apparatus according to the first embodiment of the present invention. It is a mimetic diagram showing an endoscope picture in one process of treatment using a treatment tool for endoscopes concerning a first embodiment of the present invention.
  • FIG. 1 is an overall view of an incision system 110 including an endoscope treatment tool 1 according to the present embodiment.
  • an endoscope treatment tool 1 according to the present embodiment is a medical instrument that is used together with an endoscope apparatus 100 in order to incise a living tissue in a body.
  • the endoscope treatment tool 1 constitutes an incision system 110 (endoscope treatment system) in a state where it is combined with the endoscope apparatus 100.
  • FIG. 2 is a plan view of the endoscope treatment tool 1.
  • 3A is a cross-sectional view taken along line III-III in FIG.
  • FIG. 3B is a plan view showing a distal end portion of the sheath 3 of the endoscope treatment tool 1 according to the first embodiment of the present invention.
  • 4 is a cross-sectional view taken along line IV-IV in FIG.
  • FIG. 5 is a perspective view showing a part of the sheath 3 in the endoscope treatment tool 1.
  • FIG. 6 is a plan view showing a part of the operation unit 40 of the endoscope treatment tool 1.
  • FIG. 7 is a view showing the sheath 3 of the endoscope treatment tool 1 and the distal component 41 of the operation unit 40, and only the distal component 41 of the operation unit 40 is shown in cross section.
  • FIG. 8 is a partial cross-sectional view showing the first port 49 portion of the endoscope treatment tool 1, and is a view seen in the direction of the line VIII-VIII shown in FIG. 9A is a cross-sectional view taken along line IX-IX in FIG.
  • FIG. 9B is a perspective view showing the first port 49 portion of the endoscope treatment tool 1.
  • FIG. 10 is a cross-sectional view of the distal end portion of the sheath 3 in the first virtual plane ⁇ .
  • 11 is a view of the distal portion of the sheath 3 as viewed from the direction perpendicular to the second virtual plane ⁇ .
  • 12 is a cross-sectional view taken along line XII-XII in FIG. 13 is a cross-sectional view taken along line XIII-XIII in FIG. 14 is a view showing a distal portion of the sheath 3, and includes a partial cross-sectional view of the sheath 3 as seen from the XIV-XIV line shown in FIG.
  • the endoscope treatment tool 1 has an insertion part 2 and an operation part 40.
  • the insertion unit 2 is an elongated member that is inserted into the treatment instrument channel 104 of the endoscope apparatus 100.
  • the insertion part 2 has a sheath 3 and a knife wire 30.
  • the sheath 3 is an elongated member having flexibility.
  • the sheath 3 is made of resin.
  • the operation part 40 side of the endoscope treatment tool 1 is referred to as a proximal side
  • the insertion part 2 is provided
  • the side inserted into the body is referred to as a distal side.
  • the sheath 3 has a pre-curved portion 4 in a predetermined region including the distal end 3a of the sheath 3, as shown in FIGS. 3B and 35.
  • the pre-curve portion 4 is provided with a bending force in a shape curved in a predetermined direction, and has a restoring force to restore the curved shape given in advance.
  • the central axis L1 of the sheath 3 in the pre-curve portion 4 is within a predetermined plane (hereinafter referred to as “first virtual plane ⁇ ”).
  • the distal end of the pre-curve part 4 is inserted into the duodenal papilla PV (see FIG. 23) of the patient to be treated. As shown in FIG. 3B, the distal end serial hole 23 and the distal second communication hole 24 described later are provided at the distal end portion of the pre-curved portion 4.
  • FIG. 3A when a cross section perpendicular to the central axis L1 of the sheath 3 is viewed along the central axis L1 of the sheath 3 from the proximal end 3b (see FIG. 2) of the sheath 3 toward the distal end 3a.
  • the central axis L1 is the origin
  • the first virtual plane ⁇ is the vertical axis
  • the plane is perpendicular to the first virtual plane ⁇ on the central axis L1 of the sheath 3 (hereinafter referred to as “second virtual plane ⁇ ”).
  • the configuration of the sheath 3 will be described using an orthogonal coordinate system (hereinafter referred to as a “virtual coordinate system”) with the horizontal axis as.
  • the bending direction of the pre-curve portion 4 is the upper side.
  • a first lumen 7, a second lumen 15, and a third lumen 20 are formed inside the sheath 3.
  • the first lumen 7, the second lumen 15, and the third lumen 20 are formed to extend in parallel to each other in the longitudinal direction of the sheath 3.
  • the first lumen 7 is a passage portion having an inner diameter that allows the guide wire 80 to advance and retract. That is, the first lumen 7 is a lumen in which the guide wire 80 is held.
  • the first lumen 7 has a central axis L7 located on the first virtual plane ⁇ and is located below the central axis L1 of the sheath 3, that is, in the third quadrant Q3 and the fourth quadrant Q4 of the virtual coordinate system. .
  • the first virtual plane ⁇ crosses the internal space of the first lumen 7.
  • the predetermined first virtual plane ⁇ includes the central axis L7 of the first lumen 7.
  • the first lumen 7 includes an outlet portion 12 that opens to the distal end 3 a, a guide wire housing portion 9, a slit portion 10, and an inlet portion 8 that opens to the proximal end side. And having.
  • the slit portion 10 is opened on the outer peripheral surface 3 c of the sheath 3 so as to communicate the first lumen 7 (guide wire accommodating portion 9) and the outside of the sheath 3, and It is an elongate cutout formed extending along the direction of the central axis L1.
  • the slit portion 10 has a shape in which a resin member constituting the sheath 3 is cut in the direction of the central axis L1 of the sheath 3.
  • the outer peripheral surface of the pre-curve portion 4 intersects the predetermined first virtual plane ⁇ in the proximal portion of the pre-curve portion 4 in the vicinity of the proximal end 4 b (see FIG.
  • the sheath 3 is formed along the central axis L1.
  • the position of the distal end 10a of the slit portion 10 is a position closer to the proximal end side than the distal second communication hole 24 and from the proximal end 4b of the pre-curved portion 4 (see FIG. 34). Is also located on the tip side.
  • the slit portion 10 extends to the inlet portion 8.
  • the slit portion 10 has a pair of flap portions 11 (first flap 11a, second flap 11b) that are spaced apart from each other so that the opening width of the slit portion 10 is smaller than the diameter of the guide wire 80.
  • the flap portion 11 is a pair of elastic portions that cover the guide wire housing portion 9 with a resin member constituting the sheath 3. The flap portion 11 is deformed until a gap of a size through which the guide wire 80 can pass is generated by the force of the operator when removing the guide wire 80 from the guide wire housing portion 9 through the slit portion 10.
  • the inlet portion 8 is opened to the outer peripheral surface 3 c of the sheath 3 in the vicinity of the proximal end 7 b of the first lumen 7, which is the same as the diameter of the guide wire 80 or larger than the diameter of the guide wire 80. It is a part.
  • the inlet portion 8 is an opening portion wider than the slit portion 10 where the inner surface 7c of the first lumen 7 is exposed to the outside due to the absence of the flap portion 11 described later. That is, the inlet portion 8 has a width larger than the opening width of the slit portion 10, communicates with the first lumen 7, and opens on the outer peripheral surface 3 c of the proximal end portion of the sheath 3.
  • the length of the inlet portion 8 in the direction of the central axis L ⁇ b> 1 of the sheath 3 is larger than the inner diameter of the guide wire housing portion 9 in the first lumen 7. That is, the inlet portion 8 has a long hole shape that is long in the direction of the central axis L1 of the sheath 3.
  • the shape of the inlet portion 8 may be a rectangular shape. When the shape of the inlet portion 8 has a rectangular shape, the processing for forming the inlet portion 8 is easy.
  • the left and right ends 8 c (both ends in the circumferential direction) of the inlet portion 8 in the circumferential direction of the sheath 3 are tapered so that the opening area of the inlet portion 8 gradually increases from the guide wire housing portion 9 toward the outer peripheral surface 3 c of the sheath 3. It may have a shape (see FIG. 9B).
  • the guide wire accommodating portion 9 has a circular outline in a cross section orthogonal to the central axis L ⁇ b> 1 of the sheath 3 except for a boundary with a slit portion 10 described later. That is, the guide wire accommodating portion 9 has a substantially C-shaped contour shape in a cross section orthogonal to the central axis L ⁇ b> 1 of the sheath 3.
  • the guide wire accommodating portion 9 is set to have a clearance in a state where the guide wire 80 is inserted so that the guide wire 80 can be advanced and retracted, and the inner diameter of the guide wire accommodating portion 9 is equal to the clearance dimension. It is larger than the diameter of the guide wire 80.
  • the slit portion 10 is formed so that the opening width in the circumferential direction of the sheath 3 is smaller than the inner diameter of the first lumen 7.
  • the first lumen 7 is orthogonal to the central axis L1 of the sheath 3 between the distal end 10a of the slit portion 10 and the distal end 3a of the sheath 3.
  • the guide wire 80 can be held so that the guide wire 80 can protrude from the distal end 3 a of the sheath 3.
  • the outlet 12 is opened at the distal end 3 a of the sheath 3.
  • the outlet portion 12 communicates with the guide wire housing portion 9.
  • the second lumen 15 shown in FIG. 3A is for sending a liquid such as a contrast medium from the proximal end 3b of the sheath 3 (see FIG. 2) to the distal end 3a of the sheath 3 (see FIGS. 2 and 3A). It may be used as a liquid feeding lumen.
  • the second lumen 15 can also be used as a drainage lumen for removing body fluid.
  • the second lumen 15 in the pre-curve portion 4 is located in the first quadrant Q1 in the virtual coordinate system.
  • the second lumen 15 has a proximal connection port 16 (see FIG. 9A) and a distal discharge port 17 (see FIG. 10), and a flow path for flowing liquid from the proximal connection port 16 to the distal discharge port 17. Can be used as
  • the proximal connection port 16 is an opening that communicates with a communication path 56 (described later) to the second lumen 15, and is an opening through which liquid is introduced from a second port 62 described later.
  • the distal discharge port 17 (see FIG. 10) is an opening through which the liquid introduced from the proximal connection port 16 is discharged, and is disposed at the distal end 3 a of the sheath 3.
  • the third lumen 20 is a lumen into which a knife wire 30 described later is inserted.
  • the third lumen 20 is set so that the knife wire 30 can advance and retract within the third lumen 20. That is, the third lumen 20 is set to have a clearance with the knife wire 30 inserted, and the inner diameter of the third lumen 20 is larger than the diameter of the knife wire 30 by the clearance dimension.
  • the third lumen 20 in the pre-curve portion 4 is located in the second quadrant Q2 in the virtual coordinate system.
  • the second lumen 15 and the third lumen 20 are located in the region on the curved inner surface 401 side, and the first lumen 7 is located in the region of the curved outer surface 402 side. That is, as shown in FIG. 3A, in the vicinity of the distal end 3 a of the sheath 3, above the vertical axis (above the first virtual plane ⁇ ) in the virtual coordinate system of the cross section orthogonal to the central axis L ⁇ b> 1 of the sheath 3.
  • the third lumen 20 in the pre-curve portion 4 is located in a range between 9 o'clock and 12 o'clock.
  • the third lumen 20 has a proximal opening 21 (see FIG. 7), a knife wire accommodating portion 22 (see FIG. 14), a distal first series hole 23, and a distal second communication hole 24. .
  • the proximal opening 21 is an opening that communicates with the communication path 57 (see FIG. 7) to the third lumen 20, and a knife wire 30 to be described later is inserted therein.
  • drawing part 5 in the distal end part of the pre-curve part 4, and the deformation
  • the outer diameter of the drawing part 5 has an outer diameter slightly smaller than the outer diameter of the proximal end side of the sheath 3 and the copying deformation part 6.
  • the distal first through hole 23 is disposed in the vicinity of the distal end 3 a of the sheath 3 in a region where the drawing portion 5 exists.
  • the first distal through hole 23 is opened on the outer peripheral surface 3 c of the sheath 3 and communicates with the third lumen 20.
  • the distal first series through hole 23 is located in the second quadrant Q2 in the virtual coordinate system.
  • the distal first series The through hole 23 is located in a range between 9 o'clock and 12 o'clock. That is, the first distal through hole 23 is formed at a position inside the curve in the pre-curve portion 4 and at a distance from the first virtual plane ⁇ .
  • the distal second communication hole 24 is arranged in the vicinity of the distal end 3a of the sheath 3 in a region where the drawing portion 5 exists.
  • the distal second communication hole 24 is disposed on a position closer to the distal side than the distal first series hole 23 and at a position separated from the distal first series hole 23.
  • the distal second communication hole 24 is located in the second quadrant Q2 in the virtual coordinate system. That is, the distal second communication hole 24 is formed at a position inside the curve in the pre-curve portion 4 and away from the first virtual plane ⁇ , like the distal first communication hole 23.
  • the distal second communication hole 24 and the distal first continuous hole 23 are located at the same position in the circumferential direction around the central axis L1 of the sheath 3. It is desirable to do it.
  • the knife wire 30 has a function of incising a treatment target site.
  • the knife wire 30 includes a conductive core wire 31 and an insulating coating 32 that covers the core wire 31.
  • the knife wire 30 includes a force transmission portion 33, an incision portion 34, and a distal fixing member (fixing portion) 37 in order from the proximal side.
  • the insulating coating 32 is made of, for example, polytetrafluoroethylene (PTFE), tetrafluoroethylene hexafluoropropylene resin (FEP), polyethylene, polyolefin, polyamide, vinyl chloride, latex, natural rubber, polysulfone, polyphenylsulfone,
  • PTFE polytetrafluoroethylene
  • FEP tetrafluoroethylene hexafluoropropylene resin
  • polyethylene polyolefin
  • polyamide polyamide
  • vinyl chloride vinyl chloride
  • latex latex
  • natural rubber polysulfone
  • polyphenylsulfone polyphenylsulfone
  • the outer surface of the core wire 31 is coated with a resin such as polyetherimide, POM, PEEK, polycarbonate, ABS, or a synthetic resin material thereof.
  • the incision 34 is a portion of the entire length of the knife wire 30 that is not covered with the insulating coating 32 (see FIG. 13) and is arranged outside the sheath 3.
  • the incision part 34 can incise a living tissue when a high-frequency current supplied to the core wire 31 is passed through a connector 73 (see FIG. 2) described later.
  • the incision part 34 has a knife bending part 35 and a bending part 36.
  • the force transmission portion 33 is a proximal end 30 b fixed to the slider portion 71 of the handle portion 67 in the operation portion 40 (see FIG. 2) to be described later, out of the entire length of the knife wire 30.
  • the core wire 31 is covered with an insulating coating 32.
  • a knife wire 30 is inserted into the third lumen 20 and fixed to the third lumen 20 by a distal fixing member 37.
  • the knife bending portion 35 is located in the region between the distal first communication hole 23 and the distal second communication hole 24 in the virtual coordinate system.
  • the second quadrant Q2 is arranged on the inner side of the curve in the pre-curve portion 4.
  • the knife bending portion 35 has a curved shape between the distal first series hole 23 and the distal second communication hole 24.
  • the distal end 35 a of the knife bending portion 35 may have a bent portion 36.
  • the bent portion 36 is bent in a direction substantially parallel to a tangent to the outer peripheral surface 3c of the sheath 3 in the second quadrant Q2 in the virtual coordinate system defined by the first virtual plane ⁇ and the second virtual plane ⁇ .
  • the incision 34 is bent at a position protruding from the distal first through hole 23 and bent in a direction away from the first virtual plane ⁇ from the direction in which the distal first through hole 23 extends.
  • the bent portion 36 has a bent shape in which the core wire 31 extending from the knife curved portion 35 toward the distal end 30 a of the knife wire 30 is bent toward the distal first through hole 23 in the knife wire 30. This is a portion where the core wire 31 is bent.
  • the bent portion 36 may be covered with the insulating coating 32.
  • the distal fixing member 37 is provided at the distal end 30 a of the knife wire 30 and is fixed inside the third lumen 20. That is, the distal fixing member 37 fixes the knife wire 30 and the pre-curve part 4 while being inserted into the pre-curve part 4.
  • the distal fixing member 37 is connected to the inner peripheral surface 20c of the third lumen 20 in the pre-curved portion 4 by friction, adhesion, or other connection methods. Since the distal fixing member 37 is fixed inside the third lumen 20 (pre-curved portion 4), the distal portion of the knife wire 30 does not come out of the distal first through hole 23.
  • the operation unit 40 illustrated in FIG. 2 is a part that is gripped by the operator, and is disposed at the proximal end 2b of the insertion unit 2 (the proximal end 3b of the sheath 3). Various operations for operating the endoscope treatment tool 1 are input to the operation unit 40.
  • the operation unit 40 includes a distal component 41, a flexible coupling 58, a proximal component 61, and a handle 67.
  • the distal component portion 41 is a member arranged on the most distal side in the operation portion 40.
  • the distal component part 41 includes a main body part 42, a connection part 45 to the endoscope apparatus 100, and a connection part 48 to the sheath 3.
  • the main body 42 is a hard member, and has a main body side liquid supply conduit 43 and a main body side wire passage 44 therein.
  • the main body portion 42 is connected to a first port 49 described later in the connecting portion 48 and extends in a radial direction with respect to the major axis L2 of the first port 49 (a linear direction intersecting the major axis L2).
  • the main body portion 42 extends to the proximal end 48b of the connecting portion 48 along a virtual plane including the major axis L2 of the first port 49 and the minor axis perpendicular to the major axis L2.
  • the main body side liquid feed conduit 43 forms a part of a conduit that communicates with a second port 62 (see FIG. 20) described later and the second lumen 15 described above.
  • the main body side wire passage 44 is a passage through which the force transmission portion 33 of the knife wire 30 inserted through the third lumen 20 is inserted so as to freely advance and retract.
  • the connecting portion 45 to the endoscope apparatus 100 has a hook 46 and an extending portion 47.
  • the hook 46 is a locking portion that can be locked to a gripping portion 102 (see FIG. 19) provided in the endoscope apparatus 100.
  • the extension part 47 connects the hook 46 and the main body part 42.
  • the hook 46 is an elastic member formed in a C shape so as to surround a part of the outer peripheral surface of the grip portion 102 provided in the endoscope apparatus 100.
  • the hook 46 presses the outer surface of the grip portion 102 of the endoscope apparatus 100 by a restoring force that the hook 46 itself restores in a C shape. As a result, the hook 46 engages with the grip portion 102 of the endoscope apparatus 100.
  • the extending portion 47 is a hard bar-like member that connects the main body portion 42 and the hook 46, for example.
  • the proximal end of the extending portion 47 is connected to the main body portion 42, and the distal end 47 a of the extending portion 47 is connected to the hook 46. It is preferable that the extension part 47 holds the hook 46 on the distal side of the main body part 42.
  • the connecting portion 48 to the sheath 3 has a substantially cylindrical shape into which the proximal end 7 of the sheath 3 and the vicinity thereof are inserted.
  • the connecting portion 48 to the sheath 3 may extend from the main body portion 42 toward the distal end with a gap between the connecting portion 48 and the extending portion 47.
  • the connecting portion 48 may be installed in parallel with the main body portion 42 and the extending portion 47. In such a configuration, the operator can easily hold the main body portion 42 and the extending portion 47 without obstructing the visibility of the connecting portion 48 and the first port 49 and the insertion of the guide wire 80 described later. In addition, the direction of the first port 49 can be precisely controlled.
  • the connecting portion 48 to the sheath 3 has a first port 49, a communication path 56 to the second lumen 15, and a communication path 57 to the third lumen 20.
  • the operating portion 40 (the connecting portion 48) includes a cylindrical portion formed in a substantially cylindrical shape having an inner diameter into which the proximal end 3b of the sheath 3 and the vicinity thereof can be inserted, and an inner peripheral surface of the cylindrical portion.
  • a first port 49 having an opening through which the guide wire 80 can be inserted.
  • the port fixing which fixes the 1st port 49 with respect to the sheath 3 in the proximal end 3b of the sheath 3, and its vicinity so that the opening direction of the opening part of the 1st port 49 and the opening direction of the inlet_port
  • a known fixing method such as directly bonding the sheath 3 and the first port 49 or forming a notch in the sheath 3 and mechanically locking the notch can be appropriately employed.
  • the sheath 3 does not rotate around its longitudinal axis and does not come out of the tubular portion.
  • the first port 49 is a port that serves as an entrance when the guide wire 80 (see FIG. 28) is introduced into the first lumen 7.
  • the opening of the first port 49 has an inner opening edge 50 and an outer opening edge 51.
  • it has the taper part 52 and the notch part 55 connected to an opening part.
  • the inner opening edge portion 50 forms an outline of an opening opened on the inner peripheral surface of the cylindrical portion. Further, the inner opening edge 50 has a contour line that matches the contour of the inlet portion 8 formed in the proximal portion of the sheath 3 or a contour line that surrounds the contour of the inlet portion 8. That is, the contour of the opening of the inner opening edge 50 is such that the edge (opening edge) of the inlet portion 8 of the sheath 3 is in a straight line perpendicular to the opening direction (the central axis of the first lumen 7 and the central axis of the sheath 3).
  • the inner opening edge 50 is arranged at a position where it can contact the outer peripheral surface 3 c of the sheath 3. With such a positional relationship, the sheath 3 is fixed to the operation unit 40.
  • the outer opening edge 51 forms an outline of an opening opened on the outer peripheral surface of the cylindrical portion. Further, the outer opening edge 51 is located on the outer side in the radial direction of the sheath 3 from the inner opening edge 50.
  • the outer opening edge 51 has an opening area larger than the opening area defined by the inner opening edge 50.
  • the outer opening edge 51 has a contour line that substantially matches the outer periphery of the contour of the inlet portion 8 formed in the proximal portion of the sheath 3 or a contour line that surrounds the contour of the inlet portion 8.
  • the contour of the outer opening edge 51 is located outside the inner opening edge 50.
  • the contours of the openings of the inner opening edge and the outer opening edge substantially coincide with or surround the projection portion obtained by projecting the edge of the inlet portion 8 of the sheath 3 in the opening direction.
  • the first port 49 is fixed in a state of being positioned with respect to the direction around the longitudinal axis of the sheath 3 and the longitudinal axis direction of the sheath 3.
  • the inner opening edge 50 and the outer opening edge 51 have a long axis L2 in the linear direction connecting the distal end 48a of the connecting portion 48 to the sheath 3 and the proximal end 48b of the connecting portion 48 to the sheath 3. It is formed in a circular shape.
  • the inner opening edge 50 and the outer opening edge 51 define the opening shape of the first port 49.
  • the length of the opening of the first port 49 in the long axis L2 direction can be set according to the configuration of the distal end 80a of the guide wire 80 that can be inserted into the first port 49.
  • FIG. 15 is a side view showing a configuration example of the guide wire 80 used together with the endoscope treatment tool 1.
  • 16 to 17B are side views respectively showing guide wires 81, 82, and 83 of other configuration examples of the guide wire 80 shown in FIG.
  • known configurations may be appropriately adopted as the guide wires 80, 81, 82, 83 inserted into the first port 49.
  • the guide wires 80, 81, 82, 83 inserted into the first port 49.
  • at least a part of a region (distal portion) in the vicinity of the distal end 80a of the guide wires 81 and 82 has curved shape portions 811 and 812 having a curved shape.
  • the curved shape portions 811 and 812 are shapes that are curved by forming a part of an arc. For example, as shown in FIG.
  • 82 may be adopted.
  • the vicinity area (distal part) of the distal ends 80a of the guide wires 80 and 83 may have a bent part having a restoring force for restoring the shape in which the central axes of the guide wires 80 and 83 are deflected. For example, as shown in FIGS.
  • the distal portion is provided on the distal side of the guide wires 80 and 83 with respect to the bent portion, and the bent portion is located with respect to the proximal portion of the guide wires 80 and 83.
  • the shape may be such that the distal portions of the guide wires 80 and 83 extend in a direction that forms an obtuse angle, a right angle, or an acute angle.
  • the angle-type guide wires 80, 81, 82, 83 are arranged so that the distal ends 80a of the guide wires 80, 81, 82, 83 reach the desired lumens in the lumen tissue having complicated traveling or the lumen tissue having branches. It is excellent in that it is easy to operate when inserting.
  • the lengths of the distal portions of the guide wires 80 and 83 are M20 and M23, respectively.
  • 16 and 17A the maximum tangential lengths at the tips of the curved portions 811 and 812 of the guide wires 81 and 82 are M21 and M22, respectively.
  • FIG. 18 is a view for explaining the relationship between the shape of the first port 49 and the shape of the guide wire 80 in the endoscope treatment tool 1.
  • the length M1 of the opening of the first port 49 in the longitudinal direction of the sheath 3 may be substantially equal to or slightly longer than the length M20 of the distal portion of the guide wire 80. Good.
  • the length M1 of the opening of the first port 49 in the major axis direction of the sheath 3 is substantially equal to the maximum length M21 of the tangential component at the tip of the curved shape portion 811. It may be set equal or slightly longer.
  • the length M1 of the opening of the first port 49 in the major axis direction of the sheath 3 is approximately the maximum length M22 of the tangential component at the distal end of the curved shape portion 812. It may be set equal or slightly longer.
  • the length M1 of the first port 49 in the longitudinal direction of the sheath 3 is substantially equal to or slightly longer than the length M23 of the distal portion of the guide wire 83. You only have to set it.
  • the tapered portion 52 has a distal tapered surface 53 and a proximal tapered surface.
  • the distal tapered surface 53 smoothly connects to the notch 55 at the distal end 49 a portion of the first port 49.
  • the proximal tapered surface 54 is a tapered surface that connects the inner opening edge 50 and the outer opening edge 51 at the proximal end 49 b of the first port 49 and the side portion connected to both ends thereof.
  • the distal tapered surface 53 is arranged so that the guide wire 80 is distant from the first port 49 through the notch 55. It is guided to move in the direction of the distal end 3a.
  • the proximal tapered surface 54 causes the distal end 80a of the guide wire 80 to be inserted when the distal end 80a of the guide wire 80 is inserted into the first port 49 from the outside of the connection portion 48 to the sheath 3. Guide into the first lumen 7 of the sheath 3.
  • the inlet portion 8 of the first lumen 7 is exposed to the outside so that the inner surface 7c of the first lumen 7 can be seen from the outside of the connecting portion 48 to the sheath 3. Is arranged on the outer peripheral portion of the inlet portion 8.
  • FIG. 19 is a diagram illustrating a positional relationship between the first port 49 and the operation unit 40 in a state where the endoscope treatment tool 1 is attached to the endoscope apparatus 100.
  • FIG. 20 is a diagram illustrating a positional relationship between the hook 46 and the first port 49 in a state where the endoscope treatment tool 1 is attached to the endoscope apparatus 100.
  • the opening of the first port 49 is the bending operation portion of the endoscope device 100 in a state where the operation portion 40 is locked to the grip portion 102 of the endoscope device 100 by a hook (locking portion) 46.
  • the positional relationship between the opening of the first port 49 and the hook 46 is determined so as to face the 107a side.
  • the bending operation unit 107 a side is an operation unit that can actively operate the bending deformation unit 107 b provided at the distal end portion of the endoscope apparatus 100.
  • the first port 49 only needs to be formed with a through-hole whose axial direction intersects with a virtual plane that penetrates along the axis substantially parallel to the longitudinal axis of the grip portion 102.
  • the endoscope treatment tool 1 may be fixed to the endoscope apparatus 100 so as to extend in a direction substantially parallel to the direction in which the forceps plug 103 of the endoscope apparatus 100 extends.
  • the first port 49 is used.
  • the axial direction through which the through hole penetrates (the direction of the central axis L3 described later) is a positional relationship of twist with respect to the longitudinal axis of the grip portion 102 of the endoscope apparatus 100. In the present embodiment, as shown in FIG.
  • first a straight direction from the surface defined by the inner opening edge 50 toward the surface defined by the outer opening edge 51 (hereinafter referred to as “first”
  • the direction of the center axis L3 of the opening of the port 49 is referred to as “the direction of the center axis L3”), as shown in FIG. That is, in the cross section of the operation portion 40 of the endoscope treatment tool 100 shown in FIG. 9A, it passes through the central axis L7 of the first lumen 7 and between the inner opening edge portions 50 and between the outer opening edge portions 51.
  • the direction of the central axis L3 of the opening of the first port 49 that passes between them is substantially parallel to the direction of the central axis L4 of the circle surrounding the grip portion 102 in the hook 46.
  • the opening of the first port 49 is formed so as to open around the central axis L3 of the opening of the first port 49 orthogonal to the central axis L1 of the sheath 3, as shown in FIG. 9A.
  • the central axis L3 of the 49 openings and the central axis L4 of the circle surrounding the grip portion 102 of the endoscope apparatus 100 are substantially parallel.
  • the operator grips the grip portion 102 of the endoscope apparatus 100 and operates the endoscope apparatus 100 in a state where the operation section 40 is attached and locked to the endoscope apparatus 100 by the hook 46.
  • the opening of the first port 49 is directed in a direction (see FIG. 24) that is visible to the operator.
  • the notch portion 55 is a portion where the notch is formed so as to be substantially C-shaped when the connecting portion 48 is viewed in a cross section orthogonal to the central axis L1 of the sheath 3. It is.
  • the notch 55 is such that the diameter of the connecting portion 48 is larger than the diameter of the guide wire 80 by a clearance that allows the guide wire 80 to move so that the guide wire 80 can move from the inlet portion 8 to the slit portion 10.
  • the gap in the notch portion 55 is provided along the slit portion 10 of the sheath 3.
  • the notch 55 has an inner surface 55 c that can contact the outer peripheral surface 3 c of the sheath 3, and holds the outer peripheral surface 3 c of the sheath 3.
  • the notch portion 55 is provided away from the extending portion 47 in the connecting portion 45 to the endoscope apparatus 100, and thus is transmitted from the endoscope apparatus 100 via the hook 46.
  • the external force is configured not to be transmitted to the notch portion 55.
  • the notch portion 55 and the distal portion of the first port 49 are both separated from the extending portion 47.
  • the communication path 56 to the second lumen 15 communicates with the second lumen 15 of the sheath 3, and the communication path 57 to the third lumen 20 communicates with the third lumen 20 of the sheath 3. ing.
  • the flexible connecting portion 58 is a member that connects the distal component portion 41 and the proximal component portion 61, and has flexibility.
  • the flexible coupling part 58 buffers the twist generated between the distal component part 41 and the proximal component part 61. That is, when the operation unit 40 and the endoscope apparatus 100 are connected by the hook 46, the flexible connection unit 58 is operated by the operation of the operation unit 40 and the operation of the endoscope apparatus 100. And torsion occurring between the proximal component 61 and the proximal component 61 is buffered.
  • the flexible connecting portion 58 has a communication passage 59 for feeding liquid and a communication passage 60 for knife wire inside.
  • the communication passage 59 for liquid feeding communicates with the second lumen 15.
  • the knife wire communication passage 60 communicates with the third lumen 20.
  • the proximal component 61 includes a second port 62 and a connecting portion 63 to the handle portion 67.
  • the second port 62 is a port to which a syringe containing liquid is connected.
  • a syringe filled with the contrast agent is connected to the second port 62.
  • the proximal end 62b of the second port 62 has a connector structure that can be connected to a syringe having a luer lock structure.
  • the distal end 62 a of the second port 62 communicates with a liquid-feeding communication passage 59 (see FIG. 7) formed in the flexible connection portion 58.
  • the connecting portion 63 to the handle portion 67 has a handle fixing portion 64 and a knife wire passage 66.
  • the handle fixing part 64 is provided to fix the handle part 67 in a predetermined connection state.
  • the knife wire passage 66 communicates with the knife wire communication passage 60 in the flexible connecting portion 58.
  • the handle fixing portion 64 has a claw structure 65 that can fix the distal end of the shaft portion 68 of the handle portion 67.
  • the proximal component portion 61 and the shaft portion 68 may be integrally molded.
  • the handle fixing portion 64 has a rod-like shape extending in a direction inclined with respect to the direction of the long axis L2 of the first port 49.
  • the handle fixing portion 64 has a rod shape, and gradually moves away from the long axis L2 of the first port 49 from the distal end 64a of the handle fixing portion 64 toward the proximal end 64b of the handle fixing portion 64. It has a central axis L5 that is inclined in the direction.
  • the knife wire passage 66 is a passage through which the force transmission portion 33 of the knife wire 30 is inserted so as to be movable forward and backward.
  • the distal end 66a of the knife wire passage 66 communicates with the proximal end of the knife wire communication passage 60 (see FIG. 7) at the flexible connection 58.
  • the proximal end 66 b of the knife wire passage 66 communicates with the inside of the shaft portion 68 of the handle portion 67.
  • the handle portion 67 is a portion where an input for the operator to operate the knife wire 30 is performed.
  • the handle portion 67 has a shaft portion 68 and a slider portion 71.
  • the shaft portion 68 is fixed to the handle fixing portion 64 of the proximal component portion 61.
  • the slider portion 71 is connected to the shaft portion 68.
  • the shaft portion 68 has a rod-shaped portion 69 and a ring portion 70.
  • the rod-like portion 69 is provided coaxially with the central axis L5 (see FIG. 24) of the handle fixing portion 64 or linearly along the central axis L5 of the handle fixing portion 64.
  • the ring part 70 is formed at the proximal end of the rod-like part 69.
  • the rod-shaped portion 69 is a portion to which a slider portion 71 described later is attached. Inside the rod-like portion 69, the connector 73 of the slider portion 71 and the proximal portion of the knife wire 30 are disposed.
  • the ring part 70 is an annular part through which an operator can pass a finger.
  • the slider portion 71 includes a moving body 72, a connector 73, and a finger hook portion 74.
  • the moving body 72 is connected to the shaft portion 68 so as to be movable forward and backward.
  • the connector 73 can be connected to a high frequency power supply device.
  • the finger hook portion 74 is formed with two rings 75 through which an operator's finger can pass.
  • the moving body 72 can advance and retreat in the longitudinal direction of the shaft portion 68.
  • the connector 73 is fixed to the moving body 72 and is fixed to the proximal end 33 b of the force transmission portion 33 of the knife wire 30.
  • the connector 73 is made of a conductor and is electrically connected to the core wire 31 of the knife wire 30.
  • the finger hooking portion 74 allows the operator to pass the finger through the two rings 75, and further allows the operator to pass the finger through the ring portion 70 of the rod-shaped portion 69, so that the moving body 72 is moved by the opening / closing operation of the operator's hand. It can be used to advance and retreat against.
  • the finger hooking portion 74 protrudes from the outer surface of the moving body 72 toward the outside (the direction away from the central axis L5). As shown in FIG. 19, the protruding direction of the finger hook portion 74 from the outer surface of the moving body 72 may be a plane that does not include the direction of the central axis L ⁇ b> 3 of the opening of the first port 49.
  • the protruding direction of the finger hooking portion 74 from the outer surface of the moving body 72 is a direction (hereinafter referred to as “ring extending surface ⁇ ”) orthogonal to the direction of the central axis L3 of the opening of the first port 49.
  • ring extending surface ⁇ orthogonal to the direction of the central axis L3 of the opening of the first port 49.
  • FIG. 21 is a perspective view of a treatment instrument attachment assisting tool 90 that can be attached to the endoscope apparatus 100.
  • FIG. 22 is a partial cross-sectional view showing the internal structure of the treatment instrument attachment assisting tool 90.
  • the treatment instrument attachment assisting tool 90 includes an assisting instrument main body 91, a discharge pipe 92, and a plug 93.
  • the auxiliary tool main body 91 has a cylindrical shape that can be fixed to the forceps plug 103 of the endoscope apparatus 100.
  • the discharge pipe 92 is in communication with the internal space of the auxiliary tool main body 91.
  • the plug 93 is disposed on the extension line of the central axis of the treatment instrument channel 104 from the proximal opening of the treatment instrument channel 104 in the forceps plug 103.
  • the auxiliary tool body 91 has a mounting structure that can be connected to the forceps plug 103 in a watertight manner.
  • the discharge pipe 92 can be connected to a pipe line connected to a drainage container (not shown).
  • the plug 93 is a flexible member having an opening or a cut that is close to the outer peripheral surface 3 c of the sheath 3.
  • the treatment tool attachment assisting tool 90 is fixed to the forceps plug 103 of the endoscope apparatus 100 before the treatment tool for endoscope 1 is inserted into the treatment tool channel 104 (see FIG. 24). ).
  • the liquid that has flowed back through the treatment instrument channel 104 of the endoscope apparatus 100 from the distal side toward the proximal side is mainly a discharge pipe 92. Flow into.
  • FIG. 2 shows an example in which the endoscope treatment tool 1 according to the present embodiment is used together with the endoscope apparatus 100.
  • FIG. 23 is a diagram illustrating a process during use of the endoscope treatment tool 1.
  • the side-view type endoscope apparatus 100 suitable for observing the duodenal papilla PV is used.
  • the side-view type endoscope apparatus 100 includes, for example, a cylindrical member 101, a grip portion 102, a forceps plug 103, a treatment instrument channel 104, a raising base 105, and an imaging unit 106.
  • the cylindrical member 101 is a part inserted into the body.
  • the grip portion 102 is disposed at the proximal end of the cylindrical member 101.
  • the forceps plug 103 is disposed on a part of the grip portion 102.
  • the treatment instrument channel 104 communicates with the forceps plug 103 and is disposed inside the cylindrical member 101.
  • the elevator 105 is used to change the direction of the treatment instrument or the like protruding from the treatment instrument channel 104 at the distal end 104a of the treatment instrument channel 104 in a direction orthogonal to the central axis L8 of the cylindrical member 101. It is provided so as to be movable in the opening from which the tool is projected.
  • the imaging field is directed to the imaging unit 106 in a direction orthogonal to the central axis L8 of the cylindrical member 101.
  • the imaging unit 106 is provided adjacent to an opening from which the treatment tool projects.
  • the side-view type endoscope apparatus 100 in this embodiment includes a bending mechanism 107 (see FIG. 1).
  • the bending mechanism 107 includes a bending operation unit 107a and a bending deformation unit 107b for bending the distal portion of the cylindrical member 101.
  • the endoscope treatment tool 1 includes a mode in which an operator of the endoscope apparatus 100 and an operator of the endoscope treatment tool 1 are different from each other, and a grip portion of the endoscope apparatus 100
  • the hook 46 is connected to 102 so that one operator can use the endoscope apparatus 100 by operating the endoscope treatment tool 1 in an appropriate manner.
  • the endoscope treatment tool 1 is used by connecting the hook 46 to the grip portion 102 of the endoscope apparatus 100 shown in FIG. 1
  • the operator operates the duodenal papilla, which is a treatment target part, by a known technique as shown in FIG. Guide to the PV and observe the treatment target site using the endoscope apparatus 100.
  • the treatment tool attachment assisting tool 90 may be attached to the forceps plug 103 or may not be attached.
  • FIG. 24 is a diagram of a state in which the endoscope treatment tool 1 is attached to the endoscope apparatus 100 as viewed from the viewpoint of the operator of the endoscope apparatus 100.
  • the hook 46 is attached to the grip portion 102 of the endoscope apparatus 100 with the treatment tool attachment assisting tool 90 fixed to the forceps plug 103.
  • the sheath 3 of the endoscope treatment tool 1 according to the present embodiment is inserted into the treatment tool channel 104 (see FIG. 1) of the endoscope apparatus 100 via the treatment tool attachment assisting tool 90.
  • the operation unit 40 of the endoscope treatment tool 1 is connected to the endoscope apparatus 100 by a hook 46.
  • the operator of the endoscope treatment tool 1 holds the endoscope apparatus 100 in, for example, the left hand and the sheath 3 in, for example, the right hand, and moves the sheath 3 in and out of the forceps plug 103 of the endoscope apparatus 100. Can do.
  • FIG. 25 is a diagram illustrating a process during use of the endoscope treatment tool 1.
  • FIG. 26 is a schematic diagram showing the endoscopic treatment tool 1 according to the present embodiment reflected in an endoscopic image captured using the endoscopic device 100.
  • the distal end 3a of the sheath 3 protrudes from the distal end 104a (opening) of the treatment instrument channel 104, and as shown in FIG.
  • the image is captured by the imaging unit 106 of the mirror device 100.
  • the operator introduces a contrast medium into the duodenal papilla PV to examine the running of the bile and pancreatic ducts and the presence of stones. That is, for the ERCP procedure, the pre-curved portion 4 at the distal end 3 a of the sheath 3 is protruded from the distal end 104 a of the treatment instrument channel 104 of the endoscope apparatus 100. Since the pre-curved portion 4 is previously curved, the central axis L1 of the sheath 3 is used as the rotation center until the pre-curved portion 4 follows the curved shape of the bending mechanism 107 or the raising base 105 in the treatment instrument channel 104. The pre-curve part 4 rotates.
  • the pre-curve portion 4 rotates about the central axis L1 of the sheath 3 until the bending direction of the pre-curve portion 4 coincides with the bending direction of the elevator 105 To do. Subsequently, the distal end portion (drawing portion 5) of the pre-curve portion 4 enters the imaging field of the imaging portion 106 of the endoscope apparatus 100. The operator adjusts the position of the distal end portion (drawing portion 5) of the pre-curve portion 4 by moving the proximal end 3b of the sheath 3 forward and backward in the central axis L1 direction of the sheath 3 in the operation portion 40.
  • the operator moves the proximal end 3b of the sheath 3 forward and backward, and moves the distal end 3a of the sheath 3 to a predetermined position suitable for inserting the distal end 3a of the sheath 3 into the duodenal papilla PV.
  • the position of the distal end portion of the pre-curve portion 4 is adjusted so that is positioned. Even if the proximal end 3b of the sheath 3 is not actively rotated about the central axis L1 of the sheath 3 as a rotation center, the pre-curved portion 4 is brought into the curved state of the bending mechanism 107 and the raising base 105 of the endoscope apparatus 100. Accordingly, the distal end 3a of the sheath 3 is curved in the 12 o'clock direction in the endoscopic image.
  • the outer peripheral surface of the proximal end portion of the pre-curve portion 4 is pressed by the elevator 105.
  • the position of the pressed surface 4X (see FIG. 3B) pressed by the raising base 105 in the outer peripheral surface of the pre-curve portion 4 is the distal first series through hole 23 and the distal second communication in the outer peripheral surface of the pre-curve portion 4. The position is different from the position where the hole 24 is formed.
  • the operator When positioning for inserting the distal end 3a of the sheath 3 into the duodenal papilla PV is difficult, the operator inserts the guide wire 80 from the first port 49 of the operation unit 40 into the first lumen 7, The distal end 80 a of the guide wire 80 may protrude from the distal end 7 a of the one lumen 7. In this case, the operator first inserts the distal end 80a of the guide wire 80 into the duodenal papilla PV, and then the operator inserts the distal end 3a of the sheath 3 along the guide wire 80 into the duodenum. Can be inserted into the nipple PV.
  • the knife wire 30 protrudes from the distal first through hole 23 and the distal second communication hole 24 in a direction closer to the 11 o'clock direction than the 12 o'clock direction.
  • the operator inserts the sheath 3 from the forceps plug 103 into the treatment instrument channel 104 while confirming that the knife bending portion 35 is directed in the direction between 11:00 and 12:00 on the endoscopic image.
  • the distal portion of the sheath 3 is pushed out of the elevator 105 of the endoscope apparatus 100, and the distal end 3a of the sheath 3 reaches the opening of the duodenal papilla PV and is inserted into the duodenal papilla PV.
  • the operator discharges the contrast medium from the second port 62, and the contrast medium is discharged from the distal discharge port 17 of the second lumen 15 of the sheath 3 through the duodenal papilla PV. Introduce into the pancreatic duct.
  • the operator can easily grasp the travel of the bile duct and pancreatic duct, the presence or absence of stones, the position and size thereof, and the like.
  • FIG. 27 is a schematic diagram showing an endoscopic image in a process of treatment using the endoscope treatment tool 1. As shown in FIG. 27, after the sheath 3 is introduced into the duodenal papilla PV, the operation is performed with the distal end portion (drawing portion 5) of the pre-curve portion 4 being disposed in the duodenal papilla PV by a predetermined length.
  • the slider portion 71 in the portion 40 is moved in the direction of the central axis of the rod-like portion 69 of the shaft portion 68 toward the proximal end 68b of the shaft portion 68, that is, in the direction of the central axis L5 of the handle fixing portion 64 (see FIG. 2).
  • the force transmission portion 33 of the knife wire 30 moves toward the proximal end 30b of the knife wire 30, and the distal end 30a of the knife wire 30 passes through the distal first series hole 23 of the sheath 3.
  • a force is generated that moves in the proximal direction.
  • the portion of the sheath 3 near the distal end 3 a is bent and deformed between the distal first series hole 23 and the distal second communication hole 24.
  • the incision 34 of the knife wire 30 is stretched in an arc shape with respect to the sheath 3.
  • the knife bending portion 35 (see FIG. 11) is arranged in the second quadrant Q2 in the virtual coordinate system. Therefore, when the bending direction of the pre-curve unit 4 captured by the imaging unit 106 as an endoscopic image is set to 12 o'clock, the knife bending unit 35 is located at a position deviated closer to 11 o'clock than 12 o'clock. It contacts the inner surface of the opening of the nipple PV.
  • the operator supplies a high frequency current from the high frequency power supply device to the knife wire 30 through the connector 73 of the operation portion 40.
  • the tissue in contact with the knife bending portion 35 is incised by the high-frequency current.
  • the knife bending portion 35 is bent in a natural state where no external force is applied to the knife bending portion 35.
  • the knife bending portion 35 is gradually deformed from a curved shape in a natural state to a linear shape as the force transmission portion 33 of the knife wire 30 is moved by the slider portion 71 toward the proximal end 68b of the shaft portion 68.
  • the knife bending portion 35 is gradually deformed from a curved shape in a natural state to a linear shape along a linear direction connecting the distal first series through hole 23 and the distal second communication hole 24.
  • the curvature radius of the pre-curve portion 4 is set large, the knife wire 30 is gradually deformed from a linear shape to a curved shape.
  • the bending state of the knife bending portion 35 is changed by the movement of the knife wire 30 using the slider portion 71.
  • the duodenal papilla PV Since the position avoiding the main blood vessel in the duodenal papilla PV is set to be reflected from the 11 o'clock direction on the endoscopic image, the duodenal papilla PV is incised by the knife bending portion 35 at this 11 o'clock direction position. An incision can be made with a small amount of bleeding due to the incision of the duodenal papilla PV.
  • the operator connects a syringe containing a contrast medium to the second port 62 as necessary, and the contrast medium is transferred from the second port 62 through the second lumen 15 to the duodenal papilla PV. Discharge inside.
  • the route to the calculus to be removed can be grasped on the X-ray image by the contrast medium discharged into the duodenal papilla PV.
  • FIG. 28 is a view showing an example of attaching the guide wire 80 to the endoscope treatment tool 1, and is a partial cross-sectional view taken along the line VIII-VIII in FIG.
  • FIG. 29 is a view showing another example in which the guide wire 80 is attached to the endoscope treatment tool 1, and is a partial cross-sectional view taken along the line VIII-VIII in FIG.
  • the operator introduces a guide wire 80 to be inserted into the bile duct or pancreatic duct from the duodenal papilla PV after the traveling of the bile duct or pancreatic duct can be grasped by the X-ray image.
  • the case where the guide wire 80 is introduced into the bile duct along the travel of the bile duct is illustrated.
  • the bile duct can be suitably operated so that the operator can selectively insert the guide wire 80 at the bifurcation of the bile duct and pancreatic duct or guide the guide wire 80 in a desired direction at the branch in the bile duct.
  • An angle type guide wire 80 having a curved structure at the distal end is used as the guide wire 80 inserted therein.
  • the angle type guide wire 80 has a distal end portion that is highly flexible and has a curved shape so as to flexibly follow the inner wall of the bile duct and have a restoring force in a predetermined bending direction.
  • the operator grasps a region adjacent to the proximal portion of the distal portion of the guide wire 80 and having a curved shape. To do.
  • the operator puts the curved shape portion 801 in the vicinity of the distal end 80 a of the guide wire 80 into the first lumen 7 from the first port 49.
  • the operator inserts the guide wire 80 into the first port 49 while the guide wire 80 is inclined so that the distal end 80 a of the guide wire 80 faces the distal end 49 a side of the first port 49. To do.
  • the way of inserting the distal end 80a of the guide wire 80 into the first port 49 can be appropriately selected.
  • the guide wire 80 is inserted into the first port 49 so that the distance from the distal end 80a of the guide wire 80 to the bent portion is parallel to the central axis L7 of the first lumen 7. As a result, the guide wire 80 is smoothly introduced into the first lumen 7.
  • the operator can The distal end 80a is inserted into the first port 49 so that the portion 812 is hooked on the distal end 49a of the first port 49 (see FIG. 29). Thereafter, the operator tilts the guide wire 80 toward the proximal end 49 b of the first port 49, deforms the guide wire 80 into a linear shape, and inserts the guide wire 80 into the first lumen 7. As a result, the guide wire 80 is smoothly introduced into the first lumen 7.
  • the inner surface 7 c of the first lumen 7 is visible to the operator through the first port 49. State. As a result, the operator can easily put the distal end 80 a of the guide wire 80 into the first lumen 7.
  • the opening of the first port 49 is directed to the proximal side of the endoscope apparatus 100. Therefore, the operator can insert the distal end 80 a of the guide wire 80 toward the first lumen 7 in a state where the first lumen 7 of the sheath 3 can be seen through the first port 49.
  • the first port 49 has a long hole shape that is long in the direction of the long axis L2 extending in the linear direction connecting the distal end 48a of the connecting portion 48 to the sheath 3 and the proximal end 48b of the connecting portion 48 to the sheath 3. It has a shaped opening.
  • the guide wire 80 inserted into the first port 49 can be advanced and retracted in a direction substantially along the central axis L7 of the first lumen 7 (a direction slightly inclined with respect to the central axis L7 of the first lumen 7). It is.
  • the guide wire 80 can be easily advanced and retracted with the right hand of the operator, and the occurrence of buckling of the guide wire 80 can be prevented.
  • the right hand changes the sheath 3 from the guide wire 80 and inserts the guide wire 80 into the first port 49 with the right hand. It is easy to advance and retreat according to the endoscope treatment tool 1 according to the present embodiment.
  • the already inserted guide wire 80 is used.
  • the angle-type guide wire 80 may be replaced.
  • the operator projects the guide wire 80 from the distal end 3a of the sheath 3 and guides the guide wire 80 to a desired position in the bile duct. At this time, if necessary, the operator rotates the guide wire 80 around its center line, so that the distal end 80a of the guide wire 80 is inserted into a desired branch at the bifurcation of the bile duct. 80 may be moved.
  • FIG. 30 is a diagram illustrating a process during the use of the endoscope treatment tool 1. As shown in FIG. 30, the guide wire 80 is inserted, for example, until the distal end 80a of the guide wire 80 is located at a position that has advanced to some depth beyond the calculus to be removed from the bile duct.
  • FIG. 31 is a diagram illustrating a process of removing the endoscope treatment tool 1 from the endoscope apparatus 100 while leaving the guide wire 80 attached to the endoscope treatment tool 1.
  • FIG. 32 is a diagram illustrating a process of separating the sheath 3 and the guide wire 80 of the endoscope treatment tool 1.
  • FIG. 33 is a diagram illustrating an example of a treatment performed after the endoscope treatment tool 1 is removed. After the guide wire 80 reaches a predetermined position, the endoscope treatment tool 1 is removed with the guide wire 80 left in the body. This is performed in order to introduce a known endoscopic stone removing tool (basket forceps, balloon or the like) for removing a stone into the bile duct instead of the endoscope treatment tool 1 according to the present embodiment. .
  • a known endoscopic stone removing tool basic forceps, balloon or the like
  • the notch part 55 is passed through.
  • the guide wire 80 is removed.
  • the operator does not change the position of the distal end 80 a of the guide wire 80, and moves away from the notch 55 from the proximal end 55 b of the notch 55 of the first port 49 through the inside of the notch 55.
  • the guide wire 80 is moved relative to the first port 49 to the distal end 55a. In the process in which the guide wire 80 passes through the notch 55 of the first port 49, the guide wire 80 is gradually taken out of the sheath 3 from the guide wire housing portion 9 through the slit portion 10.
  • the operator moves the sheath 3 toward the proximal end of the treatment instrument channel 104 while supporting the guide wire 80 so that the position of the guide wire 80 does not move.
  • the sheath 3 is gradually removed from the guide wire 80.
  • the operator When the outlet 12 (see FIG. 10) of the first lumen 7 in the sheath 3 reaches the position of the forceps plug 103, the operator resists the force that the guide wire 80 tries to move toward the proximal end 80b. While supporting the guide wire 80, the sheath 3 is moved toward the proximal end 80 b of the guide wire 80. The operator pulls out the outlet 12 of the sheath 3 from the forceps plug 103 without changing the position of the guide wire 80 in the body. Thereafter, the operator moves the distal portion of the sheath 3 where the outlet portion 12 of the sheath 3 is disposed toward the proximal end 80 b of the guide wire 80 and removes the sheath 3 from the guide wire 80.
  • the operator attaches the above-described known endoscope stone removing tool (for example, the basket forceps 120 shown in FIG. 33) to the guide wire 80, and this endoscope stone.
  • the removal tool is guided through the treatment tool channel 104 of the endoscope apparatus 100 to the stone to be removed.
  • the operator who operates the endoscope treatment tool 1 holds the operation part 40 of the endoscope treatment tool 1 in one hand, and inserts the guide wire 80 into the first port 49 with the opposite hand. In addition, the position of the guide wire 80 can be adjusted.
  • the operator of the endoscope apparatus 100 and the operator of the endoscope treatment tool 1 coordinate each other's operations so that the endoscope apparatus 100 and the endoscope treatment tool 1 can be operated by one operator. It is possible to proceed with the same treatment as in the above example operated by.
  • the endoscope treatment tool 1 has the first lumen 7 through the opening of the first port 49 when the hook 46 is attached to the grip portion 102 of the endoscope apparatus 100. Since the first port 49 is arranged in such a direction that the inner surface 7c can be seen, the hook 46 is attached to the grip portion 102 of the endoscope apparatus 100, and the endoscope apparatus 100 and the endoscope treatment tool 1 are used alone. In this case, the guide wire 80 can be easily inserted into the first port 49.
  • the guide wire 80 is inserted when the guide wire 80 is inserted into the first lumen 7 from the first port 49.
  • the forward / backward and rotational operations of 80 can be easily performed by one operator while holding the grip portion 102 of the endoscope apparatus 100.
  • the first port 49 has an elliptical opening shape, and the inlet 8 of the first lumen 7 can be seen when the guide wire 80 is inserted into the first port 49. For this reason, even if it is the angle type guide wire 80 in which the distal end was curved, the distal end can be easily introduced into the first lumen 7.
  • the first port 49 has an oval opening. For this reason, after the guide wire 80 is inserted into the first port 49, the guide wire 80 is moved forward and backward in a direction substantially along the central axis L 7 of the first lumen 7, so that the guide wire 80 is smoothly advanced and retracted. Can do.
  • the guide wire 80 that comes out of the first port 49 when the guide wire 80 is inserted into the first port 49 does not interfere with the handle portion 67.
  • the positional relationship between the handle fixing portion 64 and the first port 49 is set. For this reason, the handle part 67 can be easily operated in a state where the guide wire 80 is attached to the endoscope treatment tool 1.
  • the finger hook portion 74 of the slider portion 71 is provided in a plane orthogonal to the central axis L3 of the opening of the first port 49. For this reason, the finger hanger 74 does not easily interfere with the guide wire 80, and the slider 71 using the finger hanger 74 can be easily moved. That is, since the slider portion 71 is not arranged in the direction in which the guide wire 80 is inserted into and removed from the first port 49, the operation of the slider portion 71 and the operation of the guide wire 80 do not interfere.
  • Each of the above embodiments can provide a treatment instrument for an endoscope that can easily guide a guide wire having a curved shape near the distal end to a lumen.

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Abstract

This treatment tool for an endoscope includes: a sheath in which is formed a lumen that extends in a longitudinal axis direction and has an inner diameter through which a guide wire can be inserted; and an operation part which is disposed on a proximal end of the sheath, is formed substantially tubular with an inner diameter that allows the proximal end portion of the sheath to be inserted, and has a port opened so as to communicate from an inner peripheral surface to an outer peripheral surface. The sheath includes: a slit part which is formed on an outer peripheral surface of the sheath along the longitudinal axis direction of the sheath so as to communicate the lumen and an external portion of the sheath, and which is formed so that an opening width in a peripheral direction of the sheath is smaller than the inner diameter of the lumen; and an inlet which has a width greater than the opening width of the slit part, communicates with the lumen, and opens to an outer peripheral surface of the proximal end portion of the sheath. The sheath is fixed to the operation part so that when an opening edge portion of the inlet and an inner opening edge portion that forms an outline of an inner peripheral surface side of the port are projected onto the inner peripheral surface of the port from a direction along a straight line that is orthogonal to a central axis of the lumen and a central axis of the sheath, the opening edge portion substantially matches the inner opening edge portion or the opening edge portion is positioned outside the inner opening edge portion.

Description

内視鏡用処置具Endoscopic treatment tool
　本発明は、内視鏡用処置具に関する。本願は、２０１４年３月４日に、日本国に出願された特願２０１４―０４２０５２号に基づき優先権を主張し、その内容をここに援用する。 The present invention relates to an endoscope treatment tool. This application claims priority on March 4, 2014 based on Japanese Patent Application No. 2014-042052 for which it applied to Japan, and uses the content here.
　内視鏡装置を用いて十二指腸乳頭を観察しながら十二指腸乳頭部の括約筋を切開する手技として、内視鏡的乳頭括約筋切開術（Endoscopic sphincterotomy, EST）が知られている。ＥＳＴで使用される処置具が、例えば、特許文献１から特許文献４に開示されている。特許文献１には、ガイドワイヤをカテーテルのルーメンに容易に挿入するために、カテーテルのルーメンに連通するファンネル形状の延長部が設けられたガイドワイヤ挿入具が開示されている。特許文献２には、ナイフワイヤにガイド腕部を形成し、シースに形成されたスリットにガイド腕部を配置することにより、ナイフワイヤの切開部を所望の方向に向けることができる高周波ナイフが開示されている。特許文献３には、高周波ナイフワイヤの遠位端部において、絶縁されていない切開部と、切開部を除いた部分に絶縁されている絶縁部を設けることにより、安全にＥＳＴを行うことができる処置具が開示されている。特許文献４には、ガイドワイヤを容易に交換するために、カテーテルシャフトの外側の位置からガイドワイヤ管腔に連通され、シャフトの長手方向に延伸した溝を備える胆管処置用カテーテルが開示されている。 Endoscopic sphincterotomy (EST) is known as a technique for incising the sphincter of the duodenal papilla while observing the duodenal papilla using an endoscopic device. For example, Patent Literature 1 to Patent Literature 4 disclose treatment instruments used in EST. Patent Document 1 discloses a guide wire insertion tool provided with a funnel-shaped extension that communicates with the lumen of the catheter in order to easily insert the guide wire into the lumen of the catheter. Patent Document 2 discloses a high-frequency knife capable of directing an incision portion of a knife wire in a desired direction by forming a guide arm portion on a knife wire and arranging the guide arm portion in a slit formed in a sheath. Has been. In Patent Document 3, EST can be safely performed by providing a non-insulated incision at the distal end portion of the high-frequency knife wire and an insulating portion that is insulated at a portion other than the incision. A treatment tool is disclosed. Patent Document 4 discloses a bile duct treatment catheter having a groove that communicates with the guide wire lumen from a position outside the catheter shaft and extends in the longitudinal direction of the shaft in order to easily exchange the guide wire. .
米国特許第６６０６５１５号公報US Pat. No. 6,606,515 日本国特開２００１－０７０３１６号公報Japanese Laid-Open Patent Publication No. 2001-070316 日本国特開２０００－２３７２０２号公報Japanese Unexamined Patent Publication No. 2000-237202 日本国特表２００１－５１１０２３号公報Japanese National Table 2001-511026
　本発明は、上述した事情に鑑みてなされたものであって、その目的は、遠位端近傍において湾曲形状を有するガイドワイヤであっても容易にルーメンへ案内可能な内視鏡用処置具を提供することである。 The present invention has been made in view of the above-described circumstances, and an object of the present invention is to provide an endoscopic treatment instrument that can be easily guided to a lumen even with a guide wire having a curved shape in the vicinity of a distal end. Is to provide.
　本発明の第一の態様によれば、内視鏡用処置具は、長手軸方向に延びてガイドワイヤを挿通可能な内径を有するルーメンが形成されたシースと、前記シースの近位端に配されて前記シースの前記近位端部分が挿入可能な内径を有して略筒状に形成され、内周面から外周面に連通するように開口したポートを有する操作部と、を備え、前記シースは、前記シースの前記長手軸方向に沿って前記ルーメンと前記シースの外部とを連通するように前記シースの外周面に形成され、前記シースの周方向における開口幅が前記ルーメンの前記内径よりも小さくなるように形成されたスリットと、前記スリット部の前記開口幅よりも大きい幅を有して前記ルーメンと連通して前記シースの前記近位端部分の外周面に開口された入口部と、を有し、前記入口部の開口縁部及び前記ポートの内周面側の輪郭を形成する内側開口縁部を、前記ルーメンの中心軸および前記シースの中心軸に直交する直線に沿った方向から前記ポートの内周面に投影したときに前記入口部の前記開口縁部が前記内側開口縁部と略一致または前記内側開口縁部よりも外側に位置するように、前記シースが前記操作部に固定される。 According to the first aspect of the present invention, an endoscope treatment tool is disposed at a proximal end of a sheath having a lumen extending in the longitudinal axis direction and having an inner diameter through which a guide wire can be inserted. The proximal end portion of the sheath is formed in a substantially cylindrical shape having an insertable inner diameter, and has an open port that communicates from the inner peripheral surface to the outer peripheral surface. The sheath is formed on the outer peripheral surface of the sheath so as to communicate the lumen and the outside of the sheath along the longitudinal axis direction of the sheath, and the opening width in the circumferential direction of the sheath is larger than the inner diameter of the lumen. A slit formed so as to be smaller, and an inlet portion having a width larger than the opening width of the slit portion and communicating with the lumen and opened on an outer peripheral surface of the proximal end portion of the sheath And having said input The inner peripheral edge of the port from the direction along the straight line perpendicular to the central axis of the lumen and the central axis of the sheath. The sheath is fixed to the operation portion so that the opening edge portion of the inlet portion substantially coincides with the inner opening edge portion or is located outside the inner opening edge portion when projected onto the operation portion.
　本発明の第二の態様によれば、上記第一の態様に係る内視鏡用処置具において、前記ポートは、さらに、前記シースの径方向において前記内側開口縁部より外側に位置し前記内側開口縁部の開口面積よりも大きな開口面積を有する外側開口縁部を有し、前記内側開口縁部及び前記外側開口縁部を、前記ルーメンの中心軸および前記シースの中心軸に直交する直線に沿った方向から前記ポートの内周面に投影したときに、前記外側開口縁部の輪郭は前記内側開口縁部の外側に位置していてもよい。 According to the second aspect of the present invention, in the endoscope treatment tool according to the first aspect, the port is further located outside the inner opening edge in the radial direction of the sheath, and the inner side. An outer opening edge having an opening area larger than an opening area of the opening edge, and the inner opening edge and the outer opening edge are in a straight line perpendicular to the central axis of the lumen and the central axis of the sheath; The outline of the outer opening edge may be located outside the inner opening edge when projected onto the inner peripheral surface of the port from the direction along.
　本発明の第三の態様によれば、上記第二の態様に係る内視鏡用処置具において、前記操作部は、前記ポートに連結されて前記ポートの長手軸に対する放射方向に延びた本体部を有していてもよい。 According to a third aspect of the present invention, in the endoscope treatment instrument according to the second aspect, the operation portion is connected to the port and extends in a radial direction with respect to the longitudinal axis of the port. You may have.
　本発明の第四の態様によれば、上記第一の態様に係る内視鏡用処置具において、前記ガイドワイヤの遠位部の少なくとも一部は、湾曲形状に復元する復元力を有する湾曲形状部を有し、前記シースの長軸方向における前記ポートの開口の長さは、前記ガイドワイヤの前記遠位部のうち前記湾曲形状部の先端における接線方向成分の最大長さに対して同等または長く設定されていてもよい。 According to the fourth aspect of the present invention, in the endoscope treatment tool according to the first aspect, at least a part of the distal portion of the guide wire has a curved shape having a restoring force to restore the curved shape. And the length of the opening of the port in the longitudinal direction of the sheath is equal to the maximum length of the tangential component at the tip of the curved portion of the distal portion of the guide wire or It may be set longer.
　本発明の第五の態様によれば、上記第一の態様に係る内視鏡用処置具において、前記ガイドワイヤは、前記ガイドワイヤの中心軸が偏向する形状に復元する復元する復元力を有する屈曲部と、前記屈曲部よりも前記ガイドワイヤの遠位側に設けられた遠位部と、を有し、前記シースの長軸方向における前記ポートの開口の長さは、前記ガイドワイヤの前記遠位部の長さに対して同等または長く設定されていてもよい。 According to a fifth aspect of the present invention, in the endoscope treatment tool according to the first aspect, the guide wire has a restoring force for restoring to a shape in which a central axis of the guide wire is deflected. A bending portion; and a distal portion provided on the distal side of the guide wire with respect to the bending portion, and the length of the opening of the port in the longitudinal direction of the sheath is the length of the guide wire It may be set equal to or longer than the length of the distal portion.
本発明の第六の態様によれば、上記第五の態様に係る内視鏡用処置具において、前記屈曲部は、前記屈曲部よりも前記ガイドワイヤの近位側に対して鈍角または鋭角を形成する方向に前記遠位部が延びるように屈曲していてもよい。 According to a sixth aspect of the present invention, in the endoscope treatment instrument according to the fifth aspect, the bent portion has an obtuse angle or an acute angle with respect to the proximal side of the guide wire rather than the bent portion. The distal portion may be bent so as to extend in the forming direction.
　本発明の第七の態様によれば、上記第二の態様に係る内視鏡用処置具において、前記ポートは、前記内側開口縁部と前記外側開口縁部とを繋ぐテーパー部を有していてもよい。 According to a seventh aspect of the present invention, in the endoscope treatment tool according to the second aspect, the port has a tapered portion that connects the inner opening edge and the outer opening edge. May be.
　本発明の第八の態様によれば、上記第一の態様に係る内視鏡用処置具において、前記ポートは、前記ルーメンの中心軸方向に沿った長さが前記ルーメンの内径よりも長い長穴状に開口されていてもよい。 According to an eighth aspect of the present invention, in the endoscope treatment tool according to the first aspect, the port has a length that is longer than the inner diameter of the lumen along the central axis direction of the lumen. You may open in the shape of a hole.
　上記各態様に係る内視鏡用処置具によれば、遠位端近傍において湾曲形状を有するガイドワイヤをルーメンへ容易に案内することが可能である。 According to the endoscope treatment tool according to each of the above aspects, it is possible to easily guide a guide wire having a curved shape near the distal end to the lumen.
本発明の第一実施形態に係る内視鏡用処置具を備えた切開システムの全体図である。1 is an overall view of an incision system including an endoscope treatment tool according to a first embodiment of the present invention. 本発明の第一実施形態に係る内視鏡用処置具の平面図である。It is a top view of the treatment tool for endoscopes concerning a first embodiment of the present invention. 図２のIII-III線における断面図である。It is sectional drawing in the III-III line of FIG. 本発明の第一実施形態に係る内視鏡用処置具のシースの遠位端部分を示す平面図である。It is a top view which shows the distal end part of the sheath of the treatment tool for endoscopes which concerns on 1st embodiment of this invention. 図２のIV-IV線における断面図である。It is sectional drawing in the IV-IV line of FIG. 本発明の第一実施形態に係る内視鏡用処置具におけるシースの一部を示す斜視図である。It is a perspective view which shows a part of sheath in the treatment tool for endoscopes which concerns on 1st embodiment of this invention. 本発明の第一実施形態に係る内視鏡用処置具の操作部の一部を示す平面図である。It is a top view which shows a part of operation part of the treatment tool for endoscopes which concerns on 1st embodiment of this invention. 本発明の第一実施形態に係る内視鏡用処置具のシースと操作部の遠位構成部とを示す部分断面図である。It is a fragmentary sectional view which shows the sheath of the treatment tool for endoscopes which concerns on 1st embodiment of this invention, and the distal structure part of an operation part. 本発明の第一実施形態に係る内視鏡用処置具の第一ポート部分を示す部分断面図であり、図６に示すVIII-VIII線方向に見た図である。It is the fragmentary sectional view which shows the 1st port part of the treatment tool for endoscopes which concerns on 1st embodiment of this invention, and is the figure seen from the VIII-VIII line direction shown in FIG. 図６のIX-IX線における断面図である。It is sectional drawing in the IX-IX line of FIG. 本発明の第一実施形態に係る内視鏡用処置具の第一ポート部分を示す斜視図である。It is a perspective view which shows the 1st port part of the treatment tool for endoscopes which concerns on 1st embodiment of this invention. 本発明の第一実施形態に係る内視鏡用処置具のシースの遠位端部分の第一仮想平面における断面図である。It is sectional drawing in the 1st virtual plane of the distal end part of the sheath of the treatment tool for endoscopes which concerns on 1st embodiment of this invention. 本発明の第一実施形態に係る内視鏡用処置具のシースの遠位部分を第二仮想平面に垂直な方向から見た図である。It is the figure which looked at the distal part of the sheath of the treatment tool for endoscopes concerning 1st embodiment of this invention from the direction perpendicular | vertical to a 2nd virtual plane. 図１１のXII-XII線における断面図である。It is sectional drawing in the XII-XII line | wire of FIG. 図１１のXIII-XIII線における断面図である。It is sectional drawing in the XIII-XIII line | wire of FIG. 本発明の第一実施形態に係る内視鏡用処置具のシースの遠位部分を示す図であり、図１２に示すXIV-XIV線から見たシースの部分断面図を含む図である。It is a figure which shows the distal part of the sheath of the treatment tool for endoscopes which concerns on 1st embodiment of this invention, and is a figure containing the fragmentary sectional view of the sheath seen from the XIV-XIV line | wire shown in FIG. 本発明の第一実施形態に係る内視鏡用処置具とともに使用されるガイドワイヤの一構成例を示す側面図である。It is a side view which shows one structural example of the guide wire used with the treatment tool for endoscopes which concerns on 1st embodiment of this invention. 本発明の第一実施形態に係る内視鏡用処置具とともに使用されるガイドワイヤの他の構成例を示す側面図である。It is a side view which shows the other structural example of the guide wire used with the treatment tool for endoscopes which concerns on 1st embodiment of this invention. 本発明の第一実施形態に係る内視鏡用処置具とともに使用されるガイドワイヤの他の構成例を示す側面図である。It is a side view which shows the other structural example of the guide wire used with the treatment tool for endoscopes which concerns on 1st embodiment of this invention. 本発明の第一実施形態に係る内視鏡用処置具とともに使用されるガイドワイヤの他の構成例を示す側面図である。It is a side view which shows the other structural example of the guide wire used with the treatment tool for endoscopes which concerns on 1st embodiment of this invention. 本発明の第一実施形態に係る内視鏡用処置具の第一ポートにガイドワイヤを挿入する態様を示す断面図である。It is sectional drawing which shows the aspect which inserts a guide wire in the 1st port of the treatment tool for endoscopes which concerns on 1st embodiment of this invention. 本発明の第一実施形態に係る内視鏡用処置具を内視鏡装置に取り付けた状態における第一ポート及び操作部の位置関係を示す図である。It is a figure which shows the positional relationship of the 1st port and operation part in the state which attached the treatment tool for endoscopes which concerns on 1st embodiment of this invention to the endoscope apparatus. 本発明の第一実施形態に係る内視鏡用処置具を内視鏡装置に取り付けた状態におけるフックと第一ポートとの位置関係を示す図である。It is a figure which shows the positional relationship of the hook and 1st port in the state which attached the treatment tool for endoscopes which concerns on 1st embodiment of this invention to the endoscope apparatus. 本発明の第一実施形態に係る内視鏡装置に取り付け可能な処置具取付補助具の斜視図である。It is a perspective view of the treatment tool attachment auxiliary tool which can be attached to the endoscope apparatus concerning a first embodiment of the present invention. 図２１に示す処置具取付補助具の内部構造を示す部分断面図である。It is a fragmentary sectional view which shows the internal structure of the treatment tool attachment auxiliary tool shown in FIG. 本発明の第一実施形態に係る内視鏡用処置具の使用時の一過程を示す図である。It is a figure which shows one process at the time of use of the treatment tool for endoscopes which concerns on 1st embodiment of this invention. 本発明の第一実施形態に係る内視鏡用処置具が内視鏡装置に取り付けられた状態を内視鏡装置の操作者の視点から見た図である。It is the figure which looked at the state by which the treatment tool for endoscopes concerning 1st embodiment of this invention was attached to the endoscope apparatus from the viewpoint of the operator of an endoscope apparatus. 本発明の第一実施形態に係る内視鏡用処置具の使用態様を示す図である。It is a figure which shows the usage condition of the treatment tool for endoscopes which concerns on 1st embodiment of this invention. 本発明の第一実施形態に係る内視鏡装置を用いて撮像された内視鏡画像に映った内視鏡用処置具を示す模式図である。It is a schematic diagram which shows the treatment tool for endoscopes reflected in the endoscopic image imaged using the endoscope apparatus according to the first embodiment of the present invention. 本発明の第一実施形態に係る内視鏡用処置具を用いた処置の一過程における内視鏡画像を示す模式図である。It is a mimetic diagram showing an endoscope picture in one process of treatment using a treatment tool for endoscopes concerning a first embodiment of the present invention. 本発明の第一実施形態に係る内視鏡用処置具にガイドワイヤを取り付ける態様を示す図であり、図６に示すVIII-VIII線から見た断面図である。It is a figure which shows the aspect which attaches a guide wire to the treatment tool for endoscopes which concerns on 1st embodiment of this invention, and is sectional drawing seen from the VIII-VIII line shown in FIG. 本発明の第一実施形態に係る内視鏡用処置具にガイドワイヤを取り付ける他例を示す図であり、図６に示すVIII-VIII線から見た断面図である。It is a figure which shows the other example which attaches a guide wire to the treatment tool for endoscopes which concerns on 1st embodiment of this invention, and is sectional drawing seen from the VIII-VIII line shown in FIG. 本発明の第一実施形態に係る内視鏡用処置具の使用時の一過程を示す図である。It is a figure which shows one process at the time of use of the treatment tool for endoscopes which concerns on 1st embodiment of this invention. 本発明の第一実施形態に係る内視鏡用処置具に取り付けられたガイドワイヤを残して内視鏡用処置具を内視鏡装置から抜去する一過程を示す図である。It is a figure which shows one process of removing the treatment tool for endoscopes from an endoscope apparatus, leaving the guide wire attached to the treatment tool for endoscopes which concerns on 1st embodiment of this invention. 本発明の第一実施形態に係る内視鏡用処置具のシースとガイドワイヤとを分離する一過程を示す図である。It is a figure which shows one process of isolate | separating the sheath and guide wire of the treatment tool for endoscopes which concern on 1st embodiment of this invention. 本発明の第一実施形態に係る内視鏡用処置具の抜去後に行われる処置の一例を示す図である。It is a figure which shows an example of the treatment performed after extraction of the treatment tool for endoscopes which concerns on 1st embodiment of this invention. 本発明の第一実施形態の変形例の構成を示す模式図である。It is a schematic diagram which shows the structure of the modification of 1st embodiment of this invention. 本発明の第一実施形態の第二変形例の構成を示す模式図である。It is a schematic diagram which shows the structure of the 2nd modification of 1st embodiment of this invention.
　本発明の第一実施形態について説明する。図１は、本実施形態に係る内視鏡用処置具１を備えた切開システム１１０の全体図である。
　図１に示すように、本実施形態に係る内視鏡用処置具１は、体内において生体組織の切開をするために内視鏡装置１００とともに使用される医療器具である。内視鏡用処置具１は、内視鏡装置１００と組み合わされた状態で切開システム１１０（内視鏡処置システム）を構成する。 A first embodiment of the present invention will be described. FIG. 1 is an overall view of an incision system 110 including an endoscope treatment tool 1 according to the present embodiment.
As shown in FIG. 1, an endoscope treatment tool 1 according to the present embodiment is a medical instrument that is used together with an endoscope apparatus 100 in order to incise a living tissue in a body. The endoscope treatment tool 1 constitutes an incision system 110 (endoscope treatment system) in a state where it is combined with the endoscope apparatus 100.
　図２は、内視鏡用処置具１の平面図である。図３Ａは、図２のIII-III線における断面図である。図３Ｂは、本発明の第一実施形態に係る内視鏡用処置具１のシース３の遠位端部分を示す平面図である。図４は、図２のIV-IV線における断面図である。図５は、内視鏡用処置具１におけるシース３の一部を示す斜視図である。図６は、内視鏡用処置具１の操作部４０の一部を示す平面図である。図７は、内視鏡用処置具１のシース３及び操作部４０の遠位構成部４１を示す図であり、操作部４０の遠位構成部４１のみ断面で示している。図８は、内視鏡用処置具１の第一ポート４９部分を示す部分断面図であり、図６に示すVIII-VIII線方向に見た図である。図９Ａは、図６のIX-IX線における断面図である。図９Ｂは、内視鏡用処置具１の第一ポート４９部分を示す斜視図である。図１０は、シース３の遠位端部分の第一仮想平面αにおける断面図である。図１１は、シース３の遠位部分を第二仮想平面βに垂直な方向から見た図である。図１２は、図１１のXII-XII線における断面図である。図１３は、図１１のXIII-XIII線における断面図である。図１４は、シース３の遠位部分を示す図であり、図１２に示すXIV-XIV線から見たシース３の部分断面図を含む。 FIG. 2 is a plan view of the endoscope treatment tool 1. 3A is a cross-sectional view taken along line III-III in FIG. FIG. 3B is a plan view showing a distal end portion of the sheath 3 of the endoscope treatment tool 1 according to the first embodiment of the present invention. 4 is a cross-sectional view taken along line IV-IV in FIG. FIG. 5 is a perspective view showing a part of the sheath 3 in the endoscope treatment tool 1. FIG. 6 is a plan view showing a part of the operation unit 40 of the endoscope treatment tool 1. FIG. 7 is a view showing the sheath 3 of the endoscope treatment tool 1 and the distal component 41 of the operation unit 40, and only the distal component 41 of the operation unit 40 is shown in cross section. FIG. 8 is a partial cross-sectional view showing the first port 49 portion of the endoscope treatment tool 1, and is a view seen in the direction of the line VIII-VIII shown in FIG. 9A is a cross-sectional view taken along line IX-IX in FIG. FIG. 9B is a perspective view showing the first port 49 portion of the endoscope treatment tool 1. FIG. 10 is a cross-sectional view of the distal end portion of the sheath 3 in the first virtual plane α. FIG. 11 is a view of the distal portion of the sheath 3 as viewed from the direction perpendicular to the second virtual plane β. 12 is a cross-sectional view taken along line XII-XII in FIG. 13 is a cross-sectional view taken along line XIII-XIII in FIG. 14 is a view showing a distal portion of the sheath 3, and includes a partial cross-sectional view of the sheath 3 as seen from the XIV-XIV line shown in FIG.
　内視鏡用処置具１は、挿入部２と操作部４０とを有する。挿入部２は、内視鏡装置１００の処置具チャンネル１０４に挿入される細長い部材である。挿入部２は、シース３と、ナイフワイヤ３０とを有する。図１及び図２に示すように、シース３は、可撓性を有する細長い部材である。本実施形態ではシース３は樹脂製である。 The endoscope treatment tool 1 has an insertion part 2 and an operation part 40. The insertion unit 2 is an elongated member that is inserted into the treatment instrument channel 104 of the endoscope apparatus 100. The insertion part 2 has a sheath 3 and a knife wire 30. As shown in FIGS. 1 and 2, the sheath 3 is an elongated member having flexibility. In this embodiment, the sheath 3 is made of resin.
　以下、内視鏡処置具１の操作部４０側を近位側と称し、挿入部２が設けられ、体内に挿入される側を遠位側と称する。 Hereinafter, the operation part 40 side of the endoscope treatment tool 1 is referred to as a proximal side, the insertion part 2 is provided, and the side inserted into the body is referred to as a distal side.
　シース３は、図３Ｂおよび図３５に示すように、シース３の遠位端３ａを含む所定の領域にプリカーブ部４を有する。プリカーブ部４は、所定の方向へ湾曲された形状に曲げ癖が付与され、予め付与された湾曲形状に復元する復元力を有する。図３Ａ及び図３Ｂに示すように、プリカーブ部４におけるシース３の中心軸Ｌ１は、所定の一平面内（以下、「第一仮想平面α」と称する。）に存する。 The sheath 3 has a pre-curved portion 4 in a predetermined region including the distal end 3a of the sheath 3, as shown in FIGS. 3B and 35. The pre-curve portion 4 is provided with a bending force in a shape curved in a predetermined direction, and has a restoring force to restore the curved shape given in advance. As shown in FIGS. 3A and 3B, the central axis L1 of the sheath 3 in the pre-curve portion 4 is within a predetermined plane (hereinafter referred to as “first virtual plane α”).
　プリカーブ部４の遠位端部は、処置対象となる患者の十二指腸乳頭ＰＶ（図２３参照）内に挿入される。プリカーブ部４の遠位端部には、図３Ｂに示すように、後述する遠位第一連通孔２３及び遠位第二連通孔２４が設けられている。 The distal end of the pre-curve part 4 is inserted into the duodenal papilla PV (see FIG. 23) of the patient to be treated. As shown in FIG. 3B, the distal end serial hole 23 and the distal second communication hole 24 described later are provided at the distal end portion of the pre-curved portion 4.
　図３Ａに示すように、シース３の中心軸Ｌ１と直交する断面をシース３の近位端３ｂ（図２参照）から遠位端３ａへ向かってシース３の中心軸Ｌ１に沿って見たときに、中心軸Ｌ１を原点とし、第一仮想平面αを縦軸とし、シース３の中心軸Ｌ１上で第一仮想平面αと直交する平面（以下、「第二仮想平面β」と称する。）を横軸とする直交座標系（以下、「仮想座標系」と称する。）を用いてシース３の構成を説明する。仮想座標系の縦軸では、プリカーブ部４の湾曲方向を上側とする。 As shown in FIG. 3A, when a cross section perpendicular to the central axis L1 of the sheath 3 is viewed along the central axis L1 of the sheath 3 from the proximal end 3b (see FIG. 2) of the sheath 3 toward the distal end 3a. The central axis L1 is the origin, the first virtual plane α is the vertical axis, and the plane is perpendicular to the first virtual plane α on the central axis L1 of the sheath 3 (hereinafter referred to as “second virtual plane β”). The configuration of the sheath 3 will be described using an orthogonal coordinate system (hereinafter referred to as a “virtual coordinate system”) with the horizontal axis as. On the vertical axis of the virtual coordinate system, the bending direction of the pre-curve portion 4 is the upper side.
　図３Ａ及び図５に示すように、シース３の内部には、第一ルーメン７と、第二ルーメン１５と、第三ルーメン２０とが形成されている。第一ルーメン７と、第二ルーメン１５と、第三ルーメン２０とは、シース３の長手方向に互いに平行に延びて形成されている。 As shown in FIGS. 3A and 5, a first lumen 7, a second lumen 15, and a third lumen 20 are formed inside the sheath 3. The first lumen 7, the second lumen 15, and the third lumen 20 are formed to extend in parallel to each other in the longitudinal direction of the sheath 3.
　第一ルーメン７は、ガイドワイヤ８０が進退可能な内径を有する通路部分である。すなわち、第一ルーメン７は、内部にガイドワイヤ８０が保持されるルーメンである。第一ルーメン７は、第一仮想平面α上に中心軸Ｌ７が位置し、シース３の中心軸Ｌ１よりも下方、すなわち、仮想座標系の第三象限Ｑ３及び第四象限Ｑ４に位置している。具体的には、第一仮想平面αは第一ルーメン７の内部空間を横切る。また、所定の第一仮想平面αは第一ルーメン７の中心軸Ｌ７を含む。 The first lumen 7 is a passage portion having an inner diameter that allows the guide wire 80 to advance and retract. That is, the first lumen 7 is a lumen in which the guide wire 80 is held. The first lumen 7 has a central axis L7 located on the first virtual plane α and is located below the central axis L1 of the sheath 3, that is, in the third quadrant Q3 and the fourth quadrant Q4 of the virtual coordinate system. . Specifically, the first virtual plane α crosses the internal space of the first lumen 7. The predetermined first virtual plane α includes the central axis L7 of the first lumen 7.
　図３Ａおよび図５に示すように、第一ルーメン７は、遠位端３ａに開口する出口部１２と、ガイドワイヤ収容部９と、スリット部１０と、近位端側に開口する入口部８と、を有する。 As shown in FIGS. 3A and 5, the first lumen 7 includes an outlet portion 12 that opens to the distal end 3 a, a guide wire housing portion 9, a slit portion 10, and an inlet portion 8 that opens to the proximal end side. And having.
　図４及び図５に示すように、スリット部１０は、第一ルーメン７（ガイドワイヤ収容部９）とシース３の外部とを連通するようにシース３の外周面３ｃに開口され、シース３の中心軸Ｌ１方向に沿って延びて形成された細長い切欠きである。スリット部１０は、シース３を構成する樹脂部材がシース３の中心軸Ｌ１方向に切り取られた形状を有する。スリット部１０は、プリカーブ部４の近位端４ｂ（図３４参照）の近傍領域のうちプリカーブ部４の近位部において、プリカーブ部４の外周面と所定の第一仮想平面αとが交差する位置に、シース３の中心軸Ｌ１に沿って形成されている。具体的には、スリット部１０の遠位端１０ａの位置は、遠位第二連通孔２４よりも基端側の位置であって、且つプリカーブ部４の近位端４ｂ（図３４参照）よりも先端側に位置している。スリット部１０は、入口部８まで延びている。 As shown in FIGS. 4 and 5, the slit portion 10 is opened on the outer peripheral surface 3 c of the sheath 3 so as to communicate the first lumen 7 (guide wire accommodating portion 9) and the outside of the sheath 3, and It is an elongate cutout formed extending along the direction of the central axis L1. The slit portion 10 has a shape in which a resin member constituting the sheath 3 is cut in the direction of the central axis L1 of the sheath 3. In the slit portion 10, the outer peripheral surface of the pre-curve portion 4 intersects the predetermined first virtual plane α in the proximal portion of the pre-curve portion 4 in the vicinity of the proximal end 4 b (see FIG. 34) of the pre-curve portion 4. At a position, the sheath 3 is formed along the central axis L1. Specifically, the position of the distal end 10a of the slit portion 10 is a position closer to the proximal end side than the distal second communication hole 24 and from the proximal end 4b of the pre-curved portion 4 (see FIG. 34). Is also located on the tip side. The slit portion 10 extends to the inlet portion 8.
　スリット部１０は、スリット部１０の開き幅がガイドワイヤ８０の直径よりも小さくなるように互いに離間して配された一対のフラップ部１１（第一フラップ１１ａ，第二フラップ１１ｂ）を有する。フラップ部１１は、シース３を構成する樹脂部材によりガイドワイヤ収容部９を覆う一対の弾性部である。フラップ部１１は、スリット部１０を通じてガイドワイヤ８０をガイドワイヤ収容部９から取り外す際の操作者による力によって、ガイドワイヤ８０が通過可能な大きさの隙間が生じるまで変形される。 The slit portion 10 has a pair of flap portions 11 (first flap 11a, second flap 11b) that are spaced apart from each other so that the opening width of the slit portion 10 is smaller than the diameter of the guide wire 80. The flap portion 11 is a pair of elastic portions that cover the guide wire housing portion 9 with a resin member constituting the sheath 3. The flap portion 11 is deformed until a gap of a size through which the guide wire 80 can pass is generated by the force of the operator when removing the guide wire 80 from the guide wire housing portion 9 through the slit portion 10.
　図５に示すように、入口部８は、第一ルーメン７の近位端７ｂ近傍において、ガイドワイヤ８０の直径と同じあるいはガイドワイヤ８０の直径よりも大きくシース３の外周面３ｃに開口された部位である。言い換えると、入口部８は、後述するフラップ部１１が無いことによって第一ルーメン７の内面７ｃが外部に露出される、スリット部１０よりも幅広な開口部分である。すなわち、入口部８は、スリット部１０の開口幅よりも大きい幅を有して第一ルーメン７と連通してシース３の近位端部分の外周面３ｃに開口される。
　シース３の中心軸Ｌ１方向における入口部８の長さは、第一ルーメン７におけるガイドワイヤ収容部９の内径よりも大きい。すなわち、入口部８は、シース３の中心軸Ｌ１方向に長い長穴形状を有する。なお、入口部８の形状は、矩形形状であってもよい。入口部８の形状が矩形形状を有すると、入口部８を形成する加工が容易である。シース３の周方向における入口部８の左右端８ｃ（周方向の両端）は、ガイドワイヤ収容部９からシース３の外周面３ｃへ向かって入口部８の開口面積が漸次大きくなるように広がるテーパー形状を有していてもよい（図９Ｂ参照）。 As shown in FIG. 5, the inlet portion 8 is opened to the outer peripheral surface 3 c of the sheath 3 in the vicinity of the proximal end 7 b of the first lumen 7, which is the same as the diameter of the guide wire 80 or larger than the diameter of the guide wire 80. It is a part. In other words, the inlet portion 8 is an opening portion wider than the slit portion 10 where the inner surface 7c of the first lumen 7 is exposed to the outside due to the absence of the flap portion 11 described later. That is, the inlet portion 8 has a width larger than the opening width of the slit portion 10, communicates with the first lumen 7, and opens on the outer peripheral surface 3 c of the proximal end portion of the sheath 3.
The length of the inlet portion 8 in the direction of the central axis L <b> 1 of the sheath 3 is larger than the inner diameter of the guide wire housing portion 9 in the first lumen 7. That is, the inlet portion 8 has a long hole shape that is long in the direction of the central axis L1 of the sheath 3. The shape of the inlet portion 8 may be a rectangular shape. When the shape of the inlet portion 8 has a rectangular shape, the processing for forming the inlet portion 8 is easy. The left and right ends 8 c (both ends in the circumferential direction) of the inlet portion 8 in the circumferential direction of the sheath 3 are tapered so that the opening area of the inlet portion 8 gradually increases from the guide wire housing portion 9 toward the outer peripheral surface 3 c of the sheath 3. It may have a shape (see FIG. 9B).
　図４に示すように、ガイドワイヤ収容部９は、シース３の中心軸Ｌ１に対して直交する断面において後述するスリット部１０との境界を除き円形の輪郭を有している。すなわち、ガイドワイヤ収容部９は、シース３の中心軸Ｌ１に対して直交する断面において略Ｃ字状の輪郭形状を有する。ガイドワイヤ収容部９は、ガイドワイヤ８０が進退可能となるように、ガイドワイヤ８０が挿通された状態でクリアランスを有するように設定され、ガイドワイヤ収容部９の内径は、クリアランスの寸法の分だけガイドワイヤ８０の直径より大きい。スリット部１０は、シース３の周方向における開口幅が第一ルーメン７の内径よりも小さくなるように形成されている。 As shown in FIG. 4, the guide wire accommodating portion 9 has a circular outline in a cross section orthogonal to the central axis L <b> 1 of the sheath 3 except for a boundary with a slit portion 10 described later. That is, the guide wire accommodating portion 9 has a substantially C-shaped contour shape in a cross section orthogonal to the central axis L <b> 1 of the sheath 3. The guide wire accommodating portion 9 is set to have a clearance in a state where the guide wire 80 is inserted so that the guide wire 80 can be advanced and retracted, and the inner diameter of the guide wire accommodating portion 9 is equal to the clearance dimension. It is larger than the diameter of the guide wire 80. The slit portion 10 is formed so that the opening width in the circumferential direction of the sheath 3 is smaller than the inner diameter of the first lumen 7.
　図３Ａ、図３Ｂおよび図５に示すように、第一ルーメン７は、スリット部１０の遠位端１０ａとシース３の遠位端３ａとの間において、シース３の中心軸Ｌ１に対して直交する断面視で一続きの円周状の輪郭を有し、ガイドワイヤ８０がシース３の遠位端３ａから突出可能となるようにガイドワイヤ８０を保持可能である。出口部１２はシース３の遠位端３ａに開口されている。出口部１２は、ガイドワイヤ収容部９に連通されている。 As shown in FIGS. 3A, 3B, and 5, the first lumen 7 is orthogonal to the central axis L1 of the sheath 3 between the distal end 10a of the slit portion 10 and the distal end 3a of the sheath 3. The guide wire 80 can be held so that the guide wire 80 can protrude from the distal end 3 a of the sheath 3. The outlet 12 is opened at the distal end 3 a of the sheath 3. The outlet portion 12 communicates with the guide wire housing portion 9.
　図３Ａに示す第二ルーメン１５は、シース３の近位端３ｂ（図２参照）からシース３の遠位端３ａ（図２及び図３Ａ参照）までたとえば造影剤等の液体を送液するための、送液ルーメンとして使用してもよい。なお、第二ルーメン１５は、体内の液体を除去するための排液ルーメンとしても利用可能である。
　プリカーブ部４における第二ルーメン１５は、上記の仮想座標系における第一象限Ｑ１に位置している。
　第二ルーメン１５は、近位連結口１６（図９Ａ参照）と、遠位吐出口１７（図１０参照）とを有し、近位連結口１６から遠位吐出口１７まで液体を流す流路として使用可能である。 The second lumen 15 shown in FIG. 3A is for sending a liquid such as a contrast medium from the proximal end 3b of the sheath 3 (see FIG. 2) to the distal end 3a of the sheath 3 (see FIGS. 2 and 3A). It may be used as a liquid feeding lumen. The second lumen 15 can also be used as a drainage lumen for removing body fluid.
The second lumen 15 in the pre-curve portion 4 is located in the first quadrant Q1 in the virtual coordinate system.
The second lumen 15 has a proximal connection port 16 (see FIG. 9A) and a distal discharge port 17 (see FIG. 10), and a flow path for flowing liquid from the proximal connection port 16 to the distal discharge port 17. Can be used as
　近位連結口１６は、第二ルーメン１５への連通路５６（後述）に対して連通される開口であり、後述する第二ポート６２から液体が導入される開口である。 The proximal connection port 16 is an opening that communicates with a communication path 56 (described later) to the second lumen 15, and is an opening through which liquid is introduced from a second port 62 described later.
　遠位吐出口１７（図１０参照）は、近位連結口１６から導入された液体が吐出される開口であり、シース３の遠位端３ａに配されている。 The distal discharge port 17 (see FIG. 10) is an opening through which the liquid introduced from the proximal connection port 16 is discharged, and is disposed at the distal end 3 a of the sheath 3.
　図３Ａ，図４，及び図５に示すように、第三ルーメン２０は、後述するナイフワイヤ３０が挿通されたルーメンである。第三ルーメン２０は、ナイフワイヤ３０が第三ルーメン２０内を進退できるように設定されている。すなわち、第三ルーメン２０は、ナイフワイヤ３０が挿通された状態でクリアランスを有するように設定され、第三ルーメン２０の内径は、クリアランスの寸法の分だけナイフワイヤ３０の直径より大きい。プリカーブ部４における第三ルーメン２０は、上記の仮想座標系における第二象限Ｑ２に位置している。 3A, 4 and 5, the third lumen 20 is a lumen into which a knife wire 30 described later is inserted. The third lumen 20 is set so that the knife wire 30 can advance and retract within the third lumen 20. That is, the third lumen 20 is set to have a clearance with the knife wire 30 inserted, and the inner diameter of the third lumen 20 is larger than the diameter of the knife wire 30 by the clearance dimension. The third lumen 20 in the pre-curve portion 4 is located in the second quadrant Q2 in the virtual coordinate system.
　図３Ａに示すように、プリカーブ部４が湾曲形状に復元されている状態では、第二ルーメン１５と第三ルーメン２０とが湾曲形状の内側面４０１側の領域に位置しており、第一ルーメン７は湾曲形状の外側面４０２側の領域に位置している。すなわち、図３Ａに示すように、シース３の遠位端３ａ近傍において、シース３の中心軸Ｌ１に対して直交する断面の仮想座標系における縦軸の上方（第一仮想平面αの上方）を１２時とする時計の文字盤と見立てると、プリカーブ部４における第三ルーメン２０は、９時と１２時との間の範囲に位置している。
　第三ルーメン２０は、近位開口部２１（図７参照）と、ナイフワイヤ収容部２２（図１４参照）と、遠位第一連通孔２３と、遠位第二連通孔２４とを有する。 As shown in FIG. 3A, in the state where the pre-curve portion 4 is restored to the curved shape, the second lumen 15 and the third lumen 20 are located in the region on the curved inner surface 401 side, and the first lumen 7 is located in the region of the curved outer surface 402 side. That is, as shown in FIG. 3A, in the vicinity of the distal end 3 a of the sheath 3, above the vertical axis (above the first virtual plane α) in the virtual coordinate system of the cross section orthogonal to the central axis L <b> 1 of the sheath 3. When considered as a clock face at 12 o'clock, the third lumen 20 in the pre-curve portion 4 is located in a range between 9 o'clock and 12 o'clock.
The third lumen 20 has a proximal opening 21 (see FIG. 7), a knife wire accommodating portion 22 (see FIG. 14), a distal first series hole 23, and a distal second communication hole 24. .
　近位開口部２１は、第三ルーメン２０への連通路５７（図７参照）に対して連通される開口であり、後述するナイフワイヤ３０が挿入される。 The proximal opening 21 is an opening that communicates with the communication path 57 (see FIG. 7) to the third lumen 20, and a knife wire 30 to be described later is inserted therein.
　図１４に示すナイフワイヤ収容部２２は、ナイフワイヤ３０を電気的に絶縁状態で保持するように、ナイフワイヤ３０の外周を全周に亘って覆っている。 14 covers the outer periphery of the knife wire 30 over the entire circumference so as to hold the knife wire 30 in an electrically insulated state.
なお、プリカーブ部４の遠位端部にドローイング部５、プリカーブ部４の近位端部に倣い変形部６を有しても良い。ドローイング部５の外径は、シース３の基端側及び倣い変形部６の外径よりもわずかに小さい外径を有する。 In addition, you may have the drawing part 5 in the distal end part of the pre-curve part 4, and the deformation | transformation part 6 following the proximal end part of the pre-curve part 4. The outer diameter of the drawing part 5 has an outer diameter slightly smaller than the outer diameter of the proximal end side of the sheath 3 and the copying deformation part 6.
　図１１及び図１４に示すように、遠位第一連通孔２３は、シース３の遠位端３ａ近傍において、ドローイング部５が存する領域内に配されている。遠位第一連通孔２３は、シース３の外周面３ｃに開口され、第三ルーメン２０に連通されている。遠位第一連通孔２３は、上記の仮想座標系における第二象限Ｑ２に位置している。すなわち、シース３の中心軸Ｌ１に対して直交する断面の仮想座標系における縦軸の上方（第一仮想平面αの上方）を１２時とする時計の文字盤と見立てると、遠位第一連通孔２３は、９時と１２時との間の範囲に位置している。つまり、遠位第一連通孔２３は、プリカーブ部４における湾曲の内側且つ第一仮想平面αに対して離間する位置に形成されている。 As shown in FIGS. 11 and 14, the distal first through hole 23 is disposed in the vicinity of the distal end 3 a of the sheath 3 in a region where the drawing portion 5 exists. The first distal through hole 23 is opened on the outer peripheral surface 3 c of the sheath 3 and communicates with the third lumen 20. The distal first series through hole 23 is located in the second quadrant Q2 in the virtual coordinate system. That is, when the upper part of the vertical axis (above the first virtual plane α) in the virtual coordinate system of the cross section orthogonal to the central axis L1 of the sheath 3 is regarded as a clock face at 12 o'clock, the distal first series The through hole 23 is located in a range between 9 o'clock and 12 o'clock. That is, the first distal through hole 23 is formed at a position inside the curve in the pre-curve portion 4 and at a distance from the first virtual plane α.
　遠位第二連通孔２４は、シース３の遠位端３ａ近傍において、ドローイング部５が存する領域内に配されている。遠位第二連通孔２４は、遠位第一連通孔２３よりも近位側において、遠位第一連通孔２３から離間した位置に配されている。遠位第二連通孔２４は、上記の仮想座標系における第二象限Ｑ２に位置している。つまり、遠位第二連通孔２４は、遠位第一連通孔２３と同様に、プリカーブ部４における湾曲の内側且つ第一仮想平面αに対して離間する位置に形成されている。また、シース３の中心軸Ｌ１に直交する断面において、遠位第二連通孔２４と遠位第一連通孔２３とは、シース３の中心軸Ｌ１を中心とする周方向における位置が互いに一致していることが望ましい。 The distal second communication hole 24 is arranged in the vicinity of the distal end 3a of the sheath 3 in a region where the drawing portion 5 exists. The distal second communication hole 24 is disposed on a position closer to the distal side than the distal first series hole 23 and at a position separated from the distal first series hole 23. The distal second communication hole 24 is located in the second quadrant Q2 in the virtual coordinate system. That is, the distal second communication hole 24 is formed at a position inside the curve in the pre-curve portion 4 and away from the first virtual plane α, like the distal first communication hole 23. In the cross section orthogonal to the central axis L1 of the sheath 3, the distal second communication hole 24 and the distal first continuous hole 23 are located at the same position in the circumferential direction around the central axis L1 of the sheath 3. It is desirable to do it.
　ナイフワイヤ３０は、処置対象部位を切開する機能を有する。
　ナイフワイヤ３０は、導電性を有する芯線３１と、芯線３１を被覆する絶縁被膜３２とを有する。また、ナイフワイヤ３０は、近位側から順に、力量伝達部３３と、切開部３４と、遠位固定部材（固定部）３７とを有する。 The knife wire 30 has a function of incising a treatment target site.
The knife wire 30 includes a conductive core wire 31 and an insulating coating 32 that covers the core wire 31. The knife wire 30 includes a force transmission portion 33, an incision portion 34, and a distal fixing member (fixing portion) 37 in order from the proximal side.
　絶縁被膜３２は、たとえば、ポリ四フッ化エチレン（ＰＴＦＥ）、四フッ化エチレン六フッ化プロピレン樹脂（ＦＥＰ）、ポリエチレン、ポリオレフィン、ポリアミド、塩化ビニール、ラテックス、天然ゴム、ポリサルフォン、ポリフェニルサルフォン、ポリエーテルイミド、ＰＯＭ、ＰＥＥＫ、ポリカーボネイト、ＡＢＳ等の樹脂や、それらの合成樹脂材料によって芯線３１の外面にコーティングされる。 The insulating coating 32 is made of, for example, polytetrafluoroethylene (PTFE), tetrafluoroethylene hexafluoropropylene resin (FEP), polyethylene, polyolefin, polyamide, vinyl chloride, latex, natural rubber, polysulfone, polyphenylsulfone, The outer surface of the core wire 31 is coated with a resin such as polyetherimide, POM, PEEK, polycarbonate, ABS, or a synthetic resin material thereof.
　図１１に示すように、切開部３４は、ナイフワイヤ３０の全長のうち、絶縁被膜３２（図１３参照）に芯線３１が覆われておらず、シース３の外部に配される部分である。切開部３４は、後述するコネクタ７３（図２参照）を介して芯線３１に供給される高周波電流が通電されることにより生体組織を切開可能である。切開部３４は、ナイフ湾曲部３５と、屈曲部３６とを有する。 As shown in FIG. 11, the incision 34 is a portion of the entire length of the knife wire 30 that is not covered with the insulating coating 32 (see FIG. 13) and is arranged outside the sheath 3. The incision part 34 can incise a living tissue when a high-frequency current supplied to the core wire 31 is passed through a connector 73 (see FIG. 2) described later. The incision part 34 has a knife bending part 35 and a bending part 36.
　図１３及び図１４に示すように、力量伝達部３３は、ナイフワイヤ３０の全長のうち、後述する操作部４０（図２参照）におけるハンドル部６７のスライダ部７１に固定された近位端３０ｂから、切開部３４の基端側までの部分である。力量伝達部３３において、芯線３１は絶縁被膜３２に被覆されている。第三ルーメン２０内にナイフワイヤ３０が挿通され、遠位固定部材３７により、第三ルーメン２０に対して固定されている。 As shown in FIGS. 13 and 14, the force transmission portion 33 is a proximal end 30 b fixed to the slider portion 71 of the handle portion 67 in the operation portion 40 (see FIG. 2) to be described later, out of the entire length of the knife wire 30. To the proximal end side of the incision 34. In the force transmission unit 33, the core wire 31 is covered with an insulating coating 32. A knife wire 30 is inserted into the third lumen 20 and fixed to the third lumen 20 by a distal fixing member 37.
　図１１，図１２，および図１３に示すように、ナイフ湾曲部３５は、遠位第一連通孔２３と遠位第二連通孔２４との間の領域において、上記の仮想座標系における第二象限Ｑ２且つ、プリカーブ部４における湾曲よりも内側に配されている。ナイフ湾曲部３５は、遠位第一連通孔２３と遠位第二連通孔２４との間で湾曲形状をなしている。ナイフ湾曲部３５の遠位端３５ａには屈曲部３６を有しても良い。 As shown in FIGS. 11, 12, and 13, the knife bending portion 35 is located in the region between the distal first communication hole 23 and the distal second communication hole 24 in the virtual coordinate system. The second quadrant Q2 is arranged on the inner side of the curve in the pre-curve portion 4. The knife bending portion 35 has a curved shape between the distal first series hole 23 and the distal second communication hole 24. The distal end 35 a of the knife bending portion 35 may have a bent portion 36.
　屈曲部３６は、第一仮想平面α及び第二仮想平面βによって規定される仮想座標系における第二象限Ｑ２においてシース３の外周面３ｃに対する接線に対して略平行な方向に向けて曲がった形状を有する。具体的には、遠位第一連通孔２３から突出された位置で切開部３４が遠位第一連通孔２３の延びる方向から第一仮想平面αから離間する方向に曲がった形状の屈曲部３６を有する。
　屈曲部３６は、ナイフワイヤ３０において、ナイフ湾曲部３５からナイフワイヤ３０の遠位端３０ａへ向かって延びる芯線３１が遠位第一連通孔２３へ向けて屈曲された屈曲形状となるように芯線３１が折り曲げられた部位である。屈曲部３６は、絶縁被膜３２に覆われていてもよい。 The bent portion 36 is bent in a direction substantially parallel to a tangent to the outer peripheral surface 3c of the sheath 3 in the second quadrant Q2 in the virtual coordinate system defined by the first virtual plane α and the second virtual plane β. Have Specifically, the incision 34 is bent at a position protruding from the distal first through hole 23 and bent in a direction away from the first virtual plane α from the direction in which the distal first through hole 23 extends. Part 36.
The bent portion 36 has a bent shape in which the core wire 31 extending from the knife curved portion 35 toward the distal end 30 a of the knife wire 30 is bent toward the distal first through hole 23 in the knife wire 30. This is a portion where the core wire 31 is bent. The bent portion 36 may be covered with the insulating coating 32.
　遠位固定部材３７は、ナイフワイヤ３０の遠位端３０ａに設けられており、第三ルーメン２０の内部に固定されている。すなわち、遠位固定部材３７は、プリカーブ部４内に挿入された状態でナイフワイヤ３０とプリカーブ部４とを固定している。なお、遠位固定部材３７は、プリカーブ部４内の第三ルーメン２０の内周面２０ｃに対して、摩擦、接着その他の接続方法により接続される。遠位固定部材３７が第三ルーメン２０（プリカーブ部４）の内部で固定されているため、ナイフワイヤ３０の遠位部分が遠位第一連通孔２３から抜けない。 The distal fixing member 37 is provided at the distal end 30 a of the knife wire 30 and is fixed inside the third lumen 20. That is, the distal fixing member 37 fixes the knife wire 30 and the pre-curve part 4 while being inserted into the pre-curve part 4. The distal fixing member 37 is connected to the inner peripheral surface 20c of the third lumen 20 in the pre-curved portion 4 by friction, adhesion, or other connection methods. Since the distal fixing member 37 is fixed inside the third lumen 20 (pre-curved portion 4), the distal portion of the knife wire 30 does not come out of the distal first through hole 23.
　図２に示す操作部４０は、操作者によって把持される部位であり、挿入部２の近位端２ｂ（シース３の近位端３ｂ）に配されている。操作部４０には、内視鏡用処置具１を動作させるための各種の操作が入力される。
　操作部４０は、遠位構成部４１と、可撓連結部５８と、近位構成部６１と、ハンドル部６７とを有する。 The operation unit 40 illustrated in FIG. 2 is a part that is gripped by the operator, and is disposed at the proximal end 2b of the insertion unit 2 (the proximal end 3b of the sheath 3). Various operations for operating the endoscope treatment tool 1 are input to the operation unit 40.
The operation unit 40 includes a distal component 41, a flexible coupling 58, a proximal component 61, and a handle 67.
　図６に示すように、遠位構成部４１は、操作部４０における最も遠位側に配された部材である。
　遠位構成部４１は、本体部４２と、内視鏡装置１００への連結部４５と、シース３への連結部４８とを有する。 As shown in FIG. 6, the distal component portion 41 is a member arranged on the most distal side in the operation portion 40.
The distal component part 41 includes a main body part 42, a connection part 45 to the endoscope apparatus 100, and a connection part 48 to the sheath 3.
　図７に示すように、本体部４２は、硬質な部材であり、本体側送液管路４３と、本体側ワイヤ通路４４とを内部に有する。本体部４２は、連結部４８における後述する第一ポート４９に連結され、第一ポート４９の長軸Ｌ２に対する放射方向（長軸Ｌ２に交差する直線方向）に延びている。本実施形態では、本体部４２は、第一ポート４９の長軸Ｌ２及び長軸Ｌ２に直交する短軸を含む仮想平面に沿って連結部４８の近位端４８ｂへ延びている。 As shown in FIG. 7, the main body 42 is a hard member, and has a main body side liquid supply conduit 43 and a main body side wire passage 44 therein. The main body portion 42 is connected to a first port 49 described later in the connecting portion 48 and extends in a radial direction with respect to the major axis L2 of the first port 49 (a linear direction intersecting the major axis L2). In the present embodiment, the main body portion 42 extends to the proximal end 48b of the connecting portion 48 along a virtual plane including the major axis L2 of the first port 49 and the minor axis perpendicular to the major axis L2.
　本体側送液管路４３は、後述する第二ポート６２（図２０参照）と上記の第二ルーメン１５とを連通する管路の一部を形成している。 The main body side liquid feed conduit 43 forms a part of a conduit that communicates with a second port 62 (see FIG. 20) described later and the second lumen 15 described above.
　本体側ワイヤ通路４４は、第三ルーメン２０に挿通されているナイフワイヤ３０の力量伝達部３３が進退自在に挿通される通路である。 The main body side wire passage 44 is a passage through which the force transmission portion 33 of the knife wire 30 inserted through the third lumen 20 is inserted so as to freely advance and retract.
　内視鏡装置１００への連結部４５は、フック４６と、延出部４７とを有する。フック４６は、内視鏡装置１００に設けられた把持部１０２（図１９参照）に係止可能な係止部である。延出部４７は、フック４６と本体部４２とを接続する。 The connecting portion 45 to the endoscope apparatus 100 has a hook 46 and an extending portion 47. The hook 46 is a locking portion that can be locked to a gripping portion 102 (see FIG. 19) provided in the endoscope apparatus 100. The extension part 47 connects the hook 46 and the main body part 42.
　フック４６は、内視鏡装置１００に設けられた把持部１０２の外周面の一部を囲むようにＣ字状に形成される弾性部材である。フック４６は、フック４６自身がＣ字状に復元する復元力により、内視鏡装置１００の把持部１０２の外面をフック４６が押圧している。その結果、フック４６は、内視鏡装置１００の把持部１０２に対して係合する。 The hook 46 is an elastic member formed in a C shape so as to surround a part of the outer peripheral surface of the grip portion 102 provided in the endoscope apparatus 100. The hook 46 presses the outer surface of the grip portion 102 of the endoscope apparatus 100 by a restoring force that the hook 46 itself restores in a C shape. As a result, the hook 46 engages with the grip portion 102 of the endoscope apparatus 100.
　延出部４７は、例えば、本体部４２とフック４６とを接続する硬質な棒状の部材である。延出部４７の近位端は本体部４２に繋がっており、延出部４７の遠位端４７ａはフック４６と繋がっている。延出部４７は、フック４６を、本体部４２より遠位側に保持されている方が好ましい。 The extending portion 47 is a hard bar-like member that connects the main body portion 42 and the hook 46, for example. The proximal end of the extending portion 47 is connected to the main body portion 42, and the distal end 47 a of the extending portion 47 is connected to the hook 46. It is preferable that the extension part 47 holds the hook 46 on the distal side of the main body part 42.
　シース３への連結部４８は、シース３の近位端７及びその近傍が差し込まれた略筒状形状を有している。シース３への連結部４８は、延出部４７との間に隙間を有した状態で遠位端方向へ向かって本体部４２から延びていてもよい。連結部４８は、本体部４２および延出部４７と並列して設置されていてもよい。このような構成においては、操作者が本体部４２および延出部４７を保持することで、連結部４８および第一ポート４９の視認性および後述するガイドワイヤ８０の挿入を阻害することなく、容易かつ精密に第一ポート４９の向きを制御することが可能である。
　シース３への連結部４８は、第一ポート４９と、第二ルーメン１５への連通路５６と、第三ルーメン２０への連通路５７とを有する。 The connecting portion 48 to the sheath 3 has a substantially cylindrical shape into which the proximal end 7 of the sheath 3 and the vicinity thereof are inserted. The connecting portion 48 to the sheath 3 may extend from the main body portion 42 toward the distal end with a gap between the connecting portion 48 and the extending portion 47. The connecting portion 48 may be installed in parallel with the main body portion 42 and the extending portion 47. In such a configuration, the operator can easily hold the main body portion 42 and the extending portion 47 without obstructing the visibility of the connecting portion 48 and the first port 49 and the insertion of the guide wire 80 described later. In addition, the direction of the first port 49 can be precisely controlled.
The connecting portion 48 to the sheath 3 has a first port 49, a communication path 56 to the second lumen 15, and a communication path 57 to the third lumen 20.
操作部４０（連結部４８）は、シース３の近位端３ｂ及びその近傍が挿入可能な内径を有して略筒状に形成された筒状部と、その筒状部の内周面から外周面まで連通してガイドワイヤ８０を挿入可能な開口部を有する第一ポート４９と、を有している。また、第一ポート４９の開口部の開口と入口部８の開口方向が一致するように、シース３の近位端３ｂ及びその近傍において、第一ポート４９をシース３に対して固定するポート固定部（図示しない）が配置されている。ポート固定部は、シース３と第一ポート４９とを直接接着する、または、シース３に切り込みを形成し、その切り込みにメカ的に係止させる等の公知の固定方法が適宜採用できる。その結果として、シース３がその長手軸周りに回動せず、且つ筒状部からの抜けないようになっている。 The operating portion 40 (the connecting portion 48) includes a cylindrical portion formed in a substantially cylindrical shape having an inner diameter into which the proximal end 3b of the sheath 3 and the vicinity thereof can be inserted, and an inner peripheral surface of the cylindrical portion. A first port 49 having an opening through which the guide wire 80 can be inserted. Moreover, the port fixing which fixes the 1st port 49 with respect to the sheath 3 in the proximal end 3b of the sheath 3, and its vicinity so that the opening direction of the opening part of the 1st port 49 and the opening direction of the inlet_port | entrance part 8 may correspond. (Not shown) is disposed. For the port fixing portion, a known fixing method such as directly bonding the sheath 3 and the first port 49 or forming a notch in the sheath 3 and mechanically locking the notch can be appropriately employed. As a result, the sheath 3 does not rotate around its longitudinal axis and does not come out of the tubular portion.
　図６、図８、及び図９Ｂに示すように、第一ポート４９は、ガイドワイヤ８０（図２８参照）を第一ルーメン７内へ導入する際の入り口となるポートである。第一ポート４９の開口部は、内側開口縁部５０と、外側開口縁部５１と、を有する。好ましくは、テーパー部５２と、開口部と連通する切欠き部５５とを有する。 As shown in FIGS. 6, 8, and 9 </ b> B, the first port 49 is a port that serves as an entrance when the guide wire 80 (see FIG. 28) is introduced into the first lumen 7. The opening of the first port 49 has an inner opening edge 50 and an outer opening edge 51. Preferably, it has the taper part 52 and the notch part 55 connected to an opening part.
　図８及び図９Ｂに示すように、内側開口縁部５０は、筒状部の内周面に開口された開口の輪郭を形成している。また、内側開口縁部５０は、シース３の近位部分に形成された入口部８の輪郭に一致する輪郭線または入口部８の輪郭を囲むような輪郭線を有している。すなわち、内側開口縁部５０の開口の輪郭は、シース３の入口部８の縁（開口縁部）を、その開口方向（第一ルーメン７の中心軸およびシース３の中心軸に直交する直線に沿った方向）から第一ポート４９の内周面に投影した投影部分と略一致する、もしくは投影部分を囲める（内側開口縁部５０よりも外側に位置する）ような形状である。内側開口縁部５０は、シース３の外周面３ｃに接触可能な位置に配されている。このような位置関係で、シース３は操作部４０に固定されている。
　外側開口縁部５１は、筒状部の外周面に開口された開口の輪郭を形成している。また、外側開口縁部５１は、内側開口縁部５０よりシース３の径方向外側に位置している。外側開口縁部５１は、内側開口縁部５０により規定される開口面積よりも大きな開口面積を有する。外側開口縁部５１は、シース３の近位部分に形成された入口部８の輪郭の外周に略一致する輪郭線または入口部８の輪郭を囲むような輪郭線を有している。内側開口縁部５０により規定される面に対して垂直な方向から見たときに、外側開口縁部５１の輪郭は内側開口縁部５０の外側に位置する。
前述のポート固定部は、内側開口縁部および前記外側開口縁部の開口の輪郭がシース３の入口部８の縁をその開口方向に投影した投影部分と略一致する、またはその投影部分を囲むように、第一ポート４９をシース３の長手軸周りの方向およびシース３の長手軸方向に対して位置決めした状態で固定する。
　内側開口縁部５０及び外側開口縁部５１は、シース３への連結部４８の遠位端４８ａとシース３への連結部４８の近位端４８ｂとを結ぶ直線方向に長軸Ｌ２を有する長円形状で形成されている。 As shown in FIGS. 8 and 9B, the inner opening edge portion 50 forms an outline of an opening opened on the inner peripheral surface of the cylindrical portion. Further, the inner opening edge 50 has a contour line that matches the contour of the inlet portion 8 formed in the proximal portion of the sheath 3 or a contour line that surrounds the contour of the inlet portion 8. That is, the contour of the opening of the inner opening edge 50 is such that the edge (opening edge) of the inlet portion 8 of the sheath 3 is in a straight line perpendicular to the opening direction (the central axis of the first lumen 7 and the central axis of the sheath 3). The projection part projected substantially onto the inner peripheral surface of the first port 49 from the direction along the direction of the first port 49, or surrounds the projection part (located outside the inner opening edge 50). The inner opening edge 50 is arranged at a position where it can contact the outer peripheral surface 3 c of the sheath 3. With such a positional relationship, the sheath 3 is fixed to the operation unit 40.
The outer opening edge 51 forms an outline of an opening opened on the outer peripheral surface of the cylindrical portion. Further, the outer opening edge 51 is located on the outer side in the radial direction of the sheath 3 from the inner opening edge 50. The outer opening edge 51 has an opening area larger than the opening area defined by the inner opening edge 50. The outer opening edge 51 has a contour line that substantially matches the outer periphery of the contour of the inlet portion 8 formed in the proximal portion of the sheath 3 or a contour line that surrounds the contour of the inlet portion 8. When viewed from a direction perpendicular to the surface defined by the inner opening edge 50, the contour of the outer opening edge 51 is located outside the inner opening edge 50.
In the above-described port fixing portion, the contours of the openings of the inner opening edge and the outer opening edge substantially coincide with or surround the projection portion obtained by projecting the edge of the inlet portion 8 of the sheath 3 in the opening direction. As described above, the first port 49 is fixed in a state of being positioned with respect to the direction around the longitudinal axis of the sheath 3 and the longitudinal axis direction of the sheath 3.
The inner opening edge 50 and the outer opening edge 51 have a long axis L2 in the linear direction connecting the distal end 48a of the connecting portion 48 to the sheath 3 and the proximal end 48b of the connecting portion 48 to the sheath 3. It is formed in a circular shape.
　内側開口縁部５０及び外側開口縁部５１は、第一ポート４９の開口形状を規定する。第一ポート４９の開口における上記長軸Ｌ２方向の長さは、第一ポート４９に挿入可能なガイドワイヤ８０の遠位端８０ａの構成に対応して設定可能である。 The inner opening edge 50 and the outer opening edge 51 define the opening shape of the first port 49. The length of the opening of the first port 49 in the long axis L2 direction can be set according to the configuration of the distal end 80a of the guide wire 80 that can be inserted into the first port 49.
　図１５は、内視鏡用処置具１とともに使用されるガイドワイヤ８０の一構成例を示す側面図である。図１６から図１７Ｂは、図１５に示すガイドワイヤ８０の他の構成例のガイドワイヤ８１、８２、８３をそれぞれ示す側面図である。 FIG. 15 is a side view showing a configuration example of the guide wire 80 used together with the endoscope treatment tool 1. 16 to 17B are side views respectively showing guide wires 81, 82, and 83 of other configuration examples of the guide wire 80 shown in FIG.
　図１５から図１７Ｂに示すように、第一ポート４９に挿入されるガイドワイヤ８０、８１、８２、８３として、公知の構成が適宜採用されてよい。たとえば、図１６及び図１７Ａに示すように、ガイドワイヤ８１、８２の遠位端８０ａの近傍領域（遠位部）の少なくとも一部が湾曲形状とされた湾曲形状部８１１、８１２を有してもよい。湾曲形状部８１１、８１２は、円弧の一部をなして湾曲している形状である。たとえば、図１７Ａに示すように、遠位端８０ａがガイドワイヤ８２の近位方向を向くように遠位端８０ａの近傍領域の湾曲形状部８１２が半円弧状に湾曲している形状のガイドワイヤ８２を採用してもよい。また、ガイドワイヤ８０、８３の遠位端８０ａの近傍領域（遠位部）が、ガイドワイヤ８０、８３の中心軸が偏向する形状に復元する復元力を有する屈曲部を有しても良い。例えば、図１５及び図１７Ｂに示すように、遠位部が屈曲部よりもガイドワイヤ８０、８３の遠位側に設けられ、屈曲部は、ガイドワイヤ８０、８３の近位側部分に対して鈍角、直角、あるいは鋭角を形成する方向にガイドワイヤ８０、８３の遠位部が延びるように屈曲されている形状であっても良い。アングルタイプのガイドワイヤ８０、８１、８２、８３は、走行が複雑な管腔組織や分岐を有する管腔組織の内部において所望の管腔にガイドワイヤ８０、８１、８２、８３の遠位端８０ａを挿入する際の操作が容易な点で優れている。 As shown in FIG. 15 to FIG. 17B, known configurations may be appropriately adopted as the guide wires 80, 81, 82, 83 inserted into the first port 49. For example, as shown in FIG. 16 and FIG. 17A, at least a part of a region (distal portion) in the vicinity of the distal end 80a of the guide wires 81 and 82 has curved shape portions 811 and 812 having a curved shape. Also good. The curved shape portions 811 and 812 are shapes that are curved by forming a part of an arc. For example, as shown in FIG. 17A, the guide wire having a shape in which the curved shape portion 812 in the vicinity of the distal end 80a is curved in a semicircular arc shape so that the distal end 80a faces the proximal direction of the guide wire 82. 82 may be adopted. Moreover, the vicinity area (distal part) of the distal ends 80a of the guide wires 80 and 83 may have a bent part having a restoring force for restoring the shape in which the central axes of the guide wires 80 and 83 are deflected. For example, as shown in FIGS. 15 and 17B, the distal portion is provided on the distal side of the guide wires 80 and 83 with respect to the bent portion, and the bent portion is located with respect to the proximal portion of the guide wires 80 and 83. The shape may be such that the distal portions of the guide wires 80 and 83 extend in a direction that forms an obtuse angle, a right angle, or an acute angle. The angle- type guide wires 80, 81, 82, 83 are arranged so that the distal ends 80a of the guide wires 80, 81, 82, 83 reach the desired lumens in the lumen tissue having complicated traveling or the lumen tissue having branches. It is excellent in that it is easy to operate when inserting.
なお、図１５、図１７Ｂについて、ガイドワイヤ８０、８３の遠位部の長さをそれぞれＭ２０、Ｍ２３とする。また、図１６、図１７Ａについては、ガイドワイヤ８１、８２の湾曲形状部８１１、８１２の先端における接線方向の最大長さをそれぞれＭ２１、Ｍ２２とする。 15 and 17B, the lengths of the distal portions of the guide wires 80 and 83 are M20 and M23, respectively. 16 and 17A, the maximum tangential lengths at the tips of the curved portions 811 and 812 of the guide wires 81 and 82 are M21 and M22, respectively.
　図１８は、内視鏡用処置具１における第一ポート４９の形状とガイドワイヤ８０の形状との関係を説明するための図である。
　図１８に示すように、シース３の長軸方向における第一ポート４９の開口の長さＭ１は、ガイドワイヤ８０の遠位部の長さＭ２０に対してと略等しいか、わずかに長くてもよい。 FIG. 18 is a view for explaining the relationship between the shape of the first port 49 and the shape of the guide wire 80 in the endoscope treatment tool 1.
As shown in FIG. 18, the length M1 of the opening of the first port 49 in the longitudinal direction of the sheath 3 may be substantially equal to or slightly longer than the length M20 of the distal portion of the guide wire 80. Good.
　図１６に示すガイドワイヤ８１を採用する場合、シース３の長軸方向における第一ポート４９の開口の長さＭ１は、湾曲形状部８１１の先端における接線方向成分の最大長さＭ２１に対して略等しいか、わずかでも長く設定すればよい。 When the guide wire 81 shown in FIG. 16 is employed, the length M1 of the opening of the first port 49 in the major axis direction of the sheath 3 is substantially equal to the maximum length M21 of the tangential component at the tip of the curved shape portion 811. It may be set equal or slightly longer.
　図１７Ａに示すガイドワイヤ８２を採用する場合、シース３の長軸方向における第一ポート４９の開口の長さＭ１は、湾曲形状部８１２の先端における接線方向成分の最大長さＭ２２に対して略等しいか、わずかでも長く設定すればよい。 When the guide wire 82 shown in FIG. 17A is employed, the length M1 of the opening of the first port 49 in the major axis direction of the sheath 3 is approximately the maximum length M22 of the tangential component at the distal end of the curved shape portion 812. It may be set equal or slightly longer.
　図１７Ｂに示すガイドワイヤ８３を採用する場合、シース３の長軸方向における第一ポート４９の長さＭ１は、ガイドワイヤ８３の遠位部の長さＭ２３に対して略等しいか、わずかでも長く設定すればよい。 When the guide wire 83 shown in FIG. 17B is employed, the length M1 of the first port 49 in the longitudinal direction of the sheath 3 is substantially equal to or slightly longer than the length M23 of the distal portion of the guide wire 83. You only have to set it.
　図８、図９Ａ及び図９Ｂに示すように、テーパー部５２は、遠位テーパー面５３と、近位テーパー面５４とを有する。遠位テーパー面５３は、第一ポート４９の遠位端４９ａ部分において切欠き部５５に対して滑らかにつながる。近位テーパー面５４は、第一ポート４９の近位端４９ｂ及びその両端につながる側部において内側開口縁部５０と外側開口縁部５１とを繋ぐテーパー状の面である。 As shown in FIG. 8, FIG. 9A and FIG. 9B, the tapered portion 52 has a distal tapered surface 53 and a proximal tapered surface. The distal tapered surface 53 smoothly connects to the notch 55 at the distal end 49 a portion of the first port 49. The proximal tapered surface 54 is a tapered surface that connects the inner opening edge 50 and the outer opening edge 51 at the proximal end 49 b of the first port 49 and the side portion connected to both ends thereof.
　遠位テーパー面５３は、ガイドワイヤ８０が第一ポート４９を通じてシース３の第一ルーメン７内に挿入される際、ガイドワイヤ８０が第一ポート４９から切欠き部５５を介してシース３の遠位端３ａ方向へ移動するのをガイドする。 When the guide wire 80 is inserted into the first lumen 7 of the sheath 3 through the first port 49, the distal tapered surface 53 is arranged so that the guide wire 80 is distant from the first port 49 through the notch 55. It is guided to move in the direction of the distal end 3a.
　近位テーパー面５４は、ガイドワイヤ８０がシース３への連結部４８の外部から第一ポート４９内へガイドワイヤ８０の遠位端８０ａが挿入される際、ガイドワイヤ８０の遠位端８０ａをシース３の第一ルーメン７内へとガイドする。 The proximal tapered surface 54 causes the distal end 80a of the guide wire 80 to be inserted when the distal end 80a of the guide wire 80 is inserted into the first port 49 from the outside of the connection portion 48 to the sheath 3. Guide into the first lumen 7 of the sheath 3.
　テーパー部５２が形成された第一ポート４９は、シース３への連結部４８の外部から第一ルーメン７の内面７ｃが見えるように、第一ルーメン７の入口部８が外部に露出された状態で入口部８の外周部分に配されている。 In the first port 49 in which the tapered portion 52 is formed, the inlet portion 8 of the first lumen 7 is exposed to the outside so that the inner surface 7c of the first lumen 7 can be seen from the outside of the connecting portion 48 to the sheath 3. Is arranged on the outer peripheral portion of the inlet portion 8.
　図１９は、内視鏡用処置具１を内視鏡装置１００に取り付けた状態における第一ポート４９及び操作部４０の位置関係を示す図である。図２０は、内視鏡用処置具１を内視鏡装置１００に取り付けた状態におけるフック４６と第一ポート４９との位置関係を示す図である。 FIG. 19 is a diagram illustrating a positional relationship between the first port 49 and the operation unit 40 in a state where the endoscope treatment tool 1 is attached to the endoscope apparatus 100. FIG. 20 is a diagram illustrating a positional relationship between the hook 46 and the first port 49 in a state where the endoscope treatment tool 1 is attached to the endoscope apparatus 100.
　図１９に示すように、内視鏡装置１００の把持部１０２に操作部４０をフック（係止部）４６によって係止した状態で第一ポート４９の開口が内視鏡装置１００の湾曲操作部１０７ａ側に向くように、第一ポート４９の開口とフック４６との位置関係が定められている。ここで、湾曲操作部１０７ａ側とは、内視鏡装置１００の先端部に設けられた湾曲変形部１０７ｂを能動的に操作できる操作部である。第一ポート４９は、把持部１０２の長手軸と略平行な軸に沿って貫通した仮想平面と交差する軸方向を貫通方向（軸方向）とした貫通孔が形成されていればよい。内視鏡用処置具１は、内視鏡装置１００の鉗子栓１０３が延びる方向と略平行な方向に延びるように内視鏡装置１００に固定されてもよく、その場合は、第一ポート４９の貫通孔が貫通する軸方向（後述する中心軸Ｌ３方向）は内視鏡装置１００の把持部１０２の長手軸に対してねじれの位置関係である。
　本実施形態では、図８に示すように、第一ポート４９の開口において内側開口縁部５０により規定される面から外側開口縁部５１により規定される面へ向かう直線方向（以下、「第一ポート４９の開口の中心軸Ｌ３方向」と称する。）は、図２０に示すように、フック４６において把持部１０２を囲む円の中心軸Ｌ４方向とは、略平行である。すなわち、図９Ａに示された内視鏡用処置具１００の操作部４０の断面において、第一ルーメン７の中心軸Ｌ７を通り、内側開口縁部５０同士の間と外側開口縁部５１同士の間とを通る第一ポート４９の開口の中心軸Ｌ３方向は、フック４６において把持部１０２を囲む円の中心軸Ｌ４方向とは、略平行である。その結果、第一ポート４９の開口は、図９Ａに示すように、シース３の中心軸Ｌ１と直交する第一ポート４９の開口の中心軸Ｌ３を中心として開口するように形成され、第一ポート４９の開口の中心軸Ｌ３と、内視鏡装置１００の把持部１０２を囲む円の中心軸Ｌ４とが略平行である。この結果、フック４６によって操作部４０が内視鏡装置１００に取り付けられ、係止された状態で、操作者が内視鏡装置１００の把持部１０２を把持して内視鏡装置１００を操作する通常の位置関係において第一ポート４９の開口は、操作者に視認可能な方向（図２４参照）に向けられる。 As shown in FIG. 19, the opening of the first port 49 is the bending operation portion of the endoscope device 100 in a state where the operation portion 40 is locked to the grip portion 102 of the endoscope device 100 by a hook (locking portion) 46. The positional relationship between the opening of the first port 49 and the hook 46 is determined so as to face the 107a side. Here, the bending operation unit 107 a side is an operation unit that can actively operate the bending deformation unit 107 b provided at the distal end portion of the endoscope apparatus 100. The first port 49 only needs to be formed with a through-hole whose axial direction intersects with a virtual plane that penetrates along the axis substantially parallel to the longitudinal axis of the grip portion 102. The endoscope treatment tool 1 may be fixed to the endoscope apparatus 100 so as to extend in a direction substantially parallel to the direction in which the forceps plug 103 of the endoscope apparatus 100 extends. In this case, the first port 49 is used. The axial direction through which the through hole penetrates (the direction of the central axis L3 described later) is a positional relationship of twist with respect to the longitudinal axis of the grip portion 102 of the endoscope apparatus 100.
In the present embodiment, as shown in FIG. 8, in the opening of the first port 49, a straight direction from the surface defined by the inner opening edge 50 toward the surface defined by the outer opening edge 51 (hereinafter referred to as “first” The direction of the center axis L3 of the opening of the port 49 is referred to as “the direction of the center axis L3”), as shown in FIG. That is, in the cross section of the operation portion 40 of the endoscope treatment tool 100 shown in FIG. 9A, it passes through the central axis L7 of the first lumen 7 and between the inner opening edge portions 50 and between the outer opening edge portions 51. The direction of the central axis L3 of the opening of the first port 49 that passes between them is substantially parallel to the direction of the central axis L4 of the circle surrounding the grip portion 102 in the hook 46. As a result, the opening of the first port 49 is formed so as to open around the central axis L3 of the opening of the first port 49 orthogonal to the central axis L1 of the sheath 3, as shown in FIG. 9A. The central axis L3 of the 49 openings and the central axis L4 of the circle surrounding the grip portion 102 of the endoscope apparatus 100 are substantially parallel. As a result, the operator grips the grip portion 102 of the endoscope apparatus 100 and operates the endoscope apparatus 100 in a state where the operation section 40 is attached and locked to the endoscope apparatus 100 by the hook 46. In the normal positional relationship, the opening of the first port 49 is directed in a direction (see FIG. 24) that is visible to the operator.
　図８及び図９Ａに示すように、切欠き部５５は、連結部４８をシース３の中心軸Ｌ１に直交する断面で見たときに略Ｃ字状となるように切り欠きが形成された部位である。切欠き部５５は、入口部８からスリット部１０へとガイドワイヤ８０が移動できるように、ガイドワイヤ８０が移動可能なクリアランス分だけガイドワイヤ８０の直径より連結部４８の直径が大きくなるような隙間を有する。切欠き部５５における隙間は、シース３のスリット部１０に沿って設けられている。切欠き部５５は、シース３の外周面３ｃに接触可能な内面５５ｃを有しており、シース３の外周面３ｃを保持している。
　図７に示すように、切欠き部５５は、内視鏡装置１００への連結部４５における延出部４７から離間して設けられているので、内視鏡装置１００からフック４６を介して伝わる外力が切欠き部５５に伝わりにくいように構成されている。本実施形態では、切欠き部５５と、第一ポート４９の遠位部分とが、いずれも延出部４７から離間している。 As shown in FIGS. 8 and 9A, the notch portion 55 is a portion where the notch is formed so as to be substantially C-shaped when the connecting portion 48 is viewed in a cross section orthogonal to the central axis L1 of the sheath 3. It is. The notch 55 is such that the diameter of the connecting portion 48 is larger than the diameter of the guide wire 80 by a clearance that allows the guide wire 80 to move so that the guide wire 80 can move from the inlet portion 8 to the slit portion 10. Has a gap. The gap in the notch portion 55 is provided along the slit portion 10 of the sheath 3. The notch 55 has an inner surface 55 c that can contact the outer peripheral surface 3 c of the sheath 3, and holds the outer peripheral surface 3 c of the sheath 3.
As shown in FIG. 7, the notch portion 55 is provided away from the extending portion 47 in the connecting portion 45 to the endoscope apparatus 100, and thus is transmitted from the endoscope apparatus 100 via the hook 46. The external force is configured not to be transmitted to the notch portion 55. In the present embodiment, the notch portion 55 and the distal portion of the first port 49 are both separated from the extending portion 47.
　図７に示すように、第二ルーメン１５への連通路５６は、シース３の第二ルーメン１５に連通され、第三ルーメン２０への連通路５７は、シース３の第三ルーメン２０に連通されている。 As shown in FIG. 7, the communication path 56 to the second lumen 15 communicates with the second lumen 15 of the sheath 3, and the communication path 57 to the third lumen 20 communicates with the third lumen 20 of the sheath 3. ing.
　図２及び図７に示すように、可撓連結部５８は、遠位構成部４１と近位構成部６１とを連結する部材であり、可撓性を有する。可撓連結部５８は、遠位構成部４１と近位構成部６１との間に生じる捩じれを緩衝する。すなわち、可撓連結部５８は、フック４６によって操作部４０と内視鏡装置１００とが連結されている場合に、操作部４０の操作と内視鏡装置１００の操作とによって遠位構成部４１と近位構成部６１との間に生じる捩じれを緩衝する。 2 and 7, the flexible connecting portion 58 is a member that connects the distal component portion 41 and the proximal component portion 61, and has flexibility. The flexible coupling part 58 buffers the twist generated between the distal component part 41 and the proximal component part 61. That is, when the operation unit 40 and the endoscope apparatus 100 are connected by the hook 46, the flexible connection unit 58 is operated by the operation of the operation unit 40 and the operation of the endoscope apparatus 100. And torsion occurring between the proximal component 61 and the proximal component 61 is buffered.
　可撓連結部５８は、図７に示すように、送液用の連絡通路５９と、ナイフワイヤ用の連絡通路６０とを内部に有する。送液用の連絡通路５９は、第二ルーメン１５に連通している。ナイフワイヤ用の連絡通路６０は、第三ルーメン２０に連通している。 As shown in FIG. 7, the flexible connecting portion 58 has a communication passage 59 for feeding liquid and a communication passage 60 for knife wire inside. The communication passage 59 for liquid feeding communicates with the second lumen 15. The knife wire communication passage 60 communicates with the third lumen 20.
　図２に示すように、近位構成部６１は、第二ポート６２と、ハンドル部６７への連結部６３とを有する。 As shown in FIG. 2, the proximal component 61 includes a second port 62 and a connecting portion 63 to the handle portion 67.
　第二ポート６２は、液体が収容されたシリンジ等が接続されるポートである。たとえば、第二ルーメン１５を通じて造影剤をシース３の遠位端３ａから吐出させる手技においては、造影剤が充填されたシリンジが第二ポート６２に接続される。第二ポート６２の近位端６２ｂは、ルアーロック構造を有するシリンジに連結可能なコネクタ構造を有する。第二ポート６２の遠位端６２ａは、可撓連結部５８に形成された送液用の連絡通路５９（図７参照）に連通している。 The second port 62 is a port to which a syringe containing liquid is connected. For example, in the procedure of ejecting the contrast agent from the distal end 3 a of the sheath 3 through the second lumen 15, a syringe filled with the contrast agent is connected to the second port 62. The proximal end 62b of the second port 62 has a connector structure that can be connected to a syringe having a luer lock structure. The distal end 62 a of the second port 62 communicates with a liquid-feeding communication passage 59 (see FIG. 7) formed in the flexible connection portion 58.
　図２０に示すように、ハンドル部６７への連結部６３は、ハンドル固定部６４と、ナイフワイヤ通路６６とを有する。ハンドル固定部６４は、ハンドル部６７を所定の接続状態で固定するために設けられている。ナイフワイヤ通路６６は、可撓連結部５８におけるナイフワイヤ用の連絡通路６０と連通している。 As shown in FIG. 20, the connecting portion 63 to the handle portion 67 has a handle fixing portion 64 and a knife wire passage 66. The handle fixing part 64 is provided to fix the handle part 67 in a predetermined connection state. The knife wire passage 66 communicates with the knife wire communication passage 60 in the flexible connecting portion 58.
　ハンドル固定部６４は、ハンドル部６７の軸部６８の遠位端を固定可能な爪構造６５を有している。ハンドル固定部６４が設けられていることに代えて、近位構成部６１と軸部６８とが一体成型されていてもよい。
　ハンドル固定部６４は、第一ポート４９の長軸Ｌ２方向に対して傾斜する方向に延びる棒状形状を有する。具体的には、ハンドル固定部６４は棒状であり、ハンドル固定部６４の遠位端６４ａからハンドル固定部６４の近位端６４ｂへ向かうに従って、第一ポート４９の長軸Ｌ２から漸次離間するように傾斜する中心軸Ｌ５を有する。 The handle fixing portion 64 has a claw structure 65 that can fix the distal end of the shaft portion 68 of the handle portion 67. Instead of providing the handle fixing portion 64, the proximal component portion 61 and the shaft portion 68 may be integrally molded.
The handle fixing portion 64 has a rod-like shape extending in a direction inclined with respect to the direction of the long axis L2 of the first port 49. Specifically, the handle fixing portion 64 has a rod shape, and gradually moves away from the long axis L2 of the first port 49 from the distal end 64a of the handle fixing portion 64 toward the proximal end 64b of the handle fixing portion 64. It has a central axis L5 that is inclined in the direction.
　ナイフワイヤ通路６６は、ナイフワイヤ３０の力量伝達部３３が進退自在に挿通される通路である。ナイフワイヤ通路６６の遠位端６６ａは可撓連結部５８におけるナイフワイヤ用の連絡通路６０（図７参照）の近位端に連通されている。ナイフワイヤ通路６６の近位端６６ｂは、ハンドル部６７の軸部６８の内部と連通している。 The knife wire passage 66 is a passage through which the force transmission portion 33 of the knife wire 30 is inserted so as to be movable forward and backward. The distal end 66a of the knife wire passage 66 communicates with the proximal end of the knife wire communication passage 60 (see FIG. 7) at the flexible connection 58. The proximal end 66 b of the knife wire passage 66 communicates with the inside of the shaft portion 68 of the handle portion 67.
　ハンドル部６７は、操作者がナイフワイヤ３０を操作するための入力が行われる部分である。ハンドル部６７は、軸部６８とスライダ部７１とを有する。軸部６８は、近位構成部６１のハンドル固定部６４に固定されている。スライダ部７１は、軸部６８に連結されている。 The handle portion 67 is a portion where an input for the operator to operate the knife wire 30 is performed. The handle portion 67 has a shaft portion 68 and a slider portion 71. The shaft portion 68 is fixed to the handle fixing portion 64 of the proximal component portion 61. The slider portion 71 is connected to the shaft portion 68.
　軸部６８は、棒状部６９と、リング部７０とを有する。棒状部６９は、ハンドル固定部６４の中心軸Ｌ５（図２４参照）と同軸あるいはハンドル固定部６４の中心軸Ｌ５に沿って直線状に設けられている。リング部７０は、棒状部６９の近位端に形成されている。 The shaft portion 68 has a rod-shaped portion 69 and a ring portion 70. The rod-like portion 69 is provided coaxially with the central axis L5 (see FIG. 24) of the handle fixing portion 64 or linearly along the central axis L5 of the handle fixing portion 64. The ring part 70 is formed at the proximal end of the rod-like part 69.
　棒状部６９は、後述するスライダ部７１が取り付けられた部分である。棒状部６９の内部には、スライダ部７１のコネクタ７３およびナイフワイヤ３０の近位部分が配される。 The rod-shaped portion 69 is a portion to which a slider portion 71 described later is attached. Inside the rod-like portion 69, the connector 73 of the slider portion 71 and the proximal portion of the knife wire 30 are disposed.
　リング部７０は、操作者が指を通すことができる環状部分である。 The ring part 70 is an annular part through which an operator can pass a finger.
　スライダ部７１は、移動体７２と、コネクタ７３と、指掛け部７４とを有する。移動体７２は、軸部６８に対して進退移動可能に連結されている。コネクタ７３は、高周波電源装置に接続可能である。指掛け部７４は、操作者の指を通すことができる２つのリング７５が形成されている。 The slider portion 71 includes a moving body 72, a connector 73, and a finger hook portion 74. The moving body 72 is connected to the shaft portion 68 so as to be movable forward and backward. The connector 73 can be connected to a high frequency power supply device. The finger hook portion 74 is formed with two rings 75 through which an operator's finger can pass.
　移動体７２は、軸部６８の長手方向に進退自在である。
　コネクタ７３は、移動体７２に固定されており、また、ナイフワイヤ３０の力量伝達部３３の近位端３３ｂに固定されている。コネクタ７３は、導体からなり、ナイフワイヤ３０の芯線３１に電気的に接続されている。 The moving body 72 can advance and retreat in the longitudinal direction of the shaft portion 68.
The connector 73 is fixed to the moving body 72 and is fixed to the proximal end 33 b of the force transmission portion 33 of the knife wire 30. The connector 73 is made of a conductor and is electrically connected to the core wire 31 of the knife wire 30.
　指掛け部７４は、２つのリング７５に操作者が指を通し、さらに棒状部６９のリング部７０に操作者が指を通すことで、操作者の手の開閉動作によって移動体７２を棒状部６９に対して進退させるのに利用可能である。指掛け部７４は、移動体７２の外面から外側（中心軸Ｌ５から離れる方向）へ向かって突出している。図１９に示すように、移動体７２の外面からの指掛け部７４の突出方向は、第一ポート４９の開口の中心軸Ｌ３方向を含む平面でなければよい。移動体７２の外面からの指掛け部７４の突出方向は、第一ポート４９の開口の中心軸Ｌ３方向に対して直交する面（以下、「リング延出面γ」と称する。）方向であることが好ましい。このような構成により、指掛け部７４が、第一ポート４９を通じて第一ルーメン７内に導入されるガイドワイヤ８０において第一ポート４９の外部に出ている部分に対して干渉しにくい。 The finger hooking portion 74 allows the operator to pass the finger through the two rings 75, and further allows the operator to pass the finger through the ring portion 70 of the rod-shaped portion 69, so that the moving body 72 is moved by the opening / closing operation of the operator's hand. It can be used to advance and retreat against. The finger hooking portion 74 protrudes from the outer surface of the moving body 72 toward the outside (the direction away from the central axis L5). As shown in FIG. 19, the protruding direction of the finger hook portion 74 from the outer surface of the moving body 72 may be a plane that does not include the direction of the central axis L <b> 3 of the opening of the first port 49. The protruding direction of the finger hooking portion 74 from the outer surface of the moving body 72 is a direction (hereinafter referred to as “ring extending surface γ”) orthogonal to the direction of the central axis L3 of the opening of the first port 49. preferable. With such a configuration, the finger hook portion 74 is unlikely to interfere with a portion of the guide wire 80 introduced into the first lumen 7 through the first port 49 and coming out of the first port 49.
　次に、本実施形態に係る内視鏡用処置具１を内視鏡装置１００に取り付けて使用する手技において利用可能な処置具取付補助具９０の構成について説明する。図２１は、内視鏡装置１００に取り付け可能な処置具取付補助具９０の斜視図である。図２２は、処置具取付補助具９０の内部構造を示す部分断面図である。 Next, the configuration of the treatment tool attachment assisting tool 90 that can be used in the procedure of attaching the endoscope treatment tool 1 according to the present embodiment to the endoscope apparatus 100 and using it will be described. FIG. 21 is a perspective view of a treatment instrument attachment assisting tool 90 that can be attached to the endoscope apparatus 100. FIG. 22 is a partial cross-sectional view showing the internal structure of the treatment instrument attachment assisting tool 90.
　図２１及び図２２に示すように、処置具取付補助具９０は、補助具本体９１と、排出管９２と、栓体９３とを有する。補助具本体９１は、内視鏡装置１００の鉗子栓１０３に固定可能な筒形状を有する。排出管９２は、補助具本体９１の内部空間と連通されている。栓体９３は、鉗子栓１０３における処置具チャンネル１０４の近位開口から処置具チャンネル１０４の中心軸の延長線上に配されている。 As shown in FIGS. 21 and 22, the treatment instrument attachment assisting tool 90 includes an assisting instrument main body 91, a discharge pipe 92, and a plug 93. The auxiliary tool main body 91 has a cylindrical shape that can be fixed to the forceps plug 103 of the endoscope apparatus 100. The discharge pipe 92 is in communication with the internal space of the auxiliary tool main body 91. The plug 93 is disposed on the extension line of the central axis of the treatment instrument channel 104 from the proximal opening of the treatment instrument channel 104 in the forceps plug 103.
　補助具本体９１は、鉗子栓１０３に対して水密に連結可能な取付構造を有している。排出管９２は、不図示の排液容器につながる管路に接続可能である。栓体９３は、シース３の外周面３ｃに対して密着可能な程度の開口あるいは切れ目を有する柔軟な部材である。 The auxiliary tool body 91 has a mounting structure that can be connected to the forceps plug 103 in a watertight manner. The discharge pipe 92 can be connected to a pipe line connected to a drainage container (not shown). The plug 93 is a flexible member having an opening or a cut that is close to the outer peripheral surface 3 c of the sheath 3.
　本実施形態において、処置具取付補助具９０は、内視鏡用処置具１が処置具チャンネル１０４内に挿入される前に、内視鏡装置１００の鉗子栓１０３に固定される（図２４参照）。処置具取付補助具９０が鉗子栓１０３に取り付けられている状態で、内視鏡装置１００の処置具チャンネル１０４を遠位側から近位側へ向かって逆流してきた液体は、主に排出管９２へ流れ込む。このため、内視鏡装置１００の処置具チャンネル１０４を遠位側から近位側へ向かって逆流してきた液体が栓体９３から処置具取付補助具９０の外部へ漏れ出す可能性が低く抑えられている。 In the present embodiment, the treatment tool attachment assisting tool 90 is fixed to the forceps plug 103 of the endoscope apparatus 100 before the treatment tool for endoscope 1 is inserted into the treatment tool channel 104 (see FIG. 24). ). In a state where the treatment instrument attachment assisting tool 90 is attached to the forceps plug 103, the liquid that has flowed back through the treatment instrument channel 104 of the endoscope apparatus 100 from the distal side toward the proximal side is mainly a discharge pipe 92. Flow into. For this reason, the possibility that the liquid that has flowed back through the treatment instrument channel 104 of the endoscope apparatus 100 from the distal side toward the proximal side leaks out from the plug body 93 to the outside of the treatment instrument attachment aid 90 is suppressed. ing.
　次に、本実施形態に係る内視鏡用処置具１の作用について説明する。本実施形態では、内視鏡的乳頭括約筋切開術（Endoscopic sphincterotomy, EST）、内視鏡的逆行性胆管膵管造影（Endoscopic retrograde cholangiopancreatography, ERCP）、及び結石除去が一連の手技としてこの順に行われる場合において本実施形態に係る内視鏡用処置具１が内視鏡装置１００とともに利用される例を示す。 Next, the operation of the endoscope treatment tool 1 according to this embodiment will be described. In this embodiment, when endoscopic papillary sphincterotomy (Endoscopic sphincterotomy, EST), endoscopic retrograde cholangiopancreatography (Endoscopic retrograde cholangiopancreatography, ERCP), and stone removal are performed in this order as a series of procedures FIG. 2 shows an example in which the endoscope treatment tool 1 according to the present embodiment is used together with the endoscope apparatus 100.
　図２３は、内視鏡用処置具１の使用時の一過程を示す図である。
　図１及び図２３に示すように、本実施形態では、十二指腸乳頭ＰＶを観察するのに適した側視型の内視鏡装置１００が使用される。
　側視型の内視鏡装置１００は、たとえば、筒状部材１０１と、把持部１０２と、鉗子栓１０３と、処置具チャンネル１０４と、起上台１０５と、撮像部１０６とを備える。筒状部材１０１は体内に挿入される部分である。把持部１０２は、筒状部材１０１の近位端に配されている。鉗子栓１０３は、把持部１０２の一部に配されている。処置具チャンネル１０４は、鉗子栓１０３と連通され筒状部材１０１の内部に配されている。起上台１０５は、処置具チャンネル１０４の遠位端１０４ａにおいて処置具チャンネル１０４から突出される処置具等の向きを筒状部材１０１の中心軸Ｌ８に対して直交する方向へと変えるために、処置具が突出される開口部内を移動可能に設けられている。撮像部１０６は、筒状部材１０１の中心軸Ｌ８に対して直交する方向へ撮像視野が向けられている。撮像部１０６は、処置具が突出される開口部に隣接して設けられている。
　本実施形態における側視型の内視鏡装置１００は、湾曲機構１０７（図１参照）を有している。湾曲機構１０７は、筒状部材１０１の遠位部分を湾曲動作させるための湾曲操作部１０７ａ及び湾曲変形部１０７ｂを有する。 FIG. 23 is a diagram illustrating a process during use of the endoscope treatment tool 1.
As shown in FIG.1 and FIG.23, in this embodiment, the side-view type endoscope apparatus 100 suitable for observing the duodenal papilla PV is used.
The side-view type endoscope apparatus 100 includes, for example, a cylindrical member 101, a grip portion 102, a forceps plug 103, a treatment instrument channel 104, a raising base 105, and an imaging unit 106. The cylindrical member 101 is a part inserted into the body. The grip portion 102 is disposed at the proximal end of the cylindrical member 101. The forceps plug 103 is disposed on a part of the grip portion 102. The treatment instrument channel 104 communicates with the forceps plug 103 and is disposed inside the cylindrical member 101. The elevator 105 is used to change the direction of the treatment instrument or the like protruding from the treatment instrument channel 104 at the distal end 104a of the treatment instrument channel 104 in a direction orthogonal to the central axis L8 of the cylindrical member 101. It is provided so as to be movable in the opening from which the tool is projected. The imaging field is directed to the imaging unit 106 in a direction orthogonal to the central axis L8 of the cylindrical member 101. The imaging unit 106 is provided adjacent to an opening from which the treatment tool projects.
The side-view type endoscope apparatus 100 in this embodiment includes a bending mechanism 107 (see FIG. 1). The bending mechanism 107 includes a bending operation unit 107a and a bending deformation unit 107b for bending the distal portion of the cylindrical member 101.
　本実施形態に係る内視鏡用処置具１は、内視鏡装置１００の操作者と内視鏡用処置具１の操作者とがそれぞれ別である態様と、内視鏡装置１００の把持部１０２に対してフック４６を連結して、一人の操作者が内視鏡装置１００の操作者が内視鏡用処置具１を操作する態様と、の両方の態様で好適に使用可能である。 The endoscope treatment tool 1 according to the present embodiment includes a mode in which an operator of the endoscope apparatus 100 and an operator of the endoscope treatment tool 1 are different from each other, and a grip portion of the endoscope apparatus 100 The hook 46 is connected to 102 so that one operator can use the endoscope apparatus 100 by operating the endoscope treatment tool 1 in an appropriate manner.
　まず、図１に示す内視鏡装置１００の把持部１０２に対してフック４６を連結して内視鏡用処置具１を利用する場合について説明する。
　まず、内視鏡用処置具１が内視鏡装置１００に取り付けられていない状態で、操作者は、図２３に示すように公知の手技により内視鏡装置１００を処置対象部位である十二指腸乳頭ＰＶまで案内し、内視鏡装置１００を用いて処置対象部位を観察する。このとき、処置具取付補助具９０は鉗子栓１０３に取り付けられていてもよいし、取り付けられていなくてもよい。 First, a case where the endoscope treatment tool 1 is used by connecting the hook 46 to the grip portion 102 of the endoscope apparatus 100 shown in FIG. 1 will be described.
First, in a state where the endoscope treatment tool 1 is not attached to the endoscope apparatus 100, the operator operates the duodenal papilla, which is a treatment target part, by a known technique as shown in FIG. Guide to the PV and observe the treatment target site using the endoscope apparatus 100. At this time, the treatment tool attachment assisting tool 90 may be attached to the forceps plug 103 or may not be attached.
　図２４は、内視鏡用処置具１が内視鏡装置１００に取り付けられた状態を内視鏡装置１００の操作者の視点から見た図である。
　処置対象部位の観察後、図２４に示すように、処置具取付補助具９０が鉗子栓１０３に固定された状態で、フック４６が内視鏡装置１００の把持部１０２に取り付けられる。さらに、内視鏡装置１００の処置具チャンネル１０４（図１参照）に処置具取付補助具９０を介して本実施形態に係る内視鏡用処置具１のシース３が挿入される。内視鏡用処置具１の操作部４０は内視鏡装置１００に対してフック４６により連結されている。そのため、内視鏡用処置具１の操作者は、内視鏡装置１００をたとえば左手、シース３をたとえば右手に持って、内視鏡装置１００の鉗子栓１０３に対してシース３を出し入れする操作ができる。 FIG. 24 is a diagram of a state in which the endoscope treatment tool 1 is attached to the endoscope apparatus 100 as viewed from the viewpoint of the operator of the endoscope apparatus 100.
After observing the treatment site, as shown in FIG. 24, the hook 46 is attached to the grip portion 102 of the endoscope apparatus 100 with the treatment tool attachment assisting tool 90 fixed to the forceps plug 103. Further, the sheath 3 of the endoscope treatment tool 1 according to the present embodiment is inserted into the treatment tool channel 104 (see FIG. 1) of the endoscope apparatus 100 via the treatment tool attachment assisting tool 90. The operation unit 40 of the endoscope treatment tool 1 is connected to the endoscope apparatus 100 by a hook 46. Therefore, the operator of the endoscope treatment tool 1 holds the endoscope apparatus 100 in, for example, the left hand and the sheath 3 in, for example, the right hand, and moves the sheath 3 in and out of the forceps plug 103 of the endoscope apparatus 100. Can do.
　図２５は、内視鏡用処置具１の使用時の一過程を示す図である。図２６は、内視鏡装置１００を用いて撮像された内視鏡画像に映った本実施形態に係る内視鏡用処置具１を示す模式図である。
　図２５に示すように、操作者によるシース３の操作により、シース３の遠位端３ａは、処置具チャンネル１０４の遠位端１０４ａ（開口部）から突出し、図２６に示すように、内視鏡装置１００の撮像部１０６により撮像される。
　側視型の内視鏡装置１００を利用した十二指腸乳頭ＰＶに対するＥＳＴの手技においては、内視鏡装置１００が撮像した画像を、画像の上部中央を１２時とする時計の文字盤と見立てた場合、内視鏡装置１００が撮像した画像における１１時と１２時との間に十二指腸乳頭ＰＶの切開対象部位が写るように撮像部の向きを合わせる。この状態で、十二指腸乳頭ＰＶの開口部から十二指腸乳頭ＰＶを拡張するように切開することで、十二指腸乳頭ＰＶにおいて結石等を通過させるための通路を形成する。 FIG. 25 is a diagram illustrating a process during use of the endoscope treatment tool 1. FIG. 26 is a schematic diagram showing the endoscopic treatment tool 1 according to the present embodiment reflected in an endoscopic image captured using the endoscopic device 100.
As shown in FIG. 25, when the operator operates the sheath 3, the distal end 3a of the sheath 3 protrudes from the distal end 104a (opening) of the treatment instrument channel 104, and as shown in FIG. The image is captured by the imaging unit 106 of the mirror device 100.
In the EST procedure for the duodenal papilla PV using the side-view type endoscope apparatus 100, when the image captured by the endoscope apparatus 100 is regarded as a clock face at 12 o'clock in the upper center of the image The orientation of the imaging unit is adjusted so that the incision target part of the duodenal papilla PV appears between 11:00 and 12:00 in the image captured by the endoscope apparatus 100. In this state, an incision is made to expand the duodenal papilla PV from the opening of the duodenal papilla PV, thereby forming a passage for passing stones and the like in the duodenal papilla PV.
　まず、操作者は、十二指腸乳頭ＰＶ内に造影剤を導入することにより、胆管及び膵管の走行及び結石の有無を調べる。すなわち、ＥＲＣＰの手技のために、シース３の遠位端３ａにおけるプリカーブ部４を内視鏡装置１００の処置具チャンネル１０４の遠位端１０４ａから突出させる。プリカーブ部４にはあらかじめ湾曲形状がつけられているので、処置具チャンネル１０４内において、湾曲機構１０７あるいは起上台１０５における湾曲形状にプリカーブ部４が倣うまで、シース３の中心軸Ｌ１を回転中心としてプリカーブ部４が回転する。 First, the operator introduces a contrast medium into the duodenal papilla PV to examine the running of the bile and pancreatic ducts and the presence of stones. That is, for the ERCP procedure, the pre-curved portion 4 at the distal end 3 a of the sheath 3 is protruded from the distal end 104 a of the treatment instrument channel 104 of the endoscope apparatus 100. Since the pre-curved portion 4 is previously curved, the central axis L1 of the sheath 3 is used as the rotation center until the pre-curved portion 4 follows the curved shape of the bending mechanism 107 or the raising base 105 in the treatment instrument channel 104. The pre-curve part 4 rotates.
　プリカーブ部４の遠位部分が起上台１０５を通過する過程で、プリカーブ部４の湾曲方向と起上台１０５の湾曲方向とが一致するまでプリカーブ部４がシース３の中心軸Ｌ１を回転中心として回転する。続いて、プリカーブ部４の遠位端部（ドローイング部５）が内視鏡装置１００の撮像部１０６の撮像視野に進入する。操作者は、操作部４０においてシース３の近位端３ｂをシース３の中心軸Ｌ１方向に進退させてプリカーブ部４の遠位端部（ドローイング部５）の位置を調整する。具体的には、操作者は、シース３の近位端３ｂの進退操作により、シース３の遠位端３ａを十二指腸乳頭ＰＶに挿入するために好適な所定の位置にシース３の遠位端３ａが位置するように、プリカーブ部４の遠位端部の位置を調整する。なお、シース３の近位端３ｂをシース３の中心軸Ｌ１を回転中心として積極的に回転させなくても、プリカーブ部４が内視鏡装置１００の湾曲機構１０７や起上台１０５の湾曲状態に応じて受動的に回転することにより、シース３の遠位端３ａは内視鏡画像における１２時方向に湾曲した位置となる。 In the process in which the distal portion of the pre-curve portion 4 passes through the elevator 105, the pre-curve portion 4 rotates about the central axis L1 of the sheath 3 until the bending direction of the pre-curve portion 4 coincides with the bending direction of the elevator 105 To do. Subsequently, the distal end portion (drawing portion 5) of the pre-curve portion 4 enters the imaging field of the imaging portion 106 of the endoscope apparatus 100. The operator adjusts the position of the distal end portion (drawing portion 5) of the pre-curve portion 4 by moving the proximal end 3b of the sheath 3 forward and backward in the central axis L1 direction of the sheath 3 in the operation portion 40. Specifically, the operator moves the proximal end 3b of the sheath 3 forward and backward, and moves the distal end 3a of the sheath 3 to a predetermined position suitable for inserting the distal end 3a of the sheath 3 into the duodenal papilla PV. The position of the distal end portion of the pre-curve portion 4 is adjusted so that is positioned. Even if the proximal end 3b of the sheath 3 is not actively rotated about the central axis L1 of the sheath 3 as a rotation center, the pre-curved portion 4 is brought into the curved state of the bending mechanism 107 and the raising base 105 of the endoscope apparatus 100. Accordingly, the distal end 3a of the sheath 3 is curved in the 12 o'clock direction in the endoscopic image.
　図２５に示すように、プリカーブ部４の遠位端部が撮像部１０６の撮像視野内に入っている状態では、プリカーブ部４の近位端部の外周面は、起上台１０５によって押圧される。プリカーブ部４の外周面のうち起上台１０５によって押圧される被押圧面４Ｘ（図３Ｂ参照）の位置は、プリカーブ部４の外周面のうち遠位第一連通孔２３及び遠位第二連通孔２４が形成された位置とは異なる位置である。 As shown in FIG. 25, in the state where the distal end portion of the pre-curve portion 4 is in the imaging field of the imaging portion 106, the outer peripheral surface of the proximal end portion of the pre-curve portion 4 is pressed by the elevator 105. . The position of the pressed surface 4X (see FIG. 3B) pressed by the raising base 105 in the outer peripheral surface of the pre-curve portion 4 is the distal first series through hole 23 and the distal second communication in the outer peripheral surface of the pre-curve portion 4. The position is different from the position where the hole 24 is formed.
　十二指腸乳頭ＰＶにシース３の遠位端３ａを挿入するための位置決めが難しい場合には、操作者は、操作部４０の第一ポート４９からガイドワイヤ８０を第一ルーメン７内に挿通し、第一ルーメン７の遠位端７ａからガイドワイヤ８０の遠位端８０ａを突出させてもよい。この場合、操作者は、まず、ガイドワイヤ８０の遠位端８０ａを十二指腸乳頭ＰＶにまず挿入してから、続いて、操作者は、シース３の遠位端３ａをガイドワイヤ８０に沿って十二指腸乳頭ＰＶに挿入できる。 When positioning for inserting the distal end 3a of the sheath 3 into the duodenal papilla PV is difficult, the operator inserts the guide wire 80 from the first port 49 of the operation unit 40 into the first lumen 7, The distal end 80 a of the guide wire 80 may protrude from the distal end 7 a of the one lumen 7. In this case, the operator first inserts the distal end 80a of the guide wire 80 into the duodenal papilla PV, and then the operator inserts the distal end 3a of the sheath 3 along the guide wire 80 into the duodenum. Can be inserted into the nipple PV.
　図２６に示すように、シース３の遠位部分が撮像部１０６による内視鏡画像に表示され、内視鏡画像におけるプリカーブ部４の湾曲方向が１２時に設定されているときに、ナイフワイヤ３０のナイフ湾曲部３５は、１２時方向よりも１１時方向寄りの方向へ向かって遠位第一連通孔２３及び遠位第二連通孔２４から突出している。操作者は、ナイフ湾曲部３５が内視鏡画像上の１１時と１２時との間の方向に向かっていることを確認しながらシース３を鉗子栓１０３から処置具チャンネル１０４へと挿入する。これにより、シース３の遠位部分は内視鏡装置１００の起上台１０５から押し出され、シース３の遠位端３ａは十二指腸乳頭ＰＶの開口に達して十二指腸乳頭ＰＶ内に挿入される。 As shown in FIG. 26, when the distal portion of the sheath 3 is displayed in an endoscopic image by the imaging unit 106 and the bending direction of the pre-curve portion 4 in the endoscopic image is set to 12:00, the knife wire 30 The knife bending portion 35 protrudes from the distal first through hole 23 and the distal second communication hole 24 in a direction closer to the 11 o'clock direction than the 12 o'clock direction. The operator inserts the sheath 3 from the forceps plug 103 into the treatment instrument channel 104 while confirming that the knife bending portion 35 is directed in the direction between 11:00 and 12:00 on the endoscopic image. As a result, the distal portion of the sheath 3 is pushed out of the elevator 105 of the endoscope apparatus 100, and the distal end 3a of the sheath 3 reaches the opening of the duodenal papilla PV and is inserted into the duodenal papilla PV.
　シース３が十二指腸乳頭ＰＶ内に導入されたら、操作者は、第二ポート６２から造影剤を吐出させ、シース３の第二ルーメン１５の遠位吐出口１７から造影剤を十二指腸乳頭ＰＶを通じて胆管及び膵管へと導入する。造影剤の導入により、操作者は、胆管及び膵管の走行や、結石の有無及びその位置並びに大きさ等が容易に把握できる。 When the sheath 3 is introduced into the duodenal papilla PV, the operator discharges the contrast medium from the second port 62, and the contrast medium is discharged from the distal discharge port 17 of the second lumen 15 of the sheath 3 through the duodenal papilla PV. Introduce into the pancreatic duct. By introducing the contrast medium, the operator can easily grasp the travel of the bile duct and pancreatic duct, the presence or absence of stones, the position and size thereof, and the like.
　造影剤の導入後、結石の除去が必要である場合には、ＥＳＴが行われる。
　図２７は、内視鏡用処置具１を用いた処置の一過程における内視鏡画像を示す模式図である。
　図２７に示すように、シース３が十二指腸乳頭ＰＶ内に導入されたあと、プリカーブ部４の遠位端部（ドローイング部５）が所定長さだけ十二指腸乳頭ＰＶ内に配された状態で、操作部４０におけるスライダ部７１を軸部６８の近位端６８ｂ方向へ軸部６８の棒状部６９の中心軸方向、すなわち、ハンドル固定部６４の中心軸Ｌ５方向（図２参照）へ移動させる。これにより、ナイフワイヤ３０の力量伝達部３３は、ナイフワイヤ３０の近位端３０ｂ方向へと移動し、ナイフワイヤ３０の遠位端３０ａはシース３の遠位第一連通孔２３の部分を近位方向へと移動させる力が生じる。これにより、シース３の遠位端３ａ近傍の部分は、遠位第一連通孔２３と遠位第二連通孔２４との間で湾曲変形される。また、ナイフワイヤ３０の切開部３４は、シース３に対して弓状に張られる。 If it is necessary to remove the calculus after the introduction of the contrast agent, EST is performed.
FIG. 27 is a schematic diagram showing an endoscopic image in a process of treatment using the endoscope treatment tool 1.
As shown in FIG. 27, after the sheath 3 is introduced into the duodenal papilla PV, the operation is performed with the distal end portion (drawing portion 5) of the pre-curve portion 4 being disposed in the duodenal papilla PV by a predetermined length. The slider portion 71 in the portion 40 is moved in the direction of the central axis of the rod-like portion 69 of the shaft portion 68 toward the proximal end 68b of the shaft portion 68, that is, in the direction of the central axis L5 of the handle fixing portion 64 (see FIG. 2). As a result, the force transmission portion 33 of the knife wire 30 moves toward the proximal end 30b of the knife wire 30, and the distal end 30a of the knife wire 30 passes through the distal first series hole 23 of the sheath 3. A force is generated that moves in the proximal direction. As a result, the portion of the sheath 3 near the distal end 3 a is bent and deformed between the distal first series hole 23 and the distal second communication hole 24. Further, the incision 34 of the knife wire 30 is stretched in an arc shape with respect to the sheath 3.
　ナイフ湾曲部３５（図１１参照）は、上記の仮想座標系における第二象限Ｑ２に配置されている。そのため、内視鏡画像として撮像部１０６に撮像されるプリカーブ部４の湾曲方向を１２時方向と設定したときに、ナイフ湾曲部３５は１２時方向よりも１１時方向寄りにずれた位置において十二指腸乳頭ＰＶの開口部の内面に接する。 The knife bending portion 35 (see FIG. 11) is arranged in the second quadrant Q2 in the virtual coordinate system. Therefore, when the bending direction of the pre-curve unit 4 captured by the imaging unit 106 as an endoscopic image is set to 12 o'clock, the knife bending unit 35 is located at a position deviated closer to 11 o'clock than 12 o'clock. It contacts the inner surface of the opening of the nipple PV.
　ナイフ湾曲部３５がシース３に対して弓状に張られる過程で、操作者は、操作部４０のコネクタ７３を通じて高周波電源装置から高周波電流をナイフワイヤ３０に供給する。これにより、ナイフ湾曲部３５が接触している組織が高周波電流により切開される。ナイフ湾曲部３５は、ナイフ湾曲部３５に外力がかかっていない自然状態において湾曲している。ナイフ湾曲部３５は、ナイフワイヤ３０の力量伝達部３３がスライダ部７１によって軸部６８の近位端６８ｂ方向へ移動されることによって、自然状態における湾曲形状から直線形状へと漸次変形される。具体的には、ナイフ湾曲部３５は、自然状態における湾曲形状から、遠位第一連通孔２３と遠位第二連通孔２４とを結ぶ直線方向に沿った直線形状へと、漸次変形される。プリカーブ部４の曲率半径を大きく設定すると、ナイフワイヤ３０は直線形状から湾曲形状へと漸次変形される。このようにナイフ湾曲部３５の湾曲状態は、スライダ部７１を用いたナイフワイヤ３０の移動により変化する。
　十二指腸乳頭ＰＶにおける主要な血管を避けた位置が内視鏡画像上の１１時方向よりに映るように設定し、この１１時方向の位置でナイフ湾曲部３５により十二指腸乳頭ＰＶが切開されるので、十二指腸乳頭ＰＶの切開による出血量が少ない状態で切開ができる。 In the process in which the knife bending portion 35 is stretched in an arc shape with respect to the sheath 3, the operator supplies a high frequency current from the high frequency power supply device to the knife wire 30 through the connector 73 of the operation portion 40. Thereby, the tissue in contact with the knife bending portion 35 is incised by the high-frequency current. The knife bending portion 35 is bent in a natural state where no external force is applied to the knife bending portion 35. The knife bending portion 35 is gradually deformed from a curved shape in a natural state to a linear shape as the force transmission portion 33 of the knife wire 30 is moved by the slider portion 71 toward the proximal end 68b of the shaft portion 68. Specifically, the knife bending portion 35 is gradually deformed from a curved shape in a natural state to a linear shape along a linear direction connecting the distal first series through hole 23 and the distal second communication hole 24. The When the curvature radius of the pre-curve portion 4 is set large, the knife wire 30 is gradually deformed from a linear shape to a curved shape. As described above, the bending state of the knife bending portion 35 is changed by the movement of the knife wire 30 using the slider portion 71.
Since the position avoiding the main blood vessel in the duodenal papilla PV is set to be reflected from the 11 o'clock direction on the endoscopic image, the duodenal papilla PV is incised by the knife bending portion 35 at this 11 o'clock direction position. An incision can be made with a small amount of bleeding due to the incision of the duodenal papilla PV.
　十二指腸乳頭ＰＶの切開が終了した後、操作者は、必要に応じて、造影剤が入ったシリンジを第二ポート６２に接続し、第二ポート６２から第二ルーメン１５を通じて造影剤を十二指腸乳頭ＰＶ内へ吐出する。十二指腸乳頭ＰＶ内に吐出された造影剤により、除去対象となる結石までの経路がＸ線画像上で把握できる。 After the incision of the duodenal papilla PV is completed, the operator connects a syringe containing a contrast medium to the second port 62 as necessary, and the contrast medium is transferred from the second port 62 through the second lumen 15 to the duodenal papilla PV. Discharge inside. The route to the calculus to be removed can be grasped on the X-ray image by the contrast medium discharged into the duodenal papilla PV.
　図２８は、内視鏡用処置具１にガイドワイヤ８０を取り付ける一例を示す図であり、図６のVIII-VIII線から見た部分断面図である。図２９は、内視鏡用処置具１にガイドワイヤ８０を取り付ける他例を示す図であり、図６のVIII-VIII線から見た部分断面図である。
　操作者は、胆管や膵管の走行がＸ線画像により把握できた後、胆管や膵管に挿入されるガイドワイヤ８０を、十二指腸乳頭ＰＶから導入する。本実施形態では、胆管の走行に沿って胆管内へとガイドワイヤ８０を導入する場合を例示する。 28 is a view showing an example of attaching the guide wire 80 to the endoscope treatment tool 1, and is a partial cross-sectional view taken along the line VIII-VIII in FIG. FIG. 29 is a view showing another example in which the guide wire 80 is attached to the endoscope treatment tool 1, and is a partial cross-sectional view taken along the line VIII-VIII in FIG.
The operator introduces a guide wire 80 to be inserted into the bile duct or pancreatic duct from the duodenal papilla PV after the traveling of the bile duct or pancreatic duct can be grasped by the X-ray image. In this embodiment, the case where the guide wire 80 is introduced into the bile duct along the travel of the bile duct is illustrated.
　操作者が胆管と膵管との分岐部分において胆管選択的にガイドワイヤ８０を挿入したり、胆管内での分岐において所望の方向にガイドワイヤ８０を案内したりすることが好適に行えるように、胆管内に挿入されるガイドワイヤ８０として、遠位端において湾曲構造を有するアングルタイプのガイドワイヤ８０が使用される。 The bile duct can be suitably operated so that the operator can selectively insert the guide wire 80 at the bifurcation of the bile duct and pancreatic duct or guide the guide wire 80 in a desired direction at the branch in the bile duct. An angle type guide wire 80 having a curved structure at the distal end is used as the guide wire 80 inserted therein.
　アングルタイプのガイドワイヤ８０は、胆管の内壁に対して柔軟に倣いつつ所定の湾曲方向への復元力を有するように、柔軟性が高く且つ湾曲形状をなした遠位端部分を有する。このようなアングルタイプのガイドワイヤ８０を内視鏡用処置具１に取り付けるときには、操作者は、ガイドワイヤ８０の遠位部分であって湾曲形状を有する部分の近位部分に隣接した領域を把持する。次に、図２８に示すように、操作者は、ガイドワイヤ８０の遠位端８０ａ近傍における湾曲形状部８０１を、第一ポート４９から第一ルーメン７内に入れる。このとき、操作者は、ガイドワイヤ８０の遠位端８０ａが第一ポート４９における遠位端４９ａ側を向くようにガイドワイヤ８０を傾斜させた状態で、ガイドワイヤ８０を第一ポート４９に挿入する。 The angle type guide wire 80 has a distal end portion that is highly flexible and has a curved shape so as to flexibly follow the inner wall of the bile duct and have a restoring force in a predetermined bending direction. When attaching such an angle type guide wire 80 to the endoscope treatment tool 1, the operator grasps a region adjacent to the proximal portion of the distal portion of the guide wire 80 and having a curved shape. To do. Next, as shown in FIG. 28, the operator puts the curved shape portion 801 in the vicinity of the distal end 80 a of the guide wire 80 into the first lumen 7 from the first port 49. At this time, the operator inserts the guide wire 80 into the first port 49 while the guide wire 80 is inclined so that the distal end 80 a of the guide wire 80 faces the distal end 49 a side of the first port 49. To do.
　アングルタイプのガイドワイヤ８０の遠位端８０ａの近傍領域の湾曲形状に対応して、ガイドワイヤ８０の遠位端８０ａの第一ポート４９への入れ方は適宜選択可能である。 Corresponding to the curved shape in the vicinity of the distal end 80a of the angle type guide wire 80, the way of inserting the distal end 80a of the guide wire 80 into the first port 49 can be appropriately selected.
　たとえば、図１６に示すガイドワイヤ８０のように、ガイドワイヤ８０の遠位端８０ａの近傍領域の湾曲形状部８０１が鈍角をなして屈曲されている場合、図２８に示すように、操作者は、ガイドワイヤ８０の遠位端８０ａから屈曲部分までが第一ルーメン７の中心軸Ｌ７と平行になるようにガイドワイヤ８０を第一ポート４９内に挿入する。この結果、スムーズにガイドワイヤ８０が第一ルーメン７内に導入される。 For example, when the curved shape portion 801 in the region near the distal end 80a of the guide wire 80 is bent at an obtuse angle as in the guide wire 80 shown in FIG. The guide wire 80 is inserted into the first port 49 so that the distance from the distal end 80a of the guide wire 80 to the bent portion is parallel to the central axis L7 of the first lumen 7. As a result, the guide wire 80 is smoothly introduced into the first lumen 7.
　図１７Ａに示すガイドワイヤ８２のように、ガイドワイヤ８２の遠位端８０ａの近傍領域の湾曲形状部８１２が半円弧状をなして湾曲されている場合、操作者は、ガイドワイヤ８２の湾曲形状部８１２を第一ポート４９の遠位端４９ａに引掛けるように、遠位端８０ａを第一ポート４９内に挿入する（図２９参照）。その後、操作者は、ガイドワイヤ８０を第一ポート４９の近位端４９ｂ方向に倒してガイドワイヤ８０を直線状に変形させて第一ルーメン７内に挿入する。その結果、スムーズにガイドワイヤ８０が第一ルーメン７内に導入される。 When the curved shape portion 812 in the vicinity of the distal end 80a of the guide wire 82 is curved in a semicircular arc shape like the guide wire 82 shown in FIG. 17A, the operator can The distal end 80a is inserted into the first port 49 so that the portion 812 is hooked on the distal end 49a of the first port 49 (see FIG. 29). Thereafter, the operator tilts the guide wire 80 toward the proximal end 49 b of the first port 49, deforms the guide wire 80 into a linear shape, and inserts the guide wire 80 into the first lumen 7. As a result, the guide wire 80 is smoothly introduced into the first lumen 7.
　ガイドワイヤ８０、８１の遠位端８０ａの第一ポート４９への入れ方が上記のいずれの場合であっても、第一ルーメン７の内面７ｃは、第一ポート４９を通じて操作者に見えている状態である。この結果、操作者は、ガイドワイヤ８０の遠位端８０ａを容易に第一ルーメン７内に入れることができる。 Regardless of how the guide wires 80 and 81 are inserted into the first port 49 at the distal end 80 a, the inner surface 7 c of the first lumen 7 is visible to the operator through the first port 49. State. As a result, the operator can easily put the distal end 80 a of the guide wire 80 into the first lumen 7.
　フック４６により操作部４０が内視鏡装置１００の把持部１０２に連結されている状態では、第一ポート４９の開口は、内視鏡装置１００の近位側へ向けられている。このため、操作者は、第一ポート４９を介してシース３の第一ルーメン７が見える状態で、第一ルーメン７へ向けてガイドワイヤ８０の遠位端８０ａを挿入することができる。 In the state where the operation unit 40 is connected to the grip unit 102 of the endoscope apparatus 100 by the hook 46, the opening of the first port 49 is directed to the proximal side of the endoscope apparatus 100. Therefore, the operator can insert the distal end 80 a of the guide wire 80 toward the first lumen 7 in a state where the first lumen 7 of the sheath 3 can be seen through the first port 49.
　さらに、第一ポート４９は、シース３への連結部４８の遠位端４８ａとシース３への連結部４８の近位端４８ｂとを結ぶ直線方向に延びる長軸Ｌ２方向に長い長穴状の形状の開口を有する。このため、第一ポート４９に挿入されたガイドワイヤ８０は第一ルーメン７の中心軸Ｌ７に略沿った方向（第一ルーメン７の中心軸Ｌ７に対して僅かに傾斜した方向）に進退操作可能である。このため、操作者の右手でガイドワイヤ８０を進退操作しやすく、また、ガイドワイヤ８０の座屈の発生を防ぐことができる。
　すなわち、操作者が内視鏡装置１００を左手に持ちシース３を右手で進退させた状態から、右手はシース３からガイドワイヤ８０に持ち替えてガイドワイヤ８０を右手で第一ポート４９に挿入したり進退させたりすることが、本実施形態に係る内視鏡用処置具１によれば容易である。 Further, the first port 49 has a long hole shape that is long in the direction of the long axis L2 extending in the linear direction connecting the distal end 48a of the connecting portion 48 to the sheath 3 and the proximal end 48b of the connecting portion 48 to the sheath 3. It has a shaped opening. For this reason, the guide wire 80 inserted into the first port 49 can be advanced and retracted in a direction substantially along the central axis L7 of the first lumen 7 (a direction slightly inclined with respect to the central axis L7 of the first lumen 7). It is. For this reason, the guide wire 80 can be easily advanced and retracted with the right hand of the operator, and the occurrence of buckling of the guide wire 80 can be prevented.
That is, from the state in which the operator holds the endoscope apparatus 100 with the left hand and the sheath 3 is advanced and retracted with the right hand, the right hand changes the sheath 3 from the guide wire 80 and inserts the guide wire 80 into the first port 49 with the right hand. It is easy to advance and retreat according to the endoscope treatment tool 1 according to the present embodiment.
　操作者が、十二指腸乳頭ＰＶへシース３の遠位端３ａを挿入するのに先立ってガイドワイヤ８０を第一ルーメン７に挿入している場合には、すでに挿入されているガイドワイヤ８０を利用してもよいし、上記のアングルタイプのガイドワイヤ８０に交換してもよい。 When the operator has inserted the guide wire 80 into the first lumen 7 prior to inserting the distal end 3a of the sheath 3 into the duodenal papilla PV, the already inserted guide wire 80 is used. Alternatively, the angle-type guide wire 80 may be replaced.
　操作者は、シース３の遠位端３ａからガイドワイヤ８０を突出させ、胆管内の所望の位置までガイドワイヤ８０を案内する。このとき、操作者は、必要に応じて、ガイドワイヤ８０をその中心線回りに回転させ、ガイドワイヤ８０の遠位端８０ａが胆管の分岐部分において所望の分枝に挿入されるようにガイドワイヤ８０を移動させてもよい。 The operator projects the guide wire 80 from the distal end 3a of the sheath 3 and guides the guide wire 80 to a desired position in the bile duct. At this time, if necessary, the operator rotates the guide wire 80 around its center line, so that the distal end 80a of the guide wire 80 is inserted into a desired branch at the bifurcation of the bile duct. 80 may be moved.
　図３０は、内視鏡用処置具１の使用時の一過程を示す図である。図３０に示すように、ガイドワイヤ８０は、たとえば、胆管内から除去すべき結石を超えてある程度奥へ進んだ位置にガイドワイヤ８０の遠位端８０ａが位置するまで挿入される。 FIG. 30 is a diagram illustrating a process during the use of the endoscope treatment tool 1. As shown in FIG. 30, the guide wire 80 is inserted, for example, until the distal end 80a of the guide wire 80 is located at a position that has advanced to some depth beyond the calculus to be removed from the bile duct.
　図３１は、内視鏡用処置具１に取り付けられたガイドワイヤ８０を残して内視鏡用処置具１を内視鏡装置１００から抜去する一過程を示す図である。図３２は、内視鏡用処置具１のシース３とガイドワイヤ８０とを分離する一過程を示す図である。図３３は、内視鏡用処置具１の抜去後に行われる処置の一例を示す図である。
　ガイドワイヤ８０が所定の位置に達した後、体内にガイドワイヤ８０が残された状態で内視鏡用処置具１が抜去される。これは、結石を除去するための公知の内視鏡用結石除去具（バスケット鉗子やバルーン等）を本実施形態に係る内視鏡用処置具１に代えて胆管内に導入するために行われる。 FIG. 31 is a diagram illustrating a process of removing the endoscope treatment tool 1 from the endoscope apparatus 100 while leaving the guide wire 80 attached to the endoscope treatment tool 1. FIG. 32 is a diagram illustrating a process of separating the sheath 3 and the guide wire 80 of the endoscope treatment tool 1. FIG. 33 is a diagram illustrating an example of a treatment performed after the endoscope treatment tool 1 is removed.
After the guide wire 80 reaches a predetermined position, the endoscope treatment tool 1 is removed with the guide wire 80 left in the body. This is performed in order to introduce a known endoscopic stone removing tool (basket forceps, balloon or the like) for removing a stone into the bile duct instead of the endoscope treatment tool 1 according to the present embodiment. .
　図３１に示すように、操作者が内視鏡用処置具１を抜去する際には、まず、操作部４０の遠位構成部４１に配された第一ポート４９から、切欠き部５５を通じてガイドワイヤ８０を取り外す。このとき、操作者は、ガイドワイヤ８０の遠位端８０ａの位置は変化させず、第一ポート４９の切欠き部５５の近位端５５ｂから切欠き部５５の内部を通じて切欠き部５５の遠位端５５ａへ、ガイドワイヤ８０を第一ポート４９に対して移動させる。第一ポート４９の切欠き部５５をガイドワイヤ８０が通過する過程で、ガイドワイヤ８０は、ガイドワイヤ収容部９から、スリット部１０を通じてシース３の外部に徐々に取り出される。 As shown in FIG. 31, when the operator removes the endoscope treatment tool 1, first, from the first port 49 arranged in the distal component part 41 of the operation part 40, the notch part 55 is passed through. The guide wire 80 is removed. At this time, the operator does not change the position of the distal end 80 a of the guide wire 80, and moves away from the notch 55 from the proximal end 55 b of the notch 55 of the first port 49 through the inside of the notch 55. The guide wire 80 is moved relative to the first port 49 to the distal end 55a. In the process in which the guide wire 80 passes through the notch 55 of the first port 49, the guide wire 80 is gradually taken out of the sheath 3 from the guide wire housing portion 9 through the slit portion 10.
　続いて、図３２に示すように、操作者は、ガイドワイヤ８０の位置が動かないようにガイドワイヤ８０を支えつつ、シース３を処置具チャンネル１０４の近位端方向へと移動させる。操作者がシース３を処置具チャンネル１０４の近位端方向へと移動させる過程において、シース３がガイドワイヤ８０から漸次外される。 Subsequently, as shown in FIG. 32, the operator moves the sheath 3 toward the proximal end of the treatment instrument channel 104 while supporting the guide wire 80 so that the position of the guide wire 80 does not move. In the process in which the operator moves the sheath 3 toward the proximal end of the treatment instrument channel 104, the sheath 3 is gradually removed from the guide wire 80.
　シース３における第一ルーメン７の出口部１２（図１０参照）が鉗子栓１０３の位置まで達したら、操作者は、ガイドワイヤ８０がその近位端８０ｂ方向へ移動しようとする力に抗してガイドワイヤ８０を支えながら、ガイドワイヤ８０の近位端８０ｂ方向へとシース３を移動させる。操作者は、体内でのガイドワイヤ８０の位置を変化させずにシース３の出口部１２を鉗子栓１０３から引き出す。その後、操作者は、シース３の出口部１２が配されたシース３の遠位部分をガイドワイヤ８０の近位端８０ｂ方向へ移動させ、ガイドワイヤ８０からシース３を取り外す。 When the outlet 12 (see FIG. 10) of the first lumen 7 in the sheath 3 reaches the position of the forceps plug 103, the operator resists the force that the guide wire 80 tries to move toward the proximal end 80b. While supporting the guide wire 80, the sheath 3 is moved toward the proximal end 80 b of the guide wire 80. The operator pulls out the outlet 12 of the sheath 3 from the forceps plug 103 without changing the position of the guide wire 80 in the body. Thereafter, the operator moves the distal portion of the sheath 3 where the outlet portion 12 of the sheath 3 is disposed toward the proximal end 80 b of the guide wire 80 and removes the sheath 3 from the guide wire 80.
　ガイドワイヤ８０からシース３が取り外されたら、操作者は、上記の公知の内視鏡用結石除去具（たとえば図３３に示すバスケット鉗子１２０）をガイドワイヤ８０に取り付けて、この内視鏡用結石除去具を除去対象の結石まで内視鏡装置１００の処置具チャンネル１０４を通じて案内する。 When the sheath 3 is removed from the guide wire 80, the operator attaches the above-described known endoscope stone removing tool (for example, the basket forceps 120 shown in FIG. 33) to the guide wire 80, and this endoscope stone. The removal tool is guided through the treatment tool channel 104 of the endoscope apparatus 100 to the stone to be removed.
　次に、内視鏡装置１００を操作する操作者と、内視鏡用処置具１を操作する操作者とが互いに異なる例について説明する。
　この例では、内視鏡用処置具１を操作する操作者は、内視鏡用処置具１の操作部４０を片手に持ち、反対の手で、第一ポート４９へのガイドワイヤ８０の挿入及びガイドワイヤ８０の位置調整をすることができる。内視鏡装置１００の操作者と内視鏡用処置具１の操作者とは、互いの操作を協調させることで、内視鏡装置１００と内視鏡用処置具１とを一人の操作者が操作する上記の例と同様の処置を進めることができる。 Next, an example in which an operator who operates the endoscope apparatus 100 and an operator who operates the endoscope treatment tool 1 are different from each other will be described.
In this example, the operator who operates the endoscope treatment tool 1 holds the operation part 40 of the endoscope treatment tool 1 in one hand, and inserts the guide wire 80 into the first port 49 with the opposite hand. In addition, the position of the guide wire 80 can be adjusted. The operator of the endoscope apparatus 100 and the operator of the endoscope treatment tool 1 coordinate each other's operations so that the endoscope apparatus 100 and the endoscope treatment tool 1 can be operated by one operator. It is possible to proceed with the same treatment as in the above example operated by.
　以上に説明したように、本実施形態に係る内視鏡用処置具１は、フック４６を内視鏡装置１００の把持部１０２に取り付けたときに第一ポート４９の開口を通じて第一ルーメン７の内面７ｃが見えるような向きに第一ポート４９が配されるので、フック４６を内視鏡装置１００の把持部１０２に取り付けて一人で内視鏡装置１００及び内視鏡用処置具１を使用する場合にガイドワイヤ８０を容易に第一ポート４９に挿入することができる。 As described above, the endoscope treatment tool 1 according to the present embodiment has the first lumen 7 through the opening of the first port 49 when the hook 46 is attached to the grip portion 102 of the endoscope apparatus 100. Since the first port 49 is arranged in such a direction that the inner surface 7c can be seen, the hook 46 is attached to the grip portion 102 of the endoscope apparatus 100, and the endoscope apparatus 100 and the endoscope treatment tool 1 are used alone. In this case, the guide wire 80 can be easily inserted into the first port 49.
　本実施形態に係る内視鏡用処置具１では、上述の向きに第一ポート４９が配されるので、第一ポート４９から第一ルーメン７内にガイドワイヤ８０が挿入されたときにガイドワイヤ８０の進退及び回転操作が、内視鏡装置１００の把持部１０２を持ちながら一人の操作者により容易に行える。 In the endoscope treatment tool 1 according to the present embodiment, since the first port 49 is arranged in the above-described direction, the guide wire 80 is inserted when the guide wire 80 is inserted into the first lumen 7 from the first port 49. The forward / backward and rotational operations of 80 can be easily performed by one operator while holding the grip portion 102 of the endoscope apparatus 100.
　第一ポート４９が長円形状の開口形状をなし、第一ポート４９へのガイドワイヤ８０の挿入時に第一ルーメン７の入口部８が見えるように構成されている。このため、遠位端が湾曲したアングルタイプのガイドワイヤ８０であってもその遠位端を容易に第一ルーメン７内に導入できる。 The first port 49 has an elliptical opening shape, and the inlet 8 of the first lumen 7 can be seen when the guide wire 80 is inserted into the first port 49. For this reason, even if it is the angle type guide wire 80 in which the distal end was curved, the distal end can be easily introduced into the first lumen 7.
　第一ポート４９が長円形状の開口形状を有している。このため、第一ポート４９にガイドワイヤ８０が挿入された後、第一ルーメン７の中心軸Ｌ７に略沿った方向にガイドワイヤ８０を進退移動させることで、スムーズにガイドワイヤ８０を進退させることができる。 The first port 49 has an oval opening. For this reason, after the guide wire 80 is inserted into the first port 49, the guide wire 80 is moved forward and backward in a direction substantially along the central axis L 7 of the first lumen 7, so that the guide wire 80 is smoothly advanced and retracted. Can do.
　本実施形態に係る内視鏡用処置具１は、第一ポート４９にガイドワイヤ８０を挿入しているときに第一ポート４９から出た状態となるガイドワイヤ８０がハンドル部６７に干渉しないようにハンドル固定部６４と第一ポート４９との位置関係が設定されている。このため、ガイドワイヤ８０が内視鏡用処置具１に取り付けられた状態でハンドル部６７を容易に操作することができる。 In the endoscope treatment tool 1 according to the present embodiment, the guide wire 80 that comes out of the first port 49 when the guide wire 80 is inserted into the first port 49 does not interfere with the handle portion 67. The positional relationship between the handle fixing portion 64 and the first port 49 is set. For this reason, the handle part 67 can be easily operated in a state where the guide wire 80 is attached to the endoscope treatment tool 1.
　本実施形態に係る内視鏡用処置具１では、第一ポート４９の開口の中心軸Ｌ３に直交する面内にスライダ部７１の指掛け部７４が設けられている。このため、指掛け部７４がガイドワイヤ８０に干渉しにくく、指掛け部７４を用いたスライダ部７１の移動が容易にできる。つまり、ガイドワイヤ８０を第一ポート４９に対して挿抜する方向にスライダ部７１が配置されていないため、スライダ部７１の操作とガイドワイヤ８０の操作が干渉しない。 In the endoscope treatment tool 1 according to the present embodiment, the finger hook portion 74 of the slider portion 71 is provided in a plane orthogonal to the central axis L3 of the opening of the first port 49. For this reason, the finger hanger 74 does not easily interfere with the guide wire 80, and the slider 71 using the finger hanger 74 can be easily moved. That is, since the slider portion 71 is not arranged in the direction in which the guide wire 80 is inserted into and removed from the first port 49, the operation of the slider portion 71 and the operation of the guide wire 80 do not interfere.
　以上、本発明の各実施形態を説明したが、本発明の技術範囲は上記実施形態に限定されるものではなく、本発明の趣旨を逸脱しない範囲において各実施形態における構成要素の組み合わせを変えたり、各構成要素に種々の変更を加えたり、削除したりすることが可能である。本発明は前述した説明によって限定されることはない。 The embodiments of the present invention have been described above. However, the technical scope of the present invention is not limited to the above embodiments, and combinations of components in the embodiments may be changed without departing from the spirit of the present invention. Various changes can be added to or deleted from each component. The present invention is not limited by the above description.
上記各実施形態は、遠位端近傍において湾曲形状を有するガイドワイヤをルーメンへ容易に案内することができる内視鏡用処置具を提供できる。 Each of the above embodiments can provide a treatment instrument for an endoscope that can easily guide a guide wire having a curved shape near the distal end to a lumen.
　１　内視鏡用処置具
　２　挿入部
　３　シース
　７　第一ルーメン（ガイドワイヤルーメン）
　８　入口部
　１０　スリット部
　１２　出口部
　１５　第二ルーメン（送排液ルーメン）
　２０　第三ルーメン（ルーメン）
　４０　操作部
　４２　本体部
　４９　第一ポート
　５０　内側開口縁部
　５１　外側開口縁部
　５２　テーパー部
　５５　切欠き部
　６２　第二ポート
　８０　ガイドワイヤ
　９１　補助具本体
　１００　内視鏡装置
　１０４　処置具チャンネル DESCRIPTION OF SYMBOLS 1 Endoscopic treatment tool 2 Insertion part 3 Sheath 7 First lumen (guide wire lumen)
8 Inlet portion 10 Slit portion 12 Outlet portion 15 Second lumen (feed / drainage lumen)
20 Third lumen (lumen)
40 Operation part 42 Main body part 49 First port 50 Inner opening edge part 51 Outer opening edge part 52 Tapered part 55 Notch part 62 Second port 80 Guide wire 91 Auxiliary instrument main body 100 Endoscope apparatus 104 Treatment instrument channel

Claims (8)

  1. 　長手軸方向に延びてガイドワイヤを挿通可能な内径を有するルーメンが形成されたシースと、
    　前記シースの近位端に配されて前記シースの前記近位端部分が挿入可能な内径を有して略筒状に形成され、内周面から外周面に連通するように開口したポートを有する操作部と、
    　を備え、
    　前記シースは、
    前記シースの前記長手軸方向に沿って前記ルーメンと前記シースの外部とを連通するように前記シースの外周面に形成され、前記シースの周方向における開口幅が前記ルーメンの前記内径よりも小さくなるように形成されたスリットと、
    前記スリット部の前記開口幅よりも大きい幅を有して前記ルーメンと連通して前記シースの前記近位端部分の外周面に開口された入口部と、を有し、
    　　前記入口部の開口縁部及び前記ポートの内周面側の輪郭を形成する内側開口縁部を、前記ルーメンの中心軸および前記シースの中心軸に直交する直線に沿った方向から前記ポートの内周面に投影したときに前記入口部の前記開口縁部が前記内側開口縁部と略一致または前記内側開口縁部よりも外側に位置するように、前記シースが前記操作部に固定される
    　内視鏡用処置具。     A sheath formed with a lumen extending in the longitudinal direction and having an inner diameter through which a guide wire can be inserted;
    The proximal end of the sheath is arranged in a substantially cylindrical shape with an inner diameter into which the proximal end portion of the sheath can be inserted, and has a port opened so as to communicate from the inner peripheral surface to the outer peripheral surface. An operation unit;
    With
    The sheath is
    An outer circumferential surface of the sheath is formed to communicate the lumen and the outside of the sheath along the longitudinal axis direction of the sheath, and an opening width in the circumferential direction of the sheath is smaller than the inner diameter of the lumen. A slit formed as follows:
    An inlet portion having a width larger than the opening width of the slit portion and communicating with the lumen and opened at an outer peripheral surface of the proximal end portion of the sheath;
    An opening edge of the inlet and an inner opening edge that forms a contour on the inner peripheral surface side of the port are arranged in a direction along a straight line perpendicular to the central axis of the lumen and the central axis of the sheath. The sheath is fixed to the operation portion so that the opening edge of the inlet portion substantially coincides with the inner opening edge or is located outside the inner opening edge when projected onto a peripheral surface. Endoscopic treatment tool.
  2. 　前記ポートは、さらに、
    　　前記シースの径方向において前記内側開口縁部より外側に位置し前記内側開口縁部の開口面積よりも大きな開口面積を有する外側開口縁部
    　　を有し、
    　　前記内側開口縁部及び前記外側開口縁部を、前記ルーメンの中心軸および前記シースの中心軸に直交する直線に沿った方向から前記ポートの内周面に投影したときに、前記外側開口縁部の輪郭は前記内側開口縁部の外側に位置する
    　請求項１に記載の内視鏡用処置具。     The port is further
    An outer opening edge located outside the inner opening edge in the radial direction of the sheath and having an opening area larger than the opening area of the inner opening edge;
    When the inner opening edge and the outer opening edge are projected onto the inner peripheral surface of the port from a direction along a straight line perpendicular to the central axis of the lumen and the central axis of the sheath, the outer opening edge The endoscope treatment instrument according to claim 1, wherein the contour of the endoscope is located outside the inner opening edge.
  3. 　前記操作部は、前記ポートに連結されて前記ポートの長手軸に対する放射方向に延びた本体部を有する請求項２に記載の内視鏡用処置具。 The endoscopic treatment instrument according to claim 2, wherein the operation unit includes a main body unit coupled to the port and extending in a radial direction with respect to a longitudinal axis of the port.
  4. 　前記ガイドワイヤの遠位部の少なくとも一部は、湾曲形状に復元する復元力を有する湾曲形状部を有し、
      前記シースの長軸方向における前記ポートの開口の長さは、前記ガイドワイヤの前記遠位部のうち前記湾曲形状部の先端における接線方向成分の最大長さに対して同等または長く設定されている
    　請求項１に記載の内視鏡用処置具。     At least a part of the distal portion of the guide wire has a curved shape portion having a restoring force to restore the curved shape,
    The length of the opening of the port in the longitudinal direction of the sheath is set to be equal to or longer than the maximum length of the tangential direction component at the distal end of the curved portion of the distal portion of the guide wire. The endoscope treatment tool according to claim 1.
  5. 　前記ガイドワイヤは、
    　前記ガイドワイヤの中心軸が偏向する形状に復元する復元力を有する屈曲部と、
    　前記屈曲部よりも前記ガイドワイヤの遠位側に設けられた遠位部と、
    を有し、
      前記シースの長軸方向における前記ポートの開口の長さは、前記ガイドワイヤの前記遠位部の長さに対して同等または長く設定されている
    　請求項１に記載の内視鏡用処置具。     The guide wire is
    A bent portion having a restoring force to restore a shape in which the central axis of the guide wire is deflected;
    A distal portion provided on the distal side of the guide wire with respect to the bent portion;
    Have
    The treatment instrument for an endoscope according to claim 1, wherein a length of the opening of the port in the longitudinal direction of the sheath is set to be equal to or longer than a length of the distal portion of the guide wire.
  6. 　前記屈曲部は、前記屈曲部よりも前記ガイドワイヤの近位側に対して鈍角または鋭角を形成する方向に前記遠位部が延びるように屈曲している
    　請求項５に記載の内視鏡用処置具。     The endoscope according to claim 5, wherein the bent portion is bent so that the distal portion extends in a direction forming an obtuse angle or an acute angle with respect to a proximal side of the guide wire with respect to the bent portion. Treatment tool.
  7. 　前記ポートは、前記内側開口縁部と前記外側開口縁部とを繋ぐテーパー部を有する請求項２に記載の内視鏡用処置具。 3. The endoscope treatment tool according to claim 2, wherein the port has a tapered portion that connects the inner opening edge and the outer opening edge.
  8. 　前記ポートは、前記ルーメンの中心軸方向に沿った長さが前記ルーメンの内径よりも長い長穴状に開口されている
    　請求項１に記載の内視鏡用処置具。     The treatment tool for an endoscope according to claim 1, wherein the port is opened in a long hole shape having a length along a central axis direction of the lumen longer than an inner diameter of the lumen.
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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2017168762A1 (en) * 2016-03-31 2017-10-05 オリンパス株式会社 Treatment tool for endoscopes
JP2020022553A (en) * 2018-08-06 2020-02-13 周 中村 Inner retractor instrument for spine percutaneous endoscopic surgery

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH07155382A (en) * 1993-12-02 1995-06-20 Terumo Corp Guide wire inserter
JP2002514099A (en) * 1996-09-13 2002-05-14 ボストン サイエンティフィック コーポレイション Bile duct catheter replaceable by one operator
JP2004000523A (en) * 1991-05-24 2004-01-08 G David Jang Vasculogenesis catheter
WO2010129362A1 (en) * 2009-05-08 2010-11-11 Abbott Cardiovascular Systems Inc. Catheter push device

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2004000523A (en) * 1991-05-24 2004-01-08 G David Jang Vasculogenesis catheter
JPH07155382A (en) * 1993-12-02 1995-06-20 Terumo Corp Guide wire inserter
JP2002514099A (en) * 1996-09-13 2002-05-14 ボストン サイエンティフィック コーポレイション Bile duct catheter replaceable by one operator
WO2010129362A1 (en) * 2009-05-08 2010-11-11 Abbott Cardiovascular Systems Inc. Catheter push device

Cited By (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2017168762A1 (en) * 2016-03-31 2017-10-05 オリンパス株式会社 Treatment tool for endoscopes
JP6246429B1 (en) * 2016-03-31 2017-12-13 オリンパス株式会社 Endoscopic treatment tool
CN108883252A (en) * 2016-03-31 2018-11-23 奥林巴斯株式会社 Treatment instrument for endoscope
US11129517B2 (en) 2016-03-31 2021-09-28 Olympus Corporation Endoscopic treatment tool
JP2020022553A (en) * 2018-08-06 2020-02-13 周 中村 Inner retractor instrument for spine percutaneous endoscopic surgery
JP7244232B2 (en) 2018-08-06 2023-03-22 周 中村 Endo-retractor instrument for percutaneous endoscopic surgery of the spine

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