Endoscope disposal instruments

Abstract

The present invention provides an endoscope treatment instrument. The endoscope treatment instrument (6) includes: a sheath (9) having a first hole (921) opened at the front end; a knife (11) for tissue incision, which penetrates the first hole (921) and has a second hole (113) extending between the front end and the base end; a connecting member (15) located inside the sheath (9) and having a receiving path (153) with a cross-sectional area larger than that of the second hole (113); and a flow path forming member (13) arranged in a freely movable manner in the receiving path (153) and forming a flow path (133) communicating with the second hole (113), wherein the cross-sectional area of ​​the flow path (133) is smaller than that of the second hole (113).

Description

Technical Field

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

[0002] Conventionally, in ESD (Endoscopic Submucosal Dissection), treatment instruments for incision and dissection, such as a high-frequency knife, and treatment instruments for local injection and hemostasis have been used (see, for example, Patent Documents 1 to 3).

[0003] Patent Documents 1 and 2 describe endoscopic treatment instruments capable of performing tissue incision treatment and local injection treatment.

[0004] Furthermore, when performing local injection treatment or cleaning of blood, etc., as disclosed in Patent Document 3, there is known a method of ejecting liquid from the tip of an electrode for incision or peeling.

[0005] Prior art literature

[0006] Patent Literature

[0007] Patent Document 1: Chinese Patent Application Publication No. 111202485

[0008] Patent Document 2: Japanese Patent Application No. 2012-523863

[0009] Patent Document 3: Chinese Patent Application Publication No. 108272503 Summary of the Invention

[0010] Problems to be solved by the invention

[0011] In the case of local injection, water can be delivered to the submucosa at a high pressure, enabling appropriate local injection. On the other hand, in the case of cleansing, excessive water delivery during cleansing at a high pressure can create bubbles in the tissue, necessitating water delivery at a moderately reduced pressure. Therefore, the pressure generated by the water delivery when ejecting liquid into the body cavity must be adjusted depending on the application, such as local injection or cleansing.

[0012] The present invention has been made in view of the above-mentioned circumstances, and an object of the present invention is to provide an endoscopic treatment instrument capable of adjusting the pressure applied to tissue by a discharged fluid with a simple structure.

[0013] Solutions for solving problems

[0014] In order to solve the above-mentioned problems and achieve the purpose, the endoscopic treatment instrument of the present invention includes: a sheath having a first hole opening at the front end; a knife for tissue incision, which penetrates the first hole and has a second hole extending between the front end and the base end; a connecting member, which is located inside the sheath and has a storage path with a cross-sectional area larger than the cross-sectional area of ​​the second hole; and a flow path forming member, which is arranged in the storage path in a manner that can be freely advanced and retreated, and forms a flow path connected to the second hole, and the cross-sectional area of ​​the flow path is smaller than the cross-sectional area of ​​the second hole.

[0015] Effects of the Invention

[0016] According to the endoscopic treatment instrument of the present invention, the pressure applied to tissue by the ejected fluid can be adjusted with a simple structure. BRIEF DESCRIPTION OF THE DRAWINGS

[0017] Figure 1 This is a diagram showing an endoscope system according to the first embodiment.

[0018] Figure 2 It is a diagram illustrating the structure of a treatment instrument insertion portion.

[0019] Figure 3 It is a diagram illustrating the structure of a treatment instrument insertion portion.

[0020] Figure 4 It is a diagram for explaining the operation of the endoscopic treatment instrument.

[0021] Figure 5 It is a diagram for explaining the operation of the endoscopic treatment instrument.

[0022] Figure 6 It is a diagram for explaining the operation of the endoscopic treatment instrument.

[0023] Figure 7 It is a diagram for explaining the operation of the endoscopic treatment instrument.

[0024] Figure 8 It is a diagram for explaining the operation of the endoscopic treatment instrument.

[0025] Figure 9 It is a diagram illustrating the structure of a treatment instrument insertion portion according to the second embodiment.

[0026] Figure 10 It is a diagram illustrating the structure of a treatment instrument insertion portion according to the second embodiment.

[0027] Figure 11 It is a diagram illustrating the structure of a treatment instrument insertion portion according to the second embodiment.

[0028] Figure 12 It is a diagram illustrating the structure of a treatment instrument insertion portion according to the second embodiment.

[0029] Figure 13 It is a diagram illustrating the structure of a treatment instrument insertion portion according to a third embodiment.

[0030] Figure 14 It is a diagram illustrating the structure of a treatment instrument insertion portion according to a fourth embodiment.

[0031] Figure 15 It is a diagram illustrating the structure of a treatment instrument insertion portion according to a fourth embodiment.

[0032] Figure 16 It is a diagram illustrating the structure of a treatment instrument insertion portion according to a fourth embodiment.

[0033] Figure 17A It is a figure which shows an example of the shape of a protrusion.

[0034] Figure 17B It is a figure which shows an example of the shape of a protrusion.

[0035] Figure 17C It is a figure which shows an example of the shape of a protrusion.

[0036] Description of Reference Numerals

[0037] 1. Endoscope system; 2. Endoscope; 3. Display device; 4. Light source device; 5. Control device; 6. Endoscope treatment instrument; 7. 7A to 7C. Treatment instrument insertion portion; 8. Treatment instrument operating portion; 9. Sheath; 10. 10A, 10C. Second advance / retract member; 11. Blade; 12. First advance / retract member; 13. 13A, 13B. Flow path forming member; 14. 14A. Second advance / retract member body; 15. Connecting member; 16. Force applying member; 21. Endoscope insertion portion; 22. Endoscope operating portion; 23. Universal cable; 24. Connector portion; 81. Operating portion body; 82. First slider; 83. Second slider; 91. Sheath body; 92. Front end member; 100. Power supply; 111. Blade body; 112. Protrusion; 113. Second hole; 13 0, guide protrusion; 131, contact portion; 132, base end portion; 133, third hole; 134, D-shaped cutting portion; 135, second notch portion; 141, first notch portion; 151, first fitting hole; 152, second fitting hole; 153, storage hole; 154, 155, guide hole; 200, water supply source; 211, front end unit; 212, bending portion; 213, flexible tube; 22 1. Operating member; 222. Bending knob; 223. Insertion port; 811. Ring; 812. Water supply port; 821. Ring; 822. Plug; 921. First hole; 9211. Large diameter portion; 9212. Small diameter portion; 9213. First step portion; CO, power cord; P1, P1A, main flow path; SL, saline solution; T1, target site; T2, marking mark; TU, tube. DETAILED DESCRIPTION

[0038] Hereinafter, the mode for implementing the present invention (hereinafter referred to as embodiment) will be described with reference to the accompanying drawings. In addition, the present invention is not limited to the embodiment described below. In addition, the same reference numerals are used for the same parts in the description of the accompanying drawings.

[0039] (Implementation Method 1)

[0040] [Structure of the endoscope system]

[0041] Figure 1 This is a diagram showing an endoscope system 1 according to the first embodiment.

[0042] The endoscope system 1 is used in the medical field and is a system that treats a portion of a biological tissue in the body cavity (hereinafter referred to as a target portion) by applying high-frequency energy to the target portion while observing the body cavity. In addition, the treatment that can be performed by the endoscope system 1 of this embodiment 1 is treatment such as coagulation (sealing) or incision of the target portion. Figure 1 As shown, the endoscope system 1 includes an endoscope 2 , a display device 3 , a light source device 4 , a control device 5 , and an endoscope treatment instrument 6 .

[0043] A portion of the endoscope 2 is inserted into a body cavity, and an image of the subject reflected from the body cavity is captured, and an image signal generated by the capture is output. Figure 1 As shown, the endoscope 2 includes an endoscope insertion portion 21 , an endoscope operation portion 22 , a universal cable 23 , and a connector portion 24 .

[0044] At least a portion of the endoscope insertion portion 21 is flexible and is the portion to be inserted into the body cavity. Figure 1 As shown, the endoscope insertion portion 21 includes a front end unit 211 , a bending portion 212 , and a flexible tube 213 .

[0045] The distal end unit 211 is provided at the distal end of the endoscope insertion portion 21. Although not specifically shown in the drawings, the distal end unit 211 is provided with an illumination optical system, an imaging optical system, and an imaging unit.

[0046] The illumination optical system faces one end of a light guide (not shown) guided through the endoscope insertion portion 21 , and irradiates the body cavity with light guided by the light guide from the distal end of the endoscope insertion portion 21 .

[0047] The imaging optical system receives light (subject image) irradiated into the body cavity from the illumination optical system and reflected from the body cavity, and forms an image on an imaging surface of an imaging element constituting the imaging unit.

[0048] The imaging unit includes an imaging element such as a CCD (Charge Coupled Device) or a CMOS (Complementary Metal Oxide Semiconductor), captures a subject image formed by the imaging optical system, and outputs an image signal generated by the capture.

[0049] The bending portion 212 is connected to the proximal end side (endoscope operation unit 22 side) of the distal end unit 211. Although not specifically shown in the figure, the bending portion 212 has a structure in which a plurality of bending pieces are connected and is bendable.

[0050] The flexible tube 213 is connected to the proximal end side (endoscope operation unit 22 side) of the bending portion 212 , and has a vertically long and flexible shape.

[0051] The endoscope operation unit 22 is connected to the base end portion of the endoscope insertion unit 21. The endoscope operation unit 22 receives various operations performed on the endoscope 2. Figure 1 As shown, the endoscope operating portion 22 is provided with a plurality of operating members 221 , a bending knob 222 , and an insertion port 223 .

[0052] The plurality of operating members 221 are constituted by buttons and the like for accepting various operations.

[0053] The bending knob 222 is configured to be rotatable by a user's operation. Rotation of the bending knob 222 activates a bending mechanism (not shown) such as a metal or resin wire disposed within the endoscope insertion portion 21. As a result, the bending portion 212 bends.

[0054] The insertion port 223 is connected to a pipeline (not shown) extending from the front end of the endoscope insertion portion 21 to the base end side (endoscope operation portion 22 side), and is an insertion port for the treatment instrument insertion portion 7 of the endoscope treatment instrument 6 to penetrate the pipeline from the outside.

[0055] The universal cable 23 extends from the endoscope operating portion 22 in a direction different from the extending direction of the endoscope insertion portion 21 and is a cable provided with the aforementioned light guide and a signal line for transmitting the aforementioned image signal.

[0056] The connector portion 24 is provided at an end portion of the universal cable 23 and is detachably connected to the light source device 4 and the control device 5 .

[0057] The display device 3 is an LCD (Liquid Crystal Display) or an EL (ElectroLuminescence) display, and displays a predetermined image under the control of the control device 5 .

[0058] The light source device 4 emits illumination light. The illumination light emitted from the light source device 4 passes through the light guide and illumination optical system routed through the connector portion 24, the universal cable 23, the endoscope operating portion 22, and the endoscope insertion portion 21, and then is irradiated from the distal end of the endoscope insertion portion 21 toward the body cavity.

[0059] The control device 5 is configured to include a CPU (Central Processing Unit) or an FPGA (Field-Programmable Gate Array), and controls the overall operation of the display device 3 and the light source device 4 .

[0060] For example, the control device 5 performs predetermined processing on the image signal input from the imaging unit via the signal line to generate an endoscopic image. Furthermore, the control device 5 controls the operation of the display device 3 to display the endoscopic image and the like on the display device 3.

[0061] In the first embodiment, the light source device 4 and the control device 5 are configured independently of each other, but they may be integrally provided in one housing.

[0062] [Structure of Endoscopic Treatment Instrument]

[0063] The endoscopic treatment instrument 6 is, for example, a treatment instrument used in ESD (Endoscopic Submucosal Dissection). Figure 1 As shown, the endoscopic treatment instrument 6 includes a treatment instrument insertion portion 7 and a treatment instrument operation portion 8 .

[0064] like Figure 1 As shown, the treatment instrument insertion portion 7 protrudes from the distal end of the endoscope insertion portion 21 through the insertion port 223 via the conduit in the endoscope insertion portion 21 and is inserted into the body cavity, corresponding to the insertion portion of the present invention.

[0065] The detailed structure of the treatment instrument insertion portion 7 will be described in the "Structure of the Treatment Instrument Insertion Portion" described later. The "front end" hereinafter refers to one end of the treatment instrument insertion portion 7 in the insertion direction, and the "base end" hereinafter refers to the other end of the treatment instrument insertion portion 7 on the opposite side of the insertion direction.

[0066] The treatment instrument operation portion 8 is connected to the base end portion of the treatment instrument insertion portion 7. The treatment instrument operation portion 8 receives an operation performed on the endoscope treatment instrument 6. Figure 1 As shown, the treatment instrument operating portion 8 includes an operating portion main body 81 , a first slider 82 , and a second slider 83 .

[0067] The operation unit main body 81 has a longitudinally long shape and fixes the proximal end portion of a sheath 9 hereinafter described, and the sheath 9 constitutes the treatment instrument insertion portion 7. Further, as Figure 1 shown, a loop 811 for a surgical operator or the like to hook a finger is provided at the proximal end portion of the operation unit main body 81. Also, a water supply port 812 connected to a tube TU is provided in the operation unit main body 81. Further, physiological saline is supplied from a water supply source 200 such as a pump to the water supply port 812 via the tube TU.

[0068] Here, the physiological saline corresponds to the fluid of the present invention. In addition, as the fluid of the present invention, it is not limited to physiological saline, and other liquids, gases such as air, etc. may also be used.

[0069] The first slider 82 is mounted on the operation unit main body 81 so as to be movable along the length direction of the operation unit main body 81 according to an operation by a surgical operator or the like. As Figure 1 shown, a pair of loops 821 for a surgical operator or the like to hook a finger are provided on the first slider 82. Also, a plug 822 connected to a power cord CO is provided on the first slider 82. Further, the plug 822 is electrically connected to a power source 100 via the power cord CO.

[0070] The second slider 83 is mounted on the operation unit main body 81 so as to be movable along the length direction of the operation unit main body 81 according to an operation by a surgical operator or the like. In addition, the second slider 83 can move along the length direction of the operation unit main body 81 in a state independent of the first slider 82.

[0071] 〔Structure of treatment instrument insertion portion〕

[0072] Figure 2 and Figure 3 are diagrams for explaining the structure of the treatment instrument insertion portion 7. Specifically, Figure 2 is a cross-sectional view obtained by剖切 the front end portion of the treatment instrument insertion portion 7 with a plane including the central axis of the treatment instrument insertion portion 7. Further, Figure 3 is a view showing the inside of the sheath 9 at the front end portion of the treatment instrument insertion portion 7. In addition, in Figure 3 , only the sheath 9, the knife 11, and the connecting member 15 in the front end portion of the treatment instrument insertion portion 7 are剖切.

[0073] As Figures 1 to 3 shown, the treatment instrument insertion portion 7 includes a sheath 9, a second advancing / retreating member (second tube body) 10 ( Figure 2 , Figure 3 ), a knife 11 ( Figure 2 , Figure 3 ), a first advancing / retreating member (first tube body) 12 ( Figure 2 , Figure 3 )、Flow path forming member 13 ( Figure 2 、 Figure 3 ).

[0074] The sheath 9 is a portion constituting the outer surface of the treatment instrument insertion portion 7. Figures 1 to 3 As shown, the sheath 9 includes a sheath body 91 and a front end member 92 .

[0075] The sheath body 91 is a cylindrical member made of a resin material or the like and has insulating and flexible properties.

[0076] The front end member 92 is composed of a substantially cylindrical member. The front end member 92 may be composed of an electrically insulating member made of ceramic, resin material, rubber, etc., or may be composed of a member obtained by applying an insulating coating to the surface of metal, etc. The front end member 92 is inserted into the front end portion of the sheath body 91 to seal the front end portion. Figure 2 or Figure 3 As shown, the front end member 92 is provided with a first hole 921 that connects the inside and outside of the sheath 9.

[0077] The first hole 921 has a circular cross-section and is located on the central axis of the front end member 92, extending linearly along the central axis. In addition, the first hole 921 has a stepped shape in which the inner diameter of the front end portion is larger than the inner diameter of the base end portion. In the following, for the sake of convenience, the portion of the first hole 921 with a larger inner diameter on the front end side is referred to as the large diameter portion 9211 ( Figure 2 、 Figure 3 ), the portion with a smaller inner diameter on the base end side is recorded as the small diameter portion 9212 ( Figure 2 、 Figure 3 ). In addition, the step portion between the large diameter portion 9211 and the small diameter portion 9212 is described as a first step portion 9213 ( Figure 2 、 Figure 3 ).

[0078] The second advancing and retreating member 10 is inserted into the sheath body 91 and is a member for advancing and retreating the knife 11 along the central axis of the sheath 9. Figure 2 or Figure 3 As shown, the second advancing and retracting member 10 includes a second advancing and retracting member body 14 and a connecting member 15 .

[0079] The second advancement / retraction member body 14 is composed of a conductive material such as metal, and is located within the sheath 9. It is a flexible cylindrical coil extending along the central axis of the sheath 9. The base end of the second advancement / retraction member body 14 is fixed to the first slider 82. Specifically, the second advancement / retraction member 10 advances and retracts within the sheath body 91 in response to manipulation of the first slider 82 by an operator, such as a surgeon. Furthermore, the second advancement / retraction member body 14 is electrically connected to the plug 822.

[0080] The connecting member 15 connects the second advancing and retracting member 10 and the blade 11. The connecting member 15 is made of a conductive material such as metal, is located inside the sheath 9, and has a cylindrical shape extending linearly along the central axis of the sheath 9.

[0081] like Figure 2 or Figure 3 As shown, the connection member 15 is provided with a first fitting hole 151 , a second fitting hole 152 , a receiving hole 153 , and a pair of guide holes 154 , 155 .

[0082] The first fitting hole 151 corresponds to the fitting hole of the present invention. This first fitting hole 151 is a circular hole located on the central axis of the connecting member 15 and extending linearly along the central axis from the distal end toward the proximal end of the connecting member 15. Furthermore, the proximal end of the blade 11 is secured to the first fitting hole 151 while being inserted through the hole.

[0083] The second fitting hole 152 is a circular hole located on the central axis of the connecting member 15 and extending linearly along the central axis from the proximal end toward the distal end of the connecting member 15. Furthermore, the second advancement / retraction member body 14 is fixed to the second fitting hole 152 while being inserted through it. Specifically, the connecting member 15 and the second advancement / retraction member body 14 advance and retract within the sheath body 91 in conjunction with manipulation of the first slider 82 by an operator, such as a surgeon.

[0084] The connection member 15 described above may be formed of a single component, or may be formed by connecting two or more components by bonding, adhesion, or the like.

[0085] The receiving hole 153 is equivalent to the receiving path of the present invention. The receiving hole 153 is a circular hole located on the central axis of the connecting member 15 and extending linearly from the front end side to the base end side of the connecting member 15 along the central axis, and is connected to the first fitting hole 151 and the second fitting hole 152. Figure 2 or Figure 3 As shown, the flow path forming member 13 is housed in the housing hole 153 .

[0086] The inner diameter of the second fitting hole 152 is set to be substantially the same as that of the receiving hole 153. The inner diameter of the first fitting hole 151 is set to be smaller than that of the second fitting hole 152 and that of the receiving hole 153.

[0087] A pair of guide holes 154, 155 are respectively formed from the connecting member 15 Figure 2 The upper and lower outer peripheral surfaces of the Figure 2 The long hole extending in the left and right directions. Figure 2 or Figure 3 As shown, the pair of guide protrusions 130 provided on the flow path forming member 13 respectively penetrate the pair of guide holes 154 and 155 .

[0088] The outer peripheral surface of the second advancing and retracting member 10 described above is covered with a cylindrical inner tube (not shown) which is made of a resin material or the like and has insulation and flexibility.

[0089] The knife 11 is made of a conductive material such as metal, and is fixed in a state where its base end portion is inserted into the first fitting hole 151 and protrudes into the storage hole 153. That is, the knife 11 and the second advance and retreat member 10 advance and retreat in the sheath body 91 according to the operation of the first sliding part 82 by the operator such as the surgical operator. In addition, the knife 11 protrudes from the first hole 921 to the outside of the front end member 92. Moreover, the knife 11 is supplied with a high-frequency current from the power supply 100 via the power cord CO, the plug 822, the second advance and retreat member body 14 and the connecting member 15, thereby incising the target part in the body cavity. Figure 2 or Figure 3 As shown, the knife 11 includes a knife body 111 and a protrusion 112 .

[0090] The blade body 111 is composed of a cylindrical member located on the central axis of the front end member 92 and extending linearly along the central axis. Figure 2 or Figure 3 As shown, the outer diameter of the blade body 111 is set to be slightly smaller than the inner diameter of the first hole 921 .

[0091] The protrusion 112 is provided at the front end of the knife body 111 and has a disc shape coaxial with the central axis of the knife body 111. The outer diameter of the protrusion 112 is set larger than the outer diameter of the knife body 111 and smaller than the inner diameter of the large diameter portion 9211.

[0092] like Figure 2 or Figure 3As shown, the blade 11 described above is provided with a second hole 113. This second hole 113 is located on the central axis of the blade body 111 and extends along the central axis from the base end to the tip end of the blade 11. Furthermore, the blade 11 is connected to the second advancing and retreating member 10, thereby connecting the second hole 113 to the storage hole 153. Here, the cross-sectional area of ​​the second hole 113 perpendicular to the central axis is smaller than the cross-sectional area of ​​the storage hole 153 perpendicular to the central axis.

[0093] The first advance and retreat member 12 passes through the second advance and retreat member body 14, and is a member that enables the flow path forming member 13 to advance and retreat along the central axis of the sheath 9. The first advance and retreat member 12 is made of, for example, a metal material, and is a cylindrical flexible coil located on the central axis of the second advance and retreat member body 14 and extending linearly along the central axis. Moreover, the base end portion of the first advance and retreat member 12 is fixed to the second sliding member 83. That is, the first advance and retreat member 12 advances and retreats in the second advance and retreat member body 14 according to the operation of the second sliding member 83 by an operator such as a surgical operator. In addition, the first advance and retreat member 12 is connected to the water supply port 812. Moreover, the first advance and retreat member 12 serves as the main flow path P1 ( Figure 2 ) to perform its function.

[0094] The flow path forming member 13 is made of a metal material or a resin material, and is a member for adjusting the cross-sectional area of ​​the flow path between the main flow path P1 and the second hole 113, and is arranged in the receiving hole 153 in a manner that allows for free movement. Figure 2 or Figure 3 As shown, the flow path forming member 13 includes an abutting portion 131 and a base end portion 132 .

[0095] The contact portion 131 has a cylindrical shape that is located on the central axis of the connecting member 15 and extends linearly along the central axis. Here, the outer diameter of the contact portion 131 is set to be slightly smaller than the inner diameter of the receiving hole 153.

[0096] The base end portion 132 is a portion connecting the first advancing / retracting member 12 and the flow path forming member 13. This base end portion 132 is provided at the base end of the abutting portion 131 and has a cylindrical shape coaxial with the central axis of the abutting portion 131. The outer diameter of the base end portion 132 is set to be smaller than the outer diameter of the abutting portion 131 and slightly smaller than the inner diameter of the second advancing / retracting member body 14.

[0097] like Figure 2 or Figure 3As shown, the flow path forming member 13 described above is provided with a third hole (flow path) 133 located on the central axis of the abutment portion 131 and extending along the central axis from the base end to the front end of the flow path forming member 13. Furthermore, the flow path forming member 13 is connected to the first advancing and retreating member 12, thereby communicating with the main flow path P1.

[0098] Here, the cross-sectional area of ​​the third hole 133 perpendicular to the central axis is smaller than the flow path area of ​​the main flow path P1 and smaller than the cross-sectional area of ​​the second hole 113 perpendicular to the central axis.

[0099] Summarizing the above, the relationship of cross-sectional areas is: third hole 133 < main channel P1 < second hole 113 < storage hole 153. Alternatively, the main channel P1 and the second hole 113 may have the same cross-sectional area.

[0100] In addition, the outer peripheral surface of the contact portion 131 Figure 3 The left and right parts of the middle are respectively provided with D-shaped cutting parts 134. The D-shaped cutting parts 134 are composed of planes, and compared with the outer peripheral surfaces of the abutment portion 131 except that the D-shaped cutting parts 134, the gap between the D-shaped cutting parts 134 and the inner peripheral surface of the storage hole 153 is larger.

[0101] Furthermore, the outer peripheral surface of the contact portion 131 Figure 2 and Figure 3 The upper and lower portions of the housing are provided with guide protrusions 130 passing through a pair of guide holes 154 and 155, respectively.

[0102] [Operation of Endoscopic Treatment Instruments]

[0103] Next, the operation of the above-mentioned endoscopic treatment instrument 6 will be described. For the sake of convenience, the following description will be given by taking the ESD process as an example.

[0104] Figures 4 to 8 1 is a diagram illustrating the operation of the endoscope treatment instrument 6. Specifically, Figure 4 It is a diagram for explaining the marking process in ESD. Figure 5 It is a diagram explaining the local injection process in ESD. Figure 6 is with Figure 2 The corresponding cross-sectional view shows the treatment instrument insertion portion 7 set to the first state. Figure 7 is with Figure 2 The corresponding cross-sectional view shows the treatment instrument insertion portion 7 set to the second state. Figure 8 is with Figure 2 The corresponding cross-sectional view shows the treatment instrument insertion portion 7 set to the third state.

[0105] First, the operator such as a surgeon inserts the endoscope insertion portion 21 into the body cavity and moves the distal end of the endoscope insertion portion 21 to the target site T1 ( Figure 4 )nearby.

[0106] Next, the operator such as the surgeon performs the first retracting operation of pulling the first slide 82 toward the front (ring 811 side). As a result, the treatment instrument insertion portion 7 enters the first state ( 1st state) in which the protrusion 112 is located in the large diameter portion 9211, the base end of the protrusion 112 abuts against the first step portion 9213, and only the protrusion 112 protrudes from the first hole 921 to the outside of the front end member 92. Figure 6 ), that is, the protrusion 112 protrudes from the first hole 921 and the blade body 111 is located in the first hole 921. Then, the operator such as the surgeon inserts the treatment instrument insertion portion 7 in the first state from the insertion port 223 into the conduit in the endoscope insertion portion 21 and causes it to protrude from the front end of the endoscope insertion portion 21. Furthermore, even if the blade 11 protrudes slightly from the front end member 92, there will be no problem in inserting the treatment instrument insertion portion 7 in the first state from the insertion port 223 into the conduit in the endoscope insertion portion 21.

[0107] Next, an operator such as a surgeon performs a marking process as follows.

[0108] That is, the operator such as the surgeon operates the operation part (not shown) such as the foot switch while maintaining the first state of the treatment instrument insertion part 7, and a high-frequency current is supplied from the power supply 100 to the blade 11. Figure 4 As shown in (a), the operator such as the surgeon presses the protrusion 112 against the living tissue around the target site T1. As a result, the living tissue in contact with the protrusion 112 is burned. Figure 4 (a) or Figure 4 As shown in (b), a marking mark T2 is formed at the burned portion.

[0109] Then, the operator repeats the above operation several times, such as Figure 4 As shown in (c), the marking marks T2 are formed in such a number that the outer edge of the target part T1 can be grasped. Thereafter, the operator such as the surgeon stops the high-frequency current from the power supply 100 to the blade 11 .

[0110] Next, the surgeon or other operator performs a first forward movement to push in the first slider 82. This places the treatment instrument insertion portion 7 in a state where the distal end of the connecting member 15 abuts the proximal end of the distal member 92 and the blade 11 protrudes from the distal end of the sheath 9 to its maximum protruding length (a second state). Furthermore, the surgeon or other operator performs a second forward movement to push in the second slider 83. This places the treatment instrument insertion portion 7 in a state where the flow path forming member 13 moves to the first position and abuts the proximal end of the blade 11. That is, in this first embodiment, in the first position, the distal end of the abutting portion 131 abuts the proximal end of the blade 11. Thus, the flow path forming member 13 covers a portion of the proximal opening of the second hole 113 (a portion of the proximal opening of the first fitting hole 151) with the portion other than the third hole 133. At this time, it is preferred that the center of the distal opening of the third hole 133 and the center of the proximal opening of the second hole 113 be coaxial, but this is not necessarily the case.

[0111] Alternatively, the blade 11 may be attached to the connecting member 15 so that the base end of the blade 11 is located within the first fitting hole 151. In this case, the flow path forming member 13 may be configured to abut the peripheral portion of the first fitting hole 151 of the connecting member 15, rather than the base end of the blade 11. That is, the first position of the flow path forming member 13 does not necessarily require that the flow path forming member 13 abut the base end of the blade 11. Alternatively, the flow path forming member 13 may abut the peripheral portion of the first fitting hole 151 of the connecting member 15, with the first fitting hole 151 of the connecting member 15 located between the base end of the blade 11 and the flow path forming member 13. In this state, the flow path forming member 13 covers a portion of the opening on the base end side of the first fitting hole 151 with the portion other than the third hole 133.

[0112] As described above, according to the first forward operation of the first slider 82 and the second forward operation of the second slider 83, the treatment instrument insertion portion 7 becomes Figure 7 The second state is shown.

[0113] Furthermore, the operator such as the surgeon operates an operating unit (not shown) such as a foot switch while maintaining the second state of the treatment instrument insertion portion 7 by performing the first forward operation on the first slider 82 and the second forward operation on the second slider 83, thereby supplying physiological saline from the water supply source 200. Figure 7As shown by the middle arrow, the physiological saline supplied from the water supply source 200 flows from the main flow path P1 through the flow path passing through the third hole 133 and the second hole 113, and then is ejected from the front end of the knife 11. Here, the cross-sectional area of ​​the third hole 133 perpendicular to the central axis is smaller than the flow path area of ​​the main flow path P1. That is, the flow path of the physiological saline is temporarily narrowed as it passes through the third hole 133, so the flow rate of the physiological saline in the flow path (third hole 133) becomes faster, and then flows into the second hole 113. Therefore, the water potential of the physiological saline SL ejected from the front end of the knife 11 becomes relatively high, and under the water potential of the physiological saline SL, it is injected into the lower part of the target part T1 ( Figure 5 ) Then, the target site T1 is lifted up from other tissues such as the submucosa below.

[0114] Next, the operator such as a surgeon performs the incision process as follows.

[0115] That is, the operator such as a surgeon performs the first advancing operation on the first slider 82. When the first advancing operation is performed on the first slider 82, as described above, the treatment instrument insertion portion 7 is in a state where the blade 11 protrudes from the sheath 9 to the maximum protruding length.

[0116] Furthermore, while maintaining the blade 11 protruding from the sheath 9 to its maximum length by performing the first forward movement on the first slider 82, the surgeon or other operator operates an operating unit such as a foot switch (not shown), thereby supplying a high-frequency current from the power supply 100 to the blade 11. The surgeon or other operator then moves the protrusion 112 around the target site T1 while piercing the living tissue, while confirming the marking mark T2, thereby incising the entire circumference of the target site T1. Subsequently, while maintaining the third state, the submucosal layer of the mucosal layer, including the incised target site T1, is removed.

[0117] Through the above steps, ESD is completed. In addition, in each step of the above-mentioned ESD, when cleaning the surgical site, the operator such as the surgeon performs the following operations.

[0118] The operator such as the surgical operator performs the second retracting operation of pulling the second sliding member 83 toward the front (toward the ring 811). As a result, the treatment instrument insertion portion 7 becomes a state in which the flow path forming member 13 is positioned at the second position farther from the base end of the knife 11 than the first position. Specifically, in the second position, the base end portion 132 enters the second advance and retreat member body 14 and the base end of the abutment portion 131 abuts against the front end of the second advance and retreat member body 14. That is, the treatment instrument insertion portion 7 becomes a state in which the storage hole 153 is located between the second hole 113 and the third hole 133. Figure 8In the second position, the space between the base end portion 132 and the second advancing / retracting member body 14 is slightly opened and communicates with the gap between the first advancing / retracting member 12 and the second advancing / retracting member body 14 .

[0119] Furthermore, the operator such as the surgeon operates an operation unit (not shown) such as a foot switch while maintaining the third state of the treatment instrument insertion portion 7 by the second retreat operation of the second slider 83, and supplies physiological saline from the water supply source 200. Figure 8 As indicated by the middle arrow, the saline solution supplied from the water supply source 200 flows from the main flow path P1 through the third hole 133, the receiving hole 153, and the second hole 113, before being ejected from the distal end of the blade 11. The cross-sectional area of ​​the receiving hole 153 perpendicular to the central axis is larger than both the flow area of ​​the main flow path P1 and the cross-sectional area of ​​the third hole 133 perpendicular to the central axis. In other words, the saline solution flows through the receiving hole 153, where its flow path is temporarily widened, before flowing into the second hole 113. At this point, the saline solution also flows into the receiving hole 153 from the gap between the first advancing and retracting member 12 and the second advancing and retracting member body 14, where it is stored. Therefore, even if water is supplied from the third hole 133, the saline solution does not maintain its original water pressure and is ejected from the distal end of the blade 11 through the second hole 113. As a result, the water pressure of the saline solution ejected from the distal end of the blade 11 is relatively low. That is, the physiological saline solution ejected from the distal end of the blade 11 is supplied to the surgical site without being locally injected, thereby cleansing the surgical site.

[0120] As described above, the flow path cross-sectional area ratio of the second hole 113 to the third hole 133 is smaller than the flow path cross-sectional area ratio of the receiving hole 153 to the third hole 133. By utilizing this relationship in the flow path cross-sectional area ratio, the water pressure applied to the tissue by the physiological saline solution ejected from the front end of the blade 11 is adjusted.

[0121] In addition, in the first state of the treatment instrument insertion portion 7 described in the above-mentioned marking step, Figure 6 In the embodiment, the second slider 83 is in the state where the second retracting operation is performed by the operator such as the surgeon, but the present invention is not limited thereto. The first state may also be in the state where the second slider 83 is in the state where the second advancing operation is performed.

[0122] In addition, in the third state of the treatment instrument insertion portion 7 described in the above-mentioned surgical site cleaning, Figure 8 In the embodiment, the first slider 82 is operated by the operator such as the surgeon, but the present invention is not limited thereto. The third state may be a state in which the first slider 82 is operated by the operator such as the surgeon.

[0123] According to the first embodiment described above, the following effects are achieved.

[0124] In the endoscopic treatment instrument 6 of this first embodiment, the treatment instrument insertion portion 7 includes the aforementioned flow path forming member 13. Furthermore, when the flow path forming member 13 is positioned in the first position, a portion of the opening on the proximal side of the second hole 113 of the blade 11 is covered by the portion of the flow path forming member 13 other than the third hole 133. Specifically, by positioning the flow path forming member 13 in the first position, the water level of the physiological saline solution ejected from the distal end of the blade 11 can be set higher. On the other hand, by positioning the flow path forming member 13 in the second position, the water level of the physiological saline solution ejected from the distal end of the blade 11 can be set lower.

[0125] Therefore, in the endoscopic treatment instrument 6 of the first embodiment, the water level of the physiological saline solution ejected from the distal end of the blade 11 can be adjusted using a simple structure that enables the flow channel forming member 13 to move between the first position and the second position.

[0126] In particular, in the endoscopic treatment instrument 6 of the first embodiment, during ESD, the local injection process and the other process can be performed separately using the single endoscopic treatment instrument 6, without having to replace the treatment instrument between the local injection process and the other process. Therefore, convenience can be improved.

[0127] Furthermore, in the endoscopic treatment instrument 6 of this first embodiment, the first advancement / retraction member 12 and the flow path forming member 13 are disposed within the second advancement / retraction member 10. Consequently, the first advancement / retraction member 12, the second advancement / retraction member 10, and the flow path forming member 13 can be compactly integrated, allowing the treatment instrument insertion portion 7 to be reduced in diameter. Furthermore, since the first advancement / retraction member 12 and the second advancement / retraction member 10 can be independently and freely operated, it is possible to adjust only the water pressure applied to the tissue for applications such as local injection and washing, while maintaining the blade 11 in a positioned state.

[0128] (Implementation Method 2)

[0129] Next, the second embodiment will be described.

[0130] In the following description, the same reference numerals are given to the same structures as those in the above-mentioned first embodiment, and the detailed description thereof will be omitted or simplified.

[0131] The endoscopic treatment instrument 6 of this second embodiment differs from the endoscopic treatment instrument 6 described in the first embodiment in the structure of the distal end portion of the treatment instrument insertion portion 7. Hereinafter, for ease of description, the treatment instrument insertion portion of this second embodiment will be referred to as the treatment instrument insertion portion 7A.

[0132] Figures 9 to 12: is a diagram illustrating the structure of the treatment instrument insertion portion 7A according to the second embodiment. Specifically,

[0133] Figure 9 is with Figure 7 The corresponding cross-sectional view shows the treatment instrument insertion portion 7A set to the second state.

[0134] Figure 10 1 is a diagram showing the inside of the sheath 9 of the distal end portion of the treatment instrument insertion portion 7A set to the second state. Figure 10 Only the sheath body 91 and the connecting member 15 in the front end portion of the treatment instrument insertion portion 7A are cut. Figure 10 In FIG. 1 , the blade 11 is illustrated by a dashed line for convenience of explanation. Figure 11 is with Figure 8 The corresponding cross-sectional view shows the treatment instrument insertion portion 7A set to the third state. Figure 12 This is a cross-sectional view of the distal end portion of the treatment instrument insertion portion 7A, taken along a plane perpendicular to the central axis of the treatment instrument insertion portion 7A at a position passing through the blade 11, as viewed from the distal end side. Figure 12 In the figure, for the convenience of explanation, the sheath 9 and the connecting member 15 are omitted.

[0135] In the treatment instrument insertion portion 7A, as shown in FIG. Figures 9 to 11 As shown, the shapes of the second advancement and retreat member 10 and the flow path forming member 13 are different from those of the treatment instrument insertion portion 7 described in the first embodiment. Hereinafter, for ease of description, the second advancement and retreat member and the flow path forming member of the second embodiment will be referred to as the second advancement and retreat member 10A and the flow path forming member 13A, respectively.

[0136] In the second advancing and retreating member 10A, Figures 9 to 11 As shown, the shape of the second advance / retract member body 14 is different from the second advance / retract member 10 described in the above-mentioned embodiment 1. Hereinafter, for convenience of description, the second advance / retract member body of this embodiment 2 is described as a second advance / retract member body 14A.

[0137] In the second embodiment, the water supply port 812 is connected to the interior of the second advancing and retreating member body 14A, but not to the interior of the first advancing and retreating member 12. Thus, the inner peripheral surface of the second advancing and retreating member body 14A and the outer peripheral surface of the first advancing and retreating member 12 are connected via the tube TU and the water supply port 812 to form the main flow path P1A ( Figures 9 to 11 ) to perform its function.

[0138] In addition, if Figures 9 to 11As shown in FIG. 1 , a first notch portion 141 is provided at the front end portion of the second advancing / retracting member main body 14A.

[0139] The first notch portion 141 is cut from the front end toward the base end of the second advancing and retracting member body 14A, and corresponds to a communication hole of the present invention that connects the main flow path P1A and the storage hole 153 .

[0140] In addition, the outer peripheral surface of the second advancing and retracting member 10A described above is covered with an inner tube (not shown) similarly to the first embodiment described above.

[0141] In the flow path forming member 13A, the third hole 133 is not provided in comparison with the flow path forming member 13 described in the above-mentioned embodiment 1. Figures 9 to 11 As shown, a second notch portion 135 is provided, and a flow path is formed by the second notch portion 135 .

[0142] The outer circumferential surface of the flow path forming member 13A includes a pair of D-shaped cutting portions 134 formed from the front end to the base end, and is formed with a flat surface. In addition, it does not necessarily have to be a flat surface, and can also be a concave surface extending in a concave shape along the longitudinal axis. In addition, the outer circumferential surface in the cross section of the flow path forming member 13A can also be an ellipse, an oblong, or even a true circle, as long as the outer diameter is large enough to form a gap between it and the connecting member 15. According to this structure, a gap is formed between the outer circumferential surface of the flow path forming member 13A and the inner circumferential surface of the connecting member 15 to form the flow path.

[0143] The second notch portion 135 is a groove formed along the surface of the contact portion 131 from the pair of D-shaped cutout portions 134 to the front end surface of the contact portion 131 .

[0144] In addition, the operation of the endoscopic treatment instrument 6 of the second embodiment is different from that of the first embodiment described above, except that the flow path of the physiological saline solution in the treatment instrument insertion portion 7A (see FIG. Figure 9 and Figure 11 arrows shown) are different.

[0145] Specifically, in the local injection process, the operator, such as the surgeon, performs a first forward movement operation on the first slider 82 and a second forward movement operation on the second slider 83, and the treatment instrument insertion portion 7A enters the second state ( Figure 9 ). In the first position, such as Figure 12 As shown in FIG. 1 , when viewed along the central axis of the second hole 113, a portion of the second notch 135 is located within the second hole 113. That is, the flow path forming member 13A covers a portion of the opening on the base end side of the second hole 113 with the portion other than the second notch 135. Figure 9As shown by the middle arrow, the physiological saline supplied from the water supply source 200 flows from the main flow path P1A through the first notch portion 141, through the storage hole 153, the D-shaped cutting portion 134 and the second notch portion 135, flows through the flow path of the second hole 113 from the second notch portion 135, and is then ejected from the front end of the knife 11.

[0146] On the other hand, during surgical site cleaning, the second slider 83 is retracted by the operator such as the surgeon, and the treatment instrument insertion portion 7A is brought into the third state ( Figure 11 ). Moreover, if Figure 11 As shown by the middle arrow, the physiological saline supplied from the water supply source 200 flows from the main flow path P1A through the first notch 141, through the D-shaped cutting part 134, the second notch 135 and the receiving hole 153, flows from the receiving hole 153 through the flow path of the second hole 113, and is then ejected from the front end of the blade 11.

[0147] Here, the flow path cross-sectional area ratio of the second hole 113 to the gap (flow path) between the flow path forming member 13A and the inner circumferential surface of the connecting member 15 is smaller than the flow path cross-sectional area ratio of the receiving hole 153 to the gap (flow path) between the flow path forming member 13A and the inner circumferential surface of the connecting member 15. Therefore, the water potential of the physiological saline solution ejected from the distal end of the blade 11 during the local injection process is higher than the water potential of the physiological saline solution ejected from the distal end of the blade 11 during surgical site washing.

[0148] Even when the treatment instrument insertion portion 7A of the second embodiment described above is employed, the same effects as those of the first embodiment described above are achieved.

[0149] (Implementation 3)

[0150] Next, the third embodiment will be described.

[0151] In the following description, the same reference numerals are given to the same structures as those in the above-mentioned second embodiment, and the detailed description thereof will be omitted or simplified.

[0152] The endoscopic treatment instrument 6 of this third embodiment differs from the endoscopic treatment instrument 6 described in the second embodiment in the structure of the distal end portion of the treatment instrument insertion portion 7A. Hereinafter, for ease of description, the treatment instrument insertion portion of this third embodiment will be referred to as the treatment instrument insertion portion 7B.

[0153] Figure 13 : is a diagram illustrating the structure of the treatment instrument insertion portion 7B according to the third embodiment. Specifically, Figure 13 is with Figure 12 The corresponding figure.

[0154] In the treatment instrument insertion portion 7B, as shown in FIG. Figure 13 As shown, the shape of the flow channel forming member 13 is different from that of the treatment instrument insertion portion 7A described in the above-mentioned embodiment 2. Hereinafter, for convenience of description, the flow channel forming member of this embodiment 3 is described as a flow channel forming member 13B.

[0155] In the flow path forming member 13B, as shown in FIG. Figure 13 As shown, the third hole 133 described in the above-mentioned embodiment 1 is provided with respect to the treatment instrument insertion portion 7A described in the above-mentioned embodiment 2.

[0156] Furthermore, in this third embodiment, the water supply port 812 communicates with both the interior of the first advance / retract member 12 and the interior of the second advance / retract member body 14A. Specifically, the interior of the first advance / retract member 12, the inner circumferential surface of the second advance / retract member body 14A, and the outer circumferential surface of the first advance / retract member 12 function as the main flow path of the present invention, through which the physiological saline solution supplied from the water supply source 200 flows, via the tube TU and the water supply port 812. This main flow path is a combination of the main flow path P1 described in the first embodiment and the main flow path P1A described in the second embodiment.

[0157] The operation of the endoscopic treatment instrument 6 of the third embodiment differs from that of the first and second embodiments described above only in the flow path of the physiological saline solution in the treatment instrument insertion portion 7B.

[0158] Specifically, in the third embodiment, the flow path of the physiological saline solution in the treatment instrument insertion portion 7B is a combination of the flow path described in the first embodiment and the flow path described in the second embodiment.

[0159] Even when the treatment instrument insertion portion 7B of the third embodiment described above is employed, the same effects as those of the first and second embodiments described above are achieved.

[0160] (Implementation 4)

[0161] Next, the present embodiment 4 will be described.

[0162] In the following description, the same reference numerals are given to the same structures as those in the above-mentioned first embodiment, and the detailed description thereof will be omitted or simplified.

[0163] The endoscopic treatment instrument 6 of this fourth embodiment differs from the endoscopic treatment instrument 6 described in the first embodiment in the structure of the distal end portion of the treatment instrument insertion portion 7. Hereinafter, for ease of description, the treatment instrument insertion portion of this fourth embodiment will be referred to as the treatment instrument insertion portion 7C.

[0164] Figures 14 to 16: is a diagram illustrating the structure of the treatment instrument insertion portion 7C according to the fourth embodiment. Specifically, Figure 14 is with Figure 2 The corresponding cross-sectional view shows the treatment instrument insertion portion 7C set to the fourth state. Figure 15 is with Figure 2 The corresponding cross-sectional view shows the treatment instrument insertion portion 7C set to the fifth state. Figure 16 is with Figure 2 The corresponding cross-sectional view shows the treatment instrument insertion portion 7C set to the sixth state.

[0165] In the treatment instrument insertion portion 7C, as shown in FIG. Figures 14 to 16 As shown, the first advancing and retracting member 12 is omitted from the treatment instrument insertion portion 7 described in the first embodiment. In this fourth embodiment, although details are omitted, the omission of the first advancing and retracting member 12 also omits the second slider 83. Furthermore, with the omission of the first advancing and retracting member 12, the main flow path of the present invention becomes within the second advancing and retracting member body 14.

[0166] Furthermore, the treatment instrument insertion portion 7C is different from the treatment instrument insertion portion 7 described in the above-mentioned embodiment 1 in the second advancing and retreating member 10. Hereinafter, for convenience of description, the second advancing and retreating member of this embodiment 4 is described as a second advancing and retreating member 10C.

[0167] In the second advance / retract member 10C, the relationship between the second advance / retract member main body 14 and the connecting member 15 is different from that of the second advance / retract member 10 described in the first embodiment.

[0168] Specifically, in this fourth embodiment, the second advancement / retraction member body 14 is configured to be able to advance and retreat within the second fitting hole 152 and the receiving hole 153 along the central axis of the connecting member 15. Furthermore, the flow path forming member 13 is secured to the distal end of the second advancement / retraction member body 14 in such a manner that the proximal end of the abutment portion 131 of the flow path forming member 13 abuts the distal end of the second advancement / retraction member body 14 and the proximal end portion 132 is inserted into the second advancement / retraction member body 14. In other words, the flow path forming member 13 advances and retreats within the receiving hole 153 together with the second advancement / retraction member body 14 in response to manipulation of the first slider 82 by an operator, such as a surgeon.

[0169] In addition, the outer peripheral surface of the second advancing and retracting member 10C described above is covered with an inner tube (not shown) similarly to the first embodiment described above.

[0170] Furthermore, in the treatment instrument insertion portion 7C, as shown in FIG. Figures 14 to 16 As shown, the urging member 16 is arranged in the storage hole 153 .

[0171] In this embodiment 4, as Figures 14 to 16 As shown, the urging member 16 is formed of a coil spring. Furthermore, one end of the urging member 16 abuts or is fixed to the front end of the abutment portion 131, and the other end abuts or is fixed to the peripheral edge of the first fitting hole 151 of the connecting member 15. Furthermore, the urging member 16 urges the flow path forming member 13 toward the second position.

[0172] The operation of the endoscopic treatment instrument 6 of the fourth embodiment differs from that of the first embodiment described above only in the operation of the treatment instrument operating portion 8 by an operator such as a surgeon.

[0173] Specifically, in the marking process, an operator such as a surgical operator performs the first retraction operation on the first sliding member 82. As a result, the knife 11 is pulled toward the base end side by the second advance and retreat member body 14, the flow path forming member 13, and the connecting member 15. Then, the treatment instrument insertion portion 7C becomes the following state: the protrusion 112 is located in the large diameter portion 9211, the base end of the protrusion 112 abuts against the first step portion 9213, and only the protrusion 112 protrudes from the first hole 921 to the outside of the front end member 92. In addition, the flow path forming member 13 moves toward the base end side together with the second advance and retreat member body 14 in the storage hole 153, and becomes positioned in the second position separated from the base end of the knife 11.

[0174] As described above, by the first retreat operation of the first slider 82, the treatment instrument insertion portion 7C becomes Figure 14 The fourth state is shown. Furthermore, the operator, such as a surgeon, maintains the fourth state of the treatment instrument insertion portion 7C by performing the first retracting operation on the first slider 82 while operating an operating unit, such as a foot switch (not shown), to supply a high-frequency current from the power supply 100 to the blade 11. Thereafter, the operator, such as a surgeon, forms the marking mark T2 in the same manner as in the first embodiment described above.

[0175] Furthermore, during the local injection process, an operator such as a surgeon performs a third protruding operation to push the first slider 82 .

[0176] When the first slider 82 is gently pushed in during the third protrusion operation, the treatment instrument insertion portion 7C becomes Figure 15 The fifth state is shown. This fifth state is a state in which the distal end of the connecting member 15 abuts against the proximal end of the distal member 92 and the blade 11 protrudes from the distal end of the sheath 9 to its maximum protruding length. Here, the flow path forming member 13 is maintained in the second position by the biasing force of the biasing member 16.

[0177] Furthermore, when the first slider 82 is pushed in strongly during the third protrusion operation, the treatment instrument insertion portion 7C is moved from Figure 15 The fifth state shown becomes Figure 16 The sixth state is shown. In this sixth state, the flow path forming member 13 and the second advancing and retracting member body 14 overcome the force of the biasing member 16 and move toward the distal end within the housing hole 153, becoming positioned in the first position close to the base end of the blade 11. In this fourth embodiment, in the first position, the distal end of the abutting portion 131 abuts the base end of the blade 11. Thus, the flow path forming member 13 covers a portion of the proximal opening of the second hole 113 with the portion other than the third hole 133.

[0178] Then, the operator, such as a surgeon, maintains the sixth state of the treatment instrument insertion portion 7C by performing the third protruding operation on the first slider 82, and operates an operating unit such as a foot switch (not shown) to supply physiological saline from the water supply source 200. Thus, physiological saline is ejected from the distal end of the blade 11 and injected below the target site T1 in the same manner as in the first embodiment described above.

[0179] Furthermore, during the incision process, the operator such as the surgeon maintains the fifth state ( ) of the treatment instrument insertion portion 7C by performing the third protruding operation on the first slider 82. Figure 15 ) or the 6th state ( Figure 16 ) and simultaneously operates an operating unit such as a foot switch (not shown), and a high-frequency current is supplied from the power supply 100 to the blade 11. Thereafter, the operator or other operator cuts the entire circumference of the target site T1 while confirming the marking mark T2, similarly to the first embodiment described above.

[0180] During the surgical site cleaning, the operator or other operator sets the treatment instrument insertion portion 7C to the fourth state ( Figure 14 Alternatively, the operator such as the surgeon sets the treatment instrument insertion portion 7C to the fifth state ( Figure 15 ). Thereafter, the operator such as the surgeon operates an operating unit such as a foot switch (not shown) to supply physiological saline from the water supply source 200. As a result, physiological saline is ejected from the front end of the knife 11 to clean the surgical site in the same manner as in the first embodiment described above.

[0181] Even when the treatment instrument insertion portion 7C of the fourth embodiment described above is employed, the same effects as those of the first embodiment described above are achieved.

[0182] Furthermore, since the first advancing and retracting member 12 and the second slider 83 can be omitted, the structure of the endoscopic treatment instrument 6 can be simplified.

[0183] (Other Embodiments)

[0184] Although the modes for carrying out the present invention have been described above, the present invention should not be limited to only the above-described first to fourth embodiments.

[0185] In the above-mentioned first to fourth embodiments, the shape of the protrusion 112 is not limited to the shapes described in the above-mentioned first to fourth embodiments, and other shapes may be adopted.

[0186] Figures 17A to 17C 11 is a diagram showing an example of the shape of the protrusion 112 .

[0187] Specifically, if Figures 17A to 17C As shown, the protrusion 112 may also be hemispherical ( Figure 17A ), triangle shape( Figure 17B ) and other flange shapes, but is not limited to the flange shape, and may also be a hook shape ( Figure 17C ).

[0188] In the above-mentioned embodiments 1 to 4, the knife 11 is configured to be able to advance and retreat, but the present invention is not limited thereto and the knife 11 may be configured to be unable to advance and retreat. In other words, the knife 11 may be configured to always be in either of the following states (1) and (2).

[0189] (1) The blade 11 is always in a state of protruding to the maximum length from the front end of the sheath 9 (for example, Figure 7 、 Figure 8 status).

[0190] (2) The blade 11 is always in a state where only the protrusion 112 protrudes from the first hole 921 to the outside of the front end member 92 (for example, Figure 6 status).

Claims

1. An endoscope treatment instrument, wherein: The endoscope treatment instrument comprises: a sheath having a first hole opened at a front end; a knife for tissue incision, which penetrates the first hole and has a second hole extending between the front end and the base end; a connecting member connected to the knife, the connecting member being located inside the sheath and having a receiving path having a cross-sectional area larger than that of the second hole; and The flow path forming member is disposed in the housing path in a freely movable manner and has a flow path communicating with the second hole, wherein the cross-sectional area of ​​the flow path is smaller than the cross-sectional area of ​​the second hole.

2. The endoscopic treatment instrument according to claim 1, wherein: The flow channel is a third hole extending from the base end to the front end of the flow channel forming member.

3. The endoscopic treatment instrument according to claim 1, wherein The flow path is a gap formed between the outer peripheral surface of the flow path forming member and the inner peripheral surface of the connecting member.

4. The endoscopic treatment instrument according to claim 1, wherein The treatment instrument for an endoscope further includes a first advancing and retracting member that is inserted into the sheath in an advancing and retracting manner and is connected to the flow path forming member.

5. The endoscopic treatment instrument according to claim 4, wherein The endoscopic treatment instrument further includes a second advancing and retreating member that is inserted through the sheath in a freely advancing and retreating manner and is connected to the knife.

6. The endoscopic treatment instrument according to claim 5, wherein: The second advancing and retreating member has a cylindrical shape, The first advancing and retracting member is inserted into the second advancing and retracting member, and the first advancing and retracting member and the second advancing and retracting member are relatively able to advance and retract freely.

7. The endoscopic treatment instrument according to claim 6, wherein: The second advancing and retreating member comprises: a second advancing and retreating member body, which is disposed in the sheath; and The connecting member, The connecting member connects the second advancing and retracting member body and the knife.

8. The endoscopic treatment instrument according to claim 7, wherein: A main flow path is provided in the second advancing and retracting member. The main flow path communicates with the flow path and allows the fluid to flow toward the flow path.

9. The endoscopic treatment instrument according to claim 1, wherein The flow channel forming member is movable between a first position close to the base end of the blade and a second position farther from the base end of the blade than the first position.

10. The endoscopic treatment instrument according to claim 9, wherein The flow path is a third hole formed through the flow path forming member. At the second position, The receiving path is located between the second hole and the third hole.

11. The endoscopic treatment instrument according to claim 9, wherein When the flow channel forming member is positioned at the first position, a portion of the opening on the proximal end side of the second hole is covered by the flow channel forming member.

12. The endoscopic treatment instrument according to claim 9, wherein The connecting member has a fitting hole at a position closer to the front end side than the storage path. The connecting member is attached so that the base end of the blade is located inside the fitting hole.

13. The endoscopic treatment instrument according to claim 12, wherein: When the flow channel forming member is positioned at the first position, a portion of the opening on the proximal end side of the fitting hole is covered by the flow channel forming member.

14. The endoscopic treatment instrument according to claim 1, wherein A flow path cross-sectional area ratio of the second hole to the flow path is smaller than a flow path cross-sectional area ratio of the housing path to the flow path.

15. The endoscopic treatment instrument according to claim 8, wherein The main flow path is provided between the inner peripheral surface of the second advancing and retreating member body and the outer peripheral surface of the first advancing and retreating member. The second advancing and retracting member body is provided with a communication hole that connects the main flow path and the interior of the connecting member.

16. The endoscopic treatment instrument according to claim 15, wherein The flow path has: a gap formed between an outer peripheral surface of the flow path forming member and an inner peripheral surface of the connecting member; and A groove is formed from the outer peripheral surface of the flow path forming member to the front end surface of the flow path forming member.

17. The endoscopic treatment instrument according to claim 8, wherein The first advancing and retreating member has a cylindrical shape. The main flow paths are respectively provided between the inner peripheral surface of the second advancing and retracting member body and the outer peripheral surface of the first advancing and retracting member, and in the first advancing and retracting member.

18. The endoscopic treatment instrument according to claim 9, wherein A biasing member is disposed in the housing path, and the biasing member biases the flow path forming member toward the second position.

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