Endoscope treatment tool and endoscope treatment system

Abstract

This endoscope treatment tool comprises: a sheath which is an elongated member having a lumen extending in a longitudinal direction; a distal end treatment part provided to the distal end section of the sheath; an operation part provided to the proximal end section of the sheath; and a wire which is inserted into the lumen and is attached to the distal end treatment part and which is supported by the operation part so as to advance / retreat in the longitudinal direction, wherein the operation part has a lock mechanism which restricts advance / retreat of the wire in the longitudinal direction.

Description

Endoscopic treatment tool and endoscopic treatment system

[0001] The present invention relates to an endoscopic treatment instrument and an endoscopic treatment system. This application claims priority to U.S. Provisional Patent Application No. 63 / 375,987, filed September 16, 2022, the contents of which are incorporated herein by reference.

[0002] Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure in which a contrast agent, a guidewire, or various catheters are inserted from the duodenum into the bile duct to perform intraductal diagnosis, stone retrieval, drainage of strictures, etc. These procedures use an endoscope and a papillotome that can be inserted through the treatment instrument channel of the endoscope.

[0003] In the papillotome used in these procedures, the distal end of the sheath is curved to maintain a state in which a knife (treatment portion, incision portion) for incising the sphincter of nipple etc. can be made. The papillotome described in Patent Document 1 has a rotation function that rotates the sheath around the central axis of the sheath, and by rotating the sheath, the distal end where the knife is provided can be moved.

[0004] Patent No. 6856759

[0005] However, with a papillotome with a rotation function as described in Patent Document 1, it is difficult to maintain the tip curved while rotating the sheath, and to maintain a state in which the knife can make incisions. For example, when the sheath is rotated, the tip may not be able to maintain a curved state.

[0006] In light of the above circumstances, the present invention aims to provide an endoscopic treatment tool and an endoscopic treatment system equipped with an endoscopic treatment tool, in which the tip end provided with a treatment section can be easily rotated while maintaining the curved state.

[0007] In order to solve the above problems, the present invention proposes the following means: An endoscopic treatment tool according to a first aspect of the present invention includes a sheath that is an elongated member having a lumen extending in the longitudinal direction, a distal treatment section provided at the distal end of the sheath, an operation section provided at the proximal end of the sheath, and a wire that is inserted through the lumen and attached to the distal treatment section and supported by the operation section so as to be movable forward and backward in the longitudinal direction, and the operation section has a locking mechanism that restricts the forward and backward movement of the wire in the longitudinal direction.

[0008] The endoscopic treatment tool and endoscopic treatment system of the present invention make it easy to rotate the distal end portion provided with the treatment section while maintaining the curved state of the distal end portion.

[0009] 6 is an overall view of an endoscopic treatment system according to a first embodiment. FIG. 7 is a view showing a papillotome of the endoscopic treatment system. FIG. 8 is a view showing the papillotome. FIG. 9 is a cross-sectional view of a tip portion of a sheath of the papillotome. FIG. 10 is a front view of the tip portion of the sheath as viewed from the tip side. FIG. 11 is a cross-sectional view of an operating portion of the papillotome. FIG. 12 is a cross-sectional view of a base end portion of the sheath along line C1-C1 in FIG. 6. FIG. 13 is a perspective view showing a first deformation portion of the second main body. FIG. 14 is a view showing the first deformation portion and a first connecting portion before deformation. FIG. 15 is a view showing the first deformation portion and the first connecting portion after deformation. FIG. 16 is a view showing the papillotome inserted into an endoscope. FIG. 17 is a view showing a positioning step. FIG. 18 is a view showing an incision step. FIG. 19 is a view showing an operating portion of a papillotome according to a second embodiment. FIG. 19 is a view showing the first deformation portion and the first connecting portion before deformation. FIG. 19 is a view showing the first deformation portion and the first connecting portion after deformation. FIG. 19 is a view showing an operating portion of a papillotome according to a third embodiment. FIG. 19 is a view showing another aspect of an O-ring. FIG. 19 is a view showing an operating portion of a papillotome according to a fourth embodiment. FIG. 19 is a view showing an operating portion of a papillotome according to a fifth embodiment. FIG. 19 is a view explaining the action of a lever of the operating portion. 10A and 10B are diagrams illustrating the operation of the lever.

[0010] (First Embodiment) A first embodiment of the present invention will be described with reference to Fig. 1 to Fig. 13. Fig. 1 is an overall view of an endoscopic treatment system 300 according to this embodiment.

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

[0012] [Endoscope 200] The endoscope 200 is a known side-viewing flexible endoscope, and includes a long insertion section 210, an operation section 220 provided at the base end of the insertion section 210, and a universal cord 250 extending from the operation section 220. Note that the endoscope 200 may also be a direct-viewing flexible endoscope.

[0013] The insertion section 210 has a tip rigid section 211 provided at the tip, a bending section 212 that can be bent and is provided on the base end side of the tip rigid section 211, and a flexible tube section 213 that is provided on the base end side of the bending section 212. An imaging unit 216 having a light guide 215 and a CCD is provided on the side surface of the tip rigid section 211 in a state that it is exposed to the outside.

[0014] The insertion section 210 is formed with a treatment tool channel 230 for inserting an endoscopic treatment tool such as a papillotome 100. A distal end 230a of the treatment tool channel 230 opens on the side surface of the distal hard section 211. A proximal end of the treatment tool channel 230 extends to the operation section 220.

[0015] An elevator 214 is provided on the distal end hard portion 211 of the treatment instrument channel 230. The proximal end of the elevator 214 is rotatably supported by the distal end hard portion 211. An elevator operating wire 217 fixed to the distal end of the elevator 214 extends through the insertion section 210 to the proximal end side.

[0016] The bending portion 212 is configured to be bendable in the vertical and horizontal directions. The tip of a control wire is fixed to the tip side of the bending portion 212. The control wire extends through the insertion portion 210 to the control portion 220.

[0017] A knob 223 for operating the operating wire and a switch 224 for operating the imaging unit 216, etc., are provided on the proximal end side of the operation section 220. The user can bend the bending section 212 in a desired direction by operating the knob 223.

[0018] A forceps port 222 that communicates with the treatment tool channel 230 is provided on the distal end side of the operation section 220. The user can insert the endoscopic treatment tool 100 through the forceps port 222. A forceps plug 225 is attached to the forceps port 222 to prevent leakage of bodily fluids.

[0019] The universal cord 250 connects the endoscope 200 to the image control device. The image signal captured by the imaging unit 216 is transmitted to the image control device via the universal cord 250.

[0020] 2 and 3 are diagrams showing the papillotome 100. The papillotome (endoscopic treatment instrument, high-frequency treatment instrument) 100 includes a distal treatment section 1, a sheath 2, a conductive wire 3, and an operation section 5. In the following description, in the longitudinal direction A of the papillotome 100, the side that is inserted into the patient's body is referred to as the "tip side (distal side) A1," and the side of the operation section 5 is referred to as the "base side (proximal side) A2."

[0021] 4 is a cross-sectional view of the distal end portion 20 of the sheath 2. The distal treatment section 1 is provided on the outer peripheral surface of the distal end portion 20 of the sheath 2. The distal treatment section 1 has a first through hole 11 and a second through hole 12 that are inserted into the knife lumen 21. The first through hole 11 and the second through hole 12 are arranged in the longitudinal direction A. The first through hole 11 is provided on the distal side A1 of the second through hole 12. The second through hole 12 is provided on the proximal side A2 of the first through hole 11. The distal treatment section 1 is provided with a marker 15 that has a different color, pattern, etc. from the other parts of the sheath 2.

[0022] The marker 15 is formed in a line shape extending in the longitudinal direction A, and is provided in a part of the circumferential direction C where the first through-hole 11 and the second through-hole 12 are provided (the part where the incision portion 6 described below is formed). The tip of the marker 15 is located at the tip of the sheath 2, and the base end of the marker 15 is located near the second through-hole 12. The width of the marker 15 in the circumferential direction C is equal to or less than half the length of the outer periphery of the sheath 2.

[0023] The sheath 2 is an elongated member having a lumen extending along the longitudinal direction A. The sheath 2 has an outer diameter that allows it to be inserted into the treatment instrument channel 230. The sheath 2 is a soft sheath made of, for example, resin.

[0024] 5 is a front view of the distal end portion 20 of the sheath 2 as viewed from the distal end side A1. The sheath 2 is a multi-lumen tube having multiple lumens, including a knife lumen 21 through which the conductive wire 3 is inserted, an imaging lumen 22 through which a contrast agent or the like is inserted, and a guidewire lumen 23 through which a guidewire is inserted.

[0025] 6 is a cross-sectional view of the operation unit 5. The knife lumen 21 is a lumen through which the conductive wire 3 is inserted. The knife lumen 21 extends from a distal opening (first through-hole 11 and second through-hole 12) provided in the distal treatment unit 1 to a proximal opening 21b that communicates with the operation unit 5. The contrast lumen (fluid supply lumen) 22 is a lumen through which a contrast medium, a water supply fluid, or an air supply fluid is inserted. The contrast lumen 22 extends from a distal opening 22a formed at the tip of the distal end portion 20 to a proximal opening 22b that communicates with the operation unit 5.

[0026] Figure 7 is a cross-sectional view of the proximal end 26 of the sheath 2 taken along line C1-C1 in Figure 6. The guidewire lumen 23 is a lumen through which a guidewire is inserted. The guidewire lumen 23 extends from a distal opening 23a formed at the distal end of the distal portion 20 to a proximal opening 23b provided on the outer peripheral surface of the proximal end 26 of the sheath 2.

[0027] The conductive wire 3 has a conductive core wire covered with an insulating coating made of an appropriate synthetic resin. The conductive wire 3 is inserted through the knife lumen 21 of the sheath 2. The conductive wire 3 is supported by the operating unit 5 so as to be movable back and forth in the longitudinal direction A and rotatable in the circumferential direction C.

[0028] The distal end of the conductive wire 3 protrudes from the knife lumen 21 to the outside of the sheath 2 at the second through-hole 12, extends toward the distal end side A1 along the longitudinal direction A of the sheath 2, and enters the knife lumen 21 from the first through-hole 11 on the distal end side A1. The distal end 3a of the conductive wire 3 is fixed within the knife lumen 21. The portion of the conductive wire 3 that can be exposed to the outside of the sheath 2 from the first through-hole 11 and the second through-hole 12 is not covered with an insulating coating, and the core wire is exposed, constituting a wire-like cutting portion 6 that can cut tissue. The cutting portion 6 is an example of an electrode.

[0029] As shown in Fig. 6, the proximal end of the conductive wire 3 is attached to a power supply connector 55 provided on a slider 54 of the operation unit 5. When the conductive wire 3 is pulled toward the proximal side A2, the distal treatment unit 1 bends inward, and the incision site 6 is tensioned, as shown in Fig. 3. Because the part with the marker 15 bends inward, the surgeon can easily grasp the direction in which the distal end 20 of the sheath 2 will bend.

[0030] 6 , the operation unit 5 is provided at the proximal end of the sheath 2. The proximal end of the sheath 2 is attached to the operation unit 5 so as to be rotatable in the circumferential direction C. The operation unit 5 includes a first main body 51, a second main body 52, a handle 53, a slider 54, and a power supply connector 55.

[0031] The first body 51 is attached to the proximal end of the sheath 2 and is formed in a shape extending in the longitudinal direction A. The first body 51 has a proximal end convex portion 510, a first tube 511, a second tube 512, and an imaging nozzle 56.

[0032] The first tube 511 passes through the inside of the first body 51, and its tip communicates with the knife lumen 21. The conductive wire 3 passes through the first tube 511.

[0033] Second tube 512 passes through the inside of first body 51, and its tip communicates with imaging lumen 22. The base end of second tube 512 communicates with an opening of imaging nozzle 56. Fluid such as a contrast medium injected through imaging nozzle 56 passes through second tube 512 and imaging lumen 22 and is discharged from tip opening 22a formed at the tip of tip portion 20.

[0034] 8 is a perspective view showing the first deformation portion 57 of the second body 52. ​​The second body 52 is attached to the proximal end protrusion 510 of the first body 51. The second body 52 is attached to the first body 51 so as to be rotatable in the circumferential direction C. The second body 52 has a through hole 52h that penetrates along the longitudinal direction A. The conductive wire 3 is inserted through the through hole 52h. In addition, the proximal end of the second body 52 is provided with the first deformation portion 57 that is connected to the handle 53.

[0035] FIG. 9 shows the first deforming portion 57 and the first connecting portion 58 before deformation. The first deforming portion 57 is an elastically deformable member and is formed into a generally wedge-shaped convex portion. The first deforming portion 57 has a tapered portion 57a, a retaining member 57b, and a through-hole 57h. The tapered portion 57a ​​is formed into a quadrangular prism shape with the top and bottom surfaces being identical trapezoids. The width of the tapered portion 57a ​​decreases from the distal end A1 toward the proximal end A2. The retaining member 57b is provided at the proximal end of the tapered portion 57a ​​and prevents the first deforming portion 57 from separating from the handle 53. The through-hole 57h penetrates the first deforming portion 57 along the longitudinal direction A. The conductive wire 3 is inserted through the through-hole 57h.

[0036] 8 , the handle 53 is connected to the second body 52 so as to be unable to rotate in the circumferential direction C relative to the second body 52. ​​When the handle 53 is rotated in the circumferential direction C, the second body 52 rotates together with the handle 53 relative to the first body 51. A first connecting portion 58 that connects to the first deformation portion 57 of the second body 52 is provided at the tip of the handle 53.

[0037] The first connecting portion 58 is formed in a substantially wedge-shaped recess, and the first deforming portion 57 is disposed on the inside in the radial direction R. The inner surface 58a of the first connecting portion 58 is formed in a mortar shape that is recessed into the shape of a quadrangular prism, with the top and bottom surfaces being trapezoidal in shape, and the width decreases from the distal end side A1 to the proximal end side A2.

[0038] 10 is a diagram showing the first deformation portion 57 and the first connecting portion 58 after deformation. When the second body 52 and the handle 53 are brought closer to each other, the first deformation portion 57 engages with the inner surface 58a of the first connecting portion 58, thereby deforming inward in the radial direction R. As a result, the first deformation portion 57 comes into contact with the conductive wire 3 from the outside in the radial direction R, and restricts the advancement and retraction of the conductive wire 3 in the longitudinal direction A.

[0039] That is, the first deformation portion 57 engages with the first connecting portion 58 to function as a locking mechanism that restricts the advancement and retreat of the conductive wire 3 in the longitudinal direction A. Here, the "locking mechanism" is a mechanism that can restrict the advancement and retreat of the conductive wire 3 in the longitudinal direction A without restricting the rotation of the conductive wire 3 in the circumferential direction C. Note that the locking mechanism may restrict the rotation of the conductive wire 3 in the circumferential direction C.

[0040] A knob 531 is provided at the base end of the handle 53. A user can easily rotate the handle 53 in the circumferential direction C by pinching the knob 531 and rotating it in the circumferential direction C.

[0041] The slider 54 is attached to the handle 53 so as to be movable back and forth in the longitudinal direction A but not rotatable in the circumferential direction C.

[0042] The power supply connector 55 is fixed to the slider 54. The base end 3b of the conductive wire 3 is connected to the power supply connector 55. The power supply connector 55 can be connected to a high-frequency power supply device (not shown), and is connected to the conductive wire 3. The power supply connector 55 can supply high-frequency current supplied from the high-frequency power supply device to the conductive wire 3 and the incision site 6.

[0043] By rotating the handle 53 in the circumferential direction C relative to the first body 51, the second body 52, the slider 54, and the power supply connector 55 all rotate. The conductive wire 3 rotates in the circumferential direction C relative to the first body 51. As a result, the distal treatment unit 1 provided at the distal end portion 20 of the sheath 2 rotates. In other words, the conductive wire 3 also serves as a torque transmission member that transmits rotational torque in the circumferential direction C.

[0044] 11 to 13, the operation and function of the endoscopic treatment system 300 according to this embodiment will be described. Specifically, the procedure for treating the bile duct BD by endoscopic retrograde cholangiopancreatography (ERCP) will be described.

[0045] <Step S1: Endoscope Insertion Process> In step S1, the surgeon inserts the insertion section 210 of the endoscope 200 into the patient's lumen through a natural orifice such as the mouth. If necessary, the surgeon operates the operation section 220 to bend the bending section 212. The surgeon inserts the distal end rigid section 211 of the endoscope 200 up to the vicinity of the duodenal papilla.

[0046] <Step S2: Endoscope Positioning Process> In step S2, the surgeon adjusts the position of the rigid tip portion 211 of the endoscope 200 so that the duodenal papilla is within the imaging range of the imaging unit 216 of the endoscope 200. The surgeon adjusts the position of the rigid tip portion 211 by appropriately combining operations such as advancing and retreating, bending, and twisting the endoscope 200.

[0047] 11 is a diagram showing the papillotome 100 inserted into the endoscope 200. Next, in step S3, the surgeon inserts the papillotome 100 into the treatment instrument channel 230 from the forceps port (proximal end opening) 222 of the endoscope 200. The surgeon protrudes the distal end portion 20 of the sheath 2 from the distal end opening 230a.

[0048] The surgeon moves the slider 54 toward the proximal side A2 relative to the handle 53 to pull the conductive wire 3 and bend the distal end 20 of the sheath 2. As a result, the incision portion 6, which is part of the conductive wire 3, is taut, as shown in FIG. 11 . Next, the surgeon moves the main body (the first main body 51 and the second main body 52) closer to the handle 53. As a result, the first deformation portion 57 deforms inward in the radial direction R, coming into contact with the conductive wire 3 and restricting the advancement and retraction of the conductive wire 3. While maintaining the distal end 20 of the sheath 2 in a bent state, the surgeon can rotate the sheath 2 in the circumferential direction C to move the distal treatment unit 1. Alternatively, the surgeon can rotate the entire papillotome 100 in the circumferential direction C to move the distal treatment unit 1.

[0049] 12 is a diagram showing the positioning process. The surgeon may confirm whether the distal end portion 20 of the sheath 2 is facing the papilla PA by discharging fluid from the distal end opening 22a via the contrast lumen (fluid supply lumen) 22. If the surgeon can spray fluid onto the papilla PA from the distal end opening 22a, the surgeon can confirm that the distal end portion 20 of the sheath 2 has been positioned near the papilla PA.

[0050] <Step S4: Incision Step> Fig. 13 is a diagram showing the incision step. In step S4, the surgeon supplies high-frequency current from the power supply connector 55 to the incision unit 6, and operates the operation unit 5 of the papillotome 100 to incise a part of the papilla PA with the incision unit 6.

[0051] <Step S5: Contrast Imaging Step> In step S5, the surgeon pours a contrast medium into the bile duct BD from the papillotome 100. The surgeon performs X-ray imaging to obtain an X-ray image showing the bile duct BD and the like.

[0052] <Step S6: Guidewire Insertion Step> In step S6, the surgeon inserts a guidewire into the guidewire lumen 23 of the papillotome 100, causing the guidewire to protrude from the distal end opening 23a, and inserts the guidewire into the bile duct BD. Next, the surgeon removes the papillotome 100 while leaving the guidewire in the bile duct BD. This leaves only the guidewire in the bile duct BD, and an access route from the duodenum to the bile duct BD is formed.

[0053] After the access route is formed, the surgeon can perform various treatments by introducing the tip of various treatment tools along the guide wire into the bile duct BD via the access route.

[0054] According to the papillotome 100 of this embodiment, the distal end portion 20 of the sheath 2 provided with the distal treatment section 1 can be easily rotated in the circumferential direction C to move the distal end portion 20 while maintaining the curved state. Therefore, the surgeon can perform the operation of rotating the sheath 2 in the circumferential direction C while maintaining the curved state of the distal end portion 20 of the sheath 2 by himself.

[0055] Although the first embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment and includes design modifications within the scope of the present invention. Furthermore, the components shown in the above embodiment and the modified examples shown below can be configured by appropriately combining them.

[0056] Second Embodiment A papillotome 100B according to a second embodiment of the present invention will be described with reference to Figures 14 to 16. In the following description, components that are common to those already described will be assigned the same reference numerals, and duplicated descriptions will be omitted.

[0057] 14 is a diagram showing the operation unit 5B of the papillotome 100B. The papillotome (endoscopic treatment tool, high-frequency treatment tool) 100B is used as an endoscopic treatment system together with an endoscope 200, similar to the papillotome 100 of the first embodiment. The papillotome 100B includes a distal treatment section 1, a sheath 2, a conductive wire 3, and an operation unit 5B.

[0058] The operation unit 5B includes a first main body 51, a second main body 52B, a handle 53B, a slider 54, and a power supply connector 55.

[0059] The second body 52B is attached to the proximal end protrusion 510 of the first body 51. The second body 52B is attached to the first body 51 so as to be rotatable in the circumferential direction C. A through hole 52h is formed in the second body 52B, penetrating along the longitudinal direction A. The conductive wire 3 is inserted through the through hole 52h. In addition, a second connecting portion 58B is provided at the proximal end of the second body 52.

[0060] The second connecting portion 58B is formed into a substantially wedge-shaped recess, and the second deforming portion 57B is disposed on the inside in the radial direction R. The inner surface 58Ba of the second connecting portion 58B is formed into a mortar shape that is recessed into the shape of a quadrangular prism, with the top and bottom surfaces being trapezoidal in shape, and the width increases from the distal end side A1 toward the proximal end side A2.

[0061] The handle 53B is connected to the second body 52B so as to be unable to rotate relative to the second body 52B in the circumferential direction C. When the handle 53B is rotated in the circumferential direction C, the second body 52B rotates together with the handle 53B relative to the first body 51. A second deformation portion 57B that is connected to the second connecting portion 58B of the second body 52B is provided at the tip of the handle 53B.

[0062] FIG. 15 is a diagram showing the second deforming portion 57B and the second connecting portion 58B before deformation. The second deforming portion 57B is an elastically deformable member and is formed into a generally wedge-shaped convex portion. The second deforming portion 57B has a tapered portion 57Ba and a through hole 57Bh. The tapered portion 57Ba is formed into a quadrangular prism shape with the top and bottom surfaces being identical trapezoids. The width of the tapered portion 57Ba increases from the distal end side A1 toward the proximal end side A2. The through hole 57Bh penetrates the second deforming portion 57B along the longitudinal direction A. The conductive wire 3 is inserted through the through hole 57Bh.

[0063] 16 is a diagram showing the second deformation portion 57B and the second connecting portion 58B after deformation. When the second main body 52B and the handle 53B are brought closer to each other, the second deformation portion 57B engages with the inner surface 58Ba of the second connecting portion 58B, thereby deforming inward in the radial direction R. As a result, the second deformation portion 57B comes into contact with the conductive wire 3 from the outside in the radial direction R, restricting the advancement and retraction of the conductive wire 3 in the longitudinal direction A.

[0064] According to the papillotome 100B of this embodiment, it is easy to rotate the sheath 2 in the circumferential direction C to move the distal end portion 20 of the sheath 2 provided with the distal treatment section 1 while maintaining the curved state of the distal end portion 20. Therefore, the surgeon can perform the operation of rotating the sheath 2 in the circumferential direction C while maintaining the curved state of the distal end portion 20 of the sheath 2 by himself.

[0065] Although the second embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment and includes design modifications within the scope of the present invention. Furthermore, the components shown in the above embodiment and the modified examples shown below can be configured by appropriately combining them.

[0066] Third Embodiment A papillotome 100C according to a third embodiment of the present invention will be described with reference to Figures 17 and 18. In the following description, components that are common to those already described will be assigned the same reference numerals, and duplicated description will be omitted.

[0067] 17 is a diagram showing the operation section 5C of the papillotome 100C. The papillotome (endoscopic treatment tool, high-frequency treatment tool) 100C is used as an endoscopic treatment system together with an endoscope 200, similar to the papillotome 100 of the first embodiment. The papillotome 100C includes a distal treatment section 1, a sheath 2, a conductive wire 3, and an operation section 5C.

[0068] The operation unit 5C includes a first main body 51, a second main body 52C, a handle 53C, a slider 54, and a power supply connector 55.

[0069] The second body 52C is attached to the base end of the first body 51. A through hole 52h is formed in the second body 52C and penetrates along the longitudinal direction A. The conductive wire 3 is inserted through the through hole 52h.

[0070] An O-ring (ring member) 59 is stored in the through-hole 52h of the second body 52C. The conductive wire 3 is inserted through the O-ring 59 and is in contact with the O-ring 59. Therefore, compared to the first embodiment, the sliding resistance of the conductive wire 3 in the longitudinal direction A is high. Therefore, even if the surgeon releases his / her hand from the slider 54, the conductive wire 3 is less likely to advance in the longitudinal direction A, and the distal end portion 20 of the sheath 2 is more likely to maintain its curved state.

[0071] Fig. 18 is a diagram showing another embodiment of the O-ring 59. The second body 52C may house a plurality of O-rings 59 as shown in Fig. 18. This increases the sliding resistance of the conductive wire 3 in the longitudinal direction A.

[0072] The handle 53C is connected to the second body 52C so as to be unable to rotate relative to the second body 52C in the circumferential direction C and unable to move back and forth in the longitudinal direction A. When the handle 53C is rotated in the circumferential direction C, the second body 52C rotates relative to the first body 51 together with the handle 53C.

[0073] According to the papillotome 100C of this embodiment, it is easy to rotate the sheath 2 in the circumferential direction C to move the distal end portion 20 of the sheath 2 provided with the distal treatment unit 1 while maintaining the curved state of the distal end portion 20. The surgeon can maintain the curved state of the distal end portion 20 without performing any special operation. Therefore, the surgeon can perform the operation of rotating the sheath 2 in the circumferential direction C while maintaining the curved state of the distal end portion 20 of the sheath 2 by himself.

[0074] Although the third embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment and includes design modifications within the scope of the present invention. Furthermore, the components shown in the above embodiment and the modified examples shown below can be configured by appropriately combining them.

[0075] Fourth Embodiment A papillotome 100D according to a fourth embodiment of the present invention will be described with reference to Fig. 19. In the following description, components common to those already described will be assigned the same reference numerals and redundant description will be omitted.

[0076] 19 is a diagram showing an operation unit 5D of a papillotome 100D. The papillotome (endoscopic treatment instrument, high-frequency treatment instrument) 100D is used as an endoscopic treatment system together with an endoscope 200, similar to the papillotome 100 of the first embodiment. The papillotome 100D includes a distal treatment section 1, a sheath 2, a conductive wire 3, and an operation unit 5D.

[0077] The operation unit 5D includes a first main body 51, a second main body 52, a handle 53, a slider 54D, and a power supply connector 55.

[0078] The slider 54D is attached to the handle 53 so as to be movable back and forth in the longitudinal direction A and so as not to be rotatable in the circumferential direction C. The slider 54D has a screw 57D.

[0079] The screw (first pressing member) 57D can fix the position of the slider 54D relative to the handle 53.

[0080] The surgeon moves the slider 54D toward the proximal side A2 relative to the handle 53 to pull the conductive wire 3 and bend the distal end 20 of the sheath 2. With the distal end 20 of the sheath 2 bent, the surgeon tightens the screw 57D to fix the position of the slider 54D relative to the handle 53. As a result, even if the surgeon releases his / her hand from the slider 54D, the conductive wire 3 does not advance in the longitudinal direction A, and the distal end 20 of the sheath 2 can maintain its bent state.

[0081] According to the papillotome 100D of this embodiment, the distal end portion 20 of the sheath 2 provided with the distal treatment section 1 can be easily moved by rotating the sheath 2 in the circumferential direction C while maintaining the distal end portion 20 in a curved state.

[0082] Although the fourth embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment and includes design modifications within the scope of the present invention. Furthermore, the components shown in the above embodiment and the modified examples shown below can be configured by appropriately combining them.

[0083] Fifth Embodiment A papillotome 100E according to a fifth embodiment of the present invention will be described with reference to Figures 20 to 22. In the following description, components common to those already described will be assigned the same reference numerals and redundant description will be omitted.

[0084] 20 is a diagram showing the operation unit 5E of the papillotome 100E. The papillotome (endoscopic treatment tool, high-frequency treatment tool) 100E is used as an endoscopic treatment system together with an endoscope 200, similar to the papillotome 100 of the first embodiment. The papillotome 100E includes a distal treatment section 1, a sheath 2, a conductive wire 3, and an operation unit 5E.

[0085] The operation unit 5E includes a first main body 51, a second main body 52E, a handle 53E, a slider 54, and a power supply connector 55.

[0086] The second body 52E is attached to the base end of the first body 51. A through-hole 52h is formed in the second body 52E, penetrating along the longitudinal direction A. The conductive wire 3 is inserted through the through-hole 52h. A lever 57E is provided at the base end of the second body 52E.

[0087] 21 and 22 are diagrams illustrating the operation of the lever 57E. The lever (second pressing member) 57E is attached to the second main body 52E so as to be rotatable about a rotation axis 57Er. The lever 57E has a pressing portion 57Eb that can come into contact with the conductive wire 3. By rotating the lever 57E to position the pressing portion 57Eb at a position where it presses the conductive wire 3, the position of the conductive wire 3 relative to the second main body 52 can be fixed.

[0088] The surgeon moves the slider 54 toward the proximal end side A2 relative to the handle 53 to pull the conductive wire 3 and bend the distal end portion 20 of the sheath 2. With the distal end portion 20 of the sheath 2 bent, the surgeon fixes the position of the conductive wire 3 relative to the second body 52 by placing the pressing portion 57Eb in a position where it presses the conductive wire 3. As a result, even if the surgeon releases his / her hand from the slider 54, the conductive wire 3 does not advance in the longitudinal direction A, and the distal end portion 20 of the sheath 2 can maintain its bent state.

[0089] The handle 53E is connected to the second body 52E so as to be unable to rotate in the circumferential direction C relative to the second body 52E and unable to move back and forth in the longitudinal direction A. When the handle 53E is rotated in the circumferential direction C, the second body 52E rotates together with the handle 53E relative to the first body 51.

[0090] According to the papillotome 100E of this embodiment, the distal end portion 20 of the sheath 2 provided with the distal treatment section 1 can be easily moved by rotating the sheath 2 in the circumferential direction C while maintaining the distal end portion 20 in a curved state.

[0091] Although the fifth embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment and includes design modifications within the scope of the present invention. Furthermore, the components shown in the above embodiment and the modified examples shown below can be configured by appropriately combining them.

[0092] The present invention can be applied to an endoscopic treatment tool having a rotation function.

[0093] 300 Endoscopic treatment system 200 Endoscope 100, 100B, 100C, 100D, 100E Papillotome (endoscopic treatment tool, high-frequency treatment tool) 1 Distal treatment section 11 First through-hole 12 Second through-hole 15 Marker 2 Sheath 20 Distal portion 21 Knife lumen 21b Base end opening 22 Contrast lumen (liquid supply lumen) 22a Distal opening 22b Base end opening 23 Guide wire lumen 23a Distal opening 23b Base end opening 26 Base end portion 3 Conductive wire 5, 5B, 5C, 5D, 5E Operation section 51 First body 511 First tube 512 Second tube 52, 52B, 52C, 52E Second body 52h Through-hole 53, 53B, 53C, 53E Handle 531 Knob 54, 54D Slider 55 Power supply connector 56 Imaging nozzle 57 First deformation portion 57B Second deformation portion 57Bh Through hole 57a, 57Ba Tapered portion 57D Screw (first pressing member) 57E Lever (second pressing member) 57Eb Pressing portion 57Er Rotating shaft 57h Through hole 58 First connecting portion 58a Inner surface 58B Second connecting portion 58Ba Inner surface 59 O-ring (ring member) 6 Incision portion

Claims

1. A sheath is an elongated member having a lumen extending in a longitudinal direction; A distal treatment section provided at a distal end of the sheath; an operation section provided at a proximal end of the sheath and to which the sheath is attached so as to be rotatable in a circumferential direction; A wire is inserted through the lumen and attached to the distal end treatment section, and is supported by the operation section so as to be movable forward and backward in the longitudinal direction and rotatable in the circumferential direction; Equipped with The operation unit has a ring member that comes into contact with the wire so as to restrict the advancement and retreat of the wire in the longitudinal direction. Endoscopic treatment tools.

2. The distal end treatment section has a first through hole and a second through hole communicating with the lumen, The wire is inserted through the first through hole and the second through hole and exposed to the outside of the sheath. The endoscopic treatment tool according to claim 1 .

3. The sheath is attached to the operation unit so as to be rotatable in the circumferential direction, When the wire rotates in the circumferential direction, the sheath rotates in the circumferential direction. The endoscopic treatment tool according to claim 1 .

4. The operation unit includes: a main body attached to a proximal end of the sheath; A handle connected to the main body so as to be rotatable in the circumferential direction; a slider connected to the handle so as to be movable back and forth in the longitudinal direction; having The wire is connected to a connector provided on the slider. The endoscopic treatment tool according to claim 1 .

5. The ring member is provided on the main body. The endoscopic treatment tool according to claim 4.

6. A marker is provided in a portion of the sheath in a circumferential direction where the first through hole and the second through hole are provided. The endoscopic treatment tool according to claim 2 .

7. The endoscopic treatment tool according to claim 1 , An endoscope and Equipped with Endoscopic treatment system.