JPWO2018189949A1 - High frequency treatment tool for endoscope - Google Patents

Abstract

The high-frequency treatment instrument for an endoscope according to the present invention includes: a sheath (5); a linear object (4) disposed in the sheath (5); It has a first wire portion (2A) and a second wire portion (2B), and the proximal end of the first wire portion (2A) and the proximal end of the second wire portion (2B) are linear. A conductive wire (2) fixed to the object (4); a conductive wire connected to a distal end of the first wire portion (2A) and a distal end of the second wire portion (2B), respectively. A conductive tip (1); a linear object (4); a conductive connector (3) connecting the first wire portion (2A) and the second wire portion (2B); ) Protrudes from the sheath (5), the conductive connector (3), the first wire portion (2A), the second wire portion (2B), and the conductive tip ( At least one of) but in contact with the inner wall of the sheath (5).

Description

  The present invention relates to a high-frequency treatment device introduced into a living body via an endoscope. More specifically, the present invention relates to a high-frequency treatment instrument for an endoscope, which has a wire-shaped cutting portion.

  Conventionally, a treatment tool that is inserted into the human body, has an objective lens and an illumination lens at the tip, and performs treatment in the body cavity through a treatment tool insertion channel that passes from the proximal side to the distal side while observing the inside of the body cavity is introduced. There is an endoscope that does. Endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) are known as procedures using such an endoscope.

  Treatment tools used through the endoscope include knives and snares. The knife is for incising a body cavity surface. In order to perform a fine resection operation, the knife must be stably fixed to the sheath, and the operation by the operation unit on the hand side must be reliably transmitted to the distal end side. The snare is provided with a loop-shaped wire, which surrounds a ridge on the surface of a body cavity with a loop, reduces the loop diameter, narrows the root of the ridge, and cuts off. Since the loop wire of the snare pulls and squeezes the root of the lesion, the loop wire can be put in and out of the sheath, and the loop wire needs to be formed of an elastically deformable wire. Any of the treatment tools is used as a high-frequency treatment tool that supplies electric power from a hand side, generates a current, and cuts or cauterizes the surface of a body cavity.

  As a knife used through an endoscope, there is a high-frequency treatment tool disclosed in Patent Document 1. This knife includes a sheath and a needle-like electrode provided so as to protrude from the inside of the sheath and to which a high-frequency current is applied. This knife has a hard cylindrical body having a hole diameter larger than the outer diameter of the knife in the sheath, in order to regulate the amount of protrusion of the knife made of a needle-shaped electrode and to ensure the stability of the knife portion where the incision treatment is performed. Are provided, and a plurality of stopper projections are provided at a position near the hand of the knife. The surface contact between the hard cylinder and the stopper projection regulates the length of the knife protruding from the distal end surface of the sheath, so that the knife can be stably held on the center of the long axis of the sheath.

  As a snare used through an endoscope, there is a high-frequency snare disclosed in Patent Document 2. The snare includes a sheath and a conductive loop wire that is inserted and retracted into the sheath. The snare is provided with a tip electrode at the distal end of the sheath in order to reliably cauterize and sever the root of the lesion with a high-frequency current to the center without bleeding. In addition, this snare passes the tip end of the loop wire tip in order to reduce the degree of stress concentration on the bent back portion of the tip of the loop wire.

  Knives are used for ESD. The ESD has an advantage that the lesion can be finely resected by a technique for gradually removing the lesion of the digestive organ endoscopically. On the other hand, the procedure takes a long time, and the skill of the operator is also required. Snare is used for EMR. EMR can easily resect a wide area by a technique of endoscopically enclosing a lesion in a loop and squeezing the affected area to remove the lesion. However, it is difficult to accurately resect only a target portion, and the shape of a lesion that can be used is also limited.

  Therefore, incision is made around the target lesion using a knife to exfoliate a small amount.After once removing the knife from the endoscope, replace it with a snare. Techniques for shortening the procedure time while maintaining the accuracy of excision of the lesion by narrowing the area have been studied.

  As a treatment tool used for such a procedure, a treatment tool provided with a pointed head at the tip of a loop wire of a snare has been proposed. Patent Literature 3 discloses a high-frequency snare for an endoscope including a sheath and a snare loop which is elastically deformed and narrowed when pulled into the sheath. In this snare, an electrically insulating tip is fixedly attached to the tip of the snare loop so that the tip of the wire penetrates, the wire protrudes forward from the tip, and the protruding portion is a rod-shaped tip. Electrodes. This snare rod-shaped tip electrode can be used as a knife. When used as an incision knife, the snare loop is pulled into the sheath leaving the distal end portion, and only the distal end portion is projected from the sheath.

JP 2007-044393 A JP-A-11-347045 JP 2010-131100 A

  When performing ESD using a knife, it is necessary to have a structure in which the tip of the knife does not move during the procedure in order to finely remove the lesion. Further, in order to reliably transmit the movement of the operation unit at hand to the operation unit at the distal end, it is necessary that the distal end is stably fixed. On the other hand, the treatment section should be sheathed irrespective of energization or non-energization except during treatment so as not to inadvertently damage the treatment instrument insertion channel of the endoscope or the body cavity while transporting the treatment instrument to the lesion. It is desirable that it be held within and be protrudable from the sheath tip during the procedure.

  In addition, when using a treatment tool having a knife portion at the tip of the snare as a knife, the proximal side of the knife is a snare configured by an elastically deformable wire, and a snare loop is deployed after cutting with the knife portion. In consideration of strangulation of a lesion, the knife needs to be fixed to the sheath.

  In the high-frequency knife disclosed in Patent Literature 1, in order to fix the knife to the distal end of the sheath, a hard cylinder is provided on the sheath, and a stopper projection is provided on the knife. The knife is fixed by the surface contact between the hard cylinder and the stopper. With such a configuration, the number of components of the treatment tool increases. Further, since the knife is completely fixed by the surface contact between the hard cylinder and the stopper, after the knife has protruded from the distal end surface of the sheath by a predetermined length, the knife cannot be protruded any further.

  The high-frequency snare disclosed in Patent Document 2 does not intend to use the tip electrode as a knife, and thus does not disclose a fixing mechanism for the tip electrode.

  In the high-frequency snare for an endoscope disclosed in Patent Document 3, the distal knife portion is fixed by contact between the distal tip and the sheath distal end. The electrically insulating distal tip is provided in the snare loop on the distal side from the distal end surface of the sheath. For this reason, when performing a treatment in a body cavity using the distal knife portion, the distal end surface of the sheath and the distal tip come into contact with each other, so that the knife portion is not drawn into the sheath and the knife position can be stabilized. . However, when the treatment instrument is inserted into the treatment instrument insertion channel of the endoscope, or when the treatment instrument is located in the non-treatment section in the body cavity, the knife section is always exposed from the sheath. Even at times, there is a risk of hurting the surroundings.

  Accordingly, the present invention has been made in view of these problems, and in a treatment tool provided with a knife portion at the tip of a snare, a high-frequency treatment device for an endoscope that can stably fix the knife portion. The purpose is to provide.

  The high-frequency treatment instrument for an endoscope according to the present invention has the following configuration in order to solve the above-mentioned problems. The high-frequency treatment instrument for an endoscope according to the present invention includes: a sheath; a linear object disposed in the sheath; and a first wire portion and a second wire portion extending in the near-far direction of the sheath. A conductive wire having a proximal end of the first wire portion and a proximal end of the second wire portion fixed to the linear object; a distal end of the first wire portion; A conductive tip connected to the distal end of the two-wire portion; and a conductive connector connecting the linear object, the first wire portion, and the second wire portion. At least one of the conductive connector, the first wire portion, the second wire portion, and the conductive tip is in contact with the inner wall of the sheath in a state where the portion protrudes from the sheath. As described above, by configuring the components disposed in the sheath to be in contact with the inner wall of the sheath, the conductive distal tip can be stably fixed to the sheath distal end, and only the conductive distal tip can protrude from the sheath. .

  According to the present invention, since the conductive tip of the high-frequency treatment instrument for an endoscope provided with the conductive tip as a knife portion at the snare tip is stably fixed to the sheath tip, the treatment tool is used as a knife. When used, only the conductive tip can protrude from the sheath.

It is a top view of the high frequency treatment tool for endoscopes concerning one embodiment of the present invention. 1 is an enlarged plan view (partially sectional view) of a distal end portion of a high-frequency treatment instrument for an endoscope according to an embodiment of the present invention. 1 is an enlarged plan view (partially sectional view) of a distal end portion of a high-frequency treatment instrument for an endoscope according to an embodiment of the present invention. 1 is an enlarged plan view (partially sectional view) of a distal end portion of a high-frequency treatment instrument for an endoscope according to an embodiment of the present invention.

  The high-frequency treatment instrument for an endoscope according to the present invention is inserted into a treatment instrument insertion channel of an endoscope, and is used for procedures such as marking, incision, and strangulation in a body cavity, and for surgical procedures such as ESD and EMR. is there. The high-frequency treatment instrument has a knife portion and a snare portion on the distal side. When using the high-frequency treatment instrument as a knife, only the knife portion at the tip can be stably protruded from the sheath tip, and when used as a snare, a conductive wire formed, for example, in a loop shape as a snare portion. It can protrude from the sheath. Hereinafter, the high-frequency treatment instrument for an endoscope may be simply referred to as “treatment instrument”.

  As shown in FIGS. 1 to 4, the high-frequency treatment instrument for an endoscope according to the present invention includes: a sheath; a linear object arranged in the sheath; A conductive wire having a first wire portion and a second wire portion, wherein a proximal end of the first wire portion and a proximal end of the second wire portion are fixed to a linear object; A conductive tip connected to the distal end of the wire portion and the distal end of the second wire portion, respectively; a conductive connector connecting the linear object to the first and second wire portions; ; With a portion of the conductive distal tip protruding from the sheath, at least one of the conductive connector, the first wire portion, the second wire portion, and the conductive distal tip is in contact with the inner wall of the sheath. As described above, by configuring the components disposed in the sheath to be in contact with the inner wall of the sheath, the conductive distal tip can be stably fixed to the sheath distal end, and only the conductive distal tip can protrude from the sheath. it can. In addition, the distal side is the distal end side inserted into the body cavity of the endoscope, and the proximal side is the opposite side to the distal side, and the proximal side for operating the endoscope and the treatment tool is Say. Unless otherwise specified, the “length” refers to the length of the sheath in the near-far direction (the long axis direction of the sheath). Hereinafter, the “conductive connector” may be referred to as a “connector”, the “conductive wire” may be referred to as a “wire”, and the “conductive tip” may be referred to as a “tip”. The proximal ends of the first wire portion and the second wire portion include, for example, the proximal end, preferably a portion within 30 mm from the proximal end, and more preferably a portion within 20 mm from the proximal end. Further, the distal ends of the first wire portion and the second wire portion include, for example, the distal end, and are preferably portions within 30 mm from the distal end, and more preferably portions within 20 mm from the distal end.

  The sheath of the high-frequency treatment instrument for an endoscope according to the present invention is a long hollow member capable of storing a linear object or a wire therein. The inner surface of the sheath is in contact with at least one or all of a connector, a wire, and a distal tip housed inside the sheath, and has a surface property and strength enough to fix the connector, the wire, or the distal tip. . Furthermore, the sheath has a slippery outer surface that can be inserted through the treatment instrument insertion channel of the endoscope, has flexibility that bends along the shape of the treatment instrument insertion channel lumen, and reliably reaches the tissue to be treated. It is desirable to have a good balance of rigidity.

  As the sheath, for example, a coil body made of metal or synthetic resin, a cylindrical body made of a plurality of short cylindrical joint pieces connected in the long axis direction and made rotatable, a cylindrical body made of synthetic resin, or These combinations are used. Examples of the synthetic resin constituting the sheath include polyamide resins such as nylon, polyolefin resins such as polypropylene (PP) and polyethylene (PE), polyester resins such as polyethylene terephthalate (PET), and polyetheretherketone (PEEK). Fluorine resins such as aromatic polyether ketone resin, polyimide resin, polytetrafluoroethylene (PTFE), tetrafluoroethylene-perfluoroalkylvinyl ether copolymer (PFA), ethylene-tetrafluoroethylene copolymer (ETFE), etc. Can be used.

  The length of the sheath can be appropriately set according to the length of the endoscope used together, but is generally from 1650 mm to 2300 mm. The outer diameter of the sheath is preferably from 1.8 mm to 3.5 mm, and the inner diameter of the sheath is preferably from 1.2 mm to 3.0 mm. The flexibility and rigidity of the sheath can be controlled by the thickness as well as the material of the sheath. The thickness of the sheath can be selected depending on the material used, but is preferably 0.2 mm or more when the sheath is made of fluororesin. The outer diameter and the inner diameter of the sheath may be constant, or the diameter may be changed at a plurality of locations by providing a tapered portion in the sheath.

  At least one of the diameter (outer diameter) of the connector in the direction perpendicular to the perspective direction of the sheath and the diameter (outer diameter) of the distal end tip in the direction perpendicular to the perspective direction of the sheath is larger than the inner diameter of the sheath. And more preferably larger than the inner diameter of the sheath. When a part of the distal tip protrudes from the sheath, at least one of the connector and the distal tip is contacted so as to widen the inner diameter of the sheath, thereby further stably fixing the distal tip to the sheath distal end, Only the distal tip can protrude from the sheath.

  The difference between the diameter of the connector and the inner diameter of the sheath and the difference between the diameter of the distal end tip and the inner diameter of the sheath are preferably within 0.5 mm. The diameter of the connector and the diameter of the tip may be the same or different.

  The linear object is a long object arranged in the sheath. The linear object is used to connect the operation unit and the wire, move the wire into and out of the sheath, and transmit a rotation operation on the operation unit side to the wire side. With the movement of the wire, the linear object may move out of the sheath. Note that the length of the linear object needs to be longer than the treatment instrument insertion channel of the endoscope.

  It is preferable that the linear object housed in the sheath is made of an elastically deformable material. The elasticity of the linear object only needs to be elastic enough to change its shape along the sheath following the deformation of the treatment instrument insertion channel of the endoscope. The material constituting the linear object is not particularly limited as long as it is an elastically deformable material, but a superelastic alloy such as a Ni-Ti alloy, a metal such as stainless steel such as SUS303 and SUS304, and a polyamide material such as nylon. A resin such as a resin, or a combination thereof can be used.

  The linear object may be formed of one member, or may be formed by joining a plurality of members in the longitudinal direction of the linear object. When joining a plurality of wires in the middle of the long axis direction of a linear object, what is necessary is just to join between wires by a normal joining method. As a joining method, for example, there is a method such as caulking with a metal tube, welding, welding or bonding.

  The linear object may be a single wire or a stranded wire obtained by twisting the single wires. If it is a single wire, manufacture is easy. With a stranded wire, the strength of the linear object can be increased, so that operations such as rotation of the operation unit can be more reliably transmitted to the distal end.

  The wire is a long object extending in the near and far directions, and is used as a snare of a treatment tool by exposing at least a part of the wire from the distal side of the sheath. The wire has a first wire portion and a second wire portion each extending in a distal direction of the sheath, and a proximal end portion of the first wire portion and a proximal end portion of the second wire portion are connected to each other. It is fixed to a linear object.

  Preferably, at least one portion of the first wire portion is in contact with the inner wall of the sheath, and at least one portion of the second wire portion is in contact with the inner wall of the sheath. Thereby, the distal end tip is stably fixed to the sheath distal end. In addition, since at least two portions of either the first wire portion or the second wire portion are in contact with the inner wall of the sheath, the distal tip can be stably fixed to the distal end of the sheath.

  The first wire portion and the second wire portion may be formed symmetrically with respect to a line extending in the near-far direction of the sheath, or may be formed asymmetrically.

  The wire preferably has a first wire portion and a second wire portion integrally formed at a distal end. Thereby, the configuration of the wire can be simplified. Moreover, the first wire portion and the second wire portion may be separate members. Thereby, the degree of freedom in the design of the snare can be increased, for example, the materials forming the first wire portion and the second wire portion are made different to complicate the shape of the snare.

  The wire fixed to the linear object is preferably made of a conductive and elastically deformable material. The elasticity of the wire needs to be such that it restores the shape of the snare after projecting from the distal end of the sheath, for example, a loop shape. Further, in order to appropriately provide a bent portion, the wire is preferably made of a material that can be easily bent. As the material of the wire, it is preferable to use a superelastic alloy such as a Ni-Ti alloy or a metal such as stainless steel such as SUS303 and SUS304.

  The length and diameter of the wire can be appropriately selected according to the use of the snare. The length of the wire is preferably from 60 mm to 200 mm. Among them, the length of the connection portion with the linear object is preferably 2 mm to 10 mm. The diameter of the wire is preferably between 0.2 mm and 1.0 mm.

  The linear object and the wire can be connected by a normal joining method, and may be directly connected or connected via another member. As a joining method, for example, there are methods such as caulking with a metal tube, welding, welding, and bonding. When connecting both ends of an elastically deformable metal wire to a linear object, it is preferable to connect via a metal pipe.

  The connecting tool can be a connecting portion used for connecting the linear object and the wire. The connection tool may be a connection member used for connection, or may be a conductive member provided near a connection portion on the proximal end side of the wire. The connection tool is preferably made of a metal material such as stainless steel such as SUS303 and SUS304. The shape of the connector can be a circle, an ellipse, a column, a cone, or a combination thereof, or a partially bent or widened shape. The length of the connector in the distal direction of the sheath is preferably 2.0 to 10.0 mm.

  The shape of the wire is preferably a loop shape, and more preferably a loop shape in which both ends are fixed to the distal end of the linear object. The loop shape refers to, for example, an annular shape in which a snare portion including a knife portion is closed, and may be a circular shape, an elliptical shape, a polygonal shape, or the like. The shape can be changed by providing a bent portion described later by folding or bending the middle of the wire. Since a portion of the wire preferably contacts the sheath, a distal tip connected to the wire can be fixed so as to protrude from the distal end of the sheath.

  It is preferable that one portion of the first wire portion and one portion of the second wire portion on the distal end side of the wire are in contact with the sheath. This is because the wire can be more firmly fixed to the sheath when the tip is projected from the sheath. A plurality of points may be in contact with the sheath at the proximal side of the wire or at a portion between the distal side and the proximal side. Since the loop-shaped wire has a loop diameter larger than the inner diameter of the sheath, when the wire is stored in the sheath, the loop is folded and a plurality of portions of the wire come into contact with the sheath.

  The tip is a part used as a high-frequency knife. The distal tip is connected to a distal end of the first wire portion and a distal end of the second wire portion, respectively. The tip is made of a conductive material. The tip is preferably made of a metal material such as stainless steel such as SUS303 and SUS304. The shape of the tip can be appropriately selected according to the use of the knife, for example, a spherical shape, an elliptical spherical shape, a column shape, a conical shape or a shape combining these, or a bent or widened tip side. it can. The length of the distal tip in the distal and proximal directions of the sheath can be appropriately selected according to the use of the treatment tool and the protruding length from the distal end surface of the sheath, but is preferably from 2.0 mm to 5.0 mm. The distal tip is disposed at the most distal end of the treatment tool.

  The wire and the tip can be connected by a normal connection method, and may be directly connected or connected via another member, for example, caulked with a metal tube, welded, welded, or bonded. And so on. In particular, it is preferable that the distal tip has an opening, and the distal tip and the wire are connected by locating a part of the wire in the opening. Thus, the tip and the wire are efficiently connected. More preferably, an opening is provided on the proximal side of the distal tip, and the distal tip and the wire are connected by locating a part of the wire in the opening. As described above, the method of connecting the wire and the distal tip by providing the opening in the distal tip and inserting the wire through the opening includes the first wire portion and the second wire portion at the distal end of the wire. Can be suitably used when they are integrally formed. The opening can be formed by providing a through hole or a depression in the tip chip. The distal tip may be rotatable with respect to the wire, may be movable along the longitudinal axis of the wire, or may be completely fixed. The long axis direction of the wire refers to a direction along the extending direction of the wire. When the tip is movable along the long axis direction of the wire, it means that when the wire has a circular shape having both ends fixed to a linear object, the tip can be moved along the circumferential direction of the circle. Say. When the first wire portion and the second wire portion of the wire are separate members, it is preferable that the wire and the distal end tip are connected by welding, welding, or bonding.

  The depth direction of the opening of the distal end tip is preferably different from the perspective direction of the sheath, and more preferably the direction perpendicular to the perspective direction of the sheath. This allows the distal end of the tip to be located distal to the wire. As shown in FIG. 2, the distal tip 1 can be provided with an opening 11 penetrating in a direction perpendicular to the far and near directions of the sheath. Thereby, as shown in FIG. 4A, at least one of the first wire portion 2A and the second wire portion 2B is in contact with the inner wall of the sheath 5, so that the position of the distal end tip 1 can be fixed. As shown in FIG. 3, the distal tip 1 has an opening 11 as an insertion passage through which the wire 2 is inserted, and the inlet and the outlet of the insertion passage are provided on the proximal end face of the distal tip 1. Good. Thereby, a mode in which a part of the wire 2 is arranged in a direction perpendicular to the far and near directions of the sheath 5 can be obtained. By making the distal tip 1 have such an aspect and making the outer diameter of the distal tip 1 larger than the inner diameter of the sheath 5, the distal tip 1 comes into contact with the inner wall of the sheath 5 as shown in FIG. , The tip 1 can be fixed. In addition, as shown in FIG. 4C, by setting the outer diameter of the connector 3 to be larger than the inner diameter of the sheath 5, the connector comes into contact with the inner wall of the sheath. Can be. By combining these aspects, a plurality of locations may be in contact with the inner wall of the sheath.

  By making both the wire used as a snare and the tip used as a knife conductive, when using the treatment tool of the present invention as a snare, there is no non-conductive portion on the distal side of the wire, so that it is efficiently strapped. , Cauterization can be performed.

  The wire may have a bent portion. Thereby, the shape of the snare can be appropriately designed according to the size and shape of the lesion, and the type of the procedure, and the distal tip can be reliably projected and fixed to the sheath distal end more stably. . The bent portion is formed, for example, by bending a wire or joining two or more wires at an angle. Only one bent portion may be provided, or a plurality of bent portions may be provided. Further, the bent portion may be formed in a polygonal line shape or may be formed in a curved shape.

  The wire preferably has a first bent portion in the first wire portion and a second bent portion in the second wire portion. By providing the bent portion in the wire in this manner, the degree of freedom in designing the shape of the snare of the treatment tool is increased, and the distal tip can be reliably projected and fixed to the sheath distal end more stably. In FIG. 2, the first bent portion 21 and the second bent portion 22 are provided on the distal side of the center of the wire 2 in the perspective direction.

  When the wire is accommodated in the sheath, it is preferable that the first bent portion and the second bent portion are in contact with the inner wall of the sheath. Thereby, the wire can be more stably fixed by the sheath.

  When the wire is exposed outside the sheath, the first bent portion and the second bent portion are preferably formed so as to protrude radially inward of the sheath. This makes it easier for the wires to extend radially outward in the first wire portion on the proximal side of the first bent portion and in the second wire portion on the proximal side of the second bent portion. The diameter of the snare in the direction perpendicular to the far and near directions of the sheath can be increased. In addition, that the bent portion is convex inward in the radial direction of the sheath means that the convex portion of the bent portion is arranged toward the inside of the sheath. The fact that the wire is protruded outward in the radial direction of the sheath means that the wire has a loop shape that expands outward and expands.

  In the near-far direction of the sheath, the position where the first bent portion and the second bent portion are provided can be appropriately set according to the shape of the snare, but at least one of the first bent portion and the second bent portion is provided. , Is preferably provided at the distal end of the wire, and more preferably, both the first bent portion and the second bent portion are provided at the distal end. Thus, the diameter of the snare can be increased in a relatively wide range in the far and near directions of the sheath.

  The first bent portion and the second bent portion may be arranged facing each other. Accordingly, when the wire is housed in the sheath, the twist of the wire can be reduced, and unnecessary load is not applied to fix the tip. In addition, the first bent portion and the second bent portion may be formed symmetrically with respect to a line extending in the near-far direction of the sheath, or may be formed asymmetrically. Further, the first bent portion and the second bent portion may be arranged at the same position in the distance direction of the sheath, or may be arranged at different positions.

  Further, it is preferable that the first bent portion and the second bent portion are provided close to each other. When the first bent portion to the second bent portion are formed of one wire, and the tip is disposed between the first bent portion and the second bent portion, the extending direction of the wire (the long axis of the wire) Direction), the length from the first bent portion to the second bent portion is preferably not less than 1 and not more than 3 times the length of the tip tip. Thereby, the shape of the other portion of the snare is hardly affected, and the degree of freedom in designing the shape of the snare is increased.

  The first bent portion and the second bent portion may be formed before connecting the wire and the distal tip, or may be formed after connecting the wire and the distal tip.

  Further, the wire is a first wire portion, a third bent portion proximal to the first bent portion, and a second wire portion, the fourth bent portion proximal to the second bent portion. May be provided. Further, by providing the third bent portion and the fourth bent portion, it is possible to reduce the twist of the wire when storing the wire in the sheath. Further, the pressing force from the wire to the sheath caused by the deformation of the wire caused by being housed in the sheath can be controlled so that the contact between the sheath and the wire is not adversely affected. In the distance direction of the sheath, the position where the third bent portion and the fourth bent portion are provided can be appropriately set according to the shape of the snare, but the third bent portion and the fourth bent portion face each other. Preferably, they are arranged. Accordingly, when the wire is housed in the sheath, the twist of the wire can be reduced, and unnecessary load is not applied to fix the tip. Further, the third bent portion and the fourth bent portion may be formed symmetrically with respect to a line extending in the near-far direction of the sheath, or may be formed asymmetrically. In addition, the third bent portion and the fourth bent portion may be arranged at the same position in the distance direction of the sheath, or may be arranged at different positions.

  As shown in FIG. 2, the third bent portion 23 and the fourth bent portion 24 may be provided on the proximal side of the center of the wire 2 in the perspective direction. Thereby, at the center of the wire 2 in the perspective direction, the diameter of the snare in the direction perpendicular to the perspective direction of the sheath can be increased.

  It is preferable that the third bent portion and the fourth bent portion are formed so as to protrude radially inward of the sheath when the wire is exposed outside the sheath. This makes it easier for the wires to extend radially outward in the first wire portion on the distal side of the third bent portion and in the second wire portion on the distal side of the fourth bent portion. Therefore, the diameter of the snare in the direction perpendicular to the far and near directions of the sheath can be increased.

  The bent portions may be in contact with each other like the third bent portion 23 and the fourth bent portion 24 shown in FIG. 2, and may be bent like the first bent portion 21 and the second bent portion 22 shown in FIG. They may be arranged apart from each other. It is preferable that the first bent portion, the second bent portion, the third bent portion, and the fourth bent portion of the wire are formed substantially in the same plane. This is because the shape of the wire can be made simpler and the twist of the wire can be reduced. The distance between the first bent portion and the second bent portion on the same plane may be larger than the distance between the third bent portion and the fourth bent portion. By setting the distance between the bent portions in this manner, the wire is easily extended radially outward, and the wire is easily stored in the sheath.

  The third bent portion and the fourth bent portion may be formed before fixing the wire and the connector, or may be formed after fixing the wire and the connector.

  When the wire has the first wire portion and the second wire portion integrally formed at the distal end portion, the wire has one or more bent portions at the distal end portion (hereinafter referred to as a fifth bent portion). May be provided. For example, the fifth bent portion may be provided on the distal side of the first bent portion and on the distal side of the second bent portion. That is, the fifth bent portion is preferably provided between the first bent portion and the second bent portion. By providing the wire with the fifth bent portion in this way, the degree of freedom in designing the shape of the snare of the treatment tool is increased, and the distal tip can be reliably projected and fixed to the sheath distal end more stably.

  When only one fifth bent portion is provided, the fifth bent portion is preferably formed so as to protrude toward the distal side. When a plurality of fifth bent portions are provided, it is preferable that each of the fifth bent portions is formed so as to protrude radially outward of the sheath. By providing the fifth bent portion in this manner, the wire is likely to be folded from the distal side to the proximal side, so that the first wire portion and the second wire portion are suitably formed.

  When an opening is provided in the tip and the wire and the tip are connected by inserting a wire through the opening, the fifth bent portion may be arranged in the opening. Thereby, the distal tip is disposed at the most distal end of the snare, and the distal tip is easily protruded from the sheath and fixed. In addition, by disposing the distal tip at the most distal end of the wire and disposing the first bent portion and the second bent portion at both ends of the opening, the position of the distal tip with respect to the wire can be kept constant.

  When a plurality of fifth bent portions are provided, the plurality of fifth bent portions may be formed line-symmetrically with respect to a line extending in the near-far direction of the sheath, or may be formed asymmetrically. In addition, the plurality of fifth bent portions may be arranged at the same position in the perspective direction of the sheath, or may be arranged at different positions.

  The proximal side of the wire and the sheath are respectively connected to the operation handle. The operation handle performs operations of projecting, retracting, and rotating the wire from the sheath. The handle preferably has a first fixing portion to which the sheath is fixed and a second fixing portion to which the linear object is fixed. By performing the operation of pushing and pulling the second fixing portion with respect to the first fixing portion, the knife portion or the snare portion can be made to protrude at the distal end of the sheath, or these can be stored in the sheath. In addition, since the force applied to the distal tip fixed to the distal end of the sheath from the living body by the incision is smaller than the force required to move the distal tip forward and backward by operating the handle, the distal tip is not fixed to the sheath distal end during incision. I will not do it. The handle is connected to a high frequency power supply and supplies power to the wire and the tip via the wire.

  By inserting the treatment instrument of the present invention into the treatment instrument insertion channel of the endoscope, it can be introduced into the body and used. It is preferable that the distal tip and the wire are housed in the sheath even in the non-energized state, so as not to damage the inside of the treatment instrument insertion channel or the lesion other than the lesion in the body.

  The treatment tool is introduced to the lesion in the body cavity, and when performing the treatment, the handle is operated to cause the distal tip to protrude from the distal end of the sheath. At this time, when a part of the distal tip, at least one of the first wire portion and the second wire portion, and one or more of the connectors are in contact with the inner wall of the sheath, current is supplied and the distal tip is used as a high-frequency knife for treatment. . When the knife is used, at least one of the tip, the first wire portion, the second wire portion, and the connector is fixed to the sheath, so that a normal handle is used unless an excessive force is applied to the tip. Procedures such as incision and marking with a knife can be performed by operation.

  Further, when using the treatment tool as a snare, the handle is operated to project the wire from the distal end of the sheath. Each time at least one of the distal tip, the first wire portion, the second wire portion, and the connector that contacts the inner wall of the sheath projects from the sheath distal end, the pressing force for operating the handle decreases. When the connecting tool is smaller than the inner diameter of the sheath, after at least one of the distal end tip, the first wire portion, and the second wire portion protrudes from the sheath, the wire can be smoothly protruded. In this case, since the portion where the force for fixing the wire to the sheath acts is at least one of the distal tip and the first wire portion and the second wire portion, after these protrude, the distal tip is fixed to the sheath. Is difficult to work.

  Operate the handle to turn the snare loop around the lesion that requires strangulation, and operate the handle to apply power while pulling the snare proximally to cauterize the lesion that the snare loop contacts. Is done. After cauterization, the snare portion and the knife portion are housed in the sheath, and the treatment tool is removed from the body.

  This application claims the benefit of priority based on Japanese Patent Application No. 2017-0792242 filed on April 12, 2017. The entire contents of the specification of Japanese Patent Application No. 2017-0792242 filed on April 12, 2017 are incorporated herein by reference.

(Example 1)
As the treatment tool of Example 1, the treatment tool shown in FIGS. In the treatment tool, the tip 1 is made of stainless steel and has a height (length in the left-right direction in FIG. 2) of 2.2 mm, a diameter of the proximal side is 1.9 mm, and a diameter of the distal side is 0.4 mm. The body was used. A through hole 11 having a diameter of 0.5 mm was provided on the proximal side of the tip 1. As the wire 2, seven stainless steel wires each having a length of 110 mm and a diameter of 0.1 mm were used. As the linear material 4, a stainless steel wire having a diameter of 0.5 mm and stranded with each other was used.

  The wire 2 was connected to the through hole 11 of the tip 1 through the wire 2. A stainless steel pipe was inserted into both ends of the wire 2 as a connector 3 from one end of the pipe, and the pipe was caulked to fix the wire 2 to the pipe in a loop shape. The pipe had an outer diameter of 1.9 mm. The pipe was placed proximally and the tip 1 was placed at the most distal end of the wire 2. The distal tip 1 and the wire 2 are pinched, and a distance of 5.0 mm proximal to the distal end 20 of the wire 2 with respect to the first wire portion 2A and the second wire portion 2B of the wire 2 so as to increase the loop area. The wire 2 was bent such that a portion closer to the base point than the base point extends radially outward of the sheath. Thus, the first bent portion 21 was formed on the first wire portion 2A, and the second bent portion 22 was formed on the second wire portion 2B. At this time, the first bent portion 21 and the second bent portion 22 were arranged facing each other with the loop open.

  Further, with respect to the first wire portion 2A and the second wire portion 2B of the wire 2, a position 1.0 mm distal from the pipe is used as a base point so that the loop area becomes larger, and a position closer to the distal side than the base point. The wire 2 was bent so that the portion extended radially outward of the sheath 5. Thus, the third bent portion 23 was formed on the first wire portion 2A, and the fourth bent portion 24 was formed on the second wire portion 2B. Thereafter, the linear object 4 was inserted from the other end of the pipe, the pipe was caulked, and the wire 2 was fixed to the distal side of the linear object 4 via the pipe.

  As the sheath 5, a tube made of polytetrafluoroethylene having an outer diameter of 2.5 mm and an inner diameter of 1.8 mm was used. The linear object 4 was inserted from the distal side of the sheath 5, and the linear object 4 and the sheath 5 were fixed to the handle 6, respectively. By operating the handle 6, it was possible to operate the distal tip 1 and the wire 2 from the distal end of the sheath so as to be able to put in and out. The treatment instrument was introduced into the body through the endoscope, and only the distal tip 1 was protruded from the sheath, so that the lesion could be stably incised. In addition, the lesion that had been partially incised with a knife was strangled with a wire projecting entirely from the sheath, and cauterized to remove it.

1 conductive tip 11 through hole (opening)
2 conductive wire 2A first wire portion 2B second wire portion 21 first bent portion 22 second bent portion 23 third bent portion 24 fourth bent portion 3 conductive connector 4 linear object 5 sheath 6 handle

Claims (9)

A sheath,
A linear object disposed in the sheath;
A first wire portion and a second wire portion extending in the distal and proximal directions of the sheath, respectively, wherein a proximal end of the first wire portion and a proximal end of the second wire portion are A conductive wire fixed to the linear object,
A distal end of the first wire portion, and a conductive tip that is respectively connected to a distal end of the second wire portion;
A conductive connector for connecting the linear object, the first wire portion, and the second wire portion,
With a portion of the conductive distal tip protruding from the sheath, at least one of the conductive connector, the first wire portion, the second wire portion, and the conductive distal tip is connected to the sheath. A high-frequency treatment device for endoscopes in contact with the inner wall.   At least one of the diameter of the conductive connector in a direction perpendicular to the perspective direction of the sheath and the diameter of the conductive tip in a direction perpendicular to the perspective direction of the sheath is larger than the inner diameter of the sheath. The high-frequency treatment device for an endoscope according to claim 1, wherein At least one portion of the first wire portion is in contact with the inner wall of the sheath,
The high-frequency treatment device for an endoscope according to claim 1 or 2, wherein at least one portion of the second wire portion is in contact with an inner wall of the sheath.   The endoscope according to any one of claims 1 to 3, wherein the conductive wire has a first bent portion in the first wire portion and a second bent portion in the second wire portion. High frequency treatment tool for mirror.   The high-frequency treatment instrument for an endoscope according to claim 4, wherein the first bent portion and the second bent portion are in contact with an inner wall of the sheath. The conductive wire is a first bent portion that is closer to the first bent portion than the third bent portion and a second wire portion that is closer to the second bent portion than the second bent portion. A fourth bent portion,
The high-frequency treatment instrument for an endoscope according to claim 4, wherein the third bent portion and the fourth bent portion are arranged to face each other.   7. The conductive tip according to any one of claims 1 to 6, wherein the conductive tip has an opening, and the conductive tip is connected to the conductive wire by locating a part of the conductive wire in the opening. 2. The high-frequency treatment instrument for an endoscope according to claim 1.   The high-frequency treatment instrument for an endoscope according to any one of claims 1 to 7, wherein the conductive wire has the first wire portion and the second wire portion integrally formed at a distal end portion.   The high-frequency treatment instrument for an endoscope according to claim 8, wherein the conductive wire has a bent portion at the distal end.

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