Endoscopic treatment tools

Abstract

To provide an endoscope treatment instrument which in a case where an injection needle and a snare are integrated, makes it possible to smoothly transport the injection needle and the snare in a catheter and smoothly put them into and out from the tip of the catheter.SOLUTION: An endoscope treatment instrument 100 comprises: a catheter 118 insertable into a channel of an endoscope apparatus; an injection needle 150 inserted so as to be able to move forward and rearward along a longitudinal axis direction within the catheter 118; a wire 160 inserted so as to be able to move forward and rearward along the longitudinal axis direction within the catheter 118; and a guiding member 170 provided on the tip side within the catheter 118. The guiding member 170 comprises: a first groove 172 which guides the injection noodle so as to be projectable from / retractable into the tip of the catheter 118; and a second guiding part which guides the wire 160 so as to be projectable from / retractable into the tip of the catheter 118.SELECTED DRAWING: Figure 2B

Description

Technical Field

[0001] The present disclosure relates to an endoscopic treatment instrument.

Background Art

[0002] Conventionally, in the treatment of early malignant tumors and the like, for example, procedures such as EMR (endoscopic mucosal resection) and ESD (endoscopic submucosal dissection) have been performed to endoscopically remove lesions that have occurred on the mucosa in luminal organs such as the digestive tract. As an endoscopic treatment instrument for removing lesion tissue, a high-frequency knife or a high-frequency snare is used.

[0003] In endoscopic resection of colorectal polyps, a bulking agent such as physiological saline is injected into the intestinal wall with an injection needle (local injection needle) to float the polyp, the injection needle is replaced with a snare and placed around the polyp, and the polyp is resected by tightening the snare. Therefore, the injection needle and the snare wire must be replaced according to the number of resected polyps, which complicates the procedure, increases the operation time, and increases the burden on the operator and the patient.

[0004] In order to solve the above problems, an endoscopic treatment instrument in which an injection needle and a snare are integrated has been proposed and developed. For example, Patent Document 1 discloses a medical device including a combined snare and a needle, with the needle movably positioned within a lumen-type elongated control member of the snare.

Prior Art Documents

Patent Documents

[0005]

Patent Document 1

Summary of the Invention

Problems to be Solved by the Invention

[0006] However, in the endoscopic treatment instrument disclosed in Patent Document 1 and the like in the prior art, an injection needle and a snare are inserted into a single catheter, and the injection needle and the snare are arranged coaxially. Therefore, in the injection needle and the snare, for example, when protruding from the tip of the catheter or when being conveyed inside the catheter, if some problem occurs in one of the treatment instruments, both treatment instruments may become unusable. In addition, the snare disclosed in Patent Document 1 is composed of a plate shape, and there is a problem that diseased tissue cannot be excised with high precision.

[0007] Therefore, in order to solve the above problems, an object of the present disclosure is to provide an endoscopic treatment instrument capable of smoothly conveying the injection needle and the snare in the catheter and inserting and removing them from the tip of the catheter when the injection needle and the snare are integrated.

Means for Solving the Problems

[0008] To solve the above-described problems, the endoscopic treatment instrument according to the present disclosure includes a catheter that can be inserted into a channel of an endoscopic device, an injection needle that is inserted into the catheter so as to be able to advance and retreat in the longitudinal axis direction inside the catheter, a wire portion that is inserted into the catheter so as to be able to advance and retreat in the longitudinal axis direction inside the catheter, and a guiding member provided inside the catheter. at a position that enters inward by a predetermined distance from the tip of the catheter The guiding member is provided with a first guiding portion that guides the injection needle so as to be able to protrude and retract from the tip of the catheter, and a second guiding portion that guides the wire portion so as to be able to protrude and retract from the tip of the catheter. the wherein the wire part is provided on the tip side and has a snare that can be elastically deformed in an annular shape, and the second guide part of the guide member has side grooves for accommodating the opposing wires of the snare that has contracted within the catheter In addition, an endoscopic treatment instrument according to the present disclosure includes a catheter that can be inserted into a channel of an endoscope device, an injection needle that is inserted in the longitudinal axis direction within the catheter so as to be able to advance and retreat, a wire part that is inserted in the longitudinal axis direction within the catheter so as to be able to advance and retreat, a first guide part that guides the injection needle so as to be able to protrude from and retract into the tip of the catheter, and a second guide part that guides the wire part so as to be able to protrude from and retract into the tip of the catheter, and a guide member provided with the second guide part, the guide member having a main body and a head connected to the main body, the main body being provided within the catheter, the head being provided so as to protrude from the tip of the catheter, the wire part being provided on the tip side and having a snare that can be elastically deformed in an annular shape, the second guide part of the guide member being provided on the main body and having side grooves for accommodating the opposing wires of the snare that has contracted within the catheter

Effects of the Invention

[0009] According to the present disclosure, by providing a guiding member having a first guiding portion and a second guiding portion at the distal end inside the catheter, the conveyance path of the injection needle and the conveyance path of the wire portion can be provided independently within one catheter. Thereby, the injection needle and the wire portion can be advanced and retracted without interfering with each other inside the catheter, and smooth insertion and extraction from the distal opening of the catheter in the injection needle and the wire portion can be realized.

Brief Description of the Drawings

[0010]

Figure 1

Figure 2A

Figure 2B

Figure 2C

Figure 2D

Figure 3A

Figure 3B

Figure 4A

Figure 4B

Figure 5A

Figure 5B

Figure 6A

Figure 6B

Figure 6C

Figure 7

Figure 8A

Figure 8B

Figure 9A

Figure 9B

Figure 9C

Figure 9D

Figure 9E

Figure 10A

Figure 10B

Figure 11A

Figure 11B

Figure 12

Figure 13A

Figure 13B

Figure 14A

Figure 14B

Figure 15

Embodiments for Carrying Out the Invention

[0011] Hereinafter, preferred embodiments of the present disclosure will be described in detail with reference to the accompanying drawings.

[0012] <First Embodiment> [Operation Example of Endoscopic Treatment Instrument 100] FIG. 1 is an overall view of the endoscopic treatment instrument 100 according to the first embodiment. FIG. 2A is a cross-sectional view of the endoscopic treatment instrument 100 according to the first embodiment, FIG. 2B is a cross-sectional view of the catheter 118, FIG. 2C is a cross-sectional view taken along line A-A thereof, and FIG. 2D is a cross-sectional view taken along line B-B thereof. FIG. 3A is a diagram showing the operation of the first slider 120, and FIG. 3B is a diagram showing the operation of the injection needle 150 based on the operation of the first slider 120. FIG. 4A is a diagram showing the operation of the second slider 130, and FIG. 4B is a diagram showing the operation of the wire part 160 based on the operation of the second slider 130. FIG. 5A is a diagram schematically showing the wire part 160A, and FIG. 5B is a diagram schematically showing the wire part 160B as a modification.

[0013] The endoscopic treatment instrument 100 is inserted and used in a treatment instrument channel formed in the endoscopic insertion part of the endoscopic device. As shown in FIGS. 1 and 2A, the endoscopic treatment instrument 100 includes an operation unit 110, a catheter 118, an injection needle 150, a wire part 160A, and a guide member 170. The operation unit 110 has an operation unit main body 112, a first slider 120, a syringe port 122, a second slider 130, and an energization electrode 102. Each of the injection needle 150 and the wire part 160A is inserted into the catheter 118 so as to be able to advance and retreat in the longitudinal axis X direction.

[0014] The first slider 120 is located at the distal end side of the operation unit main body 112 in the longitudinal axis X direction, and is attached to the operation unit main body 112 so as to be movable forward and backward. As shown in FIGS. 3A and 3B, when the first slider 120 moves forward with respect to the operation unit main body 112, the injection needle 150 protrudes from the distal end side of the catheter 118, and when the first slider 120 moves backward with respect to the operation unit main body 112, the injection needle 150 is retracted into the catheter 118 for storage.

[0015] The syringe port 122 is a connection port for detachably attaching the tip portion (syringe barrel) of a syringe filled with a bulking agent such as physiological saline. The syringe port 122 is provided on the first slider 120 and moves integrally with the first slider 120. As shown in FIG. 2A, the proximal end portion of the syringe conduit 123 communicates with the syringe port 122. The syringe conduit 123 merges with the catheter 118 and is inserted into the catheter 118, and extends, for example, to the distal end side of the catheter 118. The syringe conduit 123 is inserted and fixed to the proximal end portion of the injection needle 150, and the bulking agent in the syringe attached to the syringe port 122 can be supplied to the injection needle 150 via the syringe conduit 123.

[0016] The second slider 130 is located behind the first slider 120 and is provided at the rear portion of the operation unit main body 112, and is attached to the operation unit main body 112 so as to be movable forward and backward. As shown in FIGS. 4A and 4B, when the second slider 130 moves forward with respect to the operation unit main body 112, the wire portion 160 protrudes from the distal end opening 119 of the catheter 118, and as shown in FIG. 2B, when the second slider 130 moves backward with respect to the operation unit main body 112, the wire portion 160A is retracted into the catheter 118. The second slider 130 is configured by a gripping portion having an annular hole into which a finger can be inserted, but is not limited to this shape. Note that the arrangement of the first slider 120 and the second slider 130 may be reversed.

[0017] The energizing electrode 102 is attached to the second slider 130 and operates integrally with the second slider 130. One end of the energizing electrode 102 protrudes outward with respect to the second slider 130, and a high-frequency power supply device (not shown) can be connected. A wire attachment portion 136 is provided at the other end of the energizing electrode 102. The base end portion of the wire portion 160A is attached to the wire attachment portion 136, and high-frequency current from the high-frequency power supply device can be supplied to the wire portion 160A via the energizing electrode 102.

[0018] The catheter 118 is a long member that can be inserted into and removed from the treatment tool channel 530 (see FIG. 6A) of the endoscope, and extends a predetermined length from the tip of the operation unit main body 112 via the cap 114. In FIG. 1A etc., the length of the catheter 118 in the longitudinal axis X direction is omitted in the illustration, but the length of the catheter 118 in the longitudinal axis X direction is, for example, 180 to 240 cm. For the catheter 118, a material having insulating properties, such as a fluororesin such as PTFE (polytetrafluoroethylene), is used. The catheter 118 has flexibility and can be inserted into and removed from the treatment tool channel of the endoscope that meanders along the curved shape of the lumen tissue etc. inside the body cavity. As shown in FIG. 2A, the catheter 118 has a tip opening 119 provided on the tip side and a lumen 118a formed over its entire length. In the present embodiment, the base end portion of the catheter 118 is attached to the tip of the operation unit main body 112 via the cap 114, but the catheter 118 may be extended along the operation unit main body 112 and its base end portion may be attached to the base end of the operation unit main body 112.

[0019] Inside the catheter 118, as shown in FIGS. 2B and 2C, a partition member 104 is disposed for partitioning the space through which the injection needle 150 passes and the space through which the wire portion 160A passes. The partition member 104 is composed of a flat plate member having a predetermined length extending in the longitudinal axis X direction, and divides the inside of the catheter 118 having a circular cross-section into two parts. For the partition member 104, a fluororesin such as a material having insulation properties, for example, PTFE (polytetrafluoroethylene), is used. In the present embodiment, a plurality of partition members 104 are provided and the plurality of partition members 104 are arranged at a predetermined interval, but a single long partition member 104 may be arranged inside the catheter 118. Further, the space through which the wire portion 160A passes may be further divided into two parts by the partition member 104. The partition member 104 may be integrally formed with the catheter 118 by a mold, for example, or a cutting portion or a hole in the longitudinal axis X direction may be formed in the catheter 118, and the partition member 104 may be retrofitted by inserting it from the cutting portion or the hole.

[0020] The wire portion 160A is made of a conductive material such as stainless steel, nickel-titanium alloy, or tungsten, and extends into the operation unit main body 112 and the catheter 118 as shown in FIG. 2A. The wire portion 160A has an operation wire 161 and a snare wire 163 as shown in FIGS. 2A and 5A.

[0021] The operation wire 161 is composed of, for example, a single stranded wire formed by twisting two metal wires. The outer peripheral surface of the operation wire 161 may be covered with a non-conductive member (not shown). The operation wire 161 is inserted into a cylindrical lead pipe 165 disposed along the longitudinal axis X direction inside the operation unit main body 112, and its base end portion is attached to the second slider 130. The tip end portion of the operation wire 161 is connected to the snare wire 163.

[0022] The snare wire 163 is a part for incising around the lesion P (see FIG. 6A), and is provided so as to be able to project and retract from the tip opening 119 of the catheter 118. As shown in FIGS. 2D and 4B, etc., the snare wire 163 is composed of a planar circular ring shape (loop shape) in which two wires 163a and 163b are curved outward and connected at the tip side. That is, it is formed in an annular shape by folding back a single wire from the tip side to the base side. The snare wire 163 is elastically deformable, and as shown in FIG. 4B, when it projects outward from the tip opening 119 of the catheter 118, it expands due to elastic force and deforms into a loop shape, and when it is drawn inside the tip opening 119 of the catheter 118, it contracts and narrows due to elastic force. In addition, in the present embodiment, the snare wire 163 is configured in a planar circular ring shape, but it is not limited to this, and it may be formed in a planar polygon by providing a plurality of bent portions on the snare wire 163.

[0023] Note that other configurations can also be adopted for the wire portion 160A. The wire portion 160B as a modification has a first operation wire 161, a second operation wire 162, and a snare wire 163, as shown in FIG. 5B.

[0024] The first operation wire 161 is composed of, for example, two metal wires 161a and 161b. The tip portion of the first operation wire 161 is connected to the base end portion of the snare wire 163, and the base end portion thereof is connected to the tip portion of the second operation wire 162. The second operation wire 162 is inserted into a lead pipe 165 arranged along the longitudinal axis X direction in the operation unit main body 112 and twisted together to be converged into a single wire. The base end portion of the second operation wire 162 is attached to the second slider 130. The snare wire 163 is provided so as to be able to project and retract from the tip opening 119 of the catheter 118. The snare wire 163 is annularly elastically deformable and incises around the lesion P (see FIG. 6A).

[0025] Returning to FIGS. 2A and 2B, the guide member 170 is a member for guiding the injection needle 150 and the snare wire 163 in a spaced-apart state so as not to interfere with each other inside the catheter 118. For the guide member 170, materials such as ceramic and plastic are used, for example. The guide member 170 is a substantially cylindrical body having a diameter smaller than the inner diameter of the catheter 118, and is attached inside the catheter 118 at a position that enters inward by a predetermined distance Y from the tip opening 119. The guide member 170 can be fixed inside the catheter 118 using a fixing member such as an adhesive. The distance Y is, for example, about 5 to 20 mm. Thereby, when pulling the snare wire 163 sandwiching the lesion P such as a polyp into the catheter 118, the lesion P larger than the opening diameter of the tip opening 119 of the catheter 118 hits the opening edge of the tip opening 119 and is inhibited, so that the lesion P can be torn off.

[0026] As shown in FIG. 2D, the guide member 170 has a first groove 172 for guiding the injection needle 150 to protrude and retract from the tip opening 119 of the catheter 118, and second grooves 174a and 174b for guiding wires 163a, 163b, etc. to protrude and retract from the tip opening 119 of the catheter 118. The first groove 172 is formed by notching the circumferential surface into a concave cross-section and is formed over the entire length in the longitudinal axis X direction. The concave shape of the first groove 172 has a diameter slightly larger than the diameter of the injection needle 150, and may be formed, for example, as a U-shaped groove along the outer shape of the injection needle 150. Note that the first groove 172 constitutes an example of a first guide portion.

[0027] The second grooves 174a and 174b are formed by notching the circumferential surface into a concave cross-section and are formed over the entire length in the longitudinal axis X direction. The concave shape of the second grooves 174a and 174b has a diameter slightly larger than the diameter of the wires 163a, 163b, etc., and may be formed, for example, as a U-shaped groove along the outer shape of the wire portion 160A. Note that the second grooves 174a and 174b constitute an example of a second guide portion.

[0028] In the present embodiment, the first groove 172 and the second grooves 174a and 174b are arranged at intervals of approximately 120° in the circumferential direction so as not to interfere with each other, but the arrangement interval is not limited to this. Further, in FIG. 2D and the like, the first groove 172 and the second grooves 174a and 174b are constituted by grooves, but at least one of the first groove 172 and the second grooves 174a and 174b may be constituted by a hole penetrating in the longitudinal axis X direction.

[0029] [Operation example of the endoscopic treatment instrument 100] Next, an operation example of the endoscopic treatment instrument 100 when excising a lesion P such as a polyp bulging from the epithelium of a living body will be described. FIGS. 6A to 6C are diagrams showing the operation of the endoscopic treatment instrument 100 when removing the lesion P.

[0030] First, the operator inserts the endoscope insertion portion 510 of the endoscope device 500 into the body cavity and identifies the lesion P while observing the image captured by the endoscope 520. The operator inserts the catheter 118 of the endoscopic treatment instrument 100 into the treatment instrument channel 530 provided in the endoscope insertion portion 510, and as shown in FIG. 6A, projects the tip of the catheter 118 from the treatment instrument channel 530 and positions it above the lesion P.

[0031] Next, the first slider 120 of the endoscopic treatment instrument 100 is advanced with respect to the operation unit main body 112, and as shown in FIG. 6B, the injection needle 150 is projected from the tip opening 119 of the catheter 118. Subsequently, the projected injection needle 150 is inserted between the lesion P and the muscular layer W, and a bulking agent such as physiological saline is injected to bulge the lesion P. After injecting the bulking agent, the first slider 120 is retracted with respect to the operation unit main body 112, the injection needle 150 is drawn into the catheter 118 from the tip opening 119 of the catheter 118, and the injection needle 150 is stored in the first groove 172 of the guide member 170 (see FIGS. 2B and 2D).

[0032] Next, the operator advances the second slider 130 of the endoscopic treatment instrument 100 relative to the operation unit main body 112, and projects the snare wire 163 from the tip opening 119 of the catheter 118 as shown in FIG. 6C. As a result, the snare wire 163 swells due to the elastic force and deforms and unfolds into a loop shape. The operator surrounds the lesion P with the snare wire 163 by placing the loop-shaped snare wire 163 over the lesion P.

[0033] Next, the operator slightly retracts the second slider 130 of the endoscopic treatment instrument 100 relative to the operation unit main body 112, and draws the proximal end side of the snare wire 163 into the catheter 118. As a result, the annular diameter of the snare wire 163 becomes smaller, and the base of the lesion P is wound by the snare wire 163.

[0034] Next, the operator operates the high-frequency power supply device to supply and energize a high-frequency current to the snare wire 163 of the wire portion 160A via the energization electrode 102. As a result, the lesion P wound by the snare wire 163 is incised while being cauterized. Finally, the operator further retracts the second slider 130 of the endoscopic treatment instrument 100 relative to the operation unit main body 112, draws the entire snare wire 163 into the catheter 118, and stores each of the wires 163a and 163b in the second grooves 174a and 174b (see FIGS. 2B and 2D).

[0035] In the above-described embodiment, a configuration is adopted in which a high-frequency current is passed through the snare wire 163, but the present invention is not limited to this. For example, the lesion P may be incised by so-called cold polypectomy in which the base of the lesion P is tightened and incised by the snare wire 163 without passing a high-frequency current through the snare wire 163.

[0036] As described above, according to the first embodiment, by providing the guide member 170 having the first groove 172 and the second grooves 174a and 174b on the distal end side within the catheter 118, the conveyance path of the injection needle 150 and the conveyance path of the wire portion 160A can be provided independently within a single catheter 118. Thereby, the injection needle 150 and the wire portion 160A can be advanced and retracted without interfering with each other within the catheter 118, and smooth insertion and extraction from the distal end opening 119 of the catheter 118 in the injection needle 150 and the wire portion 160A can be realized. Further, since the conveyance path of the injection needle 150 and the conveyance path of the wire portion 160A are provided separately, even when a problem occurs in one treatment tool, for example, the injection needle 150, the other treatment tool, for example, the wire portion 160A can be used normally.

[0037] Also, while guiding and conveying the injection needle 150 along the first groove 172 of the guide member 170 and guiding and conveying the snare wire 163 along the second grooves 172b and 172c of the guide member 170, displacement in a direction intersecting (orthogonal) to the longitudinal axis X direction in the injection needle 150 and the snare wire 163 can be prevented. Thereby, the lesion P can be excised accurately and with high precision.

[0038] Further, since the partition member 104 is provided within the catheter 118, the conveyance path of the injection needle 150 and the conveyance path of the wire portion 160A can be made independent within a single catheter 118, and interference between the injection needle 150 and the snare wire 163 can be prevented. Thereby, problems such as the injection needle 150 and the snare wire 163 getting entangled with each other can be prevented, and the conveyance of the injection needle 150 and the snare wire 163 can be performed smoothly. Also, for example, by supporting the wire portion 160A with the partition member 104 and narrowing the conveyance path, it is possible to prevent the wire portion 160A from bending.

[0039] Also, according to the present embodiment, since the conveyance path of the injection needle 150 and the conveyance path of the snare wire 163 can be provided separately within the catheter 118, the injection needle 150 and the snare wire 163 can be used in order without replacing them. Further, while the injection needle 150 and the snare wire 163 are simultaneously protruding from the distal end opening 119 of the catheter 118, an inflation agent can be injected and the lesion P can be resected. By these means, the time for replacing the injection needle 150 and the snare wire 163 can be reduced, so that a significant reduction in the operation time can be achieved.

[0040] Furthermore, according to the present embodiment, since the guide member 170 is provided at a position that enters inward by a predetermined distance Y from the distal end opening 119 of the catheter 118, cold resection in which the lesion P is resected without using high-frequency current can be suitably performed. That is, the snare wire 163 sandwiching the lesion P is drawn into the catheter 118, and while the snare wire 163 is moved by the distance Y, the lesion P larger than the distal end opening 119 hits the distal end opening edge of the catheter 118, so that the lesion P can be torn off without energization. By adopting cold resection, since the minute blood vessels running on the stalk of the polyp can be bluntly torn off to cause contraction, there is an advantage that bleeding can be made less likely than in the case of resection by cauterization with an electric scalpel.

[0041] <Second Embodiment> In the second embodiment, it is different from the configuration of the guide member 170 of the first embodiment in that the distal end portion of the guide member 270 protrudes from the distal end opening 219 of the catheter 218. In the endoscopic treatment instrument 200 of the following embodiment, redundant explanations are omitted by using the same names for the parts having the same configurations and functions as those of the endoscopic treatment instrument 100 of the first embodiment.

[0042] FIG. 7 is an overall view of the endoscopic treatment instrument 200 according to the second embodiment. FIG. 8A is a cross-sectional view of the endoscopic treatment instrument 200 according to the second embodiment, and FIG. 8B is a cross-sectional view of the catheter 218. FIG. 9A is a plan view of the guide member 270 according to the second embodiment, FIG. 9B is a side view of the guide member 270, FIG. 9C is a cross-sectional view of the guide member 270, FIG. 9D is a front view of the guide member 270, and FIG. 9E is a rear view of the guide member 270.

[0043] [Configuration example of the endoscopic treatment instrument 200] As shown in FIGS. 7 and 8A, the endoscopic treatment instrument 200 according to the present embodiment includes an operation unit 210, a catheter 218, a partition member 204, an injection needle 250, a wire unit 260, and a guide member 270. The operation unit 210 includes an operation unit main body 212, a first slider 220, a second slider 230, and an energization electrode 202. Note that, as the wire unit 260, either the structure of the wire unit 160B shown in FIG. 5A or the structure of the wire unit 160A shown in FIG. 5B may be adopted. Hereinafter, the case where the wire unit 160B is adopted as the wire unit 260 is shown. The wire unit 260 includes a first operation wire 261, a second operation wire 262, and a snare wire 263.

[0044] The guide member 270 is a member for guiding the inside of the catheter 218 in a state where the injection needle 250 and the wire unit 260 are separated from each other so as not to interfere with each other. For example, ceramic, plastic, or the like is used for the guide member 270. As shown in FIGS. 8B and 9A and the like, the guide member 270 has a main body 270a and a head 270b connected to the main body 270a. In the present embodiment, the main body 270a is provided inside the distal end side of the catheter 118, and the head 270b is provided so as to protrude outward from the distal end opening 219 of the catheter 218.

[0045] The main body 270a has a cylindrical shape with a diameter slightly smaller than or substantially the same as the inner diameter of the catheter 218, and is fixed to the tip portion within the catheter 118 by an adhesive member such as an adhesive. As shown in FIGS. 9C and 9D, side grooves 272a and 272b for accommodating opposing wires 263a and 263b (wire portion 260) that are contracted (compressed) within the catheter 218 are formed on the left and right side surfaces of the main body 270a. The side grooves 272a and 272b are formed by notching the circumferential surface into a concave cross-section and are formed over the entire length in the longitudinal axis X direction. Note that the concave shape of the side grooves 272a and 272b has a diameter slightly larger than the diameter of the wire portion 260 and may be formed as, for example, a U-shaped groove along the outer shape of the wire portion 260. Note that the side grooves 272a and 272b constitute an example of a second guiding portion.

[0046] As shown in FIGS. 9A and 9B, the head 270b has a substantially bowl shape with a diameter larger than that of the main body 270a and is attached to the tip portion of the main body 270a. A storage groove 272c for accommodating the curved tip portion 263c (see FIG. 11A) of the snare wire 263 (wire portion 260) is formed in the head 270b. The storage groove 272c is formed by notching the circumferential surface into a concave cross-section and is formed in an arc shape along the circumferential surface shape, and both ends thereof communicate with the side grooves 272a and 272b, respectively. Note that the concave shape of the storage groove 272c has a diameter slightly larger than the diameter of the wire portion 260 and may be formed as, for example, a U-shaped groove along the outer shape of the wire portion 260. Note that the storage groove 272c constitutes an example of a second guiding portion.

[0047] As shown in FIG. 9B, the storage groove 272c is inclined upward at a predetermined angle obliquely with respect to the side grooves 272a and 272b extending in the longitudinal axis X direction (horizontal direction) in the side view of the guide member 270. Thereby, when the guide member 270 is viewed from the front, the storage groove 272c can be disposed at a position deviated from the storage hole 272d formed in the axis of the guide member 270. Note that the extending direction of the storage hole 272d in the side view is preferably formed linearly from the viewpoint of cutting, but may be curved. The step portion 270c provided at the rear end edge of the head portion 270b is engaged with the end surface of the tip opening 219 of the catheter 218 as shown in FIG. 8B, and the movement of the guide member 270 into the catheter 218 is restricted.

[0048] Further, as shown in FIGS. 9C, 9D, and 9E, a storage hole 272d for guiding the injection needle 250 to be movable forward and backward in the catheter 218 is formed in the guide member 270. The storage hole 272d penetrates along the central axis (axis) of the guide member 270 and has a diameter slightly larger than or substantially the same as the diameter of the injection needle 250. The proximal end side of the storage hole 272d communicates with the inside of the catheter 218. Note that the storage hole 272d constitutes an example of the first guide portion.

[0049] [Operation Example of Endoscopic Treatment Instrument 200] FIGS. 10A and 10B are diagrams showing the operation of the injection needle 250 based on the operation of the first slider 220.

[0050] When an operator performs an operation of advancing the first slider 220 with respect to the operation unit main body 212, as shown in FIG. 10A, the injection needle 250 advances along the storage hole 272d of the guide member 270 in the catheter 218 and protrudes outward from the tip opening 219 and the head portion 270b of the catheter 218. Subsequently, in this state, the injection needle 250 protruding from the head portion 270b is inserted between the lesion portion P and the muscular layer W, and the bulking agent is injected.

[0051] Next, when an operator performs an operation to retract the first slider 220 with respect to the operation unit main body 212, as shown in FIG. 10B, the injection needle 250 is drawn into the catheter 218. As a result, the injection needle 250 is stored in the storage hole 272d of the guide member 270.

[0052] FIGS. 11A and 11B are diagrams showing the operation of the wire portion 260 based on the operation of the second slider 230.

[0053] Next, when an operator performs an operation to advance the second slider 230 with respect to the operation unit main body 212, the snare wire 263 advances along the side grooves 272a and 272b of the guide member 270 in the catheter 218, and as shown in FIG. 11A, protrudes outward from the tip opening 219 and the head portion 270b of the catheter 218. The snare wire 263 protruding from the head portion 270b is deformed by the elastic force and slightly spreads.

[0054] Next, the snare wire 263 is placed on the lesion P from the head portion 270b. Then, when an operator performs an operation to retract the second slider 230 with respect to the operation unit main body 212, the rear end side of the snare wire 263 is drawn into the catheter 218. Subsequently, a high-frequency current is applied to the snare wire 363 by the high-frequency power supply device, and the lesion P is excised.

[0055] Next, when an operator performs an operation to retract the second slider 230 with respect to the operation unit main body 212, the entire snare wire 263 is drawn into the catheter 218. As a result, as shown in FIG. 11B, the tip portion 263c of the snare wire 263 is stored in the storage groove 272c of the guide member 270, and the wires 263a and 263b of the snare wire 263 are respectively stored in the side grooves 272a and 272b. Since the opening diameter of the snare wire 263 is configured to be substantially the same as the diameter of the guide member 270, the snare wire 263 can be stored in the catheter 218 without applying too much load to the snare wire 263.

[0056] According to the second embodiment as described above, the same effects as those of the first embodiment described above can be achieved. For example, by providing the guide member 270 having the side grooves 272a, 272b, the storage groove 272c, and the storage holes 272d on the distal end side in the catheter 218, the conveyance path of the injection needle 250 and the conveyance path of the wire portion 260 can be provided independently within one catheter 218. Thereby, the injection needle 250 and the wire portion 260 can be advanced and retracted without interference within the catheter 218, and smooth insertion and extraction from the distal end opening 219 of the catheter 218 in the injection needle 250 and the wire portion 260 can be realized. Further, since the conveyance path of the injection needle 250 and the conveyance path of the wire portion 260 are provided separately, even if a problem occurs in one treatment tool, for example, the injection needle 250, the other treatment tool, for example, the wire portion 260 can be used normally.

[0057] <Third Embodiment> In the endoscopic treatment tool 300 of the third embodiment, in that the operation unit 310 is configured in a pistol shape, it is different from the operation units 110, 210 of the endoscopic treatment tools 100, 200 of the first and second embodiments. In the endoscopic treatment tool 300 of the following embodiments, the same names are used for the parts having the same configurations and functions as those of the endoscopic treatment tool 100 of the first embodiment, and redundant descriptions are omitted.

[0058] FIG. 12 is an overall view of the endoscopic treatment tool 300 according to the third embodiment. FIG. 13A is a cross-sectional view of the endoscopic treatment tool 300 according to the third embodiment, and FIG. 13B is a cross-sectional view showing the distal end side of the catheter 318 of the endoscopic treatment tool 300 shown in FIG. 2A.

[0059] [Configuration Example of Endoscopic Treatment Tool 300] As shown in FIGS. 12 and 13A, the endoscopic treatment instrument 300 includes an operation unit 310, a catheter 318, a syringe operation unit 320, a snare operation unit 330, an injection needle 350, a wire unit 360, a guide member 370, and a drive mechanism 380. Although the guide member 170 of the first embodiment described above is applied to the guide member 370, the guide member 270 of the second embodiment may be applied.

[0060] As shown in FIG. 12, the operation unit 310 has an operation unit main body 312 and an energization electrode 302. As shown in FIG. 13A, the wire unit 360 has a first operation wire 361, a second operation wire 362, and a snare wire 363.

[0061] A handle portion 313 extending downward from the lower surface of the rear portion of the operation unit main body 312 is provided on the operation unit main body 312. In the present embodiment, the operation unit main body 312 and the handle portion 313 form a pistol shape. As shown in FIG. 13A, a tank 390 for storing a swelling agent such as physiological saline is built in the handle portion 313. A connection port 391 to which a syringe (not shown) can be connected is provided at the lower end portion of the handle portion 313. The tank 390 communicates with the connection port 391, and the swelling agent can be filled into the tank 390 through the connection port 391.

[0062] As shown in FIG. 13A, a cylinder 315 that is movable along the longitudinal axis X direction and rotatable around the longitudinal axis X is provided in the operation unit main body 312. The base end portion of the wire unit 360 is attached to the cylinder 315, and the wire unit 360 can move in the front-rear direction as the cylinder 315 moves forward and backward. The rear end side of the cylinder 315 protrudes outward from the rear end portion of the operation unit main body 312, and a ring 315a for rotating the cylinder 315 and the snare wire 363 is provided on the protruding cylinder 315. Thereby, the angle of the snare wire 363 can be adjusted by rotating the ring 315a. However, in the present embodiment, since the guide member 370 is fixed to the tip side in the catheter 318, the rotation operation function is not used.

[0063] A slide mechanism 316 is attached to the tip side of the cylinder 315. The shaft 317 of the slide mechanism 316 is inserted through the long hole 312a of the operation unit main body 312 and the long hole 331a of the first grip 331. The long hole 312a of the operation unit main body 312 is formed along the longitudinal axis X direction of the operation unit main body 312. The slide mechanism 316 moves along the long hole 312a by the rotation operation of the first grip 331 and the second grip 332, and moves the cylinder 315 forward and backward with respect to the operation unit main body 312.

[0064] The energization electrode 302 is attached to the upper rear side of the operation unit main body 312. The tip of the energization electrode 302 is provided so as to be able to contact the cylinder 315, and the base end of the energization electrode 302 is configured to be connectable to a high-frequency power supply device (not shown). Thereby, the high-frequency current supplied from the high-frequency power supply device can be transmitted to the wire portion 360 via the cylinder 315. Note that the tip of the energization electrode 302 may be attached to the rear end side of the cylinder 315.

[0065] The syringe operation unit 320 has a first trigger 321 and a second trigger 322. The first trigger 321 is an operation unit for protruding the injection needle 350 from the tip of the catheter 318 and retracting the injection needle 350 into the catheter 318. The first trigger 321 is provided below the operation unit main body 312 and is configured to be pulled by an operator. When the first trigger 321 is pulled, it operates the drive mechanism 380 to advance the injection needle 350 inserted into the catheter 318. Note that the first trigger 321 is biased forward by an elastic member such as a spring (not shown).

[0066] The second trigger 322 is an operating part for supplying and injecting a bulking agent into the injection needle 350. The second trigger 322 is provided below the operating part main body 312 and on the rear side of the first trigger 321. The second trigger 322 is pressed backward by the first trigger 321 when the first trigger 321 is pulled. As shown in FIG. 13A, a rubber stopper 323 is attached to the rear end portion of the second trigger 322, and the rubber stopper 323 is attached to a tank pipe 392 communicating with the tank 390. When the rubber stopper 323 moves backward in the tank pipe 392 as the second trigger 322 retreats, the bulking agent filled in the tank 390 is pushed out and injected into the injection needle 350.

[0067] As shown in FIG. 13A, the drive mechanism 380 includes a first slide portion 381, a second slide 382, and a rotating shaft 383. The first slide portion 381 is attached above the first trigger 321 and moves integrally with the pulling operation of the first trigger 321 or the like. The first slide portion 381 is composed of an elongated flat plate member having a plurality of teeth formed on the upper surface side, and meshes with the teeth of the rotating shaft 383 disposed above.

[0068] The rotating shaft 383 is a gear having an axis in a direction perpendicular to the longitudinal axis X, and is rotatably attached to the operating part main body 312. The rotating shaft 383 rotates as the first slide portion 381 moves in the front-rear direction.

[0069] The second slide 382 is composed of an elongated flat plate member having a plurality of teeth formed on the lower side, and is disposed opposite to the upper side of the first slide portion 381. The second slide 382 meshes with the teeth of the rotating shaft 383 disposed below, and moves forward and backward with respect to the operating part main body 312 as the rotating shaft 383 rotates.

[0070] On the upper surface side of the second slide 382, a holding portion 384 for holding and fixing the syringe tube 394 is provided. The holding portion 384 moves integrally with the movement of the second slide 382, and advances and retracts the syringe tube 394 and the injection needle 350. As the configuration of the holding portion 384, for example, it may be configured to sandwich the syringe tube 394, or may be configured using a fixing member such as an adhesive.

[0071] The snare operation portion 330 has a first grip 331 and a second grip 332 which are formed of an elongated flat plate member. The first grip 331 and the second grip 332 are members for advancing the wire portion 360 in the catheter 318 when the operator grips and tilts them forward.

[0072] One end portion of the first grip 331 is rotatably attached to a shaft 334 provided at the lower end portion of the handle portion 313. The other end portion of the first grip 331 protrudes from the upper surface of the operation portion main body 312 and functions as a portion to be gripped by the operator. A shaft 335 is provided at a substantially central portion in the longitudinal direction of the first grip 331, and the shaft 335 is inserted through the long hole 332a of the second grip 332. A long hole 331a is formed in the first grip 331, and the shaft 317 of the slide mechanism 316 is inserted through the long hole 331a.

[0073] One end portion of the second grip 332 is rotatably attached to a shaft 336 provided at the upper rear side of the operation portion main body 312. A long hole 332a is formed in the second grip 332, and the shaft 335 of the first grip 331 is inserted through the long hole 332a. The other end portion of the second grip 332 protrudes from the lower surface of the handle portion 313 and functions as a gripping portion for the operator to grip.

[0074] As a result, when the first gripper 331 and the second gripper 332 are tilted forward by the operator, the slide mechanism 316 advances along the long hole 312a of the operation unit main body 312, and accordingly, the cylinder 315 and the wire part 360 advance. At least one of the first gripper 331 and the second gripper 332 is biased rearward by an elastic member such as a spring (not shown). In the present embodiment, the first gripper 331 and the second gripper 332 are held at the initial positions shown in FIG. 12 by the elastic member.

[0075] [Operation example of the endoscopic treatment instrument 300] FIGS. 14A and 14B are diagrams for explaining the operation of the injection needle 350 based on the operation of the first trigger 321 and the second trigger 322.

[0076] As shown in FIG. 14A, when the first trigger 321 is pulled by the operator in the direction of arrow D1, the first slide part 381 retreats with respect to the operation unit main body 312, so that the rotation shaft 383 rotates counterclockwise and the second slide 382 advances. As a result, the holding part 384 and the syringe tube 394 advance with respect to the operation unit main body 312, and the injection needle 350 attached to the syringe tube 394 protrudes from the tip opening 319 of the catheter 318. Subsequently, in this state, the injection needle 350 protruding from the tip part of the catheter 318 is inserted between the lesion part P and the muscular layer W.

[0077] As shown in FIG. 14B, when the first trigger 321 is further pulled by the operator in the direction of arrow D1, the second trigger 322 is pressed rearward by the first trigger 321. As a result, the rubber stopper 323 retreats, so that the swelling agent in the tank 390 is supplied to the injection needle 350 via the syringe tube 394, and the liquid is injected from the injection needle 350 near the lesion part P.

[0078] When the injection by the injection needle 350 is completed, the fingers are released from the first trigger 321 and the second trigger 322, and the first trigger 321 and the second trigger 322 return to their original positions by an elastic force such as a spring (not shown). Along with this, the first slide portion 381 advances with respect to the operation unit main body 312, and the rotary shaft 383 rotates clockwise, so that the second slide 382 and the holding portion 384 retreat. As a result, the syringe tube 394 and the injection needle 350 connected thereto retreat, and the injection needle 350 is drawn into and stored in the catheter 318.

[0079] FIG. 15 is a diagram for explaining the operation of the wire portion 360 of the injection needle 350 based on the operation of the first grip 331 and the second grip 332.

[0080] When the operator grips the first grip 331 and the second grip 332 and tilts them forward in the directions of arrow D2 and arrow D3, the slide mechanism 316 advances along the long hole 312a, so that the cylinder 315 advances with respect to the operation unit main body 312. As a result, the wire portion 360 attached to the cylinder 315 advances within the catheter 318, and the snare wire 363 at the tip side deforms into an annular shape by an elastic force from the snare wire 363 protruding from the tip opening 319 of the catheter 318.

[0081] Subsequently, after the snare wire 363 is placed on the lesion P, the first grip 331 and the second grip 332 are slightly retracted rearward to constrict the snare wire 363, and a high-frequency current is passed through the snare wire 363 by a high-frequency power supply device. As a result, the lesion P is excised.

[0082] Next, when the operator's finger is separated from the first grip 331 and the second grip 332, the first grip 331 and the second grip 332 move rearward and return to their original positions by an elastic force such as a spring (not shown). The slide mechanism 316 retreats along the long hole 312a, and the cylinder 315 and the wire portion 360 attached to the cylinder 315 retreat. As a result, the snare wire 363 is drawn into and stored in the catheter 318.

[0083] According to the third embodiment as described above, by forming the operation unit 310 in a pistol shape, from the perspective of ergonomics, when performing cold polypectomy, the necessary additional force for excising a lesion P such as a polyp can be transmitted more directly to the snare operation unit 330. As a result, the lesion P can be excised accurately and with high precision.

[0084] Further, according to the third embodiment, the same effects as those of the first embodiment described above can be achieved. For example, by providing the guide member 370 on the distal end side within the catheter 318, the injection needle 350 and the wire portion 360 can be advanced and retracted within the catheter 318 without interfering with each other, and smooth insertion and extraction from the distal end opening 319 of the catheter 318 in the injection needle 350 and the wire portion 360 can be realized. Furthermore, since the conveyance path of the injection needle 350 and the conveyance path of the wire portion 360 are provided separately, even if a problem occurs in one treatment tool, for example, the injection needle 350, the other treatment tool, for example, the wire portion 360 can be used normally.

Explanation of Reference Numerals

[0085] 100, 200, 300 Endoscopic treatment tools 118, 218, 318 Catheters 150, 250, 350 Injection needles 160A, 160B, 260, 360 Wire portions 163, 263, 363 Snare wires 170, 270, 370 Guide members 172 First groove (first guide portion) 174a, 174b Second grooves (second guide portions) 270a Main body (guide member) 270b Head portion (guide member) 272a, 272b Side grooves (second guide portions) 272c Storage groove (second guide portion) 272d Storage hole (first guide portion)

Claims

1. A catheter insertable into a channel of an endoscope device, a syringe needle inserted into the catheter so as to be movable forward and backward in the longitudinal axis direction within the catheter, a wire part inserted into the catheter so as to be movable forward and backward in the longitudinal axis direction within the catheter, and a guide member provided at a position that enters inward by a predetermined distance from the tip of the catheter within the catheter, wherein the guide member is provided with a first guide part that guides the syringe needle so as to be able to protrude from and retract into the tip of the catheter, and a second guide part that guides the wire part so as to be able to protrude from and retract into the tip of the catheter, the wire part has a snare provided at the tip side and capable of elastic deformation in an annular shape, the second guide part of the guide member has side grooves that house the respective wires of the snare that has contracted within the catheter, A treatment instrument for an endoscope.

2. A catheter insertable into a channel of an endoscope device, a syringe needle inserted into the catheter so as to be movable forward and backward in the longitudinal axis direction within the catheter, a wire part inserted into the catheter so as to be movable forward and backward in the longitudinal axis direction within the catheter, a first guide part that guides the syringe needle so as to be able to protrude from and retract into the tip of the catheter, and a guide member provided with a second guide part that guides the wire part so as to be able to protrude from and retract into the tip of the catheter, [[ID=**17]]the guide member has a main body and a head continuous with the main body, the main body is provided within the catheter, the head is provided so as to protrude from the tip of the catheter, the wire part has a snare provided at the tip side and capable of elastic deformation in an annular shape, the second guide part of the guide member is provided in the main body and has side grooves that house the respective wires of the snare that has contracted within the catheter, A treatment instrument for an endoscope.

3. The second guide part of the guide member is provided in the head and has a storage groove that stores the curved tip of the snare, The treatment instrument for an endoscope according to claim 2.

4. The first guide part is a through hole penetrating in the longitudinal axis direction or a groove formed along the longitudinal axis direction, The treatment instrument for an endoscope according to any one of claims 1 to 3.

Images