阅读说明：本技术 内窥镜用处置器具 (Treatment tool for endoscope ) 是由 樋高裕也 宫岛千贺 于 2018-09-13 设计创作，主要内容包括：一种内窥镜用处置器具(1),其包括：筒状的顶端构件(2),其安装于内窥镜的顶端；把持器具(7),其沿着内窥镜的长度轴线设于内窥镜的外侧面,用于把持生物体组织；线状的连接构件(8),其连接顶端构件(2)与把持器具(7)；电极(3),其向顶端构件(2)的顶端前方突出地配置；以及电极驱动部,其在把持器具(7)把持着生物体组织的状态下使电极(3)移动到对生物体组织进行处置的位置,顶端构件(2)具备保持部(30),该保持部(30)隔着长度轴线设于顶端构件(2)的外周面,固定连接构件(8)的端部,把持器具(7)以把持器具(7)的顶端能够以保持部(30)为中心转动的方式连接于连接构件(8),电极(3)在与把持器具(7)的顶端方向垂直的方向上延伸,在顶端构件(2)安装于内窥镜的状态下,利用电极驱动部使电极(3)沿与内窥镜的长度轴线正交的方向移动。(An endoscopic treatment instrument (1) comprising: a tubular distal end member (2) attached to the distal end of the endoscope; a grasping tool (7) which is provided on the outer surface of the endoscope along the longitudinal axis of the endoscope and grasps a living tissue; a linear connecting member (8) that connects the distal end member (2) and the grasping tool (7); an electrode (3) disposed so as to protrude forward of the tip member (2); and an electrode driving unit that moves the electrode (3) to a position where the living tissue is to be treated in a state where the grasping tool (7) grasps the living tissue, wherein the distal end member (2) includes a holding unit (30), the holding unit (30) is provided on the outer peripheral surface of the distal end member (2) with the longitudinal axis therebetween, and the end of the connecting member (8) is fixed, the grasping tool (7) is connected to the connecting member (8) so that the distal end of the grasping tool (7) can rotate about the holding unit (30), the electrode (3) extends in a direction perpendicular to the direction of the distal end of the grasping tool (7), and the electrode driving unit moves the electrode (3) in a direction perpendicular to the longitudinal axis of the endoscope in a state where the distal end member (2) is attached to the endoscope.)

1. A treatment instrument for an endoscope, wherein,

the endoscopic treatment instrument includes:

a distal end member having a cylindrical shape and attached to a distal end of the endoscope;

a grasping tool provided on an outer surface of the endoscope along a longitudinal axis of the endoscope, for grasping a living tissue;

a connecting member in a linear shape connecting the distal end member and the grasping tool;

an electrode disposed so as to protrude forward of the distal end of the distal member; and

an electrode driving unit that moves the electrode to a position where the treatment is performed on the living tissue in a state where the grasping tool grasps the living tissue,

the distal end member includes a holding portion provided on an outer peripheral surface of the distal end member with the longitudinal axis therebetween, and fixing an end portion of the connecting member,

the grasping tool is connected to the connecting member so that a distal end of the grasping tool can rotate about the holding portion,

the electrode extends in a direction perpendicular to a distal end direction of the grasping tool, and is moved in a direction orthogonal to the longitudinal axis of the endoscope by the electrode driving unit in a state where the distal end member is attached to the endoscope.

2. The endoscopic treatment instrument according to claim 1,

the electrode driving section moves the electrode in a direction along a distal end surface of the distal end member.

3. The endoscopic treatment instrument according to claim 2,

the tip member is provided with a channel extending in a direction along the length axis of the endoscope,

the holding tool includes: an elongated insertion portion inserted into the passage so as to be movable in a direction along the longitudinal axis; and a holding part disposed at the tip of the insertion part,

the connecting member guides the grip portion along an arc-shaped trajectory centered on an axis orthogonal to a plane including an axis of the tip member and an axis of the channel in a direction intersecting the longitudinal axis of the endoscope.

4. The endoscopic treatment instrument according to claim 2,

the electrode driving section moves the electrode within a range of 2/3 from a lower portion of the tip member to an entire height dimension of the tip member in a direction orthogonal to the length axis of the endoscope.

5. The endoscopic treatment instrument according to claim 2,

the electrode exposes a central portion in a direction orthogonal to the longitudinal axis of the endoscope and orthogonal to a moving direction in which the electrode is moved by the electrode driving section, and covers a length of 20% to 80% of an entire width dimension of the tip member with an electrically insulating member.

6. The endoscopic treatment instrument according to claim 5,

the exposed central portion of the electrode protrudes forward of the insulating member.

7. The endoscopic treatment instrument according to any one of claims 1 to 6,

the electrode driving part includes: a wire connected to the electrode; an elastic member having a distal end fixed to the distal end member at a position on the opposite side of the grasping tool with respect to the distal end member, the elastic member extending and contracting the electrode together with the wire in a direction orthogonal to the longitudinal axis; a tube into which the wire is movably inserted; and an operation part connected to the base end of the tube and configured to advance and retreat the wire in the longitudinal direction.

8. The endoscopic treatment instrument according to claim 7,

the tube includes: a flange-shaped portion fixed to the electrode; and a step portion provided at a position separated from the distal end of the tube toward the proximal end by a predetermined distance,

the elastic member is disposed between the stepped portion and the flange-shaped portion.

Technical Field

The present invention relates to a treatment instrument for an endoscope.

Background

A treatment instrument for an endoscope is known, which includes: a cover detachably attached to a distal end of the endoscope; and a high-frequency incision electrode which protrudes forward from the distal end of the cap, which laterally traverses the field of view of the endoscope, and which incises the tissue while observing the state of the tissue in the vicinity of the high-frequency electrode and its periphery (see, for example, patent document 1 and patent document 2).

Documents of the prior art

Patent document

Patent document 1: japanese patent laid-open publication No. 2005-66139

Patent document 2: international publication No. 2016/006407

Disclosure of Invention

Problems to be solved by the invention

However, for example, when the submucosa is incised while lifting up the mucous membrane, the position to be incised differs depending on the degree of lifting up the mucous membrane. Therefore, in the treatment instrument for an endoscope of patent document 1, it is necessary to change the degree of curvature of the bending portion of the endoscope so that the high-frequency incision electrode coincides with the position to be incised, and there is a problem that the positional relationship between the endoscope and the tissue fluctuates.

In the endoscope system of patent document 2, it is complicated to arrange the electrode unit at a position where the mucosa and the muscle layer should be accurately incised, and there is a problem that the positional relationship between the endoscope and the tissue fluctuates according to the operation of the insertion unit of the endoscope.

The invention aims to provide a treatment tool for an endoscope, which can make a high-frequency incision electrode highly accurately consistent with a part to be incised on the premise of not changing the position relation between the endoscope and tissues.

Means for solving the problems

An aspect of the present invention is a treatment instrument for an endoscope, including: a distal end member having a cylindrical shape and attached to a distal end of the endoscope; a grasping tool provided on an outer surface of the endoscope along a longitudinal axis of the endoscope, for grasping a living tissue; a connecting member in a linear shape connecting the distal end member and the grasping tool; an electrode disposed so as to protrude forward of the distal end of the distal member; and an electrode driving unit that moves the electrode to a position where the living tissue is to be treated in a state where the grasping tool grasps the living tissue, wherein the distal end member includes a holding portion that is provided on an outer peripheral surface of the distal end member with the longitudinal axis therebetween and fixes an end portion of the connecting member, the grasping tool is connected to the connecting member so that a distal end of the grasping tool can rotate about the holding portion, the electrode extends in a direction perpendicular to a distal end direction of the grasping tool, and the electrode is moved in a direction perpendicular to the longitudinal axis of the endoscope by the electrode driving unit in a state where the distal end member is attached to the endoscope.

According to the present invention, when the distal end member is attached to the distal end of the endoscope, the electrode extends in the direction perpendicular to the distal end direction of the grasping tool and is disposed in front of the distal end surface of the distal end member, and therefore, the electrode can be pressed against the living tissue and the periphery thereof can be incised while observing the position of the electrode in the visual field of the endoscope. In this case, the distal end of the grasping tool is rotated about the holding portion of the distal end member by the connecting member, the distal end of the grasping tool is brought close to the living tissue, and the living tissue is grasped by the grasping tool. Then, depending on the degree of lifting of the living tissue held by the holding tool, when the site to be incised is located above or below the current position of the electrode, for example, the electrode driving unit can be operated to move the electrode within the field of view of the endoscope. Thus, the electrode can be aligned with the site to be incised with high accuracy without changing the positional relationship between the endoscope and the tissue.

In the above aspect, the electrode driving unit may move the electrode in a direction along a distal end surface of the distal end member.

In the above aspect, the distal end member may include a channel extending in a direction along the longitudinal axis of the endoscope, and the grasping apparatus may include: an elongated insertion portion inserted into the passage so as to be movable in a direction along the longitudinal axis; and a grip portion disposed at a distal end of the insertion portion, wherein the connecting member guides the grip portion along an arc-shaped trajectory centered on an axis orthogonal to a plane including an axis of the distal end member and an axis of the channel in a direction intersecting the longitudinal axis of the endoscope.

According to this configuration, when the insertion portion is advanced relative to the channel, the grip portion guided by the connecting member along the arc-shaped trajectory moves in the direction intersecting the longitudinal axis of the endoscope, for example, from the upper side to the lower side in the visual field of the endoscope, and the tissue present below can be gripped by the grip portion. In this state, when the insertion portion is retracted with respect to the channel, the grip portion moves upward from below in a direction intersecting the longitudinal axis of the endoscope in the visual field of the endoscope, and the tissue gripped by the grip portion is lifted up.

Since the site to be incised is located further downward at the initial stage of the lifting, the electrode driving unit is operated to lower the electrode within the visual field of the endoscope, so that the electrode can be aligned with the site to be incised with high accuracy without changing the visual field of the endoscope. Further, since the site to be incised is also raised when the tissue is lifted to a high position, the electrode can be raised in the visual field of the endoscope by operating the electrode driving unit, and the electrode can be aligned with the site to be incised with high accuracy without changing the visual field of the endoscope.

In the above aspect, the electrode driving unit may move the electrode in a range from a lower portion of the tip member to 2/3 which is an entire height dimension of the tip member in a direction orthogonal to the longitudinal axis of the endoscope.

According to this configuration, the portion to be incised changes within the range of the entire height dimension 2/3 from the lower portion of the tip member to the tip member according to the degree of lifting of the tissue, and therefore, the incision can be performed at an appropriate position following the change.

In the above aspect, the electrode may be configured such that a central portion of the electrode in a direction perpendicular to the longitudinal axis of the endoscope and perpendicular to a moving direction in which the electrode is moved by the electrode driving unit is exposed, and a length of 20% to 80% of an entire width dimension of the distal end member is covered with an electrically insulating member.

According to this structure, the surrounding excess tissue can be prevented from being cut.

In the above aspect, the exposed central portion of the electrode may protrude forward of the insulating member.

According to this configuration, even if the electrode covered with the insulating member is brought into contact with the tissue, the exposed central portion can be reliably brought into contact with the tissue, and the incision can be efficiently performed.

In the above aspect, the electrode driving unit may include: a wire connected to the electrode; an elastic member having a distal end fixed to the distal end member at a position on the opposite side of the grasping tool with respect to the distal end member, the elastic member extending and contracting the electrode together with the wire in a direction orthogonal to the longitudinal axis; a tube into which the wire is movably inserted; and an operation part connected to the base end of the tube and configured to advance and retreat the wire in the longitudinal direction.

According to this configuration, the operator can move the wire forward and backward by operating the operation unit, and can move the electrode connected to the wire in the direction orthogonal to the longitudinal axis of the endoscope.

In the above aspect, the tube may include: a flange-shaped portion fixed to the electrode; and a stepped portion provided at a position separated by a predetermined distance from a distal end of the tube toward a proximal end side, wherein the elastic member is disposed between the stepped portion and the flange-shaped portion.

According to this configuration, when the operator pulls the wire backward by operating the operation unit, the elastic member is compressed between the step portion and the flange-like portion, and the electrode moves in one direction of the field of view of the endoscope, and when the wire is moved forward by releasing the pulling, the elastic member is extended by the elastic restoring force of the elastic member, and the electrode can be moved in the other direction opposite to the one direction of the field of view of the endoscope.

ADVANTAGEOUS EFFECTS OF INVENTION

According to the present invention, the following effects are produced: the electrode is made to coincide with a portion to be incised with high accuracy without changing the positional relationship between the endoscope and the tissue.

Drawings

Fig. 1 is a side view showing an endoscopic treatment instrument according to an embodiment of the present invention.

Fig. 2 is a side view showing a distal end portion of the endoscopic treatment instrument of fig. 1.

Fig. 3 is a plan view showing a distal end portion of the endoscopic treatment instrument of fig. 1.

Fig. 4 is a front view partially cut away showing a distal end portion of the endoscopic treatment instrument of fig. 1.

FIG. 5 is a partially cutaway front view showing a state in which the high-frequency incision electrode is lowered in the endoscopic treatment instrument of FIG. 4.

Fig. 6 is a side view showing a state in which the treatment instrument main body is pushed out in the endoscopic treatment instrument of fig. 1.

Fig. 7 is a side view showing a state in which the mucous membrane is lifted up by the treatment instrument main body of the endoscopic treatment instrument of fig. 6.

Fig. 8 is a side view showing a state in which the mucous membrane is further lifted by the treatment instrument main body of the endoscopic treatment instrument of fig. 7.

Fig. 9 is a front view showing a modification of the endoscopic treatment instrument of fig. 1.

Detailed Description

An endoscopic treatment instrument 1 according to an embodiment of the present invention will be described below with reference to the drawings.

As shown in fig. 1, an endoscopic treatment instrument 1 according to the present embodiment includes: a cylindrical cap (tip member) 2 attached to the tip of the endoscope 100; a high-frequency incision electrode (electrode) 3 disposed so as to protrude forward from the distal end of the cover 2; and an electrode driving unit 4 for moving the high-frequency incision electrode 3.

Hereinafter, the direction of the visual field of the endoscope 100 when the cap 2 is attached to the distal end of the endoscope 100 will be described as up, down, left, and right. Specifically, the vertical direction is a direction perpendicular to the longitudinal axis of the endoscope 100, and the horizontal direction is a direction perpendicular to the longitudinal axis of the endoscope 100 and perpendicular to the moving direction in which the high-frequency incision electrode 3 is moved by the electrode driving unit 4.

Further, the endoscopic treatment instrument 1 includes: a treatment instrument body (gripping instrument) 7 including a long and flexible insertion portion 5 and a treatment portion (gripping portion) 6 disposed at the distal end of the insertion portion 5; and a connecting member 8 that connects the treatment instrument body 7 and the cover 2.

The lid 2 has thereon: a channel 9 into which the insertion portion 5 of the treatment instrument body 7 is inserted so as to be movable in the longitudinal axis direction; and a holding portion 30 that fixes one end of the connecting member 8.

The treatment section 6 is, for example, a grasping forceps that grasps a living tissue (see fig. 6) X to be treated, and includes a pair of openable and closable grasping pieces 10, and forces applied to the proximal end side of the insertion section 5 are transmitted to the grasping pieces 10 by a wire (not shown) that penetrates through the insertion section 5, thereby opening and closing the grasping pieces 10.

The cap 2 is a transparent resin cylindrical member that covers the distal end of the endoscope 100 in the axial direction. As shown in fig. 4, the lower surface of the cap 2 is formed flat, and the upper surface of the cap 2 is formed in a cylindrical shape to facilitate movement of the treatment instrument body 7.

The channel 9 is disposed in the vicinity of the outer peripheral surface of the upper portion of the cap 2 in parallel with the axis of the cap 2, and has an inner diameter dimension into which the insertion portion 5 of the treatment instrument body 7 is inserted so as to be movable in the longitudinal axis direction.

The connecting member 8 is a wire rod, and as shown in fig. 2, penetrates through a through hole 11 formed in the treatment instrument main body 7 at the proximal end of the treatment portion 6 in a direction orthogonal to the longitudinal axis of the insertion portion 5. Both ends of the connecting member 8 are fixed by holding portions 30, and the holding portions 30 are provided on the left and right outer peripheral surfaces of the cover 2 at positions symmetrical across the longitudinal axis of the cover 2.

As shown in fig. 3 and 4, the high-frequency incision electrode 3 includes: a rod-shaped electrode portion 12 extending in the left-right direction in front of the cover 2; and an insulating cover (insulating member) 14 that is electrically insulated, exposes only a central portion (central portion) 13 of the electrode portion 12, and covers the other portions. The central portion 13 of the electrode portion 12 exposed from the insulating cover 14 is offset forward. Both ends of the electrode portion 12 are bent and extend parallel to each other.

As shown in fig. 1, the electrode driving section 4 includes: a wire 15 electrically and mechanically connected to the electrode portion 12; a longitudinal tube 16, the tip of which is fixed to the lower side of the cover 2, for inserting the thread 15 in a movable manner; and an operation portion 17 connected to the proximal end of the tube 16 and configured to advance and retreat the wire 15 in the longitudinal direction. The operation unit 17 includes: a handle 18 to be held by an operator; and a slider 19 supported to be linearly movable with respect to the handle 18, one end of the wire 15 being connected to the slider 19.

In the figure, reference numeral 20 is a plug for connecting an external power supply to the line 15.

The distal end portion of the tube 16 branches in 2 left and right directions as shown in fig. 3, and extends in a direction perpendicular to the longitudinal axis of the endoscope 100 in front of the cover 2, specifically, curves upward as shown in fig. 2.

As shown in fig. 4 and 5, the tube 16 extending upward accommodates: flange-shaped portions 21 fixed to both ends of the electrode portion 12; a stepped portion 22 provided in the tube 16 at a position separated by a predetermined distance from the distal end of the tube 16 toward the proximal end side; and a compression spring (elastic member) 23 disposed between the flange-shaped portion 21 and the stepped portion 22. The compression spring 23 is extended in a free state as shown in fig. 4, and the wire 15 is pulled toward the base end side by the operation of the operation portion 17, and the compression spring 23 is compressed as shown in fig. 5 by this pulling force.

The operation of the endoscopic treatment instrument 1 according to the present embodiment configured as described above will be described below.

In order to perform a treatment such as an Endoscopic Submucosal Dissection (ESD) using the endoscopic treatment instrument 1 of the present embodiment, first, as shown in fig. 2, a cap 2 is attached to the distal end of an endoscope 100, and the endoscopic treatment instrument 1 is attached to the endoscope 100. At this time, the channel 9 through which the treatment instrument body 7 is inserted is attached at an angle located on the upper side of the field of view of the endoscope 100.

Next, the endoscope 100 with the endoscopic treatment instrument 1 attached thereto is inserted into the body cavity of the patient, and the affected part is inserted until the affected part is disposed in the visual field of the endoscope 100. Then, the endoscope 100 is rotated about the longitudinal axis to adjust the angle at which the affected part is disposed below the visual field. Since the lower surface of the cover 2 is formed flat, the endoscope 100 can be stably held in the body cavity by pressing the lower surface of the cover 2 against the mucous membrane (living tissue) X.

In this state, the treatment section 6 is advanced as shown in fig. 6 by pressing the insertion section 5 of the treatment instrument main body 7 in the advancing direction. Since the proximal end of the treatment portion 6 of the treatment instrument main body 7 is constrained to the cap 2 by the connecting member 8, when the insertion portion 5 is continuously pressed in the longitudinal axis direction in a state where the connecting member 8 is extended without being loosened, the treatment portion 6 is moved to a downward position by the connecting member 8 along an arc-shaped trajectory having the holding portion 30 of the cap 2 as a rotation center.

At this position, the opening/closing treatment section 6 grips the mucous membrane X of the affected area, and the insertion section 5 is pulled to the proximal side, whereby the gripped mucous membrane X can be lifted as shown in fig. 7. Since the flat lower surface of the cover 2 is pressed against the mucous membrane X, the muscle layer Y can be pressed so as not to be lifted when the mucous membrane X is lifted.

In this state, since the lower layer of the mucosa X to be cut is positioned below the field of view of the endoscope, the operator gripping the handle 18 pulls the wire 15 attached to the slider 19 toward the proximal end side by sliding the slider 19 toward the handle 18.

Thereby, the flange-like portion 21 is pulled by the pulling force applied to the wire 15, and the compression spring 23 is compressed, and as shown in fig. 5, the electrode portion 12 is depressed. Then, in this state, power is supplied from the plug 20 to the electrode portion 12 via the wire 15, and the central portion 13 of the electrode portion 12 exposed from the insulating cover 14 is brought into contact with the lower layer of the mucosa X, so that the incision can be appropriately made while confirming the incision position with an endoscopic image.

As shown in fig. 7 and 8, the position to be incised varies in the vertical direction according to the degree to which the treatment instrument body 7 lifts up the mucous membrane X. In this case as well, with the endoscopic treatment instrument 1 of the present embodiment, the traction force applied to the slider 19 in the operation portion 17 is relaxed, and the compression spring 23 is extended by the elastic restoring force, so that the electrode portion 12 can be raised as shown in fig. 4 and 8, and the position to be incised can be adjusted.

As described above, the endoscopic treatment instrument 1 according to the present embodiment has the following advantages: the electrode unit 12 disposed in front of the endoscope 100 can be moved up and down without changing the field of view of the endoscope 100, and the electrode unit 12 of the radio-frequency incision electrode 3 can be appropriately adjusted to a position to be incised to perform a treatment at a desired position.

In the present embodiment, the high-frequency incision electrode 3 exposes only the central portion 13 of the rod-shaped electrode portion 12 and is covered with the insulating cover 14, so that a desired portion can be selectively incised, and the occurrence of a problem that an unnecessary portion is incised can be prevented. In this case, the length of the region where the electrode portion 12 is exposed may be 20% to 80% of the lateral width of the cover 2.

Further, since the portion of the electrode portion 12 exposed from the insulating cover 14 is offset forward, only the electrode portion 12 actually incised can be brought into contact with the living tissue X without causing the living tissue X to interfere with other portions of the high-frequency incision electrode 3.

The vertical movement range in which the high-frequency incision electrode 3 is vertically moved by the electrode driving unit 4 is preferably a range from the lower surface of the cap 2 to 2/3 of the entire height dimension in the direction orthogonal to the longitudinal axis of the endoscope 100. Since the portion to be incised varies from the lower portion of the lid 2 to the entire height 2/3 according to the degree of lifting of the living tissue X, the incision can be performed at an appropriate position following the variation.

The electrode driving unit 4 moves the high-frequency incision electrode 3 up and down by pulling the wire 15 for supplying electricity to the high-frequency incision electrode 3, but instead of this, the high-frequency incision electrode 3 may be moved up and down by any other method.

For example, as shown in fig. 9, the linear high-frequency incision electrode 3 in which only a part of the exposed portion 25 is exposed from the insulating cover 14 may be inserted into a through hole 24 provided in the upper and lower portions of the cover 2 in the axial direction, the upper and lower one end portions may be pressed toward the distal end side, and the other end portion may be pulled toward the base end side, thereby moving the exposed portion 25 up and down.

Description of the reference numerals

1. A treatment instrument for an endoscope; 2. a cap (tip member); 3. high-frequency incision electrodes (electrodes); 4. an electrode driving section; 5. an insertion portion; 6. a treatment section (gripping section); 7. a treatment instrument body (grasping instrument); 8. a connecting member; 9. a channel; 13. a central portion (central portion); 14. an insulating cover (insulating member); 15. a wire; 16. a tube; 17. an operation section; 21. a flange-like portion; 22. a step portion; 23. a compression spring (elastic member); 30. a holding section; 100. an endoscope; x, mucosa (biological tissue).