WO2018070119A1

WO2018070119A1 - Bendable treatment instrument

Info

Publication number: WO2018070119A1
Application number: PCT/JP2017/030529
Authority: WO
Inventors: 龍中楯; 誠橋爪; 俊介長井; 泰運藤田; 加藤　次郎
Original assignee: 国立大学法人九州大学; 株式会社ホギメディカル
Priority date: 2016-10-14
Filing date: 2017-08-25
Publication date: 2018-04-19
Also published as: JP2018061744A; JP6736060B2

Abstract

Provided is a bendable treatment instrument which enables a leading end section thereof having a device attached thereto to be freely bended independently of a flexible endoscope, and can prevent the device from being twisted due to a twist, about the axis, of a sheath wire member caused when insertion into the flexible endoscope is performed, and which has no possibility of causing any impediment to arrangement or movement of a person or an object when the flexible endoscope is pivoted. The bendable treatment instrument is provided with: a bendable part 4 which has a treatment member attached to the leading end thereof; a manipulation part which allows bending operation of the bendable part 4, opening and closing operations of forceps serving as the treatment member, and advancing and retracting operations of a surgical knife serving as the treatment member; a sheath wire part 5 through which manipulation performed with the manipulation part is transmitted; and an axial fixation means 100 which prevents the sheath wire part 5 from rotating about the axis thereof. The axial fixation means 100 is provided with: an engagement protrusion 105 fixed to the sheath wire part 5; and an axial fixation part 104 in which a groove 104a is formed so as to be engaged with the engagement protrusion 105, and which allows the sheath wire part 5 to move in the axial direction but prevents the sheath wire part 5 from rotating about the axis thereof. An end section, on the bendable part 4 side, of the axial fixation means 100 is curved such that the axial fixation means 100 and the pivoting center axis of a flexible endoscope become parallel to each other when the axial fixation means 100 is held by an endoscope channel.

Description

Bending treatment tool

This invention is inserted into a bending treatment instrument, in particular, into a treatment instrument channel of a flexible endoscope or a treatment instrument insertion tube of a flexible endoscope, and the abdominal cavity such as the gastrointestinal tract from the mouth or anus together with the flexible endoscope. In a bending treatment tool that reaches an internal organ and uses a treatment member such as a scalpel or forceps (hereinafter sometimes referred to as a device) to remove an affected area such as epithelial cancer, the distal end to which the device is attached The device can be freely bent independently of the endoscope, and can prevent twisting of the device due to twisting around the axis of the sheath wire member when inserted into the flexible endoscope. The present invention relates to a bending treatment instrument that does not interfere with the arrangement and movement of people and objects when turning a flexible endoscope.

Endoscopic submucosal dissection and dissection (ESD) which removes the upper layer of the mucous membrane such as the stomach and large intestine over a wide range without inserting a treatment tool through the mouth or anus in recent years. Such a technique is performed. In addition, a flexible endoscope such as a stomach camera or a large intestine camera is inserted through the mouth, anus, vagina, urethra, etc. that are originally present on the surface of the body, and a flexible endoscope is inserted through the stomach or large intestine wall to the abdominal cavity. A technique (NOTES: Natural Orifice Transoscopic Surgical: Transluminal Endoscopic Surgery) for diagnosing and treating an intra-abdominal organ by reaching is known.

Transluminal endoscopic surgery represented by such endoscopic submucosal dissection (ESD) is performed by inserting a device together with a flexible endoscope from the mouth or the like originally present on the surface of the body. In order to achieve this treatment, the body surface is not damaged at all, and complications such as infection and adhesion of the abdominal wall as in normal surgery can be eliminated. There is an advantage that invasion can be reduced.

As described in Patent Document 1, a treatment tool used for such transluminal endoscopic surgery is inserted into a flexible endoscope and bent from a distal end of the flexible endoscope. It has a bent part that can be operated freely. In addition, a sheath / wire portion that transmits the bending motion to the bending portion and an operation portion that operates the bending motion of the bending portion by pushing and pulling the sheath / wire portion are provided.

JP 2010-511440 A

However, the bending instrument described in Patent Document 1 has an outer diameter of about 4.0 mm and is not sized to be inserted into the endoscope channel of the endoscope. It was not possible to actually use it.

In addition, if the outer diameter is made thin enough to be inserted into the endoscope channel so that it can be applied to the above-mentioned endoscopic submucosal dissection and dissection (ESD), it can be freely bent and appropriately grasped with forceps. This has hindered excision with a scalpel and a scalpel, and has not achieved this.

Furthermore, since the treatment instrument described in Patent Document 1 includes an outer skin through which a wire is inserted through a cable jacket through which each wire is inserted, and the cable jacket is inserted through the cable jacket, a forceps gripping operation and a female excision operation It was difficult to sufficiently withstand the load at the time of cutting, and the excision and peeling operations were very difficult.

In addition, although the endoscope channel of a flexible endoscope has various diameters of about 3.8 mm, 3.2 mm, and 2.8 mm in diameter, each of them has a small diameter, so it is inserted into the endoscope channel. However, the use of a treatment tool that can be bent has a problem that twist due to insufficient rigidity of the outer skin occurs and the power of the wire cannot be transmitted smoothly and reliably.

Further, the conventional bending treatment tool has a means for projecting from the forceps opening because there is no means for defining an angle around the axis of the bending treatment tool with respect to the endoscope when the bending treatment tool is inserted into the endoscope. There is a problem that the direction of the angle is not fixed, and the bending direction does not coincide with the operation direction of the operation unit. For this reason, in the conventional bending treatment tool, after inserting the bending treatment tool into the endoscope, an operation called axis alignment for matching the operation direction of the operation unit and the bending direction is performed, but this operation is complicated. There was a problem of being.

Accordingly, the present invention has been made to solve the above-described problems, and is inserted into a treatment instrument channel of a flexible endoscope or a bending treatment instrument insertion tube attached to the flexible endoscope. In a bending treatment tool that allows a soft endoscope to reach the abdominal organs such as the gastrointestinal tract from the mouth or anus and removes the affected area such as epithelial cancer with a device such as a scalpel or forceps, the distal end portion to which the device is attached Can be freely bent independently of the flexible endoscope, and the device can be prevented from being twisted due to twisting around the axis of the sheath wire member when inserted into the flexible endoscope. It is another object of the present invention to provide a bending treatment instrument that does not interfere with the arrangement and movement of people and objects when turning a flexible endoscope.

The present invention has been made to achieve the above object, and is characterized by the following.

According to the first aspect of the present invention, a bending portion having a treatment member attached to the tip thereof, an operation of bending the bending portion, an opening / closing operation of forceps as the treatment member, and an operation of moving a knife as the treatment member , A sheath wire portion for transmitting the operation of the operation portion, and a shaft fixing means for preventing rotation of the sheath wire portion around the axis, wherein the shaft fixing means is fixed to the sheath wire portion. An engagement protrusion and a groove that engages with the engagement protrusion are formed to allow the sheath wire portion to move in the axial direction and prevent rotation of the sheath wire portion around the axis. An end portion on the bent portion side of the shaft fixing means, when the shaft fixing means is held in the endoscope channel, the turning center axis of the flexible endoscope, the shaft fixing means, Is characterized by being curved to be parallel It is intended to.

The invention according to claim 2 is the device sheath according to claim 1, wherein the sheath wire part is connected to the treatment member, and a device wire through which a device wire for operating the treatment member is inserted; An inner sheath composed of a bending sheath through which a plurality of bending wires for bending the bending portion are inserted, an outer sheath covering the inner sheath together, and a liner blade covering the outer sheath It has the feature in becoming.

The invention described in claim 3 is characterized in that, in the invention described in

claim

1 or 2, the shaft fixing means includes a holder fixing portion fixed to the endoscope holder.

According to a fourth aspect of the present invention, in the invention according to any one of the first to third aspects, at least one end of the shaft fixing portion includes a locking portion that closes the groove. It has a special feature.

According to a fifth aspect of the present invention, in the invention according to any one of the second to fourth aspects, at least one of the device wire and the bending wire has a swaging wire fixed to one end of a single wire. It has the feature that it consists of what is.

According to this invention, since the shaft fixing means for preventing the rotation of the sheath wire portion around the axis is provided, the sheath wire member is twisted around the axis when the device is inserted into the flexible endoscope. The device can be prevented from being twisted. As a result, since the operation direction of the bending treatment device matches the movement of the device, an intuitive operation is possible, and the operability of the bending treatment device is improved.

Further, according to the present invention, by providing the shaft fixing means, it is not necessary to perform the shaft alignment work to match the grip operation direction and the bending portion bending direction.

Further, according to the present invention, when the shaft fixing means is held at the endoscope channel port at the end on the bent portion side of the shaft fixing means, the turning center axis of the flexible endoscope and the shaft fixing means are By curving so as to be parallel, there is no possibility of disturbing the arrangement and movement of people and objects when turning the flexible endoscope.

Further, according to the present invention, the sheath / wire member can be fixed to the endoscope holder or the like installed in the flexible endoscope by providing the shaft fixing means with the holder fixing portion fixed to the endoscope holder. Therefore, the insertion posture of the bending treatment instrument can be fixed.

Further, according to the present invention, at least one end portion of the shaft fixing portion is provided with the locking portion that closes the groove that engages with the engaging protrusion fixed to the sheath wire portion, thereby the sheath wire portion. Even if it moves in the longitudinal direction, the engagement protrusion does not fall out of the groove, and the insertion posture can be kept fixed.

In addition, according to the present invention, at least one of the device wire and the bending wire is formed by welding a swaging wire to one end of a single wire, so that it is resistant to elongation and the bendability at the bent portion is improved.

It is the schematic for demonstrating the use condition of the bending treatment tool which concerns on embodiment of this invention. It is the schematic for demonstrating the usage example of the bending treatment tool which concerns on embodiment of this invention. It is a side view for demonstrating the structure of the bending treatment tool which concerns on embodiment of this invention. It is an enlarged view for demonstrating the structure of the bending part of the bending treatment tool for forceps. FIG. 5 is a longitudinal sectional view of FIG. 4. It is a perspective view which shows the structure of the hinge top located in the base end side of a bending part. It is a figure for demonstrating opening / closing operation | movement of forceps, (a) is a fragmentary sectional view which shows the closed state, (b) is a fragmentary sectional view which shows the open state. It is an enlarged view for demonstrating the structure of the bending part of the bending treatment tool for scalpels. It is a perspective view which shows the hinge member which comprises a bending part. It is a figure which shows a hinge member, (a) is the sectional view on the AA line of FIG. 9, (b) is a side view. It is a front view which shows a hinge member. It is sectional drawing for demonstrating the bending operation | movement of a bending part. It is a figure for demonstrating the structure of a sheath wire part, (a) is a fragmentary perspective view for demonstrating the structure of a sheath wire part, (b) is a wire for bending and a wire for devices. It is a longitudinal direction sectional view for explanation, and (c) is a longitudinal direction sectional view showing a bending wire and a device wire. It is longitudinal direction sectional drawing of a sheath wire part. It is a disassembled perspective view for demonstrating the internal structure of an operation part. It is a disassembled perspective view for demonstrating the structure of a rotation means. It is a disassembled perspective view for demonstrating the structure of a twisting force relief mechanism. It is a top view which shows a shaft fixing means. It is a front view which shows a shaft fixing means. It is a front view which shows the shaft fixing means which removed the shaft fixing means main body. FIG. 21 is a sectional view taken along line AA in FIG. 20. It is a figure which shows the relationship between an axis | shaft fixing means and a flexible endoscope, (a) is a front view which shows the case where the edge part by the side of the endoscope of an axis | shaft fixing means is linear, (b) It is a front view which shows the case where the edge part by the side of the bending part of a shaft fixing means is curving.

Hereinafter, an embodiment of the bending treatment tool of the present invention will be described with reference to the drawings. The following embodiments do not limit the invention according to each claim, and all combinations of features described in the embodiments are not necessarily essential to the solution means of the present invention. Absent.

FIG. 1 is a schematic diagram for explaining a use state of a bending treatment instrument according to an embodiment of the present invention. FIG. 2 is a schematic diagram for explaining an example of use of a bending treatment instrument according to an embodiment of the present invention. FIG. 3 is a side view for explaining the configuration of the bending treatment device according to the embodiment of the present invention, FIG. 4 is an enlarged view for explaining the configuration of the bending portion of the bending treatment device for forceps, and FIG. 4 is a cross-sectional view in the longitudinal direction, FIG. 6 is a perspective view showing the configuration of the hinge top located on the proximal end side of the bent portion, and FIG. 7 is a view for explaining the opening / closing operation of the forceps. Is a partial cross-sectional view showing a closed state, (b) is a partial cross-sectional view showing an open state, FIG. 8 is an enlarged view for explaining a configuration of a bending portion of a bending treatment instrument for a female, and FIG. The perspective view which shows the hinge member which comprises a bending part, FIG. 10 is a figure which shows a hinge member, (a) is a figure of FIG. -B is a side view, FIG. 11 is a front view showing a hinge member, FIG. 12 is a cross-sectional view for explaining a bending operation of the bending portion, and FIG. 13 is a sheath wire portion. 4A is a partial perspective view for explaining the configuration of the sheath wire portion, and FIG. 2B is a longitudinal direction for explaining the bending wire and the device wire. Sectional view, (c) is a longitudinal sectional view showing a bending wire and a device wire, FIG. 14 is a longitudinal sectional view of a sheath wire part, and FIG. 15 is for explaining the internal structure of the operation part. FIG. 16 is an exploded perspective view for explaining the structure of the rotating means, FIG. 17 is an exploded perspective view for explaining the structure of the twisting force relief mechanism, and FIG. 18 shows the shaft fixing means. FIG. 19 is a front view showing the shaft fixing means, and FIG. FIG. 21 is a sectional view taken along the line AA of FIG. 20, and FIG. 22 is a diagram showing the relationship between the shaft fixing means and the flexible endoscope. a) is a front view showing a case where the end portion of the shaft fixing means on the endoscope side is linear, and (b) is a front view showing a case where the end portion of the shaft fixing means on the endoscope side is curved. FIG.

As shown in FIGS. 1 and 2, a bending treatment instrument according to an embodiment of the present invention includes a forceps bending treatment tool 1 a having a forceps at the tip and a knife bending treatment tool 1 b having a knife (electric knife) at the tip. Is included. The bending

treatment instruments

1a and 1b are inserted into the endoscope channel 2a of the flexible endoscope 2 or the treatment instrument insertion tube 2b attached to the distal end of the flexible endoscope 2 to be inserted into the flexible endoscope 2. At the same time, the affected part 3a such as cancer in the abdominal cavity such as the digestive tract is diagnosed or excised from the mouth or anus of the patient 3.

At this time, since the forceps bending treatment tool 1a and the female bending treatment tool 1b are individually bent independently of the flexible endoscope 2 so as to have at least two degrees of freedom, the viewpoint of the flexible endoscope 2 is fixed. Thus, the affected part 3a can be grasped and excised, and a highly flexible procedure can be performed with a stable visual field.

Next, the configuration of the bending treatment instrument according to the embodiment of the present invention will be described with reference to FIG. In FIG. 3, the bending treatment tool 1 includes the forceps bending treatment tool 1 a and the female bending treatment tool 1 b.

The bending treatment instrument 1 includes a forceps or an electric scalpel as a treatment member attached to the distal end of the bending portion 4 having two degrees of freedom in the horizontal and vertical directions, a bending operation of the bending portion 4, an opening / closing operation of the forceps, and an electric knife. An operation unit 60 that performs a retracting operation, and a sheath wire unit 5 including a plurality of wires that transmit the operation of the operation unit 60 and a sheath through which the wires are inserted. Further, the shaft fixing means 100 is attached to the sheath wire portion 5.

The operation unit 60 is moved to the bending unit 4 by rotating a grip 61 connected to a plurality of wires inserted through the sheath wire unit 5 up and down and left and right like a joystick with respect to the operation unit main body 63. The inserted and connected wire is pushed and pulled in the longitudinal direction, thereby having a function of bending the bending portion 4. Further, as shown in FIG. 15, the grip 61 includes an operation moving body 69, and the operation moving body 69 can be pushed and pulled in the longitudinal direction, and the wire connected to the forceps 30 can be pulled by this operation. It has a function of pushing and pulling, and thereby opening and closing the forceps 30.

Furthermore, the operation unit 60 is attached to the fixed base connection unit 62 via a slider mechanism 64 that can slide the operation unit main body 63 in the longitudinal direction. By sliding the slider mechanism 64 in the longitudinal direction, the forceps 30, the bent portion 4 and the sheath wire portion 5 can be pushed and pulled along the longitudinal direction, whereby the endoscope channel 2a of the forceps 30 or the treatment. The amount of protrusion from the instrument insertion tube 2b can be adjusted.

As shown in FIG. 4, the bending portion 4 has a sheath 30 that has a forceps 30 attached to the distal end side via a hinge end 12 and that constitutes a sheath wire portion 5 via a hinge top 11 and a hinge base 13 on the proximal end side. 20 is attached. The bending portion 4 includes a plurality of hinge members 10 arranged in parallel with each other so that the bending operation can be performed by sliding adjacent hinge members 10 in a direction intersecting the axial direction. It is configured.

Specifically, as shown in FIG. 5, the bending portion 4 has a plurality of bending wires 22 inserted into the bending portion 4 with one end connected to the operation portion 60 and the other end connected to the hinge end 12. In addition, the bending wire 22 is pushed and pulled by the operation unit 60, whereby the hinge members 10 are slid to each other, whereby the bending operation is performed. The bending wire 22 and the hinge end 12 may be fixed by adhesion, or may be fixed by being hooked to the hinge end 12 by attaching a caulking member to the bending wire 22. In this way, if the bending wire 22 and the hinge end 12 are fixed using the caulking member, the strength of the connection portion between the bending wire 22 and the hinge end 12 can be improved with a simple configuration, and the bending portion can be improved. Even when the stress due to the push-pull operation of the bending wire 22 for performing the bending of 4 is concentrated on the connecting portion, the bending wire 22 can be prevented from peeling off. The material and shape of the caulking member are not particularly limited as long as the strength of the connecting portion can be improved as described above. Specifically, a metal columnar member is used.

Further, a device wire 23 having one end connected to the operation unit 60 and the other end connected to the forceps 30 is inserted so as to pass through the axial center portion of the hinge member 10, and the device wire 23 is pushed and pulled. Thus, the forceps 30 can be opened and closed. Furthermore, the device wire 23 suppresses the sliding resistance with the hinge member 10 during pushing and pulling in the bent portion 4 and prevents the hinge members 10 from being displaced in the radial direction. The fluororesin tube 17 is inserted.

The bending wire 22 and the device wire 23 are respectively inserted into an inner sheath 21 (described later) attached to the hinge top 11. As shown in FIG. 13 (b), the bending wire 22 and the device wire 23 are each formed by welding a swaging wire 28 to one end of a single wire 27 of stainless steel wire. As shown in FIG. 13 (c), the swaging wire 28 is constituted by a wire in which a plurality of stainless steel wires are wound together and then pressed from the outer periphery, thereby crimping the twisted wires together.

With this configuration, the portion corresponding to the bent portion 4 can be arranged such that the swaging wire 28 is inserted and the single wire 27 is inserted into the portion corresponding to the sheath wire portion 5. As a result, the sheath wire portion 5 has a structure strong against elongation by the insertion of the single wire 27, and the bent portion 4 can have a structure with improved bendability. Since the swaging wire 28 has a structure in which the twisted wires are crimped together as described above, when welding the swaging wire 28 to the single wire 27, the solder flows out between the twisted wires due to capillary action. Can be prevented, thereby improving the weldability.

Further, the bending wire 22 and the device wire 23 are subjected to surface treatment to suppress sliding resistance in the inner sheath 21. In this case, as shown in FIG. 13B, the outer periphery of the single wire 27 and the swaging wire 28 is inserted into the inner sheath except for the distal end side of the swaging wire 28 and the proximal end side of the single wire 27. It is preferable that a surface treatment is applied to the part. Furthermore, it is preferable to use a fluorocarbon resin or a fluorocarbon resin such as polytetrafluoroethylene (PTFE) for the surface treatment.

The sheath 20 extends to the hinge top 11, and the hinge top 11 is bent among the inner sheaths 21 constituting the sheath 20 by fitting to the hinge base 13 as shown in FIG. 6. The inner sheath 21 through which the wire 22 is inserted is guided outward. With this configuration, the bending wire 22 is smoothly guided from the sheath 20 to the bending portion 4. The inner sheath 21 is joined to the end surface of the hinge top 11 by adhesion, welding, or the like.

As shown in FIG. 7, the forceps 30 opens and closes when a pair of

forceps pieces

31 and 31 ′ rotate with respect to a pin 33 as a pivot. The

forceps pieces

31, 31 ′ are attached to the base end side, and open /

close wires

34, 34 ′ crossing each other are attached. The open /

close wires

34, 34 ′ are interlocked with the push-pull operation of the device wire 23. It is connected to a moving body 32 that moves. The moving body 32 and the open /

close wires

34 and 34 ′ are accommodated in the forceps base 35.

According to such a configuration, in the state where the device wire 23 is pulled, the moving body 32 moves to the hinge end 12 side as shown in FIG. It intersects so that it may become an acute angle with respect to an axial direction. At this time, since the connection ends of the open /

close wires

34 and 34 ′ with the forceps piece 31 are close to each other, the

forceps pieces

31 and 31 ′ are closed in conjunction with the operation of the open /

close wires

34 and 34 ′.

In the state where the device wire 23 is pushed, the moving body 32 is separated from the hinge end 12 and pushed out toward the

forceps pieces

31 and 31 as shown in FIG. 7B. At this time, the open /

close wires

34 and 34 intersect so that the crossing angle thereof becomes an obtuse angle with respect to the axial direction, so that the connection ends of the open /

close wires

34 and 34 and the forceps piece 31 are separated from each other, , 31 are opened in conjunction with the operation of the open /

close wires

34, 34.

On the other hand, as shown in FIG. 8, an electric knife 36 is attached to the bending instrument 1b for a knife through a distal end portion 37. Since the configuration of the bending portion 4 and the sheath 20 is the same as that of the above-described forceps bending treatment instrument 1a, detailed description thereof will be omitted.

The electric knife 36 is a conductive member, and is a treatment member that conducts incision and cauterization of the affected part by conducting high-frequency current. For example, the tip is formed in a spherical shape or a hook shape. Further, the protruding amount from the distal end portion 37 is configured to be appropriately adjustable by pushing and pulling the device wire 23.

Further, in the female bending treatment instrument 1b, the slip prevention members 14a and 14b are interposed between the distal end portion 37 and the hinge member 10. Like the hinge member 10, the slip prevention members 14 a and 14 b are formed with a projecting portion and a recessed portion projecting in the axial direction on the end surface in the axial direction and a claw 15 projecting in the axial direction at one end in the axial direction. The other end is formed with a groove 16 that engages with the claw 15, and the claw 15 and the groove 16 are engaged with each other so that the distal end portion 37 is displaced in the radial direction with respect to the bent portion 4. Is preventing.

As shown in FIG. 9, the hinge member 10 is a substantially cylindrical member, and has an outer diameter of 3.8 mm or less. In addition, the outer diameter of the hinge member 10 and the sheath wire part 5 is preferably 3.8 mm, more preferably 3.2 mm, and preferably 2.8 mm. By forming in this dimension, the bending treatment tool 1 can be inserted into the endoscope channel 2a. Further, in the hinge member 10, a concave portion 42 is formed along the radial direction at the outer edge portion of the base end surface 41 on the base end side in the axial direction, and protrudes in the axial direction on the front end surface 43 on the front end side. A pair of convex portions 44 disposed opposite to each other is formed.

Further, the concave portion 42 and the convex portion 44 are arranged so as to be shifted from each other by 90 ° in the circumferential direction. Furthermore, the convex portion 44 is formed in an arc shape so as to be slidable with the concave portion 42 of the adjacent hinge member 10. As shown in FIG. 11, the recessed part 42 is comprised from the curved part 42a formed in the substantially same curvature as the circular arc shape of the convex part 44, and the

linear parts

42b and 42b extended from the both ends of the curved part 42a. By forming the concave portion 42 and the convex portion 44 in this way, the

adjacent hinge members

10 and 10 are fitted to each other when bent, and can be bent to the limit without difficulty.

The hinge member 10 is formed with a plurality of bending through holes 45 penetrating in parallel with the axial direction and a device through hole 46 penetrating the shaft center portion. The bending through holes 45 are arranged at substantially equal intervals in the circumferential direction, and are formed at four positions excluding the sliding surface of the convex portion 44 of the tip surface 43 with the concave portion 42. Since the bending through hole 45 is formed at a position excluding the sliding surface of the convex portion 44 with the concave portion 42 as described above, the adjacent convex portion 44 and the concave portion 42 slide to bend the bent portion 4. In this case, the bending wire 22 inserted into the bending through hole 45 does not hinder the sliding of the convex portion 44 and the concave portion 42, and a smooth bending operation can be realized. Note that the bending through-holes 45 are formed at two locations on both ends of the convex portion 44, respectively, and are formed at a total of four locations.

Further, as shown in FIG. 10 a, an interference preventing groove 44 a that prevents the bending wire 22 from interfering is formed in the convex portion 44 continuously from the outer edge portion of the bending through hole 45. Further, the bending through-hole 45 is formed in a so-called taper shape whose diameter increases from the central portion c along the axial direction toward the distal end surface 43 on the distal end side and the end surface 41 on the proximal end side. The base end surface 41 is formed as an inclined surface inclined at a predetermined angle, and the distal end surface 43 is also formed as an inclined surface inclined at a predetermined angle θ1, and the inclined portion 4 is adjacent to the bent portion 4 when it is bent. Interference between the leading end surface 43 and the base end surface 41 is prevented.

By configuring the hinge member 10 in this way, as shown in FIG. 12, when the bending treatment tool is bent, the bending wire 22 inserted through the bending through-hole 45 is pulled, whereby the bending treatment tool is pulled. In order to stick to the outer side in the bending direction of the through hole 45, it comes into contact with the contact point Pt on the inner peripheral surface of the bending through hole 45. As described above, the bending through-hole 45 of the hinge member 10 according to this embodiment is formed in a taper shape having a diameter that increases toward both end surfaces. The area through which the bending wire formed by 45 can be inserted can be increased, and as a result, the bending angle can be increased. In addition, since the movable region of the bending wire is widened, it is possible to improve the operability of the bending treatment instrument resulting from the wire pushing and pulling.

Further, as shown in FIG. 10b,

notches

44b and 44b that are notched so as to face each other may be formed at positions that are continuous with the distal end surface 43 on both side surfaces of the convex portion 44 in the width direction. I do not care. Thus, by forming the notch 44b, it can design so that the length of the outer peripheral surface of the convex part 44 can be taken as long as possible. As a result, when the bending treatment tool is bent by the

notches

44b and 44b, the range in which adjacent hinge members 10 interfere with each other is narrowed, and the inclination angle of the hinge member is increased to increase the bending angle of the bending treatment tool. It becomes possible to do. At this time, the concave portion 42 is formed in an arc shape so as to correspond to the arc shape of the convex portion 44, and the curvature of the concave portion 42 is preferably formed larger than the curvature of the convex portion 44.

In addition, as shown in FIG. 9, the through-hole 46 for devices is formed in the ellipse shape. By forming the device through hole 46 in an elliptical shape, the movable range of the device wire 23 that is inserted through the device through hole 46 in a state in which the bent portion 4 is bent can be secured in the long axis direction. As a result, the device wire 23 can be smoothly pushed and pulled even when the bent portion 4 is bent.

Furthermore, the device through hole 46 is formed so that the long axis and the direction orthogonal to the direction in which the convex portion 44 opposes are parallel. With this configuration, the convex portion 44 can be formed thick, so that a large sliding surface of the convex portion 44 can be secured and the rigidity of the bent portion 4 can be secured.

As shown in FIGS. 13A and 14, the sheath wire portion 5 includes an inner sheath 21 through which a plurality of bending wires 22 and device wires 23 are inserted, and these inner sheaths 21 are collectively inserted. An outer sheath 24, a liner blade 25 that adheres to the outer surface of the outer sheath 24, and a protective tube 26 that adheres to the outer surface of the liner blade 25.

The inner sheath 21 has a function of guiding the pushing and pulling operation of the bending wire 22 and the device wire 23 and preventing these wires from interfering with each other. Is a so-called densely wound coil that is spirally wound with no gap. Thus, by using a flat wire, the strength of the inner sheath 21 can be ensured, the inner diameter can be increased, and the bending wire 22 and the device wire 23 inserted through the inner sheath 21 are provided. Pushing and pulling operations can be performed smoothly in the inner sheath 21. Further, by increasing the width of the flat wire to be used with respect to the thickness, the strength is increased, and the friction resistance when the bending wire 22 and the device wire 23 are pushed and pulled in the inner sheath 21 is increased. Can be reduced. Specifically, it is preferable that X: Y = 1: 10, where X is the thickness of the flat wire used and Y is the width of the flat wire. Further, the inner sheath 21 is configured not to buckle or expand / contract due to the pushing / pulling operation of the bending wire 22 and the device wire 23 by being configured as a closely wound coil.

On the other hand, when a round wire having a round cross section is used for the inner sheath 21, adjacent round wires come into line contact with each other when wound in a spiral shape. When the inner sheath 21 is bent at the time of storage or the like, the line contact position moves in the circumferential direction, and the round wire buckles, thereby causing a problem that the inner sheath 21 contracts. In addition, when the round wire is tightly wound, not only does it buckle and shrink, but there is also a problem that it does not return while being deformed. Further, as shown in FIG. 14, the inner sheath 21 through which the bending wire 22 is inserted is disposed so as to surround the inner sheath 21 through which the device wire 23 is inserted.

The outer sheath 24 is a member constituting the skeleton of the sheath wire portion 5 and has a function of protecting the bending wire 22 and the device wire 23 and transmitting the rotational force of the entire bending treatment instrument. The outer sheath 24 is configured by spirally winding a flat wire having a flat cross section made of metal, like the inner sheath 21, but is configured as a so-called loosely wound coil having a predetermined gap. . By configuring the coil as a loosely wound coil in this way, the bendability in the bending direction is improved, and even when bent with a small-diameter bend, the sheath / wire portion 5 follows the bending of the endoscope channel without causing buckling. Can be bent smoothly. As described above, since the inner sheath 21 is configured to be tightly wound, the inner sheath 21 itself is prevented from shrinking. Therefore, even if the outer sheath 24 is configured to be loosely wound, the sheath -Shrinkage of the wire part 5 can be suppressed as much as possible.

The liner blade 25 has a function of preventing the operation shaft from being shaken by the external force when an external force is applied to the bent portion 4 due to a load such as a grasping operation of the forceps 30 or an excision operation of the electric knife 36. A mesh structure in which manufactured wires are crossed and knitted is preferably used.

The protective tube 26 is a member that covers and protects the sheath wire portion 5 and electrically insulates the high frequency high voltage applied to the electric knife 36. Specifically, it is preferable to use a heat shrinkable tube made of polyolefin or the like.

As described above, according to the bending treatment instrument according to this embodiment, the outer diameters of the bent portion 4 and the sheath wire portion 5 are minimized to 3.8 mm or less that can be inserted into the endoscope channel 2a. However, when the bending portion 4 is bent, there is no possibility that the bending operation is hindered by the interference between the bending wire 22 or the device wire 23 inserted through the inside of the bending portion 4 and the hinge member 10. The pushing and pulling operation of the bending wire 22 and the device wire 23 by the operation can be reliably transmitted to the bending portion 4, the forceps 30 and the electric knife 36.

In addition, even when the outer diameter of the sheath wire portion 5 is minimized, the sheath wire portion 5 is not twisted and the operation shaft is not shaken. As a result, a more intuitive operation is possible.

Further, the bent portion 4 is constituted by the hinge member 10 that engages with each other in a concave-convex manner, and ensures a large sliding surface between the convex portion 44 and the concave portion 42, and the convex portion 44 is formed as thick as possible. In addition, it can sufficiently withstand the load caused by the grasping operation of the forceps 30 and the excision operation of the electric knife 36.

As shown in FIG. 15, the operation section 60 is attached to the fixed base connection section 62 via a slider mechanism 64 that can slide the operation section main body 63 in the longitudinal direction. By sliding the slider mechanism 64 in the longitudinal direction, the bent portion 4 and the sheath wire portion 5 can be pushed and pulled along the longitudinal direction, whereby the forceps 30 attached to the distal end of the bent portion 4 or the electric The amount of protrusion of the knife 36 from the endoscope channel 2a or the treatment instrument insertion tube 2b can be adjusted.

The fixed base connection part 62 includes a holding means 71. The holding means 71 is formed with a groove-like first mooring portion 72a and a second mooring portion 72b extending perpendicular to the longitudinal direction. The first mooring part 72a is formed higher than the second mooring part 72b.

Further, a twisting force relief mechanism 110 is attached to the distal end side of the operation unit main body 63, and a cover body 79 is attached so as to cover the twisting force relief mechanism 110. The cover body 79 is perpendicular to the first mooring part 72a and the second mooring part 72b formed in the holding means 71 along the extending direction of the first mooring part 72a and the second mooring part 72b. By being press-fitted from the direction, it is possible to moor the fixed base connecting portion 62, and the operating portion main body 63 is held in the longitudinal direction by the mooring. Since the first mooring portion 72a is formed longer than the second mooring portion 72b, the frictional force with the second mooring portion 72b is reduced when the operation portion main body 63 is attached and detached. Can be easily attached and detached.

The operation portion 60 is bent by rotating the grip 61 connected to the plurality of bending wires 22 inserted through the sheath wire portion 5 up and down and left and right like a joystick with respect to the operation portion main body 63. The wire inserted and connected to the portion 4 is pushed and pulled in the longitudinal direction, whereby the bending portion 4 is bent. Further, the grip 61 includes an operation moving body 69, and the operation moving body 69 can be pushed and pulled in the longitudinal direction. By this operation, the device wire 23 connected to the forceps 30 and the electric knife 36 is pushed. By pulling, the opening / closing operation of the forceps 30 and the operation of the electric knife 36 are performed.

The grip 61 includes a bending wire pulling portion 66 to which the bending wire 22 is attached and a grip portion 67 to which the device wire 23 is attached. The operation unit body 63 accommodates a guide unit 65, and the device wire 23 passes through the guide unit 65.

As shown in FIG. 16, the operation portion main body 63 is assembled to the cover body 79 via a rotating means 90 that rotatably assembles the operation portion main body 63 with respect to the fixed base connecting portion 62. The rotation means 90 includes a rotation groove 63a formed in the circumferential direction of the operation section main body 63, a locking member 96 made of an elastic material such as rubber, and a rotation protrusion formed in the cover body 79 corresponding to the rotation groove 63a. Part 95, and the relative rotation between the operation part main body 63 and the cover body 79 is locked by the mutual frictional force caused by the rotation protrusion 95 being pressed by the locking member 96. Since the cover body 79 and the operation unit main body 63 are locked only by a frictional force, the operation unit main body 63 is relatively easily provided by applying a rotational force that rotates the operation unit main body 63 in the circumferential direction. Can be rotated, and the bending direction of the bending portion 4 and the operation direction of the grip 61 can be matched to improve the operability.

In the bending treatment instrument 1 according to this embodiment, the shaft fixing means 100 attached to the sheath / wire portion 5 can be fixed to the endoscope holder installed in the flexible endoscope 2, so that the bending treatment instrument 1 is inserted. The posture can be fixed, thereby suppressing the bending portion 4 and the sheath wire portion 5 from rotating in the endoscope channel 2a and the treatment instrument insertion tube 2b, and the operation direction and bending of the grip portion 61. The necessity of the axis alignment operation | work which makes the bending direction of the part 4 correspond is avoided.

However, according to such a configuration, when an excessive twisting force is generated in the sheath / wire portion 5 or the like during handling of the operation unit 60, a load is applied to the shaft fixing unit 100, and the shaft fixing unit 100 is operated by the endoscope. It is conceivable that problems such as falling off the holder will occur. In order to prevent this, when a twisting force is generated in the sheath wire portion 5, a twisting force relief mechanism 110 that disperses the twisting force is attached to the operation unit 60.

As shown in FIG. 17, the twisting force relief mechanism 110 includes a twisting force relief mechanism main body 111 through which the bending wire 22 and the device wire 23 inserted through the sheath wire portion 5 are inserted, and a twisting force relief mechanism. And a rotating body 112 that is assembled to the mechanism body 111 so as to be rotatable in the circumferential direction. The rotating body 112 is moored at the end of the sheath wire part 5 and, as shown in FIG. 15, is held between the twisting force relief mechanism main body 111 and the covering member 113. The wire 23 and the bending wire 22 are held immovably in the insertion direction.

According to the torsional force relief mechanism 110 configured as described above, even if a torsional force is generated between the operation unit 60 and the sheath / wire unit 5 during handling of the operation unit 60, the rotating body 112 has a torsional force. Accordingly, the twisting force is dispersed by rotating in accordance with the rotation of the shaft fixing means 100 to prevent the load from being applied to the shaft fixing means 100.

Next, the shaft fixing means 100 will be described with reference to FIGS. As shown in FIGS. 18 and 18, the shaft fixing means 100 includes a shaft fixing means main body 101 through which the sheath wire portion 5 is inserted, and a tip locking portion 102 attached to the tip end side of the shaft fixing means main body 101. It has. The shaft fixing means main body 101 is formed with a holder fixing portion 101a that is fixed to the endoscope holder, and the insertion posture of the bending treatment instrument 1 is fixed by fixing the holder fixing portion 101a to the endoscope holder. can do. The end portion 100a on the bent portion 4 side of the shaft fixing means 100 is such that when the shaft fixing means 100 is held at the entrance of the endoscope channel 2a, the turning center axis of the flexible endoscope 2 and the shaft fixing means 100 are connected. Curved to be parallel.

Thus, by curving the end portion 100a on the bent portion 4 side of the shaft fixing means 100, the turning range of the shaft fixing means 100 is reduced as shown in FIG. There is less risk of disturbing the arrangement and movement of people and objects when turning the wheel. On the other hand, when the end portion 100a on the bent portion 4 side of the shaft fixing means 100 is linear, the turning range of the shaft fixing means 100 is increased as shown in FIG. There is a greater risk of disturbing the arrangement and movement of people and objects when turning 2.

As shown in FIG. 20 and FIG. 21, the shaft fixing means main body 101 includes a shaft fixing portion 104 in which a groove 104a is formed along the longitudinal direction, and the groove 104a is provided on the outer periphery of the sheath wire portion 5. When the fixed engagement protrusion 105 is fitted, the sheath wire portion 5 can slide in the longitudinal direction, and the sheath wire member 5 is inserted when the device is inserted into the flexible endoscope 2. It is possible to prevent twisting of the device due to twisting around the axis. The engagement protrusion 105 can be formed by fixing a pipe-shaped member having a protrusion on the outer surface to the sheath wire member 5 with an adhesive or the like. For the shaft fixing portion 104 and the engagement protrusion 105, it is necessary to select materials having good sliding properties in order to reduce the contact resistance.

By configuring in this way, the operation direction of the bending treatment instrument and the movement of the device coincide with each other, so that an intuitive operation is possible and the operability of the bending treatment instrument is improved. In addition, it is not necessary to perform an axis alignment operation that matches the operation direction of the grip 61 and the bending direction of the bending portion 4.

Note that a distal end locking portion 102 and a proximal end locking portion 103 are attached to both ends in the longitudinal direction of the shaft fixing portion 104, and the engagement protrusion 105 is attached to the distal end locking portion 102 and the proximal end locking portion 103. By abutting, the sliding in the longitudinal direction is restricted so that the engaging protrusion 105 does not fall out of the groove 104 a of the shaft fixing portion 104.

In the bending treatment instrument according to this embodiment, the case where the forceps bending treatment instrument 1a and the female bending treatment instrument 1b are respectively inserted into the endoscope channel 2a and the treatment instrument insertion tube 2b and used simultaneously will be described. However, only one of the forceps bending treatment tool 1a and the female bending treatment tool 1b may be used. Alternatively, in addition to the forceps bending treatment tool 1a and the female bending treatment tool 1b, for example, a clip bending treatment tool, an exclusion bending treatment tool, a needle holding device bending treatment tool, or the like may be used instead. In the bending treatment instrument according to the above-described embodiment, the case where the bending through holes 45 are formed at the four positions of the hinge member 10 has been described. However, the number of the bending through holes 45 can be appropriately changed. It is. Furthermore, in the bending treatment tool according to the above-described embodiment, the case where the device through hole 46 is formed in an elliptical shape has been described. If a sufficient movable range of the device wire 23 can be secured, for example, It may be formed in a circular shape.

1: Bending treatment tool 1a: Bending treatment tool for forceps 1b: Bending treatment tool for female 2: Soft endoscope 2a: Endoscope channel 2b: Tube for treatment tool insertion 3: Patient 3a: Affected part 4: Bending part 5: Sheath wire portion 10: Hinge member 11: Hinge top 12: Hinge end 13: Hinge base 14a, 14b: Displacement prevention member 15: Claw 16: Groove 17: Fluororesin tube 20: Sheath 21: Inner sheath 22: Bending wire 23: Device wire 24: Outer sheath 25: Liner blade 26: Protection tube 27: Single wire 28: Swaging wire 30: Forceps 31, 31 ': Forceps piece 32: Moving body 33: Pins 34, 34': Open / close wire 35 : Forceps base 36: electric knife 37: distal end portion 41: proximal end surface 42: recessed portion 42a: curved portion 42b: linear portion 43: distal end surface 4 : Protruding part 44a: Interference prevention groove 44b: Notch 45: Bending through hole 46: Device through hole 60: Operating part 61: Grip 62: Fixing base connecting part 63: Operating part main body 63a: Rotating groove 64: Slider mechanism 65: Guide portion 66: Bending wire pulling portion 67: Grip portion 69: Operation moving body 71: Holding means 72a: First mooring portion 72b: Second mooring portion 79: Cover body 90: Rotating means 95: Rotating protrusion 96: Locking member 100: Shaft fixing means 100a: End portion 101: Shaft fixing means body 101a: Holder fixing portion 102: Tip locking portion 103: Base end locking portion 104: Shaft fixing portion 104a: Groove 105: Engagement Projection 110: Torsional force relief mechanism 110: Torsional force relief mechanism main body 112: Rotating body 113: Cover member

Claims

A bending portion having a treatment member attached to a distal end thereof, an operation portion for performing bending operation of the bending portion, opening / closing operation of forceps as the treatment member, and movement operation of a knife as the treatment member, and operation of the operation portion A sheath wire portion for transmitting, and shaft fixing means for preventing rotation of the sheath wire portion around an axis, the shaft fixing means comprising: an engaging protrusion fixed to the sheath wire portion; A groove that engages with the mating protrusion, and a shaft fixing portion that allows movement of the sheath wire portion in the axial direction and prevents rotation of the sheath wire portion around the axis, and the shaft fixing The end portion on the bent portion side of the means is bent so that the turning center axis of the flexible endoscope and the shaft fixing means are parallel when the shaft fixing means is held in the endoscope channel. A bending treatment instrument characterized by comprising:
The sheath wire portion is inserted with a device sheath through which a device wire connected to the treatment member and operating the treatment member is inserted, and a plurality of bending wires for bending the bending portion. The bending treatment device according to claim 1, comprising an inner sheath including a bending sheath, an outer sheath that covers the inner sheath together, and a liner blade that covers the outer sheath.
The bending treatment tool according to claim 1 or 2, wherein the shaft fixing means includes a holder fixing portion fixed to the endoscope holder.
The bending treatment tool according to any one of claims 1 to 3, wherein a locking portion that closes the groove is provided at at least one end of the shaft fixing portion.
5. The bending treatment according to claim 2, wherein at least one of the device wire and the bending wire includes a swaging wire fixed to one end of a single wire. 6. Ingredients.