JPH0910220A - Treatment tool for endoscope - Google Patents

Abstract

PROBLEM TO BE SOLVED: To safely and surely perform guidance even to a part where an insertion operation is difficult such as the inside of a narrow vascular cavity and a complicated branching part and to improve operation efficiency. SOLUTION: A pair of biopsy cups 11a and 11b are fitted to the tip treatment part 4 of biopsy forceps 1 for an endoscope and the biopsy cups 11a and 11b are pivotally supported by a pin 13 to a sleeve 12 connected to the tip of a sheath 2. Then, for the biopsy cups 11a and 11b, the tip of a cup shape is made openable and closable with the pin 13 as a center. Through holes 18a and 18b are formed in the biopsy cup 11b of the tip treatment part 4 and the through hole 18b is positioned at the back in a longitudinal axis direction compared to the through hole 18a. A guiding wire 19 for guiding the main body of the biopsy forceps 1 for the endoscope is inserted to the through-holes 18a and 18b freely movably forwards and backwards.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

TECHNICAL FIELD The present invention relates to a treatment tool for an endoscope,
More specifically, the present invention relates to a treatment instrument for an endoscope, which is characterized in that it is used by being electrically connected to a body cavity through a channel of the endoscope.

[0002]

2. Description of the Related Art In recent years, an endoscopic treatment instrument to be inserted into an insertion channel of an endoscope has been widely used for observation treatment under an endoscope.

A treatment instrument for an endoscope of this type, for example, a biopsy forceps, has a coil inserted through a treatment instrument insertion channel of an endoscope as disclosed in Japanese Patent Laid-Open No. 61-247442. -Shaped flexible sheath, a pair of biopsy cups provided via a sleeve attached to the end of the flexible sheath, and connected to the rear end of the flexible sheath and inserted into the flexible sheath. And an operating portion that operates the biopsy cup via the operating wire and the operating link.
Any of these biopsy cups, operating links, sleeves, flexible sheaths, operating wires, etc. is made of metal such as stainless steel.

When the biopsy forceps is used, the insertion portion of the endoscope is previously inserted into the lumen, and then the biopsy forceps is inserted into the treatment tool insertion channel of the endoscope. After grasping in the field of view of the treatment tool, the distal end of this treatment tool is projected into the body cavity, guided to the affected area, and a pair of biopsy cups openably and closably attached to the distal end are opened and closed by the operation section. It is designed to bite the affected tissue that has formed on the inner wall of the body cavity.

By the way, as disclosed in Japanese Utility Model Publication No. 6-21449, when a biopsy forceps or the like is inserted into a thin lumen, for example, a bile duct and a pancreatic duct, a treatment tool for an endoscope previously inserted into a body cavity. After inserting a guide member, for example, a guide wire into the insertion channel, the distal end portion of the guide wire is projected into the body cavity and guided to a target site such as an affected area. And
The proximal affected part of the guide wire is passed through the through hole provided in the sleeve of the biopsy forceps, and then the biopsy forceps is inserted using the guide wire as a guide.

In the above-mentioned conventional endoscopic treatment tool, when used in combination with a guide member, for example, a guide wire, it is guided through a through hole provided in the sleeve of the distal treatment section of the endoscopic treatment tool. It is designed to pass a wire.

[0007]

However, since the sleeve has the hole through which the guide wire is inserted, the outer diameter of the distal treatment portion of the biopsy forceps for the endoscope is large, and particularly, the lumen is narrow. There is a problem that it is difficult to insert the pancreatic duct easily.

Further, since a guide wire having a small outer diameter is used especially for a portion having a narrow lumen, the elastic force of the guide wire is small. When the guide wire is inserted into the through hole provided in the sleeve of the endoscopic treatment tool,
Since there is a considerable distance from the through hole to the distal end of the treatment section, it becomes difficult to match the path of the guide wire and the insertion path of the distal end of the endoscopic treatment tool in a substantially parallel state.
The distal end portion of the endoscopic treatment tool is inclined with respect to the insertion path of the guide wire. Therefore, when passing through the branch point in the body cavity, for example, the branch point of the bile duct and the pancreatic duct, a part of the endoscopic treatment tool is caught on the inner wall of the body cavity, which makes it difficult to guide to the target site. .

Further, if the insertion operation of the endoscopic treatment tool is forcibly performed, a part of the endoscopic treatment tool is caught on the inner wall surface of the body cavity as described above to perforate the bile duct, liver, pancreas and the like. There is a fear.

When inserting a forceps with a guide wire as a guide in a narrow lumen, the forceps must be oriented in the same direction as the guide wire, and pushing the forceps requires the tip of the forceps to move in the direction of the guide wire. There is.

However, in the above-mentioned Japanese Utility Model Publication No. 6-21449, when an external force is applied to the guide wire at the proximal end of the through hole, the direction of the guide wire becomes an unexpected direction, and the forceps are thin with the guide wire inside. There is a problem that it cannot be inserted into the lumen.

The present invention has been made in view of the above circumstances, and can safely and reliably guide even a site where insertion is difficult, such as a narrow lumen or a complicated bifurcation. It is an object of the present invention to provide a treatment tool for an endoscope that can improve work efficiency.

[0013]

A treatment instrument for an endoscope according to the present invention has a pair of treatment members which can be opened and closed by moving at least one of them at a distal end portion of an insertion portion to be inserted into a body cavity. In the treatment tool for an endoscope, a guide member for guiding the treatment member to the affected part in the body cavity is provided with guide means for preventing the guide member from being directed toward the treatment member at the distal end portion. It

In the endoscopic treatment tool of the present invention, the guide member is inserted so as not to prevent the guide member from being directed toward the treatment member at the distal end portion.
It is possible to safely and reliably guide even a site where insertion work is difficult, such as a narrow lumen or a complicated bifurcation, and it is possible to improve work efficiency.

[0015]

BEST MODE FOR CARRYING OUT THE INVENTION Embodiments of the present invention will be described below with reference to the drawings.

1 to 7 relate to a first embodiment of the present invention. FIG. 1 is a configuration diagram showing a configuration of a biopsy forceps for an endoscope, and FIG. 2 is a biopsy for the endoscope of FIG. FIG. 3 is a configuration diagram showing the configuration of the rear end of the forceps, FIG. 3 is an enlarged view showing the configuration of the main part of the distal end of the endoscopic biopsy forceps 1 of FIG. 1, and FIG. 4 is the endoscopic biopsy forceps of FIG. Explanatory drawing explaining the effect | action at the time of being inserted and actually used for an endoscope, FIG. 5: is a block diagram which shows the structure of the 1st modification of the biopsy forceps for endoscopes of FIG. 1, FIG. 1 is a configuration diagram showing a configuration of a second modified example of the endoscopic biopsy forceps, and FIG. 7 is a configuration diagram showing a configuration of a third modified example of the endoscope biopsy forceps of FIG. 1.

(Structure) As shown in FIG. 1, a sheath having flexibility is provided on the distal end side of the endoscopic biopsy forceps 1 which is the endoscopic treatment tool of the first embodiment. Two are provided. An operating portion 3 is provided at the proximal end portion of the sheath 2. Further, a distal treatment section 4 is provided at the distal end of the sheath 2. The sheath 2 is composed of a close-wound coil 5 which is formed by tightly winding a stainless wire, for example.

The rear end of the sheath 2 is connected to the operating section body 6 of the operating section 3, as shown in FIG. The operation portion main body 6 includes a shaft portion 7 and a finger hook ring 8 formed at the rear end portion of the shaft portion 7. Further, a slider 9 is loosely fitted on the shaft portion 7, and a rear end of a twisted operation wire 10 is connected to the slider 9.

Returning to FIG. 1, the distal treatment section 4 is provided with a pair of biopsy cups 11a and 11b. The biopsy cups 11a and 11b are pivotally supported by a pin 13 on a sleeve 12 connected to the distal end of the sheath 2. And these biopsy cups 11a and 11b
The cup-shaped tip can be opened and closed around this pin 13.

Further, as shown in FIG. 3, the proximal ends of the biopsy cups 11a and 11b are attached to one ends of operation links 15a and 15b by pins 14a and 14b. The other ends of these operation links 15a and 15b are pin 1
It is attached to the connecting member 17 by 6. The distal end of the operating wire 10 inserted into the sheath 2 is connected to the connecting member 17 and is led out to the operating portion 3 side.

The biopsy cup 11 of the distal treatment section 4 is also provided.
b is formed with through holes 18a and 18b.
Is located rearward of the through hole 18a in the longitudinal direction. Furthermore, a guide member for guiding the main body 1a of the endoscopic biopsy forceps 1 is provided in the through holes 18a and 18b.
For example, the guide wire 19 is adapted to be inserted and removed freely.

(Operation) FIG. 4 shows an example in which the main body 1a of the biopsy forceps 1 for an endoscope is inserted into the endoscope 20 and is actually used.

When the endoscopic biopsy forceps 1 is used, the guide wire 19 is inserted into the channel 21 of the endoscope 20 previously inserted into the living body cavity before the main body 1a of the endoscopic biopsy forceps 1 is inserted. Through. Then, the distal end portion of the guide wire 19 is projected into the body cavity and guided to the affected part or the like, for example, the target site 25 of the main pancreatic duct 24. In this case, the guide wire 19 has an outer diameter dimension (for example, an outer diameter of 1.7) of a general treatment tool.
-Compared to about 3 mm) (for example, the diameter is 0.9 mm
Since it is about the following), it can be safely and surely inserted even into a site where insertion is difficult, such as in a thin lumen such as a bronchus, bile duct, or pancreatic duct. After guiding the guide wire 19 to the target site 25, the distal end portion 22 of the guide wire 19 is passed through the through hole 18a formed in the biopsy cup 11b,
18b, and then the main body 1a of the endoscopic biopsy forceps 1 is inserted to the target site 25 using the guide wire 19 as a guide.

Further, the body 1 of the endoscopic biopsy forceps 1
After inserting a into the target portion 25, the slider 9 provided on the operation portion main body 6 is slid to insert the biopsy cups 11a and 11b.
A biopsy of a living tissue or the like is performed by opening or closing. At this time, it is possible to perform the biopsy after the guide wire 19 is taken out of the body cavity while the body 1a of the endoscopic biopsy forceps 1 is left in the target site 25.

After the biopsy, the guide wire 19 is left at the target site 25 so that a treatment tool or the like to be inserted next can be easily and quickly inserted into the target site 25. The body 1a of the biopsy forceps 1 for an endoscope is removed from the endoscope 20. In addition, the body 1 a of the endoscope biopsy forceps 1 together with the guide wire 19 from the endoscope 20.
It is also possible to remove.

(Effect) As described above, in the present embodiment, the outer diameter of the distal treatment section 4 can be reduced, and the guide wire 19 previously inserted in the target site is used as a guide for the endoscope. The biopsy forceps 1 can be inserted. In addition, the guide wire 19 includes biopsy cups 11a and 11b.
The biopsy forceps 1 for endoscopy even at a small opening, for example, a duodenal papilla, or a complicated branch point, for example, a branch of the bile duct and pancreatic duct, a branch of the left and right hepatic ducts, or a branch of the bronchus The main body 1 of the endoscopic biopsy forceps 1 can be safely and reliably treated without the distal treatment section 4 of the body being caught on the wall of the body cavity.
It is possible to insert a to the target site. Therefore, the main body 1a of the endoscopic biopsy forceps 1 can be guided more safely and surely than in the conventional case, and thus the main body 1 of the endoscopic biopsy forceps 1 can be guided.
It is possible to improve the work efficiency of the insertion work of a.

The biopsy forceps 1 for an endoscope is shown in FIGS.
However, the present invention is not limited to this, and may be configured as in the first to third modified examples shown in FIGS. 5 to 7 below.

(First Modification) As shown in FIG. 5, the distal treatment section 4 of the body 1a of the endoscopic biopsy forceps 1 is a single-open type and is fixed to the distal end of the sheath 2. A base 32 having a pair of support pieces 31, a fixed biopsy cup 28b provided between the support pieces 31 and fixed to the base 32,
It may be formed from a movable biopsy cup 28a that is movable with respect to the base 32.

In the first modified example, an arm portion (not shown) is provided at the base end of the movable biopsy cup 28a, and a link mechanism (not shown) is provided at the base end of the arm portion. One end of an operation wire (not shown) is connected via. Further, the middle portion of the arm portion is rotatably supported by the pin 29 with respect to the support piece 31. In addition, the fixed biopsy cup 2 of the distal treatment section 4
8b are formed with through holes 30a and 30b.
b is located rearward of the through hole 30a with respect to the longitudinal direction, and a guide member, for example, a guide, for guiding the main body 1a of the endoscope biopsy forceps 1 in the through holes 30a and 30b. The wire can be inserted and removed freely. With this configuration, the same operation and effect as those of the first embodiment can be obtained.

(Second Modification) Further, as shown in FIG. 6, a through hole 33a is formed on the contact surface between the biopsy cups 11a and 11b of the distal treatment section 4 of the body 1a of the biopsy forceps for endoscope. However, the biopsy cup 11b may be provided with a through hole 33b, and the through hole 33b may be located behind the through hole 33a in the longitudinal direction. Further, in this second modification, a guide wire 19 for guiding the main body 1a of the endoscopic biopsy forceps 1 is inserted into the through holes 33a, 33b so as to be able to advance and retract. It With this configuration, the same operation and effect as those of the first embodiment can be obtained.

(Third Modification) Furthermore, by applying the first modification to the second modification, as shown in FIG. 7, a distal treatment of the main body 1a of the endoscopic biopsy forceps 1 is performed. The through hole 3 is formed on the contact surface of the pair of biopsy cups 28a, 28b of which the portion 4 is a single-open type.
4a and either of the biopsy cups, for example, the fixed biopsy cup 28b, may be provided with through holes 34b, respectively,
The same operation and effect as those of the first embodiment can be obtained.

8 and 9 relate to the second embodiment of the present invention. FIG. 8 is a configuration diagram showing the configuration of an endoscopic biopsy forceps, and FIG. 9 is an endoscopic biopsy of FIG. It is a block diagram which shows the structure of the modification of forceps.

Since the second embodiment is almost the same as the first embodiment, only different points will be described, and the same components will be denoted by the same reference numerals and description thereof will be omitted.

(Structure / Operation) In the second embodiment, as shown in FIG. 8, a through hole 35a is formed in the biopsy cup 11a of the distal treatment section 4 of the body 1a of the endoscope biopsy forceps. The through holes 35b are provided in the respective 11b, and the through holes 35b are located rearward of the through holes 35a in the longitudinal direction. Further, a guide wire 19 for guiding the main body 1a of the endoscopic biopsy forceps 1 is inserted into the through holes 35a and 35b so as to be able to move forward and backward.

As shown in FIG. 9, the distal treatment section 4 of the main body 1a of the endoscopic biopsy forceps, as shown in the first modification of the first embodiment, is of a one-sided opening type. The through holes 35a and 35b may be provided in the pair of biopsy cups 28a and 28b, respectively.

Other configurations and operations are the same as those of the first embodiment.

(Effect) Therefore, in this embodiment, the first
In addition to the effects of the embodiment, since the through holes are provided in each of the pair of biopsy cups, the outer diameter of the biopsy cups can be further reduced, and it is particularly easy to perform the treatment even in a narrow lumen. The biopsy forceps 1 for an endoscope can be inserted.

10 to 13 relate to the third embodiment of the present invention. FIG. 10 is a configuration diagram showing a configuration of a biopsy forceps for an endoscope, and FIG. 11 is a biopsy for the endoscope of FIG. FIG. 12 is an enlarged view showing an enlarged view of a portion B of FIG. 10 and FIG. 13 is an enlarged view showing an enlargement of a portion C of FIG. 10.

Since the third embodiment is almost the same as the first embodiment, only different points will be described, and the same components will be denoted by the same reference numerals and description thereof will be omitted.

(Structure) In the third embodiment, a lumen through which a guide wire can be inserted is provided in the insertion portion so that the lumen can be inserted into the bile duct, pancreatic duct or the like via the guide wire, and the treatment work can be simplified and treated. This is an example of a biopsy forceps that can reduce the time.

That is, the living body forceps 5 of the third embodiment
At 0, as shown in FIG.
Two lumens 52 and 53 are provided side by side from the front end side to the rear end side. As shown in FIG. 11 as seen from the arrow A in FIG. 10, the lumen 52 of the two lumens is provided with biopsy cups 54 and 55 on the distal end side, and the procedure returns to FIG. Forms a link mechanism by the fixed pin 56, the sliding pins 57 and 58, and the link 59. FIGS. 12 and 13 show enlarged views of portions B and C of FIG.

This link mechanism can be remotely operated by the slider 60 of the operating section on the near side through the operating wire 65. That is, when the biopsy forceps 50 is inserted into an endoscope and a biopsy of a mucous membrane in a body cavity is performed, the slider 60 provided on the proximal side is operated to operate the link mechanism of the distal end portion, and the biopsy cup 54, By opening / closing 55, a biopsy of a tissue piece or the like can be performed.

Further, a guide wire 61 can be inserted into the other lumen 53, and a distal end portion 62 is formed.
To the branch portion 63 are provided along with the lumen 52, and penetrate from the branch portion 63 to the base 64.

(Operation) Next, the living body forceps 5 of the present embodiment
The case where 0 is used in combination with the guide wire 61 will be specifically described.

In general, it is extremely difficult to insert a treatment tool into the bile duct or pancreatic duct via a channel of an endoscope. Therefore, a technique of inserting a guide wire into the bile duct / pancreatic duct at one end and inserting a treatment tool or the like along the guide wire has been generally performed (note that the bile duct / pancreatic duct etc. The endoscope has various diagnostics at once,
In order to perform treatment, since several different treatment tools are often used, insertion and re-insertion are frequently repeated).

For example, when the guide wire 61 has already been inserted into the bile duct or pancreatic duct, the guide wire 61 is inserted through the distal end portion 62 of the lumen 53 of the living body forceps 50, and along the guide wire 61, The biopsy forceps 50 is inserted into the endoscope → duodenal papilla → bile duct or pancreatic duct.
After insertion, as shown above, a biopsy is performed by a slide operation on the proximal side.

After the biopsy, if the living body forceps 50 is removed with the guide wire 61 left in the bile duct or the pancreatic duct, the treatment instrument can be quickly inserted when the next treatment is performed.

(Effect) As described above, in the biopsy forceps 50 of the present embodiment, by using the guide wire 61, the forceps can be easily inserted into the bile duct or the pancreatic duct. Also, two lumens 52,
Since the biopsy unit and the guide wire insertion unit do not interfere with each other, a biopsy can be performed while leaving the guide wire 61 inside the body cavity, and the treatment time can be shortened. .

The tip 62 may be cut obliquely with respect to the major axis direction. By doing so, the insertion from the duodenal papilla into the bile duct, pancreatic duct or the like can be further facilitated.

The present invention is not limited to the above embodiments. For example, in each of the above-described embodiments, the case where the present invention is applied to the biopsy forceps is shown, but it may be applied to grasping forceps and the like, and various modifications can be made without departing from the scope of the present invention. .

[Additional Notes] (Additional Statement 1) At the tip of the insertion portion to be inserted into the body cavity,
In a treatment instrument for endoscope having a pair of treatment members that can be opened and closed by moving at least one of them, a guide member for guiding the treatment member to a diseased part in the body cavity is provided with the treatment member at the distal end portion. A treatment instrument for an endoscope, which is provided with a guide means that does not hinder the orientation.

(Additional Item 2) The endoscopic treatment instrument according to Additional Item 1, wherein the guide means is a through hole provided in the treatment member.

(Additional Item 3) The through hole has first and second openings through which a guide member for guiding the treatment member to an affected part in the body cavity can be inserted so as to advance and retract. The treatment tool for an endoscope according to appendix 2.

(Additional Item 4) The endoscopic treatment according to Additional Item 3, wherein the first and second openings are simultaneously provided in either one of the pair of treatment members. Ingredient

(Additional Item 5) The endoscopic treatment tool according to Additional Item 3, wherein the first and second openings are provided in the pair of different treatment members, respectively.

(Additional Item 6) Among the first and second openings, the distal end side opening of the treatment member is provided at the contact portion of the treatment member. Endoscopic treatment tool.

(Supplementary Note 7) The endoscopic treatment instrument according to Supplementary note 1, wherein the guide means is a guide tube provided in the treatment instrument from the vicinity of the treatment member to the vicinity of the proximal side.

(Additional Item 8) The treatment instrument for an endoscope according to Additional Item 7, wherein the distal end portion of the guide tube is formed obliquely with respect to the major axis direction.

(Additional Item 9) In a treatment instrument for an endoscope having a pair of treatment members which can be opened and closed by moving at least one of them at a distal end portion of an insertion portion to be inserted into a body cavity, the treatment member includes: A first guide member for guiding the treatment member to an affected part in the body cavity, which is insertable in a retractable manner.
And a through hole having a second opening.

(Additional Item 10) The endoscopic treatment according to Additional Item 9, wherein the first and second openings are simultaneously provided in either one of the pair of treatment members. Ingredient

(Additional Item 11) The endoscopic treatment instrument according to Additional Item 9, wherein the first and second openings are provided in the pair of different treatment members, respectively.

[0062]

As described above, according to the endoscopic treatment tool of the present invention, since the guide member is inserted so as not to prevent the guide member from being directed toward the treatment member at the distal end portion, a narrow tube is inserted. It is possible to guide safely and surely even to a site where insertion work is difficult, such as a cavity or a complicated bifurcation.
There is an effect that work efficiency can be improved.

[Brief description of the drawings]

FIG. 1 is a configuration diagram showing a configuration of an endoscopic biopsy forceps according to a first embodiment of the present invention.

FIG. 2 is a configuration diagram showing a configuration of a rear end of the endoscopic biopsy forceps of FIG.

FIG. 3 is an enlarged view showing the configuration of the main part of the distal end of the endoscopic biopsy forceps 1 of FIG.

FIG. 4 is an explanatory view for explaining an action when the endoscopic biopsy forceps of FIG. 1 is inserted into an endoscope and actually used.

5 is a configuration diagram showing a configuration of a first modified example of the endoscopic biopsy forceps of FIG. 1. FIG.

FIG. 6 is a configuration diagram showing a configuration of a second modified example of the endoscopic biopsy forceps of FIG. 1.

FIG. 7 is a configuration diagram showing a configuration of a third modification of the endoscopic biopsy forceps of FIG. 1.

FIG. 8 is a configuration diagram showing a configuration of an endoscopic biopsy forceps according to a second embodiment of the present invention.

9 is a configuration diagram showing a configuration of a modified example of the endoscopic biopsy forceps of FIG. 8. FIG.

FIG. 10 is a configuration diagram showing a configuration of an endoscopic biopsy forceps according to a third embodiment of the present invention.

FIG. 11 is a configuration diagram showing a configuration of a distal end surface of the endoscopic biopsy forceps of FIG.

FIG. 12 is an enlarged view of an enlarged portion B of FIG.

FIG. 13 is an enlarged view of an enlarged portion C of FIG.

[Explanation of Codes] 1 ... Endoscopic biopsy forceps 1a ... Main body 2 ... Sheath 3 ... Operating portion 4 ... Tip treatment portion 5 ... Closely wound coil 6 ... Operating portion main body 7 ... Shaft portion 8 ... Finger ring 9 ... Slider 10 ... Operation wire 11a, 11b ... Biopsy cup 12 ... Sleeve 13, 14a, 14b, 16 ... Pin 15 ... Operation link 17 ... Connection member 18a, 18b ... Through hole 19 ... Guide wire 20 ... Endoscope 21 ... Channel 22 ... Terminal part 24 ... Main pancreatic duct 25 ... Target site

Claims (1)

[Claims] 1. A tip portion of an insertion portion to be inserted into a body cavity,
In a treatment tool for an endoscope having a pair of treatment members that can be opened and closed by moving at least one of them, a guide member for guiding the treatment member to an affected part in the body cavity is provided with the treatment member at the distal end. A treatment instrument for an endoscope, which is provided with a guide means that does not hinder the orientation.