Endoscopic treatment tools

Abstract

To provide a treatment tool for an endoscope capable of supplying liquid such as liquid medicine, physiological saline, or the like with intense water pressure from a distal end of the treatment tool without using a high-performance liquid supply pump.SOLUTION: A treatment tool for an endoscope includes: a sheath; a pipe member extending in the sheath so as to freely advance and retreat; and a conductive treatment part provided in a distal side of the pipe member and having a liquid supply port capable of supplying fluid. A flow path communicating with the liquid supply port is narrow in a part closer to a proximal side than the liquid supply port.SELECTED DRAWING: Figure 2

Description

[Technical Field]

[0001] The present invention relates to an endoscopic treatment tool. [Background technology]

[0002] Conventionally, endoscopic treatment instruments for incision and dissection, such as high-frequency knives, have been used in endoscopic treatments such as endoscopic submucosal dissection (hereinafter sometimes abbreviated as "ESD"). Endoscopic treatment instruments are capable of incising and dissecting biological tissues such as the mucosa and submucosa through an endoscope, and are configured to allow the delivery of medicinal solutions, physiological saline, and the like through a water supply hole at the distal end.

[0003] During the ESD procedure, an endoscopic injection needle is inserted into a channel formed in the insertion tube of the endoscope. The tip of the needle is inserted into a lesion in the lumen of the digestive tract, and an initial injection of medicinal solution or saline solution is performed, causing the lesion to bulge. The endoscopic injection needle is then removed from the endoscope, and an endoscopic high-frequency treatment instrument is inserted. The endoscopic high-frequency treatment instrument is used to make an incision around the lesion, peel off the exposed submucosal layer, and resect the lesion. Furthermore, over time during the procedure, the medicinal solution or saline solution injected into the submucosal layer leaks out, causing the bulging lesion to shrink. Therefore, additional injections are performed by pressing the water inlet at the distal end against the submucosal layer and supplying water as needed.

[0004] Known examples of such endoscopic treatment tools include the endoscopic treatment tool described in Patent Document 1. In the endoscopic treatment tool of Patent Document 1, a conductive helical tube is disposed on the proximal side of the high-frequency knife, and the helical tube functions as an electrode and a water supply conduit. [Prior art documents] [Patent documents]

[0005] [Patent Document 1] Chinese Patent Application Publication No. 111202485A Summary of the Invention [Problem to be solved by the invention]

[0006] The endoscopic treatment instrument of Patent Document 1 can cause variations in the shape and size of the mucosa and submucosa when they are bulged, depending on factors such as the condition of the mucosa and submucosa (e.g., mucosal thickness, surface softness, etc.). This can occur if the water supply port is not properly positioned relative to the mucosa and submucosa, or if the water pressure of the saline solution or medicinal solution delivered from the water supply port at the distal end is weak. As a result, the lesion does not bulge to the intended shape or size. In this case, the high-frequency treatment instrument and local injection needle must be replaced each time local injection is performed, lengthening the procedure time. To solve this problem, a water pump with high pressure or high flow rate, or a water pump with both high pressure and high flow rate, is required. However, these water pumps are large and expensive.

[0007] The endoscopic treatment tool in Patent Document 1 has a small water supply hole at the tip of the high-frequency knife. Therefore, if blood or mucus gets inside the water supply hole and adheres to it, repeated energization causes the adhered material to burn and solidify, clogging the water supply line, preventing the forward flow of medicinal solutions, saline, etc. Therefore, if the blockage in the water supply line cannot be cleared, the high-frequency treatment tool must be replaced with a new one, which lengthens the procedure time.

[0008] The present invention has been made in consideration of these problems, and aims to provide an endoscopic treatment tool that can deliver liquids such as medicinal solutions and saline solution with strong water force from the distal end of the treatment tool without using a high-performance water supply pump. [Means for solving the problem]

[0009] The endoscopic treatment tool according to the first aspect of the present invention comprises a sheath, a tubular member extending freely back and forth within the sheath, and a conductive treatment section provided on the distal side of the tubular member and having a water supply port through which a fluid can be supplied, and a flow path communicating with the water supply port is narrowed in part proximal to the water supply port.

[0010] In the above-described endoscopic treatment tool, the distal end of the third conduit may be located distal to the proximal end of the treatment section.

[0011] In the above-mentioned endoscopic treatment tool, the distal end of the third conduit may be located proximal to the distal end of the second conduit, and a step may be formed between the distal end of the third conduit and the second conduit.

[0012] In the above-described endoscopic treatment tool, the step portion may be provided at the proximal end of the second conduit.

[0013] In the above-described endoscopic treatment tool, the third duct may be formed at the distal end of the tubular member.

[0014] In the above-described endoscopic treatment tool, the distal end of the tubular member may be inserted into the second channel.

[0015] The above-described endoscopic treatment tool may include a cylindrical body having the third channel, and a distal end of the cylindrical body may be inserted into the second channel of the treatment section.

[0016] In the above-described endoscopic treatment tool, the third conduit may be formed proximal to the second conduit of the treatment section.

[0017] In the above-described endoscopic treatment tool, an inclined surface may be formed between the proximal end of the third conduit and the first conduit.

[0018] In the above-mentioned endoscopic treatment instrument, the sheath may have an insulating tip at its distal end that is heat-resistant and insulating, and the treatment portion may be a high-frequency knife that is inserted into the insulating tip and can be advanced and retreated relative to the sheath.

[0019] The above-mentioned endoscopic treatment tool may further include a cylindrical body having the third duct, and a connector formed of a conductive material that connects the cylindrical body to the high-frequency knife, and the protruding position of the high-frequency knife relative to the sheath may be determined by the abutment of the connector and the insulating tip.

[0020] The above-mentioned endoscopic treatment tool may further include a connector that connects the tubular member and the high-frequency knife and is made of a conductive material, and the protruding position of the high-frequency knife relative to the sheath may be determined by the abutment of the connector and the insulating tip.

[0021] In the above-mentioned endoscopic treatment tool, the high-frequency knife may have an insulating distal end member in which the water supply port is formed, and an electrically conductive portion that is electrically conductive and is arranged at the proximal end of the distal end member, with its outer edge exposed on the proximal side of the distal end member.

[0022] In the above-described endoscopic treatment tool, the treatment section may have a pair of forceps members and an axial member to which the pair of forceps members are provided on the distal side, and the second duct may be formed in the axial member. [Effects of the Invention]

[0023] According to the above-described endoscopic treatment tool, liquid such as a medicinal solution or saline solution can be delivered by a strong water force from the distal end of the treatment section without using a high-performance water delivery pump.

[0024] The present invention eliminates the need to switch between a high-frequency treatment tool and a local injection needle each time a local injection is performed, thereby preventing the procedure from taking too long.The present invention also eliminates the need to use a water pump with a high pressure or a high flow rate, thereby preventing the water pump from becoming larger and reducing its cost. [Brief explanation of the drawings]

[0025] [Figure 1] 1 is an overall view of an endoscopic treatment tool according to a first embodiment of the present invention. [Figure 2]1 is a partial cross-sectional view of an endoscopic treatment tool according to a first embodiment of the present invention. [Figure 3] 1 is a cross-sectional view of a main part of an endoscopic treatment tool according to a first embodiment of the present invention. [Figure 4] FIG. 10 is a cross-sectional view of a main part of an endoscopic treatment tool according to a modified example. [Figure 5] FIG. 10 is a cross-sectional view of a main part of an endoscopic treatment tool according to a modified example. [Figure 6] FIG. 10 is a cross-sectional view of a main part of an endoscopic treatment tool according to a modified example. [Figure 7] FIG. 10 is a cross-sectional view of a main part of an endoscopic treatment tool according to a modified example. [Figure 8] FIG. 10 is a cross-sectional view of a main part of an endoscopic treatment tool according to a modified example. [Figure 9] FIG. 9 is a view taken along line IX-IX in FIG. 8. [Figure 10] FIG. 4 is an overall view of an endoscopic treatment tool according to a second embodiment of the present invention. [Figure 11] FIG. 4 is a cross-sectional view of a main part of an endoscopic treatment tool according to a second embodiment of the present invention. [Figure 12] FIG. 10 is a cross-sectional view of a main part of an endoscopic treatment tool according to a modified example. [Figure 13] FIG. 10 is a cross-sectional view of a main part of an endoscopic treatment tool according to a modified example. [Figure 14] FIG. 10 is a cross-sectional view of a main part of an endoscopic treatment tool according to a modified example. [Figure 15] FIG. 10 is a cross-sectional view of a main part of an endoscopic treatment tool according to a modified example. DETAILED DESCRIPTION OF THE INVENTION

[0026] (First embodiment) A first embodiment of an endoscopic treatment tool according to the present invention will be described below with reference to Figs. 1 to 3. Fig. 1 is an overall view of an endoscopic treatment tool 1 according to this embodiment. Fig. 2 is a cross-sectional view of the main parts of the endoscopic treatment tool 1. In Fig. 2, the distal end portion is shown enlarged compared to the proximal portion. The endoscopic treatment tool 1 is used by being inserted into a channel of an endoscope (not shown). As shown in Fig. 1, the endoscopic treatment tool 1 has a treatment section 2 at its distal end portion and an operation section 4 at its proximal end portion.

[0027] The endoscopic treatment tool 1 has a sheath 10, a control wire 3, a high-frequency knife 2 (hereinafter simply referred to as "knife"), and an operation section 4. The operation section 4 is provided at the proximal end of the flexible sheath 10. The knife 2 is provided at the distal end of the control wire 3, and the control wire 3 is inserted inside the sheath 10. The knife 2 and the control wire 3 are provided so as to be able to move forward and backward relative to the sheath 10 in response to operation of the operation section 4. The knife 2 is configured to be able to incise tissue, etc., by passing a high-frequency current through the operation section 4 and the control wire 3. The endoscopic treatment tool 1 has a water supply conduit formed from the operation section 4 side to the distal end of the knife 2. The endoscopic treatment tool 1 is configured so that liquid can be supplied to the water supply conduit and delivered from the distal end of the knife 2.

[0028] The operation wire 3 is made of a conductive metal material such as stainless steel. A first duct 31 is formed along the entire length of the operation wire 3. The operation wire 3 is, for example, a tightly wound coil. The operation wire 3 is covered along the entire length with an insulating inner tube 6.

[0029] The sheath 10 is made of an electrically insulating material such as tetrafluoroethylene. The outer diameter of the sheath 10 is set to a size that allows it to be inserted through a channel of an endoscope (not shown). A control wire 3 is inserted through the sheath 10. The control wire 3 is movable forward and backward in a direction along the longitudinal axis C of the sheath 10. The sheath 10 and the control wire 3 constitute an insertion section that is inserted through the channel of the endoscope.

[0030] An insulating tip 8 is inserted into the distal opening of the sheath 10. The insulating tip 8 is fixed to the distal end of the sheath 10 with an adhesive (not shown) or the like. The insulating tip 8 is made of a heat-resistant, insulating material such as ceramics or resin. The insulating tip 8 has an insertion hole 82 that communicates with the internal space of the sheath 10 and opens distally. A stepped portion 83 is formed on the distal side of the insertion hole 82 in the insulating tip 8, where the opening of the insertion hole 82 has an enlarged diameter. The insulating tip 8 has a recess 84 recessed from the distal end face toward the proximal side. The outer diameter of the proximal portion of the insulating tip 8 is large enough to be inserted into the distal end of the sheath 10. The distal end of the insulating tip 8 has a large-diameter portion 85 that is larger in diameter than the proximal portion. The outer diameter of the large-diameter portion 85 is approximately equal to the outer diameter of the sheath 10. The outer periphery of the large-diameter portion 85 on the distal side has a curved surface.

[0031] As shown in Fig. 2, the operating unit 4 is provided in the proximal portion of the sheath 10. The operating unit 4 includes an operating body 43 and a slider 44. The slider 44 is provided so as to be slidable along the longitudinal axis C relative to the operating body 43. By moving the slider 44 forward and backward relative to the operating body 43, operations such as moving the knife 2 forward and backward relative to the sheath 10 can be performed.

[0032] The operation body 43 is fixed to the proximal end of the sheath 10. A slit 431 is formed in the operation body 43 along the longitudinal axis C. The slider 44 is slidable along the slit 431 relative to the operation body 43. The proximal end of the operation body 43 is provided with a ring 432 for hanging a finger.

[0033] The slider 44 is provided with a finger ring 442. The slider 44 is also provided with an electric connector 42. A high-frequency power supply device (not shown) is electrically connected to the electric connector 42. The proximal end of the operation wire 3 is electrically connected to the electric connector 42.

[0034] FIG. 3 is a cross-sectional view of the distal end portion of the slider 44 along the longitudinal axis C. The slider 44 has an insertion hole 441 for the operation wire 3. The proximal end portion of the operation wire 3 is inserted into the insertion hole 441, and the proximal end portion of the operation wire 3 is fixed. Specifically, a pair of protrusions 443 for fixing the operation wire 3 is formed inside the insertion hole 441. The protrusions 443 protrude from the inner surface of the insertion hole 441 in a direction perpendicular to the longitudinal axis C. The protrusions 443 are protrusions having a substantially cylindrical shape. The protrusions 443 protrude to such an extent that the outer circumferential surface of the proximal end portion of the operation wire 3 inserted into the insertion hole 441 comes into contact with the pair of protrusions 443.

[0035] As shown in FIG. 3 , a liquid supply nozzle 41 is provided on a slider 44. Although not shown, the liquid supply nozzle 41 is configured to allow a liquid supply means, such as a syringe or a water supply tube extended from a water pump, to be detachably attached. The liquid supply nozzle 41 has an injection port 411. An injection path 412 that communicates between the liquid supply nozzle 41 and the insertion hole 441 is formed in the slider 44. An opening 33 for injecting liquid is formed in the proximal end of the operation wire 3. The opening 33 is an opening that communicates with the inside and outside of the operation wire 3. The operation wire 3 is fixed to the insertion hole 441 at a position where the insertion hole 441 and the opening 33 face each other. As a result, communication is established between the liquid supply port 411 and the liquid supply conduit 31 of the operation wire 3. An O-ring 444 is attached to each protrusion 443. The O-ring 444 maintains a watertight seal between the operation wire 3 and the protrusion 443. When liquid is fed from the liquid feed nozzle 41, the O-ring 444 prevents the liquid from leaking from the gap between the operation wire 3 and the protrusion 443.

[0036] As shown in FIG. 2 , a cylindrical body 5 is fixed to the distal end of the operation wire 3. The cylindrical body 5 is a cylindrical member having electrical conductivity, such as stainless steel. A third duct 53 is formed in the cylindrical body 5 along the longitudinal axis C. The opening area of ​​the third duct 53 is smaller than the opening area of ​​the first duct 31 of the operation wire 3. The proximal end of the cylindrical body 5 and the distal end of the operation wire 3 are fixed by a welded portion 11. The distal end of the operation wire 3, the proximal end of the cylindrical body 5, and the welded portion 11 are covered by the distal end of the inner tube 6. As a result, the first duct 31 and the third duct 52 are connected watertight. A spiral groove 54 is formed on the outer circumferential surface of the cylindrical body 5 at a middle portion in the direction of the longitudinal axis C.

[0037] The knife 2 is an electrode member. As shown in FIG. 2 , the knife 2 is connected to the distal end of the operating wire 3 via a cylindrical body 5 and a connector 7. The knife 2 is formed of a conductive material, such as stainless steel. The knife 2 is a tubular member extending along a longitudinal axis C. That is, the knife 2 is a tubular electrode having a second duct 22 formed along the longitudinal axis C. The knife 2 has a large diameter portion 24 and a small diameter portion 25. The large diameter portion 24 is located at the distal end of the knife 2. The small diameter portion 25 is located in the region from the proximal end of the large diameter portion 24 to the proximal end 23 of the knife 2. The second duct 22 is formed inside the knife 2 and extends along the longitudinal axis C. The second duct 22 extends from the proximal end to the distal end of the knife 2 and opens at both the proximal and distal ends of the knife 2. The opening at the distal end of the knife 2 is a water supply port 21 through which a liquid is supplied. The water supply port 21 opens at the large diameter portion 24. The large diameter portion 24 has a greater radial thickness than the small diameter portion 25 .

[0038] The small diameter portion 25 is inserted into the insertion hole 82 of the insulating tip 8. The outer diameter of the small diameter portion 25 is smaller than the inner diameter of the recess 84 distal to the step portion 83 in the insertion hole 82 of the insulating tip 8. In a direction perpendicular to the longitudinal axis C, the opening area of ​​the recess 84 is larger than the area of ​​the large diameter portion 24. The knife 2 is inserted into the insulating tip 8 so as to be able to advance and retreat. When the knife 2 retreats, the large diameter portion 24 advances into the recess 84.

[0039] The distal end of the cylindrical body 5 is inserted into the second duct 22 of the knife 2. The cylindrical body 5 and the knife 2 are connected by a connector 7. The connector 7 is made of a conductive metal material such as stainless steel. The connector 7 has an insertion hole 72 formed therethrough along the longitudinal axis C. A spiral groove 71 is formed on the inner circumferential surface of the insertion hole 72 at the proximal end of the connector 7. The inner circumferential surface of the distal end 721 of the insertion hole 72 of the connector 7 has an opening dimension that allows the small diameter portion 25 of the knife 2, which will be described later, to be inserted therein. The proximal end of the knife 2 is inserted into the distal end 721 of the insertion hole 72, and the knife 2 and the connector 7 are fixed together.

[0040] The cylindrical body 5 is inserted into the insertion hole 72 from the proximal side of the connector 7, and the spiral grooves 54, 71 of the connector 7 are screwed together. The distal end of the cylindrical body 5 protrudes distally beyond the distal end of the connector 7. When the connector 7 and the cylindrical body 5 are screwed together, the proximal end 23 of the knife 2 is inserted into the distal end 721 of the insertion hole 72. In this example, the connector 7 and the cylindrical body 5 are fixed together with screws, but the method of joining the connector and the cylindrical body is not limited to screwing. For example, the connector and the cylindrical body may be joined together with an adhesive or by welding.

[0041] The knife 2 is connected to the electrical connector 42 via the connector 7, the cylindrical body 5, the welding portion 11, and the operating wire 3. As a result, electricity is applied to the knife 2 from the high-frequency power supply device connected to the electrical connector 42 via the operating wire 3, the welding portion 11, the connector 7, and the cylindrical body 5.

[0042] As shown in Figure 2, the opening area of ​​the third conduit 53 of the cylindrical body 5 is smaller than the opening areas of the first conduit 31 of the operating wire 3 and the second conduit 22 of the knife 2. Therefore, the flow path of the liquid from the operating wire 3 to the water supply port 21 of the knife 2 is once narrowed at the third conduit 53. As a result, the water pressure of the liquid supplied to the first conduit 31 of the operating wire 3 increases as it passes through the third conduit 53. The liquid with increased water pressure passes through the second conduit 22 and is supplied from the water supply port 21 of the knife 2. As a result, even if the water pressure of the liquid supplied to the first conduit 31 is low, the water force in the second conduit 22 can be increased, and water can be supplied from the water supply port 21 with increased water force.

[0043] Next, we will explain the operation of the endoscopic treatment tool 1. The endoscopic treatment tool 1 is operated by a user, such as an operator, inserting his or her fingers into the ring 432 of the operation body 31 and the ring 442 of the slider 44, and sliding the slider 44 relative to the operation body 43 in the direction along the longitudinal axis C with one hand.

[0044] By moving the slider 44 distally relative to the operation body 43, the operation wire 3 is moved distally relative to the sheath 10. As a result, the knife 2 protrudes distally beyond the insulating tip 8. At this time, when the slider 44 is pushed distally, the distal end surface 74 of the connector 7 abuts against the proximal end 81 of the insulating tip 8, as shown in FIG. 2. As a result, the knife 2 protrudes to its maximum protrusion position. In other words, the abutment of the connector 7 against the insulating tip 8 determines the protrusion position of the knife 2. The state in which the connector 7 abuts against the insulating tip 8 and the knife 2 protrudes most distally is referred to as the protruding state.

[0045] In the protruding state, the distal portion of the small diameter section 25 of the knife 2 can be protruded distally beyond the sheath 10 through the insertion hole 82 of the insulating tip 8. A liquid such as physiological saline is supplied to the first conduit 31 from the inlet 411 of the liquid supply connector 41. The liquid is supplied from the water supply port 21 to the distal side through the first conduit 31 of the operating wire 3, the third conduit 53 of the cylindrical body 5, and the second conduit 22 of the knife 2.

[0046] By moving the slider 44 proximally relative to the operation body 43, the operation wire 3 is retracted proximally relative to the sheath 10. As a result, the large diameter portion 24 comes into contact with the recess 84 of the insulating tip 8. As a result, the small diameter portion 25 of the knife 2 is housed within the internal space 10S of the sheath 10, and the operation wire 3 is positioned in a housed state where it is housed proximally.

[0047] Next, the operation of the endoscopic treatment tool 1 according to this embodiment will be described.

[0048] The distal portion of the sheath 10 of the endoscopic treatment tool 1 is protruded from the channel of the endoscope, and the knife 2 is placed opposite, for example, a lesioned mucous membrane portion that is the treatment target site in the body cavity.

[0049] A syringe or water supply tube (not shown) is attached to the inlet 411 of the liquid supply nozzle 41. The user presses the knife 2 against the vicinity of the mucous membrane of the lesion and supplies physiological saline solution contained in the syringe or water supply pump to the first conduit 31 of the operating wire 3. At this time, the knife 2 may be in either a protruding or retracted state. The physiological saline solution is supplied from the water supply port 21 to the distal side via the water supply conduit. In the endoscopic treatment tool 1, the liquid supplied to the first conduit 31 passes through the third conduit 53, then through the second conduit 22 and is supplied from the water supply port 21. The third conduit 52 has a smaller opening area than the first conduit 31. Therefore, the liquid supplied to the first conduit 31 gains stronger water pressure as it passes through the third conduit 53. This allows the water to be supplied from the water supply port 21 with strong water pressure. As a result, the water supply port 21 is pressed against the mucous membrane and submucosa of the lesion, causing the lesion to rise.

[0050] Next, a high frequency current is applied to the knife 2 from a high frequency power supply device (not shown) connected to the electric connector 42 of the operation unit 4 through the electric connector 42 , the operation wire 3 and the connector 7 .

[0051] Subsequently, for example, when the knife 2 is moved laterally perpendicular to the longitudinal axis C, the mucosa (tissue) in contact with the knife 2 is incised. After the diseased mucosa portion is completely incised in the circumferential direction, the knife 2 is brought into contact with the incision made around the diseased mucosa portion, and the entire diseased mucosa portion is excised and peeled off.

[0052] When performing procedures such as incising mucous membranes or coagulating bleeding points, bodily fluids such as mucus and blood may enter the second conduit 22 of the knife 2 through the water supply port 21 due to capillary action or the like. In this case, the mucus and blood that have adhered to the inside of the second conduit 22 due to the incision or excision made by the knife 2 may be scorched by the high temperature of the knife 2. The scorched mucus and blood in the second conduit 22 narrows the water supply conduit of the second conduit 22, making it difficult to supply water. Therefore, water is supplied through the third conduit 53 at a high water pressure to remove any scorched deposits in the second conduit 22. As described above, the liquid with increased water pressure in the third conduit 53 is supplied through the second conduit 22 and then through the water supply port 21. As a result, the scorched deposits in the second conduit 22 are peeled off from the inner circumferential surface of the second conduit 22 by the liquid pressure and are discharged from the water supply port 21.

[0053] As described above, the endoscopic treatment tool 1 according to this embodiment has the third conduit 53 between the first conduit 31 and the water supply port 21. The opening area of ​​the third conduit 53 is smaller than the opening areas of the first conduit 31 and the second conduit 22. As a result, the liquid supplied to the first conduit 31 passes through the third conduit 53, thereby increasing the water pressure of the liquid and allowing the water to be supplied from the water supply port 21 with increased water pressure. According to the endoscopic treatment tool 1, even if the output of the syringe or water supply pump that supplies the liquid to the first conduit 31 is small, the water can be supplied from the water supply port 21 with increased water pressure.

[0054] According to the endoscopic treatment tool 1 of this embodiment, by providing the third conduit 53, which has a smaller opening area than the first conduit 31 and the second conduit 22, between the distal end of the manipulation wire 3 and the water supply port 21, it is possible to supply saline or a medicinal solution with strong water pressure from the water supply port 21 without using a high-performance water supply pump. As a result, the local injection operation of supplying water to the mucosa and submucosa to swell the lesion becomes easier, there is no need to change treatment tools, and the procedure time is shortened.

[0055] According to the endoscopic treatment tool 1, by supplying water with strong water pressure from the third conduit 53, it is possible to easily remove the burnt deposits inside the second conduit 22. Therefore, it is possible to prevent the second conduit 22 from being clogged with the deposits.

[0056] The manner in which the third conduit 53 is provided is not limited to the above-mentioned example. The endoscopic treatment tool may be, for example, the modified forms shown in Figures 4 to 9. In the following description, the same parts as those in the first embodiment are denoted by the same reference numerals, and description thereof will be omitted, and only the differences will be described.

[0057] The example shown in FIG. 4 differs from the first embodiment in the configurations of the operation wire 3A, connector 7A, and cylindrical body 5A. The operation wire 3A is a soft tube made of a conductive material. When the operation wire 3A is a tube, the first conduit 31 of the operation wire 3A can be maintained in a watertight state, so the inner tube 6 is not an essential component. In the first embodiment, an example was shown in which a portion of the cylindrical body 5 protrudes proximally from the connector 7 and is connected to the operation wire 3. However, the third conduit 53A may be located between the distal end of the operation wire 3 and the water supply port 21. For example, as shown in FIG. 4, a cylindrical body 5A may be fitted into the proximal end of the second conduit 22 of the knife 2A, thereby providing a third conduit 53A with a smaller opening area than the first conduit 31 and the second conduit 22.

[0058] In the first embodiment, an example was shown in which the cylindrical body 5 is fixed to the operation wire 3, the connector 7 is fixed to the proximal end of the knife 2, and the connector 7 is screwed onto the cylindrical body 5, thereby connecting the cylindrical body and the knife 2. The manner in which the operation wire 3 and the knife 2 are connected by the connector 7 is not limited to this example. For example, as shown in FIG. 4 , the distal end of the operation wire 3A and the proximal end of the knife 2A may be inserted and fixed through an insertion hole 72 of the connector 7A. In this configuration example, the operation wire 3A and the knife 2A can be electrically connected by abutting against the connector 7A. In this case, as shown in FIG. 4 , the inner tube 6 of the first embodiment does not need to be provided. With this configuration, as in the first embodiment, the water pressure of the liquid can be increased in the third conduit 53A, and water can be supplied from the water supply port 21 with increased water pressure.

[0059] The example shown in FIG. 5 differs from the first embodiment in the configurations of the operating wire 3B, connector 7B, cylindrical body 5B, insulating tip 8B, and proximal end of the knife 2B. The configurations of the operating wire 3B, connector 7B, and cylindrical body 5B are the same as those of the modified example shown in FIG. 4. The proximal end 26 of the knife 2B has a larger diameter than the small diameter portion 25. A step 27 is formed between the small diameter portion 25 and the proximal end 26. In a direction perpendicular to the longitudinal axis C, the thickness of the proximal end 26 is greater than the thickness of the small diameter portion 25. A housing portion for the cylindrical body 5B is formed in the second duct 22 of the proximal end 26. The opening area of ​​the second duct 22 at the proximal end 26 is slightly larger than other regions, allowing the cylindrical body 5B to be fitted therein.

[0060] A recess 821 recessed toward the distal side is formed at the proximal end of the insulating tip 8B. The recess 821 has an opening dimension larger than that of the insertion hole 82 of the insulating tip 8, and a step 822 is formed in the recess 821. In the example shown in FIG. 5, when the knife 2B is pushed out, the step 27 of the proximal end 26 of the knife 2B abuts against the step 822 of the recess 821 of the insulating tip 8B. As a result, the knife 2B is positioned at a position where it protrudes most relative to the sheath 10. As with the first embodiment, the treatment tool of the modified example shown in FIG. 5 can supply liquid from the water supply port 21 with strong water pressure in the third conduit 53B.

[0061] The connector 7 and the cylindrical body 5 shown in the first embodiment are not essential components. As in the example shown in Fig. 6, the second duct 22 and the third duct 53C may be formed continuously in the knife 2C. The knife 2C has a third duct 53C on the proximal end side of the second duct 22, the third duct 53C having a smaller opening area than the second duct 22 and the first duct 31 of the operating wire 3. In this case, the proximal end of the knife 2 and the distal end of the operating wire 3 may be fixed by a welded portion 11. As in the first embodiment, the treatment tool of the modified example shown in Fig. 6 can supply liquid from the water supply port 21 while the water force of the liquid is increased in the third duct 53C.

[0062] In the example shown in FIG. 7, similar to the modified example shown in FIG. 6, a third conduit 53D is integrally formed with the knife 2D. The configuration of the third conduit 53D is the same as that of the modified example shown in FIG. 6. An inclined surface 29 is formed between the proximal end of the third conduit 53D and the proximal end of the knife 2D. The inclined surface 29 is a tapered inclined surface whose diameter decreases from the proximal end of the knife 2D toward the proximal end of the third conduit 53D. This configuration allows smooth liquid transfer from the first conduit 31 to the third conduit 53D, reducing pressure loss. As with the first embodiment, the treatment tool of the modified example shown in FIG. 7 can transfer liquid from the water supply port 21 while increasing the water pressure of the liquid in the third conduit 53D.

[0063] In the first embodiment, an example was shown in which the first conduit 31 is provided inside the operation wire 3, but the first conduit 31 may be provided separately from the operation wire. The first conduit and the third conduit are not limited to a single conduit each. As in the example shown in FIGS. 8 and 9, multiple liquid supply tubes 9 may be provided independently of the operation wire 3. In the modified example shown in FIGS. 8 and 9, three liquid supply tubes 9 are arranged around the operation wire 3. The distal end of the operation wire 3 is fixed to a connector 7E. The proximal end of the knife 2E is fixed to the connector 7E. As a result, electricity is supplied to the knife 2E via the operation wire 3 and the connector 7E. Connection conduits 73 are formed within the connector 7E. The number of connection conduits 73 is the same as the number of liquid supply tubes 9. The proximal end of each connection conduit 73 is connected to a corresponding liquid supply tube 9. The connection conduits 73 open at three locations at the proximal end of the connector 7E, spaced apart in the circumferential direction of the connector 7E, and are inclined toward the distal end of the connector 7E. The three connecting conduits 73 join at the distal end of the connector 7E. The third conduit 53E is formed distal to the joining point of the three liquid supply tubes 9. The third conduit 53E is formed at the connection point between the connector 7E and the incision 2E. The opening area of ​​the third conduit 53E is smaller than the opening area of ​​the joining point of the connecting conduits 73. With this configuration, as in the first embodiment, the diameter of the water supply conduit is reduced in the third conduit 53E, and water can be supplied with increased water pressure from the water supply port 21 of the knife 2E.

[0064] Second Embodiment An endoscopic treatment tool 1F according to a second embodiment will be described with reference to Figs. 10 to 12. The endoscopic treatment tool is not limited to a high-frequency knife, and can be applied to an endoscopic treatment tool having the functions of supplying water and applying electricity. As shown in Fig. 10, the endoscopic treatment tool 1F according to this embodiment has a treatment section in the form of forceps 2F. The configurations of the control section 4, sheath 10, control wire 3, and inner tube 6 are the same as those of the first embodiment.

[0065] The forceps 2F has a pair of forceps members 211, 212, a pair of link members 213, 214, multiple rotating shafts 216, 217, 218, an axis member 215, a cover 228, and a stopper 227. The forceps 2F has a known link mechanism. The cover 228 and the stopper 227 are integrally formed. An insertion hole 229 penetrating in the direction of the longitudinal axis C is formed in the stopper 227. A second duct 22F is formed inside the axis member 215. The proximal end of the axis member 215 is fixed to the distal end of the operation wire 3. A cylindrical body 5F is inserted into the proximal end of the second duct 22F. A third duct 53F of the cylindrical body 5F is disposed distally of the first duct 31 of the operation wire 3, and the second duct 22F is formed distally of the third duct 53F.

[0066] Link members 213 and 214 are connected to the distal end of shaft member 215 via proximal rotation shaft 218. A pair of forceps members 211 and 212 is inserted through distal rotation shaft 216, which is connected to cover 228. A through hole 216F is formed in distal rotation shaft 216, penetrating along longitudinal axis C. Through hole 216F has an opening area equivalent to that of second conduit 22F inside shaft member 215, and functions as an extension conduit of second conduit 22F. Therefore, the distal end of through hole 216F functions as water supply port 21F.

[0067] The insulating tip 8F has an expanded diameter portion 823 formed in the middle of the insertion hole 82 in the direction of the longitudinal axis C. A stopper 227 is housed in the expanded diameter portion 823. The stopper 227 restricts the range of movement of the cover 228 in the direction of the longitudinal axis C relative to the insulating tip 8F.

[0068] When the operation wire 3 is advanced or retracted relative to the sheath 10, the shaft member 215 advances or retracts relative to the cover 228. The pair of forceps members 211, 212 are rotatably connected to the cover 228 by the distal rotation shaft 216. As a result, as shown in FIG. 11 , as the operation wire 3 advances, the proximal rotation shaft 218 approaches the distal rotation shaft 216, and the pair of forceps members 211, 212 open. In this state, similar to the first embodiment, liquid is supplied through the liquid supply port 41. The liquid passes through the first conduit 31, the third conduit 53F, and the second conduit 22F and is supplied from the distal end of the shaft member 215. The liquid supplied from the distal end of the shaft member 215 passes through the water supply port 21F provided at the distal end of the through-hole 216F of the distal rotation shaft 216 and is supplied distally between the open pair of forceps members 211, 212. When the operating wire 3 is retracted, the proximal rotation shaft 218 moves proximally and separates from the distal rotation shaft 216, and as shown in FIG. 10, the pair of forceps members 211, 212 closes.

[0069] According to the endoscopic treatment tool 1F of the second embodiment, similarly to the first embodiment, the liquid can be fed from the water feed port 21F with the water pressure of the liquid being increased in the third conduit 53F.

[0070] The cylindrical body of this embodiment is not limited to the above-described configuration. For example, it may be in the form of modified examples shown in Figs. 12 and 13. In the example shown in Fig. 12, the cylindrical body 5F is provided at the distal end of the shaft member 215. In the example shown in Fig. 12, the third conduit 53F is located on the distal end side of the shaft member 215. The distal end of the cylindrical body 5F protrudes distally beyond the distal end of the shaft member 215.

[0071] 12, similarly to the second embodiment, water is supplied distally from between the pair of open forceps members 211, 212 through water supply port 21F provided at the distal end of through-hole 216F with strong water pressure in third conduit 53F. By providing third conduit 53F at the distal end of shaft member 215, water can be supplied at a strong liquid pressure in the distal portion of the device.

[0072] The modified example shown in FIG. 13 is an example in which the cylindrical body 5G is longer than the cylindrical body 5F of the modified example shown in FIG. 12. As shown in FIG. 13, the long cylindrical body 5G may be protruded to the vicinity of the distal rotation axis 216. In this case, when the pair of forceps members 211, 212 are opened, the distal end of the cylindrical body 5G protrudes distally beyond the distal rotation axis 216. As a result, with the pair of forceps members 211, 212 open, water can be delivered with stronger water pressure on the more distal side. According to the modified example shown in FIG. 13, as in the second embodiment, water can be delivered from the water delivery port 21G with the liquid in the third conduit 53G being at a stronger water pressure.

[0073] In the above embodiment, high-frequency knives 2A to 2E are used as examples of endoscopic treatment tools. However, endoscopic treatment tools are not limited to these examples. For example, endoscopic treatment tools such as those illustrated in FIGS. 14 and 15 may be used. The high-frequency treatment tool 2G shown in FIGS. 14 and 15 differs in the configuration of its distal end from the high-frequency knives 2A to 2E. The large-diameter section 24G of the high-frequency treatment tool 2G includes a distal end member 244 and a current-carrying section 241. The distal end member 244 is disposed at the distal end of the large-diameter section 24G. The distal end member 244 is formed of an insulating spherical member made of, for example, zirconia or ceramics. The current-carrying section 241 is disposed at the proximal end of the distal end member 244. The current-carrying section 241 is formed of, for example, a conductive metal material such as stainless steel, and includes an annular proximal end portion 242 and a cylindrical portion 243. The cylindrical portion 243 protrudes distally from the proximal end portion 242. The cylindrical portion 243 is inserted into and fixed to the distal end member 244. The distal end of the small diameter portion 25G is inserted into and fixed to the cylindrical portion 243. An outer peripheral edge (outer edge) 245 of the proximal end 242 of the current-carrying portion 241 is exposed along the outer peripheral surface of the proximal end of the distal end member 244. High-frequency current is applied to the current-carrying portion 241 through the operating wire 3G, the connector 7G, and the small diameter portion 25G. When energized, the outer peripheral edge 245 of the proximal end 242 of the current-carrying portion 241 comes into contact with tissue or the like, thereby enabling the tissue or the like to be incised. The cylindrical body 5G is inserted into the proximal end of the small diameter portion 25G. The liquid that has passed through the first conduit 31 is sent at increased water pressure through the third conduit 53G, and then sent through the second conduit 22G from the water supply port 21.

[0074] In the above embodiment, an example was shown in which the fluid was physiological saline, but the fluid is not limited to this and may be a medicinal solution or the like.

[0075] According to the endoscopic treatment tool 1, the liquid can be supplied from the water supply port 21 with the water pressure of the liquid increased in the third conduit 53. Therefore, even if the water supply means connected to the liquid supply connector 41 of the operation unit 4 is a low-pressure or low-flow syringe or a low-performance water supply pump, the liquid can be supplied with strong water pressure from the water supply port 21. This eliminates the need to switch between the high-frequency knife and the local injection needle to perform local injection, thereby shortening the treatment time.

[0076] Because water can be supplied from the water supply port 21 with strong water pressure, if blood or mucous membranes get into the second conduit 22 of the knife 2, the matter that adheres and burns due to repeated energization can be removed by supplying the fluid with water. As a result, clogging of the water supply conduit due to burnt matter can be prevented.

[0077] Although the embodiments of the present invention have been described above, the technical scope of the present invention is not limited to the above embodiments, and various modifications and omissions of the components in each embodiment are possible without departing from the spirit of the present invention. The present invention is not limited by the above description, but is limited only by the scope of the appended claims. [Industrial Applicability]

[0078] An endoscopic treatment tool can be provided that can deliver liquids such as medicinal solutions and saline solutions with strong water force from the distal end of the treatment tool without using a high-performance water pump. [Explanation of symbols]

[0079] 1,1A Endoscopic treatment tools 2 High-frequency knife (treatment area) 2F Forceps (treatment area) 3. Operating wire (tube member) 5 Cylinder 7 Connectors 10 Sheath 411 Inlet (supply port) 31 First pipeline 22 Second pipeline 53 Third pipeline 21 Water inlet

Claims

1. Sheath and a tubular member extending freely within the sheath; a conductive treatment section attached to the distal end of the tubular member and having a water supply port at its tip through which a fluid can be supplied; Equipped with the tubular member has a first conduit through which the fluid passes; the treatment section has a second pipeline communicating with the water supply port, a third pipe communicating with the first pipe and the second pipe, The third conduit is narrower than the first conduit and the second conduit, and is provided proximal to the water supply port. Endoscopic treatment tools.

2. the first pipe, the second pipe, and the third pipe are arranged coaxially. The endoscopic treatment tool according to claim 1 .

3. At least a portion of the third pipeline is disposed between the first pipeline and the second pipeline. The endoscopic treatment tool according to claim 1 or 2.

4. an inner diameter of at least a portion of the third pipeline is smaller than inner diameters of the first pipeline and the second pipeline; The endoscopic treatment tool according to claim 1 or 2.

5. The distal end of the third conduit is located distal to the proximal end of the treatment section. The endoscopic treatment tool according to claim 1 or 2.

6. the distal end of the third conduit is located proximal to the distal end of the second conduit; a step is formed between the distal end of the third conduit and the second conduit; The endoscopic treatment tool according to claim 1 or 2.

7. the step is provided at a proximal end of the second conduit; The endoscopic treatment tool according to claim 6.

8. the third conduit is formed at the distal end of the tubular member; The endoscopic treatment tool according to claim 1 or 2.

9. The distal end of the tubular member is inserted into the second conduit. The endoscopic treatment tool according to claim 8.

10. a cylindrical body having the third pipe line, a distal end of the cylindrical body inserted into the second duct of the treatment section; The endoscopic treatment tool according to claim 1 or 2.

11. the third conduit is formed on the proximal side of the second conduit of the treatment section; The endoscopic treatment tool according to claim 1 or 2.

12. an inclined surface is formed between the proximal end of the third conduit and the first conduit; The endoscopic treatment tool according to claim 1 .

13. the sheath has a heat-resistant and insulating tip at a distal end; The treatment portion is a high-frequency knife that is inserted into the insulating tip and can advance and retreat relative to the sheath. The endoscopic treatment tool according to claim 1 or 2.

14. a cylindrical body having the third pipe; a connector that connects the cylindrical body and the high-frequency knife and is made of a conductive material; The connector and the insulating tip come into contact with each other, thereby determining the position at which the high-frequency knife projects relative to the sheath. The endoscopic treatment tool according to claim 13.

15. a connector that connects the tubular member and the high-frequency knife and is made of a conductive material; The connector and the insulating tip come into contact with each other, thereby determining the position at which the high-frequency knife projects relative to the sheath. The endoscopic treatment tool according to claim 13.

16. The high frequency knife a distal end member having insulating properties and having the water supply port formed therein; a conductive portion that is electrically conductive and is disposed at a proximal end of the distal end member, the outer edge of which is exposed on the proximal side of the distal end member; The endoscopic treatment tool according to claim 13.

17. the treatment section has a pair of forceps members and a shaft member to which the pair of forceps members are provided on a distal side; The second pipeline is formed in the shaft member. The endoscopic treatment tool according to claim 1 or 2.

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