Suppression device, endoscopic treatment instrument, and endoscopic processing system

Abstract

An endoscopic treatment instrument (1) having a restraining device (7, 7A, 7B, 7C, 7D, 7F, 7G, 7H, 7I, 7J, 7K, 7L, 7M), the restraining device restricting the operation of a guide wire relative to a sheath (2) of the endoscopic treatment instrument (1), the sheath (2) having a lumen (21) through which the guide wire can be inserted, the restraining device covering at least one of a sheath slot (23) formed from near the distal end opening of the sheath (2) to the proximal end opening of the sheath (2) and the distal end of the proximal end opening of the sheath (2), the restraining device closing at least one of them to allow the guide wire to advance and retreat within the lumen (21), thereby preventing the guide wire from entering the sheath slot (23); the restraining device opening the sheath slot (23) and the distal end of the proximal end opening of the sheath (2) to allow the guide wire to enter the sheath slot (23).

Description

Technical Field

[0001] The present invention relates to an endoscope processing system, an endoscope treatment instrument, and an inhibition device for the endoscope processing system and the endoscope treatment instrument. Background Art

[0002] When treating a disease related to a luminal organ of the human body, in order to insert a treatment instrument into the luminal organ of a treatment target, it is sometimes necessary to use an endoscope to insert a guide wire into the luminal organ. In the case of performing the above-described endoscope operation, the endoscope is inserted into the body, and a guide wire is retained from the outside of the body to the luminal organ of the treatment target using a cannula inserted into the insertion path of the endoscope. Then, the treatment instrument is inserted into the luminal organ along the retained guide wire. During treatment, operations such as sequentially replacing a contrast agent, a dilation balloon, a cutting instrument, and other treatment instruments are often performed. Conventionally, each time a treatment instrument is replaced, it has been necessary to insert and remove a catheter for each treatment instrument.

[0003] In response to this, for example, Patent Document 1 discloses a catheter that forms a C-channel slot in the proximal portion of the shaft and has a guide wire port provided near the operation portion that communicates with the C-channel slot. In the catheter of Patent Document 1, the guide wire is inserted into the C-channel and exposed from the guide wire port. The catheter of Patent Document 1 is configured such that the guide wire can be withdrawn from the guide wire port and the guide wire can be easily inserted and removed relative to the insertion portion of the endoscope. As a result, it is possible to remove the guide wire from the insertion tool of the guide wire while leaving the guide wire in the guide wire lumen of the catheter.

[0004] Patent Document 1: Japanese Patent No. 4651823

[0005] During treatment, for example, an operation of advancing the guide wire in the luminal organ is sometimes performed. At this time, in the catheter of Patent Document 1, the operator presses the guide wire in order to advance the guide wire in the guide wire lumen. In response to this operation, the exposed portion of the guide wire advances relative to the slot on the more proximal side than the guide wire port and the C-channel slot of the catheter, and sometimes the guide wire cannot smoothly advance in the guide wire lumen. Further, when the guide wire is clamped by the slot on the more proximal side than the guide wire port and the C-channel slot, an operation is required to return the guide wire to a state where it can be advanced and retracted, which hinders shortening of the treatment time. Summary of the Invention

[0006] The present invention relates to a restraining device for restricting the operation of a guide wire relative to a sheath of an endoscopic treatment instrument. The sheath has a lumen through which the guide wire can be inserted. The restraining device is provided on a sheath connection part at the proximal end of the inserted sheath and covers at least one of a sheath slot formed from near the distal end opening of the sheath to the proximal end opening of the sheath and the distal end of the proximal end opening of the sheath. The restraining device closes at least one of the sheath slot and the distal end of the proximal end opening of the sheath, so that the guide wire can advance and retreat in the lumen, thereby preventing the guide wire from entering the sheath slot; the restraining device opens the sheath slot and the distal end of the proximal end opening of the sheath, so that the guide wire can enter the sheath slot.

[0007] The present invention relates to an endoscopic treatment instrument, which includes a sheath provided on the distal side of the endoscopic treatment instrument, a sheath connection part connected to the proximal side of the sheath, and a restraining device provided on the sheath connection part. A sheath slot is formed from near the distal end opening of the sheath to the proximal end opening of the sheath. The sheath has a lumen through which a guide wire can be inserted. The restraining device covers at least one of the sheath slot and the distal end of the proximal end opening of the sheath.

[0008] The restraining device closes at least one of the sheath slot and the distal end of the proximal end opening of the sheath, so that the guide wire can advance and retreat in the lumen, thereby preventing the guide wire from entering the sheath slot; the restraining device opens the sheath slot and the distal end of the proximal end opening of the sheath, so that the guide wire can enter the sheath slot.

[0009] The present invention further relates to an endoscopic treatment system, which includes an endoscopic device and the above-mentioned endoscopic treatment instrument used by being inserted into a treatment instrument channel of the endoscopic device.

[0010] The present invention further relates to a restraining method for restricting the operation of a guide wire relative to a sheath of an endoscopic treatment instrument by using the above-mentioned restraining device. The restraining method includes the following steps: closing at least one of the sheath slot and the distal end of the proximal end opening of the sheath through the restraining device, so that the guide wire can advance and retreat in the lumen, thereby preventing the guide wire from entering the sheath slot; opening the sheath slot and the distal end of the proximal end opening of the sheath through the restraining device, so that the guide wire can enter the sheath slot, and switching between the above two steps through the operation of the above-mentioned restraining device.

[0011] Advantages of the Invention

[0012] The endoscope treatment instrument and the method of using the endoscope treatment instrument according to the present invention can smoothly perform the advancing and retracting operations of the guide wire. BRIEF DESCRIPTION OF THE DRAWINGS

[0013] FIG. Figure 1 is a perspective view showing the usage state of the endoscope treatment instrument according to the first embodiment.

[0014] FIG. Figure 2 is a side view of a part of the endoscope treatment instrument according to the first embodiment.

[0015] FIG. Figure 3 is a side view of a part of the endoscope treatment instrument according to the first embodiment.

[0016] FIG. Figure 4 is FIG. Figure 2 a cross-sectional view taken along line IV-IV of FIG.

[0017] FIG. Figure 5 is FIG. Figure 3 a cross-sectional view taken along line V-V of FIG.

[0018] FIG. Figure 6 is a side view showing the distal part of the endoscope treatment instrument according to the embodiment.

[0019] FIG. Figure 7 is FIG. Figure 6 a cross-sectional view taken along line VII-VII of FIG.

[0020] FIG. Figure 8 is FIG. Figure 6 a cross-sectional view taken along line VIII-VIII of FIG.

[0021] FIG. Figure 9 is a schematic view showing the usage state of the endoscope treatment instrument according to the embodiment.

[0022] FIG. Figure 10 is a schematic view showing the usage state of the endoscope treatment instrument according to the embodiment.

[0023] FIG. Figure 11 is a perspective view of a part of the endoscope treatment instrument according to a modification of the first embodiment.

[0024] FIG. Figure 12 is FIG. Figure 11 a perspective view of a part of the endoscope treatment instrument.

[0025] FIG. Figure 13 is FIG. Figure 11 a side view of a part of the endoscope treatment instrument.

[0026] FIG. Figure 14 is a side view of a part of the endoscope treatment instrument according to the second embodiment.

[0027] Attached Figure 15 is the sectional view taken along line XV-XV of the attached Figure 14 .

[0028] Attached Figure 16 is the sectional view taken along line XV-XV of the attached Figure 14 of the suppression part in the second state.

[0029] Attached Figure 17 is the perspective view of a part of the endoscopic treatment instrument according to a modified example of the second embodiment.

[0030] Attached Figure 18 is the perspective view of a part of the endoscopic treatment instrument according to a modified example of the second embodiment.

[0031] Attached Figure 19 is the perspective view of a part of the endoscopic treatment instrument according to a modified example of the second embodiment.

[0032] Attached Figure 20 is the side view of a part of the endoscopic treatment instrument according to the third embodiment.

[0033] Attached Figure 21 is the attached Figure 20 sectional view taken along line XXV-XXV of the

[0034] Attached Figure 22 is the attached Figure 20 sectional view taken along line XXV-XXV of the

[0035] Attached Figure 23 is the perspective view of a part of the endoscopic treatment instrument according to a modified example of the third embodiment.

[0036] Attached Figure 24 is the perspective view of a part of the endoscopic treatment instrument according to the fourth embodiment.

[0037] Attached Figure 25 is the attached Figure 24 sectional view taken along line XXV-XXV of the

[0038] Attached Figure 26 is the attached sectional view taken along line XXV-XXV of the suppression part in the second state Figure 24 .

[0039] Attached Figure 27 is the perspective view of a part of the endoscopic treatment instrument according to a modified example of the fourth embodiment.

[0040] Attached Figure 28 is the side view of a part of the endoscopic treatment instrument according to a modified example of the fifth embodiment.

[0041] Attached Figure 29 is the attached Figure 28Cross-sectional view of line XXIX-XXIX.

[0042] Attached Figure 30 It is a cross-sectional view of the suppression part of the endoscopic treatment instrument of the sixth embodiment.

[0043] Attached Figure 31 It is a cross-sectional view of the suppression part of the endoscopic treatment instrument of the sixth embodiment.

[0044] Attached Figure 32 It is a side view of the suppression part of the endoscopic treatment instrument of the seventh embodiment.

[0045] Attached Figure 33 It is a side view of the suppression part of the endoscopic treatment instrument of the seventh embodiment.

[0046] Attached Figure 34 It is a side view showing a modified example of the endoscopic treatment instrument.

[0047] Attached Figure 35 It is a side view showing a modified example of the endoscopic treatment instrument.

[0048] Attached Figure 36 It is a flowchart showing the usage method of the endoscopic treatment instrument. Detailed implementation mode

[0049] (First embodiment)

[0050] Hereinafter, with reference to attached Figure 1 to attached Figure 10 The endoscopic treatment instrument of the present embodiment and the usage method of the endoscopic treatment instrument will be described. Attached Figure 1 It is an overall view of the state in which the endoscopic treatment instrument 1 of the present embodiment is inserted into the treatment instrument channel 105 of the endoscopic device 100 for use.

[0051] As shown in attached Figure 1 The endoscopic treatment instrument 1 of the present embodiment is a medical instrument used together with the endoscopic device 100 to cut biological tissues in the body. In the endoscopic device 100 of the present embodiment, the endoscopic insertion part 101 inserted into the body has an active bending part 107. The active bending part 107 is configured to be able to perform a bending action according to the operation of the operation part 103.

[0052] In the present embodiment, an example is shown in which the endoscopic treatment instrument 1 (hereinafter referred to as the "treatment instrument") is inserted into a side-view endoscope device 100 suitable for observing the duodenal papilla. The side-view endoscope device 100 includes, for example, an endoscope insertion portion 101, a grip portion 102, a forceps port 104, a treatment instrument channel 105, and a lift table and a camera unit (not shown). The endoscope insertion portion 101 is the portion inserted into the body. The operation portion 103 is the part where the operator performs operations. In the following description, the side where the operation portion 103 of the endoscope device 100 is provided is referred to as the proximal side P, and the end of the endoscope insertion portion where the endoscopic treatment instrument 1 protrudes is referred to as the distal side D. Similarly, the side of the operation portion 9 of the treatment instrument 1 described below is referred to as the proximal side P, and the end portion on the opposite side of the operation portion 9 in the long side direction and the end portion of the sheath 2 inserted into the body is referred to as the distal end.

[0053] The grip portion 102 is disposed at the proximal end of the endoscope insertion portion 101. The forceps port 104 is disposed in a part of the grip portion 102. The treatment instrument channel 105 is formed inside the endoscope insertion portion 101 communicating with the forceps port 104. The lift table is provided to change the direction of the endoscopic treatment instrument 1 and the like protruding from the treatment instrument channel 105 to a direction orthogonal to the central axis of the endoscope insertion portion 101 at the distal end of the treatment instrument channel 105. The camera unit is disposed at the distal end of the endoscope insertion portion 101.

[0054] The treatment instrument 1 is inserted into the treatment instrument channel 105 from the forceps port 104 and is configured to be used so as to protrude and retract from the distal end of the endoscope insertion portion 101. The treatment instrument 1 has a sheath 2, an operation portion 9, a base portion 4, and a connecting portion 5. The operation portion 9 is provided at the proximal end of the treatment instrument 1. The sheath 2 is provided on the distal side D of the treatment instrument 1. The sheath 2 and the operation portion 9 are connected together via the base portion 4 and the connecting portion 5.

[0055] The sheath 2 is an elongated member inserted into the treatment instrument channel 105. The sheath 2 is an elongated member having flexibility. In the third embodiment, the sheath 2 is made of resin. As shown in the appendix Figure 4 and 5 As shown, a guide wire lumen 21 is formed in the sheath 2. As shown in the appendix Figures 6 - 8 As shown, the guide wire lumen 21 extends from the proximal end opening 22 at the proximal end of the sheath 2 to the distal end opening 24 at the distal end of the sheath 2 throughout the entire length of the sheath 2. The guide wire lumen 21 is a lumen having a size that allows the guide wire GW to advance and retreat. As shown in the appendix Figure 7 、 8As shown, the guiding wire lumen 21 has a C-channel structure with a cross-sectional shape that is roughly C-shaped, slotted on the radially outer side of the sheath 2 and orthogonal to the long axis. A sheath slot 23 is formed in the C-channel portion. The sheath slot 23 is formed from near the distal end opening 24 of the sheath 2 all the way to the proximal end opening 22 of the sheath 2. The sheath slot 23 is elastically deformable. In addition, the width of the sheath slot 23 is slightly smaller than the outer diameter of the guiding wire GW used in combination with the treatment instrument 1. The sheath 2 is configured such that the guiding wire GW inserted into the guiding wire lumen 21 can be withdrawn from the elastically deformable sheath slot 23 to the outside of the sheath 2. The region including the portion where the distal end opening 24 is disposed is referred to as the distal end portion of the sheath 2. The region including the portion where the proximal end opening 22 is disposed is referred to as the proximal end portion of the sheath 2.

[0056] As shown in the appendix Figure 7 , 8 In addition to the guiding wire lumen 21, one or more lumens 29 are formed in the sheath 2. The lumen 29 is used as an injection path for a contrast agent, an injection path for a fluid flowing to the balloon, or an insertion path for a single knife wire.

[0057] The operation unit 9 is a part for inputting, where the input is for the operator to operate other treatment instruments inserted into the sheath 2. The operation unit 9 has a shaft portion 91 and a sliding portion 92. The shaft portion 91 is fixed to the base portion 4 and extends linearly along the long axis. The sliding portion 92 is provided to be slidable along the long axis of the shaft portion 91.

[0058] The sliding portion 92 may, for example, have a connector 93 that can be connected to a high-frequency power supply device and a finger rest portion 94. The proximal end of the knife wire described below can be electrically connected to the connector 93, for example. The operator's finger can pass through the finger rest portion 94.

[0059] An insertion port 41 is provided on the base portion 4. The insertion port 41 communicates with the lumen of the sheath described below. The insertion port 41 injects, for example, a contrast agent or a fluid for the balloon into the lumen 29, or inserts a knife wire therein.

[0060] The connection portion 5 includes a connection main body 53, a proximal connection portion 51, a hook 52, and a sheath connection portion 54. The proximal connection portion 51 is provided at the proximal end of the connection main body 53. The proximal connection portion 51 connects the base portion 4 and the connection main body 53. The distal portion of the connection main body 53 is provided with a sheath connection portion 54 and a hook 52. The sheath connection portion 54 is provided on the distal side D of the operation unit 9 and the proximal connection portion 51 along the long axis. As shown in the appendix Figure 2 , 3 As shown, the hook 52 is provided to protrude laterally from the sheath connection portion 54. The hook 52 is a locking portion that can be locked to the holding portion 102. As shown in the appendix Figure 1As shown, when the hook 52 is latched to the holding portion 102, the portion closer to the proximal side P than the connecting portion 5 of the treatment instrument 1 is held in a direction intersecting the long axis of the endoscope device 100.

[0061] As shown in the Figures 1 - 3 accompanying drawings, the proximal portion of the sheath 2 is inserted into the sheath connection portion 54. A lead wire insertion port 55 is formed in the sheath connection portion 54. A slot 56 is formed from the distal end 551 of the lead wire insertion port 55 to the distal end of the sheath connection portion 54. The slot 56 is an example of a restraining slot. The width of the slot 56 is slightly larger than the outer diameter of the lead wire GW used in combination. The lead wire insertion port 55 communicates with the lead wire lumen 21. As shown in the Figures 3 - 5 accompanying drawings, the slot 56 is disposed close to the sheath slot 23, and the circumferential positions of the respective slots 56 and 23 are disposed at substantially the same positions.

[0062] A restraining portion 7 is provided on the sheath connection portion 54. The restraining portion 7 is provided to prevent the lead wire GW extending from the lead wire insertion port 55 from entering the slot 56. The restraining portion 7 covers at least one of the slot 56 and the distal end 551 of the lead wire insertion port 55. The slot 56 is disposed at a position corresponding to the sheath slot 23, and the lead wire insertion port 55 is disposed at a position corresponding to the proximal end opening 22 of the sheath 2. Accordingly, the restraining portion 7 covers at least one of the slot 23 and the proximal end opening 22. In the present embodiment, the restraining portion 7 is provided at a position covering the slot 56.

[0063] The accompanying Figure 4 drawings are cross-sectional views of the IV-IV line of the Figure 2 accompanying drawings, showing the restraining portion 7 in the first state. The accompanying Figure 5 drawings are cross-sectional views of the V-V line of the Figure 3 accompanying drawings, showing the restraining portion 7 in the second state. As shown in the Figure 4 , 5 accompanying drawings, the restraining portion 7 includes: a fixing portion 79 connected to the sheath connection portion 54, a cover main body 71, a locking claw 73, and a gripping protrusion 72. The cover main body 71 is a circular arc-shaped portion along the outer surface of the sheath connection portion 54. The fixing portion 79 and the locking claw 73 are provided at the circumferential ends of the arc portion of the cover main body 71. The gripping protrusion 72 is provided to protrude from the outer surface of the sheath connection portion 54. The gripping protrusion 72 has a size and shape that can be gripped by an operator's finger and is provided at a position where the operator can grip it. The locking claw 73 protrudes toward the inside of the arc portion of the cover main body 71. The locking claw 73 is configured to be locked to a recess 541 provided on the outer peripheral surface of the sheath connection portion 54.

[0064] The restraining portion 7 is provided to be openable and closable with respect to the sheath connection portion 54 with the fixing portion 79 as a starting point. As shown in the Figure 4As shown, the state where the suppressing portion 7 covers the slit 56 and the locking claw 73 is locked in the recess 541 of the sheath connecting portion 54 is called the first state. In the first state, the suppressing portion 7 covers at least one of the sheath slit 23 and the distal end 551 of the guide wire insertion port 55. Figure 5 As shown, the state in which the cover body 71 rotates about the fixing portion 79 in a direction away from the sheath connection portion 54 and the slot 56 is opened is referred to as the second state. The suppressing portion 7 is configured to switch between the first state and the second state by a rotational action.

[0065] The suppressing portion 7 may be provided at a position covering at least one of the slit 56 and the distal end 551 of the guide wire insertion port 55. Figure 4 , 5 In addition to the example shown, for example, the inhibitor may be provided at a position covering the proximal portion of the slit 56 and the distal end 551 of the guide wire insertion port 55. The inhibitor 7 may be provided at a position that does not hinder the advancement and retreat of the guide wire GW in the guide wire insertion port 55 and prevents the guide wire GW from entering the slit 56 and the sheath slit 23.

[0066] Next, refer to the attached Figures 9 - 10 , Attachment Figure 36 The method of using the treatment instrument 1 is described below. In the treatment instrument 1, the sheath 2 is inserted from the forceps plug 104, the treatment instrument 1 is inserted into the treatment instrument channel 105 and extends from the distal end of the endoscope insertion part 101. The distal part of the sheath 2 can bend with the bending of the active bending part 107. Figure 1 As shown, the distal end of the sheath 2 is configured to be further bent by means of a lifting table.

[0067] Attached Figure 9 , 10 The following table shows the usage status of the treatment instrument 1. The treatment instrument 1 includes the following Figure 9 As shown in the figure, the two operators U1 and U2 use the Figure 10 In the case of use by one operator U1 as shown in the figure. In the case of use by two operators U1 and U2, as shown in the figure Figure 9 As shown, the hook 52 is released from the endoscope device 100. The operator U1 holds the endoscope device 100 and operates the endoscope device 100. The operator U2 holds the operating portion 9 of the treatment instrument 1 and operates it. The operator U2 holds the guide wire GW and performs operations to maintain the position of the guide wire GW and to advance and retreat the guide wire GW according to the treatment content. Figure 10As shown, when operated by an operator U1, the hook 52 is latched to the holding portion 102 of the endoscope insertion portion 101 to hold the position of the treatment instrument 1 relative to the endoscope apparatus 100, so that the operator U1 alone can perform all operations such as the operation of the endoscope apparatus 100 and the operation of the treatment instrument. The operators U1 and U2 who operate the treatment instrument 1 hold the guide wire GW, and perform operations to hold the position of the guide wire GW and operations to advance and retract the guide wire according to the treatment content.

[0068] First, at least one of the slot 23 and the distal end of the proximal end opening 22 is closed by the restraining portion (step S1). The guide wire GW is inserted from the guide wire insertion port 55. The distal end of the guide wire GW extends from the distal end opening 24 of the sheath 2 and is inserted into the lumen organ.

[0069] Next, in a state where at least one of the sheath slot 23 of the sheath 2 and the distal end of the proximal end opening 22 is closed, the guide wire GW is advanced or retracted within the lumen 21 (second step). That is, the guide wire GW is advanced and retracted in the first state. The proximal portion of the guide wire GW is drawn out from the proximal end opening 22 of the sheath 2 and the guide wire insertion port 55, exposed to the outside of the sheath 2 and extended. The guide wire GW is inserted through the guide wire lumen 21 so as to be freely advanced and retracted. Therefore, when the operator advances or retracts the guide wire GW drawn out from the guide wire insertion port 55, the guide wire GW advances and retracts within the guide wire lumen 21.

[0070] Due to the bent state of the sheath 2 inserted into the body or the case where the contrast agent remains in the lumen 29 after the injection of the contrast agent, etc., due to the state of the sheath 2, the guide wire GW may sometimes not be able to smoothly advance and retract in the distal region of the guide wire lumen 21. In this state, when the operator who operates the guide wire GW advances the guide wire GW, although a force in the direction of squeezing the proximal region of the guide wire GW is applied, the distal region of the guide wire GW cannot advance smoothly. As a result, the guide wire GW bends outside the guide wire insertion port 55. In this state, if the guide wire GW is continuously pressed, the guide wire GW will move from the distal end 551 of the guide wire insertion port 55 in the direction of entering the slot 56 and the sheath slot 23. If the guide wire GW is exposed to the outside of the guide wire lumen 21 at a position more distal than the proximal portion of the slot 56, the operation of returning the guide wire GW into the guide wire insertion port 55 takes time. However, in the present embodiment, when the restraining portion 7 is arranged in the first state, the restraining portion 5 covers the slot 56 and closes the slot 56. Thus, on the connecting portion 5 side, the guide wire GW is prevented from entering the slot 56 by the restraining portion 7. As a result, when the restraining portion is in the first state, it is possible to prevent the guide wire GW from entering the slot 56 against the intention of the second operator when the guide wire GW advances.

[0071] After the second step S2, the proximal end of the sheath slot 23 and the distal end of the proximal end opening 22 are opened (step S3). That is, the restraining portion 7 is switched to the second state. For example, in the case of replacing the cutting wire after injecting the contrast agent, etc., sometimes the sheath 2 is removed from the insertion portion 101 of the endoscope while keeping the guide wire GW in the body. When performing this operation, as shown in Figure 3 shown, the operator of the operating instrument 1 holds the gripping projection 72 while rotating the restraining portion 7 and switches the restraining portion to the second state so that the cover body 71 does not cover the slot 56.

[0072] Next, the guide wire GW is inserted into the slot 56 and the sheath slot 23, and while keeping the guide wire GW in the body, the sheath 2 is peeled off and the instrument 1 is removed from the insertion portion 101 of the endoscope (fourth step S4). The fourth step S4 will be described in detail. First, the guide wire GW continues to be inserted into the slot 56 and the sheath slot 23, and the guide wire GW drawn out from the proximal end opening 22 of the sheath 2 is moved near the forceps plug 104 of the endoscope device 100. After the drawn-out guide wire GW moves to the forceps plug 104, the guide wire GW is fixed to the endoscope device 100 near the forceps plug 104. Then, while keeping the guide wire GW fixed near the forceps plug 104, the base 4, that is, the instrument 1, is pulled to the proximal side P. When the hook 52 is engaged with the holding portion 103, after releasing the engagement between the hook 52 and the holding portion 102, it is pulled to the proximal side P. At this time, the extraction position of the guide wire GW moves to the distal end side of the sheath slot 23. After the instrument 1 is removed from the instrument channel 105 and the extraction position of the guide wire GW moves to the distal end of the sheath slot 23, that is, when the distal end of the sheath slot 23 moves near the forceps plug 104, the extraction of the instrument 1 is temporarily stopped, and the fixing of the guide wire GW near the forceps plug 104 is released. After releasing the fixing of the guide wire GW, while keeping the guide wire GW immobile relative to the endoscope device 100, the instrument 1 is further removed from the instrument channel 105 only. When the distal end of the sheath 2 is completely removed from the forceps plug 104, the guide wire GW is fixed near the forceps plug 104 again, and the instrument 1 is completely removed from the guide wire GW.

[0073] According to the instrument 1 of the present embodiment and the method of using the instrument, when the guide wire GW is advanced relative to the sheath 2, it is possible to prevent the guide wire GW from entering the slot 56 and the sheath slot 23, and it is possible to smoothly advance the guide wire GW relative to the sheath 2.

[0074] Since the suppression part 7 is configured to be able to switch between the first state and the second state, when the sheath 2 is removed from the endoscope insertion part 101, by switching the suppression part 7 to the second state, it is possible to smoothly remove the sheath 2 while maintaining the state where the guide wire GW is inserted into the body. As a result, it helps to shorten the operation time.

[0075] The state of the treatment instrument 1 is not limited to the above state. Attached Figures 11 - 13 A processor instrument 1A showing a modified example is shown. In the following description, the same reference numerals are given to the same structures as those already described, and redundant explanations are omitted. In the attached Figures 11 - 13 In the shown modified example, the structure of the connecting part is different from that of the above-described embodiment. The connecting part 5 of the treatment instrument 1 is not limited to the structural example of the first embodiment. For example, the hook 52 is not an essential structure. As in the treatment instrument 1A of this modified example, a structure in which the sheath 2 is inserted into the funnel tube 8 and the guide wire GW is drawn out to the outside of the sheath 2 may also be adopted.

[0076] The funnel tube 8 includes a cylindrical body 81, a funnel part 82, and a suppression part 7A. A sheath insertion path penetrating in the longitudinal axis direction is formed in the cylindrical body 81 for inserting the sheath 2 therein. The funnel part 82 protrudes and is provided on the outer surface of the middle part in the long side direction of the cylindrical body 81.

[0077] Slots 83 and 85 are formed in the cylindrical body 81 and the funnel part 82. The circumferential positions of the slots 83 and 85 and the sheath slot 23 of the sheath 2 are set at the same positions. Inside the funnel part 82, an opening 87 is formed on the side surface of the cylindrical body 81. The opening 87 on the side surface of the cylindrical body 81 is provided at a position corresponding to the proximal end opening 22 of the sheath 2. The opening 87 on the side surface of the cylindrical body 81 communicates with the guide wire lumen 21 of the sheath 2 via the proximal end opening 22.

[0078] The suppression part 7A is provided on the cylindrical body 81 on the more distal side D than the funnel part 82. As attached Figure 12 and 13 shown, the suppression part 7A is provided at a position covering the distal end of the proximal end opening 22 of the sheath 2 inserted into the cylindrical body 81 and the proximal end of the sheath slot 23. The suppression part 7A is rotatably connected to the cylindrical body 81. The suppression part 7A is configured to be able to switch between a first state in which the cover main body 71A covers the slot 85 and a second state in which the slot 85 is opened. The state of the suppression part 7A rotates about the connecting part between the fixing part 79 and the funnel tube 8 in the same manner as the suppression part 7 of the first embodiment.

[0079] The guide wire GW is inserted from the guide wire lumen 21 of the sheath 2 through the opening on the side surface of the cylindrical body 81 into the funnel part 82. The guide wire GW is drawn out from the proximal opening 84 of the funnel part 82 to the outside of the treatment instrument 1.

[0080] When the restraining portion 7A advances the guide wire GW in the first state, even if the operator of the treatment instrument 1 operates to advance the guide wire GW and the distal region of the guide wire GW does not advance, the restraining portion 7A can prevent the guide wire GW from entering a position more distal than the distal end of the slot 85 to the distal side D. As a result, it is possible to prevent the guide wire GW from entering a position more distal than the proximal end of the sheath slot 23 to the distal side D.

[0081] On the other hand, when the treatment instrument 1A is removed from the endoscope insertion portion 101 while maintaining the state where the guide wire GW is left in the body, the restraining portion 7A is rotated and switched to the second state. After that, the second operator causes the guide wire GW to enter the slot 83 from the proximal opening 84 of the funnel portion 82 and causes the guide wire GW to pass through the slot 85. In this state, when the funnel tube 8 is pulled to the proximal side P, the guide wire GW enters the sheath slot 23, and the guide wire GW is withdrawn from the guide wire lumen 21 to the outside of the sheath 2.

[0082] Similar to the first embodiment, the treatment instrument 1A of the modified example can prevent the guide wire GW from entering the sheath slot 23 when the guide wire GW advances and retreats relative to the sheath 2, and can smoothly advance the guide wire GW relative to the sheath 2.

[0083] Since the restraining portion 7A is configured to be switchable between the first state and the second state, when the sheath 2 is removed from the endoscope insertion portion 101, by switching the restraining portion 7A to the second state, it is possible to smoothly remove the sheath 2 while maintaining the state where the guide wire GW is inserted into the body. As a result, it helps to shorten the operation time.

[0084] (Second Embodiment)

[0085] Refer to the attached Figures 14 - 16 The treatment instrument 1B of the second embodiment will be described. The treatment instrument 1B of the second embodiment is an example in which the structure of the restraining portion 7B is different from that of the first embodiment. The restraining portion 7B is provided so as to be rotatable relative to the sheath connecting portion 54. The attached Figure 15 Is the cross-sectional view of the XV-XV line of the attached Figure 14 Showing the restraining portion 7B in the first state. The attached Figure 16 Is the cross-sectional view of the XV-XV line of the attached Figure 14 Showing the restraining portion 7B in the second state. As shown in the attached Figure 15 , 16 Shown, the restraining portion 7B is a member having a substantially C-shaped cross-sectional shape orthogonal to the long axis. The restraining portion 7B is rotatably mounted on the outside of the sheath connecting portion 54 having a circular cross-sectional shape orthogonal to the long axis in the circumferential direction. The attached Figure 15 Is the cross-sectional view showing the restraining portion 7B in the first state. The attached Figure 16A cross-sectional view of the suppression portion 7B showing the second state is shown.

[0086] The suppression portion 7B has a slot 74B. The slot 74B is a slot having an opening width the same as or slightly wider than that of the sheath slot 23 and the slot 56. As shown in the Figure 16 accompanying drawings, in the second state, the slot 74B of the suppression portion 7B is disposed at a position substantially the same in the circumferential direction as the sheath slot 23 and the slot 56 of the sheath connection portion 54. As shown in the Figure 15 accompanying drawings, when the suppression portion 7B is disposed in the first state, the sheath slot 23 and the slot 56 of the sheath connection portion 54 are covered by the suppression portion 7B.

[0087] Like in the present embodiment, the suppression portion 7B can also be configured to be able to switch between the first state and the second state by performing a relative rotational movement with respect to the sheath connection portion 54.

[0088] For the treatment instrument 1B according to the present embodiment, similar to the first embodiment, when the guide wire GW is advanced and retracted with respect to the sheath 2, it is possible to prevent the guide wire GW from entering the slot 56 and the sheath slot 23, and the guide wire GW can be smoothly advanced with respect to the sheath 2.

[0089] Since the suppression portion 7B is configured to be able to switch between the first state and the second state, when the sheath 2 is removed from the endoscope insertion portion 101, by rotating the suppression portion 7B and switching it to the second state, it is possible to smoothly remove the sheath 2 while maintaining the state where the guide wire GW is inserted into the body. As a result, it helps to shorten the operation time.

[0090] The state of the treatment instrument is not limited to the above state. The Figures 17 - 19 accompanying drawings show the treatment instruments 1C, 1D, and 1F of modified examples. The Figure 17 treatment instrument 1C of the modified example shown has a funnel tube 8 in the same way as the Figure 11 accompanying drawings. A suppression portion 7C having the same structure as that of the second embodiment is provided at the distal end portion of the funnel tube 8. The suppression portion 7C is rotatably mounted with respect to the funnel tube 8. The Figure 17 accompanying drawings show the suppression portion 7C in the first state. As shown in the Figure 17 accompanying drawings, in the first state, the sheath slot 23 and the slot 85 of the cylinder 81 are covered by the suppression portion 7C. When the suppression portion 7B is disposed in the second state, the slot 74C of the suppression portion 7D is disposed at a position substantially the same in the circumferential direction as the sheath slot 23 and the slot 85 of the cylinder 81. As a result, the guide wire GW can enter the slot 85 of the cylinder 81 and the sheath slot 23 through the slot 83 of the funnel portion 82, and the treatment instrument 1C can be removed while the guide wire GW is retained.

[0091] In the Figure 18In the treatment instrument 1D of the illustrated modified example, the position of the restraining portion 7D is different from that of the treatment instrument 1C of the attached Figure 17 modified example. In the treatment instrument 1D of this modified example, a restraining portion 7D is provided at the proximal portion of the funnel portion 82. A locking groove 86 for locking the restraining portion 7D is formed on the funnel portion 82. The locking groove 86 is formed along the size and shape of the restraining portion 7D. The restraining portion 7D is disposed within the locking groove 86 and is rotatably provided within the locking groove 86 in the circumferential direction. By rotating the restraining portion 7D within the locking groove 86 in the circumferential direction, it is switched between the first state and the second state. Attached Figure 18 The restraining portion 7D showing the first state is illustrated. In the first state, a part of the proximal portion of the slot 83 of the funnel portion 82 is covered by the restraining portion 7D. When a part of the proximal portion of the slot 83 of the funnel portion 82 is covered by the restraining portion 7D, the restraining guide wire GW enters the distal side D of the slot 83. Since the restraining portion 7D is provided at a position more proximal than the proximal portion of the sheath slot 23, the guide wire GW is prevented from entering the sheath slot 23. When the operator rotates the restraining portion 7D and disposes it in the second state, the circumferential positions of the slot 83 of the funnel portion 82 and the slot 74D of the restraining portion 7D are disposed at substantially the same position. The guide wire GW can enter the slot 85 of the cylinder 81 and the sheath slot 23 after passing through the slot 83 of the funnel portion 82. As a result, the treatment instrument 1C can be removed while the guide wire GW is retained.

[0092] Attached Figure 19 The treatment instrument 1F of the illustrated modified example is an example in which the funnel tube 8F is provided to be rotatable relative to the sheath 2 and serves as the restraining portion 7F. Attached Figure 19 The restraining portion 7F showing the first state is illustrated. The operator rotates the funnel tube 8 relative to the sheath 2 about the central axis, so that the restraining portion 7F can be switched between the first state and the second state. A guide wire insertion port 22F that is long in the circumferential direction is formed on the sheath 2. A through hole communicating with the guide wire insertion port 22F and the funnel portion 82 is formed on the cylinder 81F of the funnel tube 8F. Whether the restraining portion 7F is in the first state or the second state, the guide wire insertion port 22F and the through hole are in communication, and the guide wire GW can advance and retreat therein. When in the first state, the entry of the guide wire GW into the sheath slot 23 is restricted. When the operator rotates the funnel tube 8F and disposes it in the second state, the circumferential positions of the slot 83 of the funnel portion 82 and the slot 74D of the restraining portion 7D are disposed at substantially the same position as the sheath slot 23. As a result, the guide wire GW can enter the slot 85 of the cylinder 81 and the sheath slot 23 after passing through the slot 83 of the funnel portion 82, and the treatment instrument 1C can be removed while the guide wire GW is retained.

[0093] According to the attached Figures 17 - 19The treatment instruments 1C, 1D, and 1F of the illustrated modified examples can prevent the guide wire GW from entering the slot 85 and the sheath slot 23 when the guide wire GW is advanced and retracted relative to the sheath 2 in the same manner as the treatment instrument 1B of the second embodiment, and can smoothly advance the guide wire GW relative to the sheath 2.

[0094] Since the restraining portions 7C, 7D, and 7F are configured to be switchable between the first state and the second state, when the sheath 2 is removed from the endoscope insertion portion 101, the restraining portions 7C, 7D, and 7F are rotated and switched to the second state, so that the sheath 2 can be smoothly removed while maintaining the state where the guide wire GW is inserted into the body. As a result, it helps to shorten the operation time.

[0095] (Third Embodiment)

[0096] Refer to the attached Figures 20 - 22 The treatment instrument 1G of the third embodiment will be described. The treatment instrument 1G of the third embodiment is an example in which the structure of the restraining portion 7G is different from that of the first embodiment. As shown in the attached Figures 21 - 22 figure, the cover body 71G of the restraining portion 7G is provided at a position covering the distal end 551G of the slot 56 and the guide wire insertion port 55 of the sheath connection portion 54.

[0097] The attached Figure 21 , 22 is a cross-sectional view taken along line XXI-XXI of the attached Figure 20 figure. As shown in the attached Figure 21 , 22 figure, the connection portion 5G has a cylindrical shape, and the proximal portion of the sheath 2 is inserted therein. A guide wire insertion port 55 is formed in the connection portion 5G. The slot 56G extends from the distal end 551G of the guide wire insertion port 55 to the distal end of the connection portion 5G.

[0098] The restraining portion 7G is provided at a position separated from the sheath slot 23 toward the radially outer side so as to cover the sheath slot 23. The restraining portion 7G is separated from the outer peripheral surface of the sheath 2 in such a manner that the guide wire GW can move from the sheath slot 23 to the slot 56G. The slot 56G of the connection portion 5G is provided at a position deviated from the position of the sheath slot 23 in the circumferential direction. That is, the restraining portion 7G is formed with a slot 56G as an opening at a position different from the opening position of the sheath slot 23 in the circumferential direction of the sheath 2.

[0099] As shown in the attached Figure 22As shown, the guide wire GW configured to be taken out from the sheath slot 23 can be taken out to the outside from the slot 56G after passing through the gap S inside the suppression portion 7G. When the operator operates to advance the guide wire GW and the distal region of the guide wire GW does not advance, the guide wire GW moves radially outward of the connecting portion 5G within the guide wire insertion port 55. At this time, since the distal end 551G of the guide wire insertion port 55 is covered by the suppression portion 7G, the guide wire GW contacts the distal end 551G of the guide wire insertion port 55, blocking the guide wire GW from entering the slot 56G of the connecting portion 5G and the sheath slot 23. On the other hand, when the operator intends to take out the guide wire GW from the guide wire lumen 21, as shown by the double-dashed line in the attached Figure 20 . While pulling the guide wire GW radially outward of the sheath 2, the operator pulls it in the circumferential direction. As shown in the attached Figure 22 , the guide wire GW passes through the gap S inside the suppression portion 7G from the sheath slot 23 and then emerges from the slot 56G to the outside of the suppression portion 7G. That is to say, the guide wire GW can avoid the suppression portion 7G and enter the distal side D of the slot 56G. As a result, the sheath 2 can be smoothly removed while keeping the guide wire GW inserted into the body, which helps to shorten the operation time.

[0100] According to the treatment instrument 1G of the present embodiment, it is possible to prevent the guide wire GW from entering the slot 56G and the sheath slot 23 when the guide wire GW is advanced and retracted relative to the sheath 2, and it is possible to smoothly advance the guide wire GW relative to the sheath 2.

[0101] Attached Figure 23 shows a treatment instrument 1H showing a modification of the third embodiment. In the treatment instrument 1H of the modification shown in the attached Figure 23 , the structure of the connecting portion is different from that of the above embodiment. For example, the suppression portion 7G of the third embodiment can also be applied to the funnel tube 8. In the treatment instrument 1H of the present embodiment, the suppression portion 7H is integrally formed with the distal portion of the cylindrical body 81 of the funnel tube 8. A flat suppression portion 7H is provided between the slot 83 of the funnel portion 82 and the slot 85 of the cylindrical body 81. As shown in the attached Figure 23 , the suppression portion 7H extends in the circumferential direction of the cylindrical body 81 at a position where it is more distal than the funnel portion 82 and intersects with the slot 85 of the cylindrical body 81. A slot 74H is formed around the suppression portion 7. The slot 74H is formed in a curved shape. The slot 74H communicates with the slot 83 of the funnel portion 82 and the slot 85 of the cylindrical body 81. Similar to the third embodiment, the suppression portion 7H is provided at a position that separates from the sheath 2 radially outward and covers the sheath slot 23.

[0102] By providing the cover main body 71H, when the guide wire GW moves against the operator's intention to a position farther distally D than the slot 83 of the funnel portion 82, it is possible to prevent the guide wire GW from entering the sheath slot 23. On the other hand, when removing the guide wire GW from the guide wire lumen 21 of the sheath 2, the guide wire GW is inserted into the slot 83 of the funnel portion 82 and is continuously withdrawn until it is exposed at the restraining portion 7H, and then the guide wire GW is moved in the circumferential direction of the sheath 2 along the slot 74H. At this time, similar to the treatment instrument 1G, the guide wire GW passes through the gap S inside the restraining portion 7H and then is exposed from the slot 74H to the outside of the funnel tube 8.

[0103] According to the treatment instrument 1H, it is possible to prevent the guide wire GW from entering the distal end of the slot 85 and the sheath slot 23 when the guide wire GW is advanced and retracted relative to the sheath 2, and it is possible to smoothly advance the guide wire GW relative to the sheath 2. On the other hand, according to the treatment instrument 1H, if the guide wire GW is withdrawn from the slot 74H of the restraining portion 7H, the guide wire GW can be inserted into the sheath slot 23, and the guide wire GW can be removed from the guide wire lumen 21 of the sheath 2.

[0104] (Fourth Embodiment)

[0105] Refer to the attached Figures 24 - 26 Describe the treatment instrument 1I of the fourth embodiment. The treatment instrument 1I of the fourth embodiment is an example in which the structure of the restraining portion 7I is different from that of the above-described embodiments. The restraining portion 7I is provided at the distal portion of the sheath connecting portion 54. The restraining portion 7I includes a pair of pinch pieces 75, a pair of cover main bodies 71I, and a pair of protrusions 76. The restraining portion 7I is formed with a slot 74I along the slot 56 of the sheath connecting portion 54. A pair of cover main bodies 71I and a pair of pinch pieces 75 are respectively formed on both sides of the slot 74I. The restraining portion 7I is integrally formed with the sheath connecting portion 54. The cover main body 71I is provided to cover the upper part of the sheath 2 and the sheath connecting portion 54. The pinch piece 75 extends obliquely from the end of the cover main body 71I toward the side (below the attached Figure 25 ) of the sheath connecting portion 54. The pinch piece 75 is continuously formed with the cover main body 71I. A pair of protrusions 76 are provided at positions on the outer peripheral surface of the sheath connecting portion 54 that face the back surface of the pinch piece 75. The pinch piece 75 is harder than the cover main body 71I. The cover main body 71I is an example of a cover portion. The pinch piece 75 is an example of a switching member.

[0106] Attached Figure 25 、 26 is a cross-sectional view taken along line XXV-XXV of the attached Figure 24 . The attached Figure 25 shows the restraining portion 7I of the first embodiment. The attached Figure 26 shows the restraining portion 7I in the second state. In a state where no external force is applied to the pair of pinch pieces 75, as shown in the attached Figure 25As shown, a pair of cover bodies 71I are arranged close to each other and are in a first state of covering the sheath slot 23. When the restraining portion 7I is in the first state, even when the operator advances the guide wire GW and the distal region of the guide wire GW cannot advance, the restraining portion 7I can prevent the guide wire GW from entering the sheath slot 23 on the distal side D beyond the distal end of the slot 56.

[0107] As shown in the Figure 26 accompanying drawings, when a force is applied in the direction in which the lower ends of a pair of pinch pieces 75 approach each other, the back surface 752 of the pinch piece 75 abuts against the protrusion 76, the cover body 71I tilts, and the slot 74I opens. As a result, it becomes a second state in which the upper part of the sheath slot 23 is not covered. It is symmetrically provided on both sides of the slot 56 that sandwiches the sheath connecting portion 54. In the second state, when the sheath connecting portion 54 is pulled to the proximal side P, the guide wire GW enters the sheath 23, and the guide wire GW is pulled out from the guide wire lumen 21 to the outside of the sheath 2. While keeping the state where the guide wire GW remains in the body, the processing tool 1I is removed from the endoscope insertion portion 101. When the external force applied to the pinch piece 75 is released, the lower ends of the pair of pinch pieces 75 move in the direction away from each other and return to the first state.

[0108] In the treatment instrument 1I according to the present embodiment, since the restraining portion 7I is configured to be switchable between the first state and the second state, when the sheath 2 is removed from the endoscope insertion portion 101, by switching the restraining portion 7I to the second state, it is possible to smoothly remove the sheath 2 while keeping the state where the guide wire GW is inserted into the body. As a result, it helps to shorten the operation time.

[0109] The accompanying Figure 27 drawings show a treatment instrument 1J that is a modification of the fourth embodiment. In the Figure 27 treatment instrument 1J of the modification shown in the accompanying drawings, the structure of the connecting portion is different from that of the above-described embodiment. For example, the structure of the restraining portion 7I of the fourth embodiment may be applied to the funnel tube 8. In the treatment instrument 1J of this modification, a restraining portion 7J is provided at the distal portion of the funnel tube 8. The basic structure of the restraining portion 7J is the same as that of the restraining portion 7I of the fourth embodiment. The restraining portion 7J is arranged at the position covering the proximal end of the sheath slot 23. When the restraining portion 7J is in the first state, even if the guide wire GW protrudes from the slot 83 of the funnel portion 82 to the outside, the restraining portion 7A can prevent the guide wire GW from entering a position on the distal side D beyond the distal end of the slot 85. As a result, it is possible to prevent the guide wire GW from entering from the proximal end of the sheath slot 23.

[0110] On the other hand, while maintaining the state where the guide wire GW remains in the body, when the treatment instrument 1J is withdrawn from the endoscope insertion section 101, a pair of pinch pieces 75J of the clamping inhibition section 7J open and close a pair of cover bodies 71J and switch to the second state. After that, the operator inserts the guide wire GW from the proximal opening 84 of the funnel section 82 into the slot 83 and passes through the slot 85. In this state, when the funnel tube 8 is pulled to the proximal side P, the guide wire GW enters the sheath slot 23, and the guide wire GW is withdrawn from the sheath slot 23 to the outside of the sheath 2.

[0111] In the treatment instrument 1J according to the present embodiment, since the inhibition section 7J is configured to be able to switch between the first state and the second state, it is possible to prevent the guide wire GW from entering the sheath slot 23 against the operator's intention in the first state. When the sheath 2 is withdrawn from the endoscope insertion section 101, by switching the inhibition section 7J to the second state, it is possible to smoothly withdraw the sheath 2 while maintaining the state where the guide wire GW is inserted into the body. As a result, it helps to shorten the operation time.

[0112] (Fifth Embodiment)

[0113] Refer to the attached Figure 28 、 29 to describe the treatment instrument 1K of the second embodiment. In the treatment instrument 1K of the present embodiment, the structure of the inhibition section 7K is different from that of the above embodiment. The attached Figure 29 is a cross-sectional view taken along line XXIX-XXIX of the attached Figure 28 . The connecting section 5K has a cylindrical shape, and the proximal portion of the sheath 2 is inserted therein. A guide wire insertion port 55 is provided in the connecting section 5K. A slot 56K is formed from the distal end 551K of the guide wire insertion port 55 to the distal end of the connecting section 5K. The width L56 of the slot 56K is smaller than the diameter of the combined guide wire GW. Both sides of the circumferential slot 56 constitute the inhibition section 7K. As shown in the attached Figure 29 , the inhibition section 7K is provided at a position covering the proximal end of the sheath slot 23 and the distal end of the proximal end opening 22. The thickness of a pair of cover bodies 71K is thin, and they are configured to be elastically deformed under an external force. The slot 56K is an example of an inhibition slot.

[0114] When the inhibition section 7K is in the first state, the sheath slot 23 is covered by the inhibition section 7K. Therefore, even when a force is applied to make the guide wire GW located in the guide wire lumen 21 enter the slot 56K and expose to the outside more than the inhibition section 7K, a large resistance will be generated on the guide wire GW. In particular, the distal end 551K of the guide wire insertion port 55 is located closer to the proximal side P than the distal end of the proximal end opening 22 of the sheath 2. As a result, it is possible to prevent the guide wire GW from entering the proximal portion of the sheath slot 23.

[0115] On the other hand, when the operator intends to pull out the guide wire GW from the guide wire lumen 21, when a greater force is applied to the guide wire GW exposed from the guide wire insertion port 55 and the guide wire GW is moved radially outward, the guide wire GW enters the slot 56K and can enter the sheath slot 23 all the way. As a result, while maintaining the state where the guide wire GW is inserted into the body, the sheath 2 can be smoothly pulled out, which helps to shorten the operation time.

[0116] (Sixth Embodiment)

[0117] Next, refer to the attached Figure 30 、 31 to describe the treatment instrument 1L of the sixth embodiment. The attached Figure 30 、 31 is a cross-sectional view orthogonal to the long axis of the sheath 2. The attached Figure 30 shows the restraining portion 7L in the first state. The attached Figure 31 shows the restraining portion 7L in the second state. The restraining portion 7L of the treatment instrument 1L of the present embodiment includes a cylindrical body 70L and a sliding member 78. The cylindrical body 70L is formed with an insertion path that communicates from the distal end to the proximal end in the long axis direction, and the sheath 2 is inserted therethrough. The cylindrical body 70L is provided with a guide wire port in the same manner as the cylindrical body 70K of the fifth embodiment. A slot 74L extending in the long axis is formed between the guide wire port and the distal end of the cylindrical body 70K. The circumferential position of the slot 74L and the sheath slot 23 are arranged at substantially the same position. The cover main body 71L is disposed on both sides of the slot 74L.

[0118] The sliding member 78 is provided so as to be slidable relative to the cylindrical body 70L in a direction orthogonal to the long axis. The sliding member 78 has a sliding groove having a substantially U-shaped cross-sectional shape orthogonal to the long axis. The sliding groove includes: a first groove portion 781 located at the bottom of the groove, a third groove portion 783 located near the open end of the sliding groove, and a second groove portion 782 provided between the first groove portion 781 and the third groove portion 783. The first groove portion 781 is a groove having a diameter substantially equal to that of the cylindrical body 70L.

[0119] As shown in the attached Figure 30 , when the cylindrical body 70L is located in the first groove portion 781, the outer surface of the cylindrical body 70L contacts the first groove portion 781, and the pair of cover main bodies 71L abut against each other to form the first state. The second groove portion 782 is larger in opening size than the first groove portion 781 and the third groove portion 783. The second groove portion 782 is a groove having a diameter larger than that of the cylindrical body 70L.

[0120] As shown in the attached Figure 30 , when the restraining portion 7L is in the first state, the pair of cover main bodies 71L are disposed at the position of the sheath slot 23. As shown in the attached Figure 31As shown, when the cylinder body 70L is located in the second groove portion 782, the cylinder body 70L expands radially outward from the first state, and the pair of cover bodies 71L are separated from each other, so that the slot 74L opens. The sheath slot 23 is not covered by the cover body 71, and the restraining portion 7L is in the second state. Since the opening width of the third groove portion 783 is smaller than that of the second groove portion 782, it is difficult for the sliding member 78 to fall off from the cylinder body 70L.

[0121] The operator operates the sliding member 78 to switch the restraining portion 7L between the first state and the second state. When it is desired to prevent the guide wire GW from entering the sheath slot 23, the operator moves the sliding member 78 so that the cylinder body 70L is disposed in the first groove portion 781. In the first state, since the slot 74L of the cylinder body 70L is closed, it is possible to prevent the guide wire GW from entering the sheath slot 23. When the guide wire GW is withdrawn from the guide wire lumen 21, the operator moves the sliding member 78 radially with respect to the sheath 2 so that the cylinder body 70L is disposed in the second groove portion 782. As a result, the slot 74L of the cylinder body 70L opens, the sheath slot 23 opens and is not covered. In this state, when the operator moves the exposed portion of the guide wire GW radially outward, the guide wire GW enters the sheath slot 23. In this state, when the proximal portion of the treatment instrument 1L is withdrawn, it is possible to withdraw the guide wire GW from the endoscope insertion portion 101 while leaving the guide wire GW in the body.

[0122] According to the treatment instrument 1L of the present embodiment, the control portion 7L is switched between the first state and the second state by the sliding operation of the sliding member 78. Therefore, according to the treatment instrument 1L, when the guide wire GW is advanced relative to the sheath 2, it is possible to prevent the guide wire GW from entering the sheath slot 23 and to smoothly advance the guide wire GW relative to the sheath 2. On the other hand, when the sheath 2 is withdrawn from the endoscope insertion portion 101, by switching the restraining portion 7L to the second state, it is possible to smoothly withdraw the sheath 2 while maintaining the state where the guide wire GW is inserted into the body. As a result, it helps to shorten the operation time.

[0123] In the above embodiment, an example in which the sliding member 78 slides radially with respect to the sheath 2 is shown. However, the sliding member is not limited to this structure. For example, as shown in the treatment instrument 1M of the modification example shown in the appendix Figure 32 、 33 a structure in which the sliding member 78M moves in the longitudinal axis direction may be adopted.

[0124] In the appendix Figure 32 、 33In the treatment instrument 1M shown, the restraining portion 7M includes a cylindrical body 70M and a sliding member 78M. The cylindrical body 70M has a tapered portion 77M with a diameter expanding toward the distal side D. The distal end of the cylindrical body 70M has a larger outer diameter than the proximal end. The cylindrical body 70M forms a slot 74M along the long axis from the distal end to the proximal end. The slot 74M is disposed at a position corresponding to the sheath slot 23. The slot 74M is an example of a restraining slot. The sheath 2 has a proximal end opening 22 opened on the proximal side P of the sheath slot 23. The guide wire port 25 is larger than the opening width of the sheath slot 23. The cylindrical body 70M is longer in the long axis direction than the guide wire port 25 of the sheath 2. The proximal end of the cylindrical body 70M is disposed at a position closer to the proximal side P than the proximal end of the proximal end opening 22 of the sheath 2. The distal end of the cylindrical body 70M is disposed to cover the proximal end portion of the sheath slot 23 on the distal side D from the proximal end opening 22. Cover bodies 71M are formed on both sides in the circumferential direction of the slot 74M. The pair of cover bodies 71M includes and covers the boundary portion between the proximal end portion of the sheath slot 23 and the proximal end opening 22. The cylindrical body 70M is an elastically deformable resin member. The sliding member 78M is a C-shaped member harder than the cylindrical body 70M.

[0125] The sliding member 78M is locked to the outer peripheral portion of the cylindrical body 70M. The sliding member 78M is arranged to be able to slide from the proximal portion of the cylindrical body 70M to the tapered portion 77M. Attached Figure 32 The restraining portion 7M in the second state is shown. Attached Figure 33 The restraining portion 7M in the first state is shown. When the restraining portion 7M is in the second state, the cover body 71M of the cylindrical body 70M covers a part of the guide wire port 25 of the sheath 2 and forms a gap through which the guide wire GW can pass. When the sliding member 78M moves from the second state to the distal side D, the sliding member 78M advances within the tapered portion 77M. Since the cylindrical body 70M is elastically deformable, when the sliding member 78M moves toward the distal side D within the tapered portion 77M, the tapered portion 77M is pressed radially inward, and the cover bodies 71M on both sides of the slot 74M approach each other. When the cover bodies 71M on both sides approach each other, the opening size of the slot 74M elastically deforms to be smaller than the opening size of the sheath slot 23. As a result, the cover bodies 71M come into contact with each other, the slot 74M closes, and it switches to the first state in which the distal end of the guide wire port 25 and the proximal end portion of the sheath slot 23 are covered by the cover body 71M.

[0126] The treatment instrument 1M according to the present embodiment, similar to the treatment instrument 1L of the sixth embodiment, switches the restraining portion 7M between the first state and the second state by the sliding operation of the sliding member 78M. Therefore, with the treatment instrument 1M, when the guide wire GW is advanced relative to the sheath 2, it is possible to prevent the guide wire GW from entering the sheath slot 23 and to smoothly advance the guide wire GW relative to the slip sleeve 2. On the other hand, when the slip sleeve 2 is removed from the endoscope insertion portion 101, by switching the restraining portion 7M to the second state, it is possible to smoothly remove the sheath 2 while maintaining the state where the guide wire GW is inserted into the body. As a result, it helps to shorten the operation time.

[0127] In the treatment instruments of the above-described embodiments and modifications, an example of injecting a contrast agent into the lumen 29 of the sheath 2 is shown. However, the treatment instrument is not limited to this example. For example, as in the treatment instrument 1N Figure 34 shown, a structure in which a balloon 3N communicates with the lumen 29 may be employed. In the appendix Figure 34 , the balloon 3N is enlarged and schematically shown. For example, as in the treatment instrument 1P Figure 35 shown, an example may be where a knife wire 3P is inserted through the lumen 29.

[0128] As the restraining portion, an example may be to wind a medical tape around the connecting portion 5. Specifically, the restraining portion may be formed by winding a medical tape around at least one of the sheath slot 23 covering the connecting portion 5 and the distal end of the proximal opening 22.

[0129] The above describes the embodiments of the present invention. However, the technical scope of the present invention is not limited to the above embodiments, and within the scope not departing from the gist of the present invention, the combination of the constituent elements in each embodiment may be changed, or various changes or deletions may be made to each constituent element. The present invention is not limited by the foregoing description.

[0130] Industrial Applicability

[0131] The endoscope treatment instrument and the method of using the endoscope treatment instrument can smoothly advance and retract the guide wire, which helps to shorten the operation time.

[0132]

Description of Reference Numerals

[0133] 1, 1A, 1B, 1C, 1D, 1F, 1G, 1H, 1I, 1J, 1K, 1L, 1M, 1N, 1P Endoscope treatment instrument

[0134] 2 Sheath

[0135] 7, 7A, 7B, 7C, 7D, 7F, 7G, 7H, 7I, 7J, 7K, 7L, 7M Restraining portion

[0136] 9 Operating part

[0137] 23 Sheath slot

[0138] 103 Operating part

[0139] 551 Distal end

[0140] 562 Distal end

[0141] 751G Proximal end

[0142] 751K Distal end

Claims

1. A restraining device for restricting the operation of a guide wire relative to a sheath of an endoscopic treatment instrument, characterized in that, the sheath has a lumen through which the guide wire can be inserted, a sheath slot that is slotted on the radially outer side of the sheath and communicates with the lumen, and a proximal end opening that communicates with the lumen at the proximal end of the sheath slot; as the restraining device, the endoscopic treatment instrument includes: a cylinder body that forms a sheath insertion path along the long axis direction; and a sliding member that can slide relative to the cylinder body along a direction orthogonal to the long axis direction; a guide wire port is formed on the cylinder body, and a first slot extends along the long axis direction between the guide wire port and the distal end of the cylinder body; the sliding member has a sliding slot with a U-shaped cross section orthogonal to the long axis; the sliding slot includes a first slot portion and a second slot portion with an opening size larger than that of the first slot portion; when the cylinder body is located in the first slot portion, the first slot is closed in a manner that the guide wire cannot pass through, and when the cylinder body is located in the second slot portion, the first slot is opened in a manner that the guide wire can pass through.

2. An endoscopic treatment instrument, characterized in that, Including the restraining device according to claim 1.

3. An endoscope processing system, characterized in that, Including an endoscopic device and the endoscopic treatment instrument according to claim 2 used by being inserted into a treatment instrument channel of the endoscopic device.

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