Endoscopic treatment tools

Abstract

To provide a treatment tool for an endoscope capable of appropriately performing an incision or exfoliation treatment or a local injection treatment and is easier to handle.SOLUTION: A treatment tool for an endoscope includes: a sheath having a distal end and a proximal end and extending between the distal end and the proximal end; an electrode provided on a distal end portion of the sheath; and a rod provided at a position away from the electrode in a radial direction in a manner of being freely movable forward and backward. In a state where at least the electrode and the rod protrude from the sheath, a part of a flow path through which a fluid passes is formed in at least a part of a space between the electrode and the rod.SELECTED DRAWING: Figure 3

Description

[Technical field]

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

[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, etc. have been used.

[0003] The endoscopic high-frequency knives described in Patent Documents 1 and 2 can perform incision / dissection treatment and local injection treatment. [Prior art documents] [Patent documents]

[0004] [Patent Document 1] China Utility Model No. 211355353 [Patent Document 2] China Utility Model No. 209032622 Summary of the Invention [Problem to be solved by the invention]

[0005] However, the endoscopic high-frequency knives described in Patent Documents 1 and 2 have a configuration including a typical cylindrical needle and a rod-shaped knife, which results in a large outer diameter of the sheath and makes them difficult to handle.

[0006] In view of the above circumstances, an object of the present invention is to provide an endoscopic treatment tool that can suitably perform incision / dissection treatment and local injection treatment and is easy to handle. [Means for solving the problem]

[0007] In order to solve the above problems, the present invention proposes the following means. In a first aspect of the present invention, an endoscopic treatment tool comprises a sheath having a tip and a base end and extending between the tip and the base end, an electrode provided at the tip of the sheath, and a rod provided at a position radially spaced from the electrode so as to be able to move forward and backward, and when at least the electrode and the rod are protruding from the sheath, a portion of a flow path through which a fluid passes is formed at least in part between the electrode and at least a part of the rod. Effect of the Invention

[0008] The endoscopic treatment tool of the present invention can suitably perform incision / dissection treatment and local injection treatment, and is easy to handle. [Brief description of the drawings]

[0009] [Figure 1] 1 is an overall view of an endoscopic treatment system according to a first embodiment. [Diagram 2] 2 is an overall view showing a treatment tool of the endoscope treatment system. FIG. [Diagram 3] FIG. [Figure 4] 4 is a cross-sectional view of the distal end of the treatment tool with the tip of the knife in a first position. FIG. [Diagram 5] 11 is a cross-sectional view of the distal end of the treatment tool with the tip of the knife in a second position. FIG. [Figure 6] 13 is a front view of the distal end of the treatment tool as viewed from a direction along the longitudinal direction. FIG. [Figure 7] 13 is a cross-sectional view of the distal end portion of the treatment tool with a sharp member at the distal end position. FIG. [Figure 8] 8 is a cross-sectional view taken along the line C0-C0 shown in FIG. 7. [Figure 9] FIG. 11 is a cross-sectional view showing a modified example of the treatment tool. [Figure 10] FIG. [Figure 11] FIG. [Figure 12]FIG. 11 is a perspective view of a distal end portion of a treatment tool according to a second embodiment. [Figure 13] FIG. 4 is a cross-sectional view of the distal end of the treatment tool. [Figure 14] FIG. 4 is a cross-sectional view of the distal end of the treatment tool. [Figure 15] FIG. 4 is a cross-sectional view of the distal end of the treatment tool. [Figure 16] 16 is a cross-sectional view taken along the line C1-C1 shown in FIG. 15. [Figure 17] FIG. 11 is a cross-sectional view showing a modified example of the treatment tool. [Figure 18] FIG. [Figure 19] FIG. [Figure 20] FIG. 4 is a perspective cross-sectional view showing a backflow prevention member. [Figure 21] 21 is a cross-sectional view taken along line C2-C2 shown in FIG. 20. [Figure 22] FIG. 13 is a perspective view of a distal end portion of a treatment tool according to a third embodiment. [Diagram 23] FIG. 4 is a cross-sectional view of the distal end of the treatment tool. [Figure 24] FIG. 4 is a cross-sectional view of the distal end of the treatment tool. [Diagram 25] FIG. 4 is a cross-sectional view of the distal end of the treatment tool. [Figure 26] 25 is a cross-sectional view taken along line C3-C3 shown in FIG. 24. [Figure 27] FIG. 13 is a perspective cross-sectional view showing a modified example of the treatment tool. [Figure 28] FIG. [Figure 29] 29 is a cross-sectional view taken along line C4-C4 shown in FIG. 28. [Diagram 30] FIG. 13 is a perspective view of a distal end portion of a treatment tool according to a fourth embodiment. [Diagram 31] FIG. [Diagram 32] FIG. 4 is a cross-sectional view of the distal end of the treatment tool. [Diagram 33] FIG. 4 is a cross-sectional view of the distal end of the treatment tool. [Diagram 34]FIG. 4 is a cross-sectional view of the distal end of the treatment tool. [Diagram 35] 35 is a cross-sectional view taken along the line C5-C5 shown in FIG. 34. [Diagram 36] FIG. 11 is a cross-sectional view showing a modified example of the treatment tool. [Figure 37] FIG. [Figure 38] FIG. [Figure 39] FIG. 13 is a perspective view of a distal end portion of a treatment tool according to a fifth embodiment. [Diagram 40] FIG. 4 is a cross-sectional view of the distal end of the treatment tool. [Diagram 41] FIG. 4 is a cross-sectional view of the distal end of the treatment tool. [Diagram 42] FIG. 4 is a cross-sectional view of the distal end of the treatment tool. [Diagram 43] FIG. 13 is a perspective view showing a modified example of the treatment tool. [Diagram 44] FIG. 11 is a cross-sectional view of the tip portion of the modified example. [Diagram 45] FIG. 11 is a cross-sectional view of the tip portion of the modified example. [Figure 46] FIG. 11 is a cross-sectional view of the tip portion of the modified example. [Figure 47] FIG. 13 is a diagram showing a modified example of the operation unit. [Figure 48] FIG. 13 is a diagram showing a modified example of the operation unit. [Figure 49] FIG. [Figure 50] FIG. 13 is a diagram showing a modified example of the operation unit. [Figure 51] FIG. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0010] First embodiment An endoscopic treatment system 300 according to a first embodiment of the present invention will be described with reference to Fig. 1 to Fig. 7. Fig. 1 is an overall view of the endoscopic treatment system 300 according to this embodiment.

[0011] [Endoscopic treatment system 300] 1, the endoscopic treatment system 300 includes an endoscope 200 and a treatment tool 100. The treatment tool 100 is inserted into the endoscope 200 when in use.

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

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

[0014] The imaging unit 203 includes an imaging element such as a CCD or a CMOS, and can capture an image of a site to be treated. The imaging unit 203 can capture an image of the knife 2 of the treatment tool 100 in a state in which the treatment tool 100 protrudes from the distal end opening 206a of the channel 206.

[0015] The bending section 204 bends in response to an operator's operation of the operating section 207. The flexible section 205 is a tubular section having flexibility.

[0016] The operation unit 207 is connected to the flexible portion 205. The operation unit 207 has a grip 208, an input unit 209, a proximal end opening 206b of the channel 206, and a universal cord 210. The grip 208 is a portion that is held by an operator. The input unit 209 accepts an operation input for bending the bending portion 204. The universal cord 210 outputs an image captured by the imaging unit 203 to the outside. The universal cord 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 tool 100] FIG. 2 is an overall view showing the treatment tool 100. As shown in FIG. The treatment tool (treatment tool for endoscope) 100 includes a sheath 1, a knife 2, a sharp member 3, an operation wire 4 (see FIG. 4), and an operation section 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 tool 100, the side inserted into the patient's body is referred to as the "tip side (distal side) A1", and the operation section 5 side is referred to as the "base side (proximal side) A2".

[0018] The sheath 1 is a long tubular member extending from a distal end 1a to a proximal end 1b. The sheath 1 has an outer diameter allowing it to be inserted into a channel 206 of an endoscope 200, and is capable of advancing and retreating through the channel 206. As shown in FIG. 1, when the sheath 1 is inserted into the channel 206, the distal end 1a of the sheath 1 can protrude and retract through a distal end opening 206a of the channel 206.

[0019] FIG. 3 is a perspective view of the distal end of the treatment tool 100. As shown in FIG. The sheath 1 has a tube 10 extending in a 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 distal end portion of the treatment tool 100 with the distal end of the knife 2 in the first position P1. The tube 10 is a long tubular member having flexibility and insulating properties. The tube 10 is made of, for example, resin. The tip of the tube 10 is provided with an expanded diameter portion (tip portion) 10a having an outer diameter larger than that of the base end side. The expanded diameter portion (tip portion) 10a does not necessarily have to have an outer diameter larger than that of the tube 10, and may have, for example, the same outer diameter as that of the tube 10. The tip member 11 is fitted and attached inside the expanded diameter portion 10a. The tip member 11 may be bonded to the expanded diameter portion 10a by an adhesive or the like.

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

[0022] The first through hole 12 is a hole provided in the tip member 11 and penetrates the tip member 11 in the longitudinal direction A. The tip of the first through hole 12 communicates with a first opening 12a formed in a tip surface 14 of the tip member 11. The base end of the first through hole 12 communicates with an 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 on the base side A2 (see FIG. 16). 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 are in communication. 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 accommodating the flange 21 of the knife 2 is formed in the first opening 12a of the first through hole 12 of the tip 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 toward the tip side A1 beyond the tip surface 14 of the tip member 11. The flange storage portion 12f does not have to be formed in the first opening 12a.

[0025] The second through hole 13 is a hole provided in the tip member 11 and penetrates the tip member 11 in the longitudinal direction A. The tip of the second through hole 13 communicates with a second opening 13a formed in a tip surface 14 of the tip member 11. The base end of the second through hole 13 communicates with an 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 disposed away 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 tool 100 with the distal end of the knife 2 in the second position P2. The knife (electrode) 2 is a round bar-shaped metal member. Note that "round bar-shaped" includes not only a strict round bar shape but also a shape close to a round bar shape. The knife 2 is made of a material such as stainless steel. The knife 2 is conductive and a high-frequency current is passed through the knife 2. 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 freely protrude and retract from the first opening 12a to the distal end side A1. The knife 2 may be fixed in a state in which it protrudes from the first opening 12a to the distal end side A1 so as not to be able to advance or retreat.

[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 "coinciding" includes a state in which they almost coincide as well as a state in which they strictly coincide.

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

[0031] FIG. 6 is a front view of the distal end portion of the treatment tool 100 as viewed in the longitudinal direction A. FIG. The flange (tip expanded diameter 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. A length D2 of the flange 21 in a radial direction R perpendicular to the longitudinal direction A is longer than a length D1 of the knife body 20 in the radial direction R. A flat base end surface 21b is formed on the base end side A2 of the flange 21. The flange 21 is not limited to a disc shape, and may be a triangular or hook shape.

[0032] 4, when the knife 2 is retracted relative to the sheath 1, the base end surface 21b of the knife 2 comes into contact with the flange storage portion 12f of the tip member 11. By the contact between the base end surface 21b of the knife 2 and the flange storage portion 12f of the tip member 11, the tip of the knife 2 is positioned at a first position P1, which is the position on the base end side A2.

[0033] The knife body 20 and the flange 21 have a first duct 23 extending along the longitudinal direction A. The first duct 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 "cylindrical" includes not only a strictly cylindrical shape but also a shape close to a cylindrical shape. The connecting member 22 connects the knife body 20 and the first operating 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, but can advance and retreat through the second region 122 in the longitudinal direction A.

[0035] 5, when the knife 2 is advanced relative to the sheath 1, the tip of the connecting member 22 comes into contact with the step 12g of the tip member 11. When the tip of the connecting member 22 comes into contact with the step 12g of the tip member 11, the tip of the knife 2 is positioned at the second position P2, which is the position on the tip-most side A1.

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

[0037] A first operation wire 41 is attached to the base end of the connecting member 22. A high-frequency current is supplied to the knife 2 via the first operation wire 41 connected to the operation section 5. When a high-frequency current is supplied to the knife 2 from the first operation wire 41, the knife body 20 and the flange 21 function as active electrodes that output the high-frequency current to biological tissue.

[0038] Fig. 7 is a cross-sectional view of the distal end of the treatment tool 100 when 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 made of a resin material, a metal material, a ceramic material, etc. 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 part of the knife 2 that can be exposed from the tip 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 tip member 11 of the sheath 1 along the longitudinal direction A, and can freely protrude and retract from the second opening 13a to the tip side A1. The sharp member 3 is provided at a position spaced apart from the knife 2 in the radial direction R so as to be able to advance and retract in the longitudinal direction A. The sharp member 3 may be fixed so as not to be able to advance and retract in a state where it protrudes from the second opening 13a to the tip side A1.

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

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

[0042] The flange (enlarged diameter portion) 33 is provided at the base 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 base end opening 13b of the second through hole 13. The flange 33 cannot be inserted through the second through hole 13.

[0043] 7, when the sharp member 3 is advanced relative to the sheath 1, the flange 33 of the sharp member 3 comes into contact with the base end opening 13b of the second through hole 13 of the tip member 11. When the flange 33 of the sharp member 3 comes into contact with the base 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 tip position P4, which is the position on the tip side A1.

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

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

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

[0047] The first operating wire 41 is a wire that operates the knife 2. The first operating wire 41 has a coil shaft 44 and a tube 45. A tip end of the first operating wire 41 is connected to the connecting member 22 of the knife 2, and a base end of the first operating wire 41 is connected to the slider 52 of the operating section 5. Note that the first operating wire 41 may have other configurations 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 made of a material such as stainless steel. A third pipeline 43 is formed inside the coil shaft 44. The third pipeline 43 is connected to the base end of the second pipeline 24. The first pipeline 23, the second pipeline 24, and the third pipeline 43 form a water supply flow path WR. The fluid supplied from the liquid supply port 54 passes through the water supply flow path WR (the third pipeline 43, the second pipeline 24, and the first pipeline 23) and is discharged from the tip opening 23a.

[0049] The tube 45 is, for example, a heat shrink tube, provided on the outer periphery of the coil shaft 44. By covering the outer periphery of the coil shaft 44 with the tube 45, liquid does not leak from the third pipeline 43.

[0050] The second operation wire 42 is a wire that operates the sharp member 3. A tip end of the second operation wire 42 is connected to the flange 33 of the sharp member 3, and a base 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 has 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 end of the operation unit body 51 is connected to the base end 1b of the sheath 1. The operation unit 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 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 body 51 and extends to the lever 55.

[0053] The slider 52 (first slider) is attached to the operation unit 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 slider 52. When the surgeon advances or retreats the slider 52 relatively to the operation unit body 51, the first operation wire 41 and the knife 2 advance or retreat.

[0054] The power supply connector 53 is fixed to the slider 52. The power supply connector 53 is connectable to a high-frequency power supply device (not shown), and is connected to the base end of the first operation wire 41 via a conductive wire. The power supply connector 53 is capable of supplying 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 in the slider 52. 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 second pipeline 24, the first pipeline 23) and is discharged from the tip opening 23a. The liquid supply port 54 may be provided in 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 base end of the second operation wire 42 is attached to the lever 55. When the surgeon moves the lever 55 forward or backward relative to the slider 52, the second operation wire 42 and the sharp member 3 forward or backward.

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

[0058] The connecting member 22B further has a water supply port 22h in comparison 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 circumferential surface of the connecting member 22B. The water supply ports 22h are formed on both sides of the central axis O2 in the longitudinal direction A of the knife 2B.

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

[0060] The first operation wire 41B is a wire that operates the knife 2B. The first operation wire 41B has a coil shaft 44B and a tube 45. A tip end of the first operation wire 41B is connected to the connecting member 22B of the knife 2B, and a 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 made of metal, such as a single wire or a stranded wire, instead of a coil shaft. In this embodiment, the third duct 43 is not formed inside the coil shaft 44B. Therefore, the first operation wire 41B does not need to 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, and the first pipeline 23) and is discharged from the tip opening 23a.

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

[0064] As a preparatory step, the surgeon identifies the lesion by a known method. Specifically, the surgeon inserts the insertion section 202 of the endoscope 200 into the digestive tract (e.g., the esophagus, stomach, duodenum, and large intestine) and identifies the lesion while observing an image obtained by the imaging section 203 of the endoscope.

[0065] <insertion step> The surgeon inserts the treatment tool 100 into the channel 206 and causes the tip 1 a of the sheath 1 to protrude from the tip opening 206 a of the insertion section 202 .

[0066] <Marking step> 4, the surgeon moves the slider 52 of the operating unit 5 back relative to the operating unit body 51 to place the tip of the knife 2 at the first position P1. Using the tip of the flange 21 protruding from the tip surface 14 of the tip member 11, the surgeon cauterizes the biological tissue around the lesion and performs marking.

[0067] <Puncture step> 7, the surgeon advances the lever 55 of the operation unit 5 relatively to the slider 52, and places the tip of the sharp member 3 at tip position P4. The surgeon punctures and penetrates the site in the lesion where the local injection liquid (local injection liquid) is to be injected with the sharp member 3.

[0068] <Local injection step> 5, the surgeon advances the slider 52 of the operation unit 5 relatively to the operation unit body 51, and places 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 submucosal layer through the hole formed by puncturing with the sharp member 3, the surgeon supplies liquid (local injection liquid) from the liquid supply port 54. The liquid (local injection liquid) is discharged from the tip opening 23a.

[0069] <Incision and peeling step> Next, the surgeon performs an incision and dissection procedure. The surgeon advances the knife 2, and while high-frequency current is being applied, moves the flange 21 to incise the mucosa of the lesion. The surgeon also advances the knife 2, and while high-frequency current is being applied, lifts the mucosa of the incised lesion to expose the submucosa, and dissects the submucosa of the incised lesion.

[0070] The surgeon continues the above-mentioned operations (treatments) as necessary, and finally excises the lesion, completing the ESD procedure.

[0071] The treatment tool 100 and the treatment tool 100B according to this embodiment can suitably perform the incision / ablation treatment and the local injection treatment, and are easy to handle.

[0072] Although the first embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment, and design modifications and the like that do not depart from the gist of the present invention are also included. Also, the components shown in the above embodiment and modified examples can be appropriately combined to form a configuration.

[0073] Second Embodiment A treatment tool 100C according to a second embodiment of the present invention will be described with reference to Fig. 12 to Fig. 16. In the following description, the same components as those already described will be denoted by the same reference numerals, and duplicated description will be omitted.

[0074] FIG. 12 is a perspective view of the distal end of the treatment tool 100C. The treatment tool (endoscopic treatment tool) 100C, like the treatment tool 100 of the first embodiment, constitutes an endoscopic treatment system together with the endoscope 200. The treatment tool 100C includes a sheath 1, a knife 2C, a sharp member 3, a manipulation wire 4B, and a manipulation section 5.

[0075] 13 to 15 are cross-sectional views of the distal end portion of the treatment tool 100C. The knife (electrode) 2C is a round bar-shaped metal member. Note that "round bar-shaped" includes not only a strict round bar shape but also a shape close to a round bar shape. The knife 2C is made of a material such as stainless steel. The knife 2C is conductive 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 distal end member 11 of the sheath 1 along the longitudinal direction A, and can freely protrude and retract from the first opening 12a to the distal end side A1. The knife 2C may be fixed in a state in which it protrudes from the first opening 12a to the distal end side A1 so as not to be able to advance or retreat.

[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 "coinciding" includes not only a state in which they coincide exactly, but also a state in which they almost coincide.

[0078] The knife body 20C is a round bar-shaped metal member. The outer diameter of the knife body 20C is smaller than the inner diameter of the first region 121. The knife body 20C is movable 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. As in 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 of the flange 21C in the radial direction R perpendicular to the longitudinal direction A is longer than the length of the knife body 20C in the radial direction R. A flat base end surface 21b is formed on the base end side A2 of the flange 21C. The flange 21C is not limited to a disc shape, and may be a triangular or hook shape.

[0080] 13, when the knife 2C is retracted relative to the sheath 1, the base end surface 21b of the knife 2C comes into contact with the flange storage portion 12f of the tip member 11. By the contact between the base end surface 21b of the knife 2C and the flange storage portion 12f of the tip member 11, the tip of the knife 2C is positioned at a first position P1, which is the position on the base end side A2.

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

[0082] The connecting member 22C is a cylindrical member made of metal. Note that "cylindrical" 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 operating 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 through the first region 121 in the longitudinal direction A, but can advance and retreat through the second region 122 in the longitudinal direction A.

[0083] 14, when the knife 2C is advanced relative to the sheath 1, the tip of the connecting member 22C comes into contact with the step 12g of the tip member 11. When the tip of the connecting member 22C comes into contact with the step 12g of the tip member 11, the tip of the knife 2C is positioned at the second position P2, which is the position on the tip-most side A1.

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

[0085] A 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 section 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 active electrodes that output 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. The flange (enlarged diameter portion) 33 is provided at the base 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] 15, when the sharp member 3 is advanced relative to the sheath 1, the flange 33 of the sharp member 3 comes into contact with the base end opening 13b of the second through hole 13 of the tip member 11. When the flange 33 of the sharp member 3 comes into contact with the base 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 tip position P4, which is the position on the tip side A1.

[0088] As shown in Fig. 16, the flange 33 is formed in a rectangular shape when viewed from the direction along the longitudinal direction A. When the flange 33 and the base-end opening 13b of the second through-hole 13 come into contact with each other, a gap 13g is formed between the flange 33 of the sharp member 3 and the base-end opening 13b. The gap 13g is a part of the water-feeding flow path WR through which the liquid flows. Note that the flange 33 may have any shape that allows the gap 13g to be formed when the flange 33 comes into contact with the base-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 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 gap 13g, and the second through-hole 13) and is discharged from the second opening 13a.

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

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

[0092] [Modification of Treatment Tool 100C (Treatment Tool 100D)] 17 to 19 are cross-sectional views showing a treatment tool 100D which is a modified example of the treatment tool 100C. The treatment tool 100D has a water supply flow path WR different from that of the treatment tool 100C. The treatment tool 100D includes a sheath 1, a knife 2D, a sharp member 3, an operation wire 4, and an operation section 5. The knife 2D includes 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. As shown in FIG. The backflow prevention member 25 is a disk-shaped member provided on the base end side A2 of the connecting member 22B relative 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 22B from flowing back to the base 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. In addition, the backflow prevention member 25 is not limited to a member attached to the outer circumferential surface of the connecting member 22B, and may be a member attached to the inner circumferential surface of the tube 10.

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

[0095] The liquid supply port 54 is connected to the base 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 supply flow path WR (the third pipeline 43, the second pipeline 24, the water supply port 22h, the internal space 19 of the sheath 1, and the second through-hole 13) and is discharged from the second opening 13a.

[0096] According to the treatment tool 100C and the treatment tool 100D according to this embodiment, the incision / dissection treatment and the local injection treatment can be suitably performed, and they are easy to handle.

[0097] Although the second embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment, and design modifications and the like that do not depart from the gist of the present invention are also included. Also, the components shown in the above embodiment and modified examples can be appropriately combined to form a configuration.

[0098] Third embodiment A treatment tool 100E according to a third embodiment of the present invention will be described with reference to Fig. 22 to Fig. 26. In the following description, the same components as those already described will be denoted by the same reference numerals, and duplicated description will be omitted.

[0099] FIG. 22 is a perspective view of the distal end portion of the treatment tool 100E. The treatment tool (endoscopic treatment tool) 100E, like the treatment tool 100 of the first embodiment, constitutes an endoscopic treatment system together with the endoscope 200. The treatment tool 100E includes a sheath 1E, a knife 2E, a sharp member 3, a manipulation wire 4, and a manipulation section 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 allowing it to be inserted into the channel 206 of the endoscope 200, and is movable forward and backward through 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. The sheath 1E may be formed by integrally molding the tube 10 and the distal end member 11E.

[0101] 23 to 25 are cross-sectional views of the distal end portion of the treatment tool 100E. The tip member 11E is formed in a cylindrical shape. In addition to a strict cylindrical shape, the term "cylindrical shape" includes a shape close to a cylindrical shape. The tip member 11E is made of an insulating material such as resin. The tip member 11E is formed with a first through hole 12E.

[0102] The first through hole 12E is a hole provided in the tip member 11E and penetrates the tip member 11E in the longitudinal direction A. The tip of the first through hole 12E communicates with a first opening 12a formed in a tip surface 14 of the tip 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 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 are in communication. The second region 122E and the third region 123E are in communication. 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 accommodating 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 tip 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 round bar-shaped metal member. Note that "round bar-shaped" includes not only a strict round bar shape but also a shape close to a round bar shape. The knife 2E is made of a material such as stainless steel. The knife 2E is conductive and a high-frequency current is passed through the knife 2E. The knife 2E has a knife body 20, a flange 21, and a connecting member 22E.

[0106] 23, when the knife 2E is retracted relative to the sheath 1E, the base end surface 21b of the knife 2E comes into contact with the flange storage portion 12f of the tip member 11E. By the contact between the base end surface 21b of the knife 2E and the flange storage portion 12f of the tip member 11E, the tip of the knife 2E is positioned at a first position P1, which is the position on the base end side A2.

[0107] FIG. 26 is a cross-sectional view taken along line C3-C3 shown in FIG. The connecting member 22E is a metal member, and is formed in a cylindrical shape with both side surfaces in the radial direction R cut off. The connecting member 22E connects the knife body 20 and the first operating wire 41. The connecting member 22E has a maximum width in the radial direction R that is larger than the inner diameter of the first region 121. The connecting member 22E has a maximum width in the radial direction R that is larger than the inner diameter of the second region 122E. At least a part of the connecting member 22E has a width in the radial direction R that is smaller than the inner diameter of the second region 122E. Specifically, the connecting member 22E is formed in a shape in which a part of a circle is cut out when viewed from a direction along the longitudinal direction A. 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 through the first region 121 and the second region 122E in the longitudinal direction A, but can advance and retreat through the third region 123E in the longitudinal direction A.

[0108] 24, when the knife 2E is advanced relative to the sheath 1E, the tip of the connecting member 22E comes into contact with the step 12Eg of the tip member 11E. By the contact between the tip of the connecting member 22E and the step 12Eg of the tip member 11E, the tip of the knife 2E is positioned at the second position P2, which is the position on the tip-most side A1.

[0109] The connecting member 22E has a second pipeline 24 extending along the longitudinal direction A. The second pipeline 24 communicates with the first pipeline 23 and a third pipeline 43 formed in the first operating wire 41. In this embodiment, the first pipeline 23, the second pipeline 24, and the third pipeline 43 are not used as the water supply flow path WR, but are used as pipelines through which the sharp member 3 advances and retreats.

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

[0111] The sharp member 3 is inserted through the first duct 23, the second duct 24 and the third duct 43 along the longitudinal direction A, and is capable of protruding and retracting from the tip opening 23a to the tip side A1.

[0112] The flange (expanded diameter portion) 33 is provided at the base end of the main body portion 31. The outer diameter of the flange 33 is smaller than the inner diameter of the second pipeline 24. The outer diameter of at least a part of the flange 33 is larger than the inner diameter of the base end opening 23b of the first pipeline 23 and the inner diameter of the tip opening 43a of the third pipeline 43. The flange 33 can advance and retreat through the second pipeline 24, but cannot be inserted through the first pipeline 23 and the third pipeline 43.

[0113] 24, when the sharp member 3 is retracted relative to the sheath 1E and the knife body 20, the flange 33 of the sharp member 3 comes into contact with the distal opening 43a of the third duct 43 of the first operating wire 41. The contact between the flange 33 of the sharp member 3 and the distal opening 43a of the third duct 43 positions the distal end of the sharp member 3 at a base end position P3, which is the position closest to the base end side A2.

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

[0115] 25, when the sharp member 3 is advanced relative to the sheath 1E and the knife body 20, the flange 33 of the sharp member 3 comes into contact with the base end opening 23b of the first duct 23 of the knife body 20. By the contact between the flange 33 of the sharp member 3 and the base end opening 23b of the first duct 23, the tip of the sharp member 3 (the tip of the sharp portion 32) is positioned at tip position P4, which is the position on the tip side A1.

[0116] 26, the connecting member 22E is formed in a shape with a part of a circle cut out when viewed in the direction along the longitudinal direction A. When the connecting member 22E and the second region 122E come into contact with each other, 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 flow path WR through which the liquid flows.

[0117] The liquid supply port 54 is connected to the base 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 flow path WR (the internal space 19 of the sheath 1E, the first through-hole 12, the gap 122g, and the water supply groove 12e) and is discharged from the first opening 12a.

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

[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 located 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 located at the tip position P4 may be larger than the protruding amount L2.

[0120] [Modification of the treatment tool 100E (treatment tool 100F)] 27 and 28 are perspective cross-sectional views showing a treatment tool 100F which is a modified example of the treatment tool 100E. The treatment tool 100F has a different water supply flow path WR compared to the treatment tool 100E. The treatment tool 100F includes a sheath 1E, a knife 2F, a sharp member 3, an operation wire 4, and an operation section 5. The knife 2F includes 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 in comparison with the connecting member 22E. The water supply port 22h is a hole formed along the radial direction R from the second pipeline 24, and opens on the outer circumferential surface of the connecting member 22F. The water supply port 22h is formed on both sides of the central axis O2 in the longitudinal direction A of the knife 2F.

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

[0123] FIG. 29 is a cross-sectional view taken along line C4-C4 shown in FIG. 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 flange 33 of the sharp member 3 comes into contact with the tip opening 43a of the third pipe 43, a gap 43g is formed between the flange 33 and the tip opening 43a. The gap 43g is a part of the water supply flow path WR through which the liquid flows.

[0124] The liquid supply port 54 is connected to the base end of the third pipeline 43 of the sheath 1E 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 gap 43g, the second pipeline 24, the water supply port 22h, the internal space 19 of the sheath 1E, the first through-hole 12, the gap 122g, and the water supply groove 12e) and is discharged from the first opening 12a.

[0125] The treatment tools 100E and 100F according to the present embodiment can suitably perform incision and ablation treatment and local injection treatment, and are easy to handle.

[0126] Although the third embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment, and design modifications and the like that do not depart from the gist of the present invention are also included. Also, the components shown in the above embodiment and modified examples can be appropriately combined to form a configuration.

[0127] Fourth embodiment A treatment tool 100G according to a fourth embodiment of the present invention will be described with reference to Fig. 30 to Fig. 34. In the following description, the same components as those already described will be denoted by the same reference numerals, and duplicated description will be omitted.

[0128] 30 and 31 are perspective views of the distal end portion of the treatment tool 100G. The treatment tool (endoscopic treatment tool) 100G, like the treatment tool 100 of the first embodiment, constitutes an endoscopic treatment system together with the endoscope 200. The treatment tool 100G includes a sheath 1G, a knife 2G, a sharp member (needle) 3G, a manipulation wire 4, and a manipulation section 5.

[0129] The sheath 1G is a long tubular member extending from the distal end 1a to the proximal end 1b. The sheath 1G has an outer diameter allowing it to be inserted into a channel 206 of the endoscope 200, and is movable forward and backward through the channel 206. The sheath 1G has a tube 10 extending in the longitudinal direction A, and a distal end member 11G provided at the distal end of the tube 10. The sheath 1G may be formed by integrally molding the tube 10 and the distal end member 11G.

[0130] 32 to 34 are cross-sectional views of the distal end portion of the treatment tool 100G. The tip member 11G is formed in a cylindrical shape. In addition to a strict cylindrical shape, the term "cylindrical shape" includes a shape close to a cylindrical shape. The tip member 11G is formed of an insulating material such as resin. The tip member 11G has a first through hole 12G formed therein.

[0131] The first through hole 12G is a hole provided in the tip member 11G and 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 a 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 side A2. The first region 121G is a through hole whose cross section perpendicular to the longitudinal direction A has a shape of two overlapping concentric circles with different diameters. 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 121G and the second region 122 are in communication. 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. 32, the first region 121G is divided into a reduced diameter region 124 having a length R1 from the central axis O2 in the longitudinal direction A of the knife 2G, and an expanded diameter region 125 having a length R2 (length R2>length R1) from the central axis O2. In this embodiment, the reduced diameter region 124 and the expanded diameter region 125 are each formed in a semicircular shape when viewed in the longitudinal direction A.

[0134] The knife 2G is a round bar-shaped member made of metal. Note that "round bar-shaped" includes not only a strict round bar shape but also a shape close to a round bar shape. The knife 2G is made of a material such as stainless steel. The knife 2G is conductive and is energized with high-frequency current. 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 operating wire 41 are directly connected, and the first pipeline 23 and the third pipeline 43 are in communication with each other.

[0135] The central axis O2 of the knife 2G in the longitudinal direction A coincides with the central axis O1 of the sheath 1G in the longitudinal direction A. Note that "coinciding" includes a state in which they almost coincide as well as a state in which they strictly coincide.

[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 relative to the sheath 1G, the base end surface 21b of the knife 2G comes into contact with the flange storage portion (first surface) 12f of the tip member 11G. The base end surface 21b of the knife 2G comes into contact with the flange storage portion 12f of the tip member 11G, so that the tip of the knife 2G is positioned at the first position P1, which is the position on the most proximal side A2. In a state in which the base end surface 21b of the knife 2G comes into contact with the flange storage portion 12f of the tip member 11G, the sharp member 3G can freely advance and retreat in the longitudinal direction A relative to the knife 2G. The flange storage portion 12f does not 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 comes into contact with the base end surface 21b of the knife 2G.

[0138] As shown in Fig. 33, when the knife 2G is advanced relative to the sheath 1G, the tip of the first operating wire 41 comes into contact with the step (second surface) 12Gg of the tip member 11G. By the contact between the tip of the first operating wire 41 and the step 12Gg of the tip member 11G, the tip of the knife 2G is positioned at the second position P2, which is the position on the tip side A1. With the connecting member 22C in contact with the step 12Gg of the tip tip 11G, the sharp member 3G can freely advance and retreat in the longitudinal direction A relative to the knife 2G.

[0139] The sharp member (rod) 3G is a member formed from a resin material, a metal material, a ceramic material, etc. 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 a first through hole 12G of the tip member 11G of the sheath 1G along the longitudinal direction A, and can freely protrude and retract from the first opening 12Ga to the tip side A1. A tip portion 34G of the sharp member 3G is provided at a position spaced apart from the knife 2G in the radial direction R so as to be able to advance and retract in the longitudinal direction A. The sharp member 3G may be fixed so as not to be able to advance and retract in a state where it protrudes from the first opening 12a to the tip side A1.

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

[0142] A fourth duct 36 is formed inside the main body 31G. The knife 2G is inserted through the fourth duct 36. The knife 2G is movable back and forth in the longitudinal direction A through the fourth duct 36.

[0143] The flange (expanded diameter portion) 33G is provided at the base end of the main body portion 31G. The outer diameter of at least a part of the flange 33G is larger than the inner diameter of the base 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 by dividing a 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 inner peripheral surface of the main body portion 31G, and the flange 21 can freely advance and retreat on the distal side A1 from the base end 34b of the slit portion 34a. In addition, the slit portion 34a does not need to be semi-cylindrical, 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 portion 35G is a member having a sharp tip side A1 provided at the tip of the tip portion 34G. As shown in Figures 30 and 31, the sharp portion 35G has a semi-cylindrical shape with an edge 35a of the tip side A1 inclined with respect to the longitudinal direction A. The tip 35b of the sharp portion 35G is sharpened toward the tip side A1.

[0146] 35, in the first region 121G, the tip portion 34G and the sharp portion 35G cannot pass through the reduced diameter region 124, but can advance and retreat through the expanded diameter region 125. In addition, the position of the maximum outer periphery of the base end surface 21b of the knife is located outside the inner periphery 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 relative to the sheath 1G, the tip 31a of the main body 31G of the sharp member 3G comes into contact with the step 12Gg of the tip member 11G. When the tip 31a of the main body 31G of the sharp member 3G comes 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 position on the tip side A1. The tip of the sharp member 3G may be positioned at the tip position P4 when the tip of the flange 33G of the sharp member 3G comes into contact with the base end opening 12b of the first through hole 12G.

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

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

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

[0152] The liquid supply port 54 is connected to the base end of the internal space 19 of the sheath 1G 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 1G, the water supply port 22h, the second pipeline 24, and the first pipeline 23) and is discharged from the tip opening 23a.

[0153] The treatment tools 100G and 100H according to this embodiment can suitably perform incision and ablation treatment and local injection treatment, and are easy to handle.

[0154] Although the fourth embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment, and design modifications and the like that do not depart from the gist of the present invention are also included. Also, the components shown in the above-mentioned embodiment and modified examples can be appropriately combined to form a configuration.

[0155] Fifth embodiment A treatment tool 100I according to a fifth embodiment of the present invention will be described with reference to Fig. 39 to Fig. 42. In the following description, the same components as those already described will be denoted by the same reference numerals, and duplicated description will be omitted.

[0156] FIG. 39 is a perspective view of the distal end portion of the treatment tool 100I. The treatment tool (endoscopic treatment tool) 100I, like the treatment tool 100 of the first embodiment, constitutes an endoscopic treatment system together with the endoscope 200. The treatment tool 100I includes a sheath 1G, a knife 2C, a sharp member (needle) 3I, a manipulation wire 4I, and an operation section 5.

[0157] 40 to 42 are cross-sectional views of the distal end portion of the treatment tool 100I. As shown in FIG. 40, when the knife 2C is retracted relative to the sheath 1G, the base end surface 21b of the knife 2C comes into contact with the flange storage portion (first surface) 12f of the tip member 11G. The base end surface 21b of the knife 2C comes into contact with the flange storage portion 12f of the tip member 11G, so that the tip of the knife 2C is positioned at the first position P1, which is the position on the most proximal side A2. In a state in which the base end surface 21b of the knife 2C comes into contact with the flange storage portion 12f of the tip member 11G, the sharp member 3I can freely advance and retreat in the longitudinal direction A relative to the knife 2C. The flange storage portion 12f does not 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 comes into contact with the base end surface 21b of the knife 2C.

[0158] 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 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, but can advance and retreat through the second region 122 in the longitudinal direction A.

[0159] As shown in Figure 41, when the knife 2C is advanced relative to the sheath 1G, the tip of the connecting member 22C comes into contact with the step (second surface) 12Gg of the tip member 11G. By the contact between the tip of the connecting member 22C and 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 tip side A1. With the connecting member 22C in contact with the step 12Gg of the tip tip 11G, the sharp member 3I can freely advance and retreat in the longitudinal direction A relative to the knife 2C.

[0160] The sharp member 3I is a member formed of a resin material, a metal material, a ceramic material, etc. 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 channel 36 of the sharp member 31. The knife 2C is movable back and forth through the fourth channel 36 in the longitudinal direction A.

[0162] 42, when the sharp member 3I is advanced relative to the sheath 1G, the tip 31a of the main body 31G of the sharp member 3I comes into contact with the step 12Gg of the tip member 11G. By the contact between the tip 31a of the main body 31G of the sharp member 3I and 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 position on the tip side A1.

[0163] The manipulation wire 4I is a wire that passes through the internal space (duct, lumen) 19 of the sheath 1G. The manipulation wire 4I has a first manipulation wire 41B and a second manipulation 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. A tip of the second operation wire 42I is fitted onto the main body 31G of the sharp member 3I. A base end of the second operation wire 42I is connected to the lever 55 of the operation unit 5.

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

[0166] The liquid supply port 54 is connected to the base 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 supply 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, and the first through-hole 12G) and is discharged from the first opening 12Ga.

[0167] [Modification of the treatment tool 100I (treatment tool 100J)] Fig. 43 is a perspective view showing a treatment tool 100J which is a modified example of the treatment tool 100I. Figs. 44 to 46 are cross-sectional views of the distal end of the treatment tool 100J. The treatment tool 100J has a different water supply flow path WR compared to the treatment tool 100I. The treatment tool 100J includes a sheath 1G, a knife 2C, a sharp member 3J, an operation wire 4I, and an operation section 5.

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

[0169] The main body 31J further includes a water supply port 31h in comparison with the main body 31G. The water supply port 31h is a hole formed along the radial direction R from the fourth pipe 36, and opens on the outer circumferential surface of the main body 31J.

[0170] The liquid supply port 54 is connected to the base end of the internal space 19 of the sheath 1G via a duct formed in the slider 52. As shown in Figs. 43 and 46, the liquid (fluid) supplied from the liquid supply port 54 passes through the water supply flow path WR (the internal space 19 of the sheath 1G, the water supply port 31h, the fourth duct 36) and is discharged from the sharp portion 35G of the sharp member 3J. More specifically, as shown in Fig. 46, in a state in which the sharp portion 35G of the sharp member 3J and the knife 2C protrude from the first opening 12Ga (sheath 1G), a gap 36g between the knife 2C and the sharp portion 35G of the sharp member 3J forms a part of the water supply flow path 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 housed in the sheath 1G, the liquid that passes through the internal space 19 of the sheath 1G is discharged from the expanded diameter region 125 without passing through the gap 36g.

[0171] The treatment tools 100I and 100J according to the present embodiment can suitably perform incision and ablation treatment and local injection treatment, and are easy to handle.

[0172] Although the fifth embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment, and design modifications and the like that do not depart from the gist of the present invention are also included. Also, the components shown in the above-mentioned embodiment and modified examples can be appropriately combined to form a configuration.

[0173] FIG. 47 is a diagram showing an operation unit 5K which is a modified example of the operation unit 5. As shown in FIG. The operation unit 5K has 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 portion body 51. The liquid supply port 54 is connected to the base end of the third pipeline 43 via a pipeline formed in the operation portion 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 distal end side A1 relative to the first slider 52. The base end of the second operation wire 42 is attached to the second slider 55K. When the surgeon advances or retreats the second slider 55K relative to the first slider 52, the second operation wire 42 and the sharp member 3 advance or retreat.

[0176] 48 and 49 are diagrams showing an operation unit 5L which is a modified example of the operation unit 5. FIG. The operation unit 5L has an operation unit main body 51, a first slider 52L, a power supply connect 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 body 51 so as to be movable along the longitudinal direction A. A base end of the first operation wire 41 is attached to the first slider 52L. When the surgeon advances or retreats the first slider 52L relatively to the operation unit body 51, the first operation wire 41 and the knife 2 advance or retreat. When the surgeon releases the first slider 52L, the position of the first slider 52L relative to the operation unit 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 advance and retreat together with the first slider 52L, and can advance and retreat independently of the first slider 52L. A base end of the second operation wire 42 is attached to the second slider 55L. When the surgeon advances and retreats the second slider 55L relative to the operation portion main body 51, the second operation wire 42 and the sharp member 3 advance and retreat.

[0179] The switch 56 regulates 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 regulated. When the switch 56 is not pressed, the forward and backward movement of the first slider 52L and the second slider 55L is regulated.

[0180] 50 and 51 are diagrams showing an operation unit 5M which is a modified example of the operation unit 5. FIG. The operation unit 5M has 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 attached to the operation unit body 51 so as to be movable along the longitudinal direction A. A base end of the first operation wire 41 is attached to the first slider 52M. The first operation wire 41 and the knife 2 advance and retreat when the surgeon advances and retreats the first slider 52M relatively to the operation unit body 51. When the surgeon releases the first slider 52M, the position of the first slider 52M relative to the operation unit body 51 is fixed by a locking mechanism such as a ball click.

[0182] The second slider 55M is attached to the operation portion main body 51 so as to be movable along the longitudinal direction A independently of the first slider 52M. However, when the first slider 52M is retracted as shown in Fig. 50, the second slider 55M cannot move forward because it comes into contact with the first slider 52M. The base end of the second operation wire 42 is attached to the second slider 55M. When the surgeon advances or retreats the second slider 55M relative to the operation portion main body 51, the second operation wire 42 and the sharp member 3 advance or retreat.

[0183] 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 tool having a water supply function. [Explanation of symbols]

[0185] 300 Endoscopic treatment system 200 Endoscope 100, 100B, 100C, 100D, 100E, 100F, 100G, 100H, 100I, 100J Treatment tools (endoscopic treatment tools) 1,1E,1G sheath 10 Tubes 11, 11E, 11G Tip parts 12,12E,12G First through hole 12a,12Ga first aperture 12b Proximal opening 12e Water channel 12f Flange storage section 12g, 12Eg, 12Gg step 121,121G First area 122,122E Second area 122g gap 123E Third Realm 124 Diameter reduction area 125 Expansion area 13 Second through hole 13a Second opening 13b Proximal opening 13g Gap 14 Tip surface 19 Internal space (duct, lumen) 2,2B,2C,2D,2E,2F,2G,2H,2I Knife (electrode) 20,20C Knife body 21, 21C Flange (tip enlarged diameter part) 21b Proximal surface 22, 22B, 22C, 22E Connecting members 22h water inlet 23 First pipeline 23a Tip opening 23b Proximal opening 24 Second pipeline 25 Backflow prevention material 25a through hole 3, 3G, 3I, 3J Sharp parts (rods, solid needles) 31,31G,31I,31J Main body 31a Tip 32 Sharp Part 33 Flange (expanded part) 33G Flange (expanded diameter section) 33h Water inlet 34a Slit section 34b proximal end 34G tip 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 tubes 46 Interior Space 5 Control section 51 Operation unit body 52 Slider 53 Power supply connector 54 Liquid supply port 55 Lever P1 first position P2 2nd position P3 proximal position P4 tip position R Radial direction WR water flow path

Claims

1. a sheath having a distal end and a proximal end and extending between the distal end and the proximal end; An electrode provided at the tip of the sheath; a solid rod having a sharp tip provided at a distal end of the sheath so as to puncture tissue; Equipped with The electrode passes through a first opening formed on the distal end side of the sheath, The rod is provided so as to be movable forward and backward with respect to the sheath through a second opening formed at a position radially spaced from the first opening on a distal end side of the sheath, A part of a flow path through which a fluid passes is formed in a part between the electrode and the rod, A portion of the flow path includes a gap between an inner circumferential surface of the second opening and the rod. Endoscopic treatment tools.

2. The outer diameter of the rod is smaller than the minimum outer diameter of the portion of the electrode exposed from the tip of the sheath. The endoscopic treatment tool according to claim 1 .

3. The tip of the electrode is capable of protruding and retracting from the first opening of the sheath. The endoscopic treatment tool according to claim 1 .

4. The tip end of the rod is capable of protruding and retracting from the second opening of the sheath. The endoscopic treatment tool according to claim 1 or 3.

5. The outer diameter of the rod is smaller than the minimum outer diameter of the portion of the electrode exposed from the tip of the sheath. The endoscopic treatment tool according to claim 4.

6. The sheath has a tube and a tip member provided at a tip of the tube, The tip member has a through hole through which the rod can be inserted, 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 1 .

7. The rod is formed of a resin or ceramic material. The endoscopic treatment tool according to claim 1 or 6.

8. The sheath has a tube and a tip member provided at a tip of the tube, 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 1 .

9. The first opening and the second opening are formed on a tip surface of the tip member. The endoscopic treatment tool according to claim 6.

10. 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 1 or 6.

11. The tip of the sheath has a tip member 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 1 .

12. 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 11.

13. When the flange abuts against the tip member, the amount by which the rod protrudes from the second opening is shorter than the maximum amount by which the electrode protrudes from the first opening. The endoscopic treatment tool according to claim 11.

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