JP2009112538A - Treatment instrument for endoscope - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a treatment instrument for an endoscope capable of applying a bending shape retaining function of prescribed strength to a desired range of a flexible sheath, and capable of securely and easily changing the state to a state in which the instrument is passively deformed with external force or to a state in which the bending shape at any optional time can be stably retained. <P>SOLUTION: A plurality of joint rings 7 are connected in series, and by drawing a shape-retaining operation wire 15 passing through a wire guide hole 91 bored in each joint ring 7 from the proximal end side, the friction resistance between the shape-retaining operation wire 15 and the wire guide hole 91 increases, so that the bending shape of a bending shape retainable part 11 is retained. <P>COPYRIGHT: (C)2009,JPO&INPIT

Description

  The present invention relates to an endoscope treatment tool having a flexible sheath that is inserted into and removed from a treatment tool insertion channel of an endoscope.

  Intra-abdominal surgery such as cholecystectomy was previously performed by so-called laparotomy in which the abdomen is incised. Recently, a few centimeters of holes are made in the abdomen, and then a rigid endoscope is used. Laparoscopic surgery in which treatment is performed by inserting a laparoscope, a surgical treatment tool, or the like is widely performed. However, even in such a laparoscopic operation, it takes a certain amount of time for the patient who has undergone the operation to recover, and even though it is small, a wound remains on the patient's body surface.

  Therefore, a flexible endoscope is inserted into the stomach through the mouth, and a hole is made in the stomach wall with a treatment instrument passed through the treatment instrument insertion channel of the flexible endoscope, and then transendoscopically ( That is, a technique for performing intra-abdominal surgery (through a treatment instrument insertion channel of an endoscope) has attracted attention. The hole made in the stomach wall is closed with an endoscopic clip after the operation is completed.

  However, it is difficult to stabilize the posture and orientation of the distal end of the flexible endoscope during surgery for a long time, and the posture and orientation of the distal end of the insertion portion during endoscopic surgery are intended by the operator. On the contrary, transendoscopic intraperitoneal surgery cannot be performed smoothly.

Therefore, the flexible sheath of the treatment instrument is provided with a function for switching between a state in which the bent shape can be passively changed and a state in which the bent shape at an arbitrary time can be maintained as it is, and the endoscope. It is conceivable that the posture and orientation of the distal end of the flexible sheath during the operation can be controlled as the operator desires (for example, Patent Document 1).
JP 2005-46272 A

  In the conventional endoscope treatment tool described in Patent Document 1, two spiral tubes formed by spirally winding a belt-like member with a constant diameter are overlapped in the radial direction and placed in the insertion portion flexible tube. Bending shape maintenance function by generating a frictional force between two spiral tubes that are in pressure contact by twisting the inner spiral tube in the direction of increasing diameter from the base end to the direction around the axis. Is to be obtained.

  However, in such a configuration, when one spiral tube is rotated from the proximal end side in the direction around the axis, the diameter of the spiral tube increases smoothly in the region near the proximal end, but the region closer to the distal end has a larger diameter. There is a problem that it is difficult to obtain a sufficient bent shape holding function due to less spread, and a satisfactory bent shape holding function cannot be obtained because there is almost no pressure contact force between the two spiral tubes especially in the vicinity of the leading edge. .

  The present invention can provide a bent shape holding function having a desired strength within a desired range of the flexible sheath, and can stabilize the bent shape at an arbitrary point in time when the shape is passively changed by an external force. It is an object of the present invention to provide an endoscopic treatment tool that can reliably and easily switch between a state where it can be held and held.

  In order to achieve the above object, an endoscope treatment tool according to the present invention is provided on a part or all of a flexible sheath in which a treatment member is disposed at a distal end and is inserted into and removed from a treatment tool insertion channel of an endoscope. A bent shape-maintainable tube having a framework in which a plurality of short cylindrical joint rings are connected in series with a connecting shaft so as to be relatively rotatable with adjacent joint rings, and are bent in all directions as a whole. And at least three flexible shape-maintaining operation wires are connected to the tip of the bent shape-holdable tube portion, and the shape is formed in the wire guide hole provided in each joint ring. The holding operation wire is inserted, and the wire guide hole has a diameter through which the shape holding operation wire inserted therethrough passes loosely, and the shape holding operation is increased as the tension applied to the shape holding operation wire increases. Friction between wires As a result, in the state where each shape-holding operation wire is not pulled from the base end side, the bent shape-holdable tube portion is passively changeable, When the shape-maintaining operation wire is pulled from the proximal end side, the frictional resistance between each shape-maintaining operation wire and the wire guide hole is increased corresponding to the increase in the tension applied to all the shape-maintaining operation wires. By increasing, the bent shape of the bent shape holdable tube portion is held.

  Note that the wire guide hole may be formed in a substantially U-shaped shape, and the operation portion is connected to the proximal end side of the flexible sheath, so that the proximal end portion of each shape holding operation wire is Wire pulling operation for pulling together the proximal end of all shape-holding operation wires, as well as being arranged in the operation unit so as to advance and retreat in the axial direction following the bent state of the tube that can hold the bent shape The apparatus may be provided in the operation unit.

  The operation section may be provided with wire tension adjusting means for equalizing the tension of all the shape holding operation wires, and the wire tension adjusting means is one of all the shape holding operation wires. The axial positional relationship between the first wire engaging member engaged with the proximal end of the shape-retaining operation wire and the second wire engaging member engaged with the proximal end of the other shape-retaining operation wire You may adjust.

  Also, it is preferable that at least three shape-maintaining operation wires are arranged at intervals between each other in a positional relationship that there is no interval of 180 ° or more around the axis of the bent shape-maintainable tube portion. As the holding operation wires, four shape holding operation wires may be arranged at intervals of approximately 90 ° around the axis of the bent shape holding tube.

  In addition, when the tube portion that can hold the bent shape is provided near the distal end of the flexible sheath, the shape of the flexible sheath other than the tube portion that can hold the bent shape can be passively changed by an external force. The flexible shaft portion may be a flexible shaft portion that does not have shape retention, and a flexible guide pipe that guides each shape retention operation wire so as to advance and retreat in the axial direction is disposed in the flexible shaft portion. May be.

  According to the present invention, the friction between the shape holding operation wire and the wire guide hole is obtained by pulling the shape holding operation wire passing through the wire guide hole provided in each joint ring from the proximal end side. Since the resistance increases and the bent shape of the bendable shape is maintained, the bent shape of the desired strength can be set within the desired range of the flexible sheath by appropriately setting the shape of the wire guide hole. A holding function can be provided, and a state in which the shape is passively changed by an external force and a state in which the bent shape at an arbitrary time can be stably held can be switched reliably and easily.

  A plurality of short cylindrical articular rings are relatively disposed on a part or all of the flexible sheath that is disposed at the distal end and is inserted into and removed from the treatment instrument insertion channel of the endoscope. A bent shape holdable tube portion having a framework that is connected in series with a connecting shaft so as to be freely rotatable and bent in all directions as a whole is provided, and a flexible portion is provided at a distal end portion of the bent shape holdable tube portion. The tips of at least three shape-maintaining operation wires having a shape are connected to each other, and the shape-maintaining operation wires are inserted into the wire guide holes provided in the respective joint rings, and the wire guide holes are inserted into the shape. The holding operation wire has a diameter that passes gently, and is formed into a curved shape in which the frictional resistance with the shape holding operation wire increases as the tension applied to the shape holding operation wire increases. , Each shape In a state where the holding operation wire is not pulled from the proximal end side, the bent shape-holdable tube portion is passively changeable in shape, and when all the shape holding operation wires are pulled from the proximal end side, In response to the increase in tension applied to all the shape-maintaining operation wires, the frictional resistance between each shape-maintaining operation wire and the wire guide hole is increased, so that the bent shape of the tube portion that can hold the bent shape is maintained. To be.

Embodiments of the present invention will be described below with reference to the drawings.
FIG. 3 shows the overall configuration of the endoscope treatment tool according to the embodiment of the present invention, and the endoscope treatment tool can be bent as a whole in any direction and is inserted into the treatment tool insertion channel of the endoscope. A flexible sheath 1 that can be inserted and removed, an operation unit 2 connected to the proximal end of the flexible sheath 1, and a treatment member 3 provided at the distal end of the flexible sheath 1 are configured.

  The treatment member 3 of this embodiment is a pair of forceps cups for collecting a biopsy tissue that are provided so as to be openable and closable in a bowl shape toward the front, and a distal support body 10 connected to the distal end of the flexible sheath 1. It is pivotally supported to open and close. However, the treatment member 3 may be a treatment means other than the forceps cup, such as a high-frequency incision knife or a laser knife.

  The total length of the flexible sheath 1 is, for example, about 1 to 2 m, and a portion close to the tip of the flexible sheath 1 (for example, a region about 5 to 30 cm from the tip) can be bent in any direction and can be bent. It is part 11. Further, the remaining proximal end portion of the flexible sheath 1 is a flexible shaft portion 12 that can be bent in any direction.

  The difference between the bent shape-maintainable tube portion 11 and the flexible shaft portion 12 is that the bent shape-maintainable tube portion 11 is different from the operation female screw ring 5 (wire pulling operation device) in which the bent shape is arranged in the operation portion 2. Although it can hold | maintain by operation, the flexible shaft part 12 is a point which cannot hold | maintain the bent shape, and the point is mentioned later in detail.

  It should be noted that the flexible shaft 12 is not necessarily provided depending on the use or procedure of the endoscope treatment tool. In that case, the entire region of the flexible sheath 1 becomes the bent shape-maintainable tube portion 11. Further, there may be a hard part or a semi-rigid part between the bent shape-maintainable tube part 11 and the flexible shaft part 12 or on the proximal side of the flexible shaft part 12.

  A flexible treatment member operation wire 4 for opening and closing the treatment member 3 is inserted through the entire length of the flexible sheath 1 so as to be movable back and forth in the axial direction, and the proximal end of the treatment member operation wire 4 is The operation unit 2 is reached.

  In the operation unit 2, a slide operation member 14 connected to the proximal end of the treatment member operation wire 4 is arranged so as to be slidable with respect to the operation unit frame 13, and by moving the slide operation member 14 forward and backward, The treatment member operation wire 4 advances and retreats in the axial direction within the flexible sheath 1, and the treatment member 3 is driven to open and close by a known link mechanism built in the distal end support body 10.

  FIG. 4 shows the configuration of the flexible sheath 1. The treatment member operation wire 4 is not shown in FIG. 4 except for the vicinity of the most distal portion, but is inserted and disposed over the entire length of the flexible sheath 1 as described above.

  The bent shape-maintainable tube portion 11 includes a plurality of (for example, about 10 to 100) short cylindrical joint rings 7 that are adjacent to each other in the tongue piece portion in which the joint rings 7 protrude in the front-rear direction. Are connected in series by a connecting shaft 8 so as to be rotatable relative to each other, and as a whole, has a framework that can be bent in any direction. Since the articulation ring 7 only needs to have a thickness of about 0.3 to 0.4 mm, the outer diameter can be reduced.

  FIG. 5 illustrates a state in which the framework of the bent shape-maintainable tube portion 11 is bent to the maximum extent, and such a configuration and function are the same as those of a curved portion of a general endoscope. The arrangement of the connecting shaft 8 changes by 90 ° at the front and rear positions of each joint ring 7. However, other angle changes (for example, 60 °, etc.) may be used.

  Returning again to FIG. 4, the distal end of the shape-maintaining operation wire 15 is fixedly connected to the inner peripheral portion of the most advanced joint ring 7 </ b> A of the bent shape-maintainable tube portion 11. As the shape maintaining operation wire 15, a rope-like stainless steel stranded wire or the like similar to a bending operation wire of a general endoscope can be used, and a surface coating or the like is applied to improve durability. It may be.

  In the bent shape-maintainable tube portion 11 of this embodiment, four shape-maintaining operation wires 15 are arranged at approximately 90 ° around the axis as shown in FIG. 6 illustrating a VI-VI cross section in FIG. They are arranged at intervals and guided through the wire guide holes 91 of the wire guides 9 arranged to project inward from the inner peripheral portion of each joint ring 7.

  As shown in FIG. 7, the wire guide 9 corresponds to the position of the connecting shaft hole 71 drilled in each joint ring 7 so as to pass the connecting shaft 8, for each inner peripheral portion of each joint ring 7. Four are attached at intervals of 90 °. Reference numeral 92 denotes a mounting foot which is formed so as to protrude from each wire guide 9 and is inserted into the mounting hole of the joint ring 7 and mechanically fixed thereto.

  In this embodiment, the wire guide hole 91 penetratingly formed in the wire guide 9 in the front-rear direction is, as shown in FIG. 4 and FIG. 11 is formed in a shape bent in a substantially “<” shape on a plane including the axis of the bendable shape-maintainable tube portion 11 in a state where the intermediate portion is positioned closer to the outer periphery than the axial line of the bent portion 11. Yes.

  The wire guide hole 91 is formed to have an inner diameter dimension through which the shape maintaining operation wire 15 passes loosely over the entire length, but as shown in FIG. 8 and FIG. 2 which is a partially enlarged view thereof, the shape maintaining operation wire 15 is formed. Is curved to such an extent that it cannot be straightened even if it is pulled straight from the base end and becomes straight due to tension.

  In other words, each wire guide hole 91 passes while bending along the curved shape of the wire guide hole 91 if it is a flexible shape-maintaining operation wire 15, but a hard pipe having the same diameter as the shape-maintaining operation wire 15. Is formed in a curved shape so that it cannot pass through.

  With such a configuration, when all the four shape-retaining operation wires 15 are pulled simultaneously from the proximal end side, each shape corresponds to an increase in tension applied to all four shape-retaining operation wires 15. The frictional resistance between the holding operation wire 15 and the wire guide hole 91 increases.

  The inner peripheral wall surface portion of the wire guide hole 91 with which the pulled shape-maintaining operation wire 15 is slidably contacted is smoothly rounded to prevent the shape-maintaining operation wire 15 from being damaged. In addition, the wire guide hole 91 of this embodiment is curved on a plane including the axis of the bent shape-maintainable tube portion 11, but this is not necessarily required, and the circumferential direction of the bent shape-maintainable tube portion 11 is not limited. It may be curved in the direction.

  The bent shape-maintainable tube portion 11 is watertightly covered with a flexible and elastic outer tube 16 such as a rubber tube or the like, so that the outer tube 16 is not sandwiched between the gaps between the adjacent joint rings 7. A mesh tube 19 is disposed inside the outer tube 16.

  Returning to FIG. 4, the framework of the flexible shaft portion 12 is formed by, for example, a coil pipe 18 in which a stainless steel wire is spirally wound with a constant diameter. However, it may be formed of a spiral tube or a multi-lumen tube in which a stainless steel strip or the like is spirally wound with a constant diameter.

  The outer surface of the coil pipe 18 of the flexible shaft portion 12 is continuously covered with the outer tube 16 that extends over the tube portion 11 that can hold the bent shape. However, the flexible shaft portion 12 may not be covered with the outer tube 16, and the bent shape-maintainable tube portion 11 and the flexible shaft portion 12 may be covered with different outer tube.

  As shown in FIG. 9 illustrating a cross section IX-IX in FIG. 4, the treatment member operation wire 4 is disposed in the vicinity of the axial line in the flexible shaft portion 12, and four wires are disposed in the inner space around the treatment member operation wire 4. The shape maintaining operation wire 15 is disposed through the flexible guide pipe 17 over the entire length in the flexible shaft portion 12.

  Each guide pipe 17 is formed of a coil pipe in which a metal wire such as a stainless steel wire or the like is tightly wound with a certain diameter. However, any flexible pipe that has excellent compression resistance in the axial direction can be used other than the coil pipe.

  The leading end portions of the four guide pipes 17 are arranged at approximately 90 ° intervals around the axis in accordance with the arrangement of the wire guides 9 in the bent shape-holdable tube portion 11, and the bent shape-holdable tube portion 11 and the flexible shaft portion. 12 is fixed to the inner peripheral portion in the vicinity of the boundary portion with respect to 12.

  And the base end of each guide pipe 17 arrange | positioned in parallel with an axis line in the flexible shaft part 12 is fixed in the operation part 2 connected with the base end of the flexible shaft part 12, and shape maintenance is carried out from there. The proximal end of the operation wire 15 is extended.

  The flexible shaft portion 12 configured in this manner has a bent shape corresponding to the force received from the surroundings and the bent shape change of the insertion portion of the endoscope treatment tool inserted into the treatment member operation wire 4. It is always passively changeable in three dimensions and does not have the characteristic of maintaining its bent shape.

  FIG. 10 and FIG. 11 each illustrate only the framework of the bent shape-maintainable tube portion 11. As shown in FIG. 10, the bent shape-maintainable tube portion 11 has a shape that can be passively changed three-dimensionally in a state where the shape-maintaining operation wire 15 is not pulled from the proximal end side, Due to the force received from the surroundings, for example, the bent shape passively changes as shown by a two-dot chain line.

  Then, as shown in FIG. 11, when all the four shape-retaining operation wires 15 are pulled simultaneously from the base end side, the tension applied to all the four shape-retaining operation wires 15 increases. In response to the increase in the frictional resistance between each shape-holding operation wire 15 and the wire guide hole 91, the bent shape of the tube portion 11 that can hold the bent shape (Note: straight when the bending angle is zero) The bent shape of the tube portion 11 that can hold the bent shape does not change.

  In this way, in the present invention, the bent shape of the tube portion 11 capable of holding the bent shape can be held by increasing the frictional resistance between each shape holding operation wire 15 and the wire guide hole 91. The force does not vary depending on the position in the longitudinal direction.

  As a result, by appropriately setting the shape and the like of the wire guide hole 91, it is possible to impart a bent shape holding function having a desired strength to a desired range of the flexible sheath 1, and passively by an external force or the like. It is possible to easily switch between a state in which the shape changes and a state in which the bent shape at an arbitrary time can be stably maintained.

  Further, the bent shape-maintainable tube portion 11 having a frame structure in which a large number of articulation rings 7 are connected in series is not heavy, is light and easy to use, and can be easily reduced in diameter to be inserted into an endoscope treatment instrument insertion portion. It can be easily inserted through the mouth.

  In order to prevent the shape of the bent shape-maintainable tube portion 11 from being changed by pulling all the shape-retaining operation wires 15 from the base end side, it is sufficient that at least three shape-retaining operation wires 15 are provided. . However, it is necessary to arrange the shape maintaining operation wires 15 at intervals between each other in a positional relationship in which there is no interval of 180 ° or more around the axis of the bent shape maintaining tube portion 11.

  Further, even when four shape-maintaining operation wires 15 are provided as in this embodiment, each shape-maintaining operation wire 15 has an interval of 180 ° or more around the axis of the tube portion 11 capable of holding the bent shape. If they are arranged in a non-existing positional relationship, it is not always necessary to arrange them at regular intervals.

  FIG. 12 shows a mechanism arranged inside the internal thread 5 for operation of the operation unit 2, and FIG. 13 is a sectional view taken along line XIII-XIII. However, FIG. 12 illustrates different cross sections (XII-XII cross section in FIG. 13) in the left half part and the right half part.

  21 is a substantially cylindrical pedestal to which the base end of the flexible sheath 1 (not shown) is connected and fixed, and the fixed platen 22 and the pedestal 21 arranged so as not to move with respect to the pedestal 21 are: The four guide shafts 23 are connected and fixed. The guide shaft 23 is arranged in parallel with the axis at 90 ° intervals around the axis of the pedestal 21. A base end portion of each guide pipe 17 is fixed to the base 21.

  A male screw threadedly engaged with a female screw formed on the inner peripheral part of the operating female screw ring 5 is provided on the outer peripheral part of the male screw cylinder 27 slidably supported by the four guide shafts 23 in the front-rear direction (vertical direction in the figure). Is formed. Reference numeral 30 denotes the screwing portion.

  Although the internal thread 5 for operation is rotatably arranged around the axis, movement in the axial direction is restricted by the base 21 and the fixed platen 22. Therefore, by rotating the operating female screw ring 5 around the axis, the male screw cylinder 27 screwed with the operating screw ring 5 is driven to advance and retreat in the axial direction along the guide shaft 23.

  Such a male screw cylinder 27 is illustrated with first and second wire engaging members 28 and 29 with which four shape-retaining operation wires 15 (15 (I) and 15 (O)) are engaged. It is connected and fixed with screws that are not. Reference numeral 32 denotes a fixing screw for connecting and fixing the first wire engaging member 28 and the second wire engaging member 29.

  On the outer surface of the first wire engaging member 28 formed in a substantially cylindrical shape, as shown in FIG. 14, there are two shapes connected together and smoothly bent back into a U shape. An inner wire engagement groove 28g with which the proximal loop portion of the holding operation wire 15 (I) is engaged is formed in a U shape. Note that the two shape-retaining operation wires 15 (I) can be formed by a single wire, and the inner wire engagement grooves are positioned 180 ° symmetrically with respect to the central axis of the first wire engagement member 28. It is engaged with 28g.

  The proximal end portion of the shape-retaining operation wire 15 (I) can be moved back and forth along the inner wire engaging groove 28g as indicated by an arrow α, and therefore the bent shape-retainable tube portion 11 is passive. When the bending operation is performed, the proximal end portion of the shape-maintaining operation wire 15 (I) freely moves forward and backward in the axial direction along the inner wire engagement groove 28g. It does not become resistance to the bending motion of Further, when the first wire engaging member 28 is moved backward (upward in the drawing), the two shape-maintaining operation wires 15 (I) are pulled with the same tension.

  A second wire engagement member 29 formed in a substantially cylindrical shape is fitted and fixed to the outer peripheral portion of the first wire engagement member 28 as shown in FIG. Also on the outer surface of the second wire engaging member 29, the proximal end loop portions of the two shape-retaining operation wires 15 (O) connected together and smoothly bent back into a U shape are engaged. The mating outer wire engaging groove 29g is formed in a U shape with a 90 ° phase shift from the inner wire engaging groove 28g.

  The proximal end portion of the shape-retaining operation wire 15 (O) can be moved forward and backward along the outer wire engaging groove 29g as indicated by an arrow β, and therefore the bent shape-retainable tube portion 11 is passive. When the bending operation is performed, the proximal end portion of the shape-maintaining operation wire 15 (O) freely moves forward and backward in the axial direction along the outer wire engaging groove 29g. It does not become resistance to the bending motion of Further, when the second wire engaging member 29 is moved backward (upward in the drawing), the two shape-retaining operation wires 15 (O) are pulled with the same tension.

  Accordingly, the first wire engaging member 28 and the second wire engaging member 29 that are connected and fixed by the fixing screw 32 described above are integrated into the rear in the axial direction (in the drawing, as indicated by an arrow γ). When moved upward), the four shape-retaining operation wires 15 (I) and 15 (O) are pulled together.

  It is to be noted that all the shapes can be retained by adjusting the connecting position (that is, the positional relationship in the axial direction) between the first wire engaging member 28 and the second wire engaging member 29 and fixing them with the fixing screw 32. The tension applied to the operation wires 15 (I) and 15 (O) can be made uniform.

  With such a configuration, in a state where the four shape-maintaining operation wires 15 (I) and 15 (O) are not pulled toward the operation portion 2, the bent shape-maintainable tube portion 11 is passively set as described above. When the four shape-retaining operation wires 15 are pulled together from the proximal end side by rotating the operation female screw ring 5, a uniform tension is applied to each shape-retaining operation wire 15. As a result, the bent shape of the bent shape-holdable tube portion 11 is maintained as described above.

  At that time, by adjusting the amount of rotation of the operating female thread ring 5, the shape retaining force of the bent shape-maintainable tube portion 11 can be adjusted as appropriate. If the operating female thread ring 5 is returned to its original state, The shape-maintainable tube portion 11 returns to the state in which it can passively bend again.

  FIG. 16 shows an example of the use state of the above-described endoscope treatment tool. First, the insertion portion 61 of the flexible endoscope 60 is inserted into the stomach from the patient's mouth A through the esophagus, A hole B is formed in the stomach wall with a gastric wall incision treatment tool (not shown) or the like passed through the treatment instrument insertion channel.

  And if the front-end | tip of the insertion part 61 of the flexible endoscope 60 is taken out to the back side of the stomach from the hole B, as FIG. 16 shows, the treatment tool for endoscopes of this invention will be a flexible endoscope. When the treatment member 3 is in a state of facing the gallbladder C and the like from the front through the 60 treatment instrument insertion channels, the bending shape of the tube portion 11 capable of holding the bent shape is fixed by operating the internal thread 5 for operation.

  As a result, the bent shape of the bendable shape-maintainable tube portion 11 can be held as it is for a long time, so that the treatment for the gallbladder C is performed with the treatment tool inserted into the treatment tool insertion channel of the flexible endoscope 60. Surgery can be performed safely and smoothly. The bent shape-maintainable tube portion 11 is less likely to buckle in a state where the bent shape is held, for example, even when the surface of the gallbladder C is hardened, so that there is little possibility that the affected portion cannot be approached or treated. . After the treatment is completed, the bent shape-maintainable tube portion 11 is returned to a passively bendable state and removed from the treatment instrument insertion channel.

  The present invention is not limited to the above-described embodiment. For example, as shown in FIG. 17, only two wire guides 9 are attached to the inner peripheral portion of each joint ring 7 at a 180 ° symmetrical position to be bent. The holdable tube portion 11 may be configured, and the shape maintaining operation wire 15 may be configured to pass through one wire guide hole 91 for every two joint rings 7. Moreover, the wire guide in which the wire guide hole is formed straight may be mixed.

  Further, the shape of the wire guide hole 91 is such that when the shape holding operation wire 15 is pulled, the frictional resistance increases corresponding to the increase in the tension applied to the shape holding operation wire 15 (that is, the shape holding). Any shape may be used as long as it is formed in such a shape that a hard pipe having the same diameter as the operation wire 15 cannot pass through.

  Further, a chain-like wire or a wire through which a perforated bead is passed may be used as the shape-retaining operation wire 15, and the mechanism for pulling the shape-retaining operation wire 15 in the operation unit 2 is capable of holding all shapes. Any mechanism may be used as long as the operating wire 15 can be pulled at the same time and the state can be maintained. Further, the treatment tool of the present invention may be provided with a bending portion that can be bent from the operation portion 2 near the distal end. Furthermore, the present invention can also be applied to a medical probe for observation (for example, an ultrasonic probe) used by being inserted through a treatment instrument insertion channel of an endoscope.

FIG. 6 is a partially enlarged side cross-sectional view of the tube portion capable of maintaining a bent shape in a state in which no tension is applied to the shape holding operation wire of the endoscope treatment tool according to the embodiment of the present invention. FIG. 6 is a partially enlarged side cross-sectional view of the bent shape-maintainable tube portion in a state where tension is applied to the shape-maintaining operation wire of the endoscope treatment tool according to the embodiment of the present invention. 1 is a side view showing an overall configuration of an endoscope treatment tool according to an embodiment of the present invention. It is side surface sectional drawing of the part near the front-end | tip of a flexible sheath in the state in which the tension | tensile_strength is not acting on the shape maintenance operation wire of the treatment tool for endoscopes which concerns on the Example of this invention. FIG. 6 is a perspective view of the endoscope treatment tool according to the embodiment of the present invention in a state where the framework of the bent shape-maintainable tube portion is bent. It is VI-VI sectional drawing in FIG. 4 of the treatment tool for endoscopes which concerns on the Example of this invention. It is a perspective view of the joint ring single-piece | unit with which the wire guide was attached of the treatment tool for endoscopes which concerns on the Example of this invention. It is side surface sectional drawing of the part near the front-end | tip of a flexible sheath in the state in which tension | tensile_strength is acting on the shape maintenance operation wire of the treatment tool for endoscopes which concerns on the Example of this invention. It is IX-IX sectional drawing in FIG. 4 of the treatment tool for endoscopes which concerns on the Example of this invention. It is side surface sectional drawing for demonstrating bending | flexion operation | movement of the frame | frame of a bending shape maintenance possible tube part in the state in which the tension | tensile_strength is not acting on the shape maintenance operation wire of the treatment tool for endoscopes which concerns on the Example of this invention. . It is side surface sectional drawing for demonstrating bending | flexion operation | movement of the framework of the bending shape maintenance possible tube part in the state which tension | tensile_strength acts on the shape maintenance operation wire of the treatment tool for endoscopes which concerns on the Example of this invention. . It is side surface sectional drawing of the mechanism arrange | positioned inside the internal thread ring for operation of the operation part of the treatment tool for endoscopes which concerns on the Example of this invention. It is XIII-XIII sectional drawing in FIG. 12 of the treatment tool for endoscopes which concerns on the Example of this invention. It is a fragmentary perspective view of the operation wire engaging part for shape maintenance in the operation part of the treatment tool for endoscopes concerning the example of the present invention. It is a fragmentary perspective view of the operation wire engaging part for shape maintenance in the operation part of the treatment tool for endoscopes concerning the example of the present invention. It is a schematic diagram showing an example of a use state of a treatment tool for endoscopes concerning an example of the present invention. It is a perspective view of the modification of the joint ring single-piece | unit with which the wire guide was attached of the treatment tool for endoscopes which concerns on the Example of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Flexible sheath 2 Operation part 4 Treatment member operation wire 5 Female thread ring for operation (wire pulling operation apparatus)
DESCRIPTION OF SYMBOLS 7 Articulated ring 8 Connection shaft 9 Wire guide 11 Bending shape holdable tube part 12 Flexible shaft part 15 (15 (I), 15 (O)) Shape holding operation wire 17 Guide pipe 27 Male screw cylinder (wire pulling operation device)
28 1st wire engaging member (wire pulling operation device)
29 Second wire engaging member (wire pulling operation device)
32 Fixing screw (wire tension adjusting means)
60 Flexible endoscope 91 Wire guide hole

Claims (9)

A plurality of short cylindrical articular rings are relatively disposed on a part or all of the flexible sheath that is disposed at the distal end and is inserted into and removed from the treatment instrument insertion channel of the endoscope. A bent shape-maintainable tube portion having a framework that is pivotally connected in series with a connecting shaft and bent in all directions as a whole is provided,
At least three flexible shape-maintaining operation wires are connected to the distal end portion of the bent shape-retainable tube portion, and the shape-retaining tube is provided in a wire guide hole provided in each joint ring. The operation wire is inserted,
The wire guide hole is a diameter through which the shape holding operation wire inserted therethrough passes slowly, and the wire guide hole is formed between the wire and the shape holding operation wire as the tension applied to the shape holding operation wire increases. Formed in a curved shape with increased frictional resistance,
As a result, in the state where the shape-holding operation wires are not pulled from the proximal end side, the bent shape-holdable tube section can be passively changed in shape, and all the shape-holding operation wires are based on the above. When pulled from the end side, the frictional resistance between the shape-holding operation wires and the wire guide holes increases corresponding to the increase in tension applied to all the shape-holding operation wires. Thus, the endoscope treatment instrument characterized in that the bent shape of the bent shape-holdable tube portion is held.   The endoscope treatment tool according to claim 1, wherein the wire guide hole is formed in a shape bent in a substantially U shape.   An operation portion is coupled to the proximal end side of the flexible sheath so that the proximal end portion of each shape-maintaining operation wire follows the bent state of the bent shape-retainable tube portion and advances and retracts in the axial direction. The wire pulling operation device for pulling and operating the base end portions of all the shape holding operation wires together with the operation unit is provided in the operation unit. Endoscopic treatment tool.   The endoscopic treatment instrument according to claim 3, wherein the operation section is provided with wire tension adjusting means for equalizing the tension of all the shape-maintaining operation wires.   The wire tension adjusting means includes a first wire engaging member that engages with a proximal end of a part of the shape holding operation wires in all the shape holding operation wires, and another shape holding operation wire. The endoscope treatment tool according to claim 4, wherein the positional relationship in the axial direction with the second wire engaging member with which the proximal end is engaged is adjusted.   The at least three shape-maintaining operation wires are arranged at intervals between each other in a positional relationship in which there is no interval of 180 ° or more around the axis of the bent shape-retainable tube portion. The treatment tool for endoscopes according to any one of Items 5 to 5.   7. The shape holding operation wire includes four shape holding operation wires arranged at approximately 90 ° intervals around an axis of the bent shape holding tube. Endoscopic treatment tool.   When the bent shape-holdable tube portion is provided near the distal end of the flexible sheath, the shape other than the bent shape-holdable tube portion of the flexible sheath is passively changed in shape by an external force. The endoscopic treatment tool according to any one of claims 1 to 7, wherein the endoscope is a flexible shaft portion that is free and has no shape retaining property.   The endoscope treatment tool according to claim 8, wherein a flexible guide pipe is provided in the flexible shaft portion to guide the shape-maintaining operation wires so as to advance and retreat in the axial direction.

Images