Endoscope treatment tool and endoscope treatment system

Abstract

This treatment tool for an endoscope is provided with: a sheath which is a vertically long member having a cavity extending in the longitudinal direction; a tip treatment part provided at the tip of the sheath; an operation part provided at the base end part of the sheath; and a wire member that is attached to the distal end treatment section through the cavity and is supported by the operation section so as to be capable of advancing and retreating in the longitudinal direction, the operation section having a lock mechanism that restricts the advancing and retreating of the wire member with respect to the longitudinal direction.

Description

Technical Field

[0001] The present invention relates to an endoscope treatment instrument and an endoscope treatment system. This application claims priority based on U.S. Patent Provisional Application No. 63 / 375,987 filed on September 16, 2022 in the United States of America, and the contents thereof are incorporated herein by reference. Background Art

[0002] Endoscopic retrograde cholangiopancreatography (ERCP) is used to insert contrast media, guidewires, and various catheters from the duodenum into the bile duct to perform procedures such as diagnosis, stone recovery, and drainage of strictures in the bile duct. In the above procedures, an endoscope and a papillotomy knife that can pass through the treatment instrument channel of the endoscope are used.

[0003] The papillotomy knife used in the above-mentioned technique is maintained in a state where the knife (treatment part, incision part) for incising the papillary sphincter etc. can incise by bending the front end of the sheath. The papillotomy knife described in Patent Document 1 has a rotation function for rotating the sheath with the central axis of the sheath as the rotation center, and the front end provided with the knife can be moved by rotating the sheath.

[0004] Prior art literature

[0005] Patent Literature

[0006] Patent Document 1: Japanese Patent No. 6856759 Summary of the invention

[0007] Problem that the invention aims to solve

[0008] However, it is difficult for the papillotomy knife with a rotation function as described in Patent Document 1 to maintain the bent state of the front end portion while rotating the sheath and to maintain the state in which the knife can cut. For example, when the sheath is rotated, there is a situation in which the bent state of the front end portion cannot be maintained.

[0009] In view of the above circumstances, an object of the present invention is to provide an endoscopic treatment instrument which can easily rotate a distal end portion provided with a treatment portion while maintaining the distal end portion provided with a treatment portion bent, and an endoscopic treatment system including the endoscopic treatment instrument.

[0010] Solutions for solving problems

[0011] In order to solve the above-mentioned problems, the present invention proposes the following means.

[0012] The first embodiment of the present invention provides an endoscopic treatment instrument comprising: a sheath, which is an elongated member having a cavity extending in a longitudinal direction; a front end treatment portion, which is arranged at the front end portion of the sheath; an operating portion, which is arranged at the base end portion of the sheath; and a wire member, which passes through the cavity and is mounted on the front end treatment portion and is supported by the operating portion so as to be able to move forward and backward in the longitudinal direction, and the operating portion has a locking mechanism for limiting the movement of the wire member relative to the longitudinal direction.

[0013] Effects of the Invention

[0014] The endoscopic treatment instrument and the endoscopic treatment system of the present invention can easily rotate the distal end portion while maintaining the bent state of the distal end portion provided with the treatment portion. BRIEF DESCRIPTION OF THE DRAWINGS

[0015] Figure 1 It is an overall view of the endoscope treatment system according to the first embodiment.

[0016] Figure 2 This is a diagram showing a papillotomy knife of the endoscopic treatment system.

[0017] Figure 3 It is a figure which shows this papillotomy knife.

[0018] Figure 4 It is a cross-sectional view of the front end portion of the sheath of the papillotomy knife.

[0019] Figure 5 This is a front view of the front end portion of the sheath as viewed from the front end side.

[0020] Figure 6 It is a cross-sectional view of the operating portion of the papillotomy knife.

[0021] Figure 7 It is along Figure 6 A cross-sectional view of the proximal end portion of the sheath along the C1-C1 line.

[0022] Figure 8 It is a perspective view showing the first deformation portion of the second body of the operation portion.

[0023] Fig. 9 1 is a diagram showing the first deformation portion and the first connection portion before deformation.

[0024] Fig.10 2 is a diagram showing the first deformable portion and the first connecting portion after deformation.

[0025] Fig.11 This is a diagram showing the papillotomy knife inserted into an endoscope.

[0026] Fig.12 It is a diagram showing the positioning process.

[0027] Fig.13 It is a figure which shows the cutting process.

[0028] Fig.14 It is a diagram showing an operation portion of a papillotomy knife according to a second embodiment.

[0029] Fig.15 It is a figure which shows the 1st deformation|transformation part and the 1st connection part before deformation|transformation.

[0030] Fig.16 2 is a diagram showing the first deformable portion and the first connecting portion after deformation.

[0031] Fig.17 It is a diagram showing an operation portion of a papillotomy knife according to a third embodiment.

[0032] Fig.18 It is a figure which shows another form of an O-ring.

[0033] Fig.19 It is a diagram showing an operation portion of a papillotomy knife according to a fourth embodiment.

[0034] Fig. 20 It is a diagram showing an operation portion of a papillotomy knife according to a fifth embodiment.

[0035] Fig.21 It is a diagram for explaining the function of the lever of the operation portion.

[0036] Fig. 22 The figure explains the function of the rod. DETAILED DESCRIPTION

[0037] (First Embodiment)

[0038] Reference Figures 1 to 13 A first embodiment of the present invention will be described. Figure 1 It is an overall view of the endoscope treatment system 300 according to the present embodiment.

[0039] [Endoscopic treatment system 300]

[0040] The endoscope treatment system 300 includes a papillotomy knife 100 and an endoscope 200. The papillotomy knife 100 is inserted into the endoscope 200 for use.

[0041] [Endoscope 200]

[0042] The endoscope 200 is a well-known side-viewing flexible endoscope, and includes a vertically long insertion portion 210, an operation portion 220 provided at a proximal end of the insertion portion 210, and a universal cable 250 extending from the operation portion 220. Alternatively, the endoscope 200 may be a direct-viewing flexible endoscope.

[0043] The insertion portion 210 includes a distal rigid portion 211 provided at the distal end, a bending portion 212 provided at the proximal end of the distal rigid portion 211 and capable of bending, and a flexible tube portion 213 provided at the proximal end of the bending portion 212. A light guide 215 and an imaging unit 216 having a CCD are provided on the side of the distal rigid portion 211 in an exposed state.

[0044] The insertion portion 210 has a treatment instrument channel 230 for inserting an endoscopic treatment instrument such as the papillotomy knife 100. A distal end portion 230a of the treatment instrument channel 230 opens at a side surface of the distal end hard portion 211. A proximal end portion of the treatment instrument channel 230 extends to the operation portion 220.

[0045] A lifting platform 214 is provided at a portion of the treatment instrument channel 230 corresponding to the distal rigid portion 211. The base end portion of the lifting platform 214 is rotatably supported by the distal rigid portion 211. A lifting platform operation wire 217 fixed to the distal end portion of the lifting platform 214 passes through the insertion portion 210 and extends toward the base end side.

[0046] The bending portion 212 is configured to be bendable in the vertical direction and the horizontal direction. The front end of the operation wire is fixed to the front end side of the bending portion 212. The operation wire passes through the insertion portion 210 and extends to the operation portion 220.

[0047] A knob 223 for operating the operation wire and a switch 224 for operating the imaging unit 216 and the like are provided on the proximal end side of the operation portion 220. The user can operate the knob 223 to bend the bending portion 212 in a desired direction.

[0048] A forceps opening 222 communicating with the treatment instrument channel 230 is provided at the front end side of the operation portion 220. The user can insert the endoscopic treatment instrument 100 through the forceps opening 222. A forceps plug 225 is attached to the forceps opening 222 to prevent leakage of body fluids.

[0049] The universal cable 250 connects the endoscope 200 to the image control device. The image pickup signal captured by the image pickup unit 216 is transmitted to the image control device via the universal cable 250.

[0050] [Nipple incision knife 100]

[0051] Figure 2 and Figure 3 FIG. 1 is a diagram showing a papillotomy knife 100 .

[0052] The papillotomy knife (endoscopic treatment instrument, high-frequency treatment instrument) 100 includes a distal treatment portion 1, a sheath 2, a conductive wire 3, and an operating portion 5. In the following description, in the longitudinal direction A of the papillotomy knife 100, the side inserted into the patient's body is referred to as the "distal side (distal side) A1", and the operating portion 5 side is referred to as the "proximal side (proximal side) A2".

[0053] Figure 4 2 is a cross-sectional view of the front end portion 20 of the sheath 2 .

[0054] The front end treatment portion 1 is provided on the outer peripheral surface of the front end portion 20 of the sheath 2. The front end treatment portion 1 has a first through hole 11 and a second through hole 12 that penetrate the knife cavity 21. The first through hole 11 and the second through hole 12 are arranged along the length direction A. The first through hole 11 is provided at a position closer to the front end side A1 than the second through hole 12. The second through hole 12 is provided at a position closer to the base end side A2 than the first through hole 11. A mark 15 different from other parts of the sheath 2, such as a color or pattern, is attached to the front end treatment portion 1.

[0055] The mark 15 is formed in a linear shape extending in the longitudinal direction A, and is provided in a part of the circumferential direction C where the first through hole 11 and the second through hole 12 are provided (a part constituting the incision portion 6 described later). The front end of the mark 15 is arranged at the front end of the sheath 2, and the base end of the mark 15 is arranged near the second through hole 12. The width of the mark 15 in the circumferential direction C is less than the length of half the outer circumference of the sheath 2.

[0056] The sheath 2 is an elongated member having a lumen extending along the longitudinal direction A. The sheath 2 has an outer diameter that allows insertion into the treatment instrument channel 230. The sheath 2 is, for example, a soft sheath made of resin.

[0057] Figure 5 This is a front view of the distal end portion 20 of the sheath 2 as viewed from the distal end side A1.

[0058] The sheath 2 is a multi-lumen tube having a plurality of lumens, including a knife lumen 21 for the conductive wire 3 to pass through, a contrast lumen 22 for contrast agents to pass through, and a guide wire lumen 23 for the guide wire to pass through.

[0059] Figure 6 It is a cross-sectional view of the operation portion 5 .

[0060] The blade cavity 21 is a cavity through which the conductive wire 3 is inserted. The blade cavity 21 extends from a distal opening (the first through hole 11 and the second through hole 12) provided in the distal treatment portion 1 to a proximal opening 21b communicating with the operation portion 5.

[0061] The contrast cavity (liquid delivery cavity) 22 is a cavity through which contrast medium, water delivery fluid, and gas delivery fluid pass. The contrast cavity 22 extends from a distal opening 22a formed at the distal end of the distal end portion 20 to a proximal opening 22b communicating with the operation portion 5 .

[0062] Figure 7 It is along Figure 6 2 is a cross-sectional view of the proximal end portion 26 of the sheath 2 of the C1-C1 line.

[0063] The guidewire lumen 23 is a lumen through which a guidewire is inserted, and extends from a front end opening 23 a formed at the front end of the front end portion 20 to a proximal end opening 23 b provided on the outer peripheral surface of the proximal end portion 26 of the sheath 2 .

[0064] The conductive wire 3 has a conductive core wire covered with an insulating film made of a suitable synthetic resin. The conductive wire 3 passes through the blade cavity 21 of the sheath 2. The conductive wire 3 is supported by the operation portion 5 so as to be able to advance and retreat in the longitudinal direction A and to be able to rotate in the circumferential direction C.

[0065] The front end of the conductive wire 3 protrudes from the knife cavity 21 to the outside of the sheath 2 in the second through hole 12, extends along the length direction A of the sheath 2 to the front end side A1, and enters the knife cavity 21 from the first through hole 11 on the front end side A1. The front end 3a of the conductive wire 3 is fixed in the knife cavity 21. The portion of the conductive wire 3 that is exposed to the outside of the sheath 2 from the first through hole 11 and the second through hole 12 is not covered with an insulating film, and the core wire is exposed, forming a linear incision portion 6 that can incise tissue. The incision portion 6 is an example of an electrode.

[0066] like Figure 6 As shown in FIG. 1 , the base end of the conductive wire 3 is attached to a power supply connector 55 provided on a slider 54 of the operating portion 5. By pulling the conductive wire 3 toward the base end side A2, the conductive wire 3 is Figure 3 As shown, the distal end treatment portion 1 is bent inward and the incision portion 6 is in a state of being stretched. Since the portion marked with the mark 15 is bent inward, the operator can easily understand the direction in which the distal end portion 20 of the sheath 2 is bent.

[0067] like Figure 6 As shown, the operation part 5 is provided at the base end of the sheath 2. The base end of the sheath 2 is mounted on the operation part 5 so as to be rotatable relative to the operation part 5 in the circumferential direction C. The operation part 5 includes a first body 51, a second body 52, a handle 53, a slider 54, and a power supply connector 55.

[0068] The first body 51 is attached to the proximal end of the sheath 2 and is formed in a shape extending in the longitudinal direction A. The first body 51 includes a proximal end convex portion 510 , a first tube 511 , a second tube 512 , and a contrast tube head 56 .

[0069] The first tube 511 passes through the interior of the first body 51 , and the front end thereof is communicated with the knife cavity 21 . The conductive wire 3 passes through the first tube 511 .

[0070] The second tube 512 passes through the interior of the first body 51, and the front end is connected to the contrast cavity 22. The base end of the second tube 512 is connected to the opening of the contrast tube head 56. The contrast medium or other fluid injected from the contrast tube head 56 is discharged from the front end opening 22a formed at the front end of the front end portion 20 via the second tube 512 and the contrast cavity 22.

[0071] Figure 8 It is a perspective view showing the first deformation portion 57 of the second body 52 .

[0072] The second body 52 is mounted on the proximal end convex portion 510 of the first body 51. The second body 52 is mounted on the first body 51 so as to be rotatable relative to the first body 51 in the circumferential direction C. A through hole 52h is formed in the second body 52 and passes through the second body 52 along the longitudinal direction A. The conductive wire 3 passes through the through hole 52h. In addition, a first deformation portion 57 connected to the handle 53 is provided at the proximal end of the second body 52.

[0073] Fig. 9 It is a diagram showing the first deforming portion 57 and the first connecting portion 58 before deformation.

[0074] The first deformation portion 57 is a member capable of elastic deformation, and is formed as a roughly wedge-shaped convex portion. The first deformation portion 57 has a cone 57a, a stopper 57b, and a through hole 57h. The cone 57a is formed in a trapezoidal quadrangular prism shape with the upper surface and the bottom surface being the same shape. The width of the cone 57a decreases from the front end side A1 toward the base end side A2. The stopper 57b is provided at the base end of the cone 57a to prevent the first deformation portion 57 from separating from the handle 53. The through hole 57h penetrates the first deformation portion 57 along the length direction A. The conductive wire 3 passes through the through hole 57h.

[0075] like Figure 8 As shown, the handle 53 is connected to the second body 52 so as not to rotate relative to the second body 52 in the circumferential direction C. If the handle 53 is rotated in the circumferential direction C, the second body 52 and the handle 53 rotate together relative to the first body 51. A first connecting portion 58 connected to the first deformation portion 57 of the second body 52 is provided at the front end of the handle 53.

[0076] The first connection portion 58 is formed as a substantially wedge-shaped recessed portion, and the first deformed portion 57 is arranged inside in the radial direction R. The inner side surface 58a of the first connection portion 58 is formed in a mortar shape that is recessed in a trapezoidal quadrangular prism shape with the upper surface and the bottom surface having the same shape, and the width decreases from the front end side A1 toward the base end side A2.

[0077] Fig.10It is a diagram showing the first deforming portion 57 and the first connecting portion 58 after deformation.

[0078] The second body 52 and the handle 53 are brought close to each other, whereby the first deformable portion 57 is engaged with the inner side surface 58a of the first connecting portion 58 and deformed inward in the radial direction R. As a result, the first deformable portion 57 contacts the conductive wire 3 from the outer side in the radial direction R, and restricts the conductive wire 3 from advancing and retreating in the longitudinal direction A.

[0079] That is, the first deformation portion 57 functions as a locking mechanism that restricts the advance and retreat of the conductive wire 3 in the longitudinal direction A by engaging with the first connecting portion 58. Here, the "locking mechanism" refers to a mechanism that does not restrict the rotation of the conductive wire 3 relative to the circumferential direction C but can restrict the advance and retreat of the conductive wire 3 relative to the longitudinal direction A. In addition, the locking mechanism can also restrict the rotation of the conductive wire 3 relative to the circumferential direction C.

[0080] A knob 531 is provided at the base end of the handle 53. The user can easily rotate the handle 53 in the circumferential direction C by pinching the knob 531 and rotating it in the circumferential direction C.

[0081] The slider 54 is attached to the handle 53 so as to be able to move forward and backward in the longitudinal direction A relative to the handle 53 and to be unable to rotate in the circumferential direction C relative to the handle 53 .

[0082] The power supply connector 55 is fixed to the slider 54. The base end 3b of the conductive wire 3 is connected to the power supply connector 55. The power supply connector 55 can be connected to a high-frequency power supply device (not shown) and is connected to the conductive wire 3. The power supply connector 55 can supply the high-frequency current supplied from the high-frequency power supply device to the conductive wire 3 and the incision portion 6.

[0083] By rotating the handle 53 relative to the first body 51 in the circumferential direction C, the second body 52, the slider 54, and the power supply connector 55 rotate together. The conductive wire 3 rotates relative to the first body 51 in the circumferential direction C. As a result, the distal end treatment portion 1 provided at the distal end portion 20 of the sheath 2 rotates. That is, the conductive wire 3 also serves as a torque transmission member that transmits the rotational torque relative to the circumferential direction C.

[0084] [Operation of the Endoscope Treatment System 300]

[0085] Next, refer to Figures 11 to 13 The operation and function of the endoscopic treatment system 300 of the present embodiment will be described. Specifically, a method of treating the bile duct BD by endoscopic retrograde cholangiopancreatography (ERCP) will be described.

[0086] <Step S1: Endoscope Insertion Step>

[0087] In step S1, the operator inserts the insertion portion 210 of the endoscope 200 into the lumen of the patient through a natural opening such as the mouth. The operator operates the operation portion 220 to bend the bending portion 212 as needed. The operator inserts the distal end hard portion 211 of the endoscope 200 to the vicinity of the duodenal papilla.

[0088] <Step S2: Endoscope alignment step>

[0089] In step S2, the operator adjusts the position of the distal rigid portion 211 of the endoscope 200 so that the duodenal papilla enters the imaging range of the imaging unit 216 of the endoscope 200. The operator adjusts the position of the distal rigid portion 211 by appropriately combining the advance and retreat operation, bending operation, and twisting operation of the endoscope 200.

[0090] <Step S3: Nipple incision knife positioning process>

[0091] Fig.11 This is a diagram showing the papillotomy knife 100 inserted into the endoscope 200 .

[0092] Next, in step S3, the operator inserts the papillotomy knife 100 into the treatment instrument channel 230 from the forceps port (base end opening) 222 of the endoscope 200. The operator causes the distal end portion 20 of the sheath 2 to protrude from the distal end opening 230a.

[0093] The operator moves the slider 54 toward the base end side A2 relative to the handle 53 to pull the conductive wire 3, thereby bending the front end portion 20 of the sheath 2. As a result, Fig.11 As shown, the incision portion 6, which is a part of the conductive wire 3, is in a state of being stretched. Next, the surgeon brings the main body (the first main body 51 and the second main body 52) and the handle 53 closer. As a result, the first deformation portion 57 deforms inward in the radial direction R and contacts the conductive wire 3, thereby limiting the advance and retreat of the conductive wire 3. The surgeon can rotate the sheath 2 in the circumferential direction C while maintaining the bent state of the front end portion 20 of the sheath 2 to move the front end treatment portion 1. Alternatively, the surgeon can rotate the papillomatomy knife 100 as a whole in the circumferential direction C to move the front end treatment portion 1.

[0094] Fig.12 It is a diagram showing the positioning process.

[0095] Alternatively, the operator discharges the fluid from the front end opening 22a through the contrast cavity (liquid delivery cavity) 22 to confirm whether the front end portion 20 of the sheath 2 is directed toward the nipple PA. If the operator can apply the fluid to the nipple PA from the front end opening 22a, the operator can confirm that the front end portion 20 of the sheath 2 has been arranged near the nipple PA.

[0096] <Step S4: Cutting process>

[0097] Fig.13 It is a figure which shows the cutting process.

[0098] In step S4 , the operator supplies high-frequency current to the incision portion 6 from the power supply connector 55 , operates the operation portion 5 of the nipple incision knife 100 , and incises a part of the nipple PA using the incision portion 6 .

[0099] <Step S5: Imaging process>

[0100] In step S5, the operator causes the contrast medium to flow into the bile duct BD from the papillotomy knife 100. The operator acquires an X-ray image of the bile duct BD and the like by performing X-ray imaging.

[0101] <Step S6: Guidewire Insertion Step>

[0102] In step S6, the operator inserts the guide wire into the guide wire lumen 23 of the papillotomy knife 100, makes the guide wire protrude from the front end opening 23a, and inserts the guide wire into the bile duct BD. Next, the operator removes the papillotomy knife 100 while leaving the guide wire in the bile duct BD. Thus, only the guide wire is left in the bile duct BD, forming an access channel from the duodenum to the bile duct BD.

[0103] After the access channel is formed, the operator can introduce the distal end portions of various treatment instruments into the bile duct BD through the access channel along the guide wire, thereby enabling various treatments to be performed.

[0104] According to the papillotomy knife 100 of this embodiment, it is easy to rotate the sheath 2 in the circumferential direction C to move the distal end portion 20 while maintaining the distal end portion 20 of the sheath 2 provided with the distal end treatment portion 1 in a bent state. Therefore, the operator can perform the operation of rotating the sheath 2 in the circumferential direction C while maintaining the distal end portion 20 of the sheath 2 in a bent state.

[0105] Above, the first embodiment of the present invention is described in detail with reference to the accompanying drawings, but the specific structure is not limited to this embodiment, and also includes design changes within the scope of the gist of the present invention. In addition, the constituent elements shown in the above-mentioned embodiment and the modified examples shown below can be appropriately combined and constituted.

[0106] (Second Embodiment)

[0107] Reference Figures 14 to 16 A papillotomy knife 100B according to a second embodiment of the present invention will be described. In the following description, the same reference numerals are given to the same configurations as those already described, and duplicate descriptions will be omitted.

[0108] Fig.14This is a diagram showing the operation unit 5B of the papillotomy knife 100B.

[0109] Similar to the papillotomy knife 100 of the first embodiment, the papillotomy knife (endoscopic treatment instrument, high-frequency treatment instrument) 100B is used as an endoscope treatment system together with the endoscope 200. The papillotomy knife 100B includes a distal treatment portion 1, a sheath 2, a conductive wire 3, and an operation portion 5B.

[0110] The operation unit 5B includes a first body 51 , a second body 52B, a handle 53B, a slider 54 , and a power supply connector 55 .

[0111] The second body 52B is mounted on the proximal end protrusion 510 of the first body 51. The second body 52B is mounted on the first body 51 so as to be rotatable relative to the first body 51 in the circumferential direction C. A through hole 52h is formed in the second body 52B and penetrates the second body 52B along the longitudinal direction A. The conductive wire 3 passes through the through hole 52h. In addition, a second connecting portion 58B is provided at the proximal end of the second body 52.

[0112] The second connection portion 58B is formed as a substantially wedge-shaped recessed portion, and the second deformed portion 57B is arranged inside in the radial direction R. The inner side surface 58Ba of the second connection portion 58B is formed in a mortar shape that is recessed in a trapezoidal quadrangular prism shape with the upper surface and the bottom surface having the same shape, and the width increases from the distal end side A1 toward the proximal end side A2.

[0113] The handle 53B is connected to the second body 52B so as not to rotate relative to the second body 52B in the circumferential direction C. When the handle 53B is rotated in the circumferential direction C, the second body 52B rotates relative to the first body 51 together with the handle 53B. A second deformation portion 57B connected to the second connection portion 58B of the second body 52B is provided at the front end of the handle 53B.

[0114] Fig.15 It is a diagram showing the second deformation portion 57B and the second connection portion 58B before deformation.

[0115] The second deformable portion 57B is an elastically deformable member, and is formed as a substantially wedge-shaped convex portion. The second deformable portion 57B has a taper 57Ba and a through hole 57Bh. The taper 57Ba is formed in a trapezoidal quadrangular prism shape with the upper surface and the bottom surface being the same shape. The width of the taper 57Ba increases from the front end side A1 toward the base end side A2. The through hole 57Bh penetrates the second deformable portion 57B along the length direction A. The conductive wire 3 passes through the through hole 57Bh.

[0116] Fig.16 1 and 10 are diagrams showing the second deforming portion 57B and the second connecting portion 58B after deformation.

[0117] The second body 52B and the handle 53B are brought close to each other, whereby the second deformable portion 57B is engaged with the inner side surface 58Ba of the second connecting portion 58B and deformed inward in the radial direction R. As a result, the second deformable portion 57B contacts the conductive wire 3 from the outer side in the radial direction R, and restricts the conductive wire 3 from advancing and retreating in the longitudinal direction A.

[0118] According to the papillotomy knife 100B of this embodiment, it is easy to rotate the sheath 2 in the circumferential direction C to move the distal end portion 20 while maintaining the distal end portion 20 of the sheath 2 provided with the distal end treatment portion 1 in a bent state. Therefore, the operator can perform the operation of rotating the sheath 2 in the circumferential direction C while maintaining the distal end portion 20 of the sheath 2 in a bent state.

[0119] Above, the second embodiment of the present invention is described in detail with reference to the accompanying drawings, but the specific structure is not limited to this embodiment, and also includes design changes within the scope of the gist of the present invention. In addition, the constituent elements shown in the above-mentioned embodiment and the modified examples shown below can be appropriately combined and constituted.

[0120] (Third Embodiment)

[0121] Reference Fig.17 , Fig.18 A papillotomy knife 100C according to a third embodiment of the present invention will be described. In the following description, the same reference numerals are given to the same configurations as those already described, and duplicate descriptions will be omitted.

[0122] Fig.17 This is a diagram showing an operation unit 5C of the papillotomy knife 100C.

[0123] Similar to the papillotomy knife 100 of the first embodiment, the papillotomy knife (endoscopic treatment instrument, high-frequency treatment instrument) 100C is used as an endoscope treatment system together with the endoscope 200. The papillotomy knife 100C includes a distal treatment portion 1, a sheath 2, a conductive wire 3, and an operation portion 5C.

[0124] The operation unit 5C includes a first body 51 , a second body 52C, a handle 53C, a slider 54 , and a power supply connector 55 .

[0125] The second body 52C is attached to the base end of the first body 51. The second body 52C is provided with a through hole 52h that penetrates the second body 52C along the longitudinal direction A. The conductive wire 3 passes through the through hole 52h.

[0126] The through hole 52h of the second body 52C accommodates an O-ring (ring member) 59. The conductive wire 3 passes through the O-ring 59 and contacts the O-ring 59. Therefore, compared with the first embodiment, the sliding resistance of the conductive wire 3 relative to the longitudinal direction A is higher. Therefore, even if the operator removes his hand from the slider 54, the conductive wire 3 is not easy to move forward in the longitudinal direction A, and it is easy to maintain the bent state of the front end portion 20 of the sheath 2.

[0127] Fig.18 It is a diagram showing another form of the O-ring 59 .

[0128] like Fig.18 As shown, the second body 52C may house a plurality of O-rings 59. The sliding resistance of the conductive wire 3 in the longitudinal direction A becomes higher.

[0129] The handle 53C is connected to the second body 52C so as to be non-rotatable relative to the second body 52C in the circumferential direction C and non-advancing / retracting relative to the second body 52C in the longitudinal direction A. When the handle 53C is rotated in the circumferential direction C, the second body 52C rotates relative to the first body 51 together with the handle 53C.

[0130] According to the papillotomy knife 100C of the present embodiment, it is easy to rotate the sheath 2 in the circumferential direction C to move the distal end portion 20 while maintaining the distal end portion 20 of the sheath 2 provided with the distal end treatment portion 1 in a bent state. The operator can maintain the bent state of the distal end portion 20 without performing a special operation. Therefore, the operator can perform the operation of rotating the sheath 2 in the circumferential direction C while maintaining the bent state of the distal end portion 20 of the sheath 2 by himself.

[0131] The third embodiment of the present invention is described in detail with reference to the accompanying drawings, but the specific structure is not limited to this embodiment, and also includes design changes within the scope of the gist of the present invention. In addition, the components shown in the above-mentioned embodiment and the modified examples shown below can be appropriately combined and constituted.

[0132] (Fourth Embodiment)

[0133] Reference Fig.19 A papillotomy knife 100D according to a fourth embodiment of the present invention will be described. In the following description, the same reference numerals are given to the same configurations as those already described, and duplicate descriptions will be omitted.

[0134] Fig.19 This is a diagram showing an operation unit 5D of the papillotomy knife 100D.

[0135] Similar to the papillotomy knife 100 of the first embodiment, the papillotomy knife (endoscopic treatment instrument, high-frequency treatment instrument) 100D is used as an endoscope treatment system together with the endoscope 200. The papillotomy knife 100D includes a distal treatment portion 1, a sheath 2, a conductive wire 3, and an operation portion 5D.

[0136] The operation unit 5D includes a first body 51 , a second body 52 , a handle 53 , a slider 54D, and a power supply connector 55 .

[0137] The slider 54D is attached to the handle 53 so as to be able to move forward and backward relative to the handle 53 in the longitudinal direction A and to be unable to rotate relative to the handle 53 in the circumferential direction C. The slider 54D has a screw 57D.

[0138] The screw (first pressing member) 57D can fix the position of the slider 54D relative to the handle 53 .

[0139] The surgeon moves the slider 54D toward the base end side A2 relative to the handle 53 to pull the conductive wire 3, thereby bending the front end portion 20 of the sheath 2. The surgeon tightens the screw 57D while the front end portion 20 of the sheath 2 is bent, thereby fixing the position of the slider 54D relative to the handle 53. As a result, even if the surgeon removes his hand from the slider 54D, the conductive wire 3 does not move forward in the longitudinal direction A, and the bent state of the front end portion 20 of the sheath 2 can be maintained.

[0140] According to the papillotomy knife 100D of the present embodiment, it is easy to rotate the sheath 2 in the circumferential direction C to move the distal end portion 20 while maintaining the distal end portion 20 of the sheath 2 provided with the distal end treatment portion 1 in a bent state.

[0141] The fourth embodiment of the present invention is described in detail with reference to the accompanying drawings, but the specific structure is not limited to this embodiment, and also includes design changes within the scope of the gist of the present invention. In addition, the components shown in the above-mentioned embodiment and the modified examples shown below can be appropriately combined and constituted.

[0142] (Fifth Embodiment)

[0143] Reference Figure 20 to Figure 22 A nipple cutter 100E according to a fifth embodiment of the present invention will be described. In the following description, the same reference numerals are given to the same configurations as those already described, and duplicate descriptions will be omitted.

[0144] Fig. 20 This is a diagram showing the operation unit 5E of the papillotomy knife 100E.

[0145] Similar to the papillotomy knife 100 of the first embodiment, the papillotomy knife (endoscopic treatment instrument, high-frequency treatment instrument) 100E is used as an endoscope treatment system together with the endoscope 200. The papillotomy knife 100E includes a distal treatment portion 1, a sheath 2, a conductive wire 3, and an operation portion 5E.

[0146] The operation unit 5E includes a first body 51 , a second body 52E, a handle 53E, a slider 54 , and a power supply connector 55 .

[0147] The second body 52E is attached to the base end of the first body 51. The second body 52E is provided with a through hole 52h that penetrates the second body 52E along the longitudinal direction A. The conductive wire 3 passes through the through hole 52h. In addition, a rod 57E is provided at the base end of the second body 52E.

[0148] Fig.21 and Fig. 22 It is a diagram for explaining the function of the rod 57E.

[0149] The rod (second pressing member) 57E is rotatably mounted on the second body 52E around the rotation axis 57Er. The rod 57E has a pressing portion 57Eb that can contact the conductive wire 3. By rotating the rod 57E and placing the pressing portion 57Eb at a position to press the conductive wire 3, the position of the conductive wire 3 relative to the second body 52 can be fixed.

[0150] The surgeon moves the slider 54 toward the base end side A2 relative to the handle 53 to pull the conductive wire 3, thereby bending the front end portion 20 of the sheath 2. The surgeon disposes the pressing portion 57Eb at a position to press the conductive wire 3 while the front end portion 20 of the sheath 2 is bent, thereby fixing the position of the conductive wire 3 relative to the second body 52. ​​As a result, even if the surgeon removes his hand from the slider 54, the conductive wire 3 does not move forward in the longitudinal direction A, and the bent state of the front end portion 20 of the sheath 2 can be maintained.

[0151] The handle 53E is connected to the second body 52E so as to be non-rotatable relative to the second body 52E in the circumferential direction C and non-advancing / retracting relative to the second body 52E in the longitudinal direction A. When the handle 53E is rotated in the circumferential direction C, the second body 52E rotates relative to the first body 51 together with the handle 53E.

[0152] According to the papillotomy knife 100E of the present embodiment, it is easy to rotate the sheath 2 in the circumferential direction C to move the distal end portion 20 while maintaining the distal end portion 20 of the sheath 2 provided with the distal end treatment portion 1 in a bent state.

[0153] The fifth embodiment of the present invention is described in detail with reference to the accompanying drawings, but the specific structure is not limited to this embodiment, and also includes design changes within the scope of the gist of the present invention. In addition, the components shown in the above-mentioned embodiment and the modified examples shown below can be appropriately combined and constituted.

[0154] Industrial Applicability

[0155] The present invention can be applied to an endoscopic treatment instrument having a rotation function, etc.

[0156] Description of Reference Numerals

[0157] 300, endoscopic treatment system; 200, endoscope; 100, 100B, 100C, 100D, 100E, papillotomy knife (endoscopic treatment instrument, high-frequency treatment instrument); 1, front end treatment part; 11, first through hole; 12, second through hole; 15, mark; 2, sheath; 20, front end; 21, knife cavity; 21b, base end opening; 22, contrast cavity (liquid supply cavity); 22a, front end opening; 22b, base end opening; 23, guide wire cavity; 23a, front end opening; 23b, base end opening; 26, base end; 3, conductive wire; 5, 5B, 5C, 5D, 5E, operating part; 51, first body; 511, first tube; 512, first Two tubes; 52, 52B, 52C, 52E, second body; 52h, through hole; 53, 53B, 53C, 53E, handle; 531, knob; 54, 54D, sliding member; 55, power supply connector; 56, angiography tube head; 57, first deformation part; 57B, second deformation part; 57Bh, through hole; 57a, 57Ba, cone; 57D, screw (first pressing member); 57E, rod (second pressing member); 57Eb, pressing part; 57Er, rotating shaft; 57h, through hole; 58, first connecting part; 58a, inner side surface; 58B, second connecting part; 58Ba, inner side surface; 59, O-ring (ring member); 6, cutting part.

Claims

1. An endoscope treatment instrument, wherein: The endoscope treatment instrument comprises: a sheath which is an elongated member having a lumen extending along its length; A front end treatment portion, which is disposed at the front end portion of the sheath; an operating portion disposed at the base end of the sheath; as well as a wire member which passes through the lumen and is attached to the distal end treatment portion and is supported by the operation portion so as to be able to move forward and backward along the longitudinal direction, The operation portion includes a lock mechanism that restricts the wire member from advancing or retreating in the longitudinal direction.

2. The endoscopic treatment instrument according to claim 1, wherein: The wire member is supported by the operation portion so as to be rotatable in the circumferential direction.

3. The endoscopic treatment instrument according to claim 1, wherein: The front end treatment portion has a first through hole and a second through hole communicating with the cavity, The wire member passes through the first through hole and the second through hole to be exposed to the outside of the sheath.

4. The endoscopic treatment instrument according to claim 2, wherein: The sheath is mounted on the operation portion so as to be rotatable in the circumferential direction relative to the operation portion, and the sheath rotates in the circumferential direction when the wire member rotates in the circumferential direction.

5. The endoscopic treatment instrument according to claim 1, wherein: The operating unit has: a main body mounted on the base end of the sheath; a handle connected to the main body so as to be rotatable in a circumferential direction relative to the main body; and a sliding member connected to the handle so as to be able to move forward and backward relative to the handle along the length direction, The wire member is connected to a connector provided on the slider.

6. The endoscopic treatment instrument according to claim 5, wherein: The locking mechanism is provided on the first deformation portion of the main body. When the main body and the handle are brought close to each other, the first deformation portion deforms radially inward to come into contact with the wire member, thereby restricting the advancement and retreat of the wire member.

7. The endoscopic treatment instrument according to claim 5, wherein: The locking mechanism is provided on the second deformation portion of the handle, When the body and the handle are brought close to each other, the second deformation portion deforms radially inward to come into contact with the wire member, thereby restricting the advancement and retreat of the wire member.

8. The endoscopic treatment instrument according to claim 5, wherein: The locking mechanism is a ring member that contacts the wire member provided on the main body.

9. The endoscopic treatment instrument according to claim 5, wherein: The locking mechanism is a first pressing member provided on the sliding member. The first pressing member can fix the position of the slider relative to the handle.

10. The endoscopic treatment instrument according to claim 5, wherein: The locking mechanism is a second pressing member provided on the main body, The second pressing member can fix a position of the wire member relative to the main body.

11. The endoscopic treatment instrument according to claim 3, wherein: A mark is provided at a portion of the sheath in the circumferential direction where the first through hole and the second through hole are provided.

12. An endoscope treatment system, wherein: The endoscope treatment system has: The endoscope treatment instrument according to claim 1; and Endoscope.

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