Treatment tool for endoscope

Abstract

To provide a treatment tool for an endoscope capable of suitably performing incision / peeling treatment and local injection treatment and easy to handle.SOLUTION: A treatment tool for an endoscope includes a sheath, an electrode provided at a distal end portion of the sheath so as to be movable forward and backward, a rod provided so as to be movable forward and backward with respect to the electrode and the sheath, a through-hole that extends in a direction along a longitudinal axis of the electrode and through which the rod passes, and a conduit that extends in the direction along the longitudinal axis of the electrode, is a part of a flow path through which a fluid passes, and is different from the through-hole.SELECTED DRAWING: Figure 3

Description

Technical Field

[0001] The present invention relates to an endoscopic treatment instrument. This application claims the benefit of U.S. Provisional Application No. 63 / 476,800, filed Dec. 22, 2022, and U.S. Provisional Application No. 63 / 487,426, filed Feb. 28, 2023, the entire contents of which are incorporated herein by reference.

Background Art

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

[0003] The high-frequency knife for endoscopes described in Patent Document 1 and Patent Document 2 can perform incision and dissection procedures and local injection procedures.

Prior Art Documents

Patent Documents

[0004]

Patent Document 1

Patent Document 2

Summary of the Invention

Problems to be Solved by the Invention

[0005] However, since the high-frequency knife for endoscopes described in Patent Document 1 and Patent Document 2 has a configuration having a general cylindrical needle and a rod-shaped knife, the outer diameter of the sheath becomes large and it is not easy to handle.

[0006] In view of the above circumstances, an object of the present invention is to provide an endoscopic treatment instrument that can suitably perform incision and dissection procedures and local injection procedures and is easy to handle.

Means for Solving the Problems

[0007] In order to solve the above problems, the present invention proposes the following means. An endoscopic treatment instrument according to a first aspect of the present invention includes a sheath, an electrode provided at a distal end portion of the sheath so as to be movable forward and backward, a rod provided so as to be movable forward and backward with respect to the electrode and the sheath, a through hole extending in a direction along the longitudinal axis of the electrode and through which the rod passes, and a pipe line extending in a direction along the longitudinal axis of the electrode, which is a part of a flow path through which a fluid passes and is different from the through hole.

Advantages of the Invention

[0008] The endoscopic treatment instrument of the present invention can suitably perform incision / stripping treatment and local injection treatment, and is easy to handle.

Brief Description of the Drawings

[0009]

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

Figure 6

Figure 7

Figure 8

Figure 9

Figure 10

Figure 11

Figure 12

Figure 13

Figure 14

Figure 15

Figure 16

Figure 17

Figure 18

Figure 19

Figure 20

Figure 21

Figure 22

Figure 23

Figure 24

Figure 25

Figure 26

Figure 27

Figure 28

Figure 29

Figure 30

Figure 31

Figure 32

Figure 33

Figure 34

Figure 35

Figure 36

Figure 37

Figure 38

Figure 39

Figure 40

Figure 41

Figure 42

Figure 43

Figure 44

Figure 45

Figure 46

Figure 47

Figure 48

Figure 49

Figure 50

Figure 51

Embodiments for Carrying Out the Invention

[0010] (First Embodiment) The endoscope treatment system 300 according to the first embodiment of the present invention will be described with reference to FIGS. 1 to 7. FIG. 1 is an overall view of the endoscope treatment system 300 according to this embodiment.

[0011] [Endoscope Treatment System 300] As shown in FIG. 1, the endoscopic treatment system 300 includes an endoscope 200 and a treatment instrument 100. The treatment instrument 100 is used by being inserted into the endoscope 200.

[0012] [Endoscope 200] The endoscope 200 is a known flexible endoscope and includes an insertion portion 202 that is inserted into the body from the tip, and an operation portion 207 that is attached to the proximal end of the insertion portion 202.

[0013] The insertion portion 202 has an imaging portion 203, a bending portion 204, and a flexible portion 205. The imaging portion 203, the bending portion 204, and the flexible portion 205 are arranged in this order from the tip of the insertion portion 202. Inside the insertion portion 202, a channel 206 for inserting the treatment instrument 100 is provided. At the tip of the insertion portion 202, a tip opening 206a of the channel 206 is provided.

[0014] The imaging portion 203 includes an imaging element such as a CCD or a CMOS, and can image a site to be treated. The imaging portion 203 can image the knife 2 of the treatment instrument 100 in a state where the treatment instrument 100 protrudes from the tip opening 206a of the channel 206.

[0015] The bending portion 204 bends according to the operation of the operation portion 207 by the operator. The flexible portion 205 is a tubular portion having flexibility.

[0016] The operation portion 207 is connected to the flexible portion 205. The operation portion 207 has a grip 208, an input portion 209, a proximal end opening 206b of the channel 206, and a universal code 210. The grip 208 is a portion that is gripped by the operator. The input portion 209 receives an operation input for bending the bending portion 204. The universal code 210 outputs an image captured by the imaging portion 203 to the outside. The universal code 210 is connected to a display device such as a liquid crystal display via an image processing device including a processor or the like.

[0017] [Treatment Instrument 100] FIG. 2 is an overall view showing the treatment instrument 100. The treatment instrument (endoscopic treatment instrument) 100 includes a sheath 1, a knife 2, a sharp member 3, an operation wire 4 (see FIG. 4), and an operation unit 5. The operation wire 4 has a first operation wire 41 connected to the knife 2 and a second operation wire 42 connected to the sharp member 3. In the following description, in the longitudinal direction A of the treatment instrument 100, the side inserted into the patient's body is referred to as the "tip side (distal side) A1", and the operation unit 5 side is referred to as the "base end side (proximal side) A2".

[0018] The sheath 1 is a long tubular member extending from the tip 1a to the base end 1b. The sheath 1 has an outer diameter that can be inserted into the channel 206 of the endoscope 200 and can advance and retreat in the channel 206. As shown in FIG. 1, in a state where the sheath 1 is inserted into the channel 206, the tip 1a of the sheath 1 can protrude from and retract into the tip opening 206a of the channel 206.

[0019] FIG. 3 is a perspective view of the tip portion of the treatment instrument 100. The sheath 1 has a tube 10 extending in the longitudinal direction A and a tip member 11 provided at the tip of the tube 10. Note that the sheath 1 may be formed by integrally molding the tube 10 and the tip member 11.

[0020] FIG. 4 is a cross-sectional view of the tip portion of the treatment instrument 100 with the tip of the knife 2 at the first position P1. The tube 10 is a long tubular member having flexibility and insulation. The tube 10 is formed of, for example, resin. At the tip of the tube 10, a diameter-expanded portion (tip portion) 10a having a larger outer diameter than the base end side is provided. Note that the diameter-expanded portion (tip portion) 10a does not necessarily have to have a larger outer diameter than the tube 10 and may have the same outer diameter as the tube 10, for example. The tip member 11 is fitted and attached inside the diameter-expanded portion 10a. Note that the tip member 11 may be adhered to the diameter-expanded portion 10a with an adhesive or the like.

[0021] The distal end member 11 is formed in a cylindrical shape. Note that the "cylindrical shape" includes not only a strict cylindrical shape but also a shape close to a cylindrical shape. The distal end member 11 is preferably formed of an insulating material such as resin. A first through hole 12 and a second through hole 13 are formed in the distal end member 11.

[0022] The first through hole 12 is a hole provided in the distal end member 11 and penetrating the distal end member 11 in the longitudinal direction A. The tip of the first through hole 12 communicates with a first opening 12a formed in the distal end face 14 of the distal end member 11. The base end of the first through hole 12 communicates with the internal space 19 of the tube 10. The knife 2 is inserted through the first through hole 12.

[0023] The first through hole 12 has a first region 121 on the tip side A1 and a second region 122 (see FIG. 16) on the base end side A2. The first region 121 is a part of the through hole penetrating in the longitudinal direction A, and preferably has a circular cross section perpendicular to the longitudinal direction A. The second region 122 is a part of the through hole penetrating in the longitudinal direction A, and preferably has a circular cross section perpendicular to the longitudinal direction A. The first region 121 and the second region 122 communicate with each other. The inner diameter of the first region 121 is smaller than the inner diameter of the second region 122. A step 12g is formed between the first region 121 and the second region 122.

[0024] A flange storage portion 12f capable of storing the flange 21 of the knife 2 is formed in the first opening 12a of the first through hole 12 of the distal end member 11. When the knife 2 is accommodated in the sheath 1 and the flange 21 is accommodated in the flange storage portion 12f, that is, when the flange 21 abuts against the flange storage portion 12f, the tip of the knife 2 protrudes to the tip side A1 with respect to the distal end face 14 of the distal end member 11. Note that the flange storage portion 12f may not be formed in the first opening 12a.

[0025] The second through hole 13 is a hole provided in the distal end member 11 and penetrating the distal end member 11 in the longitudinal direction A. The tip of the second through hole 13 communicates with a second opening 13a formed in the distal end face 14 of the distal end member 11. The base end of the second through hole 13 communicates with the internal space 19 of the tube 10. The sharp member 3 is inserted through the second through hole 13.

[0026] The second opening 13a of the second through-hole 13 is arranged to be radially separated from the first opening 12a of the first through-hole 12 in the radial direction R. The first through-hole 12 and the second through-hole 13 are not in direct communication with each other.

[0027] FIG. 5 is a cross-sectional view of the distal end portion of the treatment instrument 100 where the tip of the knife 2 is at the second position P2. The knife (electrode) 2 is a metal round bar-shaped member. Note that the "round bar shape" includes not only a strict round bar shape but also a shape close to the round bar shape. The knife 2 is formed of a material such as stainless steel, for example. The knife 2 has conductivity and a high-frequency current is passed through it. The knife 2 has a knife body 20, a flange 21, and a connecting member 22.

[0028] The knife 2 is inserted through the first through-hole 12 of the distal end member 11 of the sheath 1 along the longitudinal direction A, and can protrude and retract from the first opening 12a toward the distal end side A1. Note that the knife 2 may be fixed so as not to be able to advance or retreat in a state of protruding from the first opening 12a toward the distal end side A1.

[0029] The central axis O2 of the knife 2 in the longitudinal direction A preferably coincides with the central axis O1 of the sheath 1 in the longitudinal direction A. Note that the "coincidence" includes not only a strictly coincident mode but also a mode that is almost coincident.

[0030] The knife body 20 is a metal round bar-shaped member. The outer diameter of the knife body 20 is smaller than the inner diameter of the first region 121. The knife body 20 can advance and retreat in the first region 121 in the longitudinal direction A.

[0031] FIG. 6 is a front view of the distal end portion of the treatment instrument 100 as viewed from the direction along the longitudinal direction A. The flange (tip diameter-expanded portion) 21 is a disc-shaped conductive member provided at the tip of the knife body 20. In a front view seen from the direction along the longitudinal direction A, the outer periphery of the flange 21 is formed concentrically with the outer periphery of the knife body 20. The length D2 in the radial direction R perpendicular to the longitudinal direction A of the flange 21 is longer than the length D1 in the radial direction R of the knife body 20. A flat base end face 21b is formed on the base end side A2 of the flange 21. Note that the flange 21 is not limited to a disc shape, and may be a triangular shape or a hook shape.

[0032] As shown in FIG. 4, when the knife 2 is retracted with respect to the sheath 1, the base end face 21b of the knife 2 and the flange storage portion 12f of the tip member 11 come into contact. By the base end face 21b of the knife 2 and the flange storage portion 12f of the tip member 11 coming into contact, the tip of the knife 2 is positioned at the first position P1 which is the most base end side A2 position.

[0033] The knife body 20 and the flange 21 have a first conduit 23 extending along the longitudinal direction A. The first conduit 23 communicates with a tip opening 23a formed in the flange 21. The tip opening 23a is an opening provided on the tip side A1 of the flange 21.

[0034] The connecting member 22 is a cylindrical member made of metal. Note that the "cylindrical shape" includes not only a strict cylindrical shape but also a shape close to a cylindrical shape. The connecting member 22 connects the knife body 20 and the first operation wire 41. The outer diameter of the connecting member 22 is larger than the inner diameter of the first region 121 and smaller than the inner diameter of the second region 122. The connecting member 22 cannot be inserted through the first region 121 in the longitudinal direction A, and can advance and retreat in the longitudinal direction A in the second region 122.

[0035] As shown in FIG. 5, when the knife 2 is advanced with respect to the sheath 1, the tip of the connecting member 22 and the step 12g of the tip member 11 come into contact. By the tip of the connecting member 22 and the step 12g of the tip member 11 coming into contact, the tip of the knife 2 is positioned at the second position P2 which is the most tip side A1 position.

[0036] The connecting member 22 has a second conduit 24 extending along the longitudinal direction A. The second conduit 24 communicates with the first conduit 23 and the third conduit 43 formed in the first operation wire 41.

[0037] The first operation wire 41 is attached to the proximal end of the connecting member 22. High-frequency current is supplied to the knife 2 via the first operation wire 41 connected to the operation unit 5. When high-frequency current is supplied from the first operation wire 41 to the knife 2, the knife body 20 and the flange 21 function as active electrodes for outputting the high-frequency current to the living tissue.

[0038] FIG. 7 is a cross-sectional view of the distal end portion of the treatment instrument 100 where the sharp member 3 is at the distal end position P4. FIG. 8 is a cross-sectional view taken along the line C0-C0 shown in FIG. 7. The sharp member (rod, solid needle) 3 is a rod-shaped member formed of a resin material, a metal material, a ceramic material, or the like. The sharp member 3 is a member thinner than the knife 2, and the outer diameter D3 of the sharp member 3 is smaller than the minimum outer diameter D1 of the portion of the knife 2 that can be exposed from the distal end member 11 of the sheath 1. The sharp member 3 has a main body portion 31, a sharp portion 32, and a flange 33.

[0039] The sharp member 3 is inserted through the second through-hole 13 of the distal end member 11 of the sheath 1 along the longitudinal direction A, and can protrude and retract from the second opening 13a to the distal end side A1. The sharp member 3 is provided so as to be able to advance and retreat in the longitudinal direction A at a position radially separated from the knife 2. Note that the sharp member 3 may be fixed so as not to be able to advance and retreat in a state where it protrudes from the second opening 13a to the distal end side A1.

[0040] The main body portion 31 is a long round bar-shaped member. Note that the “round bar shape” includes not only a strict round bar shape but also a shape close to the round bar shape. The outer diameter of the main body portion 31 is smaller than the inner diameter of the second through-hole 13. The main body portion 31 can advance and retreat in the longitudinal direction A through the second through-hole 13.

[0041] The sharp portion 32 is provided at the tip of the main body portion 31, and the distal end side A1 is formed in a tapered shape. The sharp portion 32 can advance and retreat in the longitudinal direction A through the second through-hole 13.

[0042] The flange (diameter-expanded portion) 33 is provided at the proximal end of the main body portion 31. The outer diameter of at least a part of the flange 33 is larger than the inner diameter of the proximal end opening 13b of the second through hole 13. The flange 33 cannot be inserted through the second through hole 13.

[0043] As shown in FIG. 7, when the sharp member 3 is advanced with respect to the sheath 1, the flange 33 of the sharp member 3 comes into contact with the proximal end opening 13b of the second through hole 13 of the tip member 11. By the flange 33 of the sharp member 3 coming into contact with the proximal end opening 13b of the second through hole 13, the tip of the sharp member 3 (the tip of the sharp portion 32) is positioned at the tip position P4 which is the most tip-side A1 position.

[0044] The protruding amount L3 of the sharp member 3 protruding from the second opening 13a when the tip of the sharp portion 32 is disposed at the tip position P4 (the maximum protruding amount of the sharp member 3, see FIG. 7) is longer than the protruding amount L2 of the knife 2 protruding from the first opening 12a when the tip of the knife 2 is disposed at the second position P2 (the maximum protruding amount of the knife 2, see FIG. 5).

[0045] Note that the protruding amount L3 of the sharp member 3 protruding from the second opening 13a when the tip of the sharp portion 32 is disposed at the tip position P4 may be shorter than the protruding amount L2 of the knife 2 protruding maximally from the first opening 12a when the tip of the knife 2 is disposed at the second position P2.

[0046] The operating wire 4 is a wire that passes through the internal space (pipe line, lumen) 19 of the sheath 1. The operating wire 4 has a first operating wire 41 and a second operating wire 42.

[0047] The first operating wire 41 is a wire for operating the knife 2. The first operating wire 41 has a coil shaft 44 and a tube 45. The tip of the first operating wire 41 is connected to the connecting member 22 of the knife 2, and the proximal end of the first operating wire 41 is connected to the slider 52 of the operating portion 5. Note that the first operating wire 41 may be in another form as long as it is a hollow shaft.

[0048] The coil shaft 44 is a hollow coil wire made of metal. The coil shaft 44 is formed of a material such as stainless steel, for example. Inside the coil shaft 44, a third pipe 43 is formed. The third pipe 43 is connected to the proximal end of the second pipe 24. The first pipe 23, the second pipe 24, and the third pipe 43 form a water supply passage WR. The fluid supplied from the liquid supply port 54 passes through the water supply passage WR (the third pipe 43, the second pipe 24, the first pipe 23) and is discharged from the tip opening 23a.

[0049] The tube 45 is a tube provided on the outer peripheral portion of the coil shaft 44 and is, for example, a heat shrinkable tube. By covering the outer peripheral portion of the coil shaft 44 with the tube 45, liquid does not leak from the third pipe 43.

[0050] The second operation wire 42 is a wire that operates the sharp member 3. The tip of the second operation wire 42 is connected to the flange 33 of the sharp member 3, and the proximal end of the second operation wire 42 is connected to the lever 55 of the operation unit 5.

[0051] As shown in FIGS. 1 and 2, the operation unit 5 includes an operation unit main body 51, a slider 52, a power supply connector 53, a liquid supply port 54, and a lever 55.

[0052] The tip of the operation unit main body 51 is connected to the proximal end 1b of the sheath 1. The operation unit main body 51 has an internal space through which the first operation wire 41 and the second operation wire 42 can be inserted. The first operation wire 41 passes through the internal space 19 of the tube 10 and the internal space of the operation unit main body 51 and extends to the slider 52. The second operation wire 42 passes through the internal space 19 of the tube 10 and the internal space of the operation unit main body 51 and extends to the lever 55.

[0053] The slider 52 (first slider) is attached to the operation unit main body 51 so as to be movable along the longitudinal direction A. The proximal end of the first operation wire 41 is attached to the slider 52. By the operator moving the slider 52 forward and backward relative to the operation unit main body 51, the first operation wire 41 and the knife 2 move forward and backward.

[0054] The power supply connector 53 is fixed to the slider 52. The power supply connector 53 can be connected to a high-frequency power supply device (not shown) and is connected to the proximal end portion of the first operation wire 41 via a conductive wire. The power supply connector 53 can supply the high-frequency current supplied from the high-frequency power supply device to the knife 2 via the first operation wire 41. Note that the power supply connector 53 may be fixed to the operation unit main body 51 instead of the slider 52.

[0055] The liquid supply port 54 is provided on the slider 52. The liquid supply port 54 is connected to the proximal end of the third pipe 43 via a pipe formed in the slider 52. The liquid supplied from the liquid supply port 54 passes through the water supply flow path WR (third pipe 43, second pipe 24, first pipe 23) and is discharged from the tip opening 23a. Note that the liquid supply port 54 may be provided on the operation unit main body 51 instead of the slider 52.

[0056] The lever 55 (second slider) is attached to the slider 52 so as to be movable along the longitudinal direction A. The proximal end of the second operation wire 42 is attached to the lever 55. By the operator moving the lever 55 forward and backward relative to the slider 52, the second operation wire 42 and the sharp member 3 move forward and backward.

[0057] [Modification example of the treatment instrument 100 (treatment instrument 100B)] FIGS. 9 to 11 are cross-sectional views showing a treatment instrument 100B which is a modification example of the treatment instrument 100. The treatment instrument 100B has a different water supply flow path WR compared to the treatment instrument 100. The treatment instrument 100B includes a sheath 1, a knife 2B, a sharp member 3, an operation wire 4B, and an operation unit 5. The knife 2B has a knife body 20, a flange 21, and a connecting member 22B.

[0058] The connecting member 22B further has a water supply port 22h as compared with the connecting member 22. The water supply port 22h is a hole formed along the radial direction R from the second pipeline 24 and opens on the outer peripheral surface of the connecting member 22B. The water supply ports 22h are formed on both sides with respect to the central axis O2 in the longitudinal direction A of the knife 2B.

[0059] The operation wire 4B is a wire that passes through the internal space (pipeline, lumen) 19 of the sheath 1. The operation wire 4B includes a first operation wire 41B and a second operation wire 42.

[0060] The first operation wire 41B is a wire that operates the knife 2B. The first operation wire 41B includes a coil shaft 44B and a tube 45. The tip of the first operation wire 41B is connected to the connecting member 22B of the knife 2B, and the base end of the first operation wire 41B is connected to the slider 52 of the operation unit 5.

[0061] The coil shaft 44B may be a coil shaft, or may be a solid wire of a single wire or a stranded wire made of metal instead of the coil shaft. In the present embodiment, a third pipeline 43 is not formed inside the coil shaft 44B. Therefore, the first operation wire 41B may not have the tube 45.

[0062] The liquid supply port 54 is connected to the base end of the internal space 19 of the sheath 1 via a pipeline formed in the slider 52. The liquid supplied from the liquid supply port 54 passes through the water supply flow path WR (the internal space 19 of the sheath 1, the water supply port 22h, the second pipeline 24, the first pipeline 23) and is discharged from the tip opening 23a.

[0063] [Method of using the endoscope treatment system 300] Next, a procedure using the endoscope treatment system 300 of the present embodiment (method of using the endoscope treatment system 300) will be described. Specifically, local injection treatment and incision / dissection treatment of a lesion site in endoscopic treatment such as ESD (endoscopic submucosal dissection) will be described.

[0064] As a preparatory operation, the operator identifies the lesion by a known method. Specifically, the operator inserts the insertion portion 202 of the endoscope 200 into the digestive tract (for example, the esophagus, stomach, duodenum, large intestine), and identifies the lesion while observing the image obtained by the imaging portion 203 of the endoscope.

[0065] <Insertion step> The operator inserts the treatment instrument 100 into the channel 206, and causes the tip 1a of the sheath 1 to protrude from the tip opening 206a of the insertion portion 202.

[0066] <Marking step> As shown in FIG. 4, the operator relatively retracts the slider 52 of the operation portion 5 with respect to the operation portion main body 51, and disposes the tip of the knife 2 at the first position P1. Using the tip portion of the flange 21 protruding from the tip surface 14 of the tip member 11, the living tissue around the lesion is cauterized for marking.

[0067] <Puncturing step> As shown in FIG. 7, the operator relatively advances the lever 55 of the operation portion 5 with respect to the slider 52, and disposes the tip of the sharp member 3 at the tip position P4. The operator punctures and penetrates the location where the local injection liquid (local injection solution) is to be injected at the lesion with the sharp member 3.

[0068] <Local injection step> As shown in FIG. 5, the operator relatively advances the slider 52 of the operation portion 5 with respect to the operation portion main body 51, and disposes the tip of the knife 2 at the second position P2. With the tip opening 23a of the tip of the knife 2 inserted into the submucosa through the hole formed by puncturing with the sharp member 3, the operator feeds the liquid (local injection solution) from the liquid supply port 54. The liquid (local injection solution) is discharged from the tip opening 23a.

[0069] <Incision and dissection step> Next, the operator performs the incision and dissection procedure. The operator advances the knife 2 and moves the flange 21 while passing a high-frequency current to incise the mucosa of the lesion. Further, the operator advances the knife 2 and, while passing a high-frequency current, lifts the incised mucosa of the lesion to expose the submucosa and dissects the submucosa of the incised lesion.

[0070] The operator continues the above-described operations (procedures) as necessary, finally excises the lesion, and ends the ESD procedure.

[0071] According to the treatment instrument 100 and the treatment instrument 100B according to the present embodiment, the incision and dissection procedure and the local injection procedure can be preferably performed, and the handling is easy.

[0072] As described above, the first embodiment of the present invention has been described in detail with reference to the drawings. However, the specific configuration is not limited to this embodiment, and design changes and the like within the scope not departing from the gist of the present invention are also included. Further, the components shown in the above-described embodiments and modified examples can be appropriately combined.

[0073] (Second Embodiment) The treatment instrument 100C according to the second embodiment of the present invention will be described with reference to FIGS. 12 to 16. In the following description, the same reference numerals are given to the configurations common to those already described, and the overlapping description is omitted.

[0074] FIG. 12 is a perspective view of the tip of the treatment instrument 100C. The treatment instrument (treatment instrument for an endoscope) 100C, like the treatment instrument 100 of the first embodiment, constitutes an endoscope treatment system together with the endoscope 200. The treatment instrument 100C includes a sheath 1, a knife 2C, a sharp member 3, an operation wire 4B, and an operation unit 5.

[0075] FIGS. 13 to 15 are cross-sectional views of the tip of the treatment instrument 100C. The knife (electrode) 2C is a metal round bar-shaped member. Note that the "round bar shape" includes not only a precise round bar shape but also a shape close to the round bar shape. The knife 2C is formed of a material such as stainless steel, for example. The knife 2C has conductivity and a high-frequency current is passed through it. The knife 2C has a knife body 20C, a flange 21C, and a connecting member 22C.

[0076] The knife 2C is inserted through the first through hole 12 of the tip member 11 of the sheath 1 along the longitudinal direction A, and can project in and out from the first opening 12a to the tip side A1. Note that the knife 2C may be fixed so as not to be able to advance or retreat in a state of protruding from the first opening 12a to the tip side A1.

[0077] The central axis O2 of the knife 2C in the longitudinal direction A preferably coincides with the central axis O1 of the sheath 1 in the longitudinal direction A. Note that the "coincidence" includes not only a strictly coincident mode but also a mode that is almost coincident.

[0078] The knife body 20C is a metal round bar-shaped member. The outer diameter of the knife body 20C is smaller than the inner diameter of the first region 121. The knife body 20C can advance and retreat in the first region 121 in the longitudinal direction A.

[0079] The flange (tip enlarged diameter portion) 21C is a disc-shaped conductive member provided at the tip of the knife body 20C. Similar to the first embodiment, in a front view seen from the direction along the longitudinal direction A, the outer periphery of the flange 21C is formed concentrically with the outer periphery of the knife body 20C. The length in the radial direction R perpendicular to the longitudinal direction A of the flange 21C is longer than the length in the radial direction R of the knife body 20C. A planar base end face 21b is formed on the base end side A2 of the flange 21C. Note that the flange 21C is not limited to a disc shape and may be a triangular shape or a hook shape.

[0080] As shown in FIG. 13, when the knife 2C is retracted with respect to the sheath 1, the base end surface 21b of the knife 2C contacts the flange storage portion 12f of the tip member 11. When the base end surface 21b of the knife 2C contacts the flange storage portion 12f of the tip member 11, the tip of the knife 2C is positioned at the first position P1, which is the most proximal position A2.

[0081] The knife body 20C and the flange 21C do not have the first conduit 23 extending along the longitudinal direction A.

[0082] The connecting member 22C is a metal cylindrical member. Note that the "cylindrical shape" includes not only a strict cylindrical shape but also a shape close to a cylindrical shape. The connecting member 22C connects the knife body 20C and the first operation wire 41B. The outer diameter of the connecting member 22C is larger than the inner diameter of the first region 121 and smaller than the inner diameter of the second region 122. The connecting member 22C cannot be inserted into the first region 121 in the longitudinal direction A, and can advance and retreat in the second region 122 in the longitudinal direction A.

[0083] As shown in FIG. 14, when the knife 2C is advanced with respect to the sheath 1, the tip of the connecting member 22C contacts the step 12g of the tip member 11. When the tip of the connecting member 22C contacts the step 12g of the tip member 11, the tip of the knife 2C is positioned at the second position P2, which is the most distal position A1.

[0084] The connecting member 22C does not have the second conduit 24 extending along the longitudinal direction A.

[0085] The first operation wire 41B is attached to the base end of the connecting member 22C. A high-frequency current is supplied to the knife 2C from the first operation wire 41B connected to the operation unit 5. When a high-frequency current is supplied to the knife 2C via the first operation wire 41B, the knife body 20C and the flange 21C function as an active electrode that outputs the high-frequency current to the biological tissue.

[0086] FIG. 16 is a cross-sectional view taken along the line C1-C1 shown in FIG. 15. The flange (diameter-expanded portion) 33 is provided at the proximal end of the main body portion 31. The outer diameter of at least a part of the flange 33 is larger than the inner diameter of the second through-hole 13. The flange 33 cannot be inserted through the second through-hole 13.

[0087] As shown in FIG. 15, when the sharp member 3 is advanced with respect to the sheath 1, the flange 33 of the sharp member 3 comes into contact with the proximal-end opening 13b of the second through-hole 13 of the tip member 11. By the flange 33 of the sharp member 3 coming into contact with the proximal-end opening 13b of the second through-hole 13, the tip (the tip of the sharp portion 32) of the sharp member 3 is positioned at the tip position P4 which is the most distal position A1.

[0088] As shown in FIG. 16, when viewed from the direction along the longitudinal direction A, the flange 33 is formed in a rectangular shape. When the flange 33 and the proximal-end opening 13b of the second through-hole 13 are in contact, there is a gap 13g between the flange 33 of the sharp member 3 and the proximal-end opening 13b. The gap 13g is a part of the water supply flow path WR through which the liquid flows. Note that the flange 33 may have a shape in which the gap 13g is formed when it comes into contact with the proximal-end opening 13b, and may be, for example, an oval shape or an elliptical shape when viewed from the direction along the longitudinal direction A.

[0089] The liquid supply port 54 is connected to the proximal end of the internal space 19 of the sheath 1 via a pipe line formed in the slider 52. The liquid supplied from the liquid supply port 54 passes through the water supply flow path WR (the internal space 19 of the sheath 1, the gap 13g, the second through-hole 13) and is discharged from the second opening 13a.

[0090] The protruding amount L3 of the sharp member 3 protruding from the second opening 13a when the tip of the sharp portion 32 is disposed at the tip position P4 (the maximum protruding amount of the sharp member 3, see FIG. 15) is longer than the protruding amount L2 of the knife 2C protruding from the first opening 12a when the tip of the knife 2C is disposed at the second position P2 (the maximum protruding amount of the knife 2C, see FIG. 14).

[0091] In addition, the protruding amount L3 of the sharp member 3 protruding from the second opening 13a when the tip of the sharp part 32 is disposed at the tip position P4 may be shorter than the protruding amount L2 of the knife 2C protruding maximally from the first opening 12a when the tip of the knife 2C is disposed at the second position P2.

[0092] [Modification example of treatment instrument 100C (treatment instrument 100D)] FIGS. 17 to 19 are cross-sectional views showing a treatment instrument 100D which is a modification example of the treatment instrument 100C. The treatment instrument 100D has a different water supply flow path WR compared to the treatment instrument 100C. The treatment instrument 100D includes a sheath 1, a knife 2D, a sharp member 3, an operation wire 4, and an operation unit 5. The knife 2D has a knife body 20C, a flange 21C, a connecting member 22B, and a backflow prevention member 25.

[0093] FIG. 20 is a perspective cross-sectional view showing the backflow prevention member 25. The backflow prevention member 25 is a disk-shaped member provided on the proximal end side A2 with respect to the water supply port 22h of the connecting member 22B. The backflow prevention member 25 prevents the liquid discharged to the outside of the connecting member 22B from the water supply port 22h from flowing back to the proximal end side A2. The backflow prevention member 25 is not limited to a member fixed to the connecting member 22B, and may be a member that slides along the connecting member 22B, such as an O-ring made of urethane rubber. Further, the backflow prevention member 25 is not limited to a member attached to the outer peripheral surface of the connecting member 22B, and may be a member attached to the inner peripheral surface of the tube 10.

[0094] FIG. 21 is a cross-sectional view taken along the line C2-C2 shown in FIG. 20. The backflow prevention member 25 is a member that covers the internal space 19 when viewed from the direction along the longitudinal direction A. The backflow prevention member 25 has a through hole 25a through which the second operation wire 42 is inserted.

[0095] The liquid supply port 54 is connected to the proximal end of the third pipeline 43 of the sheath 1 via a pipeline formed in the slider 52. The liquid supplied from the liquid supply port 54 passes through the water flow path WR (the third pipeline 43, the second pipeline 24, the water supply port 22h, the internal space 19 of the sheath 1, the second through hole 13) and is discharged from the second opening 13a.

[0096] According to the treatment instrument 100C and the treatment instrument 100D according to the present embodiment, an incision and peeling treatment and a local injection treatment can be preferably performed, and the handling is easy.

[0097] As described above, the second embodiment of the present invention has been described in detail with reference to the drawings. However, the specific configuration is not limited to this embodiment, and design changes and the like within the scope not departing from the gist of the present invention are also included. In addition, the components shown in the above-described embodiment and modification examples can be configured by appropriately combining them.

[0098] (Third Embodiment) The treatment instrument 100E according to the third embodiment of the present invention will be described with reference to FIGS. 22 to 26. In the following description, the same reference numerals are given to the configurations common to those already described, and the overlapping descriptions are omitted.

[0099] FIG. 22 is a perspective view of the distal end portion of the treatment instrument 100E. The treatment instrument (treatment instrument for endoscope) 100E, like the treatment instrument 100 of the first embodiment, constitutes an endoscope treatment system together with the endoscope 200. The treatment instrument 100E includes a sheath 1E, a knife 2E, a sharp member 3, an operation wire 4, and an operation unit 5.

[0100] The sheath 1E is a long tubular member extending from the distal end 1a to the proximal end 1b. The sheath 1E has an outer diameter that can be inserted into the channel 206 of the endoscope 200 and can advance and retreat in the channel 206. The sheath 1E has a tube 10 extending in the longitudinal direction A and a distal end member 11E provided at the distal end of the tube 10. Note that the sheath 1E may be formed by integrally molding the tube 10 and the distal end member 11E.

[0101] Figures 23 to 25 are cross-sectional views of the distal end of the treatment instrument 100E. The distal end member 11E is formed in a cylindrical shape. Note that the "cylindrical shape" includes not only a strict cylindrical shape but also a shape close to a cylindrical shape. The distal end member 11E is formed of an insulating material such as resin. A first through hole 12E is formed in the distal end member 11E.

[0102] The first through hole 12E is a hole provided in the distal end member 11E and penetrating the distal end member 11E in the longitudinal direction A. The tip of the first through hole 12E communicates with a first opening 12a formed in the distal end surface 14 of the distal end member 11E. The base end of the first through hole 12E communicates with the internal space 19 of the tube 10. The knife 2E is inserted through the first through hole 12E.

[0103] The first through hole 12E has a first region 121 on the tip side A1, a second region 122E, and a third region 123E on the base end side A2. The second region 122E is a part of the through hole penetrating in the longitudinal direction A, and preferably has a circular cross-section perpendicular to the longitudinal direction A. The third region 123E is a part of the through hole penetrating in the longitudinal direction A, and preferably has a circular cross-section perpendicular to the longitudinal direction A. The first region 121 and the second region 122E communicate with each other. The second region 122E and the third region 123E communicate with each other. The inner diameter of the first region 121 is smaller than the inner diameter of the second region 122E. The inner diameter of the second region 122E is smaller than the inner diameter of the third region 123E. A step 12Eg is formed between the second region 122E and the third region 123E.

[0104] A flange storage portion 12f capable of storing the flange 21 of the knife 2E and a water supply groove 12e are formed in the first opening 12a of the first through hole 12E of the distal end member 11E. Even when the flange 21 is stored in the flange storage portion 12f, the water supply groove 12e is not blocked by the flange 21, and the liquid supplied to the first through hole 12 is discharged from the water supply groove 12e.

[0105] The knife (electrode) 2E is a metal round bar-shaped member. Note that the "round bar shape" includes not only a strict round bar shape but also a shape close to the round bar shape. The knife 2E is formed of a material such as stainless steel, for example. The knife 2E has conductivity and a high-frequency current is passed through it. The knife 2E has a knife body 20, a flange 21, and a connecting member 22E.

[0106] As shown in FIG. 23, when the knife 2E is retracted with respect to the sheath 1E, the base end face 21b of the knife 2E and the flange storage portion 12f of the tip member 11E come into contact. By the base end face 21b of the knife 2E and the flange storage portion 12f of the tip member 11E coming into contact, the tip of the knife 2E is positioned at the first position P1 which is the position on the most proximal side A2.

[0107] FIG. 26 is a cross-sectional view taken along the line C3-C3 shown in FIG. 24. The connecting member 22E is a metal member and is formed in a shape in which both side surfaces in the radial direction R of the cylindrical shape are cut off. The connecting member 22E connects the knife body 20 and the first operation wire 41. The connecting member 22E has a maximum width that is larger than the inner diameter of the first region 121 in the radial direction R. The connecting member 22E has a maximum width that is larger than the inner diameter of the second region 122E in the radial direction R. At least a part of the connecting member 22E has a width that is smaller than the inner diameter of the second region 122E in the radial direction R. Specifically, when viewed from the direction along the longitudinal direction A, the connecting member 22E is formed in a shape in which a part of a circle is cut out. The maximum width of the connecting member 22E in the radial direction R is smaller than the inner diameter of the third region 123E. Therefore, the connecting member 22 cannot be inserted into the first region 121 and the second region 122E in the longitudinal direction A, and can advance and retreat in the longitudinal direction A in the third region 123E.

[0108] As shown in FIG. 24, when the knife 2E is advanced with respect to the sheath 1E, the tip of the connecting member 22E and the step 12Eg of the tip member 11E come into contact. By the tip of the connecting member 22E and the step 12Eg of the tip member 11E coming into contact, the tip of the knife 2E is positioned at the second position P2 which is the position on the most distal side A1.

[0109] The connecting member 22E has a second conduit 24 extending along the longitudinal direction A. The second conduit 24 communicates with the first conduit 23 and the third conduit 43 formed in the first operation wire 41. In the present embodiment, the first conduit 23, the second conduit 24, and the third conduit 43 are not used as a water supply flow path WR, but are used as conduits through which the sharp member 3 moves forward and backward.

[0110] The first operation wire 41 is attached to the proximal end of the connecting member 22E. High-frequency current is supplied to the knife 2E via the first operation wire 41 connected to the operation unit 5. When high-frequency current is supplied from the first operation wire 41 to the knife 2E, the knife body 20 and the flange 21 function as active electrodes that output the high-frequency current to the living tissue.

[0111] The sharp member 3 is inserted through the first conduit 23, the second conduit 24, and the third conduit 43 along the longitudinal direction A, and can protrude and retract from the tip opening 23a to the tip side A1.

[0112] The flange (diameter-expanded portion) 33 is provided at the proximal end of the main body portion 31. The outer diameter of the flange 33 is smaller than the inner diameter of the second conduit 24. The outer diameter of at least a part of the flange 33 is larger than the inner diameter of the proximal end opening 23b of the first conduit 23 and the inner diameter of the tip opening 43a of the third conduit 43. The flange 33 can move forward and backward in the second conduit 24 and cannot be inserted through the first conduit 23 and the third conduit 43.

[0113] As shown in FIG. 24, when the sharp member 3 is retracted with respect to the sheath 1E and the knife body 20, the flange 33 of the sharp member 3 comes into contact with the tip opening 43a of the third conduit 43 of the first operation wire 41. By the flange 33 of the sharp member 3 coming into contact with the tip opening 43a of the third conduit 43, the tip of the sharp member 3 is positioned at the proximal position P3, which is the most proximal side A2 position.

[0114] When the tip of the sharp member 3 is disposed at the proximal position P3, the sharp portion 32 of the sharp member 3 is housed in the second conduit 24.

[0115] As shown in Fig. 25, when the sharp member 3 is advanced with respect to the sheath 1E and the knife body 20, the flange 33 of the sharp member 3 comes into contact with the proximal opening 23b of the first conduit 23 of the knife body 20. By the flange 33 of the sharp member 3 coming into contact with the proximal opening 23b of the first conduit 23, the tip of the sharp member 3 (the tip of the sharp portion 32) is positioned at the tip position P4, which is the most distal position A1.

[0116] As shown in Fig. 26, when viewed from the direction along the longitudinal direction A, the connecting member 22E is formed in a shape in which a part of a circle is cut out. When the connecting member 22E and the second region 122E come into contact, a gap 122g is formed between the connecting member 22E and the second region 122E. The gap 122g is a part of the water supply passage WR through which the liquid flows.

[0117] The liquid supply port 54 is connected to the proximal end of the internal space 19 of the sheath 1E via a conduit formed in the slider 52. The liquid supplied from the liquid supply port 54 passes through the water supply passage WR (the internal space 19 of the sheath 1E, the first through hole 12, the gap 122g, the water supply groove 12e) and is discharged from the first opening 12a.

[0118] The protruding amount L3 of the sharp member 3 protruding from the first opening 12a when the tip of the sharp portion 32 is disposed at the tip position P4 (the maximum protruding amount of the sharp member 3, see Fig. 25) is longer than the protruding amount L2 of the knife 2E protruding from the first opening 12a when the tip of the knife 2E is disposed at the second position P2 (the maximum protruding amount of the knife 2E, see Fig. 24).

[0119] The maximum protruding amount of the sharp member 3 protruding from the first opening 23a when the tip of the sharp portion 32 is disposed at the tip position P4 is smaller than the protruding amount L2. Note that the maximum protruding amount of the sharp member 3 protruding from the first opening 23a when the tip of the sharp portion 32 is disposed at the tip position P4 may be larger than the protruding amount L2.

[0120] [Modified Example of the Treatment Instrument 100E (Treatment Instrument 100F)] Figs. 27 to 28 are perspective cross-sectional views showing a treatment instrument 100F which is a modification of the treatment instrument 100E. The treatment instrument 100F has a different water supply passage WR compared with the treatment instrument 100E. The treatment instrument 100F includes a sheath 1E, a knife 2F, a sharp member 3, an operation wire 4, and an operation section 5. The knife 2F has a knife body 20, a flange 21, a connecting member 22F, and a backflow prevention member 25.

[0121] The connecting member 22F further has a water supply port 22h compared with the connecting member 22E. The water supply port 22h is a hole formed along the radial direction R from the second pipe 24 and opens on the outer peripheral surface of the connecting member 22F. The water supply port 22h is formed on both sides with the central axis O2 in the longitudinal direction A of the knife 2F interposed therebetween.

[0122] The backflow prevention member 25 is a disk-shaped member provided on the proximal end side A2 of the connecting member 22F with respect to the water supply port 22h. The backflow prevention member 25 prevents the liquid discharged from the water supply port 22h to the outside of the connecting member 22F from flowing back to the proximal end side A2.

[0123] Fig. 29 is a cross-sectional view taken along line C4 - C4 shown in Fig. 28. The backflow prevention member 25 is a member that covers the internal space 19 when viewed from the direction along the longitudinal direction A. When the tip opening 43a of the third pipe 43 contacts the flange 33 of the sharp member 3, a gap 43g is formed between the flange 33 and the tip opening 43a. The gap 43g is a part of the water supply passage WR through which the liquid flows.

[0124] The liquid supply port 54 is connected to the proximal end of the third pipe 43 of the sheath 1E via a pipe formed in the slider 52. The liquid supplied from the liquid supply port 54 passes through the water supply passage WR (the third pipe 43, the gap 43g, the second pipe 24, the water supply port 22h, the internal space 19 of the sheath 1E, the first through hole 12, the gap 122g, the water supply groove 12e) and is discharged from the first opening 12a.

[0125] According to the treatment instrument 100E and the treatment instrument 100F according to the present embodiment, an incision and peeling treatment and a local injection treatment can be preferably performed, and the handling is easy.

[0126] As described above in detail with reference to the drawings for the third embodiment of the present invention, the specific configuration is not limited to this embodiment, and design changes and the like within the scope not departing from the gist of the present invention are also included. Further, the constituent elements shown in the above-described embodiments and modified examples can be configured by appropriately combining them.

[0127] (Fourth Embodiment) The treatment instrument 100G according to the fourth embodiment of the present invention will be described with reference to FIGS. 30 to 34. In the following description, for the configurations common to those already described, the same reference numerals are given and redundant descriptions are omitted.

[0128] FIGS. 30 and 31 are perspective views of the tip of the treatment instrument 100G. The treatment instrument (treatment instrument for endoscope) 100G, like the treatment instrument 100 of the first embodiment, constitutes an endoscope treatment system together with the endoscope 200. The treatment instrument 100G includes a sheath 1G, a knife 2G, a sharp member (needle) 3G, an operation wire 4, and an operation unit 5.

[0129] The sheath 1G is a long tubular member extending from the tip 1a to the base end 1b. The sheath 1G has an outer diameter that can be inserted into the channel 206 of the endoscope 200 and can advance and retreat in the channel 206. The sheath 1G has a tube 10 extending in the longitudinal direction A and a tip member 11G provided at the tip of the tube 10. Note that the sheath 1G may be formed by integrally molding the tube 10 and the tip member 11G.

[0130] FIGS. 32 to 34 are cross-sectional views of the tip of the treatment instrument 100G. The tip member 11G is formed in a cylindrical shape. Note that the “cylindrical shape” includes not only a strict cylindrical shape but also a shape close to a cylindrical shape. The tip member 11G is formed of an insulating material such as resin. A first through hole 12G is formed in the tip member 11G.

[0131] The first through-hole 12G is provided in the tip member 11G and is a hole that penetrates the tip member 11G in the longitudinal direction A. The tip of the first through-hole 12G communicates with a first opening 12Ga formed in the tip surface 14 of the tip member 11G. The base end of the first through-hole 12G communicates with the internal space 19 of the tube 10. The knife 2G and the sharp member 3G are inserted through the first through-hole 12G.

[0132] The first through-hole 12G has a first region 121G on the tip side A1 and a second region 122 on the base end side A2. The first region 121G is a through-hole whose cross-section perpendicular to the longitudinal direction A has a shape in which two concentric circles with different diameter dimensions are overlapped. The second region 122 is a part of a through-hole that penetrates in the longitudinal direction A, and preferably has a circular cross-section perpendicular to the longitudinal direction A. The first region 121G and the second region 122 communicate with each other. The inner diameter of the first region 121G is smaller than the inner diameter of the second region 122. A step 12Gg is formed between the first region 121G and the second region 122. The central axis of the second region 122 coincides with the central axis O2, and the central axis of the first region 121G is eccentric from the central axis O2.

[0133] FIG. 35 is a cross-sectional view taken along the line C5-C5 shown in FIG. 34. As shown in FIG. 32, the first region 121G is divided into a reduced-diameter region 124 whose length from the central axis O2 in the longitudinal direction A of the knife 2G is length R1 and an enlarged-diameter region 125 whose length from the central axis O2 is length R2 (length R2 > length R1). In the present embodiment, the reduced-diameter region 124 and the enlarged-diameter region 125 are each formed in a semi-circular shape when viewed from the direction along the longitudinal direction A.

[0134] The knife 2G is a metal round bar-shaped member. Note that the "round bar shape" includes not only a strict round bar shape but also a shape close to the round bar shape. The knife 2G is formed of a material such as stainless steel. The knife 2G has conductivity and a high-frequency current is passed through it. The knife 2G has a knife body 20 and a flange 21. The knife 2G does not have a connecting member 22. The knife body 20 and the first operation wire 41 are directly connected, and the first pipe 23 and the third pipe 43 communicate with each other.

[0135] The central axis O2 in the longitudinal direction A of the knife 2G coincides with the central axis O1 in the longitudinal direction A of the sheath 1G. Note that the term "coincides" includes not only the mode of exact coincidence but also the mode of almost coincidence.

[0136] The knife body 20 can advance and retreat in the first region 121G. The radius of the knife body 20 is smaller than the length R1. Therefore, the knife body 20 can advance and retreat in the reduced-diameter region 124 in the first region 121G.

[0137] As shown in FIG. 32, when the knife 2G is retracted with respect to the sheath 1G, the base end surface 21b of the knife 2G contacts the flange storage portion (first surface) 12f of the tip member 11G. When the base end surface 21b of the knife 2G contacts the flange storage portion 12f of the tip member 11G, the tip of the knife 2G is positioned at the first position P1, which is the most proximal position A2. With the base end surface 21b of the knife 2G in contact with the flange storage portion 12f of the tip member 11G, the sharp member 3G can advance and retreat in the longitudinal direction A with respect to the knife 2G. Note that the flange storage portion 12f does not necessarily have to be formed in the first opening 12Ga. In that case, the tip surface of the tip member 11G is the first surface and contacts the base end surface 21b of the knife 2G.

[0138] As shown in FIG. 33, when the knife 2G is advanced with respect to the sheath 1G, the tip of the first operation wire 41 contacts the step (second surface) 12Gg of the tip member 11G. When the tip of the first operation wire 41 contacts the step 12Gg of the tip member 11G, the tip of the knife 2G is positioned at the second position P2, which is the most distal position A1. With the connecting member 22C in contact with the step 12Gg of the tip chip 11G, the sharp member 3G can advance and retreat in the longitudinal direction A with respect to the knife 2G.

[0139] The sharp member (rod) 3G is a member formed of a resin material, a metal material, a ceramic material, or the like. The sharp member 3G has a main body portion 31G, a flange 33G, a tip portion 34G, and a sharp portion 35G.

[0140] The sharp member 3G is inserted through the first through hole 12G of the tip member 11G of the sheath 1G along the longitudinal direction A, and can project in and out from the first opening 12Ga to the tip side A1. The tip portion 34G of the sharp member 3G is provided so as to be able to advance and retreat in the longitudinal direction A at a position separated from the knife 2G in the radial direction R. Note that the sharp member 3G may be fixed so as not to be able to advance and retreat in a state of protruding from the first opening 12a to the tip side A1.

[0141] The main body portion 31G is a long cylindrical member. Note that the "cylindrical shape" includes not only a strict cylindrical shape but also a shape close to the cylindrical shape. The outer diameter of the main body portion 31G is larger than the inner diameter of the first region 121G and smaller than the inner diameter of the second region 122. The main body portion 31G cannot be inserted through the first region 121G in the longitudinal direction A, and can advance and retreat in the longitudinal direction A through the second region 122.

[0142] A fourth pipeline 36 is formed inside the main body portion 31G. The knife 2G is inserted through the fourth pipeline 36. The knife 2G can advance and retreat in the longitudinal direction A through the fourth pipeline 36.

[0143] The flange (diameter-expanded portion) 33G is provided at the proximal end of the main body portion 31G. At least a part of the outer diameter of the flange 33G is larger than the inner diameter of the proximal end opening 12b of the first through hole 12G. The flange 33G cannot be inserted through the first through hole 12G. The tip of the second operation wire 42 is connected to the flange 33G of the sharp member 3G.

[0144] The tip portion 34G extends from the tip of the main body portion 31G and is formed in a semi-cylindrical shape obtained by dividing the cylindrical member along the longitudinal direction A. That is, the tip portion 34G has a slit portion 34a formed in a semi-cylindrical shape. A part of the flange 21 protrudes radially outward from the outer peripheral surface and / or the inner peripheral surface of the main body portion 31G, and the flange 21 can advance and retreat on the distal side A1 from the proximal end 34b of the slit portion 34a. Further, the slit portion 34a does not necessarily have to be in a semi-cylindrical shape, and for example, a groove having a width smaller than the inner diameter of the main body portion 31 may be formed along the longitudinal direction A.

[0145] The sharp part 35G is a member with a sharp tip side A1 provided at the tip of the tip part 34G. As shown in FIGS. 30 and 31, the sharp part 35G is formed such that the edge 35a of the semi-cylindrical tip side A1 is inclined with respect to the longitudinal direction A. The tip 35b of the sharp part 35G tapers toward the tip side A1.

[0146] As shown in FIG. 35, the tip part 34G and the sharp part 35G cannot pass through the reduced-diameter region 124 and can advance and retreat in the enlarged-diameter region 125 in the first region 121G. Also, the position of the maximum outer circumference of the base end surface 21b of the knife is located outside the inner circumferential surface of the reduced-diameter region 124, and the flange 21 cannot pass through the reduced-diameter region 124.

[0147] As shown in FIG. 34, when the sharp member 3G is advanced with respect to the sheath 1G, the tip 31a of the main body part 31G of the sharp member 3G comes into contact with the step 12Gg of the tip member 11G. By the tip 31a of the main body part 31G of the sharp member 3G coming into contact with the step 12Gg of the tip member 11G, the tip of the sharp member 3G is positioned at the tip position P4, which is the most tip-side A1 position. Note that the tip of the flange 33G of the sharp member 3G may come into contact with the base end opening 12b of the first through-hole 12G so that the tip of the sharp member 3G is positioned at the tip position P4.

[0148] The protruding amount L3 of the sharp member 3G protruding from the first opening 12Ga when the tip of the sharp part 35G is disposed at the tip position P4 (the maximum protruding amount of the sharp member 3G, see FIG. 34) is longer than the protruding amount L2 of the knife 2G protruding from the first opening 12Ga when the tip of the knife 2G is disposed at the second position P2 (the maximum protruding amount of the knife 2G, see FIG. 33).

[0149] The liquid supply port 54 is connected to the base end of the third pipeline 43 via a pipeline formed in the slider 52. The liquid supplied from the liquid supply port 54 passes through the water supply flow path WR (the third pipeline 43, the first pipeline 23) and is discharged from the tip opening 23a.

[0150] [Modification example of the treatment instrument 100G (treatment instrument 100H)] Figs. 36 to 38 are cross-sectional views showing a treatment instrument 100H which is a modified example of the treatment instrument 100G. The treatment instrument 100H has a different water supply passage WR compared to the treatment instrument 100G. The treatment instrument 100H includes a sheath 1G, a knife 2H, a sharp member 3G, an operating wire 4B, and an operating section 5. The knife 2H has a knife body 20, a flange 21, and a connecting member 22B.

[0151] The knife 2H is inserted through the fourth pipe 36. The knife 2H is movable forward and backward in the longitudinal direction A of the fourth pipe 36.

[0152] The liquid supply port 54 is connected to the proximal end of the internal space 19 of the sheath 1G via a pipe formed in the slider 52. The liquid supplied from the liquid supply port 54 passes through the water supply passage WR (the internal space 19 of the sheath 1G, the water supply port 22h, the second pipe 24, the first pipe 23) and is discharged from the tip opening 23a.

[0153] According to the treatment instruments 100G and 100H according to the present embodiment, an incision / stripping treatment and a local injection treatment can be suitably performed, and the handling is easy.

[0154] As described above, the fourth embodiment of the present invention has been described in detail with reference to the drawings. However, the specific configuration is not limited to this embodiment, and design changes and the like within the scope not departing from the gist of the present invention are also included. In addition, the constituent elements shown in the above-described embodiments and modified examples can be combined as appropriate.

[0155] (Fifth Embodiment) The treatment instrument 100I according to the fifth embodiment of the present invention will be described with reference to Figs. 39 to 42. In the following description, the same reference numerals are given to the configurations common to those already described, and the overlapping description is omitted.

[0156] Fig. 39 is a perspective view of the tip portion of the treatment instrument 100I. The treatment instrument (endoscopic treatment instrument) 100I constitutes an endoscopic treatment system together with the endoscope 200, similar to the treatment instrument 100 of the first embodiment. The treatment instrument 100I includes a sheath 1G, a knife 2C, a sharp member (needle) 3I, an operating wire 4I, and an operating section 5.

[0157] Figs. 40 to 42 are cross-sectional views of the tip of the treatment instrument 100I. As shown in Fig. 40, when the knife 2C is retracted with respect to the sheath 1G, the base end face 21b of the knife 2C contacts the flange storage section (first face) 12f of the tip member 11G. When the base end face 21b of the knife 2C contacts the flange storage section 12f of the tip member 11G, the tip of the knife 2C is positioned at the first position P1, which is the position on the most proximal side A2. With the base end face 21b of the knife 2C in contact with the flange storage section 12f of the tip member 11G, the sharp member 3I can move forward and backward in the longitudinal direction A with respect to the knife 2C. Note that the flange storage section 12f does not necessarily need to be formed in the first opening 12Ga. In that case, the tip face of the tip member 11G is the first face and contacts the base end face 21b of the knife 2C.

[0158] The connecting member 22C connects the knife body 20C and the first operating wire 41B. The outer diameter of the connecting member 22C is larger than the inner diameter of the first region 121G and smaller than the inner diameter of the second region 122. The connecting member 22C cannot be inserted through the first region 121G in the longitudinal direction A and can move forward and backward in the longitudinal direction A through the second region 122.

[0159] As shown in Fig. 41, when the knife 2C is advanced with respect to the sheath 1G, the tip of the connecting member 22C contacts the step (second face) 12Gg of the tip member 11G. When the tip of the connecting member 22C contacts the step 12Gg of the tip member 11G, the tip of the knife 2C is positioned at the second position P2, which is the position on the most distal side A1. With the connecting member 22C in contact with the step 12Gg of the tip chip 11G, the sharp member 3I can move forward and backward in the longitudinal direction A with respect to the knife 2C.

[0160] The sharp member 3I is a member formed of a resin material, a metal material, a ceramic material, or the like. The sharp member 3I has a main body portion 31G, a tip portion 34G, and a sharp portion 35G. The sharp member 3I does not have a flange 33G.

[0161] The knife 2C is inserted through the fourth pipeline 36 of the sharp member 3I. The knife 2C can advance and retreat in the longitudinal direction A of the fourth pipeline 36.

[0162] As shown in FIG. 42, when the sharp member 3I is advanced with respect to the sheath 1G, the tip 31a of the main body portion 31G of the sharp member 3I contacts the step 12Gg of the tip member 11G. By the tip 31a of the main body portion 31G of the sharp member 3I contacting the step 12Gg of the tip member 11G, the tip of the sharp member 3I is positioned at the tip position P4, which is the most tip-side A1 position.

[0163] The operation wire 4I is a wire that passes through the internal space (pipeline, lumen) 19 of the sheath 1G. The operation wire 4I has a first operation wire 41B and a second operation wire 42I.

[0164] The second operation wire 42I is a wire that operates the sharp member 3I. The second operation wire 42I is a hollow coil wire made of metal. The second operation wire 42I may be a tube. The tip of the second operation wire 42I is externally fitted to the main body portion 31G of the sharp member 3I. The base end of the second operation wire 42I is connected to the lever 55 of the operation unit 5.

[0165] The protruding amount L3 of the sharp member 3I protruding from the first opening 12Ga when the tip of the sharp portion 35G is disposed at the tip position P4 (the maximum protruding amount of the sharp member 3I, see FIG. 42) is longer than the protruding amount L2 of the knife 2C protruding from the first opening 12Ga when the tip of the knife 2C is disposed at the second position P2 (the maximum protruding amount of the knife 2C, see FIG. 41).

[0166] The liquid supply port 54 is connected to the proximal end of the second operation wire 42I via a pipeline formed in the slider 52. The liquid supplied from the liquid supply port 54 passes through the water flow path WR (the internal space 46 of the second operation wire 42I, the fourth pipeline 36, the internal space 19 of the sheath 1G, the first through hole 12G) and is discharged from the first opening 12Ga.

[0167] [Modified Example of the Treatment Instrument 100I (Treatment Instrument 100J)] FIG. 43 is a perspective view showing a treatment instrument 100J which is a modified example of the treatment instrument 100I. FIGS. 44 to 46 are cross-sectional views of the tip portion of the treatment instrument 100J. The treatment instrument 100J has a different water flow path WR compared to the treatment instrument 100I. The treatment instrument 100J includes a sheath 1G, a knife 2C, a sharp member 3J, an operation wire 4I, and an operation unit 5.

[0168] The sharp member 3J is a member formed of a resin material, a metal material, a ceramic material, or the like. The sharp member 3J has a main body portion 31J, a tip portion 34G, and a sharp portion 35G.

[0169] The main body portion 31J further has a water supply port 31h compared to the main body portion 31G. The water supply port 31h is a hole formed along the radial direction R from the fourth pipeline 36 and opens on the outer peripheral surface of the main body portion 31J.

[0170] The liquid supply port 54 is connected to the proximal end of the internal space 19 of the sheath 1G via a pipeline formed in the slider 52. The liquid (fluid) supplied from the liquid supply port 54 passes through the water supply passage WR (the internal space 19 of the sheath 1G, the water supply port 31h, the fourth pipeline 36) and is discharged from the sharp part 35G of the sharp member 3J as shown in FIGS. 43 and 46. More specifically, as shown in FIG. 46, when the sharp part 35G of the sharp member 3J and the knife 2C protrude from the first opening 12Ga (sheath 1G), the gap 36g between the knife 2C and the sharp part 35G of the sharp member 3J forms a part of the water supply passage WR, and the liquid that has passed through the internal space 19 of the sheath 1G passes through the gap 36g. As shown in FIGS. 44 and 45, when the sharp member 3J is accommodated in the sheath 1G, the liquid that has passed through the internal space 19 of the sheath 1G is discharged from the enlarged diameter region 125 without passing through the gap 36g.

[0171] According to the treatment instruments 100I and 100J according to this embodiment, the incision and peeling treatment and the local injection treatment can be preferably carried out, and the handling is easy.

[0172] As described above, the fifth embodiment of the present invention has been described in detail with reference to the drawings. However, the specific configuration is not limited to this embodiment, and design changes and the like within the scope not departing from the gist of the present invention are also included. In addition, the constituent elements shown in the above-described embodiments and modified examples can be combined as appropriate.

[0173] FIG. 47 is a diagram showing an operation unit 5K which is a modified example of the operation unit 5. The operation unit 5K includes an operation unit main body 51, a first slider 52, a power supply connector 53, a liquid supply port 54, and a second slider 55K.

[0174] The liquid supply port 54 is provided in the operation unit main body 51. The liquid supply port 54 is connected to the proximal end of the third pipeline 43 via a pipeline formed in the operation unit main body 51.

[0175] The second slider 55K is attached to the operation unit main body 51 so as to be movable along the longitudinal direction A. The second slider 55K is attached to the tip side A1 with respect to the first slider 52. The base end of the second operation wire 42 is attached to the second slider 55K. By the operator moving the second slider 55K forward and backward relative to the first slider 52, the second operation wire 42 and the sharp member 3 move forward and backward.

[0176] FIG. 48 and FIG. 49 are diagrams showing an operation unit 5L which is a modified example of the operation unit 5. The operation unit 5L includes an operation unit main body 51, a first slider 52L, a power supply connector 53, a liquid supply port 54, a second slider 55L, and a switch 56.

[0177] The first slider 52L is attached to the operation unit main body 51 so as to be movable along the longitudinal direction A. The base end of the first operation wire 41 is attached to the first slider 52L. By the operator moving the first slider 52L forward and backward relative to the operation unit main body 51, the first operation wire 41 and the knife 2 move forward and backward. When the operator releases the hand from the first slider 52L, the position of the first slider 52L with respect to the operation unit main body 51 is fixed by a locking mechanism such as a ball click.

[0178] The second slider 55L is attached to the first slider 52L so as to be movable along the longitudinal direction A. The second slider 55L can move forward and backward together with the first slider 52L, and can also move forward and backward independently with respect to the first slider 52L. The base end of the second operation wire 42 is attached to the second slider 55L. By the operator moving the second slider 55L forward and backward relative to the operation unit main body 51, the second operation wire 42 and the sharp member 3 move forward and backward.

[0179] The switch 56 restricts the forward and backward movement of the first slider 52L and the second slider 55L along the longitudinal direction A. When the switch 56 is pressed, the forward and backward movement of the first slider 52L and the second slider 55L is not restricted. When the switch 56 is not pressed, the forward and backward movement of the first slider 52L and the second slider 55L is restricted.

[0180] FIGS. 50 and 51 are diagrams showing an operation unit 5M which is a modified example of the operation unit 5. The operation unit 5M includes an operation unit main body 51, a first slider 52M, a liquid supply port 54, and a second slider 55M.

[0181] The first slider 52M is movably attached to the operation unit main body 51 along the longitudinal direction A. The proximal end of the first operation wire 41 is attached to the first slider 52M. By the operator moving the first slider 52M forward and backward relative to the operation unit main body 51, the first operation wire 41 and the knife 2 move forward and backward. When the operator releases the hand from the first slider 52M, the position of the first slider 52M relative to the operation unit main body 51 is fixed by a locking mechanism such as a ball click.

[0182] The second slider 55M is movably attached to the operation unit main body 51 along the longitudinal direction A independently of the first slider 52M. However, in the state where the first slider 52M is retracted as shown in FIG. 50, the second slider 55M cannot move forward because it contacts the first slider 52M. The proximal end of the second operation wire 42 is attached to the second slider 55M. By the operator moving the second slider 55M forward and backward relative to the operation unit main body 51, the second operation wire 42 and the sharp member 3 move forward and backward.

[0183] Note that the operation unit 5K, the operation unit 5L, and the operation unit 5M which are modified examples of the operation unit 5 can be used in place of the operation unit 5 of the first to fifth embodiments.

Industrial Applicability

[0184] The present invention can be applied to an endoscopic treatment instrument having a water supply function and the like.

Explanation of Signs

[0185] 300 Endoscopic treatment system 200 Endoscope 100, 100B, 100C, 100D, 100E, 100F, 100G, 100H, 100I, 100J Treatment instrument (endoscopic treatment instrument) 1, 1E, 1G Sheath 10 Tube 11, 11E, 11G Tip member 12, 12E, 12G First through-hole 12a, 12Ga First opening 12b Base end opening 12e Water supply groove 12f Flange storage part 12g, 12Eg, 12Gg Step 121, 121G First region 122, 122E Second region 122g Gap 123E Third region 124 Reduced diameter region 125 Enlarged diameter region 13 Second through-hole 13a Second opening 13b Base end opening 13g Gap 14 Tip surface 19 Internal space (pipe, lumen) 2, 2B, 2C, 2D, 2E, 2F, 2G, 2H, 2I Knife (electrode) 20, 20C Knife body 21, 21C Flange (tip enlarged diameter part) 21b Base end surface 22, 22B, 22C, 22E Connecting member 22h Water supply port 23 First pipe 23a Tip opening 23b Base end opening 24 Second pipe 25 Backflow prevention member 25a Through-hole 3,3G,3I,3J Sharp members (rods, solid needles) 31,31G,31I,31J Body part 31a Tip 32 Sharp part 33 Flange (diameter-expanded part) 33G Flange (diameter-expanded part) 33h Water inlet 34a Slit part 34b Base end 34G Tip part 35G Sharp part 35a Edge 35b Tip 36 Fourth pipeline 4,4B,4I Operating wire 41,41B First operating wire 42,42I Second operating wire 43 Third pipeline 43a Tip opening 43g Gap 44,44B Coil shaft 45 Tube 46 Internal space 5 Operating part 51 Operating part body 52 Slider 53 Power supply connector 54 Liquid supply port 55 Lever P1 First position P2 Second position P3 Base end position P4 Tip position R Radial direction WR Water flow path

Claims

1. A sheath, An electrode provided at the tip of the sheath so as to be movable forward and backward; a rod provided so as to be movable forward and backward with respect to the electrode and the sheath; a through hole extending in a direction along the longitudinal axis of the electrode and through which the rod passes; a conduit extending in a direction along a longitudinal axis of the electrode, which is a part of a flow path through which a fluid passes and is different from the through hole; Equipped with Endoscopic treatment tools.

2. The conduit is formed in the electrode. The endoscopic treatment tool according to claim 1 .

3. The sheath includes a tube and a tip member connected to a tip portion of the tube, The through hole is formed in the tip member. The endoscopic treatment tool according to claim 1 or 2.

4. The electrode passes through a first opening, which is a tip of the duct formed on the tip side of the sheath, The rod passes through a second opening, which is a tip of the through hole formed at a position on the tip side of the sheath and radially spaced from the first opening. The endoscopic treatment tool according to claim 3 .

5. The rod has a sharp tip so that it can puncture tissue. The endoscopic treatment tool according to claim 4.

6. The sheath includes a tube and a tip member connected to a tip portion of the tube, The conduit is formed in the tip member, The electrode passes through the conduit. The endoscopic treatment tool according to claim 1 .

7. The through hole is formed in the electrode, The rod passes through the through hole. The endoscopic treatment tool according to claim 1 or 6.

8. The rod has a sharp tip so that it can puncture tissue. The endoscopic treatment tool according to claim 7.

9. The rod has a flange on a proximal side relative to a proximal opening of the through hole, An outer diameter of at least a portion of the flange is larger than an inner diameter of the base end opening of the through hole. The endoscopic treatment tool according to claim 3 .

10. The rod is made of a resin or ceramic material. The endoscopic treatment tool according to claim 3 or 9.

11. The first opening and the second opening are formed on a distal end surface of the distal end member. The endoscopic treatment tool according to claim 4.

12. The first opening and the second opening are formed on a distal end surface of the distal end member. The endoscopic treatment tool according to claim 4.

13. a maximum protrusion amount of the rod from the second opening is greater than a maximum protrusion amount of the electrode from the first opening; The endoscopic treatment tool according to claim 4.

14. The tip member is formed of an insulating material, the first opening and the second opening are formed in the tip member, The rod has a flange that abuts against the tip member when the tip of the rod protrudes from the second opening. The endoscopic treatment tool according to claim 4.

15. a protruding amount of the rod from the second opening when the flange abuts against the tip member is longer than a maximum protruding amount of the electrode from the first opening; The endoscopic treatment tool according to claim 14.

16. a protruding amount of the rod from the second opening when the flange abuts against the tip member is shorter than a maximum protruding amount of the electrode from the first opening; The endoscopic treatment tool according to claim 14.

Images