Endoscopic treatment instrument and endoscopic treatment instrument system

Abstract

To provide a treatment instrument for an endoscope, a treatment instrument system for an endoscope, and an operation method of a treatment instrument for an endoscope that allow a plurality of treatments such as a local injection treatment, incision / dissection treatments, and a hemostatic treatment to be executed by switching the tip structure of the treatment instrument without deteriorating flexibility.SOLUTION: A treatment instrument for an endoscope includes: a sheath extending in a longitudinal direction; a partial sheath inserted into the sheath so as to advance or retreat; an insulation chip connected to the tip of the partial sheath; and a metal rod inserted into the partial sheath and the insulation chip so as to advance or retreat, which includes a protrusion protruding in a radial direction. The rod can rotate at a first angle and a second angle in a circumferential direction relative to the partial sheath in a state where at least part of the tip of the rod is stored in the insulation chip. The partial sheath has a slit extending in a longitudinal direction. The protrusion can slide in the slit when the rod is at the first angle. When the protrusion is locked at the partial sheath when the rod is at the second angle, the tip of the rod is positioned relative to the partial sheath in a longitudinal direction.SELECTED DRAWING: Figure 17

Description

Technical Field

[0001] The present invention relates to an endoscopic treatment instrument and Endoscopic Treatment Instrument System and pertains thereto. This application claims priority based on U.S. Provisional Patent Application No. 63 / 478,812 filed in the United States on January 6, 2023, the content of which is 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, endoscopic treatment instruments for local injection, and endoscopic treatment instruments for hemostasis have been used.

[0003] For example, Patent Document 1 describes an endoscopic high-frequency treatment instrument capable of performing incision and dissection procedures and hemostasis procedures.

Prior Art Documents

Patent Documents

[0004]

Patent Document 1

Summary of the Invention

Problems to be Solved by the Invention

[0005] However, in the high-frequency knife described in Patent Document 1, since another sheath (the driving sheath for the first electrode) is inserted inside the outer sheath from the tip to the base end, there is a possibility that the flexibility may be reduced.

[0006] In view of the above circumstances, the present invention aims to provide an endoscopic treatment instrument that does not reduce flexibility and can switch the tip structure of the treatment instrument to perform a plurality of procedures such as local injection procedures, incision and dissection procedures, and hemostasis procedures and Endoscopic Treatment Instrument System and serves this purpose.

Means for Solving the Problems

[0007] The endoscopic treatment instrument according to the first aspect of the present invention includes a resin sheath extending in the longitudinal direction, a partial sheath that is inserted into the sheath so as to be able to advance and retreat and has conductivity, an insulating tip connected to the tip side of the partial sheath, and a metal rod that is inserted into the partial sheath and the insulating tip so as to be able to advance and retreat and has a protruding portion protruding in the radial direction. When at least a part of the tip of the rod is accommodated in the insulating tip, the rod can rotate in the circumferential direction with respect to the partial sheath at a first angle and a second angle. The partial sheath has a slit extending in the longitudinal direction. When the rod is at the first angle, the protruding portion can slide in the slit. When the rod is at the second angle, the protruding portion engages with the partial sheath, so that the tip of the rod is positioned with respect to the partial sheath in the longitudinal direction.

Effect of the Invention

[0008] An endoscopic treatment instrument that can switch the tip structure of the treatment instrument without reducing flexibility and can perform a plurality of treatments such as local injection treatment, incision and peeling treatment, and hemostasis treatment. and Endoscopic Treatment Instrument System can be provided.

Brief Description of the Drawings

[0009]

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Mode 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 15. FIG. 1 is an overall view of the endoscope treatment system 300 according to the present embodiment.

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

[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 endoscope operation portion 207 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 (Charge Coupled Device) or a CMOS (Complementary Metal Oxide Semiconductor), and can image a site to be treated. The imaging portion 203 can image the rod 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 endoscope operation portion 207 by the operator. The flexible portion 205 is a tubular portion having flexibility.

[0016] The endoscope operation portion 207 is connected to the flexible portion 205. The endoscope operation portion 207 has a grip 208, an input portion 209, a proximal end opening 206b of the channel 206, and a universal cord 210. The grip 208 is a portion gripped by the operator. The input portion 209 receives an operation input for bending the bending portion 204. The universal cord 210 outputs an image captured by the imaging portion 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 and 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 rod 2, an insulating member 3, an operating wire 4 (see FIG. 5), and an operating section 5. 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 A1", and the operating section 5 side is referred to as the "base end side A2".

[0018] The sheath 1 is a long resin member having flexibility and insulation, 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. An insulating member 3 is held at the tip 1a of the sheath 1. The insulating member 3 has an insulating tip 31 having an insertion hole 31a penetrating in the longitudinal direction A, and a first holding portion 32 provided in the insertion hole 31a. The rod 2 is inserted into the insertion hole 31a.

[0020] FIG. 4 is a side view of the tip portion of the treatment instrument 100. The rod 2 is a substantially round bar-shaped member made of metal that is inserted into the sheath 1 so as to be able to advance and retreat, and is provided so as to be able to protrude from and retract into the tip side A1 from the insertion hole 31a of the insulating member 3. The rod 2 is formed of a material such as stainless steel, for example. The rod 2 has conductivity and a high-frequency current is passed through it. The rod 2 has a rod body 20 and a flange 21. The central axis O2 of the rod 2 in the longitudinal direction A substantially coincides with the central axis O1 of the sheath 1 in the longitudinal direction A.

[0021] FIG. 5 is a cross-sectional view of the tip portion of the treatment instrument 100. The rod body 20 is a substantially cylindrical member made of metal that extends in the longitudinal direction A. An operation wire 4 is attached to the proximal end of the rod body 20. The rod body 20 supplies a high-frequency current supplied from the operation wire 4 connected to the operation unit 5 to the flange 21. When a high-frequency current is supplied from the operation wire 4 to the rod 2, the rod body 20 and the flange 21 function as a monopolar electrode that outputs the high-frequency current to the living tissue.

[0022] The flange 21 is a substantially cylindrical conductive member provided at the tip of the rod 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 rod body 20. As shown in FIG. 4, the diameter (length in the radial direction R) L1 of the flange 21 is larger than the diameter (length in the radial direction R) L2 of the rod body 20.

[0023] The rod body 20 and the flange 21 have a first water supply pipe 22 which is a pipe extending along the longitudinal direction A. The first water supply pipe 22 communicates with a tip opening 22a formed in the flange 21. The tip opening 22a opens to the tip side A1.

[0024] The insulating member 3 has a substantially cylindrical insulating chip 31 formed of a material having insulating properties such as ceramic, and a first holding portion 32 provided in an insertion hole 31a surrounded by the inner peripheral surface of the insulating chip 31. The insulating member 3 is held at the tip of the sheath 1 by the second holding portion 1c. In the insertion hole 31a, a holding region (second region R2) which is a region where the first holding portion 32 is arranged, and a remaining region which is a region other than that are formed. The remaining region has a first region R1 on the tip side A1 with respect to the second region R2 and a third region R3 on the base end side A2 with respect to the second region R2.

[0025] The insulating chip 31 is formed with a groove portion 31b having a groove shape in which the outer peripheral surface on the proximal end side A2 is recessed in the radial direction R. Further, a second holding portion 1c having a claw shape extending from the opening of the sheath 1 toward the central axis O1 of the sheath 1 is formed at the tip 1a of the sheath 1. The insulating member 3 is held at the tip of the sheath 1 by the engagement of the groove portion 31b of the insulating chip 31 and the second holding portion 1c of the sheath 1.

[0026] The groove portion 31b and the second holding portion 1c only need to have a shape that can detachably attach the insulating member 3 to the sheath 1. The groove portion 31b may be formed on the entire circumference in the circumferential direction C on the outer periphery of the insulating chip 31, or may be formed only on a part thereof. Further, the second holding portion 1c may be formed on the entire circumference in the circumferential direction C of the opening of the sheath 1, or may be formed only on a part thereof. By adjusting the formed range, shape, etc. in the groove portion 31b and the second holding portion 1c, the force with which the sheath 1 holds the insulating member 3 can be adjusted.

[0027] Further, at the tip 1a of the sheath 1, a stopper 33 is provided on the proximal end side A2 with respect to the insulating member 3. The stopper 33 is a member that restricts the movement of the insulating member 3 toward the proximal end side A2 when a force is applied to the proximal end side A2 with respect to the insulating member 3, and suppresses the movement of the insulating member 3 toward the proximal end side A2. Resin, metal, etc. can be used for the stopper 33, but the stopper 33 is preferably formed of a material having insulating properties.

[0028] The stopper 33 is a cylindrical member whose central axis substantially coincides with the central axis O1 of the sheath 1. Further, the rod body 20 is inserted into the opening surrounded by the inner peripheral surface of the stopper 33.

[0029] The first holding portion 32 is a member that can hold the flange 21 provided at the tip of the rod 2. The first holding portion 32 is disposed in the second region R2 of the insertion hole 31a. The holding force (first holding force) with which the first holding portion 32 holds the tip of the rod 2 is greater than the holding force (second holding force) with which the second holding portion 1c holds the insulating member 3.

[0030] FIG. 6 is a perspective view of the distal end of the treatment instrument 100 in a state where the first holding portion 32 holds the flange 21. Further, FIG. 7 is a side view of the distal end of the treatment instrument 100 in the state of FIG. 6. In FIGS. 6 and 7, the insulating member 3 is disconnected from the sheath 1 and is connected to the distal end of the rod 2.

[0031] FIG. 8 is a cross-sectional view of the distal end of the treatment instrument 100 in the state of FIG. 6. The insulating member 3 is attached to the distal end of the rod 2 by the first holding portion 32 holding the flange 21. Further, when the first holding portion 32 holds the flange 21, the distal end of the insulating member 3 is located on the distal end side A1 with respect to the distal end of the rod 2.

[0032] The first holding portion 32 is provided in the insertion hole 31a of the insulating chip 31 and is a substantially cylindrical member formed of an elastic member such as a resin material. The first holding portion 32 sandwiches the flange 21 in the longitudinal direction A and holds the distal end of the rod 2.

[0033] The first holding portion 32 has, for example, a convex shape extending toward the central axis side of the insulating chip 31 on the distal end side A1 and the proximal end side A2. The first holding portion 32 holds the distal end of the rod 2 by sandwiching the flange 21 with this convex shape in the longitudinal direction A. When the distal end of the rod 2 is located in the holding region where the first holding portion 32 is disposed, the first holding portion 32 holds the distal end of the rod 2, and the insulating member 3 is connected to the rod 2. When the distal end of the rod 2 is located in the remaining region where the first holding portion 32 is not disposed, since the distal end of the rod 2 is not held by the first holding portion 32, the insulating member 3 is released with respect to the rod 2, and the rod 2 can move forward and backward with respect to the insulating member 3.

[0034] When the distal end of the rod 2 is located in the first region R1, since the distal end of the rod 2 is not held by the first holding portion 32, it can protrude and retract on the distal end side A1 with respect to the insulating member 3. Further, when the distal end of the rod 2 is located in the second region R2, when the force applied to the proximal end side A2 with respect to the distal end of the rod 2 is greater than the holding force (first holding force) by which the first holding portion 32 holds the distal end of the rod 2, the distal end of the rod 2 can move from the second region R2 to the third region R3.

[0035] The first holding part 32 only needs to have a shape capable of holding the tip of the rod 2. For example, a snap-fit structure utilizing elasticity or the like can be adopted. The first holding part 32 may also have a structure that holds the tip of the rod 2 by using frictional force. The first holding part 32 and the flange 21 can be connected or released by moving the rod 2 forward and backward in the longitudinal direction A. The forward and backward movement of the rod 2 in the longitudinal direction A will be described later.

[0036] The operating wire 4 is a shaft that passes through the internal space 1s of the sheath 1 and has a coil shaft 40 and a tube 41. The tip of the operating wire 4 is connected to the rod 2, and the base end of the operating wire 4 is connected to the operating part 5. Note that the operating wire 4 may have other forms as long as it is a hollow shaft.

[0037] The coil shaft 40 is a metal coil wire. The coil shaft 40 is formed of a material such as stainless steel, for example. A second water supply passage 42 is formed inside the coil shaft 40. The second water supply passage 42 is connected to the base end of the first water supply passage 22.

[0038] The tube 41 is a tube provided on the outer peripheral portion of the coil shaft 40 and is, for example, a heat-shrinkable tube. By covering the outer peripheral portion of the coil shaft 40 with the tube 41, liquid does not leak from the second water supply passage 42.

[0039] Here, in this specification, the treatment instrument 100 in a state where the insulating member 3 is connected to the tip of the rod 2 as shown in FIG. 8 is referred to as an "IT knife". In the treatment instrument 100 in the IT knife state, since the tip of the rod 2 is covered with the insulating member 3 having insulating properties, when a high-frequency current is supplied, the rod body 20 functions as a monopolar electrode.

[0040] In addition, as shown in FIG. 5, the treatment instrument 100 in a state where the tip of the rod 2 is not covered by the insulating member 3 is referred to as a "needle-shaped knife". In the treatment instrument 100 in the needle-shaped knife state, when a high-frequency current is supplied, the rod body 20 and the flange 21 function as monopolar electrodes.

[0041] 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, and a liquid supply port 54.

[0042] FIG. 9 is a cross-sectional view of the operation unit 5. 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 operation wire 4 can be inserted. The operation wire 4 passes through the internal space 1s of the sheath 1 and the internal space 5s of the operation unit main body 51 and extends to the slider 52.

[0043] The slider 52 is attached to the operation unit main body 51 so as to be movable along the longitudinal direction A. The slider 52 is attached to the sheath 1 connected to the operation unit main body 51 via a first O-ring 52a. The proximal end 4b of the operation wire 4 is attached to the slider 52. By the operator moving the slider 52 relative to the operation unit main body 51 forward and backward, the operation wire 4 and the rod 2 move forward and backward.

[0044] 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 operation wire 4 via a conductive wire 53w. The power supply connector 53 can supply the high-frequency current supplied from the high-frequency power supply device to the rod 2 via the operation wire 4. The high-frequency power supply device and the power supply connector 53 are connected by, for example, a cable through which a high-frequency current can flow, and the high-frequency power is supplied from the high-frequency power supply device to the power supply connector 53 via this cable.

[0045] The liquid supply port 54 is provided on the slider 52. The liquid supply port 54 is connected to the proximal end of the second water supply pipe 42 via a third water supply pipe 56 formed in the slider 52. The liquid supplied from the liquid supply port 54 passes through the third water supply pipe 56, the second water supply pipe 42, and the first water supply pipe 22 and is discharged from the tip opening 22a.

[0046] [Method of Using the Endoscopic Treatment System 300] Next, a procedure using the endoscopic treatment system 300 of the present embodiment (method of using the endoscopic treatment system 300) will be described. Specifically, local injection treatment, incision and dissection treatment, and hemostasis treatment of a lesion site in endoscopic treatment such as ESD (endoscopic submucosal dissection) will be described.

[0047] As a preparatory work, the operator identifies the lesion site by a known method. Specifically, the operator inserts the insertion portion 202 of the endoscope 200 into the digestive tract (for example, esophagus, stomach, duodenum, large intestine), and identifies the lesion site while observing the image obtained by the imaging portion 203 of the endoscope.

[0048] [Insertion Step] The operator inserts the treatment instrument 100 into the channel 206, and projects the tip 1a of the sheath 1 from the tip opening 206a of the insertion portion 202. FIG. 10 is a cross-sectional view of the tip portion of the treatment instrument 100 in the insertion step. In the insertion step, the insulating member 3 is held by the sheath 1. Further, the tip of the rod 2 is located in the first region R1, and since the first holding portion 32 does not hold the tip of the rod 2, the tip of the rod 2 can protrude and retract on the tip side A1 of the insulating member 3.

[0049] [Local Injection Step] Next, the operator advances the slider 52 of the operation unit 5 relative to the operation unit main body 51 to project the rod 2 into the state shown in FIG. 5 (needle knife). At this time, since the first holding portion 32 does not hold the flange 21 and the insulating member 3 is held by the sheath 1, the rod 2 advances relative to the sheath 1 and the insulating member 3. The operator moves the flange 21 in a state where a high-frequency current is applied, incises and penetrates the location where the local injection liquid (local injection solution) is to be injected at the lesion site, and waters with the tip opening 22a of the tip of the rod 2 inserted into the submucosa layer (local injection step).

[0050] <Incising and Dissecting Step> Next, the operator performs an incising and dissecting procedure. The operator retracts the slider 52 relative to the operation unit main body 51 and causes the first holding portion 32 to hold the tip of the rod 2. At this time, when the force pulling the rod 2 toward the proximal end side A2 is greater than the force received by the tip of the rod 2 from the first holding portion 32 toward the distal end side A1, the tip of the rod 2 moves from the first region R1 to the second region R2. Since the first holding portion 32 is formed of an elastic member, the flange 21 retreats while elastically deforming the convex shape on the distal end side A1 in the convex shape of the first holding portion 32 extending toward the central axis side of the insulating tip 31, and is sandwiched and held by the first holding portion 32 in the longitudinal direction A.

[0051] The operator advances the slider 52 relative to the operation unit main body 51 from the state shown in FIG. 11 where the first holding portion 32 holds the flange 21. At this time, the first holding force with which the first holding portion 32 of the insulating member 3 holds the tip of the rod 2 is greater than the second holding force with which the second holding portion 1c of the sheath 1 holds the insulating member 3. Therefore, the connection between the insulating member 3 and the sheath 1 is released before the connection between the tip of the rod 2 pushed toward the distal end side A1 and the first holding portion 32 is released. As a result, when the slider 52 is advanced relative to the operation unit main body 51 and the rod 2 advances, the tip of the rod 2 remains in the second region R2 without moving from the second region R2 to the first region R1, the connection between the insulating member 3 and the sheath 1 is released while the tip of the rod 2 and the insulating member 3 remain connected, and the insulating member 3 advances together with the rod 2, and the tip of the treatment instrument 100 becomes the state shown in FIG. 8 (IT knife).

[0052] The operator moves the insulating member 3 and the rod 2 while passing a high-frequency current, and incises the mucosa of the lesion using the rod body 20. At this time, since the insulating member 3 is connected to the tip of the rod 2, the operator can press the insulating member 3 against the mucosa and incise it with the rod body 20 while pulling the loose mucosa. Further, since the insulating member 3 has insulating properties, it is possible to suppress damage to the living tissue around the incised site.

[0053] Further, the operator moves the insulating member 3 and the rod 2, and while passing a high-frequency current, lifts the incised mucosa of the lesion to expose the submucosa, and peels the submucosa of the incised lesion.

[0054] <Hemostasis step> When bleeding occurs during the incision and peeling procedure, the operator performs a hemostasis procedure. The operator relatively retracts the slider 52 with respect to the operation unit main body 51. The insulating member 3 and the rod 2 retract, and the base end side A2 of the insulating member 3 contacts the tip end side A1 of the stopper 33. At this time, when the force pulling the tip of the rod 2 located in the second region R2 toward the base end side A2 is greater than the first holding force with which the first holding portion 32 holds the tip of the rod 2, the tip of the rod 2 is movable from the second region R2 to the third region R3.

[0055] When, in a state where the insulating member 3 is in contact with the stopper 33, a force greater than the first holding force is applied to the rod 2 toward the base end side A2 to further retract the rod 2, the rod 2 relatively retracts with respect to the insulating member 3 whose movement toward the base end side A2 is restricted by the stopper 33, and retracts while elastically deforming the convex shape on the base end side A2 of the first holding portion 32. As a result, the connection between the first holding portion 32 and the flange 21 is released, and the state shown in FIG. 12 is obtained. At this time, the groove portion 31b of the insulating tip 31 and the second holding portion 1c of the sheath 1 may or may not be fitted again.

[0056] When the groove portion 31b and the second holding portion 1c are not refitted again, if the connection between the insulating member 3 and the rod 2 is released, the insulating member 3 will drop off from the tip 1a of the sheath 1 and reach the state shown in FIG. 13. At this time, in order to prevent the insulating member 3 from being left in the digestive tract, it is desirable that the sheath 1 and the insulating member 3 are connected by a connecting member (not shown) such as a string member.

[0057] Also, in the state shown in FIG. 12, when the groove portion 31b and the second holding portion 1c are refitted, the insulating member 3 may be dropped off from the tip 1a of the sheath 1 by advancing the rod 2 and extruding the first holding portion 32 with the flange 21. For example, when trying to move the tip of the rod 2 from the third region R3 to the second region R2, the force received by the first holding portion 32 from the tip of the rod 2 to the tip side A1 is greater than the second holding force with which the second holding portion 1c holds the insulating member 3. As a result, the tip of the rod 2 does not move from the third region R3 to the second region R2, the connection between the sheath 1 and the insulating member 3 is released, and the insulating member 3 drops off from the tip 1a of the sheath 1.

[0058] By removing the insulating member 3 from the tip of the rod 2, the tip of the treatment instrument 100 becomes a needle-shaped knife with the flange 21 exposed. The operator advances the slider 52 relative to the operation unit main body 51 in the treatment instrument 100 in the state of FIG. 13, advances the rod 2, and cauterizes the bleeding point with an energized high-frequency current while pressing the rod body 20 and the flange 21 to stop the bleeding (hemostasis step).

[0059] Before or after the hemostasis treatment, the operator may perform local injection treatment or incision and dissection treatment again using the treatment instrument 100 in which the insulating member 3 has fallen off to become a needle knife. Also, when performing treatment with the IT knife again, the operator removes the insertion portion 202 of the endoscope 200 from the digestive tract. At this time, since the insulating member 3 removed from the rod 2 is connected to the sheath 1 by a connecting member, the insulating member 3 is removed from the digestive tract together with the insertion portion 202 without being left in the digestive tract. The operator attaches the insulating member 3 to the second holding portion 1c of the sheath 1 or the tip of the rod 2, inserts the tip of the treatment instrument 100 into the digestive tract again in the state of FIG. 10 or FIG. 11, and can perform incision and dissection using the IT knife in which the flange 21 is covered with the insulating member 3. Also, when blood or mucus adheres to the insulating member 3, the operator can replace the insulating member 3 attached to the tip of the treatment instrument 100 with a new one.

[0060] The operator continues the above-described operation (treatment) as necessary, finally excises the lesion, and ends the ESD procedure.

[0061] According to the treatment instrument 100 according to the present embodiment, the tip structure of the treatment instrument 100 can be easily switched, and a plurality of treatments such as local injection treatment, incision and dissection treatment, and hemostasis treatment can be performed. Also, according to the treatment instrument 100 according to the present embodiment, a decrease in flexibility in the sheath 1 can be suppressed.

[0062] 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. Also, the constituent elements shown in the above-described embodiments and modified examples can be combined as appropriate.

[0063] (Modification Example 1-1) In the above embodiment, the shape of the flange 21 is cylindrical. However, the form of the flange 21 is not limited to this. The flange 21 may be substantially cylindrical with chamfers at the entire circumferences of the tip side A1 and the base end side A2. In the flange 21 that moves in the first region R1, the second region R2, and the third region R3, by forming the outer circumference into a chamfered shape, the catching between the flange 21 and the first holding portion 32 is reduced, and the rod 2 can be advanced or retracted with a smaller force.

[0064] (Modification 1-2) In the above embodiment, a cylindrical flange 21 is provided at the tip of the rod 2. However, the form of the rod 2 is not limited to this. FIG. 14 is a diagram showing a flange 21A which is a modification of the flange 21. The flange 21A is formed in a triangular shape in a front view seen from the tip side A1. The first holding portion 32 may have a shape capable of holding the tip of the rod 2. For example, the flange 21A can be held by having a shape that sandwiches the three sides of the triangular flange 21A in the longitudinal direction A.

[0065] (Modification 1-3) In the above embodiment, a flange 21 is provided at the tip of the rod 2. However, the form of the rod 2 is not limited to this. FIG. 15 is a diagram showing a rod 2A which is a modification of the rod 2. The tip portion 24 of the rod 2A is formed in a hook shape. A tip opening 22a that opens to the tip side A1 is formed in the tip portion 24. The first holding portion 32 may have a shape capable of holding the tip of the rod 2A. For example, the rod 2A can be held by having a shape that sandwiches the bent tip of the tip portion 24 of the rod 2A in the longitudinal direction A.

[0066] (Second Embodiment) The treatment instrument 100B according to the second embodiment of the present invention will be described with reference to FIGS. 16 to 24. In the following description, for the configurations common to those already described, the same reference numerals are given and redundant descriptions are omitted.

[0067] [Treatment instrument 100B] FIG. 16 is an overall view showing the treatment instrument 100B. The treatment instrument (endoscope treatment instrument) 100B, similar to the treatment instrument 100 of the first embodiment, constitutes an endoscope treatment system together with the endoscope 200. The treatment instrument 100B includes a sheath 1, a rod 2B, an insulating member 3B, an operating wire 4, and an operating section 5B.

[0068] FIG. 17 is a perspective view of the tip of the treatment instrument 100B. An insulating member 3B is inserted into the tip 1a of the sheath 1 so as to be able to advance and retract. The insulating member 3B has an insulating tip 31B having an insertion hole 31Ba penetrating in the longitudinal direction A, and a cylindrical partial sheath 34B connected to the proximal end side A2 of the insulating tip 31B. Note that the cylindrical shape does not necessarily have to be a precise cylinder. The rod 2B is inserted into the insertion hole 31Ba and the hollow portion of the partial sheath 34B.

[0069] The rod 2B is a metal round bar-shaped member that can advance and retract with respect to the sheath 1 and the insulating member 3B, and is provided so as to be able to protrude and retract from the insertion hole 31Ba of the insulating member 3B to the tip side A1. Note that the round bar shape does not necessarily have to be a precise round bar. The rod 2B is formed of a material such as stainless steel, for example. The rod 2B has conductivity and a high-frequency current is passed through it. The rod 2B has a rod body 20B and a flange 21. The central axis O2 in the longitudinal direction A of the rod 2B coincides with the central axis O1 in the longitudinal direction A of the sheath 1. Note that the central axis O1 and the central axis O2 do not necessarily have to coincide precisely. Also, the rod body 20B and the flange 21 have a first water supply passage 22.

[0070] The rod body 20B is a cylindrical member made of metal that extends in the longitudinal direction A. An operation wire 4 is attached to the proximal end of the rod body 20B. Note that the cylindrical shape does not necessarily have to be a precise cylinder. The rod body 20B supplies the high-frequency current supplied from the operation wire 4 connected to the operation unit 5B to the flange 21. When a high-frequency current is supplied from the operation wire 4 to the rod 2B, the rod body 20B and the flange 21 function as a monopolar electrode that outputs the high-frequency current to the living tissue.

[0071] The rod body 20B has a protrusion 20Ba. The protrusion 20Ba is provided on the outer peripheral surface of the rod body 20B and has a protruding shape that protrudes in the radial direction R. The protrusion 20Ba has a cuboid shape in which one surface is connected to the outer peripheral surface of the rod body 20B. Note that the cuboid shape does not necessarily have to be a precise cuboid.

[0072] The insulating tip 31B is a cylindrical member formed of a material having insulating properties such as ceramic. Note that the cylindrical shape does not necessarily have to be a precise cylinder. The partial sheath 34B is formed of a material having conductivity such as metal. The partial sheath 34B has a slit 34Ba that is a cut extending in the longitudinal direction A, and a step portion 34Bb that is a notch provided continuously with the slit 34Ba. The slit 34Ba may be a through hole that penetrates the partial sheath 34B in the radial direction R.

[0073] The rod 2B is rotatable in the circumferential direction C with respect to the partial sheath 34B. FIG. 17 is a perspective view when the rod 2B is positioned at the first angle P1 with respect to the partial sheath 34B. When the rod 2B is at the first angle P1, the protrusion 20Ba is disposed within the range of the slit 34Ba. Therefore, in the longitudinal direction A, the protrusion 20Ba and the partial sheath 34B do not come into contact with each other, and the rod 2B is movable forward and backward in the longitudinal direction A with respect to the partial sheath 34B.

[0074] FIG. 18 is a perspective view of the tip of the treatment instrument 100B when the rod 2B is positioned at the second angle P2 with respect to the partial sheath 34B. The rod 2B is rotatable in the circumferential direction C with respect to the partial sheath 34B within at least a range from the first angle P1 to the second angle P2. Here, the first angle P1 and the second angle P2 are the angles (positions) of the rod 2B with respect to the partial sheath 34B. Note that the rod 2B is rotatable in the circumferential direction C between the first angle P1 and the second angle P2 in a state where at least a part of the tip (here, the flange 21) of the rod 2B is accommodated in the insertion hole 31Ba within the insulating tip 31B.

[0075] FIG. 19 is a cross-sectional view of the tip of the treatment instrument 100B in the state of FIG. 18. The protrusion 20Ba is positioned at the stepped portion 34Bb where the proximal end side A2 of the partial sheath 34B is notched when the rod 2B is at the second angle P2. At this time, as shown in FIG. 19, the tip of the insulating tip 31B is positioned on the tip side A1 with respect to the tip of the rod 2B. Further, the protrusion 20Ba has a height such that it can contact the partial sheath 34B in the radial direction R. Therefore, the tip side A1 of the protrusion 20Ba positioned at the second angle P2 contacts the stepped portion 34Bb of the partial sheath 34B.

[0076] As shown in FIG. 19, the insulating member 3B has a first contact portion 35B that can contact and face the surface of the proximal end side A2 of the flange 21 in the longitudinal direction A. The first contact portion 35B is a portion that extends from the outer periphery toward the central axis side of the insulating tip 31B at the proximal end side A2 of the insulating tip 31B.

[0077] When the rod 2B is at the first angle P1, since the protrusion 20Ba is disposed within the range of the slit 34Ba, the rod 2B can move forward and backward in the longitudinal direction A with respect to the sheath 1 and the insulating member 3B. When the rod 2B moves forward and backward in the longitudinal direction A at the first angle P1, the protrusion 20Ba slides within the slit 34Ba. Therefore, the rod body 20B and the flange 21 can protrude and retract to the tip side A1 with respect to the insulating member 3B, and the rod body 20B and the flange 21 can be used as a needle knife that functions as a monopolar electrode.

[0078] Further, a second O-ring 36B is provided on the outer periphery of the partial sheath 34B. The second O-ring 36B is in contact with the inner peripheral surface of the sheath 1 and the outer peripheral surface of the partial sheath 34B. The second O-ring 36B is formed of a material such as a rubber material, and holds the partial sheath 34B against the sheath 1 by frictional force. In the present embodiment, the treatment instrument 100B has two second O-rings 36B, but the number of second O-rings 36B may be one or three or more.

[0079] In the rod 2B that moves forward and backward in the longitudinal direction A located at the first angle P1 or the rod 2B that rotates in the circumferential direction C, when the partial sheath 34B receives a force from the rod 2B due to frictional force or the like generated between the outer peripheral surface of the rod body 20B and the inner peripheral surface of the partial sheath 34B, since the holding force by which the second O-ring 36B holds the partial sheath 34B against the sheath 1 is greater than the force received by the partial sheath 34B from the rod 2B, movement of the partial sheath 34B relative to the sheath 1 is suppressed.

[0080] When the rod 2B is at the second angle P2, the protrusion 20Ba is disposed in the stepped portion 34Bb. The stepped portion 34Bb is an opening continuous with the slit 34Ba in the circumferential direction C. Therefore, by rotating the rod 2B in the circumferential direction C, the protrusion 20Ba moves from the slit 34Ba to the stepped portion 34Bb. At this time, the rod 2B rotates from the first angle P1 to the second angle P2.

[0081] The partial sheath 34B is held on the inner peripheral surface of the sheath 1 by the second O-ring 36B. When the rod 2B at the second angle P2 advances toward the distal end side A1, the surface of the distal end side A1 of the protrusion 20Ba abuts against the surface of the proximal end side A2 of the stepped portion 34Bb. At this time, since the force by which the protrusion 20Ba pushes the stepped portion 34Bb toward the distal end side A1 is greater than the force by which the insulating member 3B is held on the sheath 1 by the second O-ring 36B, the insulating member 3B is pushed by the protrusion 20Ba and advances toward the distal end side A1 together with the rod 2B.

[0082] At this time, the tip of the insulating chip 31B is located on the tip side A1 with respect to the tip of the rod 2B, and the outer periphery of the flange 21 is surrounded by the insulating chip 31B. Further, since the partial sheath 34B has conductivity, the high-frequency current supplied to the rod 2B is supplied to the partial sheath 34B through the contact portion between the partial sheath 34B and the protrusion 20Ba. Therefore, the partial sheath 34B can be used as an IT knife that functions as a monopolar electrode.

[0083] Note that the partial sheath 34B does not necessarily have the step portion 34Bb. Even if the partial sheath 34B does not have the step portion 34Bb, the protrusion 20Ba of the rod 2B located at the second angle P2 locks to the base end of the partial sheath 34B, so that the insulating member 3B can be advanced to the tip side A1 together with the rod 2B. In this case, for example, by providing the operation unit 5B with an angle fixing means capable of positioning the rod 2B at the first angle P1 or the second angle P2, the angle of the rod 2B with respect to the partial sheath 34B can be positioned. The angle fixing means in the operation unit 5B will be described later.

[0084] The length of the partial sheath 34B in the longitudinal direction A is preferably 30 mm or less. Since the flexibility of the sheath 1 in the range where the partial sheath 34B is inserted decreases, by setting the length of the partial sheath 34B to 30 mm or less, a decrease in the flexibility of the sheath 1 can be suppressed.

[0085] When the rod 2B located at the second angle P2 is moved to the base end side A2, the surface of the base end side A2 of the flange 21 and the surface of the tip side A1 of the first contact portion 35B come into contact, and the insulating member 3B is pushed by the flange 21 to the base end side A2 and retracts. At this time, the force with which the rod 2B pushes the insulating member 3B to the base end side A2 is greater than the holding force with which the sheath 1 holds the insulating member 3B by the second O-ring 36B.

[0086] When the rod 2B is positioned at the second angle P2, the tip of the rod 2B is positioned with respect to the partial sheath 34B in the longitudinal direction A. Specifically, as shown in FIG. 19, at the proximal end side A2, the protrusion 20Ba is locked (contacted) to the stepped portion 34Bb, and at the distal end side A1, the flange 21 is locked (contacted) to the first contact portion 35B, so that the tip of the rod 2B is positioned with respect to the partial sheath 34B in the longitudinal direction A. Further, by locking the protrusion 20Ba to the partial sheath 34B, the state where the tip of the rod 2B is accommodated in the insertion hole 31Ba is maintained.

[0087] Also, since the diameter of the outer periphery of the insulating chip 31B is larger than the diameter of the outer periphery of the sheath 1, the insulating chip 31B pushed toward the proximal end side A2 comes to rest at the distal end side A1 of the sheath 1 with the surface of the proximal end side A2 of the insulating chip 31B in contact with the sheath 1. From this state, by rotating the rod 2B to the first angle P1, it is possible to return to the state of the needle-shaped knife shown in FIG. 17 again. When switching to the IT knife, the rod 2B is rotated from the first angle P1 to the second angle P2, and the operation of pushing out the insulating member 3B to the distal end side A1 by the rod 2B is performed again.

[0088] FIG. 20 is a cross-sectional view of the operation unit 5B. The distal end portion of the operation unit main body 51B is connected to a cylindrical connecting portion 55B extending in the longitudinal direction A. Note that the cylindrical shape does not necessarily have to be a strict cylinder. The operation unit main body 51B has an internal space through which the operation wire 4 can be inserted. The operation wire 4 passes through the internal space 1s of the sheath 1 and the internal space 5s of the operation unit main body 51B and extends to the slider 52.

[0089] The operation unit main body 51B has a connecting flange 51Ba at its distal end portion. The connecting flange 51Ba has a flange shape extending outward in the radial direction R at the cylindrical distal end portion of the operation unit main body 51B and is provided over the entire circumference in the circumferential direction C. Note that the cylindrical shape does not necessarily have to be a strict cylinder. Also, the slider 52 does not rotate in the circumferential direction C with respect to the operation unit main body 51B.

[0090] The connecting portion 55B has a connecting groove 55Ba at its base end. The connecting groove 55Ba is a groove shape provided on the inner peripheral surface of the base end of the connecting portion 55B, and is rotatably fitted to the connecting flange 51Ba in the circumferential direction C. The tip of the connecting portion 55B is connected to the sheath 1. Further, the connecting portion 55B is attached to the sheath 1 via a second O-ring 52Ba.

[0091] When the operation unit main body 51B and the slider 52 rotate in the circumferential direction C with respect to the connecting portion 55B, the sheath 1 does not rotate because it is connected to the connecting portion 55B. Since the operation wire 4 is connected to the slider 52, it rotates in the circumferential direction C together with the operation unit main body 51B and the slider 52. At this time, the rod 2B connected to the tip of the operation wire 4 also rotates in the circumferential direction C in the same manner. As a result, when the operation unit main body 51B and the slider 52 are rotated in the circumferential direction C with respect to the connecting portion 55B, the rod 2B rotates in the circumferential direction C with respect to the sheath 1.

[0092] By rotating the operation unit main body 51B and the slider 52 in the circumferential direction C with respect to the connecting portion 55B, the rod 2B can be rotated to the first angle P1 and the second angle P2. By rotating the operation unit main body 51B and the slider 52, the rod 2B can be rotated to the first angle P1 and the second angle P2 with respect to the sheath 1, and the needle knife and the IT knife can be easily switched. Note that the rotation speeds of the operation unit main body 51B and the slider 52 and the rod 2B do not have to match. The operation unit 5B only needs to have a structure that transmits the rotational motion to the rod 2B and can switch between the first angle P1 and the second angle P2.

[0093] FIG. 21 is a cross-sectional view of the operation unit 5B taken along the line X-X shown in FIG. 20. On the outer peripheral surface of the connecting flange 51Ba in the operation unit main body 51B, a positioning portion 51Bb having a protruding shape protruding outward in the radial direction R is provided. Further, on the inner peripheral surface of the connecting groove 55Ba in the connecting portion 55B, a fixing portion 55Bb and a temporary fixing portion 55Bc having a protruding shape protruding inward in the radial direction R are provided. The positioning portion 51Bb, the fixing portion 55Bb, and the temporary fixing portion 55Bc have a shape that can contact each other in the circumferential direction C.

[0094] In the operation unit main body 51B that rotates in the circumferential direction C with respect to the connecting portion 55B, the positioning portion 51Bb, the fixing portion 55Bb, and the temporary fixing portion 55Bc have a function of fixing the angle of the operation unit main body 51B with respect to the connecting portion 55B to an angle corresponding to the first angle P1 or the second angle P2 in the rod 2B. That is, the positioning portion 51Bb, the fixing portion 55Bb, and the temporary fixing portion 55Bc are angle fixing means capable of positioning the angle of the rod 2B at the first angle P1 or the second angle P2. When the treatment tool 100B is inserted into the channel 206 in the state where the endoscope 200 is curved, the positions of the positioning portion 51Bb, the fixing portion 55Bb, and the temporary fixing portion 55Bc may be set in consideration of the rotational transmission property of the operation unit 5B with respect to the rod 2B.

[0095] For example, in a front view seen from the proximal end side A2, when the operation unit main body 51B rotates counterclockwise in the circumferential direction C with respect to the connecting portion 55B, the positioning portion 51Bb first contacts the temporary fixing portion 55Bc of the connecting portion 55B in the rotational direction (circumferential direction C). When the operation unit main body 51B is further rotated counterclockwise and the force for rotating the operation unit main body 51B is greater than the force received by the positioning portion 51Bb from the temporary fixing portion 55Bc, the positioning portion 51Bb passes through the temporary fixing portion 55Bc. Here, when the positioning portion 51Bb passes through the temporary fixing portion 55Bc, it is necessary to apply a certain amount of force to rotate the operation unit main body 51B. By making the surfaces of the positioning portion 51Bb and the temporary fixing portion 55Bc that contact each other have a rounded shape or an inclined shape, the force required for the positioning portion 51Bb to pass through the temporary fixing portion 55Bc can be adjusted.

[0096] The positioning portion 51Bb that has passed through the temporary fixing portion 55Bc then comes into contact with the fixing portion 55Bb in the rotational direction. Here, even if the operation unit main body 51B is further rotated counterclockwise, the positioning portion 51Bb does not pass through the fixing portion 55Bb. Also, when the operation unit main body 51B is rotated clockwise, the positioning portion 51Bb comes into contact with the temporary fixing portion 55Bc again, so the operation unit main body 51B will not rotate clockwise unless a certain amount of force is applied to rotate the operation unit main body 51B.

[0097] Therefore, the positioning portion 51Bb stays between the temporary fixing portion 55Bc and the fixing portion 55Bb, and the angle of the operation unit main body 51B with respect to the connecting portion 55B is fixed. By arranging the positioning portion 51Bb, the fixing portion 55Bb, and the temporary fixing portion 55Bc so that the rod 2B is fixed at the first angle P1 or the second angle P2, the rod 2B can be easily fixed at the first angle P1 or the second angle P2, and the needle knife and the IT knife can be easily switched. Also, it is possible to suppress the operator from unintentionally switching the angle of the rod 2B and prevent the needle knife and the IT knife from being accidentally switched. Note that the method of fixing the angle of the operation unit main body 51B with respect to the connecting portion 55B and the method of fixing the rod 2B at the first angle P1 or the second angle P2 are not limited to this. For example, a clip (not shown) that is fixed to the connecting portion 55B and temporarily fixes the position of the operation unit main body 51B or the slider 52 with respect to the connecting portion 55B may be used.

[0098] According to the treatment instrument 100B according to the present embodiment, the tip structure of the treatment instrument 100B can be easily switched, and a plurality of treatments such as local injection treatment, incision and dissection treatment, and hemostasis treatment can be performed by the same usage method as the treatment instrument 100 of the first embodiment. Also, according to the treatment instrument 100B according to the present embodiment, a decrease in flexibility in the sheath 1 can be suppressed.

[0099] 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. Also, the constituent elements shown in the above-described embodiments and modified examples can be combined as appropriate.

[0100] (Modification Example 2-1) In the above-described embodiment, the insulating member 3B is provided with the first contact portion 35B. However, the form of the insulating member 3B is not limited to this. FIG. 22 is a view showing an insulating member 3C which is a modification of the insulating member 3B. The insulating member 3C has a second contact portion 34Bc on the base end side A2 of the slit 34Ba or the stepped portion 34Bb. By arranging the second contact portion 34Bc so as to contact the base end side A2 of the protrusion 20Ba, even if the insulating member 3C does not have the first contact portion 35B, when the rod 2B is moved to the base end side A2, the protrusion 20Ba and the second contact portion 34Bc come into contact with each other, and the insulating member 3C can move to the base end side A2 together with the rod 2B.

[0101] (Modification Example 2-2) In the above-described embodiment, the insulating member 3B is provided with the stepped portion 34Bb which is a notch provided continuously with the slit 34Ba. However, the form of the insulating member 3B is not limited to this. FIG. 23 is a view showing an insulating member 3D which is a modification of the insulating member 3B. A part of the surface of the stepped portion 34Bb of the insulating member 3D on the tip side A1 has an inclined portion 34Bt which is an inclined surface inclined toward the tip side A1, and the stepped portion 34Bb and the slit 34Ba are smoothly connected. By providing the inclined portion 34Bt, even when the positions of the protrusion 20Ba and the stepped portion 34Bb in the longitudinal direction A are displaced when the rod 2B is rotated from the first angle P1 to the second angle P2, the rod 2B can be rotated in the circumferential direction C to bring the protrusion 20Ba into contact with the stepped portion 34Bb.

[0102] (Modification Example 2-3) In the above embodiment, one step portion 34Bb is provided on one side in the circumferential direction C of the slit 34Ba in the insulating member 3B. However, the form of the step portion 34Bb is not limited to this. FIG. 24 is a view showing an insulating member 3E which is a modified example of the insulating member 3B. The insulating member 3E has two step portions 34Bb arranged on both sides of the slit 34Ba in the circumferential direction C. Note that the number of step portions 34Bb may be three or more, or there may be a plurality of them at the tip end portion and the base end portion of the insulating member 3E. At this time, the shapes and arrangements of the positioning portion 51Bb, the fixing portion 55Bb, and the temporary fixing portion 55Bc can be appropriately changed according to the form of the insulating member 3E.

[0103] For example, in the case of the insulating member 3E shown in FIG. 24, in the operation unit main body 51B and the connecting portion 55B, the fixing portion 55Bb and the temporary fixing portion 55Bc are arranged at positions corresponding to the two step portions 34Bb arranged on both sides of the slit 34Ba. Further, since the rod 2B can rotate clockwise and counterclockwise from the first angle P1, in the connecting portion 55B, the positioning portion 51Bb when the rod 2B is at the first angle P1 is sandwiched between the two temporary fixing portions 55Bc in the circumferential direction C. By doing so, the operation unit main body 51B is fixed at the angle at which the rod 2B is located at the first angle P1, and can rotate clockwise and counterclockwise from the first angle P1 when a certain amount of force is applied.

Explanation of Signs

[0104] 100, 100B Treatment instrument for endoscope 1 Sheath 1a Tip of the sheath 1c Second holding portion 2, 2A, 2B Rod 20, 20B Rod body 20Ba Protrusion 22 First water supply pipeline 21, 21A Flange 3, 3B, 3C, 3D, 3E Insulating member 31, 31B Insulating chip 31a, 31Ba Insertion hole 31b Groove portion 32 First holding portion 33 Stopper 34B Partial Sheath 34Ba Slit 34Bb Step Portion 34Bc Second Contact Portion 34Bt Inclined Portion 35B First Contact Portion 4 Operating Wire (Shaft) 5, 5B Operating Portion 52 Slider A Longitudinal Direction A1 Tip Side A2 Base End Side C Circumferential Direction R Radial Direction L1 Diameter of Flange L2 Diameter of Rod Body R1 First Region R2 Second Region R3 Third Region P1 First Angle P2 Second Angle

Claims

1. A resin sheath extending in the longitudinal direction, A partial sheath that is inserted into the sheath so as to be able to advance and retreat and has conductivity, An insulating tip connected to the tip side of the partial sheath, A metal rod inserted into the partial sheath and the insulating tip and having a protrusion protruding in the radial direction, Comprising, When at least a part of the tip of the rod is accommodated in the insulating tip, the rod can rotate the first angle and the second angle in the circumferential direction with respect to the partial sheath, The partial sheath has a slit extending in the longitudinal direction, When the rod is at the first angle, the protrusion can slide within the slit, When the rod is at the second angle, the protrusion engages with the partial sheath, whereby the tip of the rod is positioned with respect to the partial sheath in the longitudinal direction, An endoscopic treatment instrument.

2. The insulating tip has an insertion hole through which the rod can be inserted, When the rod is at the second angle, the protrusion engages with the partial sheath, thereby maintaining a state in which the tip of the rod is accommodated in the insertion hole, The endoscopic treatment instrument according to claim 1.

3. The rod is, A substantially cylindrical rod body extending in the longitudinal direction, A substantially cylindrical flange provided at the tip of the rod and having a diameter larger than the diameter of the rod body, Having, The insulating tip has a first contact portion that can contact the base end side of the flange, The endoscopic treatment instrument according to claim 1.

4. The partial sheath is provided continuously with the slit and includes a step portion that contacts the tip side of the protrusion of the rod positioned at the second angle, The endoscopic treatment instrument according to claim 1.

5. The partial sheath is provided on the base end side of the slit or the step portion and has a second contact portion that can contact the base end side of the protrusion, The endoscopic treatment instrument according to claim 4.

6. A shaft provided at the base end of the rod and having an internal space communicating with the conduit of the rod, An operation portion provided at the base end of the shaft and having a slider that can rotate with respect to the sheath, Further comprising, The rod can rotate the first angle and the second angle in conjunction with the rotation of the slider, The endoscopic treatment instrument according to claim 1.

7. Further comprising a connecting portion that rotatably connects the sheath and the slider, The slider and the connecting portion are in contact with each other in the circumferential direction and have a protrusion shape that restricts the rotation of the slider at the first angle or the second angle. The endoscopic treatment instrument according to claim 6.

8. The partial sheath has at least two or more of the stepped portions provided on both sides of the slit in the circumferential direction. The endoscopic treatment instrument according to claim 4.

9. At least a part of the surface on the tip side of the stepped portion is inclined toward the tip side and connected to the slit. The endoscopic treatment instrument according to claim 4.

10. The partial sheath has a length in the longitudinal direction of 30 mm or less. The endoscopic treatment instrument according to claim 1.

11. An endoscopic treatment instrument according to any one of claims 1 to 10, A high-frequency power source that supplies a high-frequency current to the rod, A cable that connects the endoscopic treatment instrument and the high-frequency power source and enables the high-frequency current to be energized, Comprising: An endoscopic treatment instrument system.

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