Endoscope disposal instruments

Abstract

An endoscopic disposal instrument comprises: a sheath; a hollow tube extending within the sheath, the hollow tube having a flow path formed along its longitudinal axis; and a stenosis member capable of narrowing the flow path, thereby changing the cross-sectional area of ​​the flow path; the endoscopic disposal instrument is configured to change the flow velocity of a fluid flowing in the flow path by narrowing the flow path in a direction intersecting the longitudinal axis of the hollow tube through the stenosis member.

Description

Technical Field

[0001] The present invention relates to an endoscope treatment instrument. Background Art

[0002] Conventionally, endoscopic treatments such as ESD (endoscopic submucosal dissection) have used endoscopic treatment instruments such as high-frequency knives for incision and dissection, endoscopic treatment instruments for local injection, and endoscopic treatment instruments for hemostasis.

[0003] The specification of Chinese Patent Publication No. CN111202485A and Japanese Patent Application No. 2012-523863 describe an endoscopic treatment instrument capable of performing tissue incision treatment and local injection.

[0004]

Prior art literature

[0005] [Patent Literature]

[0006] [Patent Document 1] China Patent Publication No. CN111202485A

[0007] [Patent Document 2] Japanese Patent Publication No. 2012-523863 Summary of the Invention

[0008] [Problems to be solved by the present invention]

[0009] In endoscopic treatments such as ESD, there is a need to perform additional local injections after removing the endoscopic disposal instrument (e.g., a local injection needle) used for local injection. In such cases, a high-frequency cutter with a water supply function is used to perform local injections in the submucosal layer. However, when using a high-frequency cutter to perform additional local injections, if the water pressure is not strong, the transported liquid may not reach the submucosal layer, making it difficult to perform local injections. On the other hand, when cleaning the surgical site, if the water pressure is not strong, the transported liquid may spread on the tissue surface, the endoscopic field of view may deteriorate, and cleaning may be difficult. The existing high-frequency cutters described in the Chinese Patent Publication CN111202485A and the Japanese Patent Application No. 2012-523863 cannot select a water pressure suitable for their purpose.

[0010] In view of the above circumstances, an object of the present invention is to provide an endoscope treatment instrument capable of switching water potential.

[0011]

Solution to the problem

[0012] According to one embodiment, an endoscopic treatment instrument comprises: a sheath; a hollow tube extending within the sheath, which forms a flow path along the longitudinal axis; a narrowing member, which can narrow the flow path, thereby changing the cross-sectional area of ​​the flow path; and by narrowing the flow path through the narrowing member, the flow rate of the fluid flowing in the flow path can be changed.

[0013] According to one embodiment, an endoscopic treatment instrument comprises: a sheath having a tube holding member provided at a distal end; a cutter having a water supply line formed thereon and being arranged to be movable relative to the sheath; and by protruding and retracting the cutter from the distal end of the tube holding member, the cross-sectional area of ​​the water supply line is changed, thereby switching the flow rate of the fluid passing through the water supply line.

[0014] According to one embodiment, an endoscope treatment instrument comprises: a sheath having a tube holding member provided at the distal end; an incision instrument formed with a water supply pipeline and arranged to be movable relative to the sheath; by protruding and retracting the incision instrument from the distal end of the tube holding member, the cross-sectional area of ​​the water supply pipeline is changed, thereby switching the flow rate of the fluid passing through the water supply pipeline.

[0015] Effects of the invention

[0016] According to the treatment instrument for endoscope of the present invention, the flow rate of the fluid passing through the water supply conduit can be switched by protruding and retracting the incision tool from the distal end of the sheath. BRIEF DESCRIPTION OF THE DRAWINGS

[0017] Figure 1 This is an overall diagram of the endoscope treatment system according to the first embodiment.

[0018] Figure 2 This is an overall view showing a treatment instrument of the endoscopic treatment system according to the first embodiment.

[0019] Figure 3 This is a perspective view of the distal end portion of the treatment instrument according to the first embodiment.

[0020] Figure 4 It is a cross-sectional view of the distal end portion of the treatment instrument according to the first embodiment.

[0021] Figure 5 It is a cross-sectional view of the distal end portion of the treatment instrument according to the first embodiment.

[0022] Figure 6 It is a cross-sectional view of a distal end portion of a treatment instrument according to a modified example of the first embodiment.

[0023] Figure 7 It is a cross-sectional view of a distal end portion of a treatment instrument according to a modified example of the first embodiment.

[0024] Figure 8 It is a cross-sectional view of a distal end portion of a treatment instrument according to a modified example of the first embodiment.

[0025] Figure 9 It is a cross-sectional view of a distal end portion of a treatment instrument according to a modified example of the first embodiment.

[0026] Figure 10 It is a cross-sectional view of a distal end portion of a treatment instrument according to a modified example of the first embodiment.

[0027] Figure 11 It is a cross-sectional view of a distal end portion of a treatment instrument according to a modified example of the first embodiment.

[0028] Figure 12 It is a cross-sectional view of a distal end portion of a treatment instrument according to a modified example of the first embodiment.

[0029] Figure 13 It is a cross-sectional view of a distal end portion of a treatment instrument according to a modified example of the first embodiment.

[0030] Figure 14 It is a cross-sectional view of the distal end portion of the treatment instrument according to the second embodiment.

[0031] Figure 15 It is a cross-sectional view of the distal end portion of the treatment instrument according to the second embodiment.

[0032] Figure 16 It is a perspective view of a constriction member according to a second embodiment.

[0033] Figure 17 It is a cross-sectional view of a distal end portion of a treatment instrument according to a modified example of the second embodiment.

[0034] Figure 18 It is a cross-sectional view of a distal end portion of a treatment instrument according to a modified example of the second embodiment.

[0035] Figure 19 It is a cross-sectional view of a distal end portion of a treatment instrument according to a modified example of the second embodiment.

[0036] Figure 20 It is a cross-sectional view of a distal end portion of a treatment instrument according to a modified example of the second embodiment.

[0037] Figure 21 It is a cross-sectional view of the distal end portion of the treatment instrument according to the third embodiment.

[0038] Figure 22 It is a cross-sectional view of the distal end portion of the treatment instrument according to the third embodiment.

[0039] Figure 23 This is a perspective view of a constriction member according to a third embodiment.

[0040] Figure 24 It is a cross-sectional view of a distal end portion of a treatment instrument according to a modified example of the third embodiment.

[0041] Figure 25 It is a cross-sectional view of a distal end portion of a treatment instrument according to a modified example of the third embodiment.

[0042] Figure 26 It is a perspective view of a narrowing member according to a modified example of the third embodiment.

[0043] Figure 27 It is a cross-sectional perspective view of the distal end portion of the treatment instrument according to the fourth embodiment.

[0044] Figure 28 It is a cross-sectional view of the distal end portion of the treatment instrument according to the fourth embodiment.

[0045] Figure 29 It is a cross-sectional view of the distal end portion of the treatment instrument according to the fourth embodiment.

[0046] Figure 30 It is a side view of the operating portion of the treatment instrument according to the fourth embodiment. DETAILED DESCRIPTION

[0047] (First embodiment)

[0048] Regarding the endoscope treatment system 300 of the first embodiment of the present invention, refer to Figures 1 to 5 Provide explanation. Figure 1 It is an overall diagram of the endoscope treatment system 300 according to this embodiment.

[0049] [Endoscope treatment system 300]

[0050] like Figure 1 As shown, the endoscope treatment system 300 includes an endoscope 200 and a treatment instrument 100. The treatment instrument 100 is used in a manner of being inserted into the endoscope 200.

[0051] [Endoscope 200]

[0052] The endoscope 200 is a well-known flexible endoscope and includes an insertion portion 202 inserted into the body from the distal end and an operation portion 207 attached to the proximal end of the insertion portion 202 .

[0053] The insertion section 202 includes an imaging section 203, a bending section 204, and a flexible section 205. The imaging section 203, the bending section 204, and the flexible section 205 are arranged in this order from the distal end of the insertion section 202. A channel 206 for inserting the treatment instrument 100 is provided within the insertion section 202. A distal opening 206a of the channel 206 is formed at the distal end of the insertion section 202.

[0054] The imaging unit 203 includes an imaging element such as a CCD or CMOS. The imaging unit 203 can capture images of the area to be treated. When the treatment instrument 100 protrudes from the distal opening 206a of the channel 206, the imaging unit 203 can capture images of the hollow tube 2 of the treatment instrument 100.

[0055] The bending portion 204 bends in response to an operator's operation of the operating portion 207. The soft portion 205 is a flexible tubular portion.

[0056] The operating section 207 is connected to the flexible section 205. The operating section 207 includes a handle 208, an input section 209, a proximal opening 206 of the channel 206, and a universal cable 210. The handle 208 is gripped by the operator. The input section 209 receives operational input for bending the bending section 204. The universal cable 210 outputs images captured by the imaging section 203 to the outside. The universal cable 210 is connected to a display device such as a liquid crystal display via an image processing device including a processor.

[0057] [Disposal device 100]

[0058] Figure 2 1 is an overall view showing the treatment instrument 100 .

[0059] The treatment instrument (treatment instrument for endoscope) 100 includes a sheath 1, a hollow tube 2, an operation wire 4, and an operating portion 5. In the following description, in the longitudinal direction A of the treatment instrument 100, the side inserted into the patient's body is referred to as the "distal side A1", and the operating portion 5 side is referred to as the "proximal side A2". Figure 2 , the distal portion of the treatment instrument 100 is shown enlarged.

[0060] The sheath 1 is flexible and insulating, and is a long resin member extending from the distal end 1a to the proximal end 1b. Figure 1 The outer diameter of the channel 206 of the endoscope 200 is shown. The sheath 1 is configured to be able to advance and retreat in the channel 206. Figure 1 As shown, in a state where the sheath 1 is inserted into the channel 206 , the distal end 1 a of the sheath 1 can protrude from and retract from the distal opening 206 a of the channel 206 .

[0061] Figure 3 It is a perspective view of the distal end portion of the treatment instrument 100 . Figure 4 and Figure 5 is a cross-sectional view of the distal end portion of the treatment instrument 100. Figure 4As shown, a tube holder (tube holding member) 11 is attached to the distal end 1a of the sheath 1. The tube holder 11 has a through-hole 12 extending therethrough in the longitudinal direction A. The tube holder 11 is made of an insulating material. A step 13 is formed around the periphery of the through-hole 12 on the distal end surface 15 of the tube holder 11. The step 13 is a recessed portion sized to accommodate a flange 21 of the hollow tube 2, described later. The hollow tube 2 is inserted into the through-hole 12.

[0062] The hollow tube 2 is a roughly round rod-shaped member made of metal. The hollow tube 2 is formed of a conductive metal material such as stainless steel. The hollow tube 2 is conductive. The hollow tube 2 is a tubular member having a flow path 23 formed along the longitudinal direction A. The flow path 23 extends between the distal end 2a and the proximal end 2b of the hollow tube 2. The hollow tube 2 has a tube body 20 and a flange 21. The flange 21 is provided at the distal end of the tube body 20. The flange 21 has a circular ring shape with an outer diameter larger than that of the tube body 20. In the front view viewed from the direction along the longitudinal direction A, the outer periphery of the flange 21 forms a concentric circle with the outer periphery of the tube body 20. As the distal end of the flange 21, a distal opening 22a is opened. A side hole (opening) 27 connected to the flow path 23 is formed in the tube body 20 of the hollow tube 2. The side hole 27 is open in a portion of the circumference of the hollow tube 2.

[0063] The flange 21 described in this embodiment is an annular shape having an outer diameter larger than that of the pipe body 20 , but is not limited to an annular shape and may be a polygonal shape such as a triangle or a quadrilateral, or an elliptical shape.

[0064] An operating wire 4 is attached to the proximal end of the tube body 20. The operating wire 4 is formed of a conductive metal material, such as stainless steel. A water supply conduit 42 is formed along the entire length of the operating wire 4. The operating wire 4 is, for example, a tightly wound coil. The operating wire 4 is inserted through the interior space of the sheath 1.

[0065] The proximal end 2b of the hollow tube 2 is connected to the distal end 4a of the operating wire 4. The proximal end 2b of the hollow tube 2 and the distal end 4a of the operating wire 4 are connected via a connecting tube 7. The proximal end 2b of the hollow tube 2 and the distal end 4a of the operating wire 4 are arranged in a contact state within the through-hole of the connecting tube 7. The proximal end 2b of the hollow tube 2 and the distal end 4a of the operating wire 4 are fixed to the connecting tube 7. The opening 23a of the proximal end 2b of the tube body 20 is connected to the operating wire 4. The water supply pipe 42 is connected to the proximal end of the flow path 23 of the hollow tube 2, enabling the circulation of liquid (fluid).

[0066] A narrowing member 8 is installed on the connecting pipe 7. Figures 3 to 5As shown, the narrowing member 8 is installed on the distal side of the connecting tube 7. The narrowing member 8 has a roughly semi-cylindrical shape that divides the cylindrical member along the length direction A. The narrowing member 8 has a contact surface 82. The contact surface 82 of the narrowing member 8 is arranged opposite to the outer surface of the hollow tube 2 and contacts each other. The narrowing member 8 has a narrow portion 81. The narrowing portion 81 is a protrusion having a size that can enter the side hole 27 of the hollow tube 2. The narrowing portion 81 extends toward the distal side from the contact surface 82 arranged along the outer surface of the hollow tube 2. As shown in FIG. Figure 5 As shown, the narrow portion 81 has a narrow surface 811 extending in a direction intersecting the central axis O in the longitudinal direction A of the hollow tube 2. In this embodiment, the narrow surface 811 is substantially orthogonal to the central axis O and faces proximally.

[0067] The narrow portion 81 is located outside the flow path 23 of the hollow tube 2. Specifically, in a natural state without external forces, the narrow portion 81 is located flush with the inner circumferential surface of the flow path 23 of the hollow tube 2, or is located outside the inner circumferential surface. In the narrowing member 8, at least the narrowing portion 81 is configured to be elastically deformable. In this embodiment, the narrowing member 8 is entirely formed of an elastically deformable material.

[0068] The operating wire 4 is covered throughout its entire length by an insulating sheath 6. The distal end of the sheath 6 extends to the connecting tube 7, covering the proximal portion of the connecting tube 7. The proximal end 83 of the stenosis member 8 is covered by the distal end of the sheath 6. The sheath 6 is, for example, a heat shrink tube. Covering the outer periphery of the operating wire 4 with the sheath 6 prevents liquid from leaking from the water supply conduit 42 of the operating wire 4.

[0069] The tube body 20 supplies high-frequency current supplied from the operation wire 4 connected to the operation part 5 to the flange 21. When high-frequency current is supplied from the operation wire 4 to the hollow tube 2, the tube body 20 and the flange 21 function as a single electrode for outputting the high-frequency current to living tissue.

[0070] The hollow tube 2 is inserted into the through hole 12 of the tube holder 11 and is provided so as to be able to advance and retreat relative to the sheath 1. The hollow tube 2 can protrude from the through hole 12 of the tube holder 11 toward the distal side A1. Figure 4 This is a cross-sectional view when the hollow tube 2 is arranged in the most retracted position. Figure 5 This is a cross-sectional view when the hollow tube 2 is arranged in the most advanced position. The central axis O of the hollow tube 2 in the longitudinal direction A is substantially consistent with the central axis of the sheath 1 in the longitudinal direction A.

[0071] like Figure 1 and Figure 2As shown, the operating portion 5 includes an operating portion body 51, a slider 52, a power supply connector 53, and a liquid supply port 54. The distal end of the operating portion body 51 is connected to the proximal end 1b of the sheath 1. The operating portion body 51 has an internal space through which the operating wire 4 can be inserted. The operating wire 4 extends through the internal space of the sheath 1 and the internal space of the operating portion body 51 to the slider 52.

[0072] The slider 52 is mounted so as to be movable relative to the operating portion body 51 in the longitudinal direction A. The slider 52 is attached to the sheath 1 connected to the operating portion body 51 via an O-ring. The proximal end of the operating wire 4 is mounted on the slider 52. The operating wire 4 and the hollow tube 2 advance and retract as the surgeon advances and retracts the slider 52 relative to the operating portion body 51.

[0073] The power supply connector 53 is fixed to the slider 52. The power supply connector 53 is connected to the proximal end of the operating wire 4 via a power supply cable (not shown). The power supply connector 53 can be connected to a high-frequency power supply device (not shown). The high-frequency current provided by the high-frequency power supply device is supplied to the hollow tube 2 via the power supply connector 53 and the operating wire 4.

[0074] The liquid supply port 54 is provided on the slider 52. The liquid supply port 54 is connected to the proximal end of the water supply conduit 42 of the operating wire 4 via the water supply conduit formed in the slider 52. The liquid supplied from the liquid supply port 54 passes through the water supply conduit of the slider 52, the water supply conduit 42 of the operating wire 4 and the flow path 23, and is discharged from the distal opening 22a (shown in FIG. Figure 5 ) ejected.

[0075] The surgeon advances and retracts the slider 52 relative to the operating portion main body 51, allowing the operating wire 4 and hollow tube 2 to advance and retract relative to the sheath 1. When retracted, the hollow tube 2 can be accommodated within the stepped portion 13 of the tube holder 11. The length from the distal end of the hollow tube 2 to the stenosis member 8 in the longitudinal direction A is greater than the length of the tube holder 11.

[0076] like Figure 7As shown, if the slider 52 is further pressed at the point where the stenosis member 8 contacts the proximal end of the tube holder 11, the stenosis portion 81 is subjected to a force pushing proximally toward the tube holder 11. At this point, the stenosis member 8 is also subjected to a force pushing distally from the operating wire 4. As a result, the stenosis portion 81 is compressed and deformed in the longitudinal direction A, extending and deforming in a direction intersecting the longitudinal direction A. As a result, the stenosis portion 81 protrudes from the side hole 27 into the flow path 23, narrowing the flow path 23. In other words, the protrusion of the stenosis portion 81 blocks a portion of the flow path 23, narrowing its cross-sectional area. The stenosis portion 81 temporarily narrows the flow path 23. Liquid supplied to the flow path 23 of the hollow tube 2 passes through the area narrowed by the stenosis portion 81, increasing its flow rate. The liquid, with its increased pressure, is discharged from the distal opening 22a. As a result, the water pressure within the flow path 23 is increased, allowing water to be supplied from the distal opening 22a with a higher pressure. For example, even if the pressure of a pressure pump (not shown) feeding liquid into the water supply pipe is low, the liquid flow rate in the flow path 23 of the hollow tube 2 can be increased, and water can be fed from the distal opening 22a with increased water pressure.

[0077] In this embodiment, the narrow surface 811 is shown as being substantially perpendicular to the central axis O and facing proximally. However, the orientation of the narrow surface 811 is not limited to this example. The narrow surface 811 may be configured to narrow a portion of the fluid flow path 23. The narrow surface 811 may also be inclined in a direction intersecting the longitudinal direction A.

[0078] If the sliding member 52 is retracted to retract the operating wire 4 and the hollow tube 2 relative to the sheath 1, the stenosis member 8 will be separated from the tube holder 11. As a result, the stenosis member 8 returns to a natural state without being subjected to external forces, and the compression of the stenosis portion 81 is released. Figure 5 The state shown protruding into the flow path 23 returns to Figure 4 The state shown is that the narrow portion 81 is roughly flush with the inner wall of the flow path 23. That is, the relative position of the hollow tube 2 with respect to the sheath 1 is displaced, and the narrow portion 81 protrudes from and retracts relative to the flow path 23 from the side hole 27. The front end of the narrow portion 81 protrudes from the side hole 27 into the flow path 23, and the narrow portion 81 is located at a position radially inward of the inner circumference of the flow path 23, so that the flow path 23 becomes narrow. This form is called the first form. The form in which the narrow portion 81 is flush with the inner circumference of the flow path 23 or is located radially outward of the inner circumference is called the second form. The narrowing member 8 forms the second form in a natural state without being subjected to external force, and forms the first form from the second form through deformation of the narrow portion 81 by being subjected to external force.

[0079] [How to use endoscopic treatment instruments]

[0080] Next, an example of how to use the endoscopic treatment instrument 100 of this embodiment will be described. Specifically, the following describes local injection treatment, incision / stripping treatment, and hemostasis treatment of lesions in endoscopic treatments such as ESD (endoscopic submucosal dissection). The surgeon identifies the lesion using known methods. For example, the surgeon inserts the insertion portion 202 of the endoscope 200 into the digestive tract (e.g., the esophagus, stomach, duodenum, or large intestine) while observing the image obtained by the endoscope's imaging unit 203 to identify the lesion.

[0081] Next, the surgeon inserts the treatment instrument 100 into the channel 206, causing the distal end 1a of the sheath 1 to protrude from the distal opening 206a of the insertion portion 202. The surgeon advances the slider 52 of the operating portion 5 relative to the operating portion body 51, causing the hollow tube 2 to protrude distally from the distal end 1a of the sheath 1.

[0082] The surgeon moves the slider 52 toward the distal side A1 relative to the operating portion body 51, thereby moving the hollow tube 2 toward the distal side A1. As a result, the flange 21 of the hollow tube 2 protrudes toward the distal side A1 relative to the sheath 1. At this time, if the slider 52 is pushed toward the distal side, as shown in FIG. Figure 5 As shown, the operating wire 4 and hollow tube 2 are advanced relative to the sheath 1, and the distal end 84 of the stenosis member 8 is advanced to a position where it contacts the proximal end surface 14 (proximal end wall) of the tube holder 11. The operating wire 4 and hollow tube 2 can be advanced and retreated from a position where the flange 21 is accommodated within the step 13 to a position where the stenosis member 8 contacts the proximal end surface 14 of the tube holder 11.

[0083] The surgeon presses the distal end of the hollow tube 2 against the lesion where the liquid for local injection (local injection solution) is injected, and performs water delivery (local injection step) in a state where the distal opening 22a is pressed against the tissue. When the hollow tube 2 is pressed against the lesion, the hollow tube 2 protrudes the most, the stenosis member 8 contacts the proximal end surface 14 of the tube holder 11, and the stenosis 81 is compressed. As a result, the stenosis 81 protrudes into the flow path 23 (first form). In this state, a liquid such as physiological saline from the liquid supply port 54 is supplied to the water supply line 42 of the slider 52. The liquid is delivered (emitted) from the distal opening 22a toward the distal side through the water supply line 42 of the operating wire 4 and the flow path 23. The cross-sectional area (flow path area) of the flow path 23 at the position of the stenosis 81 becomes smaller. Therefore, the liquid supplied to the flow path 23 flows through the part where the flow path is narrowed due to the protruding stenosis 81, and the liquid flow rate is relatively increased compared to the second form. As a result, water can be delivered from distal opening 22a with a strong water flow. Consequently, by pressing distal opening 22a against the mucosa of the lesion, water can be delivered with a strong water flow, causing the lesion to rise. Local injection treatment for raising the lesion before incision can also be performed by puncturing the lesion with a hollow needle using a known local injection device.

[0084] After the lesion is raised, the surgeon performs incision and peeling treatment (incision and peeling step). A high-frequency current is supplied to the hollow tube 2 through the power supply connector 53 and the operating wire 4 from a high-frequency power supply device not shown in the figure connected to the power supply connector 53 of the operating part 5. The flange 21 of the energized hollow tube 2 acts as a high-frequency cutter. The surgeon moves the flange 21 in a lateral direction perpendicular to the longitudinal axis A, for example, to cut the mucosa (tissue) in contact with the flange 21. After the lesion mucosa portion is completely cut in the circumferential direction, the flange 21 is abutted against the incision around the cut lesion mucosa portion, thereby completely removing and peeling off the lesion mucosa portion. In addition, the surgeon advances the treatment instrument 100, and while the high-frequency current is supplied, the surgeon lifts the cut lesion mucosa to expose the submucosal layer, and peels off the submucosal layer of the cut lesion portion.

[0085] The surgeon performs additional local injections as needed. The surgeon makes the hollow tube 2 protrude as far as possible toward the distal side A1. The surgeon presses the flange 21 against the area where the additional local injection solution is to be injected, and delivers water from the distal opening 22a (additional local injection step). As described above, if the hollow tube 2 protrudes as far as possible, the narrowing member 8 contacts the proximal end surface 14 of the tube holder 11 and presses the narrowing portion 81, and the narrowing portion 81 protrudes into the flow path 23. The cross-sectional area (flow path area) of the flow path 23 at the position of the narrowing portion 81 becomes smaller (first form). In this state, the liquid supplied from the liquid supply port 54 to the water supply line of the slider 52, the water supply line 42 of the operating wire 4, and the flow path 23 flows through the area where the flow path is narrowed due to the protruding narrowing portion 81, and the flow rate of the liquid becomes faster than in the second form. Therefore, the liquid supplied to the flow path 23 can be delivered from the distal opening 22a in a state with strong water potential. If the distal opening 22a is brought into contact with the mucosa of the lesion and the flange 21 is pressed, water is supplied with a strong force, and additional local injection can be performed.

[0086] If bleeding occurs during incision or dissection, the surgeon performs hemostasis by pressing down and contacting the flange 21 heated by high-frequency current to cauterize the bleeding site and stop the bleeding (hemostasis step).

[0087] The surgeon cleans the surgical site as needed (cleaning step). At this point, the surgeon positions the hollow tube 2 in a position set back from the local injection and incision / stripping steps. Specifically, with the stenosis member 8 positioned away from the proximal end surface 14 of the tube holder 11 toward the proximal side A2, a liquid such as physiological saline is delivered. When the stenosis member 8 is positioned away from the proximal end surface 14 of the tube holder 11, the stenosis member 8 is in a natural state (second configuration) unaffected by external forces. When the stenosis member 8 is in the natural state, the stenosis portion 81 is, for example, located flush with the inner surface of the flow path 23 of the tube body 20. Alternatively, the stenosis portion 81 is located radially outward of the inner surface of the flow path 23 within the side hole 27. In other words, the stenosis portion 81 is positioned so as not to interfere with the flow path 23. In this state, the hollow tube 2 can deliver water with a weaker water pressure than during local injection. During surgical site cleaning, water delivery is performed at a position where the flange 21 is separated from the tissue. If water is delivered at a high pressure, as during local injection, at a location where flange 21 is separated from the tissue, foam or liquid will splash back from the area being cleaned, impairing the view of the endoscope's imaging unit 203 and hindering treatment. However, if stenosis 81 is positioned so as not to interfere with flow path 23, the water pressure will be weaker than during local injection, enabling effective cleaning. When cleaning the surgical site, stenosis 81 can be located proximally away from proximal end surface 14 of hollow tube 2.

[0088] The surgeon continues to perform the above-mentioned actions (treatments) as needed, and finally removes the lesion to complete the ESD operation.

[0089] The treatment instrument 100 of this embodiment enables various treatments such as local injection, incision and dissection, hemostasis, additional local injection, and surgical site cleansing. The treatment instrument 100 of this embodiment enables various treatments such as local injection, incision and dissection, hemostasis, additional local injection, and surgical site cleansing without inserting or removing the treatment instrument 100 from the channel 206 of the endoscope 200.

[0090] While the first embodiment of the present invention has been described in detail with reference to the accompanying drawings, the specific configuration is not limited to this embodiment and includes design modifications within the scope of the present invention. Furthermore, the components described in the above embodiments and modifications may be combined as appropriate. In the following description, components identical to those already described will be denoted by the same reference numerals, and repeated description will be omitted.

[0091] The stenosis member 8 is not limited to a substantially semi-cylindrical shape. For example, the stenosis member 8 may be an elongated shape extending along the longitudinal direction A to cover the side hole 27 and the proximal region of the side hole 27.

[0092] (Variation 1-1)

[0093] Reference Figure 6 and Figure 7 , which describes a modification of the above embodiment. Figure 6 and Figure 7 As shown, a recess 141 may be formed on the proximal surface 14 of the tube holder 11. The recess 141 is formed at the boundary portion between the proximal surface 14 and the through hole 12, recessed from the proximal surface 14 toward the distal side. The recess 141 is an opening of a size that the distal end portion of the stenosis member 8 can enter. Specifically, the recess 141 is an opening of a size that contacts the stenosis member 8 when the distal end portion of the stenosis member 8 enters. In the recess 141, a surface 14a that is located on the distal side and perpendicular to the longitudinal axis of the through hole 12 constitutes the proximal surface 14a. A portion 143 that is radially outward of the recess 141 constitutes a limiting portion 143 that protrudes toward the proximal side A2 of the longitudinal axis of the through hole. As shown Figure 7 As shown, the operating wire 4 and hollow tube 2 advance, and the distal end 84 of the stenosis member 8 enters and contacts the recess 141. When the operating wire 4 is pushed toward the distal side A1 while the distal end of the stenosis member 8 is in the recess 141, the stenosis portion 81 in contact with the proximal end surface 14a is compressed by an external force. Because the outer periphery of the stenosis member 8 is positioned within the recess 141 and covered by the restricting portion 143, the compressive force of the stenosis portion 81 acts toward the central axis O. As a result, the compressed stenosis portion 81 protrudes from the outside of the tube body 20 into the flow path 23. Therefore, the compressed stenosis portion 81 can be smoothly protruded into the flow path 23. Furthermore, because the compressed stenosis portion 81 protrudes radially into the flow path 23, the stenosis surface 811 is easily oriented in a direction substantially orthogonal to the central axis O. As a result, the cross-sectional area (flow path area) of the flow path 23 can be more reliably narrowed, and the flow rate of the liquid flowing through the flow path 23 can be switched via the stenosis portion 81. As a result, the treatment instrument 100 can easily switch the water potential of the liquid supplied from the distal opening 22a.

[0094] (Variation 1-2)

[0095] Reference Figure 8 and Figure 9 The concave portion 141 may be any shape as long as the constriction member 8 is inserted so that the constriction portion 8 can enter the flow path 23. Figure 6 The shape shown. Figure 8 and Figure 9 As shown, the recess 142 may have a tapered shape. The recess 142 is formed with a tapered surface (inclined surface) whose cross-sectional area decreases from the proximal end surface 14 of the tube holder 11 toward the distal end. The opening of the proximal end surface of the recess 142 is large enough to accommodate the distal end of the stenosis member 8.

[0096] like Figure 9As shown, the operating wire 4 and the hollow tube 2 advance, and the distal end 84 of the stenosis member 8 enters the recess 142 and makes contact. If the operating wire 4 is pushed toward the distal side A1 when the distal end portion of the stenosis member 8 enters the recess 142, the stenosis 81 will be compressed by an external force. If the hollow tube 2 advances, the outer peripheral edge 841 of the distal end 84 of the stenosis 81 contacts the recess 142 while being pushed along the tapered surface, and the stenosis 81 is elastically deformed and protrudes into the flow path 23 (first form). At this time, by advancing the operating wire 4 and the hollow tube 2, the stenosis 8 can be smoothly protruded into the flow path 23. In this modified example, the inner peripheral surface of the stenosis 81 plays the role of the narrow surface 811. As a result, the stenosis 81 can be smoothly protruded into the flow path 23, and the cross-sectional area (flow path area) of the flow path 23 can be more reliably narrowed. On the other hand, by retracting the operation wire 4 and the hollow tube 2, the narrowed portion 81 gradually returns to its original position (second state) where it does not protrude into the flow path 23. As described above, the flow rate of the liquid flowing in the flow path 23 can be switched, so the treatment instrument 100 can easily switch the water level of the liquid supplied from the distal opening 22a.

[0097] The distal end of the connecting tube 7 has a tapered surface 74 at a portion thereof that faces the narrowing member 8 across the central axis. The tapered surface 74 of the connecting tube 7 is inclined so as to decrease in diameter toward the distal end. The tapered surface 74 is inclined so as not to contact the recess 142 until the distal end of the narrowing member 8 contacts the recess 142. Therefore, the connecting tube 7 does not interfere with the contact between the narrowing portion 81 and the recess 142. The tapered surface 74 of the connecting tube 7 is not a necessary feature. As described above, the connecting tube 7 can be formed in any shape that does not interfere with the contact of the narrowing portion 81 with the recess 142.

[0098] exist Figure 8 and Figure 9 In the illustrated example, a concave portion 142 having a tapered surface and a substantially conical opening is formed coaxially with the through-hole 12. However, the concave portion 142 is not limited to this shape. For example, the concave portion 142 may be formed only at a position opposing the stenosis member 8 and may have a tapered surface. Alternatively, the concave portion 141 may be formed on the proximal end surface 14 of the tube holder 11.

[0099] In addition, although the inclined surface is provided in the recessed portion 142 of the tube holder 11 in this example, the inclined surface may alternatively be provided on the outer peripheral edge 841 of the distal end 84 of the narrowed portion 81. The inclined surface provided on the outer peripheral edge 841 of the distal end 84 of the narrowed portion 81 is inclined so as to decrease in diameter as it moves toward the distal end. This inclined surface may be a straight tapered surface or a curved surface with an arc.

[0100] Alternatively, the inclined surface may be provided on both the recess 142 of the tube holder 11 and the outer periphery of the distal end 84 of the narrowed portion 81. In this case, the inclinations of both surfaces may be appropriately adjusted so that when the operation wire 4 is pushed toward the distal side A1 with the distal end of the narrowing member 8 inserted into the recess 142, the narrowed portion 81 elastically deforms and smoothly protrudes into the flow path 23.

[0101] (Variation 1-3)

[0102] Reference Figure 10 and Figure 11 Modifications of the above-described embodiment will be described. Figure 8 and Figure 9 The narrow member 8 of the modified example shown may further include a slit 86. In the longitudinal direction A, the slit 86 is located at a position distal to the contact surface 82 with the hollow tube 2. The slit 86 is formed from the outer surface 85 of the narrow member 8 in a direction substantially perpendicular to the longitudinal direction A. The position of the slit 86 in the longitudinal direction A overlaps with the proximal edge 271 of the side hole 27 of the hollow tube 2, or is located distally A1 relative to the proximal edge 271. Preferably, as Figure 10 As shown, the slit 86 is located at the boundary between the contact surface 82 and the narrow portion 81 in the longitudinal direction A. Figure 11 As shown, the operating wire 4 and the hollow tube 2 move forward, and the outer peripheral edge 841 of the distal end 84 of the stenosis member 8 enters the recess 142 and comes into contact. If the operating wire 4 is pushed toward the distal side A1 when the distal end of the stenosis member 8 enters the recess 142, the stenosis 81 is subjected to external force, and the stenosis 81 will be elastically deformed with the slit 86 as the starting point. The stenosis 81 is guided by the inclination of the recess 142 and protrudes from the outside of the tube body 20 toward the flow path 23. As a result, the compressed stenosis 81 can smoothly protrude into the flow path 23. As a result, the cross-sectional area (flow path area) of the flow path 23 can be narrowed more reliably, and the flow rate of the liquid flowing through the flow path 23 can be switched by the stenosis 81. Therefore, the disposal instrument 100 changes to the second form and the first form as the hollow tube 2 moves relative to the sheath 1, and the water potential of the liquid supplied from the distal opening 22a can be easily switched.

[0103] (Variation 1-4)

[0104] In the above embodiment and modification, an example is shown in which one side hole 27 is opened in the circumferential direction of the hollow tube 2 and one narrow portion 81 protrudes and retracts into the flow path 23. However, the number of narrow portions 81 and side holes 27 is not limited to one, and there may be multiple. Figure 12 and Figure 13 As shown, the treatment instrument 100 may include a pair of side holes 27 and a pair of narrowed portions 81 at positions opposite to each other across the central axis O of the hollow tube 2. Figure 13As shown, the operating wire 4 and the hollow tube 2 advance, and the outer peripheral edge 841 of the distal end 84 of the stenosis member 8 enters the recess 142 and comes into contact. If the operating wire 4 is pushed toward the distal side A1 when the distal end of the stenosis member 8 enters the recess 142, the stenosis portion 81 will be subjected to an external force, and the pair of stenosis portions 81 will be guided by the inclination of the recess 142, each protruding from the outside of the tube body 20 toward the flow path 23. In the case of this example, the surface along the longitudinal direction A of the stenosis portion 81 acts as the stenosis surface 811. According to the treatment instrument 100 of this example, the pair of stenosis portions 81 can be smoothly protruded into the flow path 23. As a result, the cross-sectional area (flow path area) of the flow path 23 can be narrowed more reliably, and the flow rate of the liquid flowing through the flow path 23 can be switched by the stenosis portion 81. As a result, the treatment instrument 100 can easily switch the water level of the liquid supplied from the distal opening 22a. By making a pair of narrowed portions 81 protrude and retract into the flow path 23, the difference between the wide cross-sectional area portion and the narrowed portion of the flow path 23 can be enlarged, and water can be supplied in a state with a strong water potential. On the other hand, if the operating wire 4 and the hollow tube 2 retreat, the pair of narrowed portions 81 will move radially outward, switching to a state in which the flow of the liquid in the flow path 23 is not hindered by the narrowed portions 81. Therefore, the water potential of the liquid supplied from the distal opening 22a can be greatly changed. Although not shown in the figure, each narrowed portion in this example may also have Figure 10 and Figure 11 Slit 86 is shown.

[0105] According to the treatment instrument 100 of the above-described embodiment and its variations, by manipulating the operating wire 4 and hollow tube 2 forward and backward relative to the sheath 1, the narrowed portion 81 protrudes and retracts relative to the flow path 23, thereby changing the cross-sectional area of ​​the flow path 23. Specifically, by manipulating the slider 52 of the operating portion 5 forward and backward, the cross-sectional area of ​​the flow path 23 can be changed, and the water pressure of the liquid supplied from the distal opening 22a through the flow path 23 can be switched. Therefore, for example, during local injection and re-local injection, liquid can be supplied from the distal opening 22a with a high water pressure, while during surgical site cleansing, liquid can be supplied from the distal opening 22a with a low water pressure.

[0106] (Second embodiment)

[0107] Regarding the treatment instrument 100B of the second embodiment, refer to Figures 14 to 16 In the following description, the same components as those already described are denoted by the same reference numerals and redundant descriptions are omitted.

[0108] Figure 14 and Figure 15 It is a cross-sectional view showing the distal end portion of the treatment instrument 100B.

[0109] Like the treatment instrument 100 of the first embodiment, the treatment instrument (endoscopic treatment instrument) 100B constitutes an endoscope treatment system together with the endoscope 200. The treatment instrument 100B includes a sheath 1, a hollow tube 2, a tube holder 11B, a constriction member 8B, an operation wire 4, a connecting tube 7B, and an operation portion 5.

[0110] In this embodiment, the constriction member 8B is provided in the tube holder 11B. Specifically, a receiving portion 16 (recess) is formed in the middle portion of the tube holder 11B in the longitudinal direction A. The constriction member 8B is provided in the receiving portion 16. The receiving portion 16 is recessed radially from the inner circumference of the through-hole 12 toward the outer circumference of the tube holder 11B. In this embodiment, the receiving portion 16 is a circular recessed portion around the through-hole 12, and the through-hole 12 and the receiving portion 16 are in communication with each other.

[0111] In the hollow tube 2, the side holes 27B are formed at two locations separated from each other in the circumferential direction of the tube body 20. Figure 14 and Figure 15 In the example shown, the two side holes 27B are opened at positions separated by 180 degrees in the circumferential direction. Figure 14 As shown, the distal edge 272 of the side hole 27B is inclined. Specifically, the distal edge 272 of the side hole 27B is inclined so that the edge portion on the outer surface of the hollow tube 2 is more distal than the edge portion on the inner surface of the flow path 23.

[0112] As in the first embodiment, the proximal end of the hollow tube 2 and the distal end of the operating wire 4 are connected by a connecting tube 7. The connecting tube 7 is entirely covered by a cannula 6. The distal end 61 of the cannula 6 covers the distal portion of the connecting tube 7 and contacts the outer surface of the hollow tube 2. The side hole 27B is located further distally than the cannula 6.

[0113] Figure 16This is a three-dimensional view of the narrowing member 8B of this embodiment. The narrowing member 8B includes a main body 80, a narrowing portion 81B, and a retaining portion 89. The main body 80 has a generally annular shape with an opening 88 formed in the center. The narrowing portion 81B is a protrusion extending radially from the main body 80 toward the center O8 of the opening 88. The narrowing portion 81B includes a base 871 and a narrowing piece 872 radially extending from the opening 88. The base 871 is a columnar portion extending radially from the opening 88. The narrowing piece 872 has a quadrangular pyramidal shape that tapers from the base 871 toward the center O8 of the opening 88. The narrowing piece 872 is softer than the base 871 and can be elastically deformed when subjected to external force. The narrowing portions 81B are respectively provided protruding at positions separated by 180 degrees in the circumferential direction of the main body 80. A pair of retaining portions 89 are provided between the pair of narrowing portions 81B. The retaining portion 89 includes a retaining base 891 and a retaining piece 892. The retaining base 891 is a columnar portion extending radially from the opening 88. The retaining piece 892 has a shape whose thickness in the longitudinal direction gradually decreases from the retaining base 891 toward the center O8 of the opening 88. The protruding end of the narrowing piece 872 has a pointed shape, and the protruding end of the retaining piece 892 has a long side. The retaining piece 892 is softer than the retaining base 891 and can elastically deform when subjected to external force. The narrowing member 8B is an integrally formed member made of, for example, an elastic resin, hard rubber, or the like.

[0114] like Figure 14 and Figure 15 As shown, the stenosis member 8B is disposed within the housing portion 16 of the tube holder 11B. The radial opening of the housing portion 16 is sized to accommodate the outer diameter of the main body 80 of the stenosis member 8B. The opening of the housing portion 16 in the longitudinal direction A is larger than the dimension (thickness) of the main body 80 in the longitudinal direction A. The distal side or proximal side of the stenosis member 8B engages with the housing portion 16, and the outer periphery of the main body 80 contacts the inner periphery of the housing portion 16 for installation. In the illustrated example, the distal side of the main body 80 engages the distal side of the housing portion 16.

[0115] The hollow tube 2 is inserted through the through-hole 12 of the tube holder 11B. The tube body 20 of the hollow tube 2 is inserted through the through-hole 12 and the opening 88 of the narrowing member 8B. The distance between the bases 871 of the pair of narrowing portions 81B and the distance between the retaining bases 891 of the pair of retaining portions 89 is smaller than the outer diameter of the hollow tube 2. Within the opening 88 of the narrowing member 8B, the hollow tube 2 moves forward and backward while contacting the narrowing tabs 872 and retaining tabs 892. The retaining tabs 892 are constantly in contact with the outer circumference of the hollow tube 2 in an elastically deformed state. The pair of narrowing tabs 872 are positioned corresponding to the pair of side holes 27B of the hollow tube 2. When contacting the outer circumference of the hollow tube 2, the narrowing tabs 872 elastically deform, bending in the longitudinal direction A relative to the bases 871. As the hollow tube 2 moves forward and backward, if the narrowing tabs 872 move to the position of the side hole 27B, they enter the side hole 27B and protrude toward the inside of the flow path 23. In this example, when the hollow tube 2 is located Figure 14 In the storage position shown, the narrow piece 872 contacts the outer peripheral surface of the hollow tube 2 and is elastically deformed and bent toward the proximal side. Although not shown, the retaining piece 892 is also elastically deformed and bent. Figure 15 As shown, when the operating wire 4 and hollow tube 2 advance, if the stenosis piece 872 enters the side hole 28B, the stenosis piece 872 will return to its original shape, extending radially and protruding into the flow path 23. Although not shown in the figure, the retaining piece 892 contacts the outer peripheral surface of the hollow tube 2, undergoes elastic deformation and bends. When the operating wire 4 and hollow tube 2 retreat from a position where the flange 21 of the hollow tube 2 protrudes distally beyond the tube retainer 11, the stenosis piece 872 is guided toward the outside of the hollow tube 2 along the inclined surface of the distal edge 272 of the side hole 27B. In addition, the hollow tube 2 can be rotated about the central axis O to change the relative position of the side hole 27B of the hollow tube 2 and the stenosis piece 872, thereby switching between the first and second forms. That is, if the stenosis piece 872 is arranged in a position opposite to the side hole 27B, the stenosis piece 872 will enter the side hole 27B and protrude toward the inside of the flow path 23, forming the first form. When the operating portion is rotated to move the hollow tube 2 relative to the sheath 1 around the central axis O, the position of the side hole 27B is shifted from the narrow piece 872, and the narrow piece 872 is separated from the side hole 27B, thereby achieving the second state.

[0116] According to the present embodiment, the proximal side of the stenosis piece 872 plays the role of the stenosis surface 811 by the advancement and retreat of the operating wire 4 and the hollow tube 2. By the advancement of the operating wire 4 and the hollow tube 2 relative to the sheath 1, the stenosis piece 872 smoothly protrudes into the flow path 23, and the cross-sectional area of ​​the flow path 23 can be more reliably narrowed (first form). On the other hand, by the action of retreating the operating wire 4 and the hollow tube 2, the stenosis piece 872 returns to its original position where it does not protrude into the flow path 23 (second form). As a result, the switching of the water potential of the liquid supplied from the distal opening 22a through the flow path 23 can be reliably implemented. Therefore, the disposal instrument 100 changes into the first form and the second form as the hollow tube 2 moves relative to the sheath 1, and the water potential of the liquid supplied from the distal opening 22a can be easily switched.

[0117] In this example, the narrowing member 8B is shown as having a pair of narrowing portions 81B and a pair of retaining portions 89. However, the narrowing member is not limited to this example. For example, one, three, or more narrowing portions 81B may be provided. The retaining portions 89 serve to stably hold the hollow tube 2 during its advancement and retraction. To alter the water flow in the flow path 23, the retaining portions 89 are not essential components of the narrowing member 8B.

[0118] The treatment instrument 100B of this embodiment can be used to perform various treatments, such as local injection, incision and dissection, hemostasis, additional local injection, and surgical site cleansing, using the same method of use as the treatment instrument 100 of the first embodiment. The treatment instrument 100B of this embodiment can be used to perform various treatments, such as local injection, incision and dissection, hemostasis, additional local injection, and surgical site cleansing, without inserting or removing the treatment instrument 100B from the channel 206 of the endoscope 200.

[0119] The second embodiment of the present invention has been described in detail with reference to the drawings, but the specific configuration is not limited to this embodiment and includes design changes within the scope of the present invention.

[0120] In the above embodiment, the distal edge 272 of the side hole 27B is tilted, but the shape of the side hole 27B is not limited thereto. The side hole 27B only needs to be opened so as to allow the narrow piece 872 of the narrow portion 81B to protrude and retract.

[0121] (Variation 2-1)

[0122] Reference Figure 17 and Figure 18 A modification of the above embodiment will be described. Figure 17 and Figure 18As shown, the narrowing member 8B can be arranged on a portion of the circumference of the hollow tube 2. When viewed from the longitudinal direction A, the narrowing member 8B of this example has a semicircular shape. For example, when viewed from the longitudinal direction A, the narrowing member 8B can be arranged on a portion of the circumference of the hollow tube 2 in a semicircular shape, a fan shape, a 3 / 4 arc shape, etc. In this example, a narrowing portion 81B is provided. The movement of the narrowing piece 872 as the hollow tube 2 advances and retreats is the same as in the second embodiment. The storage portion 16 of the tube holder 11B is formed on a portion of the circumference of the through hole 12 corresponding to the shape of the narrowing portion 81B. According to the treatment device 100B of this example, as in the second embodiment, the narrowing piece 872 elastically deforms as the hollow tube 2 advances and retreats, and can protrude and retract from the side hole 27B into the flow path 23. Therefore, the cross-sectional area of ​​the flow path 23 can be more reliably narrowed by the narrowing piece 872, and the flow rate of the liquid flowing through the flow path 23 can be switched by the narrowing portion 81. As a result, the treatment instrument 100B can easily switch the water level of the liquid supplied from the distal opening 22a. As in this modified example, by providing the stenosis member 8B on a portion of the circumference of the hollow tube 2, the contact area between the stenosis piece 872 and the outer surface of the hollow tube 2 can be suppressed to a small area, allowing the hollow tube 2 to move forward and backward smoothly.

[0123] According to the treatment instrument 100B of the above-described embodiment and modified example, by manipulating the operating wire 4 and hollow tube 2 forward and backward relative to the sheath 1, the narrow portion 81B protrudes and retracts relative to the flow path 23, thereby changing the cross-sectional area (flow path area) of the flow path 23. Specifically, by manipulating the slider 52 of the operating portion 5 forward and backward, the cross-sectional area of ​​the flow path 23 can be changed, and the water pressure of the liquid supplied from the distal opening 22a through the flow path 23 can be switched. Therefore, for example, during local injection and re-local injection, liquid can be supplied from the distal opening 22a with a high water pressure, while during surgical site cleansing, liquid can be supplied from the distal opening 22a with a low water pressure.

[0124] (Variation 2-2)

[0125] Reference Figure 19 and Figure 20 A modification of the above embodiment will be described. Figure 19 and Figure 20 As shown, the side hole 27B can be positioned further distally to the side A1 than in the above-described embodiment. In this embodiment, the side hole 27B is located further distally to the side A1 than midway between the distal end 2a of the hollow tube 2 and the distal end 61 of the cannula 6. More specifically, when at least a portion of the flange 21 is received by the step 13, the side hole 27B is positioned so that the stenosis member 8B enters the side hole 27B.

[0126] According to the above configuration, when the flange 21 is housed in the stepped portion 13, the base 871 of the narrowed portion 81 protrudes radially inward from the side hole 27B, thereby narrowing the flow path 23 and relatively increasing the flow rate of the liquid flowing through the flow path 23. At this time, the distal edge 272 of the side hole 27B is inclined from the proximal end toward the distal end of the central axis O.

[0127] (Third embodiment)

[0128] Regarding the treatment instrument 100C of the third embodiment, refer to Figures 21 to 23 In the following description, the same components as those already described are denoted by the same reference numerals and redundant descriptions are omitted.

[0129] Figure 21 and Figure 22 This is a cross-sectional view showing the distal end portion of a treatment instrument 100C. Similar to the treatment instrument 100 of the first embodiment, the treatment instrument (endoscopic treatment instrument) 100C, together with the endoscope 200, constitutes an endoscopic treatment system. The treatment instrument 100C includes a sheath 1C, a hollow tube 2, a tube holder 11C, a stenosis member 8C, an operating wire 4, a connecting tube 7C, and an operating portion 5. The connecting tube 7C, the operating wire 4, and the hollow tube 2 have the same configuration as the second embodiment.

[0130] In this embodiment, the stenosis member 8C is mounted on the tube holder 11C. The stenosis member 8C is mounted on the distal side A1 of the distal end 1a of the sheath 1. Specifically, the stenosis member 8C is provided at a portion of the tube holder 11C that protrudes from the distal end 1a of the sheath 1. Figure 23 8C is a perspective view of a narrow member 8C. The narrow member 8C is a resin member having insulating properties. The narrow member 8C has a main body 80C, a narrow portion 81C and a holding portion 89. The main body 80C has an arc shape and has a size that is flush with the outer peripheral surface of the sheath 1. Figure 21 and Figure 22 As shown, the portion of the tube holder 11C that protrudes distally from the distal end 1a of the sheath 1 has a distal step 17. Its radial thickness is smaller than the base end of the tube holder 11C, which is inserted and secured within the distal end of the sheath 1. The main body 80C has a contact surface 82 for contact with the tube holder 11C. The inner circumference of the main body 80C constitutes the contact surface 82. The contact surface 82 is positioned opposite the outer circumference of the distal step 17 of the tube holder 11C and is engaged and secured thereto. An opening 88 is formed in the distal portion of the main body 80C, on the side toward the central axis O of the sheath 1 and tube holder 11C.

[0131] The narrow portion 81C is a protrusion extending radially from the main body 80C toward the center axis O of the tube holder 11C. The narrow portion 81C protrudes toward the through hole 12 side relative to the contact surface 82. The narrow portion 81C has a base 871 and a narrow piece 872 in the radial direction from the opening 88. The base 871 is a columnar portion extending radially from the opening 88. The narrow piece 872 has a quadrangular pyramid shape that becomes thinner from the base 871 toward the center axis O of the tube holder 11C. The narrow piece 872 is softer than the base 871 and can be elastically deformed if subjected to external force. A pair of retaining portions 89 are respectively provided to protrude from positions 180 degrees apart in the circumferential direction of the main body 80C. The narrow portion 81C is provided between the pair of retaining portions 89.

[0132] If the narrowing member 8C is fixed to the distal step portion 17 of the tube holder 11C, in a natural state where the narrowing portion 81C is not subjected to external force, the narrowing portion 81C protrudes toward the center axis O side compared to the inner circumferential surface of the through hole 12. The narrowing portion 81C protrudes to a position where it contacts the outer surface of the hollow tube 2 inserted through the through hole 12. The narrowing piece 872 is arranged at a position corresponding to the side hole 27 of the hollow tube 2. The narrowing piece 872 elastically deforms when it contacts the outer circumferential surface of the hollow tube 2 and bends relative to the base 871 in the longitudinal direction A (second form). Through the advance and retreat of the hollow tube 2, if the positions of the narrowing piece 872 and the side hole 27 in the longitudinal direction A are consistent, the narrowing piece 872 will enter the side hole 27 and protrude toward the inner side of the flow path 27 (first form). In this case, as Figure 21 As shown, when the hollow tube 2 is in the retracted position, the narrow piece 872 contacts the outer peripheral surface of the hollow tube 2 and elastically deforms and bends toward the proximal side. Although not shown, the retaining piece 892 also elastically deforms and bends. The operating wire 4 and the hollow tube 2 advance, as shown in FIG. Figure 22 As shown, if the narrow piece 872 enters the side hole 27, the narrow piece 872 will return to its original shape, extend radially, and protrude into the flow path 23 (second form). Although omitted from the figure, the retaining piece 892 contacts the outer peripheral surface of the hollow tube 2 and undergoes elastic deformation and bends. Figure 21 As shown, the narrow portion 81 is elastically deformed by an external force, forming a second form that does not hinder the flow of the liquid through the flow path 23. Figure 22 As shown, in a natural state without external forces, the narrowed portion 81 returns to its original shape, transitioning from the second state to the first state. In the second state, the cross-sectional area (flow path area) of the flow path 23 becomes narrower. Therefore, the treatment instrument 100C changes between the first and second states as the sheath 1 moves relative to the hollow tube 2, making it possible to easily switch the level of the liquid supplied from the distal opening 22a.

[0133] According to the treatment instrument 100C of this embodiment, as in the first embodiment, various treatments such as local injection, incision and dissection, hemostasis, additional local injection, and surgical site cleansing can be performed. According to the treatment instrument 100C of this embodiment, various treatments such as local injection, incision and dissection, hemostasis, additional local injection, and surgical site cleansing can be performed without inserting or removing the treatment instrument 100C from the channel 206 of the endoscope 200.

[0134] According to the treatment instrument 100C of this embodiment, since the stenosis member 8C is positioned at a position protruding further than the distal end 1a of the sheath 1, the stenosis portion 81C can be positioned closest to the protruding end of the hollow tube 2. As a result, the stenosis portion 81C can be positioned closer to the distal opening 22a of the hollow tube 2 and project into the flow path 23. Since the stenosis portion 81C projects into the flow path 23 near the distal opening 22a of the hollow tube 2, the force of the water discharged from the distal opening 22a can be increased.

[0135] While the third embodiment has been described in detail with reference to the accompanying drawings, the specific configuration is not limited to this embodiment and includes design modifications within the scope of the present invention. Furthermore, the components described in the above embodiments and modifications can be combined as appropriate. In the following description, components identical to those already described will be denoted by the same reference numerals, and repeated description will be omitted.

[0136] (Variation 3-1)

[0137] Reference Figures 24 to 26 The stenosis member is not limited to any other member as long as it has a stenosis portion that can be switched between a position that blocks a portion of the flow path and a position that does not block the flow path 23. Figure 23 In addition, the number of the narrow portion 81C and the side hole 27 is not limited to one, and a plurality of them may be provided. Figure 24 and Figure 25As shown, the stenosis member 8C can be positioned so as to cover the entire circumference of the distal end of the tube holder 11C. When viewed in the longitudinal direction A, the stenosis member 8C in this example has a circular shape. In this example, a pair of side holes 27 open at positions opposing each other across the central axis O of the hollow tube 2, and the stenosis portion 81C includes a pair of stenosis portions 81 at positions corresponding to the pair of side holes 27. A pair of retaining portions 89 are circumferentially disposed between the pair of stenosis portions 81C. The flange 21 of the hollow tube 2 is positioned distally of the stenosis member 8C. The diameter of the distal portion of the tube holder 11C is smaller than the diameter of the insertion portion inserted into the distal end 1a of the sheath 1. The stenosis member 8C is attached from the distal side of the tube holder 11C, covering the outer circumference of the distal portion. The inner circumferential surface of the main body 80C forms the contact surface with the tube holder 11C. The stenosis member 8C is attached from the outside of the distal portion of the tube holder 11C. The movement of the narrowing piece 872 accompanying the advancement and retreat of the hollow tube 2 is the same as that of the third embodiment.

[0138] By having the pair of narrowed portions 81C protrude and retract from the outside of the pair of side holes 27 into the flow path 23, the difference between the wide and narrow sections of the flow path 23 can be increased, allowing water to be supplied with a stronger water pressure. On the other hand, when the operating wire 4 and hollow tube 2 are retracted, the pair of narrowed portions 81C move toward the outside of the hollow tube 2, switching to a state where the flow path 23 is not obstructed by the narrowed portions 81C. This significantly changes the water pressure of the liquid supplied from the distal opening 22a.

[0139] Although omitted from the illustration, each narrow part of this example may have Figure 10 and Figure 11 The slit 86 shown. The holding portion 89 plays a role in stably holding the hollow tube 2 when the hollow tube 2 moves forward and backward. From the purpose of changing the water flow in the flow path 23, the holding portion 89 is not an essential component of the narrowing member 8C.

[0140] (Fourth embodiment)

[0141] For the treatment instrument 100D of the fourth embodiment, refer to Figures 27 to 29 In the following description, the same components as those already described are denoted by the same reference numerals and redundant descriptions are omitted.

[0142] Figure 27It is a stereoscopic view showing the distal portion of the treatment instrument 100D of the fourth embodiment, in which a portion is shown in a cross-section along the longitudinal direction A. The treatment instrument 100D includes a sheath 1, a hollow tube 2, a tube holder 11, a connecting member 7, an operating wire for flow adjustment (second operating wire) 9, an operating wire for a tool (first operating wire) 4, and an operating portion 5. The sheath 1, the tube holder 11, and the operating wire 4 for a tool are the same as those in the above-mentioned embodiment. The hollow tube 2 does not have the side hole 27 of the above-mentioned embodiment. The other structures are the same as those in the above-mentioned embodiment. The operating wire 9 for flow adjustment is a wire having a hollow portion for operating the flow adjustment member 70 described later to move forward and backward relative to the sheath 1. The interior of the operating wire 9 for flow adjustment is hollow throughout its entire length. The operating wire 9 for flow adjustment is inserted into the inner side of the operating wire 4 for a tool.

[0143] The connecting member 7 is a member that connects the hollow tube 2 and the tool operation wire 4. The connecting member 7 has a main body 78 and a flow path adjustment member (narrowing member) 79. The main body 78 has a through hole and a slit 781 formed along the central axis O. The slit 781 is a space formed in the central part of the longitudinal direction A of the connecting member 7. The proximal end of the hollow tube 2 is inserted and fixed in the through hole that is located farther away than the slit 781. With this structure, the connecting member 7 itself also advances and retreats by the advance and retreat of the sliding member 52, and as a result, the hollow tube 2 connected to the connecting member 7 advances and retreats. The opening of the proximal end of the hollow tube 2 opens in the slit 781. The tool operation wire 4 is inserted and fixed in the through hole that is located farther away than the slit 781. At the distal end of the tool operation wire 4, a part of the circumferential side wall is opened to form a drain port 49.

[0144] The flow path adjustment member 79 includes a base 790, a first tube 792, a second tube 794, and a guide protrusion 793. The first tube 792 and the second tube 794 respectively include a first flow path and a second flow path, and the cross-sectional area (flow path area) of the first flow path and the second flow path is smaller than the cross-sectional area (flow path area) of the hollow portion of the tool operation wire 4. The first tube 792 is a tube located on the distal side of the base 790. The second tube 794 is a tube located on the proximal side of the base 790. The base 790 has a guide surface arranged parallel to the inner wall of the slit 781 and has a through hole extending along the central axis O. The guide protrusion 793 protrudes in a direction approximately perpendicular to the central axis O. In this example, a pair of guide protrusions 793 are provided, and each guide protrusion 793 protrudes from the base 793 in a direction approximately perpendicular to the central axis O in a direction different from each other.

[0145] The first tube 792, the base 790, and the second tube 794 are internally connected along the central axis O. The second tube 794 is fixed to the distal end of the flow path adjustment operation wire 9. Similar to the above-described embodiment, liquid supplied to the flow path adjustment operation wire 9 passes through the second tube 794, the base 790, and the first tube 792, and is discharged from the distal opening 791 of the first tube 792. Furthermore, liquid can also be supplied to the lumen of the tool operation wire 4, and liquid passing between the lumen of the tool operation wire 4 and the flow path adjustment operation wire 9 is discharged from the drain port 49 of the tool operation wire 4.

[0146] The flow path adjusting member 79 is disposed in the slit 781. The flow path adjusting member 79 is slidable along the central axis O in the slit 781.

[0147] like Figure 30 As shown, the operating portion 5C of this embodiment has a rod 55. The tool operating wire 4 can be advanced and retreated independently of the flow path adjustment operating wire 9 by operating the slider 52 of the operating portion. The connecting member 7 advances and retreats along with the advance and retreat operation of the tool operating wire 4. Since the hollow tube 2 is fixed to the connecting member 7, the hollow tube 2 advances and retreats relative to the sheath 1 by operating the tool operating wire 4. The flow path adjustment operating wire 9 and the flow path adjustment member 79 are configured to be able to advance and retreat relative to the sheath 1 by the advance and retreat operation of the rod 55. The flow path adjustment operating wire 9 can advance and retreat relative to the tool operating wire 4. The flow path adjustment member 79 advances and retreats in the slit 781 of the connecting member 7 along with the advance and retreat of the flow path adjustment operating wire 9. At the position where the flow path adjustment member 79 contacts the proximal end in the slit 781, the distal opening 791 of the first tube 792 separates from the proximal end of the hollow tube 2 toward the proximal side and opens in the slit 781. As Figure 29 As shown, when the flow path adjustment member 79 is advanced toward the distal side in the slit 781 , the distal opening 791 of the first tube 792 enters the flow path 23 from the proximal end of the hollow tube 2 and communicates with the flow path 23 .

[0148] If liquid is supplied into the flow path adjusting operating wire 9 at a point where the distal opening 791 of the first tube 792 is separated from the proximal end of the hollow tube 2, the liquid will flow into the proximal end of the hollow tube 2 and be supplied from the distal opening 22a of the hollow tube 2. If liquid is supplied into the flow path adjusting operating wire 9 at a point where the distal opening 791 of the first tube 792 is separated from the proximal end of the hollow tube 2, the liquid will flow from the distal opening 791 of the first tube 792 into the slit 781 and from the slit 781 into the interior of the hollow tube 2. As a result, the liquid supplied from the distal opening 22a of the hollow tube 2 is weakened. If the flow path adjustment component 79 moves forward, thereby delivering liquid in a state where the distal opening 791 of the first tube 792 is connected to the flow path 23 of the hollow tube 2 (a state where the distal end of the first tube 792 is inserted into the interior of the hollow tube 2), the liquid will flow into the hollow tube 2 from the first tube 792 whose cross-sectional area (flow path area) is smaller than the flow path 23, and the water potential of the liquid supplied from the distal opening 22a of the hollow tube 2 becomes stronger.

[0149] Furthermore, the main body 78 of the connecting member 7 is not necessarily a necessary component, and the hollow tube 2 and the tool operation wire 4 may be directly connected without passing through the main body 78. In this case, the flow path adjustment member 79 does not necessarily have a base 790. For example, the front end of the second tube 794 may be directly connected to the base end of the first tube 792. The front end of the flow path adjustment wire 9 is connected to the second tube 794, and the flow path adjustment wire 9 is inserted through the hollow portion of the tool operation wire 4. In this case, the second tube 794 may be in contact with the proximal end of the hollow tube 2 instead of the base 790.

[0150] In the case of such a configuration, the distal end of the first tube 792 can be made to protrude from the distal opening 22a of the hollow tube 2 by advancing the operating wire 9 for flow adjustment. At this time, the second tube 794 is positioned by contacting the proximal end of the hollow tube 2. As a result, the water potential of the liquid supplied from the distal opening 791 of the first tube 792 becomes stronger. In addition, when the distal opening 791 of the first tube 792 is positioned near the distal opening 22a of the hollow tube 2 by advancing the operating wire 9 for flow adjustment, the water potential of the liquid supplied from the distal opening 22a of the hollow tube 2 is similarly strong. If the distal opening 791 of the first tube 792 is sufficiently moved away from the distal opening 22a of the hollow tube 2 toward the proximal side by retreating the operating wire 9 for flow adjustment, the water potential of the liquid supplied from the distal opening 22a becomes weaker.

[0151] The treatment instrument 100D of this embodiment enables various treatments, including local injection, incision and dissection, hemostasis, additional local injection, and surgical site cleansing, without inserting or removing the treatment instrument 100D from the channel 206 of the endoscope 200.

[0152] According to the treatment instrument 100D of this embodiment, by inserting the flow path adjustment member 79 into the flow path 23 of the hollow tube 2, the cross-sectional area of ​​one portion of the flow path 23 can be made larger than that of the rest of the flow path 23, thereby increasing the water flow rate of the liquid. In other words, the first and second modes can be switched by operating the slider of the operating portion.

[0153] According to the treatment instrument 100D of the present embodiment, the first form and the second form can be switched regardless of the protruding state of the hollow tube 2 in the sheath 1 .

[0154] The fourth embodiment has been described in detail above with reference to the accompanying drawings, but the specific structure is not limited to this embodiment, and also includes design changes within the scope that does not deviate from the main points of the present invention. In addition, the components shown in the above-mentioned embodiments and modifications can be appropriately combined. In this embodiment, an example is shown in which liquid can also flow between the lumen of the tool operating wire 4 and the flow path adjustment operating wire 9, but based on the purpose of switching the water level of the liquid supplied from the distal opening 22a of the hollow tube 2, it is not a necessary structure for the liquid to be able to flow between the lumen of the tool operating wire 4 and the flow path adjustment operating wire 9.

[0155] According to the treatment instrument 100 of each of the above-described embodiments, the step portion 13 is provided, so that when the hollow tube 2 is retracted, the flange 21 can be accommodated within the step portion 13. In the above-described embodiments, an example is shown in which the step portion 13 is formed at the distal end of the tube holder 11. However, for the purpose of adjusting the flow rate of the liquid, the step portion 13 is not necessarily required.

Claims

1. An endoscope treatment instrument, wherein: have: jacket; a hollow tube extending within the sheath, the hollow tube forming a flow path along its longitudinal axis; a stenosis member, wherein the stenosis portion of the stenosis member is inserted into the hollow tube, thereby changing the cross-sectional area of ​​the flow path; The endoscopic treatment instrument is configured so that the hollow tube is inserted through the narrow portion to narrow the flow path and thereby change the flow rate of the fluid flowing in the flow path.

2. The endoscopic treatment instrument according to claim 1, wherein: An opening communicating with the flow path is formed on the side wall of the hollow tube. The stenosis member is located outside the hollow tube, The narrow portion can be inserted into the opening from the outside of the hollow tube. The hollow tube is relatively displaced with respect to the sheath, so that the narrow portion protrudes from the opening and retracts relative to the flow path.

3. The endoscopic treatment instrument according to claim 1, wherein: The endoscopic treatment instrument includes a tube holding member provided at the distal end of the sheath, and the tube holding member is formed with a through hole through which the hollow tube is inserted.

4. The endoscopic treatment instrument according to claim 2, wherein: The narrowing member further includes a contact surface that contacts the outer peripheral surface of the hollow tube, and the narrowing portion extends from the contact surface and is configured to be bend in a direction intersecting the longitudinal axis of the hollow tube and protrude into the flow path. The narrow portion is formed with a narrow surface extending in a direction intersecting the longitudinal axis direction of the hollow tube to narrow the flow path.

5. The endoscopic treatment instrument according to claim 2, wherein: The stenosis member has a first configuration and a second configuration, The first embodiment is a configuration in which the narrowing portion protrudes from the opening into the flow path, the narrowing portion being located radially inward of the inner circumferential surface of the flow path, thereby narrowing the flow path. In the second aspect, the narrowed portion is located outside the flow path or is located flush with the inner peripheral surface of the flow path.

6. The endoscopic treatment instrument according to claim 5, wherein: The stenosis member assumes the second shape in a natural state without being subjected to an external force, and the stenosis portion deforms from the second shape to assume the first shape when subjected to an external force.

7. The endoscopic treatment instrument according to claim 5, wherein: The stenosis member forms the first shape in a natural state without being subjected to an external force, and the stenosis portion is deformed from the first shape to form the second shape when subjected to an external force.

8. The endoscopic treatment instrument according to claim 5, wherein: When the stenosis member is in the first configuration, the stenosis portion is located within the flow path. When the stenosis member is in the second state, the stenosis portion abuts against the outer peripheral surface of the hollow tube.

9. The endoscopic treatment instrument according to claim 3, wherein: A first recess is formed in the proximal end wall of the tube holding member, The first recess is formed at a boundary portion between the proximal end wall and the through hole and is recessed from the proximal end wall toward the distal side.

10. The endoscopic treatment instrument according to claim 3, wherein: The through hole of the tube holding member has an inclined surface that is inclined in a direction approaching the hollow tube as it moves from a proximal end of the through hole toward a distal direction.

11. The endoscopic treatment instrument according to claim 5, wherein: A tube holding member is provided at the distal end of the sheath, the tube holding member being formed with a through hole for inserting the hollow tube therethrough. The through hole of the tube holding member has an inclined surface that is inclined toward the direction approaching the hollow tube as it moves from the proximal end of the through hole toward the distal side. When the narrowing member is in the first configuration, the narrowing portion abuts against the inclined surface. When the stenosis member is in the second configuration, the stenosis portion is separated from the inclined surface.

12. The endoscopic treatment instrument according to claim 4, wherein: The narrowing member has a slit formed on the outer peripheral surface along a direction intersecting the longitudinal axis direction. In the direction along the longitudinal axis of the hollow tube, the position of the slit overlaps with the proximal edge of the opening or is located further distal than the proximal edge of the opening.

13. The endoscopic treatment instrument according to claim 3, wherein: An opening communicating with the flow path is formed on the side wall of the hollow tube. The stenosis member is provided on the tube holding member, The narrow portion can be inserted into the opening from the outside of the hollow tube. The hollow tube is relatively displaced with respect to the sheath, so that the narrow portion can protrude from the opening and retract relative to the flow path.

14. The endoscopic treatment instrument according to claim 2, wherein: The narrow portion can protrude and retract relative to the flow path by advancing and retracting the hollow tube relative to the sheath along the longitudinal axis, or by rotating the hollow tube around the longitudinal axis of the hollow tube.

15. The endoscopic treatment instrument according to claim 1, wherein The hollow tube includes a first operating wire connected to the proximal end of the hollow tube via a connecting member and a second hollow operating wire fixed to the stenosis member at the distal end.

16. The endoscopic treatment instrument according to claim 15, wherein: The stenosis member is inserted into the flow path of the hollow tube so that a cross-sectional area of ​​a portion of the flow path is smaller than a cross-sectional area of ​​a remaining portion of the flow path.

17. The endoscopic treatment instrument according to claim 15, wherein: The stenosis member includes a first tube that can be inserted into the hollow tube and a second tube that can be inserted into the interior of the first operating wire. The first tube has a second flow path having a cross-sectional area smaller than that of the flow path of the hollow tube. The second tube has a third flow path communicating with the hollow portion of the first operating wire. The second flow path of the first tube and the third flow path of the second tube are in communication with each other.

18. The endoscopic treatment instrument according to claim 17, wherein: By abutting the second tube against the hollow tube, the distal end of the first tube can be positioned to protrude from the distal opening of the hollow tube or to be located near the distal opening.

19. An endoscope treatment instrument, wherein: have: a sheath having a tube retaining member disposed at a distal end; The cutting device is formed with a water supply conduit and is arranged to be movable relative to the sheath. By protruding and retracting the cutting tool from the distal end of the tube holding member, the narrow portion of the narrowing member protrudes and retracts relative to the water supply pipe, changing the cross-sectional area of ​​the water supply pipe, thereby switching the flow rate of the fluid flowing in the water supply pipe.

20. The endoscopic treatment instrument according to claim 19, wherein An opening communicating with the water supply pipe is formed on the side wall of the cutting tool. The narrowing member is provided on the outside of the incision tool, and the narrowing portion can be inserted into the water supply pipe through the opening. By operating the incision tool to project and retract from the distal end of the tube holding member, the narrowed portion projects and retracts from the opening relative to the water supply pipe.

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