JP2006230635A

JP2006230635A - Medical treatment instrument

Info

Publication number: JP2006230635A
Application number: JP2005048139A
Authority: JP
Inventors: Tomihisa Kato; 富久加藤
Original assignee: Asahi Intecc Co Ltd
Current assignee: Asahi Intecc Co Ltd
Priority date: 2005-02-24
Filing date: 2005-02-24
Publication date: 2006-09-07

Abstract

<P>PROBLEM TO BE SOLVED: To provide a medical treatment instrument 1 of a high-quality sheathed structure which is provided with a fore-end treatment part 5, a back-end hand operation part 4 and a sheathed body 2 of an elongated and flexible solid coiling body penetrated by a core material 3 for operation connecting the fore-end treatment part 5 and the hand operation part 4 and which is not elongated by increase in space between coils even it is crooked in a body cavity or whose core material 3 is not subjected to a tensile load due to bending. <P>SOLUTION: The sheathed body 2 of the medical treatment instrument 1 is composed of a coil of an irregular shaped double strand which is a combination of a tapered isosceles hypotenuse strand 7 and an arcuate circumference strand 8. Their mutually joining edge can relatively slide in the radial direction of the coil body by the bending external force. <P>COPYRIGHT: (C)2006,JPO&NCIPI

Description

本発明は、体腔内に挿入して生体採取等の所定の治療を行う内視鏡用処置具・内視鏡用生検鉗子・多機能外科用器具等の体腔内治療用の医療用処置具に関するものである。 The present invention relates to an endoscopic treatment instrument, an endoscopic biopsy forceps, a multi-function surgical instrument, and the like, which are inserted into a body cavity to perform a predetermined treatment such as collection of a living body. It is about.

前記の体腔内治療用の医療用処置具は、曲りくねった細い血管の体腔内に挿入して体外に位置する手元操作部を「押し・引き・回転」手動操作して前端の先端処置部を操作して所要の体腔内治療を施すので、細長可撓性のシース体に可撓性の芯材を貫換し、その芯材をシース体後端の手元操作部とシース体前端の先端処置部に連結した基本形態のものが普及しており特許文献１〜４に示す背景技術のものがある。 The medical treatment tool for treatment in the body cavity is inserted into the body cavity of a narrow and slender blood vessel, and the hand operation part located outside the body is manually operated by “pushing / pulling / rotating” and the front end treatment part is moved. Because it is operated to perform the required intracorporeal treatment, the flexible core material is replaced with an elongated flexible sheath body, and the core material is treated at the proximal end of the sheath body and the distal end treatment of the sheath body front end. The basic form connected to the unit is widespread, and there are background arts shown in Patent Documents 1 to 4.

即ち、特許文献１の医療用処置具は「単素線の密着巻き長尺コイル体」のシース体に芯材を内挿した構造を特徴としており、特許文献２の内視鏡用鉗子・特許文献３の内視鏡用処置具・特許文献４の多機能外科用器具のいずれも同じく「単素線の密着巻きコイル体」のシース体構造を特徴としている。 That is, the medical treatment instrument of Patent Document 1 is characterized by a structure in which a core material is inserted into a sheath body of a “single-wire closely wound long coil body”. Both the endoscopic treatment tool of Document 3 and the multi-function surgical instrument of Patent Document 4 are characterized by the sheath structure of a “single-element tightly wound coil body”.

特開２００１−０１７３８６公報JP 2001-017386 A 特開２００２−０１１０１７公報JP 2002-011017 A 特開平１０−２９０８０３号公報Japanese Patent Laid-Open No. 10-290803 特開２００２−２８２２６１公報JP 2002-282261 A

以上の背景技術の医療用処置具のシース体は「単線のコイル素線を所要径に密着コイル巻きした密着コイル形態」から成るので、曲りくねった血管へ長尺のシース体を挿入すると、曲げ部位のシース体は曲げによる引張り荷重を生ずる曲げ外側のコイル素線が曲げ外力に応じて素線間隙間を生じて曲り変形し、その曲げ応力を保持したまま変形する。そして、曲げによる圧縮荷重を生ずる曲げ内側のコイル素線は同じく曲げ圧縮応力を保持したまま素線密着状態で曲げ変形し、その曲げ状態が持続される。 Since the sheath body of the medical treatment device of the above background art is composed of “a close coil form in which a single coil element wire is tightly wound around a required diameter”, if a long sheath body is inserted into a winding blood vessel, the sheath body is bent. In the sheath body at the site, the coil wire on the outside of the bending that generates a tensile load due to bending is bent and deformed by generating a gap between the wires according to the bending external force, and the bending is maintained while maintaining the bending stress. The coil wire inside the bend that generates a compressive load due to bending is similarly bent and deformed while keeping the bending compressive stress, and the bent state is maintained.

以上の曲げプロセスから、シース体の曲げ変形部はストレート形態への復元応力が常に存在しているので、その復元力によって血管壁へ強く圧接した状態となって血管壁の損傷をもたらすと共に、シース体の挿入前進性を阻害する。 From the above bending process, the bending deformation portion of the sheath body always has a restoring stress to the straight form, and thus the restoring force brings the vessel wall into a state of being strongly pressed against the vessel wall and causing damage to the vessel wall. Inhibits the body's insertion advanceability.

さらに、シース体中心線の曲げ中立線が曲げ変形によって伸長変形してシース体の長尺化変形を必然的に生ずる。従って、そのシース体の中空部を貫挿する芯材は有効作動長が変化すると共に、強い引張り荷重を生ずるので、体腔内挿入中の先端処置部５に有害な作動力を生じたり、手元操作部による該芯材の押し・引き・回転の操作性を阻害して当該治療性を損う難点がある。なお、この背景技術のシース体の詳細な説明は、後述する本発明の効果の段落において、本発明のもののシース体の作用効果と対比して補足説明する。 Further, the bending neutral line of the center line of the sheath body expands and deforms due to the bending deformation, and the sheath body inevitably undergoes an elongated deformation. Accordingly, the effective length of the core material penetrating the hollow portion of the sheath body is changed and a strong tensile load is generated. Therefore, a harmful operating force is generated in the distal treatment section 5 during the insertion into the body cavity, or the hand operation is performed. There is a difficulty that the operability of pushing, pulling, and rotating the core material by the part is hindered and the therapeutic property is impaired. In addition, the detailed description of the sheath body of this background art will be supplementarily described in the paragraph of the effect of the present invention to be described later in comparison with the operation effect of the sheath body of the present invention.

以上の技術課題を解決する本発明の医療用処置具１は（その基本形態を示す図１参照）「前端の先端処置部５と後端の手元操作部４を備え、かつ先端処置部５と手元操作部４を連結した操作用芯材３を貫挿した細長可撓性の密着巻きコイル体のシース体２から成る医療用処置具１において、シース体２が、先細２等辺斜辺素線７と円弧外周素線８の組合せにして、曲げ外力によって相互接合縁を前記コイル体の径方向に相対滑り自在にした異形複素線コイル部から成る構造」が特徴である。 The medical treatment instrument 1 of the present invention that solves the above technical problems (see FIG. 1 showing its basic form) is provided with a front-end distal treatment section 5 and a rear-end hand operation section 4, and the distal treatment section 5 In a medical treatment instrument 1 comprising a sheath body 2 of an elongated flexible close-wound coil body through which an operation core material 3 connected with a hand operation section 4 is inserted, the sheath body 2 is a tapered isosceles strand 7 having a tapered isosceles side. And an arc outer peripheral wire 8, and is characterized by a structure comprising a deformed complex wire coil portion in which the mutual joint edges are relatively slidable in the radial direction of the coil body by a bending external force ”.

即ち、前記基本構成の本発明の医療用処置具のシース体は、相互に側面を接合させて対となる「前記２等辺斜辺素線と円弧外周素線」を、シース体の曲げ外力によって極めて容易に「該シース体の中心に近づく方向または遠ざかる方向に相対滑りさせて、曲げ変形による引張り応力・圧縮応力を吸収させて素線間隙間を生じさせないで曲げ変形自在に成す」思想から成るものである。 That is, the sheath body of the medical treatment device of the present invention having the above-described basic structure has the above-mentioned isosceles elemental wire and arcuate outer peripheral wire that are paired by joining the side surfaces to each other by the bending external force of the sheath body. Easily composed of the concept of “relatively sliding in the direction approaching or moving away from the center of the sheath body to absorb the tensile stress / compressive stress caused by bending deformation and to be able to bend and deform without causing gaps between wires” It is.

なお、前記構成要件における先細２等辺斜辺素線７は（図１（Ｃ）参照）２等辺３角形を意味し、その２等辺は直線面・前記円弧外周線の外周に整合させた緩曲面のもの、角丸形態のものが含まれる。そして、円弧外周線８とは「円形線・弦を有する切欠円形線」を意味し、その素線７・８は図１（Ｂ）例示のように２等辺斜辺と円弧外周を相互接合する形態に組合せる。 In addition, the tapered isosceles strand 7 in the above-mentioned constituent elements means an isosceles triangle (see FIG. 1 (C)), and the isosceles are a straight surface and a gently curved surface aligned with the outer periphery of the arc outer periphery. And rounded corners are included. The arc outer peripheral line 8 means “a circular line / notched circular line having a chord”, and the strands 7 and 8 are formed by mutually joining the isosceles hypotenuse and the arc outer periphery as illustrated in FIG. Combine with.

前記基本構成のシース体２を主要部に成す本発明の医療用処置具１は下記の特有の主たる作用効果がある。即ち、（図２（Ｂ）参照）単条コイル体３１から成る背景技術のシース体３０は、体腔内の屈曲部位で曲げ外力を受けると曲げ中立面のコイル中心線６の外側のコイル素線３１が曲げによる引張り応力に比例する素線間隙間Ｃを生じて、ストレート状態への復元応力を温存させたまま曲がり変形する。従って、その復元応力によって曲げ変形の両端部位が血管壁等へ強圧接して摺動挿入を続けたりセットされるので、血管壁等の体腔壁の損傷をもたらすと共に、続いて成すべき体腔内挿入の挿入性を阻害する。 The medical treatment tool 1 according to the present invention, which has the basic structure sheath body 2 as a main part, has the following specific main functions and effects. That is, (see FIG. 2 (B)) the sheath 30 of the background art composed of the single-strand coil body 31 is subjected to a bending external force at the bending portion in the body cavity, and the coil element outside the coil center line 6 of the bending neutral plane. The wire 31 creates a gap C between the wires that is proportional to the tensile stress caused by bending, and the wire 31 is bent and deformed while maintaining the restoring stress to the straight state. Therefore, both ends of the bending deformation are pressed against the blood vessel wall by the restoring stress, and sliding insertion is continued or set, so that the body cavity wall such as the blood vessel wall is damaged, and the insertion into the body cavity to be performed subsequently is performed. Inhibits insertion.

さらに、その曲げ状態のシース体３０の引張り側のコイル体は素線間隙間Ｃの発生によって全長が長くなり、体腔内で極めて多数回屈曲させるので屈曲ポイント毎に前記長大化現象が累積して体腔内挿入セット状態ではシース体３０の相当量の長尺化が生ずる。かくして、その長尺化によってシース体３０内の芯材３の有効作動長を著しく減殺したり、芯材３に有害な張力を生じて、手元操作部４による先端処置部５の作動機能を低下させて当該治療性を損う難点がある。 Further, the coil body on the tension side of the sheath body 30 in the bent state becomes longer due to the generation of the inter-element gaps C, and is bent very many times in the body cavity, so that the above-mentioned lengthening phenomenon is accumulated at each bending point. In the body cavity insertion set state, a considerable amount of the sheath body 30 is elongated. Thus, the effective operation length of the core material 3 in the sheath body 30 is remarkably reduced by the lengthening of the core material, or harmful tension is generated in the core material 3 to reduce the operation function of the distal treatment section 5 by the hand operation section 4. Therefore, there is a difficulty in impairing the therapeutic properties.

一方、前記基本構成の本発明の医療用処置具１のシース体２は、曲げ応力によって前記相対滑り自在の素線組合せから成るので、（図２（Ａ）参照）体腔内屈曲部を通過するときには、シース体２の押し込み操作力によって素線７・８間に隙間を全く生ずることなく容易かつ自在に曲がり変形する。そして、曲げ応力を残存させないで血管等の曲折形状に順応して自在曲がり変形すると共に、ストレート状態の復元が極めて容易になる特段の直曲塑性（少なる外力で容易に自在に曲り変形したりストレート状に成って、その形状を維持する性質）が存在する。 On the other hand, the sheath body 2 of the medical treatment instrument 1 of the present invention having the above-described basic structure is composed of the above-described relatively slidable element combination by bending stress (see FIG. 2 (A)) and passes through the body cavity bending portion. In some cases, the pushing force of the sheath body 2 is easily and freely bent and deformed without generating any gap between the strands 7 and 8. And without bending stress, it can bend and deform in conformity with the bent shape of blood vessels, etc., and can be easily bent and deformed easily with a little external force. It has the property of being straight and maintaining its shape.

従って、複雑に屈曲する体腔内へ挿入するとき、その屈曲形状に順応して素線間隙間を生ずることなく極めて円滑に挿入進行するので、先端処置部５が芯材３の張力によって挿入進行中に無用に作動することがなく機能が安定確保され、病変部到着後の手元操作部４による先端処置部５の操作機能が極めて良好に安定する。そして、シース体２の挿入進行中や挿入セット後の屈曲変形による復元力反発力は殆ど無く、その屈曲変形によって血管壁等を損傷するおそれはない。 Therefore, when inserting into a body cavity that is bent in a complicated manner, the distal treatment section 5 is being inserted due to the tension of the core material 3 because the insertion progresses very smoothly without adapting to the bent shape and generating a gap between the strands. Therefore, the function is stably ensured, and the operation function of the distal treatment section 5 by the hand operation section 4 after arrival of the lesioned part is extremely well stabilized. And there is almost no restoring force repulsion force by the bending deformation during the insertion progress of the sheath body 2 or after the insertion set, and there is no possibility that the blood vessel wall or the like is damaged by the bending deformation.

即ち、別体素線にして相互に傾斜面・円弧面の側縁を接合させる前記構成要件の「先細２等辺斜辺素線７と円弧外周素線８」は、その接合部位がコイル中心に近づく方向または遠ざかる方向に相対滑りし易い「斜辺と円弧接合」形態であることから、曲げ外力による「シース体長さ方向の素線間圧縮外力または引張り外力」によって極めて容易に相対滑りを生じて素線間隙間を生ずることなく、その曲げ外力を吸収して曲げによる長尺化を生ずることなくシース体２のコイル形態を的確に維持する。 In other words, in the above-mentioned constituent element “tapered isosceles element wire 7 and arc outer periphery element wire 8” which joins the side edges of the inclined surface and the arc surface to each other as separate element wires, the joining part approaches the coil center. Because of the “slope and arc joint” configuration, which easily slips in the direction of the wire or away from the wire, it is extremely easy to generate a relative slip due to the “external compression or tensile force between the wires in the sheath body length direction” due to the bending external force. The coil form of the sheath body 2 is accurately maintained without generating an interstitial gap and absorbing the bending external force without causing an increase in length due to bending.

そして、その曲げ状態においてストレート状復元外力が加わると、前記素線は前記の曲げ変形と逆方向の外力を受けて、原位置復帰の相対滑りを生じて応力を残留させることなくストレート形態へ復元し、その曲直変化を反復することができる。なお、体腔内のシース体２の前記相対滑り量は微量であり、かつ「斜辺と円弧接合形態」であることから接合素線の接合が外れてコイル形態を崩くおそれは無く、正常なコイル形状が維持できる。 When a straight restoring external force is applied in the bent state, the element wire receives an external force in the direction opposite to the bending deformation, causing a relative slip of returning to the original position, and restoring to a straight configuration without causing stress to remain. And it is possible to repeat the straight-line change. In addition, since the relative slip amount of the sheath body 2 in the body cavity is a very small amount, and the “slope side and arc joining form”, there is no possibility that the joining element wire is detached and the coil form is lost, and the normal coil The shape can be maintained.

なお補足すれば（図２（Ｃ）参照）「基本諸元とストレート状態の芯材３の遊動長（Ｌ）」を同一にしたとき、背景技術のシース体３０による遊動長の変化量はδ１（Ａ１−Ｌ）となってシース体３０側が引き込まれる（マイナス側）。これに対して、本発明のシース体２による遊動長の変化量はδ２（Ａ２−Ｌ）となって微小ながらシース体２より遠ざかる。背景技術のシース体３０による遊動長（Ｌ）が小さくなる理由は、シース体３０を屈曲させると、コイル素線間に隙間が開いて全長が長くなり、その分シース体３０内へ芯材が引き込まれるからである。又、本発明のシース体２による遊動長（Ｌ）がわずかではあるが増大する理由は、シース体２を屈曲させると各素線が相対滑り移動により素線間隙間を発生させず、シース体２の全長がほとんど変化せず、そして、芯材は屈曲部において、シース体２内を最短距離にて配置されるからである。 If supplementary (see FIG. 2 (C)), when the “basic specifications and the free length (L) of the core material 3 in the straight state” are the same, the amount of change in the free length by the sheath body 30 of the background art is δ1. It becomes (A1-L) and the sheath body 30 side is drawn (minus side). On the other hand, the amount of change in the floating length by the sheath body 2 of the present invention is δ2 (A2-L), and is far from the sheath body 2 although it is minute. The reason why the free length (L) by the sheath body 30 of the background art is reduced is that when the sheath body 30 is bent, a gap is opened between the coil strands and the entire length is increased, and the core material is inserted into the sheath body 30 accordingly. Because it is drawn. The reason why the floating length (L) by the sheath body 2 of the present invention is slightly increased is that when the sheath body 2 is bent, each strand does not generate a gap between the strands due to relative sliding movement, and the sheath body 2 This is because the overall length of 2 hardly changes, and the core material is disposed within the sheath body 2 at the shortest distance at the bent portion.

さらに、本発明のシース体２は下記の特有の作用効果がある。即ち（図２（Ｄ）参照）シース体２を形成する異形複素線は、曲げ部位において相対滑りして下方に空隙１２を生ずる形態となり、この空隙１２が反射エコー部として機能し、さらに、シース体２外周に公知の樹脂被覆Ｆを設けることによって反射エコー部が「反射エアー層」として機能し、治療時の「超音波三次元エコー」の下においてより明瞭な超音波観察画像を描出できる。 Furthermore, the sheath body 2 of the present invention has the following specific effects. That is, (see FIG. 2 (D)), the deformed complex line forming the sheath body 2 has a form in which the air gap 12 is generated by sliding relative to each other at the bending portion, and the air gap 12 functions as a reflection echo portion. By providing a known resin coating F on the outer periphery of the body 2, the reflection echo portion functions as a “reflection air layer”, and a clearer ultrasonic observation image can be drawn under the “ultrasonic three-dimensional echo” at the time of treatment.

この理由は、このような空隙１２は、体組織に比べて超音波を反射しやすく、又、体組織等とエアー層とは音響インピーダンス（組織密度ρと音速Ｃとの積ρＣ）の差を非常に大きくさせる為、この境界面で超音波をほとんど反射させるからである。そして、このような空隙１２は連続した螺旋溝となっている為、連続した屈曲形態部として画像認識させることができる。この結果、「超音波三次元エコー」の下において、当該治療性の一段の向上を図ることができる。 This is because such voids 12 are more likely to reflect ultrasonic waves than body tissue, and the body tissue and the air layer have a difference in acoustic impedance (product ρC of tissue density ρ and sound velocity C). This is because the ultrasonic wave is almost reflected at this boundary surface in order to make it very large. And since such a space | gap 12 is a continuous spiral groove, it can be made to recognize an image as a continuous bending form part. As a result, under the “ultrasonic three-dimensional echo”, the therapeutic property can be further improved.

以下、図３〜図６を参照して前記基本形態から成る本発明の好ましい実施例を説明する。 A preferred embodiment of the present invention having the above basic form will be described below with reference to FIGS.

まず図３は、芯材３を貫挿したシース体２の両端に押し引き操作片１１から成る手元操作部４と、芯材２の押し引きによって開閉する生検カップ１２から成る先端処置部５を有する公知形態の「内視鏡用処置具２０と、内視鏡用生検鉗子２１」の医療用処置具が示されており、いずれもシース体２が前記基本形態の樹脂被覆Ｆつきの構造に設定されている。 First, FIG. 3 shows a distal operation section 5 including a hand operation section 4 including a push-pull operation piece 11 at both ends of a sheath body 2 through which the core material 3 is inserted, and a biopsy cup 12 opened and closed by pushing and pulling the core material 2. 2 shows a medical treatment tool of “endoscopic treatment tool 20 and endoscopic biopsy forceps 21” having a known form, and the sheath body 2 has a structure with the resin coating F of the basic form. Is set to

この図３実施例のものは、下記の特有作用がある。即ち、背景技術のシース体から成るものは体腔内の曲部急激曲げおよび屈曲形態の累積に伴って素線間隙間の発生によってシース体２を屈曲させるのみで芯材３を操作した状態と成って、生検カップ１２が体腔内の曲部急激曲げ部等で術者の意図に反して、開閉又は回転動作して、体腔内壁の傷つけ等治療性を阻害するトラブルがある。しかし、本実施例のものは前記の特有作用によって、体腔内挿入による屈曲が大になっても術者の意図に反して開閉又は回転作動せず、良好な回転操作性・シース体２の長尺化防止等によって生検カップ１２の開閉操作性が良好に確保できる。そして、超音波環境下における反射エコー部・反射エアー層形成によって明瞭な画像を描出して、生体組織採取の治療が極めて容易的確にできる。 The embodiment shown in FIG. 3 has the following special effects. In other words, the sheath body of the background art is in a state in which the core member 3 is operated only by bending the sheath body 2 due to the generation of gaps between the strands due to the rapid bending of the curved portion in the body cavity and the accumulation of the bending forms. In addition, the biopsy cup 12 opens and closes or rotates against the surgeon's intention at the bent portion or the like in the body cavity, and there is a trouble that impairs the therapeutic properties such as damaging the inner wall of the body cavity. However, in the present embodiment, due to the above-mentioned unique action, even if the bending due to insertion into the body cavity becomes large, it does not open / close or rotate against the operator's intention, and good rotational operability / length of the sheath body 2 The opening / closing operability of the biopsy cup 12 can be secured satisfactorily by preventing the scaling. Then, a clear image can be drawn by the formation of a reflective echo portion and a reflective air layer in an ultrasonic environment, and treatment for collecting a living tissue can be performed very easily and accurately.

次に図４（Ａ）は、シース体２後端の手元操作部４の「押し・引き・回転操作」によって、シース体２先端の先端処置部５のループ部１３を拡縮させて生検組織を緊縛する公知形態の内視鏡処置具２２の医療用処置具１が示してあり、図４（Ｂ）はシース体２後端の手元操作部４のプル操作によってシース体２前端の先端処置部５のクリップ１４を生体組織へ留置させる公知形態の多機能外科用器具２３の医療用処置具１が示してあり、この図４（Ａ）（Ｂ）のいずれものシース体２も前記基本形態の構造に設定されている。 Next, FIG. 4A shows a biopsy tissue by expanding and contracting the loop portion 13 of the distal treatment section 5 at the distal end of the sheath body 2 by “pushing / pulling / rotating operation” of the hand operation section 4 at the rear end of the sheath body 2. FIG. 4B shows a distal end treatment of the front end of the sheath body 2 by a pull operation of the hand operation section 4 at the rear end of the sheath body 2. FIG. 4 shows a medical treatment instrument 1 of a multi-function surgical instrument 23 in a known form in which the clip 14 of the section 5 is placed in a living tissue, and any of the sheath bodies 2 in FIGS. 4A and 4B is also in the basic form. Is set in the structure.

以上の図４実施例のものは、前記の本発明の主たる特有作用に基づく下記の特有作用がある。即ち、背景技術の内視鏡処置具は、同じく屈曲変形による芯材３の引っ張り力発生によってループ部１３の操作性が悪く、ループ部１３によるポリープの緊縛力が変化して、緊縛力不足によるポリープ抜けを生じたり、ポリープの過強緊縛の不良を生ずるトラブルがある。しかし、本実施例の図４（Ａ）のものは体腔内挿入のシース体２が極度の屈曲形態を呈しても、シース体２の各素線が相対滑り移動を生じて芯材３の有効作動長を著しく減殺することがないため生体組織採取のループ部１３の開口操作が安定維持されると共に、ループ部１３の揺動防止・良好な操作によって生体組織の良好な採取性が確保できる。そして、前記の反射エコー部・反射エアー層形成による明瞭な超音波観察画像描出によって当該治療性が特段に向上する。 The above-described embodiment of FIG. 4 has the following specific actions based on the main specific actions of the present invention. That is, the endoscopic treatment tool of the background art has poor operability of the loop portion 13 due to the generation of the tensile force of the core material 3 due to bending deformation, and the binding force of the polyp by the loop portion 13 changes, resulting in insufficient binding force. There are troubles that cause polyps to drop out or cause poor polyp binding. However, in FIG. 4A of the present embodiment, even if the sheath body 2 inserted into the body cavity has an extremely bent form, each strand of the sheath body 2 causes relative sliding movement, and the core material 3 is effective. Since the operating length is not significantly reduced, the opening operation of the loop portion 13 for collecting the biological tissue is stably maintained, and the good collection of the biological tissue can be ensured by preventing the swinging of the loop portion 13 and performing a good operation. And the said therapeutic property improves especially by the clear ultrasonic observation image drawing by the said reflective echo part and reflective air layer formation.

そして、図４（Ｂ）のものは、従来技術の「シース体が密着コイル巻き形態」において、体腔内で屈曲させると曲げ部分の引張側のコイル素線が開いて芯材３の有効長が大きく変動してクリップ１４の位置変動・揺動をもたらして操作性を困難にしたり、クリップ１４の体内留置不備を生ずるトラブルが存在する。しかし、そのシース体２が前記基本形態から成るので、体腔内で極度屈曲変形させてもシース体２の長さ変化量は極めて少く、操作ストローク不足を生ずることなく操作性が極めて安定し、クリップ１４の体腔内留置の治療性が特段に向上する。 4 (B) shows that in the prior art “sheath body is in the form of tightly wound coil”, when it is bent in the body cavity, the coil wire on the pulling side of the bent portion is opened and the effective length of the core 3 is increased. There are troubles that greatly change and cause position fluctuation / swing of the clip 14 to make the operability difficult or cause the clip 14 to be placed in the body. However, since the sheath body 2 has the above basic form, the amount of change in the length of the sheath body 2 is extremely small even when extremely bent and deformed in the body cavity, and the operability is extremely stable without causing a shortage of the operation stroke. The therapeutic properties of 14 body cavity placements are particularly improved.

詳しくは（図４（Ｃ）参照）多機能外科用器具２３は、手元操作部４を引張り操作すると、その反力を密着コイル巻きのシース体２が受けて支えることによって、クリップフック１５が伸ばされてクリップ１４が体内に留置される操作プロセスとなる。このケースにおいて背景技術のシース体は、屈曲させると曲率半径が大なる引張り側の線間に隙間を生ずるのでクリップ１４がシース体内に入り込んで先端からのクリップ位置が変動する。そして、手元操作によって圧縮反力を受けると前記線間隙間が小となり、これによる操作力の大・小によってシース体が揺動して消化器管等の損傷をもたらす。 For details (see FIG. 4 (C)), when the multi-function surgical instrument 23 is operated by pulling the hand operating portion 4, the clip coil 15 is extended by receiving and supporting the reaction force of the sheath body 2 wound with a close coil. This is an operation process in which the clip 14 is placed in the body. In this case, when the sheath body according to the background art is bent, a gap is formed between the lines on the pulling side where the radius of curvature is large, so that the clip 14 enters the sheath body and the clip position from the tip changes. When the compression reaction force is received by the hand operation, the gap between the lines becomes small, and the sheath body swings due to the magnitude of the operation force thereby causing damage to the digestive tract and the like.

さらに、操作ストロークがシース体のコイルばねに吸収されて所要引張りストロークの先端部への伝達が困難となり、クリップフック１５が伸ばされず体内留置できない機能不全をもたらす難点がある。 Furthermore, since the operation stroke is absorbed by the coil spring of the sheath body, it becomes difficult to transmit the required tension stroke to the distal end portion, and there is a problem that the clip hook 15 is not stretched and cannot function in the body.

しかし、本発明のシース体２から成るものは、屈曲させても長さ変化量が極めて小にして操作ストローク不足の発生が無く、その上屈曲形態に関係なく操作応答性が極めて良く、安定したクリップ留置が確保できる。 However, the sheath body 2 of the present invention has an extremely small length change amount even when bent, and there is no shortage of the operation stroke. Moreover, the operation responsiveness is extremely good and stable regardless of the bending form. Clip placement can be secured.

続いて図５を参照して他の実施例を説明する。即ち、図５（Ａ）は手元操作部４の回転操作によってシース体２内の芯材３（ワイヤ）の張力を調整して先端処置部５の内視鏡を可変させる公知形態の内視鏡２４が示してあり、図５（Ｂ）はシース体２内に「芯材３に当るリード線２６」を内挿すると共に、このリード線２６の先端に連結したセンサー２７（先端処置部５に当る）を備えたセンサー付ガイドワイヤ２５が示してあり、このいずれものシース体２は前記基本形態の構造に設定されている。 Next, another embodiment will be described with reference to FIG. That is, FIG. 5A shows a known form of endoscope in which the endoscope of the distal treatment section 5 is varied by adjusting the tension of the core material 3 (wire) in the sheath body 2 by rotating the hand operation section 4. In FIG. 5B, a “lead wire 26 that hits the core material 3” is inserted into the sheath body 2, and a sensor 27 connected to the distal end of the lead wire 26 (on the distal treatment section 5). A guide wire 25 with a sensor provided) is shown, and any of the sheath bodies 2 is set to the structure of the basic form.

以上の図５（Ａ）（Ｂ）のものは、シース体２が前記の主たる作用効果を奏する前記基本形態であることから、内視鏡２４は先端処置部５の操作性がシース体２の屈曲形態に影響されないため、屈曲させることのみによる変動・揺動さらに術者の意図に反する作動を生じない特段の高性能にして当該治療性が一段と向上する。そして、センサー付ガイドワイヤ２５は「背景技術のもののコイル線間隙間からの乱流の発生による血圧波不安定波形の防止」「リード線２６断線による画像停止トラブルを防止する」等の特有の従たる作用効果がある。 5 (A) and 5 (B) above are the basic configuration in which the sheath body 2 exhibits the main effects described above, the endoscope 24 has the operability of the distal treatment section 5 of the sheath body 2. Since it is not influenced by the bending form, the therapeutic performance is further improved by a particularly high performance that does not cause fluctuations / oscillations caused only by bending and also does not cause an operation contrary to the operator's intention. The sensor-equipped guide wire 25 is a special subordinate such as “preventing blood pressure wave instability waveform due to turbulent flow from the gap between the coil wires of the background art” and “preventing image stop trouble due to disconnection of the lead wire 26”. Has a working effect.

即ち、背景技術のシース体から成る「センサー付きガイドワイヤ」は、冠動脈閉塞部の術後効果の確認のために血管内へ挿入すると、血管屈曲部による曲げ変形によってリード線２６が引っ張られて断線してセンサー２７の機能を失うトラブルがあり、さらに急激曲げ部位に過大な素線隙間を生じさせて血流を乱流させることがあり、この乱流によって血液波測定が不安定波形を呈して測定性を阻害する不良現象がある。しかし、本発明のシース体から成るものは、素線間隙間の発生がないので、リード線２６への無用な張力が発生せず、以上の従来難点が解消される。 That is, when the “guide wire with sensor” made of the sheath body of the background art is inserted into the blood vessel for confirmation of the postoperative effect of the coronary artery occlusion portion, the lead wire 26 is pulled due to bending deformation by the blood vessel bending portion, and the wire breaks. Then, there is a trouble of losing the function of the sensor 27, and furthermore, an excessively large wire gap is generated in a sudden bending part, and the blood flow may be turbulent. This turbulent flow causes blood wave measurement to show an unstable waveform. There is a defective phenomenon that hinders measurement. However, in the case of the sheath body of the present invention, since there is no generation between the wire gaps, unnecessary tension is not generated on the lead wire 26, and the above conventional problems are solved.

次に図６を参照して他の実施例を説明する。即ち、シース体２を主要部に成す医療用処置具１において、図６（Ａ）のものは前記基本形態から成る先端側ゾーン２Ａと、この先端側ゾーン２Ａに直列連結した中空撚線コイル体から成る手元側ゾーン２Ｃの２ゾーン形態に設定されている。そして図６（Ｂ）のものは、同じく前記基本形態から成る先端側ゾーン２Ａと、中空撚線コイル体から成る中間ゾーン２Ｂと、可撓性の中空管体から成る手元側ゾーン２Ｃが直列連結された３ゾーン形態に設定されている。 Next, another embodiment will be described with reference to FIG. That is, in the medical treatment instrument 1 having the sheath body 2 as a main part, the one shown in FIG. 6A is a distal end side zone 2A having the basic form and a hollow stranded coil body connected in series to the distal end side zone 2A. It is set to the two-zone form of the hand side zone 2C. In FIG. 6B, the tip side zone 2A also comprising the basic configuration, the intermediate zone 2B comprising a hollow stranded coil body, and the hand side zone 2C comprising a flexible hollow tube are connected in series. It is set to a linked three-zone form.

以上の図６のものは下記の特有作用がある。即ち、医療用処置具１は蛇行血管内・消化器管内等の屈曲細管の体腔内に深く挿入するので長さ方向の先柔後剛の傾斜特性にして手元剛性による良好な押込み・回転操作性の確保と、先柔による体腔内への円滑挿入・深部挿入性を図るのが「好ましい一般技術概念」であることから、この図６実施例のものは前記２Ａによる本発明の特有の作用効果と、前記複数ゾーン形態による先柔後剛の一般技術特性が併存付与できる。 The above FIG. 6 has the following specific actions. That is, since the medical treatment instrument 1 is inserted deeply into the body cavity of a bent tubule such as a meandering blood vessel or a digestive tract, it has a slanting characteristic in the longitudinal direction and has good pushing / rotating operability due to the rigidity at hand. 6A and 6B is a “preferable general technical concept” for ensuring smooth insertion and smooth insertion / deep insertion into the body cavity by the tip softness. Therefore, the embodiment of FIG. In addition, the general technical characteristics of the pre-flexible go-go by the multi-zone form can be provided together.

そして、さらに補足すれば図６（Ａ）のものは単条コイル体の場合と異なり中空撚線コイル体を用いる為、先端側への回転伝達力を向上させることができる。この理由は手元側操作部を回転させると、単条コイル体の場合は、一本の線材で回転力を支える構造の為、屈曲部の体腔内壁等との各接点・各部位間毎異なる不均質な捻り溜りが発生しているからである。これに対して、中空撚線コイル体は、多数本の素線を用いている為、各素線が中空撚線コイル体の中心軸側へ傾斜していて、この傾斜角が単条コイル体の場合より「大」となっている為、先端側へよりスムーズな回転力を伝えることができる。 And if it supplements further, since the thing of FIG. 6 (A) uses a hollow stranded wire coil body unlike the case of a single strip coil body, the rotational transmission force to the front end side can be improved. The reason for this is that when the proximal side operation part is rotated, in the case of a single-strand coil body, the structure that supports the rotational force with a single wire, the contact between the bent part and the body cavity inner wall, etc. This is because a homogeneous twist pool has occurred. On the other hand, since the hollow stranded coil body uses a large number of strands, each strand is inclined toward the central axis side of the hollow stranded coil body, and this inclination angle is a single coil body. Since it is “larger” than the case of, a smoother rotational force can be transmitted to the tip side.

また、ここで用いる中空撚線コイル体は、ロープ撚線機による撚合形態が望ましい。その理由は、撚合と同時に素線全周に加工変質層（硬化層）を形成することにより、中空撚線コイル体を全長にわたって均質化できるからである（多条線のマンドレル巻き付け工法では、多条巻回単位毎隙間が発生しやすい）。そして、図６（Ｂ）のものは中空管体からなる為、さらに、手元側回転力を先端側へ伝え易くなり、体腔内等の屈曲形態に対応した傾斜機能を有する構造体である。 The hollow stranded wire coil body used here is preferably in a twisted form by a rope stranded wire machine. The reason is that by forming a work-affected layer (cured layer) on the entire circumference of the strand simultaneously with twisting, the hollow stranded coil body can be homogenized over the entire length (in the multi-strand mandrel winding method, Multiple gaps are likely to occur in multiple winding units). And since the thing of FIG. 6 (B) consists of a hollow tube body, it becomes a structure which becomes easy to transmit a hand side rotational force to a front end side, and has the inclination function corresponding to bending forms, such as a body cavity.

なお補足すれば、前記多ゾーン形態に用いる中空撚線コイル体は、多数本の素線をロープ撚線機を用いてロープ状に撚り合せて、中心材を抜いた中空形態、または、多数の素線を中空状に撚合構成した形態が好ましく、この形態のものはロープ撚線機による「波付け・形付け時の治具を通過させることによって線材全周に加工変質層（硬化層）」が形成される。そして、前記のゾーン連結は「ロー付・溶接・管ピースによるかしめ」等の工法による。 If supplemented, the hollow stranded coil body used in the multi-zone configuration is a hollow configuration in which a large number of strands are twisted into a rope shape using a rope twisting machine, and the central member is removed, or a large number A form in which the strands are twisted in a hollow shape is preferable, and this form is “processed alteration layer (cured layer) on the entire circumference of the wire by passing a jig for corrugation and shaping with a rope twisting machine” Is formed. The zone connection is performed by a method such as “brazing / welding / caulking by pipe piece”.

そして、中空撚線コイル体の実施例として、線径０．３３ｍｍのステンレス鋼線材（オーステナイト系）を例えば１２本撚合して、コイル体外径が１．６ｍｍとなる構成とする。又、線径０．３３ｍｍの構成が、直径０．１１ｍｍの素線を７本撚合した構成としてもよい。そして、ステンレス鋼線材と超弾性特性を有するニッケル−チタン合金線材の混合撚線又はいずれか一方とした撚合構成を用いてもよい。そして、中空管体の使用材質は、ステンレス鋼線材又は前記ニッケル・チタン合金線材いずれを用いてもよい。さらに、本発明に用いる異形複素線は、直径０．３ｍｍの円弧外周素線と、底辺が０．３５ｍｍ高さが０．３ｍｍ二等辺斜辺素線を用い、又、使用材質はステンレス鋼線材を用い、コイル成形加工を容易にする為、二種の線材の一方を熱処理により軟材質（引張り強さが８０〜１２０Ｋｇｆ／ｍｍ^２）として、硬質材（引張り強さが１８０〜３００Ｋｇｆ／ｍｍ^２）との組合せを用いた構造としてもよい。又、形状記憶特性を有する前記ニッケル−チタン合金線材を用いてもよい。 As an example of a hollow stranded wire coil body, for example, 12 stainless steel wire rods (austenite type) having a wire diameter of 0.33 mm are twisted so that the outer diameter of the coil body becomes 1.6 mm. Further, the configuration having a wire diameter of 0.33 mm may be a configuration in which seven strands having a diameter of 0.11 mm are twisted. And you may use the twisted structure made into the mixed stranded wire of the stainless steel wire and the nickel-titanium alloy wire which has a superelastic characteristic, or any one. The material used for the hollow tube may be a stainless steel wire or the nickel / titanium alloy wire. Furthermore, the deformed complex wire used in the present invention is an arc outer peripheral wire with a diameter of 0.3 mm, an isosceles strand with a base of 0.35 mm and a height of 0.3 mm, and the material used is a stainless steel wire. In order to facilitate the coil forming process, one of the two types of wire is softened by heat treatment (tensile strength is 80 to 120 kgf / mm ² ) and hard material (tensile strength is 180 to 300 kgf / mm ² ). It is good also as a structure using the combination. Moreover, you may use the said nickel-titanium alloy wire which has a shape memory characteristic.

本発明の医療用処置具のシース体の基本形態を示し、（Ａ）はその全体正面図、（Ｂ）はそのシース体の構造説明図、（Ｃ）はシース体の素線の形状説明図The basic form of the sheath body of the medical treatment tool of this invention is shown, (A) is the whole front view, (B) is the structure explanatory drawing of the sheath body, (C) is the shape explanatory drawing of the strand of a sheath body 図１の基本形態のシース体と背景技術のシース体の作用対比の説明にして、（Ａ）（Ｂ）はその曲げ形態説明図、（Ｃ）（Ｄ）はその特有作用の説明図1A and 1B are explanatory views of the bending form, and FIGS. 1C and 1D are explanatory views of the specific action. 本発明１実施例の医療用処置具を示し、（Ａ）（Ｂ）とはその正面図1 shows a medical treatment instrument according to an embodiment of the present invention, and (A) and (B) are front views thereof. 本発明１実施例の医療用処置具を示し、（Ａ）（Ｂ）はその正面図、（Ｃ）は作用説明図The medical treatment tool of this invention 1 example is shown, (A) (B) is the front view, (C) is action explanatory drawing. 本発明１実施例の医療用処置具を示し、（Ａ）（Ｂ）はその正面図1 shows a medical treatment instrument according to an embodiment of the present invention, and (A) and (B) are front views thereof. 本発明１実施例の医療用処置具を示し、（Ａ）（Ｂ）はその部分正面図1 shows a medical treatment instrument according to an embodiment of the present invention, and (A) and (B) are partial front views thereof.

符号の説明Explanation of symbols

１医療用処置具
２シース体
３芯材
４手元操作部
５先端処置部
６コイル中心線
７先細２等辺斜辺素線
８円弧外周素線
１２生検カップ
１３ループ部
１４クリップ
２０内視鏡用処置具
２１内視鏡用生検鉗子
２２内視鏡用処置具
２３多機能外科用器具
２４内視鏡
２５センサー付ガイドワイヤ
３０背景技術のシース体
Ｃ空隙
Ｆ被覆
DESCRIPTION OF SYMBOLS 1 Medical treatment tool 2 Sheath body 3 Core material 4 Hand operation part 5 Tip treatment part 6 Coil centerline 7 Tapered isosceles hypotenuse element 8 Arc outer periphery strand 12 Biopsy cup 13 Loop part 14 Clip 20 Endoscope treatment Tool 21 Endoscopic biopsy forceps 22 Endoscopic treatment tool 23 Multi-function surgical instrument 24 Endoscope 25 Sensor-equipped guide wire 30 Background art sheath body C Cavity F Covering

Claims

前端の先端処置部と後端の手元操作部を備え、かつ該先端処置部と該手元操作部を連結した操作用芯材を貫挿した細長可撓性の密着巻きコイル体のシース体から成る医療用処置具において、前記シース体が、先細２等辺斜辺素線と円弧外周素線の組合せにして、曲げ外力によって相互接合縁を前記コイル体の径方向に相対滑り自在にした異形複素線コイルから成る構造を特徴とする医療用処置具。 It comprises a sheath body of an elongated flexible close-wound coil body having a front end treatment section and a rear end hand operation section, and through which an operation core material connecting the front treatment section and the hand operation section is inserted. In the medical treatment instrument, the deformed complex wire coil in which the sheath body is a combination of a tapered isosceles hypotenuse element wire and an arc outer periphery element wire, and the mutual joining edge is relatively slidable in the radial direction of the coil body by a bending external force A medical treatment tool characterized by a structure comprising:

先細２等辺斜辺素線が、凹円弧等辺の２等辺３角形線から成る請求項１に記載の医療用処置具。 The medical treatment instrument according to claim 1, wherein the tapered isosceles hypotenuse element wire is an isosceles triangle line of an equilateral concave arc.

円弧外周素線が、弦をコイル中心線と平行に成す切欠円形線から成る請求項１に記載の医療用処置具。 The medical treatment instrument according to claim 1, wherein the arc outer peripheral wire is formed of a notched circular line in which a chord is formed in parallel with the coil center line.

請求項１〜請求項３のいずれかのシース体から成り、手元操作部による芯材のプッシュ・プル操作によって、先端処置部の生検カップを開閉作動させる生体組織採取構造の内視鏡用処置具・内視鏡用生検鉗子の医療用処置具。 Endoscopic treatment of a biological tissue collection structure comprising the sheath body according to any one of claims 1 to 3, wherein the biopsy cup of the distal treatment section is opened and closed by a push / pull operation of a core material by a hand operation section. Medical treatment instrument for biopsy forceps for endoscopes and endoscopes.

請求項１〜請求項３のいずれかのシース体から成り、手元操作部による芯材のプル操作によって、先端処置部の生体組織緊縛用ループ部を縮径作動させる内視鏡用処置具構造の医療用処置具。 An endoscopic treatment instrument structure comprising the sheath body according to any one of claims 1 to 3, wherein the core tissue pulling operation of the distal treatment section is reduced in diameter by pulling the core material by a hand operation section. Medical treatment tool.

請求項１〜請求項３のいずれかのシース体から成り、手元操作部による芯材のプル操作によって先端処置部のクリップを生体組織へ留置させる多機能外科用器具構造の医療用処置具。 A medical treatment instrument having a multifunctional surgical instrument structure comprising the sheath body according to any one of claims 1 to 3, wherein a clip of a distal treatment section is placed in a living tissue by a pulling operation of a core material by a hand operation section.

請求項１〜請求項３のいずれかのシース体から成り、手元操作部による芯材ワイヤの回転操作によって該ワイヤの張力を調整して先端処置部を可変作動させる形態の内視鏡構造の医療用処置具。 A medical treatment of an endoscope structure comprising the sheath body according to any one of claims 1 to 3, wherein the distal end treatment portion is variably operated by adjusting the tension of the wire by a rotating operation of the core material wire by the hand operation portion. Treatment tool.

請求項１〜請求項３のいずれかのシース体から成り、該シース体のコイル体内にセンサーを内蔵したセンサー付きガイドワイヤ構造の医療用処置具。 A medical treatment instrument having a guide wire structure with a sensor, comprising the sheath body according to any one of claims 1 to 3, wherein a sensor is incorporated in a coil body of the sheath body.

シース体が、請求項１〜請求項３のいずれかの異形複素線コイル部から成る先端側ゾーンと、該先端側ゾーンに直列連結した中空撚線コイル体から成る手元側ゾーンから成る２ゾーン形態の医療用処置具。 A two-zone configuration in which the sheath body is composed of a distal-side zone comprising the deformed complex wire coil portion of any one of claims 1 to 3 and a proximal-side zone comprising a hollow stranded coil body connected in series to the distal-side zone. Medical treatment tool.

シース体が、請求項１〜請求項３のいずれかの異形複素線コイル部から成る先端側ゾーンと、該先端側ゾーンに直列連結した中空撚線コイル体から成る中間ゾーンと、該中間ゾーンに直列連結した中空管体から成る手元側ゾーンから成る３ゾーン形態の医療用処置具。
A sheath body comprises a distal end side zone comprising the deformed complex wire coil portion according to any one of claims 1 to 3, an intermediate zone comprising a hollow stranded coil body connected in series to the distal end side zone, and an intermediate zone. A medical treatment instrument in a three-zone configuration comprising a proximal zone comprising hollow tubes connected in series.