Endoscopic treatment tool

Abstract

An endoscopic treatment tool (1) having a suppression device (7, 7A, 7B, 7C, 7D, 7F, 7G, 7H, 7I, 7J, 7K, 7L, 7M) that regulates the operation of a guide wire with respect to a sheath (2) of the endoscopic treatment tool (1), the sheath (2) having a lumen (21) through which the guide wire can be inserted, a suppression device covering at least one of a sheath slot (23) formed from the vicinity of the distal end opening of the sheath (2) to the proximal end opening of the sheath (2) and a distal end of the proximal end opening of the sheath (2), the suppression device closing at least one of the sheath slot (23) and the distal end of the proximal end opening of the sheath (2) to advance and retreat the guide wire inside the lumen (21), thereby preventing the guide wire from entering the sheath slot (23); the restraining device opens the sheath slot (23) and the distal end of the sheath (2), which is open at the proximal end, so that the guide wire can enter the sheath slot (23).

Description

[0001] This application is a divisional application of the Chinese patent application with application number 202110340697.7, invention name "Suppression device, suppression method, endoscope disposal instrument and endoscope processing system", application date of March 30, 2021, and priority date of October 6, 2020. Technical Field

[0002] The present invention relates to an endoscopic treatment instrument. Background Art

[0003] When treating diseases related to the body's luminal organs, in order to insert the treatment instrument into the luminal organ of the treatment object, it is sometimes necessary to use an endoscope to insert a guide wire into the luminal organ. When performing the above-mentioned endoscopic operation, the endoscope is inserted into the body, and a cannula inserted into the insertion path of the endoscope is used to retain the guide wire from the outside of the body to the luminal organ of the treatment object. Then, the treatment instrument is inserted into the luminal organ along the retained guide wire. During treatment, the following operations are often performed: multiple treatment instruments such as contrast agents, dilation balloons, and incision instruments are replaced in sequence. In the past, every time a treatment instrument was replaced, it was necessary to plug and unplug the catheter for each treatment instrument.

[0004] For example, Patent Document 1 discloses a catheter having a C-channel slot formed in the proximal portion of the shaft, and a guidewire port located near the operating portion communicating with the C-channel slot. In the catheter of Patent Document 1, a guidewire is inserted into the C-channel and emerges from the guidewire port. The catheter of Patent Document 1 is configured so that the guidewire can be withdrawn from the guidewire port, making it relatively easy to insert and remove the guidewire from the endoscope insertion portion. As a result, the guidewire can be removed from the guidewire insertion tool while remaining within the guidewire lumen of the catheter.

[0005] Patent Document 1: Japanese Patent No. 4651823

[0006] During treatment, for example, a guidewire is sometimes advanced within a lumen of an organ. In this case, in the catheter of Patent Document 1, the operator squeezes the guidewire to advance it within the guidewire lumen. This operation causes the exposed portion of the guidewire to advance relative to the narrow slot distal to the guidewire port and the narrow slot of the catheter's C-channel, sometimes preventing the guidewire from advancing smoothly within the guidewire lumen. Furthermore, when the guidewire is clamped by the narrow slot distal to the guidewire port and the narrow slot of the C-channel, an operation is required to return the guidewire to a state where it can be advanced and retracted, hindering the reduction of treatment time. Summary of the Invention

[0007] The present invention relates to an inhibition device for limiting the operation of a guide wire relative to a sheath of an endoscopic treatment instrument, the sheath having a lumen through which the guide wire can be inserted, the inhibition device being arranged on a sheath connecting portion into which the proximal end of the sheath is inserted, and covering at least one of a sheath slot formed from the vicinity of the distal end opening of the sheath to the proximal end opening of the sheath and the distal end of the proximal end opening of the sheath, the inhibition device closing the sheath slot and at least one of the distal end of the proximal end opening of the sheath, thereby allowing the guide wire to advance and retreat within the lumen, thereby preventing the guide wire from entering the sheath slot; the inhibition device opening the sheath slot and the distal end of the proximal end opening of the sheath, thereby allowing the guide wire to enter the sheath slot.

[0008] The present invention relates to an endoscopic treatment instrument, comprising a sheath provided on the distal side of the endoscopic treatment instrument, a sheath connecting portion connected to the proximal side of the sheath, and a restraining device provided on the sheath connecting portion, wherein a sheath slot is formed from the vicinity of the distal end opening of the sheath to the proximal end opening of the sheath, the sheath having a lumen through which a guide wire can be inserted, and the restraining device covers at least one of the sheath slot and the distal end of the proximal end opening of the sheath.

[0009] The inhibition device closes at least one of the sheath slot and the distal end of the proximal end opening of the sheath, thereby allowing the guide wire to advance and retreat in the lumen, thereby preventing the guide wire from entering the sheath slot; the inhibition device opens the sheath slot and the distal end of the proximal end opening of the sheath, thereby allowing the guide wire to enter the sheath slot.

[0010] The present invention also relates to an endoscope treatment system including an endoscope apparatus and the endoscope treatment instrument inserted into a treatment instrument channel of the endoscope apparatus for use.

[0011] The present invention further relates to an inhibition method, which uses the above-mentioned inhibition device to limit the operation of the guide wire relative to the sheath of the endoscopic treatment instrument. The inhibition method includes the following steps: closing the sheath slot and at least one of the distal end of the proximal end opening of the sheath by the inhibition device, so that the guide wire moves forward and backward in the lumen, thereby preventing the guide wire from entering the sheath slot; opening the sheath slot and the distal end of the proximal end opening of the sheath by the inhibition device, so that the guide wire enters the sheath slot, and switching between the above-mentioned two steps is performed by the action of the above-mentioned inhibition device.

[0012] Effects of the Invention

[0013] According to the endoscopic treatment instrument and the method for using the endoscopic treatment instrument of the present invention, the guide wire can be smoothly advanced and retracted. BRIEF DESCRIPTION OF THE DRAWINGS

[0014] Attachment Figure 1 It is a perspective view showing the use state of the endoscopic treatment instrument according to the first embodiment.

[0015] Attachment Figure 2 It is a side view of a part of the endoscopic treatment instrument according to the first embodiment.

[0016] Attachment Figure 3 It is a side view of a part of the endoscopic treatment instrument according to the first embodiment.

[0017] Attachment Figure 4 It is attached Figure 2 A cross-sectional view taken along line IV-IV.

[0018] Attachment Figure 5 It is attached Figure 3 Cross-sectional view of line VV.

[0019] Attachment Figure 6 It is a side view showing a distal portion of the endoscopic treatment instrument according to the embodiment.

[0020] Attachment Figure 7 It is attached Figure 6 A cross-sectional view taken along line VII-VII.

[0021] Attachment Figure 8 It is attached Figure 6 A cross-sectional view taken along line VIII-VIII.

[0022] Attachment Figure 9 It is a schematic diagram showing a usage state of the endoscopic treatment instrument according to the embodiment.

[0023] Attachment Figure 10 It is a schematic diagram showing a usage state of the endoscopic treatment instrument according to the embodiment.

[0024] Attachment Figure 11 This is a perspective view of a portion of an endoscopic treatment instrument according to a modified example of the first embodiment.

[0025] Attachment Figure 12 It is attached Figure 11 A three-dimensional view of a portion of an endoscopic treatment instrument.

[0026] Attachment Figure 13 It is attached Figure 11 Side view of a portion of an endoscopic disposal instrument.

[0027] Attachment Figure 14 It is a side view of a part of the endoscopic treatment instrument according to the second embodiment.

[0028] Attachment Figure 15 It is attached Figure 14 Cross-sectional view along line XV-XV.

[0029] Attachment Figure 16 It is the attachment of the suppression part of the second state. Figure 14 Cross-sectional view along line XV-XV.

[0030] Attachment Figure 17 It is a perspective view of a part of an endoscopic treatment instrument according to a modified example of the second embodiment.

[0031] Attachment Figure 18 It is a perspective view of a part of an endoscopic treatment instrument according to a modified example of the second embodiment.

[0032] Attachment Figure 19 It is a perspective view of a part of an endoscopic treatment instrument according to a modified example of the second embodiment.

[0033] Attachment Figure 20 It is a side view of a part of the endoscopic treatment instrument according to the third embodiment.

[0034] Attachment Figure 21 It is attached Figure 20 Cross-sectional view along line XXV-XXV.

[0035] Attachment Figure 22 It is attached Figure 20 Cross-sectional view along line XXV-XXV.

[0036] Attachment Figure 23 It is a perspective view of a part of an endoscopic treatment instrument according to a modified example of the third embodiment.

[0037] Attachment Figure 24 It is a perspective view of a part of an endoscopic treatment instrument according to a fourth embodiment.

[0038] Attachment Figure 25 It is attached Figure 24 Cross-sectional view along line XXV-XXV.

[0039] Attachment Figure 26 The second state of the suppression unit Figure 24 Cross-sectional view along line XXV-XXV.

[0040] Attachment Figure 27 It is a perspective view of a part of an endoscopic treatment instrument according to a modified example of the fourth embodiment.

[0041] Attachment Figure 28 It is a side view of a part of an endoscopic treatment instrument according to a modification of the fifth embodiment.

[0042] Attachment Figure 29 It is attached Figure 28Cross-sectional view of line XXIX-XXIX.

[0043] Attachment Figure 30 It is a cross-sectional view of the suppressing portion of the endoscopic treatment instrument according to the sixth embodiment.

[0044] Attachment Figure 31 It is a cross-sectional view of the suppressing portion of the endoscopic treatment instrument according to the sixth embodiment.

[0045] Attachment Figure 32 It is a side view of the suppressing portion of the endoscopic treatment instrument according to the seventh embodiment.

[0046] Attachment Figure 33 It is a side view of the suppressing portion of the endoscopic treatment instrument according to the seventh embodiment.

[0047] Attachment Figure 34 It is a side view showing a modified example of the endoscopic treatment instrument.

[0048] Attachment Figure 35 It is a side view showing a modified example of the endoscopic treatment instrument.

[0049] Attachment Figure 36 This is a flowchart showing a method of using an endoscopic treatment instrument. DETAILED DESCRIPTION

[0050] (First embodiment)

[0051] Below, refer to the attached Figure 1 To the attached Figure 10 The endoscope treatment instrument and the method of using the endoscope treatment instrument according to this embodiment will be described. Figure 1 This is an overall view of a state in which the endoscopic treatment instrument 1 of the present embodiment is inserted into the treatment instrument channel 105 of the endoscope apparatus 100 and is used.

[0052] As attached Figure 1 As shown, the endoscopic treatment instrument 1 of this embodiment is a medical instrument used together with an endoscope device 100 for incising biological tissue within the body. In the endoscope device 100 of this embodiment, the endoscope insertion portion 101 inserted into the body has an active bending portion 107. The active bending portion 107 is configured to bend in response to operation of the operating portion 103.

[0053] In this embodiment, an example is shown in which an endoscopic treatment instrument 1 (hereinafter referred to as "treatment instrument") is inserted into a side-viewing endoscope device 100 suitable for observing the duodenal papilla. The side-viewing endoscope device 100 includes, for example, an endoscope insertion portion 101, a grip portion 102, a forceps plug 104, a treatment instrument channel 105, and a lifting platform and camera unit (not shown). The endoscope insertion portion 101 is the portion inserted into the body. The operating portion 103 is the portion operated by the operator. In the following description, the side of the endoscope device 100 where the operating portion 103 is located is referred to as the proximal side P, and the end of the endoscope insertion portion where the endoscopic treatment instrument 1 extends is referred to as the distal side D. Similarly, the side of the treatment instrument 1 described below where the operating portion 9 is located is referred to as the proximal side P, and the end of the sheath 2 opposite the operating portion 9 in the longitudinal direction and inserted into the body is referred to as the distal end.

[0054] The grip 102 is located at the proximal end of the endoscope insertion section 101. The forceps plug 104 is located at a portion of the grip 102. A treatment instrument channel 105 is formed within the endoscope insertion section 101 and communicates with the forceps plug 104. A lifting platform is provided at the distal end of the treatment instrument channel 105 to change the direction of the endoscopic treatment instrument 1 and the like extending from the treatment instrument channel 105 to a direction perpendicular to the central axis of the endoscope insertion section 101. An imaging unit is provided at the distal end of the endoscope insertion section 101.

[0055] The treatment instrument 1 is inserted through the forceps plug 104 into the treatment instrument channel 105 and is configured to be used by extending and retracting from the distal end of the endoscope insertion portion 101. The treatment instrument 1 includes a sheath 2, an operating portion 9, a base 4, and a connecting portion 5. The operating portion 9 is provided at the proximal end of the treatment instrument 1. The sheath 2 is provided at the distal side D of the treatment instrument 1. The sheath 2 and the operating portion 9 are connected via the base 4 and the connecting portion 5.

[0056] The sheath 2 is an elongated member inserted into the treatment instrument channel 105. The sheath 2 is an elongated member having flexibility. In the third embodiment, the sheath 2 is made of resin. Figure 4 and 5 As shown, a guide wire lumen 21 is formed in the sheath 2. Figure 6-8 As shown, the guidewire lumen 21 extends over the entire length of the sheath 2, from the proximal end opening 22 of the sheath 2 to the distal end opening 24 of the sheath 2. The guidewire lumen 21 is a lumen having a size that allows the guidewire GW to advance and retreat. Figure 7 、 8As shown, the guide wire lumen 21 has a C-channel structure that is grooved on the radially outer side of the sheath 2 and has a roughly C-shaped cross-sectional shape perpendicular to the long axis. A sheath slot 23 is formed on the C-channel portion. The sheath slot 23 is formed from near the distal end opening 24 of the sheath 2 to the proximal end opening 22 of the sheath 2. The sheath slot 23 is elastically deformable. In addition, the width of the sheath slot 23 is slightly smaller than the outer diameter of the guide wire GW used in combination with the disposal instrument 1. The sheath 2 is constructed so that the guide wire GW inserted into the guide wire lumen 21 can be pulled out of the sheath 2 from the elastically deformable sheath slot 23. The area including the portion where the distal end opening 24 is arranged is referred to as the distal end portion of the sheath 2. The area including the portion where the proximal end opening 22 is arranged is referred to as the proximal end portion of the sheath 2.

[0057] As attached Figure 7 、 8 As shown, in addition to the guidewire lumen 21, the sheath 2 also has one or more lumens 29. The lumens 29 are used as a path for injecting contrast media, a path for injecting fluid into the balloon, or a path for inserting a single knife wire.

[0058] The operating portion 9 is a location for inputting information used by the operator to operate other treatment instruments inserted into the sheath 2. The operating portion 9 comprises a shaft 91 and a sliding portion 92. The shaft 91 is fixed to the base 4 and extends linearly along its long axis. The sliding portion 92 is configured to slide along the long axis of the shaft 91.

[0059] The sliding portion 92 may include, for example, a connector 93 that can be connected to a high-frequency power supply device and a finger-engaging portion 94. The connector 93 may be electrically connected to, for example, the proximal end of a knife wire described below. The operator's finger may pass through the finger-engaging portion 94.

[0060] The base 4 is provided with an insertion port 41. The insertion port 41 is connected to the lumen of the sheath described below. The insertion port 41 is used to inject contrast media or fluid for the balloon into the lumen 29 or to insert a knife wire therein.

[0061] The connecting portion 5 includes a connecting body 53, a proximal connecting portion 51, a hook 52, and a sheath connecting portion 54. The proximal end of the connecting body 53 is provided with the proximal connecting portion 51. The proximal connecting portion 51 connects the base 4 and the connecting body 53. The distal portion of the connecting body 53 is provided with a sheath connecting portion 54 and the hook 52. The sheath connecting portion 54 is provided along the long axis at the distal side D of the operating portion 9 and the proximal connecting portion 51. As shown in the attached figure, Figure 2 、 3 As shown, the hook 52 extends to the side of the sheath connecting portion 54. The hook 52 is a locking portion that can be locked in the holding portion 102. Figure 1As shown, when the hook 52 is engaged with the holding portion 102 , the portion of the treatment instrument 1 closer to the side P than the connecting portion 5 is held in a direction intersecting the long axis of the endoscope apparatus 100 .

[0062] As attached Figure 1-3 As shown, the proximal portion of the sheath 2 is inserted into the sheath connecting portion 54. The sheath connecting portion 54 is provided with a guide wire insertion port 55. A slit 56 is formed from the distal end 551 of the guide wire insertion port 55 to the distal end of the sheath connecting portion 54. The slit 56 is an example of a restraining slit. The width of the slit 56 is slightly larger than the outer diameter of the guide wire GW used in combination. The guide wire insertion port 55 is connected to the guide wire lumen 21. As shown in the attached Figure 3-5 As shown, the slot 56 and the sheath slot 23 are arranged close to each other, and the circumferential positions of the slots 56 and 23 are arranged at substantially the same position.

[0063] The sheath connection portion 54 is provided with a suppressing portion 7. The suppressing portion 7 is provided to suppress the guidewire GW extending from the guidewire insertion port 55 from entering the slit 56. The suppressing portion 7 covers at least one of the slit 56 and the distal end 551 of the guidewire insertion port 55. The slit 56 is located at a position corresponding to the sheath slit 23, and the guidewire insertion port 55 is located at a position corresponding to the proximal opening 22 of the sheath 2. Therefore, the suppressing portion 7 covers at least one of the slit 23 and the proximal opening 22. In this embodiment, the suppressing portion 7 is provided so as to cover the slit 56.

[0064] Attachment Figure 4 It is attached Figure 2 The cross-sectional view along line IV-IV shows the suppressing portion 7 in the first state. Figure 5 It is attached Figure 3 The cross-sectional view of the VV line shows the suppression portion 7 in the second state. Figure 4 、 5 As shown, the suppression portion 7 includes: a fixing portion 79 connected to the sheath connecting portion 54, a cover body 71, a locking claw 73, and a holding protrusion 72. The cover body 71 is an arc-shaped portion along the outer surface of the sheath connecting portion 54. The fixing portion 79 and the locking claw 73 are provided at the end portion in the circumferential direction of the arc portion of the cover body 71. The holding protrusion 72 is provided to extend toward the outer surface of the sheath connecting portion 54. The holding protrusion 72 has a size and shape that can be grasped by the operator with his fingers, and is provided at a position where the operator can grasp it. The locking claw 73 extends toward the inner side of the arc portion of the cover body 71. The locking claw 73 is configured to be latched in the recessed portion 541 provided on the outer peripheral surface of the sheath connecting portion 54.

[0065] The suppression part 7 is provided so as to be openable and closable relative to the sheath connection part 54 with the fixing part 79 as a starting point. Figure 4As shown, the state where the suppressing portion 7 covers the slit 56 and the locking claw 73 is locked in the recess 541 of the sheath connecting portion 54 is called the first state. In the first state, the suppressing portion 7 covers at least one of the sheath slit 23 and the distal end 551 of the guide wire insertion port 55. Figure 5 As shown, the state in which the cover body 71 rotates about the fixing portion 79 in a direction away from the sheath connection portion 54 and the slot 56 is opened is referred to as the second state. The suppressing portion 7 is configured to switch between the first state and the second state by a rotational action.

[0066] The suppressing portion 7 may be provided at a position covering at least one of the slit 56 and the distal end 551 of the guide wire insertion port 55. Figure 4 、 5 In addition to the example shown, for example, the inhibitor may be provided at a position covering the proximal portion of the slit 56 and the distal end 551 of the guide wire insertion port 55. The inhibitor 7 may be provided at a position that does not hinder the advancement and retreat of the guide wire GW in the guide wire insertion port 55 and prevents the guide wire GW from entering the slit 56 and the sheath slit 23.

[0067] Next, refer to the attached Figure 9-10 , Attachment Figure 36 The method of using the treatment instrument 1 is described below. In the treatment instrument 1, the sheath 2 is inserted from the forceps plug 104, the treatment instrument 1 is inserted into the treatment instrument channel 105 and extends from the distal end of the endoscope insertion part 101. The distal part of the sheath 2 can bend with the bending of the active bending part 107. Figure 1 As shown, the distal end of the sheath 2 is configured to be further bent by means of a lifting table.

[0068] Attachment Figure 9 、 10 The following table shows the usage status of the treatment instrument 1. The treatment instrument 1 includes the following Figure 9 As shown in the figure, the two operators U1 and U2 use the Figure 10 In the case of use by one operator U1 as shown in the figure. In the case of use by two operators U1 and U2, as shown in the figure Figure 9 As shown, the hook 52 is released from the endoscope device 100. The operator U1 holds the endoscope device 100 and operates the endoscope device 100. The operator U2 holds the operating portion 9 of the treatment instrument 1 and operates it. The operator U2 holds the guide wire GW and performs operations to maintain the position of the guide wire GW and to advance and retreat the guide wire GW according to the treatment content. Figure 10As shown, when operated by a single operator U1, the hook 52 is locked to the grip 102 of the endoscope insertion portion 101 to maintain the position of the treatment instrument 1 relative to the endoscope apparatus 100. Thus, the operator U1 alone can perform all operations, including operation of the endoscope apparatus 100 and operation of the treatment instrument 1. Operators U1 and U2 operating the treatment instrument 1 grip the guide wire GW and perform operations to maintain the position of the guide wire GW and to advance and retract the guide wire according to the treatment content.

[0069] Initially, at least one of the slit 23 and the distal end of the proximal end opening 22 is closed by the inhibitor (step S1). The guide wire GW is inserted from the guide wire insertion port 55. The distal end of the guide wire GW extends from the distal end opening 24 of the sheath 2 and is inserted into the luminal organ.

[0070] Next, with at least one of the sheath slot 23 and the distal end of the proximal end opening 22 of the sheath 2 closed, the guide wire GW is advanced or retracted within the lumen 21 (second step). That is, the guide wire GW is advanced or retracted in the first state. The proximal portion of the guide wire GW is pulled out from the proximal end opening 22 of the sheath 2 and the guide wire insertion port 55, exposed to the outside of the sheath 2 and extended. The guide wire GW is inserted and moved forward and backward freely within the guide wire lumen 21. Therefore, when the operator advances or retracts the guide wire GW pulled out from the guide wire insertion port 55, the guide wire GW moves forward and backward within the guide wire lumen 21.

[0071] The sheath 2's bent state after insertion or residual contrast agent in the lumen 29 after injection can sometimes prevent the guidewire GW from smoothly advancing or retracting within the distal region of the guidewire lumen 21. In this state, when the operator advances the guidewire GW, despite applying force to compress the proximal region of the guidewire GW, the distal region of the guidewire GW cannot be smoothly advanced. As a result, the guidewire GW bends outside the guidewire insertion port 55. Continued pressure on the guidewire GW in this state causes the guidewire GW to move from the distal end 551 of the guidewire insertion port 55 toward the slot 56 and the sheath slot 23. If the guidewire GW protrudes from the guidewire lumen 21 at a position further distal to the proximal portion of the slot 56 than the proximal portion of the slot 56, returning the guidewire GW to the guidewire insertion port 55 takes time. However, in this embodiment, when the inhibitor 7 is in the first position, the inhibitor 5 covers the slit 56 and closes the slit 56. Therefore, on the side of the connecting portion 5, the inhibitor 7 prevents the guide wire GW from entering the slit 56. As a result, when the inhibitor is in the first position, the guide wire GW is prevented from entering the slit 56 against the second operator's intention when the guide wire GW is advanced.

[0072] After the second step S2, the proximal end of the sheath slot 23 and the distal end of the proximal end opening 22 are opened (step S3). That is, the suppressing portion 7 is switched to the second state. For example, when replacing the knife wire after injecting a contrast agent, the sheath 2 may be removed from the endoscope insertion portion 101 while the guide wire GW remains in the body. When performing this operation, as shown in the attached Figure 3 As shown, the operator who operates the treatment instrument 1 rotates the suppression portion 7 while gripping the gripping protrusion 72 , and switches the suppression portion to the second state so that the cover body 71 does not cover the slit 56 .

[0073] Next, the guide wire GW is inserted into the slot 56 and the sheath slot 23. While the guide wire GW remains in the body, the sheath 2 is peeled off and the treatment instrument 1 is removed from the endoscope insertion portion 101 (fourth step S4). Step S4 will be described in detail. First, the guide wire GW is further inserted into the slot 56 and the sheath slot 23. The guide wire GW, which has been extracted from the proximal end opening 22 of the sheath 2, is moved near the forceps plug 104 of the endoscope device 100. After the extracted guide wire GW has moved to the forceps plug 104, it is secured to the endoscope device 100 near the forceps plug 104. Then, while the guide wire GW remains secured near the forceps plug 104, the base 4, i.e., the treatment instrument 1, is pulled toward the proximal side P. If the hook 52 is engaged with the grip 103, the hook 52 is released from the grip 102 and the treatment instrument 1 is pulled toward the proximal side P. At this time, the guide wire GW is withdrawn from the treatment instrument channel 105 and the guide wire GW is withdrawn to the distal end of the sheath slot 23. After the treatment instrument 1 is withdrawn from the treatment instrument channel 105 and the guide wire GW is withdrawn to the distal end of the sheath slot 23, that is, after the distal end of the sheath slot 23 moves to the vicinity of the forceps plug 104, withdrawal of the treatment instrument 1 is temporarily stopped and the guide wire GW is released from the vicinity of the forceps plug 104. After the guide wire GW is released, while the guide wire GW is held stationary relative to the endoscope device 100, only the treatment instrument 1 is further withdrawn from the treatment instrument channel 105. After the distal end of the sheath 2 is completely withdrawn from the forceps plug 104, the guide wire GW is again secured to the vicinity of the forceps plug 104, and the treatment instrument 1 is completely withdrawn from the guide wire GW.

[0074] According to the treatment instrument 1 and the method of using the treatment instrument of this embodiment, when the guide wire GW is advanced relative to the sheath 2, the guide wire GW can be prevented from entering the slit 56 and the sheath slit 23, and can be smoothly advanced relative to the sheath 2.

[0075] Since the inhibitor 7 is configured to be switchable between a first state and a second state, when the sheath 2 is removed from the endoscope insertion portion 101, the inhibitor 7 is switched to the second state, thereby allowing the sheath 2 to be removed smoothly while the guide wire GW remains inserted into the body. This contributes to shortening the surgical time.

[0076] The state of the treatment instrument 1 is not limited to the above-mentioned state. Figure 11-13 A treatment tool 1A of a modified example is shown. In the following description, the same reference numerals are given to the same components as those already described, and the full description thereof is omitted. Figure 11-13 The illustrated modification differs from the aforementioned embodiment in the structure of the connecting portion. The connecting portion 5 of the treatment instrument 1 is not limited to the structure of the first embodiment. For example, the hook 52 is not a required feature. As with the treatment instrument 1A of this modification, a configuration in which the sheath 2 is inserted into the funnel tube 8 and the guidewire GW is withdrawn from the sheath 2 is also possible.

[0077] The funnel tube 8 comprises a barrel 81, a funnel portion 82, and a suppressing portion 7A. The barrel 81 is formed with a sheath insertion path extending along the longitudinal direction for inserting the sheath 2. The funnel portion 82 extends from the outer surface of the barrel 81 in the middle of the longitudinal direction.

[0078] Slots 83 and 85 are formed in the barrel 81 and the funnel 82. Slots 83 and 85 are circumferentially located at the same positions as the sheath slot 23 of the sheath 2. An opening 87 is formed on the side of the barrel 81 inside the funnel 82. The opening 87 on the side of the barrel 81 is located at a position corresponding to the proximal opening 22 of the sheath 2. The opening 87 on the side of the barrel 81 communicates with the guidewire lumen 21 of the sheath 2 via the proximal opening 22.

[0079] The suppressing portion 7A is provided on the cylinder 81 at the distal side D relative to the funnel portion 82. Figure 12 and 13 As shown, the suppressing portion 7A is positioned to cover the distal end of the proximal opening 22 of the sheath 2 inserted into the cylindrical body 81 and the proximal end of the sheath slot 23. The suppressing portion 7A is rotatably coupled to the cylindrical body 81. The suppressing portion 7A is configured to switch between a first state in which the cover body 71A covers the slot 85 and a second state in which the slot 85 is open. Similar to the suppressing portion 7 of the first embodiment, the suppressing portion 7A rotates about the connection between the fixing portion 79 and the funnel tube 8.

[0080] The guide wire GW is inserted from the guide wire lumen 21 of the sheath 2 through the opening on the side of the cylinder 81 to the funnel 82. The guide wire GW is drawn out from the proximal opening 84 of the funnel 82 to the outside of the treatment instrument 1.

[0081] When the inhibitor 7A advances the guide wire GW in the first state, even if the operator of the treatment instrument 1 advances the guide wire GW and the distal region of the guide wire GW does not advance, the inhibitor 7A can prevent the guide wire GW from entering a position further distal to the distal side D than the distal end of the slot 85. As a result, the guide wire GW can be prevented from entering a position further distal to the distal side D than the proximal end of the sheath slot 23.

[0082] Meanwhile, while retaining the guidewire GW within the body, the treatment instrument 1A is removed from the endoscope insertion portion 101. The second operator rotates the restraining portion 7A to switch to the second state. The second operator then directs the guidewire GW from the proximal opening 84 of the funnel 82 into the slit 83 and passes the guidewire GW through the slit 85. In this state, when the funnel tube 8 is pulled toward the proximal side P, the guidewire GW enters the sheath slit 23 and is withdrawn from the guidewire lumen 21 to the exterior of the sheath 2.

[0083] Like the first embodiment, the treatment instrument 1A of the modified example can prevent the guide wire GW from entering the sheath slot 23 when the guide wire GW is advanced or retreated relative to the sheath 2 , and can smoothly advance the guide wire GW relative to the sheath 2 .

[0084] Since the inhibitor 7A is configured to switch between a first state and a second state, when the sheath 2 is removed from the endoscope insertion portion 101, the inhibitor 7A is switched to the second state, thereby allowing the sheath 2 to be removed smoothly while the guide wire GW remains inserted into the body. This contributes to shortening the surgical procedure time.

[0085] (Second embodiment)

[0086] Refer to the attached Figure 14-16 A treatment instrument 1B according to the second embodiment will be described. The treatment instrument 1B according to the second embodiment is an example in which the structure of the suppression portion 7B is different from that of the first embodiment. The suppression portion 7B is provided so as to be rotatable relative to the sheath connection portion 54. Figure 15 It is attached Figure 14 The cross-sectional view along the line XV-XV shows the suppressing portion 7B in the first state. Figure 16 It is attached Figure 14 The cross-sectional view along the line XV-XV shows the suppression portion 7B in the second state. Figure 15 、 16 As shown in FIG. 1 , the suppressing portion 7B is a member having a substantially C-shaped cross section perpendicular to the long axis. The suppressing portion 7B is rotatably mounted on the outside of the sheath connecting portion 54 having a circular cross section perpendicular to the long axis. Figure 15 FIG1 shows a cross-sectional view of the suppression portion 7B in the first state. Figure 16A cross-sectional view showing the suppressing portion 7B in the second state.

[0087] The suppression portion 7B has a slot 74B. The slot 74B is a slot having an opening width that is the same as or slightly wider than the sheath slot 23 and the slot 56. Figure 16 As shown in the second state, the slit 74B of the suppression portion 7B is arranged at substantially the same position in the circumferential direction as the sheath slit 23 and the slit 56 of the sheath connection portion 54. Figure 15 As shown, when the suppression portion 7B is arranged in the first state, the suppression portion 7B covers the sheath slit 23 and the slit 56 of the sheath connecting portion 54 .

[0088] As in the present embodiment, the suppressing portion 7B may be configured to be switchable between the first state and the second state by performing a relative rotational motion with respect to the sheath coupling portion 54 .

[0089] According to the treatment instrument 1B of this embodiment, similarly to the first embodiment, the guide wire GW can be prevented from entering the slit 56 and the sheath slit 23 when the guide wire GW is moved forward or backward relative to the sheath 2 , and the guide wire GW can be smoothly advanced relative to the sheath 2 .

[0090] Since the inhibitor 7B is configured to switch between a first state and a second state, when removing the sheath 2 from the endoscope insertion portion 101, the inhibitor 7B is rotated and switched to the second state, thereby allowing the sheath 2 to be removed smoothly while maintaining the guide wire GW inserted into the body. This contributes to shortening the surgical time.

[0091] The status of the disposal instrument is not limited to the above status. Figure 17-19 Modified examples of treatment instruments 1C, 1D, and 1F are shown. Figure 17 The treatment device 1C of the modified example shown is Figure 11 The funnel tube 8 is also provided. The distal end of the funnel tube 8 is provided with a suppressing portion 7C having the same structure as that of the second embodiment. The suppressing portion 7C is rotatably mounted relative to the funnel tube 8. Figure 17 The suppression unit 7C in the first state is shown. Figure 17 As shown, in the first state, the sheath slot 23 and the slot 85 of the barrel 81 are covered by the inhibitor 7C. When the inhibitor 7B is in the second state, the slot 74C of the inhibitor 7D is positioned approximately at the same circumferential position as the sheath slot 23 and the slot 85 of the barrel 81. As a result, the guide wire GW can pass through the slot 83 of the funnel 82 into the slot 85 of the barrel 81 and the sheath slot 23, allowing the treatment instrument 1C to be removed while the guide wire GW is retained.

[0092] In the attached Figure 18In the treatment instrument 1D of the modified example shown, the position of the suppressing portion 7D is Figure 17 The treatment instrument 1C of the modified example is different. The treatment instrument 1D of this modified example is provided with an inhibition portion 7D at the proximal portion of the funnel portion 82. A locking groove 86 for locking the inhibition portion 7D is formed on the funnel portion 82. The locking groove 86 is formed along the size and shape of the inhibition portion 7D. The inhibition portion 7D is arranged in the locking groove 86 and is rotatably provided in the locking groove 86 in the circumferential direction. By rotating the inhibition portion 7D in the circumferential direction in the locking groove 86, switching between the first state and the second state is achieved. Figure 18 The inhibitor 7D is shown in the first state. In the first state, a portion of the proximal portion of the slit 83 of the funnel 82 is covered by the inhibitor 7D. When a portion of the proximal portion of the slit 83 of the funnel 82 is covered by the inhibitor 7D, the guide wire GW is prevented from entering the distal side D of the slit 83. Since the inhibitor 7D is positioned closer to the distal side P than the proximal portion of the sheath slit 23, the guide wire GW is prevented from entering the sheath slit 23. When the operator rotates the inhibitor 7D and places it in the second state, the circumferential positions of the slit 83 of the funnel 82 and the slit 74D of the inhibitor 7D are arranged at approximately the same position. The guide wire GW can pass through the slit 83 of the funnel 82 and enter the slit 85 of the barrel 81 and the sheath slit 23. As a result, the treatment instrument 1C can be removed with the guide wire GW retained.

[0093] Attachment Figure 19 The treatment instrument 1F of the modified example shown is an example in which a funnel tube 8F is provided to be rotatable relative to the sheath 2 and serves as the suppressing portion 7F. Figure 19 The suppression portion 7F is shown in the first state. The operator rotates the funnel tube 8 relative to the sheath 2 around the central axis, thereby switching the suppression portion 7F between the first state and the second state. A guide wire insertion port 22F that is longer in the circumferential direction is formed on the sheath 2. A through hole that communicates with the guide wire insertion port 22F and the funnel portion 82 is formed on the cylinder 81F of the funnel tube 8F. Regardless of whether the suppression portion 7F is in the first state or the second state, the guide wire insertion port 22F and the through hole are connected, and the guide wire GW can move forward and backward therein. When in the first state, the guide wire GW is restricted from entering the sheath slot 23. When the operator rotates the funnel tube 8F and configures it in the second state, the slot 83 of the funnel portion 82 and the slot 74D of the suppression portion 7D are configured at approximately the same position in the circumferential direction as the sheath slot 23. As a result, the guide wire GW can pass through the slot 83 of the funnel portion 82 and enter the slot 85 of the cylindrical body 81 and the sheath slot 23 , and the treatment instrument 1C can be removed with the guide wire GW remaining.

[0094] According to the attached Figure 17-19The treatment instruments 1C, 1D, and 1F of the illustrated modifications can prevent the guide wire GW from entering the slit 85 and the sheath slit 23 when the guide wire GW is moved forward and backward relative to the sheath 2 in the same manner as the treatment instrument 1B of the second embodiment, and can smoothly advance the guide wire GW relative to the sheath 2.

[0095] Since the restraining portions 7C, 7D, and 7F are configured to switch between a first state and a second state, when the sheath 2 is removed from the endoscope insertion portion 101, the restraining portions 7C, 7D, and 7F are rotated and switched to the second state, thereby smoothly removing the sheath 2 while maintaining the guide wire GW inserted into the body. This contributes to shortening the surgical time.

[0096] (Third embodiment)

[0097] Refer to the attached Figure 20-22 A treatment instrument 1G according to a third embodiment will be described. The treatment instrument 1G according to the third embodiment is an example in which the structure of the suppression portion 7G is different from that of the first embodiment. Figure 21-22 As shown, the cover body 71G of the suppressing portion 7G is provided at a position covering the slit 56 of the sheath coupling portion 54 and the distal end 551G of the guide wire insertion port 55 .

[0098] Attachment Figure 21 、 22 It is attached Figure 20 The sectional view of the XXI-XXI line. Figure 21 、 22 As shown, the connecting portion 5G has a cylindrical shape and the proximal portion of the sheath 2 is inserted therein. The connecting portion 5G is provided with a guide wire insertion port 55. A slot 56G is formed from a distal end 551G of the guide wire insertion port 55 to the distal end of the connecting portion 5G.

[0099] The suppression portion 7G is provided at a position radially outwardly spaced from the sheath slot 23, covering the sheath slot 23. The suppression portion 7G is spaced from the outer circumferential surface of the sheath 2 so that the guide wire GW can move from the sheath slot 23 to the slot 56G. The slot 56G of the connecting portion 5G is provided at a position offset circumferentially from the sheath slot 23. In other words, the suppression portion 7G has the slot 56G formed as an opening at a position different from the opening of the sheath slot 23 along the circumferential direction of the sheath 2.

[0100] As attached Figure 22As shown, the guide wire GW is constructed so that it can be taken out from the narrow slot 56G to the outside after passing through the gap S on the inner side of the inhibition portion 7G. When the operator performs the operation to advance the guide wire GW and the distal region of the guide wire GW does not advance, the guide wire GW moves to the radially outer side of the connection portion 5G in the guide wire insertion port 55. At this time, since the distal end 551G of the guide wire insertion port 55 is covered by the inhibition portion 7G, the guide wire GW contacts the distal end 551G of the guide wire insertion port 55, blocking the guide wire GW from entering the narrow slot 56G of the connection portion 5G and the sheath narrow slot 23. On the other hand, when the operator intends to take out the guide wire GW from the guide wire lumen 21, as shown in the attached Figure 20 As shown by the double dotted line in FIG. 1 , the operator pulls the guide wire GW radially outward from the sheath 2 while pulling it circumferentially. Figure 22 As shown, the guide wire GW passes through the gap S inside the restraining portion 7G from the sheath slot 23 and emerges from the slot 56G to the outside of the restraining portion 7G. In other words, the guide wire GW can avoid the restraining portion 7G and enter the distal side D of the slot 56G. As a result, the sheath 2 can be removed smoothly while the guide wire GW remains inserted into the body, which helps shorten surgical time.

[0101] According to the treatment instrument 1G of this embodiment, the guide wire GW can be prevented from entering the slit 56G and the sheath slit 23 when the guide wire GW is advanced or retreated relative to the sheath 2 , and the guide wire GW can be smoothly advanced relative to the sheath 2 .

[0102] Attachment Figure 23 A treatment instrument 1H according to a modified example of the third embodiment is shown. Figure 23 In the treatment instrument 1H of the modified example shown, the structure of the connecting portion is different from that of the above embodiment. For example, the suppression portion 7G of the third embodiment can also be applied to the funnel tube 8. In the treatment instrument 1H of this embodiment, the suppression portion 7H is formed integrally with the distal portion of the barrel 81 of the funnel tube 8. A flat plate-shaped suppression portion 7H is provided between the narrow groove 83 of the funnel portion 82 and the narrow groove 85 of the barrel 81. Figure 23 As shown, the suppression portion 7H extends along the circumference of the cylindrical body 81 at a position intersecting the slit 85 of the cylindrical body 81, located further distally than the funnel portion 82. A slit 74H is formed around the suppression portion 7. The slit 74H is curved. The slit 74H communicates with the slit 83 of the funnel portion 82 and the slit 85 of the cylindrical body 81. As in the third embodiment, the suppression portion 7H is positioned radially outwardly away from the sheath 2 and covers the sheath slit 23.

[0103] The provision of the cover body 71H prevents the guide wire GW from entering the sheath slit 23 in the event that the guide wire GW moves to a position further distal to the slit 83 of the funnel 82 than the operator's intention. On the other hand, when removing the guide wire GW from the guide wire lumen 21, the guide wire GW is inserted into the slit 83 of the funnel 82 and withdrawn until it is exposed within the inhibition portion 7H. Thereafter, the guide wire GW is moved along the slit 74H in the circumferential direction of the sheath 2. At this time, similar to the treatment instrument 1G, the guide wire GW passes through the gap S inside the inhibition portion 7H and emerges from the slit 74H to the outside of the funnel tube 8.

[0104] According to the treatment instrument 1H, the guide wire GW can be prevented from entering the distal end of the slit 85 and the sheath slit 23 when the guide wire GW is moved forward or backward relative to the sheath 2, and the guide wire GW can be smoothly advanced relative to the sheath 2. On the other hand, according to the treatment instrument 1H, when the guide wire GW is withdrawn from the slit 74H of the inhibition portion 7H, the guide wire GW can be entered into the sheath slit 23, and the guide wire GW can be removed from the guide wire lumen 21 of the sheath 2.

[0105] (Fourth embodiment)

[0106] Refer to the attached Figures 24-26 The treatment instrument 1I of the fourth embodiment is described. The treatment instrument 1I of the fourth embodiment is an example in which the structure of the suppression portion 7I is different from the above-mentioned embodiments. The suppression portion 7I is provided at the distal portion of the sheath connecting portion 54. The suppression portion 7I includes a pair of pinching pieces 75, a pair of cover bodies 71I, and a pair of protrusions 76. The suppression portion 7I is formed with a narrow groove 74I along the narrow groove 56 of the sheath connecting portion 54. A pair of cover bodies 71I and a pair of pinching pieces 75 are formed on both sides of the narrow groove 74I. The suppression portion 7I is formed integrally with the sheath connecting portion 54. The cover body 71I is provided to cover the sheath 2 and the upper part of the sheath connecting portion 54. The pinching piece 75 extends from the end of the cover body 71I to the side of the sheath connecting portion 54 (attached). Figure 25 The pinch piece 75 is formed continuously with the cover body 71I. A pair of protrusions 76 are provided on the outer peripheral surface of the sheath connecting portion 54 at positions opposite the back surface of the pinch piece 75. The pinch piece 75 is harder than the cover body 71I. The cover body 71I is an example of a cover portion. The pinch piece 75 is an example of a switching member.

[0107] Attachment Figure 25 、 26 It is attached Figure 24 XXV-XXV line cross-sectional view. Figure 25 FIG. 7 shows the suppressing portion 7I of the first embodiment. Figure 26 The second state of the suppressing portion 7I is shown. When no external force is applied to the pair of pinching pieces 75, as shown in FIG. Figure 25As shown, the pair of cover bodies 71I are arranged close to each other and are in a first state covering the sheath slot 23. When the inhibitor 7I is in the first state, even if the operator advances the guide wire GW and the distal region of the guide wire GW cannot advance, the inhibitor 7I can prevent the guide wire GW from entering the sheath slot 23 further distal to the distal side D than the distal end of the slot 56.

[0108] As attached Figure 26 As shown, when force is applied in a direction that brings the lower ends of the pair of pinching tabs 75 closer together, the back surface 752 of the pinching tab 75 abuts the protrusion 76, the cover body 71I tilts, and the slot 74I opens. As a result, the second state is achieved, in which the upper portion of the sheath slot 23 is uncovered. The pinching tabs 75 are symmetrically arranged on both sides of the slot 56 that encloses the sheath connection portion 54. In the second state, when the sheath connection portion 54 is pulled to the proximal side P, the guidewire GW enters the sheath 23 and is withdrawn from the guidewire lumen 21 to the outside of the sheath 2. While maintaining the guidewire GW within the body, the treatment instrument 1I is removed from the endoscope insertion portion 101. When the external force applied to the pinching tabs 75 is released, the lower ends of the pair of pinching tabs 75 move away from each other and return to the first state.

[0109] According to the treatment instrument 1I of this embodiment, the inhibitor 7I is configured to be switchable between a first state and a second state. Therefore, when the sheath 2 is removed from the endoscope insertion portion 101, the inhibitor 7I is switched to the second state, thereby enabling the sheath 2 to be removed smoothly while maintaining the guide wire GW inserted into the body. This contributes to shortening the surgical time.

[0110] Attachment Figure 27 A treatment instrument 1J according to a modified example of the fourth embodiment is shown. Figure 27 In the treatment instrument 1J of the modified example shown, the structure of the connecting portion is different from that of the above-mentioned embodiment. For example, the structure of the suppression portion 7I of the fourth embodiment can also be applied to the funnel tube 8. In the treatment instrument 1J of this modified example, the suppression portion 7J is provided at the distal portion of the funnel tube 8. The basic structure of the suppression portion 7J is the same as that of the suppression portion 7I of the fourth embodiment. The suppression portion 7J is arranged at a position covering the proximal end of the sheath slot 23. When the suppression portion 7J is in the first state, even if the guide wire GW is exposed to the outside from the slot 83 of the funnel portion 82, the suppression portion 7A can prevent the guide wire GW from entering a position closer to the distal side D than the distal end of the slot 85. As a result, the guide wire GW can be prevented from entering from the proximal end of the sheath slot 23.

[0111] Meanwhile, while retaining the guidewire GW within the body, the operator removes the treatment instrument 1J from the endoscope insertion portion 101. The operator then pinches the pair of tabs 75J of the suppression portion 7J and opens and closes the pair of cover bodies 71J, switching the position to the second position. The operator then directs the guidewire GW from the proximal opening 84 of the funnel portion 82 into the slit 83 and through the slit 85. In this position, when the funnel tube 8 is pulled toward the proximal side P, the guidewire GW enters the sheath slit 23 and is withdrawn from the sheath 2.

[0112] According to the treatment instrument 1J of this embodiment, since the inhibitor 7J is configured to switch between a first state and a second state, it is possible to prevent the guide wire GW from entering the sheath slot 23 against the operator's will in the first state. When the sheath 2 is removed from the endoscope insertion portion 101, switching the inhibitor 7J to the second state allows the sheath 2 to be removed smoothly while maintaining the guide wire GW inserted into the body. This contributes to shortened surgical time.

[0113] (Fifth embodiment)

[0114] Refer to the attached Figure 28 、 29 A treatment instrument 1K according to a second embodiment will be described. The treatment instrument 1K according to this embodiment differs from the above-described embodiment in the structure of the suppressing portion 7K. Figure 29 It is attached Figure 28 The cross-sectional view of the line XXIX-XXIX of FIG. The connecting portion 5K has a cylindrical shape, and the proximal portion of the sheath 2 is inserted therein. A guide wire insertion port 55 is provided on the connecting portion 5K. The narrow groove 56K is formed from the distal end 551K of the guide wire insertion port 55 to the distal end of the connecting portion 5K. The width L56 of the narrow groove 56K is smaller than the diameter of the guide wire GW used in combination. Both sides of the narrow groove 56 in the circumferential direction constitute the suppression portion 7K. As shown in FIG. Figure 29 As shown, the suppression portion 7K is provided at a position covering the proximal end of the sheath slot 23 and the distal end of the proximal end opening 22. The pair of cover bodies 71K are thin and are configured to be elastically deformable under external force. The slot 56K is an example of a suppression slot.

[0115] When the inhibitor 7K is in the first position, the sheath slot 23 is covered by the inhibitor 7K. Therefore, even if a force is applied that would cause the guidewire GW, located within the guidewire lumen 21, to enter the slot 56K and emerge beyond the inhibitor 7K, significant resistance will be exerted on the guidewire GW. In particular, the distal end 551K of the guidewire insertion port 55 is located closer to the proximal side P than the distal end of the proximal opening 22 of the sheath 2. As a result, the guidewire GW is prevented from entering the proximal portion of the sheath slot 23.

[0116] On the other hand, when the operator intends to remove the guide wire GW from the guide wire lumen 21, by applying a greater force to the guide wire GW exposed from the guide wire insertion port 55 and moving the guide wire GW radially outward, the guide wire GW enters the slit 56K and can enter all the way into the sheath slit 23. As a result, the sheath 2 can be smoothly removed while the guide wire GW remains inserted into the body, which helps shorten the surgical time.

[0117] (Sixth embodiment)

[0118] Next, refer to the attached Figure 30 、 31 A treatment instrument 1L according to a sixth embodiment will be described. Figure 30 、 31 It is a cross-sectional view perpendicular to the long axis of the sheath 2. Figure 30 FIG. 1 shows the suppressing portion 7L in the first state. Figure 31 The suppression portion 7L in the second state is shown. The suppression portion 7L of the treatment instrument 1L of this embodiment includes a cylinder 70L and a sliding member 78. The cylinder 70L is formed with an insertion path from the distal end to the proximal end along the longitudinal direction, and the sheath 2 is inserted therein. The cylinder 70L is provided with a guide wire port in the same manner as the cylinder 70K of the fifth embodiment. A narrow groove 74L extending along the longitudinal axis is formed between the guide wire port and the distal end of the cylinder 70K. The circumferential position of the narrow groove 74L and the sheath narrow groove 23 are arranged at approximately the same position. The cover body 71L is arranged on both sides of the narrow groove 74L.

[0119] The sliding member 78 is configured to slide relative to the cylindrical body 70L in a direction perpendicular to the longitudinal axis. The sliding member 78 has a sliding groove having a generally U-shaped cross-section perpendicular to the longitudinal axis. The sliding groove comprises a first groove portion 781 located at the bottom of the groove, a third groove portion 783 located near the open end of the sliding groove, and a second groove portion 782 disposed between the first and third groove portions 781 and 783. The first groove portion 781 has a diameter substantially equal to that of the cylindrical body 70L.

[0120] As attached Figure 30 As shown, when the cylinder 70L is located in the first groove 781, the outer surface of the cylinder 70L contacts the first groove 781, and the pair of cover bodies 71L abut against each other, forming the first state. The second groove 782 is larger than the opening size of the first groove 781 and the third groove 783. The second groove 782 is a groove larger than the diameter of the cylinder 70L.

[0121] As attached Figure 30 As shown, when the suppression portion 7L is in the first state, the pair of cover bodies 71L are arranged at the positions of the sheath slots 23. Figure 31As shown, when the cylindrical body 70L is positioned in the second groove 782, the cylindrical body 70L expands radially outward from the first state, separating the pair of cover bodies 71L, thereby opening the slit 74L. The sheath slit 23 is not covered by the cover body 71, and the restraining portion 7L is in the second state. Because the opening width of the third groove 783 is smaller than that of the second groove 782, the sliding member 78 is less likely to fall out of the cylindrical body 70L.

[0122] The operator operates the sliding member 78 to switch the restraining portion 7L between the first and second states. To prevent the guidewire GW from entering the sheath slot 23, the operator moves the sliding member 78, positioning the barrel 70L in the first groove 781. In the first state, the slot 74L of the barrel 70L is closed, preventing the guidewire GW from entering the sheath slot 23. To remove the guidewire GW from the guidewire lumen 21, the operator moves the sliding member 78 radially of the sheath 2, positioning the barrel 70L in the second groove 782. As a result, the slot 74L of the barrel 70L opens, uncovering the sheath slot 23. In this state, if the operator moves the exposed portion of the guidewire GW radially outward, the guidewire GW enters the sheath slot 23. In this state, when the proximal portion of the treatment instrument 1L is removed, the guidewire GW can be removed from the endoscope insertion portion 101 while remaining within the body.

[0123] According to the treatment instrument 1L of this embodiment, the control unit 7L switches between the first and second states by sliding the sliding member 78. Therefore, according to the treatment instrument 1L, when the guide wire GW is advanced relative to the sheath 2, the guide wire GW is prevented from entering the sheath slot 23, allowing the guide wire GW to be smoothly advanced relative to the sheath 2. On the other hand, when the sheath 2 is removed from the endoscope insertion portion 101, by switching the restraining unit 7L to the second state, the sheath 2 can be smoothly removed while the guide wire GW remains inserted into the body. This contributes to shortened surgical time.

[0124] In the above embodiment, an example is shown in which the sliding member 78 slides in the radial direction of the sheath 2. However, the sliding member is not limited to this structure. Figure 32 、 33 As with the treatment instrument 1M of the illustrated modification, a structure may be employed in which the sliding member 78M is moved in the longitudinal direction.

[0125] In the attached Figure 32 、 33In the treatment instrument 1M shown, the suppression portion 7M includes a cylinder 70M and a sliding member 78M. The cylinder 70M has a tapered portion 77M whose diameter increases toward the distal side D. The distal end of the cylinder 70M has a larger outer diameter than the proximal end. The cylinder 70M forms a narrow groove 74M along the long axis from the distal end to the proximal end. The narrow groove 74M is arranged at a position corresponding to the sheath narrow groove 23. The narrow groove 74M is an example of a suppression narrow groove. The sheath 2 has a proximal end opening 22 on the proximal side P of the sheath narrow groove 23. The guide wire port 25 is wider than the opening width of the sheath narrow groove 23. The cylinder 70M is longer than the length of the guide wire port 25 of the sheath 2 in the long axis direction. The proximal end of the cylinder 70M is arranged at a position closer to the proximal side P than the proximal end of the proximal end opening 22 of the sheath 2. The distal end of the cylindrical body 70M is positioned to cover the proximal end of the sheath slot 23, which is located further distally than the proximal end opening 22. Cover bodies 71M are formed on both sides of the slot 74M in the circumferential direction. The pair of cover bodies 71M encompass and cover the boundary between the proximal end of the sheath slot 23 and the proximal end opening 22. The cylindrical body 70M is an elastically deformable resin component. The sliding member 78M is a C-shaped member that is more rigid than the cylindrical body 70M.

[0126] The sliding member 78M is locked to the outer periphery of the cylinder 70M. The sliding member 78M is provided so as to be able to slide from the proximal portion of the cylinder 70M to the tapered portion 77M. Figure 32 FIG. 2 shows the suppressing portion 7M in the second state. Figure 33 The suppressor 7M is shown in its first state. When the suppressor 7M is in its second state, the cover body 71M of the cylinder 70M covers a portion of the guidewire port 25 of the sheath 2, creating a gap for the guidewire GW to pass through. When the sliding member 78M moves from the second state to the distal side D, it advances within the tapered portion 77M. Because the cylinder 70M is elastically deformable, when the sliding member 78M moves toward the distal side D within the tapered portion 77M, the tapered portion 77M is pressed radially inward, bringing the cover bodies 71M on both sides of the slot 74M closer together. As the cover bodies 71M on both sides approach each other, the opening size of the slot 74M elastically deforms to become smaller than the opening size of the sheath slot 23. As a result, the cover bodies 71M come into contact, closing the slot 74M and switching to the first state in which the distal end of the guidewire port 25 and the proximal end of the sheath slot 23 are covered by the cover body 71.

[0127] According to the treatment instrument 1M of this embodiment, similar to the treatment instrument 1L of the sixth embodiment, the inhibitor 7M switches between the first and second states by sliding the sliding member 78M. Therefore, according to the treatment instrument 1M, when the guide wire GW is advanced relative to the sheath 2, the guide wire GW is prevented from entering the sheath slot 23, and the guide wire GW can be smoothly advanced relative to the sliding sleeve 2. On the other hand, when the sliding sleeve 2 is removed from the endoscope insertion portion 101, by switching the inhibitor 7M to the second state, the sheath 2 can be smoothly removed while the guide wire GW remains inserted into the body. This contributes to shortened surgical time.

[0128] In the treatment instruments of the above-mentioned embodiments and modifications, an example of injecting a contrast agent into the lumen 29 of the sheath 2 is shown. However, the treatment instrument is not limited to this example. Figure 34 Like the treatment device 1N shown in FIG. 1 , a structure in which a balloon 3N is connected to the lumen 29 may also be adopted. Figure 34 In FIG. 3 , the balloon 3N is enlarged and schematically shown. For example, as shown in FIG. Figure 35 As in the treatment instrument 1P shown in the figure, an example in which the knife wire 3P is inserted into the lumen 29 may be adopted.

[0129] The restraining portion may be formed by wrapping medical tape around the connecting portion 5. Specifically, the restraining portion may be formed by wrapping medical tape around at least one of the sheath slot 23 and the distal end of the proximal end opening 22 of the connecting portion 5.

[0130] The above describes various embodiments of the present invention. However, the technical scope of the present invention is not limited to the above embodiments. The combination of components in each embodiment may be modified, or various modifications or deletions may be made to each component without departing from the spirit of the present invention. The present invention is not limited by the above description.

[0131] Industrial Applicability

[0132] An endoscopic treatment instrument and a method for using the endoscopic treatment instrument enable smooth advancement and retraction of a guide wire, thereby contributing to shortening the operation time.

[0133] [Description of Reference Numerals]

[0134] 1, 1A, 1B, 1C, 1D, 1F, 1G, 1H, 1I, 1J, 1K, 1L, 1M, 1N, 1P Endoscopic disposal instruments

[0135] 2 sheath

[0136] 7, 7A, 7B, 7C, 7D, 7F, 7G, 7H, 7I, 7J, 7K, 7L, 7M Suppression unit 9 Operation unit

[0137] 23 sheath slots

[0138] 103 Operation Department

[0139] 551 distal end

[0140] 562 distal end

[0141] 751G near end

[0142] 751K remote end

Claims

1. An endoscopic treatment instrument comprising a restraining device for restraining the operation of a guide wire relative to a sheath, characterized in that: The sheath has a lumen for the guide wire to pass through, a sheath slot slotted radially outwardly of the sheath and communicating with the lumen, and a proximal end opening at a proximal end of the sheath slot communicating with the lumen. The suppressing device is provided in at least one of the sheath slot and the distal region of the proximal end opening so as to be openable and closable in the longitudinal direction of the endoscopic treatment instrument. With the suppressing device, the guide wire can be prevented from entering the sheath slot by maintaining a state in which at least one of the sheath slot and the distal region of the proximal end opening is closed.

2. The endoscopic treatment instrument according to claim 1, wherein The restraining device includes a fixing portion, a cover body and a locking claw. The cover body is rotatable with the fixing portion as a starting point.

3. The endoscopic treatment instrument according to claim 1 or 2, characterized in that: The restraining device is provided at the sheath connecting portion into which the proximal end of the sheath is inserted.

4. The endoscopic treatment instrument according to claim 3, wherein: The fixing portion connects the suppression device to the sheath connecting portion. The locking claw can be locked to the outer peripheral surface of the sheath connecting portion.

5. The endoscopic treatment instrument according to claim 3, wherein A guide wire insertion port communicating with the lumen is formed on the sheath connection portion, and a slot is formed from a distal end of the guide wire insertion port to a distal end of the sheath connection portion.

6. The endoscopic treatment instrument according to claim 3, wherein: The restraining device includes a holding protrusion, The holding protrusion is provided on the outer surface of the sheath connecting portion.

7. The endoscopic treatment instrument according to claim 1 or 2, characterized in that: The endoscopic treatment instrument includes a funnel tube through which the sheath is inserted and through which the guide wire is pulled out of the sheath. The funnel tube includes a cylindrical body and a funnel portion, and the suppressing device is provided on the cylindrical body distal to the funnel portion.

8. The endoscopic treatment instrument according to claim 7, characterized in that The fixing portion connects the suppression device to the cylinder. The locking claw can be locked on the outer peripheral surface of the cylindrical body.

9. The endoscopic treatment instrument according to claim 7, characterized in that The cylindrical body is formed with a sheath insertion path penetrating along the longitudinal direction. The funnel portion is extended outwardly from the outer surface of the cylindrical body. The funnel portion and the cylindrical body are formed with a narrow groove along the longitudinal direction.

10. The endoscopic treatment instrument according to claim 7, wherein The restraining device includes a holding protrusion, The holding protrusion extends outwardly and is arranged on the outer surface of the cylinder.

Images