JP2021141965A - Treatment instrument for endoscope - Google Patents

Abstract

PROBLEM TO BE SOLVED: To realize a simple connecting structure in which the number of connecting members between a coil sheath and a tip treatment tool support member is zero or only one is provided, facilitation of assembly and cost reduction can be realized.
SOLUTION: An operation wire 12 arranged in a coil sheath 11a is moved forward and backward by an operation unit 13, and the tip of the cylinder 14a and the tip of the cylinder 14a are inseparably fitted to the tip of the coil sheath 11a. Tip treatment tool support member 14 having a pair of opposing arm portions 14b extending to the side, and tip treatment piece 15 that is supported between the pair of arm portions 14b and receives the advancing / retreating motion force of the operation wire 12 to perform a required treatment. , 16 and the tip treatment tool support member 14 has a bearing portion 14d in which the tubular portion 14a is split in half between the arm portions 14b and protrudes inward from the rear end of the inner peripheral surface of each half split body. A pair of half-split bodies 14A and 14B are overlapped and fixed.
[Selection diagram] Fig. 4

Description

The present invention relates to an endoscopic treatment tool having a tip treatment piece at the tip, which is inserted into and removed from the channel of the endoscope and treats a lesion site in the field of view of the endoscope.

Endoscopic channels are used for endoscopic treatment tools that are inserted into the body cavity and perform direct examination and treatment of lesions in the body cavity with minimal invasiveness. The endoscopic treatment tool has a tip treatment piece at the tip, is detachably housed in the channel of the endoscope, and treats the lesion site with the tip treatment piece in the field of view of the endoscope (living tissue). It is used to remove the affected area, sample, excise, hemostasis, etc.). Generally, the endoscope is operated by a doctor, and the treatment tool is operated by another doctor or technician.

The reference numerals used in the following description of the endoscopic treatment tool of Patent Documents 1-3 are the reference numerals used in the respective patent documents.

In the endoscopic treatment tool shown in Patent Document 1, a rear portion having a large cylindrical inner diameter of the connecting tubular portion 16 is fitted and welded to the tip end portion of the coil sheath 11, and the inner diameter of the connecting tubular portion 16 is formed. By forcibly fitting the tip body 15 into the small tip, a connecting cylinder is formed in the small diameter portion between the flange 15a and the collar 15b provided at the tip and the rear end of the outer peripheral surface of the tip body 15. The tip portion having a small inner diameter of the portion 16 is loosely fitted.

Further, the endoscopic treatment tool shown in Patent Document 1 is provided with an electrically insulating coating on each of the tip treatment piece 13, the support shaft 14, and the tip body 15, and is provided on the outer peripheral surface of the flexible coil sheath 11. It has a configuration in which an electrically insulating insulating tube 18 is covered over the entire length, so that a high-frequency current is applied to the tip treatment piece 13 through the operation wire 12, and the tip treatment piece 13 can perform a treatment for obtaining a bleeding effect or the like. ing.

Further, in the endoscopic treatment tool shown in Patent Document 2, a pair of scissors pieces (tip treatment pieces) 36a and 36b are arranged between a pair of arms of the tip support frame 41 and skewered by a rotation shaft 35. The thin cylinder member 40a and the retaining member 41b are sequentially fitted to the small diameter cylinder portion of the tip support frame 41 from the rear end, and the retaining member 41b is welded to the small diameter cylinder portion of the tip support frame 41. At the same time, the rear portion of the thick tubular member 40b of the connecting tubular portion 40 is fitted and welded to the tip of the sheath 31, and then the tip of the thick tubular member 40b of the connecting tubular portion 40 is fitted with the retaining member 41b. It is fitted in the middle of the thin cylinder member 40a, and the thick cylinder member 40b and the thin cylinder member 40a are welded to form a connecting tubular portion 40. Therefore, the connecting cylindrical portion 40 connects the tip support member 41 and the sheath 31 so as to be relatively rotatable.

In the endoscopic treatment tool shown in Patent Document 3, a pair of scissors pieces (tip treatment pieces) 36a and 36b are arranged between a pair of arms of the tip support member 14, and are skewered by a rotation shaft 35. A pair of half-split rings 43 are overlapped and welded to the rear end surface of the tip support member 14 in a state where the tip small diameter portion provided with the ring 42 of the coil sheath 31 is connected and inserted into the cylinder portion of the tip support member 14. Become. Therefore, the tip support member 14 and the coil sheath 31 are relatively rotatable and axially movable, and are inseparable from each other due to the ring 42 and the pair of half-split rings 43.

Japanese Unexamined Patent Publication No. 2007-289595, FIGS. 1, 3 Japanese Unexamined Patent Publication No. 2018-33501 JP-A-2018-68474

In the endoscopic treatment tool shown in Patent Document 1, it is difficult to fit the tip body 15 and the connecting tubular portion 16. That is, the outer diameter of the flange portion 15b of the tip body 15 is larger than the inner diameter of the tip portion of the connecting tubular portion 16, and the outer diameter between the flange portions 15a and 15b of the tip body 15 is the connecting tubular portion 16. The condition is that the inner diameter of the tip is smaller than that of the tip, and since it is a very small part, it is difficult to control the dimensions and assemble. If it is fitted into the tip portion of 16, the tip body 15 cannot rotate with respect to the connecting tubular portion 16, and therefore, the opening / closing direction of the pair of tip treatment pieces 13 may not be appropriately matched to the affected portion. There is. Therefore, the size of the flange portion 15b can be made sufficiently large for easy assembly, and the tip body 15 has been improved so that it can smoothly rotate relative to the coil sheath 11. If possible, the connecting tubular portion 16 is eliminated and the number of parts is increased. There is a problem that we want to reduce the number of products, improve the ease of assembly, and reduce the manufacturing cost.

The endoscopic treatment tool shown in Patent Document 1 has a simple structure in which the number of parts and the assembly man-hours are not large, but there are the following problems when assembling the pair of tip treatment pieces 13 to the tip body 15. be. After fitting the support shaft 14 into one shaft hole of the tip body 15, the support shaft 14 is fitted into the shaft hole provided at the intersection of the pair of tip treatment pieces 13, and further into one shaft hole of the tip body 15. Although it is fitted, the electrically insulating coating on both end faces of the supporting shaft 14 and the edge on the supporting shaft fitting side of one of the shaft holes of the tip body 15 is peeled off, so that the electrically insulating coating is formed again after assembly. This results in impeding the smooth opening and closing of the pair of tip treatment pieces 13. Therefore, there is a problem that it is desired to improve the electrical insulating coating such as the end portion of the support shaft 14 so as not to peel off.

The endoscopic treatment tool shown in Patent Document 2 has a large number of parts and a large number of man-hours for assembly. Therefore, there is a problem that the thin cylinder member 40a, the thick cylinder member 40b, and the retaining member 41b can be eliminated, the number of parts can be reduced, the assembling property can be improved, and the manufacturing cost can be reduced.

The endoscopic treatment tool shown in Patent Document 3 has a pair of half-split rings 43 as extremely small parts, and is difficult to assemble. Therefore, there is a problem that it is desired to improve the configuration so that the ring 42 and the pair of half-split rings 43 can be eliminated, reduce the number of parts, improve the assembling property, and reduce the manufacturing cost.

The present invention has been made to solve the common problem as the first aspect among such problems, and the connecting member between the coil sheath and the tip treatment tool support member is set to zero (directly connected without being provided). ) Or, it is an object of the present invention to provide an endoscopic treatment tool capable of realizing a simple connection structure in which only one is provided, facilitation of assembly, and cost reduction.

In order to achieve the above object, the endoscopic treatment tool according to the first aspect of the present invention has a flexible coil sheath, an operation wire arranged so as to be able to move forward and backward in the coil sheath, and after the coil sheath. An operation unit provided at an end for advancing / retreating the operation wire, a tubular portion connected to the tip of the coil sheath or a connecting tubular portion provided at the tip, and extending to the tip side from the tubular portion. The coil sheath includes a tip treatment tool support member having a pair of opposing arms, and a tip treatment tool that is supported between the arms and receives the advancing / retreating motion force of the operation wire to treat a living body affected portion. The tip portion or the connecting tubular portion provided at the tip portion is provided with a tip small diameter portion avoiding the tip portion, and the tip treatment tool support member is split in half between the arms. A pair of half-split bodies having a semi-annular annular bearing portion that is provided so as to project inward from the rear end of the inner peripheral surface of the half-split body and is fitted to the small diameter portion at the tip are overlapped and fixed. It is a feature.

In the endoscopic treatment tool according to the second aspect of the present invention, in addition to the configuration of the first aspect, the bearing portion of the tip treatment tool support member is fitted in a fixed state on the tip small diameter portion. It is characterized by that.

In the endoscopic treatment tool according to the third aspect of the present invention, in addition to the configuration of the first aspect, the bearing portion of the tip treatment tool support member is rotatably fitted to the tip small diameter portion. It is characterized by that.

In the endoscopic treatment tool according to the fourth aspect of the present invention, in addition to the configuration of any one of the first to third aspects, the pair of halves have a recess for positioning on the halves. It is characterized in that the convex portions are distributed and provided.

In the endoscopic treatment tool according to the fifth aspect of the present invention, in addition to the configuration of any one of the first, third, and fourth aspects, the tip portion is further attached to the coil sheath or the connecting tubular portion. A small diameter portion having a required length, which is a portion to be fitted with the bearing portion, is provided to avoid the bearing portion, and the bearing portion is provided so as to be fitted so as to be movable in the axial direction. ..

In the endoscopic treatment tool according to the sixth aspect of the present invention, in addition to the configuration of any one of the first, third, and fourth aspects, the tip treatment tool support member is attached to the connecting cylindrical portion. It is characterized in that a convex portion and an arcuate concave portion that function as a pair that restricts rotation at a required angle of less than 360 degrees are distributed and provided in the cylindrical portion and the connecting cylindrical portion.

According to the present invention, the tip treatment tool support member is directly connected to the tip small diameter portion formed in the coil sheath so as not to be detachable and rotatably directly, or the tip treatment tool support member is connected to the connecting tubular portion added to the tip portion of the coil sheath. It is possible to realize a configuration in which the coil sheath and the tip treatment tool support member are directly connected to each other in a non-removable and rotatably manner, so that the number of connecting members between the coil sheath and the tip treatment tool support member is zero (directly connected without being provided), or only one is provided. It is possible to provide an endoscopic treatment tool that can realize a simple connection structure that only needs to be provided, facilitate assembly, and reduce costs.

It is a figure for demonstrating an endoscopic system including an endoscopic treatment tool which concerns on Embodiment 1 of this invention. It is an overall view of the endoscopic treatment tool which concerns on Embodiment 1 of this invention. Regarding the endoscopic treatment tool according to the first embodiment of the present invention, FIG. 3 (A) is a longitudinal front view showing the tip of the treatment tool in a state where the tip treatment tool is open, and FIG. 3 (B) shows the tip treatment tool. It is a longitudinal front view which shows the tip part of the treatment tool in a closed state. Regarding the endoscopic treatment tool according to the first embodiment of the present invention, FIG. 4A is a perspective view showing a tip treatment tool support member and a tip portion of a coil sheath, and FIG. 4B is a tip treatment tool support member. It is a vertical cross-sectional view showing the tip of the coil sheath. The tip treatment tool support member according to the first embodiment of the present invention, FIG. 5 (A) is a side view of the tip treatment tool support member, and FIG. 5 (B) is a view from the split surface side of one tip treatment tool support member. 5 (C) is a perspective view of one tip treatment tool support member, and FIG. 5 (D) is a perspective view of the other tip treatment tool support member. It is a longitudinal front view which shows the tip part of the treatment tool in the state which the tip treatment tool is open, which concerns on the endoscopic treatment tool of Embodiment 2 of this invention. It is a longitudinal front view which shows the tip part of the treatment tool in the state which the tip treatment tool is open, which concerns on the endoscopic treatment tool of Embodiment 3 of this invention. Regarding the endoscopic treatment tool of one modification of the present invention, FIG. 8 (A) is a front view showing the tip of the treatment tool in a state where the tip treatment tool is open, and FIG. 8 (B) is a front view showing the tip treatment tool with the tip treatment tool closed. A vertical sectional side view showing the tip of the treatment tool in the state of being in the state, FIG. 8C is a perspective view showing a state in which a tip treatment tool support member made of a pair of halves is connected to the tip small diameter portion of the coil sheath. Regarding the endoscopic treatment tool of one modification of the present invention, FIG. 9A is a side view of the tip treatment tool support member, and FIG. 9B is a view from the split surface side of one tip treatment tool support member. 9 (C) is a perspective view of one tip treatment tool support member, and FIG. 9 (D) is a perspective view of the other tip treatment tool support member.

Hereinafter, embodiments relating to the endoscopic treatment tool according to the present invention will be described with reference to the drawings. In the following description, the side where the tip treatment tool is located is referred to as the tip side, and the side where the operation unit is located is referred to as the base end side.

[Embodiment 1]
[Endoscope system]
FIG. 1 shows an endoscopic system 1 to which the endoscopic treatment tool according to the first embodiment is applied. The endoscope system 1 has an insertion unit 2 for inserting into the body cavity of a living body, and an endoscope operation unit provided at the base end and having a dial for bending the tip of the insertion unit 2 in the vertical and horizontal directions. 3 and a treatment tool introduction unit 4 arranged so as to connect between the insertion unit 2 and the endoscope operation unit 3 are provided, and the treatment tool introduction unit 4 is provided in the longitudinal direction from the treatment tool introduction unit 4 toward the tip of the insertion unit 2. The formed endoscopic channel 5 is formed, and a pair of tip treatment pieces (scissors) 15 as tip treatment tools for treating the biologically affected part of the endoscopic treatment tool 10 described later in the endoscope channel 5 , 16 and the sheath 11 are configured to be inserted.

[Basic configuration of endoscopic treatment tools]
The endoscopic treatment tool 10 according to the first embodiment is an electrocauterization incision scissors for an endoscope, and a required current is applied to the living tissue while sandwiching the living tissue in the body cavity between a pair of tip treatment pieces 15 and 16. The incision is made while cauterizing and stopping bleeding.

The endoscopic treatment tool 10 according to the first embodiment has a flexible elongated sheath 11 that is inserted into and removed from the endoscopic channel 5 as shown in FIGS. 1 to 3 (A) and 3 (B). , An operation wire 12 arranged so as to be able to advance and retreat in the sheath 11, an operation unit 13 for advancing and retreating and rotating the operation wire 12, a tip treatment tool support member 14 provided outside the tip of the sheath 11, and a tip. The treatment tool support member 14 is provided with a pair of tip treatment pieces 15 and 16 rotatably supported by a support shaft 18.

The sheath 11 is an elongated tubular body having a length of 500 to 2000 mm, having flexibility and having an appropriate waist strength (flexion resistance). The sheath 11 of the present embodiment is composed of a coil sheath 11a and a resin outer cover 11b that covers the outer surface of the coil sheath 11a. The resin outer cover 11b is made of PTE, PEEK, PPS, polyethylene, polyimide, etc., and has flexibility and electrical insulation. As the coil sheath 11a, for example, it is preferable to use a coil sheath formed by tightly winding a metal material such as a stainless wire having a rectangular cross section.

In the endoscopic treatment tool 10, an electrically insulating film is formed on the outer surface of the tip treatment tool support member 14. In the configuration in which the resin outer cover 11b is not provided, an electric insulating film may be formed on the inner and outer surfaces of the coil sheath 11a.

Except for the blades, the pair of tip treatment pieces 15 and 16 are provided with an electrically insulating coating on the outer surface and are in an electrically insulated state, so that a current flows between the blades when the blades are closed to each other. There is. Further, a hydrophilic film is formed on the resin outer cover 11b of the sheath 11, the tip treatment tool support member 14, and the electrical insulating coatings on the outer surfaces of the pair of tip treatment pieces 15 and 16, so that the tip treatment piece 15 is formed. , 16 to sheath 11 can be smoothly introduced into the body cavity without twitching.

The operation wire 12 is loosely arranged in the sheath 11 so as to be able to advance and retreat, and is composed of a torque wire that is conductive and has a large rotational followability. The operation wire 12 may have, for example, a total length made of stainless steel, or may be formed by connecting a base end side portion made of stainless steel and a tip end side portion made of nitinol (nickel titanium alloy) with a stainless steel pipe. ..

As shown in FIG. 2, the operation unit 13 has an operation unit main body 13a whose tip is connected to the base end of the coil sheath 11a and an operation unit main body within a range corresponding to slits provided on the side surface portion of the operation unit main body 13a. It has a slider 13b which is provided so as to be fitted on the 13a and slides, and is connected to the base end of the operation wire 12 introduced inside from the tip surface of the operation unit main body 13a, and has the operation unit main body 13a and the slider 13b. The operating wire 12 can be relatively moved to the coil sheath 11a by relatively sliding (advancing / retreating) the operating wire 12, and the operating wire 12 can be moved to the left (tip side) in the drawing by moving the slider 13b. Is configured to move to the tip side. Therefore, the operation unit 13 is configured to advance / retreat and rotate the operation wire 12 relative to the coil sheath 11a.

The operation wire 12 and the coil sheath 11a may have either a configuration in which the base ends are rotatable integrally with each other or a configuration in which the operation wire 12 is rotatable with respect to the coil sheath 11a over the entire length.

As shown in FIGS. 3A and 3B, the tip treatment tool support member 14 faces the tubular portion 14a fitted and connected to the tip portion of the coil sheath 11a and the tubular portion 14a extending toward the distal end side from the tubular portion 14a. It has a pair of arms 14b.

The pair of tip treatment pieces 15 and 16 are made of stainless steel or nitinol (nickel-titanium alloy), and the middle 15a and 16a intersect and overlap between the pair of arm portions 14b, and the middle (intersection) 15a, The portion ahead of 16a is composed of a pair of scissors pieces that are formed in a blade shape, for example, and overlap in an X shape.

The pair of tip treatment pieces 15 and 16 have shaft holes (unsigned) at the intersections 15a and 16a. The support shaft 18 inserted into the shaft holes of the intersecting portions 15a and 16a is supported at both ends by fitting both ends thereof to the bearing portions 14c for the support shaft provided on the arm portions 14b and 14b on both sides. The rear ends of the pair of tip treatment pieces 15 and 16 on the base end side portions 15b and 16b are pin-connected to the tips of the pair of opening / closing operation links 19 and 20, and further, the pair of opening / closing operation links 19 and 20 are connected. The rear end is pin-connected to the advance / retreat transmission link 21, and the tip of the operation wire 12 is fitted into the wire receiving hole provided inside from the rear end surface of the advance / retreat transmission link 21 to tighten the screw from the side surface of the advance / retreat transmission link 21. Is screwed in or connected and fixed by silver brazing, soldering, caulking, etc.

The pair of tip treatment pieces 15 and 16 are held by the pair of arm portions 14b of the tip treatment tool support member 14 so as to rotate around the support shaft 18, and the operation wire 12 is relatively moved to the coil sheath 11a. Then, the pair of opening / closing operating links 19 and 20 operate so that the opening angle becomes large.

That is, when the operating wire 12 is relatively moved toward the tip end side with respect to the coil sheath 11a, the proximal end side portions 15b and 16b receive the advancing / retreating motion force of the operating wire 12 to open the legs, and the pair of tip end side portions 15c and 16c Is in the open state (FIG. 3 (A)). Further, when the operation wire 12 is relatively moved to the proximal end side by the coil sheath 11a, the pair of distal end side portions 15c and 16c are closed (FIG. 3B).

Therefore, by advancing and retreating the operation wire 12, when the tip side portions 15c and 16c of the pair of tip treatment pieces 15 and 16 are closed, an electric current is applied to cauterize the biological tissue in the body cavity and make an incision while stopping bleeding. It is configured to perform procedures such as excision of living tissue.

[Characteristic configuration of endoscopic treatment tools]
As shown in FIG. 4A, the tip treatment tool support member 14 has a tubular portion 14a and a pair of opposed arm portions 14b extending beyond the line end surface of the tubular portion 14a. Then, as shown in FIGS. 4 (A) and 5 (A), the tip treatment tool support member 14 is formed by combining a pair of half-split bodies 14A and 14B in which the tubular portion 14a is divided in half between the arm portions 14b. .. Therefore, each of the half-split bodies 14A and 14B has an integral shape of the half-cylinder portion 14a1 and the arm portion 14b1 and the half-cylinder portion 14a2 and the arm portion 14b2.

As shown in FIGS. 5 (B)-(D), each of the half-split bodies 14A and 14B is provided with a bearing portion 14c for a support shaft for supporting the end portion of the support shaft 18 on the arm portion 14b, and is a semicircle. A semi-annular bearing portion 14d projecting inward is provided at the rear end of the inner peripheral surface of the portion 14a1, and a semi-annular wall 14g projecting inward is provided at the tip of the inner peripheral surface of the semi-cylindrical portions 14a1 and 14a2. The convex portion 14e for positioning and the concave portion 14f are distributed and provided on each semicircular surface of the tubular portion 14a. Although the bearing portion 14c for the support shaft shown in the figure is provided as a through hole, it may be a cylindrical recess (non-through hole) provided from the half-split surface side.

The pair of halves constituting the tubular portion 14a are made by firing fine particles made of stainless steel or nitinol (nickel-titanium alloy) by the MIM method (metal powder injection molding), and a precise shape and dimensions can be obtained. ..

Therefore, in the first stage assembly procedure of the pair of halves 14A and 14B and the pair of tip treatment pieces 15 and 16 on the coil sheath 11a, the pair of tip treatment pieces 15 and 16 are crossed and the intersections 15a and 16a are crossed. The central portion of the support shaft 18 is fitted into the shaft hole, then the rear ends of the tip treatment pieces 15 and 16 and the tips of the pair of opening / closing operating links 19 and 20 are pin-connected, and further, the pair of opening / closing operation is performed. The rear ends of the links 19 and 20 and the advancing / retreating transmission link 21 are pin-connected, and the advancing / retreating transmission link 21 and the operation wire 12 are further connected.

In the subsequent assembly procedure of the second stage, the bearing portions 14c for the support shafts of the pair of semicircles 14A and 14B are fitted into the shaft holes of the intersections 15a and 16a of the pair of tip treatment pieces 15 and 16 to fit the support shaft 18 (FIG. 4 (B)), the convex portion 14e and the concave portion 14f are engaged (FIG. 4 (A)), and a pair of semi-annular bearing portions 14d are used to form the tip of the coil sheath 11a. A pair of half split bodies 14A and 14B are overlapped with each other by sandwiching the tip small diameter portion 11a2 formed so as to avoid the escape prevention convex portion 11a1 (FIG. 4B), and both sides of the outer peripheral surfaces of the semicircular portions 14a1 are overlapped with each other. The entire length of the overlapping line 14i is fixed (laser welded) (FIG. 4 (A)). By this laser welding, the electrical insulating coating in the region along the overlapping line of the outer peripheral surfaces of the semi-cylindrical portions 14a1 is peeled off, but since the positions are separated from the blade portions of the pair of tip treatment pieces 15 and 16, the current is applied. It does not interfere with the incision while energizing and cauterizing the living tissue to stop bleeding. The pair of semicircular annular walls 14g pass through the advance / retreat transmission link 21.

The pair of semicircular annular bearing portions 14d are fitted with the tip small diameter portion 11a2 formed so as to avoid the tip portion 11a1 of the coil sheath 11a so as to be relatively rotatable and axially movable, and the tip portion 11a1 is treated with the tip. It serves to prevent the tool support member 14 from escaping from the coil sheath 11a. When the small-diameter tip portion 11a2 is provided, grinding processing may be performed including the tip portion, and a ring corresponding to the tip portion 11a1 may be fitted and fixed by laser welding, silver brazing, or the like. Further, in order to reinforce the coil sheath thinned by grinding, laser light is irradiated to the ground portion and the vicinity of the ground portion, or an alloy (wax) material having a melting point lower than that of the coil is coated, or a combination thereof, etc. The coil sheath is reinforced so that the strength becomes equal to or higher than a predetermined value, and the surface is processed to be lubricated.

Since it can be assembled as described above, the support shaft 18 can be formed into a stepped shaft shape having a large diameter at the center, and the pair of tip treatment pieces 15 and 16 can be guaranteed to be opened and closed stably. Further, since the convex portion 14e and the concave portion 14f are engaged with each other, the pair of half-split bodies 14A and 14B can be quickly and accurately aligned in the axial direction, and the pair of supporting shafts 18 are supported at both ends. The bearing portions 14c for the support shafts of the half-split bodies 14A and 14B are located on a precise uniaxial line, and the middle 15a and 16a of the pair of tip treatment pieces 15 and 16 and the pair of arm portions 14b are in parallel contact with each other. Therefore, the pair of arm portions 14b can hold the pair of tip treatment pieces 15 and 16 so as to guarantee smooth rotation.

According to the endoscopic treatment tool 10 having the above configuration, the tip treatment tool support member 14 is directly connected to the tip small diameter portion 11a2 formed on the coil sheath 11a so as to be movable, non-removable, and rotatable in the axial direction. It can be realized as a simple configuration that does not intervene in the connecting parts at the tip of the above, and thus a simple connecting structure can be realized, assembly can be facilitated, and cost can be reduced. The tip treatment tool support member 14 may be non-rotatably connected to the tip small diameter portion 11a2.

Further, it is provided as an electrocautering scissors for an endoscope, a hemostat forceps, or the like that can perform a procedure for obtaining a hemostatic effect or the like with a pair of tip treatment pieces 15 and 16, such as the endoscopic treatment tool 10 of the first embodiment. In this case, an electrically insulating coating is provided on the outer peripheral surface of the coil sheath 11a, or is covered with a resin jacket 11b, and further, the tip treatment pieces 15 and 16, the tip treatment tool support member 14, and the support shaft 18, respectively. However, since both ends of the support shaft 18 are fitted with a pair of half-split bodies 14A and 14B, the support shaft 18 has a large diameter at the center and both ends. It can be formed with a small diameter, and if a through hole is provided as a bearing portion of the half-split body and both ends of the support shaft 18 are fitted and both are laser welded, the welded portion can be small (the electrical insulating coating can be formed). Welding is performed from the half-split surface side when both ends of the support shaft 18 are fitted by providing shaft holes (non-penetrating) as the bearing portion of the half-split body. It can be carried out.

[Embodiment 2]
FIG. 6 shows the endoscopic treatment tool 10A according to the second embodiment. The endoscopic treatment tool 10A is an electrocautery incision scissors for an endoscope as in the first embodiment.

[Basic configuration of endoscopic treatment tools]
In the endoscopic treatment tool 10A, the pair of tip treatment pieces 15 and 16 as the tip treatment tools do not have the opening / closing operation links 19 and 20 and the advance / retreat transmission link 21 shown in FIG. Two operation wires 12A and 12B are passed through the inside. The tips of the two operating wires 12A and 12B project between the arms 14b of the tip treatment tool support member 14 provided on the tip of the sheath 11, and the intervals are gradually widened, so that the pair of tip treatment pieces 15 and 16 It is connected to the locking hole at the rear end of the base end side portions 15b and 16b of the above. Therefore, the tip of the pair of tip treatment pieces 15 and 16 is expanded or contracted by the expansion / contraction of the spread angle of the tip portions of the two operation wires 12A and 12B by moving the two operation wires 12A and 12B back and forth integrally. The side portions 15c and 16c are designed to open and close. The other components related to the basic configuration are the same as those in the first embodiment, and each component is designated by the same reference numeral as in the first embodiment.

[Characteristic configuration of endoscopic treatment tools]
Since the characteristic configuration of the endoscopic treatment tool 10A is the same as that of the first embodiment and the action / effect is also the same as that of the first embodiment, the description thereof will be omitted. The respective reference numerals of the components are the same as those in the first embodiment, and the same reference numerals are given. Assembly can be performed in the same procedure as in the first embodiment.

The action and effect of the characteristic configuration of the endoscopic treatment tool of the second embodiment is the same as the action and effect of the first embodiment. The method of using the endoscopic treatment tool of the second embodiment is the same as that of the first embodiment.

[Embodiment 3]
[Basic configuration of endoscopic treatment tools]
As shown in FIG. 7, the endoscopic treatment tool 10B according to the third embodiment is an endoscopic electrocautery incision scissors, and has a flexible elongated sheath 11B that is inserted into and removed from the endoscopic channel. , An operation wire 12 arranged so as to be able to advance and retreat in the sheath 11B, an operation unit for advancing and retreating and rotating the operation wire 12 (not shown; see FIG. 2), and a tip treatment provided outside the tip of the sheath 11B. The tip side portions 15c and 16c are opened and closed by the tool support member 14 and the tip treatment tool support member 14 rotatably supported by the support shaft 18 and connected to the operation wire 12 through the advance / retreat operation of the operation wire 12 by the operation unit. A pair of tip treatment pieces 15 and 16 as a tip treatment tool for treating the living tissue in the body cavity are provided. In the endoscopic treatment tool 10B, the outer surfaces of the sheath 11B, the operation wire 12, the tip treatment tool support member 14, and the pair of tip treatment pieces 15 and 16 are hydrophilically coated.

The sheath 11B is composed of a coil sheath 11Ba and a resin outer cover 11Bb that covers the outer surface of the coil sheath 11Ba. The coil sheath 11Ba is formed by tightly winding a metal material such as a stainless wire having a circular cross-sectional shape, for example.

The pair of tip treatment pieces 15 and 16 are supported by the tip treatment tool support member 14 by the support shaft 18, and the advance / retreat transmission link 21 and the pair of opening / closing operation links are operated by operating the operation unit to advance / retreat the operation wire 12. The advancing / retreating operation force is transmitted to the pair of tip treatment pieces 15 and 16 via 19 and 20, and when the tip side portions 15c and 16c of the pair of tip treatment pieces 15 and 16 open and close and close, an electric current is applied. It is the same configuration as in the first embodiment that the living tissue in the body cavity is cauterized to stop bleeding and an incision is made to perform treatment such as excision of the living tissue or sampling. The same components as those of the first embodiment are designated by the same reference numerals as those of the first embodiment, and the description thereof will be omitted.

[Characteristic configuration of endoscopic treatment tools]
As shown in FIG. 7, as a component that deviates from the basic configuration, the connecting tubular portion 22 has a connecting tubular portion 22 that connects the coil sheath 11Ba and the tip treatment tool support member 14. The tip treatment tool support member 14 is connected to the connecting tubular portion 22 by laser welding together the half-cylindrical portions 14a1 of a pair of half-split bodies manufactured by the MIM method as in the first embodiment.

The connecting tubular portion 22 extends from the large-diameter tubular portion 22a, which is fitted to the tip of the coil sheath 11a and fixed by laser welding, silver brazing, soldering, etc., and the large-diameter tubular portion 22a. The tip small-diameter tubular portion 22b to which the tubular portion 14a of the tip treatment tool support member 14 is fitted and the tip portion of the tip small-diameter tubular portion 22b are provided so as to project radially outward and the tubular portion of the tip treatment tool support member 14. It has an escape prevention convex portion 22c that prevents the 14a from detaching.

In addition, in the third embodiment, there are the following advantages of providing the connecting cylindrical portion 22.

Since the connecting tubular portion 22 can be fired by the MIM method (metal powder injection molding) and the inner diameter of the tip small diameter tubular portion 22b can be made smaller than the inner diameter of the coil sheath 11Ba, the connecting tubular portion 22 can be fired. As a function of connecting the tip treatment tool support member 14 to the tubular portion 14a, a function capable of relative rotation at a required angle of less than 360 degrees can be added.

Specifically, the cylindrical portion 14a of the tip treatment tool support member 14 is provided with a tip-side convex portion 14j for restricting rotation, and the end surface of the stepped portion of the connecting tubular portion 22 is for restricting rotation. The arcuate concave portion 22d on the base end side of the above is provided. The tip end side convex portion 14j and the base end side arcuate concave portion 22d are provided so as to have the following relationship. When the operation wire 12 is moved in the coil sheath 11a toward the tip end side by, for example, 1 mm, the tip end side convex portion 14j is slightly escaped from the proximal end side arcuate concave portion 22d and becomes a disengaged state, and the tip treatment is applied to the coil sheath 11a. The tool support member 14 is freely rotatable, and conversely, when the operation wire 12 is moved back to the proximal end side in the coil sheath 11a by, for example, 1 mm, the distal end side convex portion 14j engages with the proximal end side arcuate concave portion 22d. In the combined state, the tip treatment tool support member 14 can rotate with respect to the coil sheath 11a by a required angle of less than 360 degrees.

As described above, according to the endoscopic treatment tool 10B of the third embodiment, the operation wire 12 is set to a small size (for example, about 1 mm) for opening and closing the pair of tip treatment pieces 15 and 16. On the other hand, it is possible to move forward and backward in the axial direction, and the pair of tip treatment pieces 15 and 16 are rotated about the axis by making a minute-dimensional stroke in the direction (front side) close to the affected area from the closed state of the pair of tip treatment pieces 15 and 16. It can be moved, and the pair of treatment parts can be aligned with the affected part in an appropriate direction without any hassle, and the pair of tip treatment pieces 15 and 16 can be operated backward from the open state. By making the wire 12 a minute stroke, the rotation angle of the pair of tip treatment pieces 15 and 16 around the axis can be limited.

Therefore, when the operation unit is operated to bring the pair of tip treatment pieces 15 and 16 close to the affected portion of the living tissue in the body cavity, the operation unit is operated to advance the operation wire 12 and the opening / closing operation links 15d and 16d. Open the legs to open the pair of tip treatment pieces 15 and 16. At this time, the tip portion of the operation wire 12 in which the tip end side convex portion 14j is separated from the base end side arcuate concave portion 22d in the axial direction is in a rotation-free state. When the open orientation of the pair of tip treatment pieces 15 and 16 is not appropriate for treating (sandwiching) the affected portion, the operation portion can be easily operated to rotate the tip portion of the operation wire 12. When the open orientation of the pair of tip treatment pieces 15 and 16 is at an appropriate position for the affected area, the operation unit is operated so that the pair of tip treatment pieces 15 and 16 are brought close to each other by a minute dimension so as to sandwich the affected area. At this time, even if the open orientation of the pair of tip treatment pieces 15 and 16 changes, the tip portion of the operation wire 12 is in a rotation-free state, so that it can be easily corrected. Next, when the operation unit is operated to retract the operation wire 12, the opening / closing operation links 15d and 16d operate to close the legs, and the pair of tip treatment pieces 15 and 16 are closed so as to sandwich the affected part. Immediately before the pair of tip treatment pieces 15 and 16 sandwich the affected portion, the tip side convex portion 14j comes to the position corresponding to the proximal end side arcuate concave portion 22d, so that the tip portion of the operation wire 12 is free to rotate. Since the rotation angle is restricted, the tip of the operation wire 12 is pulled up to the rotation angle restricted state when the pair of tip treatment pieces 15 and 16 sandwich the affected portion. Therefore, according to the endoscopic treatment tool 10B of the third embodiment, a series of operations of closing the pair of tip treatment pieces 15 and 16, sandwiching the affected part, pulling up by a minute size, and limiting the rotation angle is performed. It can be performed with only one hand of the tool operator, and the treatment can be performed safely and efficiently.

As a modification of the endoscopic treatment tool 10B of the third embodiment, an arcuate concave portion is provided in the tubular portion 14a of the tip treatment tool support member 14, and the convex portion engaging with the arcuate concave portion is formed in the connecting tubular portion 22. It may be provided. Further, unlike the endoscopic treatment tool 10A of the second embodiment shown in FIG. 6, the pair of tip treatment pieces 15 and 16 do not have the opening / closing operation links 19 and 20 and the advance / retreat transmission link 21. , Two operation wires 12A and 12B may be passed through the sheath 11. Further, there is no tip side convex portion 14j and a base end side arcuate concave portion 22d, and the tubular portion 14a of the tip treatment tool support member 14 is provided in a fixed state on the tip small diameter tubular portion 22b of the connecting tubular portion 22. It may be a modified example.

[Other Embodiments]
8 (A), (B), and (C) show the tip treatment tool of the endoscopic treatment tool according to a modification of the present invention. The pair of tip treatment pieces 15C and 16C as the tip treatment tool of the endoscopic treatment tool 10C has a shape in which the tip side portions 15c and 16c are arcuate and have a square protrusion on the tip outside, and the tip side. When the part is closed, it can be used as a needle-shaped knife or marker, and when it is opened and closed, it can be used as scissors.

As shown in FIG. 8B, since the tip treatment pieces 15C and 16C have a small thickness dimension in the direction along the support shaft 18, each arm portion 14b is provided so that the tip wall portion 14h protrudes. There is. The support shaft 18 is formed on a stepped shaft having a large diameter portion at the center and a small diameter portion on both sides. The tip treatment tool support member 14 shown in FIGS. 9A to 9D differs from the configuration of the tip treatment tool support member of the above-described embodiment in that it has a protruding portion 14h.

In the endoscopic treatment tool 10C as well, as in the first embodiment (see FIGS. 5 (A)-(D)), the tip treatment tool support member 14 is composed of a pair of halves (unsigned). A pair of halves are stacked so as to sandwich the small diameter portion 11a2 at the tip of the coil sheath 11a, and laser welding or the like is performed integrally. Tip treatment piece The tip treatment tool support member 14 and the coil sheath 11a are rotatably connected to each other so as not to be detached. Since the other configurations are substantially the same as those in the first embodiment, they are designated by the same reference numerals as those in FIG. 3 and the description thereof will be omitted.

According to the present invention, the tip treatment tool support member is directly connected to the tip small diameter portion formed in the coil sheath so as not to be detachable and rotatably directly, or the tip treatment tool support member is connected to the connecting tubular portion added to the tip portion of the coil sheath. It is possible to realize a configuration in which the coil sheath and the tip treatment tool support member are directly connected to each other in a non-removable and rotatably manner, so that the number of connecting members between the coil sheath and the tip treatment tool support member is zero (directly connected without being provided), or only one is provided. It is possible to provide an excellent endoscopic treatment tool, which has the effects of realizing a simple connection structure, facilitating assembly, and reducing costs.

1 ... Endoscopic system,
2 ... Insertion part,
3 ... Endoscope operation unit,
4 ... Treatment tool introduction part,
5 ... Endoscopic channel,
10, 10A, 10B, 10C ... Endoscopic treatment tools,
11, 11B ... Sheath,
11a ... Coil sheath,
11a1 ... Tip (convex to prevent escape),
11a2 ... Small diameter part at the tip,
11b ... Resin jacket,
12 ... Operation wire,
13 ... Operation unit,
13a ... Operation unit body,
13b ... Slider,
14 ... Tip treatment tool support member,
14A, 14B ... Half body,
14a ... Cylinder,
14a1 ... Half cylinder,
14b, 14b ... Arms,
14c ... Bearing for support shaft,
14d ... Bearing part,
14e ... Convex part,
14f ... recess,
14g ... Semi-circular ring wall,
14h ... Thick tip,
14i ... Overlay line,
14j ... Tip side convex part (convex part),
15, 16, 15C, 16C ... Tip treatment piece (tip treatment tool),
15a, 16a ... Middle (intersection),
15b, 16b ... Base end side portion,
15c, 16c ... Tip side part,
15d, 16d ... Link for opening / closing operation,
18 ... Support shaft,
19, 20 ... Link for opening / closing operation,
21 ... Advance / retreat transmission link,
22 ... Cylindrical part for connection,
22a ... Large diameter cylinder,
22b ... Small diameter tube at the tip,
22c ... Convex part for prevention of escape,
22d ... Arc-shaped recess on the base end side (arc-shaped recess),

Claims (6)

Flexible coil sheath and
An operation wire arranged so as to be able to advance and retreat in the coil sheath,
An operation unit provided at the rear end of the coil sheath for advancing and retreating the operation wire,
A tip treatment tool support member having a tubular portion connected to the tip end portion of the coil sheath or a connecting tubular portion provided at the tip end portion and a pair of opposed arm portions extending toward the tip end side from the tubular portion.
It is provided with a tip treatment tool that is supported between the arms and receives the advancing / retreating motion force of the operation wire to treat the affected part of the living body.
A small diameter portion at the tip is provided at the tip of the coil sheath or a tubular portion for connection provided at the tip so as to avoid the tip.
The tip treatment tool support member is provided so that the tubular portion is split in half between the arms and protrudes inward from the rear end of the inner peripheral surface of each half split body and is fitted to the tip small diameter portion. A treatment tool for an endoscope, characterized in that a pair of semicircular bodies having an annular bearing portion are overlapped and fixed to each other. The endoscopic treatment tool according to claim 1, wherein the bearing portion of the tip treatment tool support member is fitted in a fixed state on the tip small diameter portion. The endoscopic treatment tool according to claim 1, wherein the bearing portion of the tip treatment tool support member is rotatably fitted to the tip small diameter portion. The endoscopic treatment according to any one of claims 1 to 3, wherein the pair of halves are provided with a concave portion for positioning and a convex portion distributed on the half surface. Ingredients. The coil sheath is provided with a small-diameter portion having a required length, which is a portion where the bearing portion is fitted, avoiding the tip portion, and the bearing portion is provided so as to be fitted so as to be movable in the axial direction. The endoscopic treatment tool according to any one of claims 1, 3 and 4. A convex portion and an arcuate concave portion that function as a pair that restricts the rotation of the tip treatment tool support member with respect to the connecting tubular portion at a required angle of less than 360 degrees are formed between the tubular portion and the connecting tubular portion. The treatment tool for an endoscope according to any one of claims 1, 3 and 4, wherein the treatment tool is provided separately from the unit.

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