WO2017018218A1

WO2017018218A1 - Medical instrument

Info

Publication number: WO2017018218A1
Application number: PCT/JP2016/070662
Authority: WO
Inventors: 良恵相川; 三日市　高康
Original assignee: オリンパス株式会社
Priority date: 2015-07-24
Filing date: 2016-07-13
Publication date: 2017-02-02
Also published as: JPWO2017018218A1

Abstract

This medical instrument is provided with: a snare wire that is retractably inserted into a channel inside an insertion part of an endoscope; and a cap member that has an interior space, a first part, and a second part that is arranged such that the interior space is interposed between the first part and the second part, wherein the first part can be attached to the tip of the insertion part in accordance with the phase of the channel. A restricting member is provided to the interior space on the first part side of the cap member, said regulating member being for stipulating the protrusion direction of the snare wire protruding from the channel, and for restricting the movement of the snare wire in a direction orthogonal to a plane that is parallel to the central axis of the insertion part, the lengthwise axis of the channel, and the line segment connecting said central axis to said lengthwise axis.

Description

Medical instruments

The present invention relates to a medical device.
This application claims priority based on Japanese Patent Application No. 2015-147000 for which it applied to Japan on July 24, 2015, and uses the content here.

In recent years, endoscopic mucosal resection has attracted attention as a means of treating early cancer. As one aspect of EMR, a technique using a medical device (EMR using a cap: EMRC) in which a transparent cap is attached to the distal end of an endoscope insertion portion is known (for example, see Patent Document 1).

In the medical instrument disclosed in Patent Document 1, a claw portion protruding inward is formed on the inner peripheral surface of the tip of the cap. When excising the mucous membrane, the snare wire of the high frequency snare is fed into the cap, and the snare wire is hooked on the nail portion to form a pre-loop. The mucous membrane is excised by sucking the mucous membrane into the cap, binding it with a looped snare wire, and energizing the high-frequency snare.

Japanese Unexamined Patent Publication No. 2004-230053

In the endoscope treatment tool disclosed in Patent Document 1, when the snare wire is projected into the cap, it is necessary to project the snare wire toward the claw portion of the cap. However, since the treatment instrument channel of the endoscope through which the high-frequency snare is inserted is away from the nail part, it is not always easy to project the tip of the snare wire toward the nail part. Therefore, the tip of the snare wire may hit the mucous membrane without hitting the nail portion. Even if the snare wire is fed into the cap in this state, there is a problem that the snare wire slips and it is difficult to form a pre-loop.

The present invention has been made in view of such a problem, and an object thereof is to provide a medical instrument capable of easily forming a pre-loop.

According to the first aspect of the present invention, a medical instrument includes a snare wire that is inserted into a channel in an insertion portion of an endoscope so as to be able to advance and retract, an internal space, and the first portion and the first portion. And a cap member that can be attached to the distal end of the insertion portion in accordance with the phase of the channel. The inner space on the first part side of the cap member defines a protruding direction of the snare wire protruding from the channel, a center line of the insertion portion, a longitudinal axis of the channel, the center line, and the A restricting member is provided that restricts the movement of the snare wire in a direction orthogonal to a plane parallel to all of the line segments connecting the longitudinal axes.

According to the second aspect of the present invention, in the medical instrument according to the first aspect, the restriction member may be a tube body through which the snare wire can be inserted.
According to the third aspect of the present invention, in the medical device according to the second aspect, the central axis of the tube body may be inclined with respect to the longitudinal axis of the channel.
According to the fourth aspect of the present invention, in the medical device according to the second aspect, the inner diameter of the distal end of the tube body may be less than the inner diameter of the channel.

According to a fifth aspect of the present invention, in the medical device according to the first aspect, the restriction member is formed of the cap member on a side opposite to the central axis of the internal space with respect to the longitudinal axis of the channel. It may be fixed to the inner surface.
According to a sixth aspect of the present invention, in the medical device according to the first aspect, the restriction member is formed on the cap member so that a proximal end of the restriction member and a distal end of the insertion portion are separated from each other. It may be provided in the internal space.

According to the seventh aspect of the present invention, in the medical device according to the first aspect, a communication hole that communicates with the internal space may be provided on a proximal end side of the restriction member.
According to the eighth aspect of the present invention, in the medical device according to the first aspect, a notch may be provided on the second part side on the proximal end side of the regulating member.
According to a ninth aspect of the present invention, in the medical device according to the first aspect, the length from the distal end surface to the proximal end surface of the cap member on the first portion side is the length on the second portion side. It may be shorter than the length from the front end surface to the base end surface of the cap member.

According to a tenth aspect of the present invention, the medical device according to the first aspect is provided on the inner surface of the cap member on the distal end side on the second part side, and the snare wire loops along the inner surface. You may further provide the guide member which guides so that it may form and controls the retreat | retreat to the said insertion part side of the said snare wire.

According to the eleventh aspect of the present invention, in the medical instrument according to the tenth aspect, both end portions of the guide member may extend toward the first portion. In the side view of the cap member, the guide member and the axis of the cap member may intersect so as to form an acute angle on the proximal end side of the cap member.
According to a twelfth aspect of the present invention, in the medical instrument according to the tenth aspect, the guide member has at least a parallel part parallel to the distal end surface of the cap member on the second part side. Also good.
According to a thirteenth aspect of the present invention, in the medical instrument according to the tenth aspect, the region where the guide member is provided may be half or less of the entire circumference of the inner surface of the cap member.
According to the fourteenth aspect of the present invention, in the medical instrument according to the tenth aspect, the distance from the distal end surface of the cap member to the guide member on the first part side is from the distal end surface of the regulating member. It may be longer than the distance to the tip surface of the cap member.

The medical device according to the present invention can easily form a pre-loop.

1 is an overall view showing a medical device according to a first embodiment of the present invention. It is a figure which shows the high frequency treatment tool of FIG. It is the figure which looked at the cap member of FIG. 1 from the front. It is sectional drawing of the cap member of FIG. It is the schematic which shows one form at the time of use of the medical device of FIG. It is the schematic which shows one form at the time of use of the medical device of FIG. It is the schematic which shows one form at the time of use of the medical device of FIG. It is the schematic which shows one form at the time of use of the conventional medical device. It is a figure which shows the cap member of the 1st modification of this invention. It is a figure which shows the cap member of the 1st modification of this invention. It is a figure which shows the cap member of the 1st modification of this invention. It is a figure which shows the cap member of the 2nd modification of this invention. It is a figure which shows the cap member of the 2nd modification of this invention. It is a figure which shows the cap member of the 2nd modification of this invention. It is a figure which shows the cap member of the 3rd modification of this invention. It is a figure which shows the cap member used for the medical device of 2nd Embodiment of this invention. It is a side view of the cap member of FIG. It is the schematic which shows one form at the time of use of the medical device of FIG. It is a figure which shows the other form of the guide member shown in FIG. It is sectional drawing which shows the cap member of the 4th modification of this invention. It is the schematic which shows one form at the time of use of the cap member of FIG.

[First Embodiment]
An endoscopic tissue excision apparatus according to a first embodiment of the present invention will be described with reference to FIGS. Hereinafter, the tissue excision apparatus for endoscope is simply referred to as “tissue excision apparatus”.

FIG. 1 is an overall view showing a state in which the tissue excision apparatus of the present embodiment is attached to an endoscope.
As shown in FIG. 1, the tissue excision device 1 includes a cap member 10 and a high-frequency treatment instrument 20 and is a medical instrument that can be used with a known endoscope 30. The known endoscope 30 includes, for example, an insertion portion 31 in which a channel 31 a is formed, and an operation portion 32 that operates a distal end 31 b of the insertion portion 31.
The high-frequency treatment instrument 20 is inserted into the channel 31a so as to be able to advance and retract. The inner diameter of the channel 31a is, for example, 2.8 mm. In addition, an imaging unit 33 for observing the treatment target site is disposed at the distal end 31b of the insertion unit 31.

The high-frequency treatment tool 20 is a treatment tool capable of excising a treatment target site. As shown in FIGS. 1 and 2, the high-frequency treatment instrument 20 includes a snare wire 21, a sheath part 22 that can store the snare wire 21, and a treatment instrument operation part 23 disposed on the proximal end side of the snare wire 21. ing.
As shown in FIG. 2, the snare wire 21 has a first wire portion 21a, a second wire portion 21b, a folded portion 21c, and a third wire portion 21d, and is formed in a substantially loop shape.
The second wire portion 21b extends substantially linearly, and the first wire portion 21a and the third wire portion 21d are formed to be curved. Further, the folded portion 21c is folded back approximately 180 degrees in a U shape.
The snare wire 21 is formed of a conductive member, and a high frequency current is supplied from a high frequency power supply device (not shown). The snare wire 21 can cut the tissue when it comes into contact with the tissue in a state where a high-frequency current is applied.
The loop shape of the snare wire 21 shown in the present embodiment is merely an example, and a loop curved symmetrically with respect to the axis of the sheath portion 22 may be formed.

As shown in FIG. 2, the sheath portion 22 is a substantially cylindrical member having flexibility, and is, for example, a resin tube.
The snare wire 21 is inserted through the sheath portion 22 so as to be able to advance and retreat, and is configured to protrude and retract from the distal end of the sheath portion 22 in accordance with an operation by the treatment instrument operation portion 23.

As shown in FIG. 1, the treatment instrument operation unit 23 includes a main body part 24 fixed to the proximal end side of the sheath part 22 and a slider part 25 attached to the main body part 24.
The main body portion 24 includes a shaft portion 26 having a center line coaxially with the sheath portion 22, and a finger hook ring 27 formed at the proximal end of the shaft portion 26. The shaft portion 26 guides the slider portion 25 so as to move the slider portion 25 along the center line of the shaft portion 26.

The proximal end of the snare wire 21 is connected to the slider portion 25. Accordingly, the snare wire 21 is moved back and forth with respect to the sheath portion 22 by moving the slider portion 25 forward and backward with respect to the shaft portion 26. In the present embodiment, when the slider portion 25 is advanced with respect to the shaft portion 26, the snare wire 21 protrudes from the distal end of the sheath portion 22. Further, when the slider portion 25 is retracted with respect to the shaft portion 26, the snare wire 21 is accommodated in the sheath portion 22.
Further, the connector 28 disposed on the slider portion 25 can be connected to a high frequency power supply device (not shown). The snare wire 21 is electrically connected to the connector 28, and a high frequency current can be supplied to the snare wire 21 via the connector 28.

As shown in FIG. 1, the cap member 10 can be attached to the distal end 31 b of the insertion portion 31. In the present embodiment, the cap member 10 is attached to the distal end 31b of the insertion portion 31 so that the center line (axis line) O1 of the cap member 10 and the center line O2 of the insertion portion 31 substantially coincide.
Moreover, it is preferable that the cap member 10 is transparent in a portion overlapping the visual field so as not to obstruct the visual field observed by the imaging unit 33. The entire cap member 10 may be formed of a transparent material.
The cap member 10 has a substantially cylindrical shape with both ends opened, and has an internal space. Further, the cap member 10 includes a cylindrical portion 11 having a claw portion 11 a protruding toward the internal space at the tip, and a connecting portion 12 that can be attached to the tip 31 b of the insertion portion 31.

The distal end surface 11b of the cylindrical portion 11 is in contact with the treatment target site. Further, the distal end surface 11b of the cylindrical portion 11 is inclined with respect to the center line O1, and the inclination angle is set based on the approach angle of the endoscope 30 with respect to the treatment target site.
The cylindrical part 11 has a short axis part (first part) 13 and a long axis part (second part) 14 by tilting the distal end surface 11b. A length L1 from the distal end surface 11b to the proximal end surface 11c on the short shaft portion 13 side is configured to be shorter than a distance L2 from the distal end surface 11b to the proximal end surface 11c on the long shaft portion 14 side. The long shaft portion 14 is disposed so as to sandwich an internal space between the long shaft portion 14 and the short shaft portion 13.

In the present embodiment, as shown in FIG. 3, the cap member 10 is mounted on the distal end 31b of the insertion portion 31 so that the short shaft portion 13 matches the phase of the channel 31a when viewed from the center line O1 and O2 directions. Yes. That is, the cap member 10 is mounted on the distal end 31b of the insertion portion 31 so that the position of the channel 31a and the position of the short shaft portion 13 of the cap member 10 coincide with each other in the circumferential direction centered on the center lines O1 and O2. ing. In the present embodiment, since the notch 15 is provided at a position corresponding to the short shaft portion 13 of the claw portion 11a, the position of the notch 15 and the position of the channel 31a in the circumferential direction match.
Note that FIG. 3 shows a tube body, which will be described later, for the sake of simplicity.

As shown in FIGS. 1 and 3, the claw portion 11a protrudes from the inner periphery of the tip of the cylindrical portion 11 toward the center line O1, and is formed in a substantially annular shape. A snare wire 21 can contact the inner surface 11d of the claw portion 11a. The claw portion 11 a defines the opening shape and the size of the distal end portion of the cap member 10 when the cap member 10 is attached to the distal end 31 b of the insertion portion 31.

As shown in FIG. 4, the inner surface of the cap member 10 opposite to the center line O1 of the cap member 10 with respect to the longitudinal axis O3 of the channel 31a, that is, the inner space on the short shaft portion 13 side of the cylindrical portion 11 is formed. A substantially cylindrical tube body (regulating member) 16 is provided. The tube body 16 defines the protruding direction of the sheath portion 22 and the snare wire 21 protruding from the channel 31a and intersects the longitudinal axis O3 of the channel 31a excluding the protruding direction of the snare wire 21 (shown in FIG. 3). As described above, the center line O2 of the insertion portion, the longitudinal axis O3 of the channel 31a, and the line segment connecting the center line O2 of the insertion portion and the longitudinal axis O3 of the channel 31a are orthogonal to a plane Sv that is parallel. The movement of the snare wire 21 in the direction (including the direction Dh) is also restricted.

The tube body 16 is disposed in the internal space of the cylindrical portion 11 so that the central axis O4 of the tube body 16 is inclined with respect to the longitudinal axis O3 of the channel 31a. The tube body 16 is fixed to the inner surface of the cylindrical portion 11 with an adhesive 17 or the like. The adhesive 17 is preferably a biocompatible resin such as polypropylene resin or polycarbonate resin.
The tube body 16 is disposed in the internal space of the cap member 10 such that the first end (end on the insertion portion 31 side) 16a of the tube body 16 and the distal end surface 31c of the insertion portion 31 are spaced apart from each other by a predetermined distance. ing. Specifically, the first end 16a of the tube body 16 is disposed at a position facing the tip of the channel 31a and spaced from the tip of the channel 31a (for example, about 1 mm to 2 mm).
The tube body 16 has a second end (end on the front end surface 11b side of the cap member 10) 16b facing the notch 15 and spaced from the notch 15 (for example, about 2.0 mm to 5.0 mm). It is arranged at the position.
Since the sheath portion 22 is inserted through the tube body 16, the inner diameter of the tube body 16 is slightly larger than the outer diameter of the sheath portion 22. If the inner diameter of the tube body 16 is too much larger than the outer diameter of the sheath portion 22, the movement of the sheath portion 22 cannot be sufficiently regulated, which is not preferable. For example, when the outer diameter of the sheath part is 2.0 mm, the inner diameter of the tube body 16 is preferably 2.8 mm, for example. In this embodiment, the inner diameter of the tube body 16 is constant at 2.8 mm from the distal end to the proximal end.

Next, the operation of the tissue excision apparatus 1 according to this embodiment will be described.
Below, the case where EMRC is performed by combining the endoscope 30 and the tissue resection device 1 will be described as an example.

First, a counter electrode plate (not shown) connected to the high frequency power supply device as a counter electrode opposed to the snare wire 21 of the high frequency treatment instrument 20 is attached to the patient's body.
Subsequently, as shown in FIG. 1, the cap member 10 is attached to the distal end 31 b of the insertion portion 31 of the endoscope 30. Although not shown, the endoscope 30 is inserted into the body cavity by a well-known technique, the distal end of the endoscope 30 is guided to the treatment target site T, and the treatment target site T is captured in the field of view of the imaging unit 33.
A saline S or the like is locally injected into the submucosal layer of the treatment target site T with a local injection needle (not shown) to bulge the periphery of the treatment target site T as shown in FIG.

The surgeon inserts the high-frequency treatment tool 20 into the channel 31a of the endoscope 30. The sheath portion 22 protruding from the tip of the channel 31a is in a position where it can be visually recognized using an endoscopic image. The surgeon inserts the sheath portion 22 into the tube body 16 and causes the distal end of the sheath portion 22 to protrude from the distal end of the tube body 16. Note that the endoscope 30 may be inserted into the body cavity in a state where the distal end of the sheath portion 22 is disposed in the tube body 16 in advance.
The slider part 25 of the treatment instrument operation part 23 shown in FIG. At this time, the tube body 16 suppresses the shake of the sheath portion 22 in the direction intersecting the central axis O4 of the tube body 16, and the protruding direction of the snare wire 21 is fixed. In this state, the snare wire 21 is fed out. As shown in FIG. 6, the folded portion 21c of the snare wire 21 is drawn out toward the cutout portion 15, and then the first wire portion 21a, the second wire portion 21b, and the third wire portion 21d are the inner surface 11d of the claw portion 11a. Abut along. In this manner, the loop-shaped snare wire 21 (pre-loop P) is preferably formed in the cylindrical portion 11.

The tip surface 11b of the cap member 10 is brought into contact with the treatment target site T, and the operator makes negative pressure in the cap member 10 using suction means (not shown) provided in the endoscope 30, whereby FIG. As shown, the treatment target site T is pulled into the cap member 10. In the cap member 10, the treatment target site T enters the pre-loop P by pulling the treatment target site T into the inside from the opening of the cap member 10.

In a state where the treatment target portion T is drawn into the cap member 10, the slider portion 25 of the treatment instrument operation portion 23 shown in FIG. 1 is slid toward the proximal end side with respect to the shaft portion 26. As a result, the proximal end side of the pre-loop P is drawn into the sheath portion 22, and the treatment target site T is bound.
Next, the high frequency power supply device is operated to supply high frequency current to the high frequency treatment instrument 20. A high-frequency current is applied to the pre-loop P, and the treatment target site T bound by the pre-loop P is excised while being cauterized.

According to the tissue excision apparatus 1 of the present embodiment, the tube body 16 restricts the movement of the sheath portion 22 in the direction intersecting the longitudinal axis O3 of the channel 31a, and thus the sheath portion 22 protruding from the channel 31a. The protruding direction of the (snare wire 21) is defined. Thereby, since the snare wire 21 protrudes toward the notch part 15 reliably, it becomes possible to form the pre-loop P easily along the inner surface 11d of the nail | claw part 11a.

On the other hand, the conventional cap member 110 is not provided with a tube body (regulating member) as shown in FIG. When the conventional cap member 110 is used, the sheath portion 22 may be pushed back toward the insertion portion 31 by the treatment target portion T when the treatment target portion T is pulled into the cap member 110. When the sheath part 22 is pushed back, the sheath part 22 may move to the proximal end side of the channel 31a. Thereby, the pre-loop P will collapse. However, in the tissue excision apparatus 1 according to the present embodiment, even if the sheath portion 22 is retracted, the tube body 16 substitutes for the sheath portion 22 and continues to define the protruding direction of the snare wire 21, so that the pre-loop P is broken. Can be prevented.
Furthermore, when the cap member 110 not provided with the tube body (regulating member) is used, the sheath portion 22 protruding from the tip of the channel 31a may be directed toward the center line O1 of the cap member 10. In this case, it is necessary to move the treatment instrument operation section 23 on the hand side forward or backward, or to rotate the sheath section 22 toward the claw section 11a.
Therefore, in the conventional cap member 110, the procedure is complicated, and it is difficult to project the snare wire 21 toward the claw portion 11a.

Moreover, in this embodiment, since the regulating member is the tube body 16, the protruding direction of the sheath portion 22 (snare wire 21) can be reliably defined.
Further, since the central axis O4 of the tube body 16 is inclined with respect to the longitudinal axis O3 of the channel 31a, the snare wire 21 can be easily projected toward the claw portion 11a.
Further, the first end 16 a of the tube body 16 is separated from the tip of the channel 31 a, and the tube body 16 is disposed in the cylindrical portion 11. As a result, when the tissue cut by the snare wire 21 is sucked, the tissue can be sucked from the gap through the channel 31a.

Further, the second end 16 b of the tube body 16 is separated from the notch 15. Here, when the distance from the second end 16b of the tube body 16 to the cutout portion 15 is 2.0 mm to 5.0 mm or less, the pre-loop P of the snare wire 21 protruding from the tube body 16 is not well formed. Since a problem may occur, the pre-loop P can be easily formed by maintaining a certain distance.
Further, since the notch 15 is formed in the claw portion 11a, the notch 15 serves as a mark, and by aligning the notch 15 and the channel 31a in the circumferential direction, the channel 31a and the tube body 16 can be easily aligned. .
Moreover, since the front end surface 11b of the cylindrical part 11 inclines with respect to the centerline O1, the cap member 10 can make the angle which the cap member 10 and the treatment object site | part T make small. Thereby, the tissue excision device 1 can easily approach the treatment target site T.

The position at which the snare wire 21 protrudes from the sheath portion 22 is not particularly limited. In the present embodiment, as shown in FIG. 7, the snare wire 21 is fed out after the sheath portion 22 protrudes from the tip of the tube body 16, but when the tip of the sheath portion 22 is located in the tube body 16. Alternatively, the snare wire 21 may be fed out toward the notch 15. Even in this case, since the protruding direction of the snare wire 21 can be defined, the pre-loop P can be easily formed.
In the present embodiment, the cap member 10 in which the distal end surface 11b of the cylindrical portion 11 is inclined with respect to the center line O1 is used, but the distal end surface 11b of the cylindrical portion 11 is perpendicular to the center line O1. Even if it is a cap member, the same effect can be acquired.

[Modification 1]
A tissue excision apparatus according to Modification 1 of the present invention will be described with reference to FIGS. 9 to 11.
The tissue excision apparatus according to this modified example will be described in this respect because the configuration of the regulating member is different from that of the regulating member of the first embodiment.
In the following description of each modification, the same components as those described above are denoted by the same reference numerals, and redundant descriptions are omitted.
In the first modification, the wire portion 40 is used as the restricting member. As shown in FIGS. 9 and 10, the wire portion 40 includes a first wire portion 41 and a second wire portion 42 disposed on the channel 31a side, a third wire portion 43 formed in a quadrangular shape, and a third wire portion 40. Leg portions 44 extending from the apexes of the wire portions 43 toward the short shaft portion 13. The tips of the leg portions 44 are fixed to the inner surface of the cylindrical portion 11 with an adhesive or the like.
The distance between the first wire portion 41 and the second wire portion 42 gradually increases toward the insertion portion 31 when viewed from the long shaft portion 14 side.

According to the first modification, as shown in FIG. 11, the sheath portion 22 protruding from the channel 31 a can easily enter between the base end side leg portions 44 by the first wire portion 41 and the second wire portion 42. Then, it is guided to between the leg portions 44 on the distal end side. Since the movement of the sheath portion 22 in the direction intersecting the longitudinal axis O3 of the channel 31a is restricted by the wire portion 40, the protruding direction of the sheath portion 22 protruding from the channel 31a is defined. Thereby, since the snare wire 21 protrudes toward the notch part 15 reliably, it becomes possible to form the pre-loop P easily along the inner surface 11d of the nail | claw part 11a.

[Modification 2]
A tissue excision apparatus according to Modification 2 of the present invention will be described with reference to FIGS.
Since the structure of the tube body of the tissue excision apparatus according to this modification is different from the structure of the tube body of the first embodiment, this will be described.

As shown in FIGS. 12 and 13, the tube body (regulating member) 50 is formed in a tapered shape whose inner diameter increases from the distal end 50a toward the proximal end 50b.
The opening dimension D1 of the base end 50b of the tube body 50 is the same as the inner diameter D2 of the channel 31a, and the inner diameter D3 of the distal end 50a of the tube body 50 is less than the inner diameter D2 of the channel 31a. In this modification, the opening dimension D1 of the base end 50b of the tube body 50 is 2.8 mm, and the inner diameter D3 of the distal end 50a of the tube body 50 is 2.1 mm. The outer diameter of the sheath part 22 is 2.0 mm.
A notch 51 is provided at the base end 50 b of the tube body 50. As shown in FIG. 13, the cutout portion 51 is disposed so as to face the long shaft portion 14 side.

Next, the operation of the tissue excision apparatus according to this modification will be described.
After excising the treatment target site T as described above, the high-frequency treatment tool 20 is removed from the endoscope 30, and another treatment tool, for example, a grasping forceps 52 is inserted into the channel 31a. At this time, as shown in FIG. 14, the grasping forceps 52 can be advanced through the notch 51 without being inserted into the tube body 50. That is, the grasping forceps 52 protrudes into the internal space of the cylindrical portion 11 without the tube body 50 getting in the way. Then, the incised treatment target site T is grasped by the grasping forceps 52 and discharged out of the body via the channel 31a.

According to the second modification, since the tube body 50 is formed in a taper shape, the sheath portion 22 protruding from the channel 31 a can easily enter the tube body 50. Further, since the inner diameter D3 of the distal end 50a of the tube body 50 is less than the inner diameter D2 of the channel 31a, the inner diameter D3 of the distal end 50a of the tube body 50 is smaller than the opening dimension D1 of the base end 50b. Thereby, since the blur of the sheath part 22 can be suppressed more, it becomes possible to prescribe | regulate the protrusion direction of the sheath part 22 (snare wire 21) more reliably.
In addition, since the tube body 50 is provided with the notch 51, when the grasping forceps 52 is advanced without passing through the tube body 50, the tube forceps 52 can be removed from the channel 31a without being obstructed. Can be protruded.

Note that, as in the first embodiment, the notch 51 as in this modification may be formed in the tube body 16 having a constant inner diameter.

[Modification 3]
A tissue excision apparatus according to Modification 3 of the present invention will be described with reference to FIG.
Since the configuration and arrangement of the tube body are different from the configuration and arrangement of the tube body of the first embodiment, this point will be described in the tissue excision apparatus of this modification.

In the first embodiment, the tube body 16 is disposed with a space from the tip of the channel 31a. However, in this modification, the tube body (regulating member) 60 is disposed without a space from the tip of the channel 31a. ing. When the cap member is attached to the distal end 31 b of the insertion portion 31, the tube body 60 is a cylindrical portion so that the first end 60 a of the tube body 60 contacts the distal end surface 31 c of the insertion portion 31 as shown in FIG. 15. 11 is disposed in the internal space.
A communication hole 61 that communicates with the internal space is provided on the proximal end side of the tube body 60. The communication hole 61 is arranged to face the long shaft portion 14 side.

According to the third modification, since the tube body 60 is arranged without being spaced from the tip of the channel 31a, the tube body 60 is more reliably guided to the tube body 60 when the high-frequency treatment instrument 20 is inserted into the channel 31a. be able to.
Further, since the communication hole 61 is provided in the tube body 60, when the tissue cut by the snare wire 21 is sucked, the tissue can be sucked from the communication hole 61 through the channel 31a.

[Second Embodiment]
A second embodiment of the present invention will be described with reference to FIGS.
The tissue excision apparatus of the present embodiment includes a cap member 71 instead of the cap member 10 of the first embodiment. The cap member 71 is different from the cap member 10 of the first embodiment in the configuration further including the guide member 70.
In the following description, the same components as those described above are denoted by the same reference numerals, and redundant description is omitted.

As shown in FIG. 16, the guide member 70 is provided on the inner surface on the distal end side of the cap member 71 on the long shaft portion 14 side. The guide member 70 guides the snare wire 21 to form a pre-loop along the inner surface, and restricts the retraction of the snare wire 21 toward the insertion portion 31.
Further, both end portions 70a of the guide member 70 extend from the long shaft portion 14 toward the short shaft portion 13 as shown in FIG. In the side view of the cap member 71, the guide member 70 intersects so that an angle α formed between the extending direction of the guide member 70 and the center line O 1 a of the cap member 71 forms an acute angle on the base end side of the cap member 71. .
The region where the guide member 70 is provided is substantially half of the entire circumference of the inner surface of the cap member 71.

Next, the operation of the tissue excision apparatus of this embodiment will be described.
The process up to the process of expanding the periphery of the treatment target site T and feeding the snare wire 21 from the distal end of the sheath portion 22 is the same as in the first embodiment.
In the present embodiment, when the snare wire 21 is unwound from the distal end of the sheath portion 22, as shown in FIG. 18, the folded portion 21c of the snare wire 21 is unwound toward the notch portion 15, and then the first wire portion 21a, The 2 wire part 21b and the 3rd wire part 21d contact | abut along the inner surface 11d of the nail | claw part 11a. At this time, since the snare wire 21 is guided by the guide member 70 along the inner surface 11d of the claw portion 11a so as to form the pre-loop P, the retraction of the snare wire 21 toward the insertion portion 31 is restricted. The snare wire 21 on the side of the portion 14 is held between the inner surface 11d of the claw portion 11a and the guide member 70.

Even when the snare wire 21 on the long shaft portion 14 side is pushed toward the insertion portion 31 by the treatment target portion T when the treatment target portion T is pulled into the cap member 10, the insertion portion 31 of the snare wire 21 is pushed by the guide member 70. Suppresses backwards to the side. Further, as described above, even when the sheath portion 22 is pushed, the tube body 16 can be substituted for the sheath portion 22, and the protruding direction of the snare wire 21 can be continuously defined. That is, it is possible to prevent the pre-loop P from collapsing even when the folded portion 21c is pushed or the sheath portion 22 is pushed.

According to the tissue excision apparatus of this embodiment, the guide member 70 restricts the snare wire 21 from retreating toward the insertion portion 31, so that the snare wire 21 on the long shaft portion 14 side floats toward the insertion portion 31 ( Can be prevented.
Further, both end portions 70 a of the guide member 70 extend toward the short shaft portion 13, and the extending direction of the guide member 70 and the axis of the cap member 71 are in the base end side of the cap member 71 in a side view of the cap member 10. Therefore, the snare wire 21 can be easily guided toward the tip of the cap member 71.

Although both end portions 70 a of the guide member 70 are provided so as to extend from the long shaft portion 14 toward the short shaft portion 13, only one side may be configured to extend toward the short shaft portion 13.
In the present embodiment, the region where the guide member 70 is provided is substantially half of the entire circumference of the inner surface of the cap member 71, but is not particularly limited. Since the tube body 16 is provided on the short shaft portion 13 side, the region where the guide member 70 is provided does not have to be the entire circumference, and the entire circumference including the long shaft portion 14 side of the inner surface of the cap member 71. The above-described effects can be obtained with about one-fourth to less than half.
Further, the guide member is not linear when viewed from the side, and may be curved so that the end 72a of the guide member 72 faces the connecting portion 12 as shown in FIG.

[Modification 4]
A tissue excision apparatus according to Modification 4 of the present invention will be described with reference to FIGS.
The tissue excision apparatus according to this modification includes a cap member 80 instead of the cap member 71 of the second embodiment.

As shown in FIG. 20, in the cap member 80, the tip end face 11b of the cylindrical portion 11 is perpendicular to the center line O1. That is, the length L1 of the first part 13 and the length L2 of the second part 14 are the same length.
As shown in FIGS. 20 and 21, the guide member 81 includes a parallel portion 82 extending toward the first portion 13 in parallel to the distal end surface 11b on the second portion 14 side, and an end of the parallel portion 82 on one side. And an inclined portion 83 that is inclined from the portion 82a toward the first portion 13 side. In addition, an angle β formed by the extending direction of the inclined portion 83 and the center line O1 of the cap member 80 intersects with the base end side of the cap member 80 so as to form an acute angle.

The guide member 81 is such that the distance L3 from the distal end surface 11b of the cap member 80 to the proximal end 83a of the inclined portion 83 is longer than the distance L4 from the distal end surface 11b of the cap member 80 to the second end 16b of the tube body 16. The tube body 16 is disposed in the internal space of the cylindrical portion 11.

In the fourth modification, when the snare wire 21 is unwound from the distal end of the sheath portion 22, the guide member 81 restricts the snare wire 21 from moving backward toward the insertion portion 31 as shown in FIG. The 14th snare wire 21 is held between the inner surface 11d of the claw portion 11a and the guide member 81.

According to this modification, when using the cap member 80 in which the distal end surface 11b of the cylindrical portion 11 is perpendicular to the center line O1, the parallel portion 82 parallel to the distal end surface 11b is provided on the second portion 14 side. Accordingly, the backward movement of the portion of the snare wire 21 from the second portion 14 side toward the first portion 13 side toward the insertion portion 31 side can also be restricted.
Further, by providing the inclined portion 83 so that the distance L3 is longer than the distance L4, the snare wire 21 fed out from the sheath portion 22 and arranged on the second portion 14 side is guided from the parallel portion 82 to the distal end surface 11b side. It becomes easy to be done.
As in the second embodiment, it is possible to provide the parallel portion 82 on the cap member 80 in which the distal end surface 11b of the cylindrical portion 11 is inclined with respect to the center line O1.
Moreover, although demonstrated using the tube body 16 quoted in 1st Embodiment as a tube body used for 2nd Embodiment and a 4th modification, any tube body of the modification 1 to the modification 3 is used. Also good.

As mentioned above, although preferable embodiment of this invention was described, this invention is not limited to these embodiment. Additions, omissions, substitutions, and other modifications can be made without departing from the spirit of the present invention.
For example, although the structure which provided the notch part in a part of nail | claw part of the cap member was shown, the notch part does not necessarily need to be formed. That is, a claw portion may be formed in a ring shape at the tip of the cap member.
The tube body is arranged so that the central axis of the tube body is inclined with respect to the longitudinal axis of the channel. However, the central axis of the tube body and the central axis of the channel coincide with each other according to the shape of the cylindrical portion. In addition, a tube body may be arranged.
Moreover, you may integrally mold a guide member with a cylindrical part with the same material as a cylindrical part.
The present invention is not limited by the above description, but only by the appended claims.

[Additional notes]
A snare wire inserted through a channel in the insertion portion of the endoscope so as to be able to advance and retract;
A first member and a second member, the first member being attachable to the distal end of the insertion portion in accordance with the phase of the channel, and a cap member having an internal space.
A regulating member that regulates the protruding direction of the snare wire protruding from the channel in the internal space on the first part side of the cap member and regulates the movement in the horizontal direction intersecting the longitudinal axis of the channel. Is provided,
The length from the front end surface to the base end surface of the cap member on the first part side is longer than the length from the front end surface to the base end surface of the cap member on the second part side. A guide member that guides the snare wire so as to form a loop along the inner surface and restricts the retraction of the snare wire toward the insertion portion is provided on the inner surface of the distal end side of the medical device.

According to the present invention, a medical device capable of easily forming a pre-loop can be provided.

O1, O1a Cap member center line (axis)
O2 center line of insertion part O3 longitudinal axis of channel O4 center axis of tube body D2 inner diameter of channel D3 inner diameter of tube body tip Dh direction Sv plane 1 tissue excision device (medical instrument)
10, 71, 80 Cap member 13 Short shaft part (first part)
14 Long shaft (second part)
16 Tube body (regulating member)
31 Insertion part 31a Channel 31b Tip of insertion part 40 Wire part (regulating member)
61 Communication hole 70 Guide member

Claims

A snare wire inserted through a channel in the insertion portion of the endoscope so as to be able to advance and retract;
An internal space; a first portion; and a second portion disposed so as to sandwich the internal space between the first portion and the first portion according to the phase of the channel. A cap member attachable to the distal end of the insertion portion;
The inner space on the first part side of the cap member defines a protruding direction of the snare wire protruding from the channel, a center line of the insertion portion, a longitudinal axis of the channel, the center line, and the A medical device provided with a regulating member that regulates the movement of the snare wire in a direction orthogonal to a plane parallel to all of the line segments connecting the longitudinal axes.
The medical device according to claim 1, wherein the restriction member is a tube body through which the snare wire can be inserted.
The medical instrument according to claim 2, wherein a central axis of the tube body is inclined with respect to the longitudinal axis of the channel.
The medical instrument according to claim 2, wherein an inner diameter of a distal end of the tube body is less than an inner diameter of the channel.
The medical device according to claim 1, wherein the restriction member is fixed to an inner surface of the cap member opposite to a central axis of the internal space with respect to the longitudinal axis of the channel.
The medical instrument according to claim 1, wherein the restriction member is provided in the internal space of the cap member such that a proximal end of the restriction member and a distal end of the insertion portion are separated from each other.
The medical instrument according to claim 1, wherein a communication hole communicating with the internal space is provided on a proximal end side of the restriction member.
The medical device according to claim 1, wherein a notch is provided on the second part side on the proximal end side of the restriction member.
The medical device according to claim 1, wherein a length from the distal end surface to the proximal end surface of the cap member on the first part side is shorter than a length from the distal end surface to the proximal end surface of the cap member on the second part side.
A guide member that is provided on the inner surface of the cap member on the distal end side on the second portion side, guides the snare wire to form a loop along the inner surface, and regulates the retraction of the snare wire toward the insertion portion. The medical device according to claim 1.
Both end portions of the guide member extend toward the first portion,
The medical device according to claim 10, wherein the guide member and the axis of the cap member intersect so as to form an acute angle on the proximal end side of the cap member in a side view of the cap member.
The medical device according to claim 10, wherein the guide member has a parallel portion parallel to a distal end surface of the cap member on at least the second portion side.
The medical instrument according to claim 10, wherein a region where the guide member is provided is equal to or less than half of the entire circumference of the inner surface of the cap member.
The medical device according to claim 10, wherein a distance from a distal end surface of the cap member to the guide member on the first part side is longer than a distance from a distal end surface of the regulating member to the distal end surface of the cap member.