Endoscopic treatment tools

Abstract

To improve the efficiency of manipulation.SOLUTION: An endoscopic treatment tool comprises: a tubular part; a rod-like member arranged so as to protrude from a tip surface of the tubular part, and in which the amount of protrusion from the tip surface is variable in accordance with operation of an operation part; a first connection port to which a device for water supply or suction can be connected; a first tip opening formed in a tip surface of the rod-like member; a first pipe line formed in the tubular part so as to extend in an axial direction of the tubular part, of which a tip communicates with the first tip opening, and of which a base end communicates with the first connection port; a second connection port to which the device can be connected; a second tip opening formed in the tip surface of the tubular part; and a second pipe line formed in the tubular part so as to extend in the axial direction, of which a tip communicates with the second tip opening, and of which a base end communicates with the second connection port.SELECTED DRAWING: Figure 9

Description

[Technical Field]

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

[0002] Endoscopic submucosal dissection (hereinafter referred to as "ESD") is known as a method capable of resecting widespread lesions such as early esophageal cancer, early gastric cancer, and early colon cancer en bloc using an endoscope. The ESD procedure involves marking the area to be resected (marking procedure), locally injecting a medicinal solution into the submucosa to elevate the mucosal lesion (local injection procedure), incising the area around the mucosal lesion according to the marking, then peeling the submucosa (incision and peeling procedure), and stopping bleeding that occurs on the peeled ulcer surface or during the incision and peeling (hemostasis procedure). This type of procedure uses an endoscopic treatment instrument equipped with a nozzle or the like that applies a high-frequency current to peel the mucosa or the like (see, for example, Patent Document 1). [Prior art documents] [Patent documents]

[0003] [Patent Document 1] Japanese Patent Application Publication No. 2019-213883 Summary of the Invention [Problem to be solved by the invention]

[0004] In procedures using this type of endoscopic treatment tool, for example, water may be supplied to the submucosal layer for local injection or to identify the site for hemostasis during bleeding, or blood or mucus may be suctioned to ensure a surgical field. With the conventional endoscopic treatment tool exemplified in Patent Document 1, when supplying water, if a suction pump is connected to the endoscopic treatment tool, it is necessary to disconnect the suction pump before connecting the water supply pump to the endoscopic treatment tool. Similarly, when suctioning, if a water supply pump is connected to the endoscopic treatment tool, it is necessary to disconnect the suction pump before connecting the suction pump to the endoscopic treatment tool. Such pump replacement work contributes to a decrease in the efficiency of the procedure.

[0005] The present invention has been made in view of the above circumstances, and an object of the present invention is to provide an endoscopic treatment tool that can improve the efficiency of procedures. [Means for solving the problem]

[0006] An endoscopic treatment tool according to one embodiment of the present invention comprises a tubular portion, a rod-shaped member arranged to protrude from the distal end surface of the tubular portion and whose protrusion from the distal end surface can be varied in response to operation of an operating portion, a first connection port to which an instrument for water supply or suction can be connected, a first distal opening formed on the distal end surface of the rod-shaped member, a first conduit formed within the tubular portion and extending in the axial direction of the tubular portion, the tip of which communicates with the first distal opening and the base end of which communicates with the first connection port, a second connection port to which an instrument can be connected, a second distal opening formed on the distal end surface of the tubular portion, and a second conduit formed within the tubular portion and extending in the axial direction, the tip of which communicates with the second distal opening and the base end of which communicates with the second connection port.

[0007] The endoscopic treatment tool according to one embodiment of the present invention may further include a tube communicating with the through passage formed in the rod-shaped member. In this case, the first distal end opening is an opening of the through passage formed in the distal end surface of the rod-shaped member. The first conduit includes the through passage and the tube.

[0008] The endoscopic treatment tool according to one embodiment of the present invention may be configured such that the proximal end of the rod-shaped member is inserted into the distal end of the tube so that the through passage and the tube communicate with each other. In this case, as the tube advances and retreats axially within the tubular portion in response to operation of the operating unit, the rod-shaped member also advances and retreats axially, changing the amount by which the rod-shaped member protrudes from the distal end surface of the tubular portion.

[0009] In a front view of the distal end surface of the tubular portion, the rod-shaped member may be located in a central region of the distal end surface of the tubular portion, and the second distal opening may be located in a peripheral region of the distal end surface of the tubular portion located outside the central region.

[0010] Furthermore, a plurality of second distal end openings may be formed on the distal end surface of the tubular portion, in which case the plurality of second distal end openings are positioned at equal intervals around the periphery of the rod-shaped member in a front view.

[0011] The tubular portion may also include a sheath and a cap-shaped member attached to the sheath to close the distal opening of the sheath. In this case, the cap-shaped member supports the rod-shaped member slidably in the axial direction and has a first through passage penetrating the cap-shaped member, with a base-end opening communicating with the sheath and a distal-end opening formed in the distal surface of the cap-shaped member, and a second through passage penetrating the cap-shaped member and extending in the axial direction around the first through passage. The second through passage forms part of the second conduit. The distal opening of the second through passage is a second distal opening and is formed in the distal surface of the cap-shaped member.

[0012] The tubular portion may include a support path that supports the rod-shaped member so that the rod-shaped member is slidable in the axial direction. In this case, the support path forms a part of the second pipe path.

[0013] The tubular portion may also include a sheath and a cap-shaped member attached to the sheath so as to close the distal opening of the sheath. In this case, the support passage is a third through passage that penetrates the cap-shaped member, has a base-end opening that communicates with the sheath, and has a distal-end opening formed in the distal surface of the cap-shaped member. The third through passage forms part of the second conduit.

[0014] An endoscopic treatment tool according to one embodiment of the present invention may be configured such that at least a portion of the first duct passes through the second duct, and a sealing member that ensures airtightness of the second duct inside the tubular portion is arranged on the outer periphery of the portion of the first duct that passes through the second duct.

[0015] The endoscopic treatment tool according to one embodiment of the present invention may further include a contact portion to which a high-frequency power source for passing a high-frequency current can be connected, and a conductive wire disposed within the tubular portion. In this configuration, the rod-shaped member is conductive. The wire has a distal end electrically connected to the rod-shaped member and a proximal end electrically connected to the contact portion. [Effects of the Invention]

[0016] According to one embodiment of the present invention, an endoscopic treatment tool capable of improving the efficiency of a procedure is provided. [Brief explanation of the drawings]

[0017] [Figure 1] 1 is a perspective view showing a configuration of an endoscopic treatment tool according to an embodiment of the present invention. [Figure 2] 1 is a side cross-sectional view showing a configuration of an endoscopic treatment tool according to an embodiment of the present invention. [Figure 3] 1 is a side cross-sectional view showing a configuration of an endoscopic treatment tool according to an embodiment of the present invention. [Figure 4] 1 is an enlarged view showing a portion of an endoscopic treatment tool according to an embodiment of the present invention. FIG. [Figure 5A] 1 is an enlarged view showing a portion of an endoscopic treatment tool according to an embodiment of the present invention. FIG. [Figure 5B]1 is an enlarged view showing a portion of an endoscopic treatment tool according to an embodiment of the present invention. FIG. [Figure 6] 1 is an enlarged view showing a portion of an endoscopic treatment tool according to an embodiment of the present invention. FIG. [Figure 7] 1 is an enlarged view showing a portion of an endoscopic treatment tool according to an embodiment of the present invention. FIG. [Figure 8A] 1 is a perspective view of a distal end of a tubular portion of an endoscopic treatment tool according to an embodiment of the present invention. [Figure 8B] 1 is a perspective view of a distal end of a tubular portion of an endoscopic treatment tool according to an embodiment of the present invention. [Figure 9] 1 is a front view of a distal end surface of a tubular portion of an endoscopic treatment tool according to an embodiment of the present invention. FIG. [Figure 10] 1 is a cross-sectional view showing a water supply conduit provided in an endoscopic treatment tool according to an embodiment of the present invention. [Figure 11] 1 is a cross-sectional view showing a suction channel provided in an endoscopic treatment tool according to an embodiment of the present invention. [Figure 12A] FIG. 10 is a perspective view of the distal end of a tubular portion of an endoscopic treatment tool according to a modified example of the present invention. [Figure 12B] FIG. 10 is a perspective view of the distal end of a tubular portion of an endoscopic treatment tool according to a modified example of the present invention. [Figure 13] FIG. 10 is a front view of the distal end surface of a tubular portion of an endoscopic treatment tool according to a modified example of the present invention. [Figure 14] FIG. 10 is a cross-sectional view showing a water supply conduit provided in an endoscopic treatment tool according to a modified example of the present invention. [Figure 15] FIG. 10 is a cross-sectional view showing a suction channel provided in an endoscopic treatment tool according to a modified example of the present invention. DETAILED DESCRIPTION OF THE INVENTION

[0018] Hereinafter, an endoscopic treatment tool according to one embodiment of the present invention will be described with reference to the drawings.

[0019] 1 is a perspective view showing the configuration of an endoscopic treatment tool 1 according to one embodiment of the present invention. The endoscopic treatment tool 1 includes a first conduit and a second conduit, and by connecting a water supply pump to one conduit and a suction pump to the other conduit, for example, it is possible to perform either water supply or suction, or both, simultaneously, without replacing the pumps.

[0020] As will be described in detail later, the endoscopic treatment tool 1 includes a water supply conduit 60 and a suction conduit 70 as examples of the first conduit and the second conduit. A water pump, for example, is connected to the base end of the water supply conduit 60. When a cleaning liquid is supplied by the water pump, the cleaning liquid is ejected to the outside from the tip of the endoscopic treatment tool 1 via the water supply conduit 60. In addition, a suction pump, for example, is connected to the base end of the suction conduit 70. When the suction pump is driven, deposits within the body cavity are sucked into the suction conduit 70 and placed in a container or the like provided with the suction pump.

[0021] As shown in FIG. 1 , the endoscopic treatment tool 1 includes a tubular portion 10. In the following description, the axial direction (longitudinal direction) of the tubular portion 10 is referred to as the Z direction, and two directions that are perpendicular to the Z direction and perpendicular to each other are referred to as the X direction and the Y direction. The mutually perpendicular X direction, Y direction, and Z direction form a right-handed system. For convenience of explanation, the positive side of the Z direction will also be referred to as the front side, the negative side of the Z direction will also be referred to as the rear side, the positive side of the Y direction will also be referred to as the upper side, and the negative side of the Y direction will also be referred to as the lower side. However, these directional names are used for convenience in describing the relative positional relationships of the components and do not indicate absolute directions.

[0022] 2 and 3 are side cross-sectional views showing the configuration of an endoscopic treatment tool 1 according to one embodiment of the present invention. FIG. 2 shows a YZ cross section including the central axis of the tubular portion 10. FIG. 3 shows an XZ cross section including the central axis of the tubular portion 10. FIG. 4 is an enlarged view of a portion PA in FIG. 2. FIGS. 5A and 5B are enlarged views of a portion PB in FIG. 2. FIG. 6 is an enlarged view of a portion PC in FIG. 3. FIG. 7 is an enlarged view of a portion PD in FIG. 3. FIGS. 8A and 8B are perspective views of the tip of the tubular portion 10. FIG. 9 is a view of the tip surface 10A of the tubular portion 10 as viewed from the positive side in the Z direction (in other words, a front view of the tip surface 10A).

[0023] The tubular portion 10 includes a sheath 11 that can be inserted into a treatment tool insertion channel of an endoscope (not shown), a stopper 12 that is fitted into the distal opening of the sheath 11, and a housing portion 13 that holds the base end of the sheath 11 and each of the components.

[0024] The sheath 11 is a flexible insulating tube made of resin, and is made of, for example, PEEK (polyetheretherketone) or PTFE (polytetrafluoroethylene).

[0025] The stopper 12 is a cap-shaped member having an outer diameter substantially the same as the inner diameter of the sheath 11, and has a retaining protrusion formed on its outer peripheral surface. The stopper 12 is press-fitted into the sheath 11 from the distal end opening of the sheath 11 and engages with the inner surface of the sheath 11. In other words, the stopper 12 is attached to the sheath 11 so as to close the distal end opening of the sheath 11. The stopper 12 is an insulating member, and is made of, for example, ceramics. The tip surface of the stopper 12 is the tip surface 10A of the tubular portion 10. Therefore, the tip surface 10A of the tubular portion 10 is also called the tip surface 10A of the stopper 12.

[0026] The stopper 12 has a through passage 121 formed therein, which extends through its center in the Z direction. A plurality of through passages 122 are formed around the through passage 121, extending parallel to the through passage 121 and penetrating the stopper 12. In this embodiment, four through passages 122 are formed around the through passage 121, arranged at equal intervals (specifically, 90-degree intervals), but the number of through passages 122 is not limited to this. There may be one through passage 122, or there may be two, three, five or more through passages 122. The opening on the tip side of the through passage 122 is referred to as "tip opening 122A (second tip opening)."

[0027] A through passage 131 is formed in the housing 13, extending in the Z direction. The base end of the sheath 11 is inserted into the tip of the through passage 131. The base end of the sheath 11 inserted into the through passage 131 is fixed to the inner wall surface of the through passage 131 by adhesive or the like.

[0028] The endoscopic treatment tool 1 includes a slider 20 (operation unit). The tip of the slider 20 is attached to the base end of the through passage 131 of the housing unit 13. The outer diameter of the tip of the slider 20 is slightly smaller than the diameter (inner diameter) of the through passage 131. Therefore, the slider 20 is able to slide in the Z direction within the through passage 131. In addition, a retaining protrusion is formed on the outer peripheral surface of the tip of the slider 20. Therefore, the slider 20 will not come off the through passage 131.

[0029] A through passage 201 is formed in the slider 20, extending in the Z direction and penetrating the slider 20. The base end of the tube 30 is inserted into the tip of the through passage 201. The base end of the tube 30 inserted into the through passage 201 is fixed to the inner wall surface of the through passage 201 by adhesive or the like.

[0030] The tube 30, whose base end is inserted into the through passage 201 of the slider 20, is disposed so as to extend in the Z direction through the through passage 131 of the housing 13 and up to the vicinity of the tip of the sheath 11. The tube 30 is an insulating tube made of flexible resin. The tube 30 is made of, for example, PEEK or PTFE.

[0031] A plug 40 (contact portion) connectable to a high-frequency power source (not shown) is provided on the side of the housing 13. The base end of the plug 40 is electrically connected to the base end of a wire 41, which is a conductive member. The wire 41 is routed inside the tubular portion 10, passing through a through passage 131 in the housing 13 and reaching near the tip of the sheath 11. The tip of the wire 41, which is arranged near the tip of the sheath 11, is electrically connected to a high-frequency knife 50 (rod-shaped member). The plug 40 and the wire 41 are joined together by, for example, a joining material such as solder, brazing, laser welding, etc. The wire 41 and the high-frequency knife 50 are also joined together by, for example, a joining material such as solder, brazing, laser welding, etc.

[0032] A high-frequency knife 50 (rod-shaped member) is inserted through the through-passage 121 of the stopper 12. The high-frequency knife 50 is a rod-shaped metal member made of SUS or the like. A high-frequency current is supplied to the high-frequency knife 50 from a high-frequency power source via a plug 40 and a wire 41. The high-frequency current applied to the high-frequency knife 50 enables incision, ablation, and other treatments of tissue within the body cavity.

[0033] The proximal end of the high-frequency knife 50 is inserted into the distal end of the tube 30, which is arranged near the distal end of the sheath 11. The proximal outer diameter of the high-frequency knife 50 is slightly larger than the inner diameter of the tube 30. Therefore, the distal end of the tube 30 elastically deforms to fit closely against the outer peripheral surface of the proximal end of the high-frequency knife 50, and the proximal end of the high-frequency knife 50 is covered airtightly.

[0034] In this way, the high-frequency knife 50 and the slider 20 are mechanically connected via the through passage 131 of the housing 13 and the tube 30 inserted into the sheath 11. When the surgeon moves the slider 20 to the positive side in the Z direction or the negative side in the Z direction, the tube 30 attached to the through passage 201 of the slider 20 and the high-frequency knife 50 attached to the tip of the tube 30 move forward and backward together in the Z direction. As a result, the high-frequency knife 50 slides in the Z direction within the through passage 121 of the stopper 12, and the amount of protrusion from the tip surface 10A of the stopper 12 changes in response to the surgeon's operation on the slider 20.

[0035] That is, as the tube 30 moves back and forth in the Z direction within the tubular portion 10 in response to operation of the slider 20, the high-frequency knife 50 also moves back and forth in the Z direction, and the amount by which the high-frequency knife 50 protrudes from the tip surface 10A of the tubular portion 10 changes.

[0036] As described above, the stopper 12, which is an example of a cap-shaped member, has a through passage 121 that supports the high-frequency knife 50, which is an example of a rod-shaped member, so that the knife 50 can slide in the Z direction. The through passage 121 is an example of a first through passage and supports the high-frequency knife 50 so that the knife 50 can slide in the Z direction. The through passage 121 penetrates the stopper 12 in the Z direction, with a base-end opening communicating with the sheath 11 and a tip-end opening formed in the tip surface 10A of the stopper 12. The through passage 122 is an example of a second through passage that penetrates the stopper 12 in the Z direction and is formed to extend around the through passage 121 in the Z direction. The through passage 122 forms a part of the suction pipe line 70, which is an example of a second pipe line. The tip-end opening of the through passage 122 is a tip opening 122A, which is an example of a second tip opening, and is formed in the tip surface 10A of the stopper 12.

[0037] When the slider 20 is moved in the negative Z direction, the high-frequency knife 50 also moves in the negative Z direction. A protruding member 501 that protrudes laterally around the entire circumference is formed on the tip side surface of the high-frequency knife 50. The outer diameter of the protruding member 501 is larger than the diameter (inner diameter) of the through passage 121 of the stopper 12. Therefore, when the high-frequency knife 50 is moved in the negative Z direction, the protruding member 501 comes into contact with the tip surface 10A of the tubular portion 10 (see FIGS. 5A and 8A). This restricts the movement of the high-frequency knife 50 in the negative Z direction. At this time, the amount of protrusion of the high-frequency knife 50 from the tip surface 10A is minimized.

[0038] When the slider 20 is moved in the positive Z direction, the high-frequency knife 50 also moves in the positive Z direction. When the high-frequency knife 50 is moved in the positive Z direction, a step 502 formed on the outer peripheral surface of the high-frequency knife 50 comes into contact with the base end surface 12A of the stopper 12 (see FIG. 5B). This restricts the movement of the high-frequency knife 50 in the positive Z direction. At this time, the amount of protrusion of the high-frequency knife 50 from the tip end surface 10A of the tubular portion 10 is maximized. The high-frequency knife 50 is configured by welding an outer cylinder to the base end of an inner cylinder in which a through passage 503 (described later) is formed. One end of this outer cylinder forms the step 502.

[0039] In this way, the surgeon can vary the amount of protrusion from the distal end surface 10A of the high-frequency knife 50, which is disposed so as to protrude from the distal end surface 10A of the tubular portion 10, by operating the slider 20. The surgeon operates the slider 20 according to the procedure content (marking, local injection, incision, dissection, hemostasis, etc.) and causes the high-frequency knife 50 to protrude from the distal end surface 10A by an appropriate amount.

[0040] For example, during marking treatment, the surgeon retracts the high-frequency knife 50 to the knife retraction position (see FIGS. 5A and 8A), presses the distal end surface 10A against the mucous membrane around the lesion, and applies high-frequency current to the high-frequency knife 50. This forms a marking mark around the lesion.

[0041] During various procedures, including marking, it may be difficult to ensure a clear surgical field due to blood or mucus adhering to the body cavity. In this case, the surgeon can ensure a clear surgical field by aspirating the blood or mucus through the distal opening 503A formed in the high-frequency knife 50 (or the distal opening 122A formed in the distal end surface 10A of the tubular portion 10). The specific configuration of the suction channel (either the first channel or the second channel) provided in the endoscopic treatment tool 1 will be described later.

[0042] Local injection is a procedure in which a liquid is locally injected into the submucosal layer of a lesion to be incised, thereby lifting the mucosa of the lesion to be incised. During this local injection procedure, the surgeon advances the high-frequency knife 50 to the knife forward position (see Figures 5B and 8B) and, while high-frequency current is being applied, drills a hole for inserting the high-frequency knife 50 into the submucosal layer. Next, the surgeon inserts the high-frequency knife 50 into the submucosal layer and injects a medicinal liquid into the submucosal layer from the distal end opening 503A (first distal end opening) of the high-frequency knife 50.

[0043] It is also possible to inject a medicinal solution into the submucosal layer through the distal opening 122A formed on the distal end surface 10A of the tubular portion 10. In this case, the surgeon advances the high-frequency knife 50 to the knife forward position (see FIGS. 5B and 8B) and, with a high-frequency current running, drills a hole for inserting the distal end surface 10A of the tubular portion 10 into the submucosal layer. The surgeon then retracts the high-frequency knife 50 to the knife retracted position (see FIGS. 5A and 8A) and inserts the distal end surface 10A into the submucosal layer. Once the distal end surface 10A has been inserted into the submucosal layer, the surgeon injects a medicinal solution into the submucosal layer through the distal opening 122A.

[0044] The specific configuration of the water supply conduit (the other of the first conduit and the second conduit) in the endoscopic treatment tool 1 will be described later.

[0045] During the incision procedure, the surgeon advances the high-frequency knife 50 to the knife advance position (see FIGS. 5B and 8B) while checking the positions of the high-frequency knife 50 and the marking marks using an endoscopic image. In this state, the surgeon applies high-frequency current to the high-frequency knife 50 and moves the high-frequency knife 50 along the marking marks to perform a circumferential incision. At this time, the protruding member 501 fits into the mucosa and functions as a kind of retainer. Therefore, the high-frequency knife 50 will not inadvertently come out of the mucosa during the incision.

[0046] During the ablation procedure, the surgeon advances the high-frequency knife 50 to the knife advance position (see Figures 5B and 8B) and applies high-frequency current, then lifts the incised lesion and cauterizes and ablates the submucosal layer of the incised lesion. During the ablation procedure, just as during the incision procedure, the protruding member 501 is appropriately caught within the mucosa. Therefore, the high-frequency knife 50 does not slip and accidentally come out of the mucosa.

[0047] During hemostasis treatment, the surgeon retracts the high-frequency knife 50 to the knife retraction position (see Figures 5A and 8A), presses the high-frequency knife 50 against the bleeding ulcer or mucosa, and applies high-frequency current to the high-frequency knife 50 to cauterize it.

[0048] Hemostatic treatment is not limited to stopping bleeding from an ulcer after a lesion has been dissected, but is also performed to stop bleeding from an area that has developed during incision or dissection. To remove blood and mucus adhering to the high-frequency knife 50 during such hemostatic treatment, the surgeon can spray a cleaning liquid from the distal opening 122A to clean the high-frequency knife 50. Furthermore, blood and mucus adhering to the body cavity can make it difficult to visually identify the bleeding area. In such cases, the surgeon can spray liquid into the body cavity from the distal opening 503A to remove the blood and mucus while aspirating the blood and mucus through the distal opening 122A. This allows the surgeon to more easily visually identify the bleeding area. Alternatively, liquid may be sprayed into the body cavity from the distal opening 122A to remove the blood and mucus while aspirating the blood and mucus through the distal opening 503A.

[0049] The specific configuration of the water supply conduit 60 provided in the endoscopic treatment tool 1 will be described. Fig. 10 is a cross-sectional view of the endoscopic treatment tool 1 showing the water supply conduit 60. In Fig. 10, the hatched area is the water supply conduit 60. As shown in Fig. 10, the water supply conduit 60 is made up of a through passage 201 formed in the slider 20, the tube 30, and a through passage 503 formed in the high-frequency knife 50. The through passage 503 is a through passage that extends through the high-frequency knife 50 in the Z direction.

[0050] The base end of the through passage 201 of the slider 20 is a connection port 201A (first connection port) to which an instrument can be connected. The instrument that can be connected to the connection port 201A is an instrument for supplying water or suctioning, such as a water pump, a suction pump, a syringe, etc.

[0051] 10, the through passage 201 of the slider 20 communicates with the tube 30, and the tube 30 communicates with the through passage 503 of the high-frequency knife 50. Therefore, for example, when a water pump is connected to the connection port 201A, a cleaning liquid or the like supplied to the through passage 201 via the connection port 201A flows through the tube 30 and the through passage 503 and is sprayed to the outside from a distal opening 503A (an opening on the distal side of the through passage 503) formed on the distal surface of the high-frequency knife 50. This makes it possible to inject a medicinal solution into the submucosa and remove deposits (blood and mucus).

[0052] By connecting a suction pump to connection port 201A, water supply pipeline 60 can function as a suction pipeline. In this case, deposits such as blood and mucus adhering to the inside of the body cavity are sucked into through passage 503 through tip opening 503A. The deposits sucked into through passage 503 are placed into a container or the like provided in the suction pump via tube 30 and through passage 201.

[0053] A specific configuration of the suction channel 70 provided in the endoscopic treatment tool 1 will be described. Figure 11 is a cross-sectional view of the endoscopic treatment tool 1 showing the suction channel 70. In Figure 11, the hatched area is the suction channel 70.

[0054] Here, a through passage 132 is formed in the housing 13, branching off obliquely upward from the through passage 131. The base end of the through passage 132 branching off from the through passage 131 is a connection port 132A (second connection port) to which an instrument can be connected. Similar to the connection port 201A of the slider 20, an instrument for supplying water or suction can be connected to the connection port 132A.

[0055] 11 , the suction pipeline 70 is made up of through passages 131, 132, the sheath 11, and a plurality of through passages 122 formed in the stopper 12. More specifically, the tube 30, which forms part of the water supply pipeline 60, passes through the through passage 131 and the sheath 11. Therefore, the part of the through passage 131 that is defined by the inner wall surface of the through passage 131 and the outer peripheral surface of the tube 30 forms part of the suction pipeline 70. In addition, the part of the sheath 11 that is defined by the inner peripheral surface of the sheath 11 and the outer peripheral surface of the tube 30 forms part of the suction pipeline 70.

[0056] 11 , through passage 132 communicates with through passage 131, through passage 131 communicates with sheath 11, and sheath 11 communicates with each through passage 122. Therefore, for example, when a suction pump is connected to connection port 132A, deposits in the body cavity are sucked into through passage 122 through distal end opening 122A formed on distal end surface 10A of stopper 12. The deposits sucked into through passage 122 are placed into a container or the like provided in the suction pump via sheath 11 and through passages 131 and 132.

[0057] By connecting a water pump to the connection port 132A, the suction conduit 70 can function as a water supply conduit. In this case, a cleaning solution or the like supplied to the through passage 132 via the connection port 132A flows through the through passage 131, the sheath 11, and the through passage 122, and is sprayed to the outside from each tip opening 122A. This makes it possible to inject a medicinal solution into the submucosal layer or remove deposits.

[0058] In this way, by providing two separate and independent ducts in the endoscopic treatment tool 1, water supply or suction can be performed without replacing the pump. It is also possible to perform both water supply and suction simultaneously. For example, it is possible to perform various procedures such as local injection while constantly suctioning blood or mucus by operating the suction pump. In other words, a configuration that allows water supply and suction to be performed simultaneously makes it possible to always maintain a good surgical field during ESD procedures.

[0059] Furthermore, when a high-frequency current is applied to the high-frequency knife 50, there is a possibility that deposits such as hemoglobin or proteins thermally coagulated by cauterization may adhere to the portion of the high-frequency knife 50 that comes into contact with the mucous membrane. For example, by constantly operating the suction pump to constantly suction blood and mucus around the high-frequency knife 50 while performing various procedures such as local injection, the deposits can be reduced. In other words, by configuring the high-frequency knife 50 to simultaneously supply water and suction, it is possible to reduce the amount of thermally coagulated material that may adhere to the high-frequency knife 50 during ESD treatment.

[0060] To allow the tube 30 to move back and forth in the Z direction when the slider 20 is operated, it is necessary to form a small gap between the inner wall surface of the through passage 131 and the outer circumferential surface of the tube 30 disposed within the through passage 131. However, if such a gap exists, it is not possible to ensure airtightness of the through passage 131 within the tubular portion 10. Therefore, in this embodiment, an O-ring 80 (sealing member) that airtightly seals this gap is fitted onto the outer periphery of the tube 30. That is, the O-ring 80 that ensures airtightness of the suction pipe line 70 within the tubular portion 10 is disposed on the outer periphery of the portion of the water supply pipe line 60 that passes through the suction pipe line 70 (the outer periphery of a portion of the tube 30 that passes through the through passage 131).

[0061] By fitting the O-ring 80, frictional resistance occurs between the outer peripheral surface of the tube 30 and the O-ring 80. This frictional resistance causes the slider 20 to move in the Z direction with an appropriate load when operated. This makes it easier for the surgeon to move the slider 20 by small amounts, making it easier to adjust the amount of protrusion of the high-frequency knife 50.

[0062] As shown in Fig. 9, in a front view of the distal end surface 10A of the tubular portion 10, the high-frequency knife 50 is located in the central region of the distal end surface 10A. Furthermore, four distal end openings 122A are located at equal intervals in a peripheral region of the distal end surface 10A located outside this central region (in other words, around the high-frequency knife 50). In this way, the high-frequency knife 50 and the distal end openings 122A are located without overlapping in a front view, and even when the high-frequency knife 50 is retracted to the knife retracted position (see Figs. 5A and 8A), the distal end opening 122A is not blocked by the high-frequency knife 50. Therefore, both water supply and suction can be performed at all times.

[0063] As shown in Figure 9, when viewed from the front, the outer periphery of the protrusion member 501 and the tip opening 122A are in contact with each other, which prevents the tip opening 122A from being blocked by the high-frequency knife 50, while ensuring a large diameter for the tip opening 122A (and the through passage 122).

[0064] It is possible to simultaneously perform both water supply and suction even if the tip opening 122A is somewhat blocked by the high-frequency knife 50. In order to increase the diameter of the tip opening 122A (and the through passage 122), an arrangement may be adopted in which part of the tip opening 122A overlaps with the high-frequency knife 50 in front view (in other words, part of the tip opening 122A is hidden by the protruding member 501 in front view).

[0065] The above is a description of exemplary embodiments of the present invention. The embodiments of the present invention are not limited to those described above, and various modifications are possible within the scope of the technical concept of the present invention. For example, the embodiments of the present invention also include appropriate combinations of embodiments explicitly shown as examples in the specification or obvious embodiments.

[0066] In the above embodiment, the through passage 122 of the stopper 12 and the through passage 503 of the high-frequency knife 50 have a substantially circular cross section in the direction perpendicular to the axis, but the shapes of the through passages 122 and 503 are not limited to this. The through passages 122 and 503 may have a different cross section in the direction perpendicular to the axis, such as an ellipse or a prism.

[0067] An endoscopic treatment tool 1 according to a modified example of the present invention will be described with reference to FIGS. 12A and 12B and FIGS.

[0068] 12A and 12B are views similar to FIGS. 8A and 8B, respectively, and are perspective views of the tip of the tubular section 10 according to this modified example. FIG. 13 is a view similar to FIG. 9, and is a view of the tip surface 10A of the tubular section 10 according to this modified example when viewed from the positive side in the Z direction (in other words, a front view of the tip surface 10A). FIG. 14 is a view similar to FIG. 10, and is a cross-sectional view of the endoscopic treatment tool 1 showing the water supply conduit 60 according to this modified example. FIG. 15 is a view similar to FIG. 11, and is a cross-sectional view of the endoscopic treatment tool 1 showing the suction conduit 70 according to this modified example.

[0069] In this modified example, descriptions that overlap with the above embodiment will be omitted as appropriate. Furthermore, in this modified example, the configurations of the water supply pipe 60 and the suction pipe 70 behind the tip of the tubular portion 10 are essentially the same as those in the above embodiment. Therefore, only the water supply pipe 60 and the suction pipe 70 at the tip of the tubular portion 10 are shown in Figures 14 and 15, respectively.

[0070] In this modified example, the through passage 121' of the stopper 12 is an example of a support passage that supports the high-frequency knife 50, which is an example of a rod-shaped member, so that it can slide in the Z direction, and also forms part of the suction passage 70, which is an example of a second passage (see FIGS. 12B, 14, 15, etc.). As shown in FIGS. 14 and 15, the through passage 121' is also an example of a third through passage that penetrates the stopper 12 in the Z direction, and has an opening on the base end side that communicates with the sheath 11 and an opening on the tip end side that is formed in the tip surface 10A of the stopper 12. The opening on the tip end side of the through passage 121' will be referred to as a "tip opening 121A'."

[0071] More specifically, the through passage 121' is a single through passage formed in a plus shape (in other words, a + shape) in the XY cross section. The high-frequency knife 50 is disposed so as to penetrate the through passage 121' in the Z direction at a portion where a portion extending in the X direction and a portion extending in the Y direction intersect in the XY cross section (in other words, a central region of the through passage 121' in the XY cross section).

[0072] In this modification, the water supply pipeline 60 is configured by the through passage 201 formed in the slider 20, the tube 30, and the through passage 503 formed in the high-frequency knife 50, as in the above embodiment.

[0073] In contrast, the configuration of the suction conduit 70 is different from that of the above embodiment. In this modification, the suction conduit 70 is composed of the through passages 131 and 132 of the housing 13, the sheath 11, and the through passage 121'. Therefore, for example, when a suction pump is connected to the connection port 132A, deposits in the body cavity are sucked into the through passage 121' through the distal end opening 121A' formed on the distal end surface 10A of the stopper 12. The deposits sucked into the through passage 121' are placed into a container or the like provided for the suction pump via the sheath 11 and the through passages 131 and 132.

[0074] In this modification, the through passage 121' that supports the high-frequency knife 50 so that it is slidable in the Z direction also serves as part of the suction pipe line 70. This makes it possible to reduce, for example, the outer diameter of the tubular portion 10 compared to the configuration of the above embodiment (i.e., the configuration in which the through passage 122 is formed around the through passage 121). Also, it is possible to increase the volume of the suction pipe line 70 at the tip portion of the tubular portion 10. Increasing the volume of the suction pipe line 70 makes it possible, for example, to increase the amount of deposits that can be sucked per unit time.

Claims

1. a tubular portion; a rod-shaped member disposed to protrude from a distal end surface of the tubular portion, the protruding amount from the distal end surface being variable in response to operation of the operating portion; a first connection port to which at least a water supply device can be connected; a first tip opening formed on a tip surface of the rod-shaped member; a first conduit formed in the tubular portion and extending in the axial direction of the tubular portion, the first conduit having a distal end communicating with the first distal end opening and a proximal end communicating with the first connection port; a second connection port to which at least a suction tool can be connected; a second distal end opening formed on a distal end surface of the tubular portion; a second conduit formed in the tubular portion and extending in the axial direction, the second conduit having a distal end communicating with the second distal end opening and a proximal end communicating with the second connection port; Equipped with The tubular portion is Sheath and a cap-shaped member attached to the sheath so as to close a distal end opening of the sheath; Including, The cap-shaped member has a through-path formed therethrough that passes through the cap-shaped member in the axial direction from the tip end to the base end, The through passage is In a cross-sectional view, the shape has a first through-hole region located at the center and a second through-hole region extending outward from the first through-hole region, the rod-shaped member is supported slidably in the axial direction in a portion having the first through-region; forming a part of the second pipeline; The opening at the tip end side of the through passage is the second tip opening, and is formed on the tip end surface of the cap-shaped member, the sizes and shapes of the rod-shaped member and the second penetrating region are set so that the rod-shaped member does not block a part of an opening portion of the second tip opening corresponding to the second penetrating region, regardless of a protrusion amount of the rod-shaped member, When the rod-shaped member provided with the first distal end opening in a water supplying state is in a fully retracted state, a part of the second distal end opening in a suctioning state is not blocked. Endoscopic treatment tools.

2. The through passage has a shape having a plurality of second through regions extending in a positive direction from the first through region in a cross-sectional view. The endoscopic treatment tool according to claim 1 .

3. The rod-shaped member further includes a tube communicating with a through passage separate from the through passage, the first tip opening is an opening of the other through passage formed in the tip surface of the rod-shaped member, the first pipeline includes the other through passage and the tube; The endoscopic treatment tool according to claim 1 or 2.

4. a base end of the rod-shaped member is inserted into a tip end of the tube so that the other through-path communicates with the tube; As the tube advances and retreats in the axial direction within the tubular portion in response to operation of the operating portion, the rod-shaped member also advances and retreats in the axial direction, and the amount of protrusion of the rod-shaped member from the distal end surface of the tubular portion changes. The endoscopic treatment tool according to claim 3 .

5. At least a portion of the first pipeline passes through the second pipeline; a seal member for ensuring airtightness of the second pipeline inside the tubular portion is disposed on the outer periphery of a portion of the first pipeline that passes through the second pipeline; The endoscopic treatment tool according to any one of claims 1 to 4.

6. a contact portion to which a high frequency power source for passing a high frequency current can be connected; a conductive wire disposed within the tubular portion; Further provided with the rod-shaped member is electrically conductive; The wire has a tip end electrically connected to the rod-shaped member and a base end electrically connected to the contact portion. The endoscopic treatment tool according to any one of claims 1 to 5.

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