JP7300174B2 - endoscopic instrument - Google Patents

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JP7300174B2
JP7300174B2 JP2019214899A JP2019214899A JP7300174B2 JP 7300174 B2 JP7300174 B2 JP 7300174B2 JP 2019214899 A JP2019214899 A JP 2019214899A JP 2019214899 A JP2019214899 A JP 2019214899A JP 7300174 B2 JP7300174 B2 JP 7300174B2
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寿雄 桑井
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National Hospital Organization
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本発明は、内視鏡処置具に関する。 The present invention relates to an endoscope treatment instrument.

内視鏡治療後出血に対する予防対策として粘膜欠損部に対するクリップ縫縮が多くの施設で行われている。やや大きめの粘膜欠損の場合は、端からファスナーを上げるようにクリップを順にかけていくことにより縫縮が可能である。しかしながらかなり大きめの粘膜欠損の場合には通常のクリップのみで縫縮することは困難である。 As a preventive measure against bleeding after endoscopic treatment, clip suturing of mucosal defects is performed at many facilities. In the case of a slightly larger mucosal defect, suturing is possible by sequentially applying clips as if lifting the fastener from the edge. However, it is difficult to suture a fairly large mucosal defect with a normal clip alone.

かなり大きめの粘膜欠損の場合の処置方法として、例えばHold-and-drag閉鎖術がある。この方法はクリップ状把持具にて粘膜欠損の健常粘膜を軽く把持する。そして把持したまま対側まで引き寄せた後に、引き寄せた粘膜をクリップ片側のアームにかけたままクリップをわずかに開いて、対側粘膜も含めて再度把持する手法である。しかしながら引き寄せた粘膜が外れてしまう場合があり、かかる場合は繰り返して掴み直しをトライする必要がある。 Treatment methods for fairly large mucosal defects include, for example, hold-and-drag closure. In this method, the healthy mucosa with mucosal defect is lightly gripped with a clip-shaped gripper. Then, after pulling the mucous membrane to the contralateral side while holding it, the clip is slightly opened while the pulled mucous membrane is hung on the arm on one side of the clip, and the mucous membrane on the contralateral side is gripped again. However, the pulled mucous membrane may come off, and in such a case, it is necessary to repeatedly try to grasp it again.

内視鏡治療後の縫縮術のコツ,西澤俊宏,Gastroenterological Endoscopyvol.59(6),Jun 2017.Tips for suturing after endoscopic treatment, Toshihiro Nishizawa, Gastroenterological Endoscopyvol.59(6), Jun 2017.

本発明はかかる問題点に鑑みてなされたものであって、大きめの粘膜欠損部であっても簡易且つ確実に縫縮することができる内視鏡処置具を提供することを目的とする。 SUMMARY OF THE INVENTION It is an object of the present invention to provide an endoscopic instrument capable of easily and reliably suturing even a large mucosal defect.

本発明にかかる内視鏡処置具は、内視鏡のチャネル内に挿入可能なチューブ状のシース(10)と、前記シース(10)に挿通された駆動ワイヤ(11)と、前記駆動ワイヤ(11)の遠位端に取り付けられた第１外刃(21)、第２外刃(22)、及び、中刃(23)と、を有し、前記第２外刃(22)は弾性体からなり、前記第２外刃(22)は前記第１外刃(21)に対して付勢力により先端に行くに従って略Ｖ状に開脚しており、前記第１外刃(21)及び前記中刃(23)は開閉可能な一対の第１把持片であり、前記駆動ワイヤ(11)を前記シース(10)に対して遠位側にスライドさせることにより前記第１外刃(21)及び中刃(23)を開き、前記駆動ワイヤ(11)を前記シース(10)に対して近位側にスライドさせることにより前記第１外刃(21)及び中刃(23)を閉じる開閉部(30)と、を備え、前記第１外刃(21)及び前記第２外刃(22)は開閉可能な一対の第２把持片であり、前記駆動ワイヤ(11)を前記シース(10)に対して遠位端側にスライドさせることにより前記シース(10)の遠位端から突出して第１外刃(21)及び第２外刃(22)を開き、前記駆動ワイヤ(11)を前記シース(10)に対して近位端側にスライドさせることにより前記シース(10)内に埋没して第１外刃(21)及び第２外刃(22)を閉じる、ことを特徴とする。 The endoscopic treatment instrument according to the present invention comprises a tubular sheath (10) that can be inserted into a channel of an endoscope, a drive wire (11) inserted through the sheath (10), and the drive wire ( 11) has a first outer blade (21), a second outer blade (22), and a middle blade (23) attached to the distal end of the second outer blade (22), wherein the second outer blade (22) is an elastic body The second outer cutter (22) is opened in a substantially V-shape toward the tip by a biasing force against the first outer cutter (21), and the first outer cutter (21) and the The middle blade (23) is a pair of first gripping pieces that can be opened and closed, and by sliding the drive wire (11) distally with respect to the sheath (10), the first outer blade (21) and An opening/closing part ( 30), wherein the first outer cutter (21) and the second outer cutter (22) are a pair of second gripping pieces that can be opened and closed, and the drive wire (11) is attached to the sheath (10). The first outer blade (21) and the second outer blade (22) protrude from the distal end of the sheath (10) by sliding to the distal end side with respect to the sheath (10) to open the drive wire (11). It is characterized by being buried in the sheath (10) and closing the first outer cutter (21) and the second outer cutter (22) by sliding it to the proximal end side with respect to (10).

本発明によれば、大きめの粘膜欠損部であっても簡易且つ確実に縫縮することができる。 According to the present invention, even a large mucosal defect can be sutured easily and reliably.

菱形リンク機構にて第１把持片を開閉する第１実施形態にかかる内視鏡処置具を説明する図であって、第１外刃、第２外刃、及び、中刃が開いている状態を説明する図である。FIG. 10 is a view for explaining the endoscopic treatment instrument according to the first embodiment that opens and closes the first gripping piece with a diamond-shaped link mechanism, showing a state in which the first outer blade, the second outer blade, and the middle blade are open; It is a figure explaining. 菱形リンク機構にて第１把持片を開閉する第１実施形態にかかる内視鏡処置具を説明する図であって、第１外刃と中刃とが閉じている状態を説明する図である。FIG. 4B is a view for explaining the endoscope treatment instrument according to the first embodiment in which the first gripping piece is opened and closed by the rhomboidal link mechanism, and is a view for explaining a state in which the first outer blade and the middle blade are closed; . 菱形リンク機構にて第１把持片を開閉する第１実施形態にかかる内視鏡処置具を説明する図であって、第１外刃と中刃とが閉じており、且つ、第１外刃と第２外刃とが閉じている状態を説明する図である。FIG. 10 is a view for explaining the endoscope treatment instrument according to the first embodiment that opens and closes the first gripping piece with a diamond-shaped link mechanism, in which the first outer blade and the middle blade are closed and the first outer blade is closed; and the second outer cutter are closed. 菱形リンク機構にて第１把持片を開閉する第１実施形態にかかる内視鏡処置具の使用態様を説明する図であって、そのうち(a)は粘膜欠損を把持する前の状態を説明する図であり、(b)は第１外刃と中刃とが閉じて粘膜欠損の一端を軽く把持した状態を説明する図であり、(c)は第１外刃と第２外刃とが閉じて粘膜欠損の一端側と他端側とを強固に把持した状態を説明する図である。FIG. 10A is a view for explaining the mode of use of the endoscopic treatment instrument according to the first embodiment in which the first gripping piece is opened and closed by a rhomboidal link mechanism, of which (a) is for explaining the state before gripping a mucosal defect (b) is a diagram for explaining a state in which the first outer cutter and the middle cutter are closed and one end of the mucosal defect is lightly gripped; FIG. 10 is a diagram illustrating a state in which one end side and the other end side of the mucosal defect are closed and firmly grasped; シュート機構にて第１把持片を開閉する第２実施形態にかかる内視鏡処置具を説明する図であって、第１外刃、第２外刃、及び、中刃が開いている状態を説明する図である。FIG. 10 is a view for explaining the endoscope treatment instrument according to the second embodiment that opens and closes the first gripping piece by means of a chute mechanism, showing a state in which the first outer blade, the second outer blade, and the middle blade are open; It is a figure explaining. シュート機構にて第１把持片を開閉する第２実施形態にかかる内視鏡処置具を説明する図であって、第１外刃と中刃とが閉じている状態を説明する図である。FIG. 10 is a diagram for explaining the endoscope treatment instrument according to the second embodiment in which the first gripping piece is opened and closed by the chute mechanism, and is a diagram for explaining a state in which the first outer blade and the middle blade are closed; シュート機構にて第１把持片を開閉する第２実施形態にかかる内視鏡処置具を説明する図であって、第１外刃と中刃とが閉じており、且つ、第１外刃と第２外刃とが閉じている状態を説明する図である。FIG. 10 is a view for explaining the endoscope treatment instrument according to the second embodiment that opens and closes the first gripping piece by the chute mechanism, the first outer blade and the middle blade are closed, and the first outer blade and the middle blade are closed; It is a figure explaining the state where the 2nd outer cutter is closed. シュート機構にて第１把持片を開閉する第２実施形態にかかる内視鏡処置具の使用態様を説明する図であって、そのうち(a)は粘膜欠損を把持する前の状態を説明する図であり、(b)は第１外刃と中刃とが閉じて粘膜欠損の一端を軽く把持した状態を説明する図であり、(c)は第１外刃と第２外刃とが閉じて粘膜欠損の一端側と他端側とを強固に把持した状態を説明する図である。FIG. 10A is a view for explaining a state before grasping a mucosal defect; FIG. (b) is a diagram for explaining a state in which the first outer cutter and the middle cutter are closed and one end of the mucosal defect is lightly grasped, and (c) is a diagram in which the first outer cutter and the second outer cutter are closed. FIG. 10 is a view for explaining a state in which one end side and the other end side of a mucosal defect are firmly grasped.

以下、添付の図面を参照して本発明の実施形態について具体的に説明するが、当該実施形態は本発明の原理の理解を容易にするためのものであり、本発明の範囲は、下記の実施形態に限られるものではなく、当業者が以下の実施形態の構成を適宜置換した他の実施形態も、本発明の範囲に含まれる。 Hereinafter, embodiments of the present invention will be described in detail with reference to the accompanying drawings. The embodiments are intended to facilitate understanding of the principles of the present invention, and the scope of the present invention is as follows. The scope of the present invention is not limited to the embodiments, and other embodiments in which the configurations of the following embodiments are appropriately replaced by those skilled in the art are also included in the scope of the present invention.

(1)第１実施形態
図１は本発明にかかる内視鏡処置具(900)の概略を説明する図である。図１に示されるように、本発明にかかる内視鏡処置具(900)は、内視鏡のチャネル内に挿入可能なチューブ状の可撓性を有するシース(10)と、シース(10)に挿通された駆動ワイヤ(11)と、駆動ワイヤ(11)の遠位端に取り付けられた第１外刃(21)、第２外刃(22)、及び、中刃(23)を有する。 (1) First Embodiment FIG. 1 is a diagram for explaining the outline of an endoscope treatment instrument (900) according to the present invention. As shown in FIG. 1, an endoscopic treatment instrument (900) according to the present invention includes a tubular flexible sheath (10) that can be inserted into a channel of an endoscope, and a and a first outer blade (21), a second outer blade (22) and a middle blade (23) attached to the distal end of the drive wire (11).

第１外刃(21)及び中刃(23)は開閉可能な一対の第１把持片であり、例えば内視鏡的粘膜下層剥離術(ESD;endoscopic submucosal dissection)後の潰瘍部の粘膜を把持することができる。開閉部(30)は略菱形のリンク機構であり、駆動ワイヤ(11)をシース(10)に対して遠位側にスライドさせることにより第１外刃(21)及び中刃(23)が開き、一方、駆動ワイヤ(11)をシース(10)に対して近位側にスライドさせることにより第１外刃(21)及び中刃(23)が閉じる。第１外刃(21)及び第２外刃(22)の長さは同じであり、中刃(23)の長さは第１外刃(21)及び第２外刃(22)の長さよりも短い。 The first outer blade (21) and the middle blade (23) are a pair of first gripping pieces that can be opened and closed, and grip the mucous membrane of an ulcer after, for example, endoscopic submucosal dissection (ESD). can do. The opening/closing part (30) is a substantially diamond-shaped link mechanism, and by sliding the driving wire (11) distally with respect to the sheath (10), the first outer blade (21) and the middle blade (23) are opened. Meanwhile, the drive wire (11) is slid proximally relative to the sheath (10) to close the first outer blade (21) and the middle blade (23). The first outer cutter (21) and the second outer cutter (22) have the same length, and the middle cutter (23) is longer than the first outer cutter (21) and the second outer cutter (22). is also short.

具体的には、開閉部(30)は、第１把持片を揺動可能に支持するブラケット(33)と、ブラケット(33)に設けられた第１揺動軸(31)と、前記第１外刃(21)の末端部と前記第１揺動軸(31)とを接続する第１脚部(34)と、前記中刃(23)の末端部と前記第１揺動軸(31)とを接続する第２脚部(35)と、前記第１外刃(21)と前記中刃(23)と貫通して揺動可能に支持する第２揺動軸(32)とを備える。 Specifically, the opening/closing part (30) includes a bracket (33) that swingably supports the first gripping piece, a first swing shaft (31) provided on the bracket (33), and the first swing shaft (31). A first leg (34) connecting the distal end of the outer blade (21) and the first swing shaft (31); the distal end of the middle blade (23) and the first swing shaft (31); and a second swing shaft (32) penetrating through the first outer blade (21) and the middle blade (23) to swingably support them.

図示しない内視鏡ハンドル部を操作して駆動ワイヤ(11)を遠位端側に移動させると押圧力がブラケット(33)を介してリンク機構である開閉部(30)に伝達され、このリンク機構の作動により第１鉗子片が開かれるようになっている。 When the endoscope handle portion (not shown) is operated to move the drive wire (11) to the distal end side, the pressing force is transmitted to the opening/closing portion (30), which is a link mechanism, through the bracket (33). Actuation of the mechanism opens the first forceps piece.

図２は本発明にかかる内視鏡処置具(900)の概略を説明する図であって、第１外刃(21)及び中刃(23)からなる第１把持片が閉じている状態を説明する図である。図示しない内視鏡ハンドル部を操作して駆動ワイヤ(11)を近位側に移動させると、牽引力がブランケット(33)を介してリンク機構である開閉部(30)に伝達され、リンク機構の作動により第１鉗子片が閉じられる。 FIG. 2 is a diagram for explaining the outline of the endoscopic treatment instrument (900) according to the present invention, showing a state in which the first gripping piece consisting of the first outer blade (21) and the middle blade (23) is closed. It is a figure explaining. When the endoscope handle portion (not shown) is operated to move the drive wire (11) to the proximal side, the pulling force is transmitted to the opening/closing portion (30), which is the link mechanism, through the blanket (33), thereby opening the link mechanism. Actuation closes the first forceps piece.

第２外刃(22)は例えば金属製の弾性体からなり、第２外刃(22)は第１外刃(21)に対して付勢力により先端に行くに従って略Ｖ状に開脚している。第１外刃(21)及び第２外刃(22)は開閉可能な一対の第２把持片であり、駆動ワイヤ(11)をシース(10)に対して遠位端側にスライドさせることによりシース(10)の遠位端から突出して第１外刃(21)及び第２外刃(22)を開き、一方、駆動ワイヤ(11)をシース(10)に対して近位端側にスライドさせることによりシース(10)内に埋没して第１外刃(21)及び第２外刃(22)が閉じる。 The second outer cutter (22) is made of, for example, a metal elastic body, and the second outer cutter (22) spreads in a substantially V-shape as it goes toward the tip by a biasing force against the first outer cutter (21). there is The first outer cutter (21) and the second outer cutter (22) are a pair of second gripping pieces that can be opened and closed. Protrudes from the distal end of the sheath (10) to open the first outer blade (21) and the second outer blade (22), while the drive wire (11) slides to the proximal end side with respect to the sheath (10). As a result, the first outer cutter (21) and the second outer cutter (22) are closed by being buried in the sheath (10).

図３は本発明にかかる内視鏡処置具900の概略を説明する図であって、第１外刃(21)及び中刃(23)からなる第１把持片が閉じており、且つ、第１外刃(21)及び第２外刃(22)からなる第２把持片も閉じている状態を説明する図である。第１把持片が閉じている状態で、更に、図示しない内視鏡ハンドル部を操作して駆動ワイヤ(11)を近位側に移動させると、略Ｖ状に開脚している第２把持片がシース(10)内に埋没して第１外刃(21)及び第２外刃(22)が閉じる。 FIG. 3 is a diagram for explaining the outline of an endoscope treatment instrument 900 according to the present invention, in which the first gripping piece consisting of the first outer blade (21) and the middle blade (23) is closed and the first gripping piece is closed. FIG. 10 is a diagram illustrating a state in which the second gripping piece consisting of the first outer cutter (21) and the second outer cutter (22) is also closed. When the endoscope handle portion (not shown) is operated to move the drive wire (11) to the proximal side while the first gripping piece is closed, the second gripping piece which is open in a substantially V shape is opened. The first outer cutter (21) and the second outer cutter (22) are closed by embedding the piece in the sheath (10).

次に第１実施形態にかかる内視鏡処置具(900)の使用態様について説明する。 Next, the mode of use of the endoscopic treatment instrument (900) according to the first embodiment will be described.

内視鏡的粘膜切除術(Endoscopic mucosal resection:EMR)は内視鏡を用いて筋層以下（粘膜下層の奥）に障害を与えずに、粘膜下層の深さで粘膜層を広く切除し、組織を回収する技術である。EMR後の粘膜欠損に対するクリップを用いた内視鏡的縫縮術は術後遅発性出血の予防に有用であるが、大きめの粘膜欠損の場合はクリップによる縫縮が困難となる虞がある。 Endoscopic mucosal resection (EMR) uses an endoscope to widely excise the mucosal layer at the depth of the submucosa without damaging the muscle layer (back of the submucosa), It is a technique for recovering tissues. Endoscopic closure using clips for mucosal defects after EMR is useful for preventing postoperative delayed bleeding, but in the case of large mucosal defects, clip closure may be difficult. .

ESDは、腫瘍径に関わらず腫瘍の一括切除が可能であり、従来の内視鏡治療では切除困難であった腫瘍に対しても内視鏡での低侵襲な治療が可能となる。ESD後の切除後潰瘍底は剥き出しの状態で術後経過観察されることがあり、粘膜が欠損した状態の潰瘍底は術後の腹痛や発熱の原因の一つになる場合がある。ESD後の術後潰瘍底に対してのクリップ閉鎖では大きめの粘膜欠損の場合、術後潰瘍底の適切な閉鎖が困難となる虞がある。 ESD enables en bloc resection of tumors regardless of tumor size, and enables minimally invasive endoscopic treatment of tumors that were difficult to resect with conventional endoscopic treatment. The ulcer floor after resection after ESD may be observed in a bare state after surgery, and the ulcer floor with mucous membrane defect may be one of the causes of postoperative abdominal pain and fever. In the case of large mucosal defects, it may be difficult to adequately close the postoperative ulcer bed with clip closure after ESD.

上述のようなEMR又はESD後の大きめの粘膜欠損の場合であっても、本実施形態にかかる内視鏡処置具を使用する下記に示す手順により適切な閉鎖が可能となる。 Even in the case of a large mucosal defect after EMR or ESD as described above, appropriate closure can be achieved by the procedure described below using the endoscopic treatment instrument according to the present embodiment.

図４(a)に示されるように、例えば開口面が略楕円形の粘膜欠損部(44)がある場合、駆動ワイヤ(11)をシース(10)に対して近位側にスライドさせることにより第１外刃(21)及び中刃(23)が閉じることで粘膜欠損部の一端を軽く把持する。即ち、一回目の把持は、第１外刃(21)及び中刃(23)が閉じることによる粘膜欠損部の一端側の把持である。 As shown in FIG. 4( a ), for example, when there is a mucosal defect ( 44 ) with a substantially elliptical opening surface, by sliding the drive wire ( 11 ) proximally with respect to the sheath ( 10 ), By closing the first outer blade (21) and the middle blade (23), one end of the mucosal defect is lightly grasped. That is, the first gripping is gripping of one end side of the mucosal defect by closing the first outer cutter (21) and the middle cutter (23).

次に図４(b)に示されるように、第１外刃(21)及び中刃(23)が閉じて粘膜欠損部の一端を軽く把持した状態にて、粘膜欠損部の他端側へ移動させる。 Next, as shown in FIG. 4(b), the first outer blade (21) and the middle blade (23) are closed to lightly grip one end of the mucosal defect, and then the blade is moved toward the other end of the mucosal defect. move.

次に図４(c)に示されるように、第１把持片が閉じている状態から、更に、駆動ワイヤ11を近位側に移動させると、略Ｖ状に開脚している第２把持片がシース(10)内に埋没して第１外刃(21)及び第２外刃(22)が閉じて、粘膜欠損部の一端側と他端側とを把持する。即ち、二回目の把持は、第１外刃(21)及び第２外刃(22)が閉じることによる粘膜欠損部の一端側と他端側との把持である。 Next, as shown in FIG. 4(c), when the drive wire 11 is further moved to the proximal side from the state in which the first gripping piece is closed, the second gripping piece which is open in a substantially V shape is opened. The piece is buried in the sheath (10) and the first outer cutter (21) and the second outer cutter (22) are closed to grasp one end and the other end of the mucosal defect. That is, the second grasping is grasping of one end side and the other end side of the mucosal defect by closing the first outer cutter (21) and the second outer cutter (22).

これによりかなり大きめの粘膜欠損の場合であっても、引き寄せた粘膜欠損部の一端側が外れることなく簡易且つ確実に縫縮することができる。 As a result, even in the case of a fairly large mucosal defect, one end side of the drawn mucosal defect can be easily and reliably sutured without coming off.

(2)第２実施形態
図５は本発明にかかる内視鏡処置具(910)の概略を説明する図である。図５に示されるように、本発明にかかる内視鏡処置具(910)は、内視鏡のチャネル内に挿入可能なチューブ状のシース(50)と、シース(50)に挿通された駆動ワイヤ(51)と、駆動ワイヤ(51)の遠位端に取り付けられた第１外刃(61)、第２外刃(62)、及び、中刃(63)を有する。第１外刃(61)及び第２外刃(62)の長さは同じであり、中刃(63)の長さは第１外刃(61)及び第２外刃(62)の長さよりも短い。 (2) Second Embodiment FIG. 5 is a diagram for explaining the outline of an endoscope treatment instrument (910) according to the present invention. As shown in FIG. 5, the endoscopic treatment instrument (910) according to the present invention includes a tubular sheath (50) that can be inserted into a channel of an endoscope, and a drive tube that is inserted through the sheath (50). It has a wire (51) and a first outer blade (61), a second outer blade (62) and a middle blade (63) attached to the distal end of the drive wire (51). The first outer cutter (61) and the second outer cutter (62) have the same length, and the middle cutter (63) is longer than the first outer cutter (61) and the second outer cutter (62). is also short.

第１外刃(61)及び中刃(63)は開閉可能な一対の第１把持片であり、例えば内視鏡的粘膜下層剥離術後の潰瘍部の粘膜を把持することができる。開閉部(60)は、第１把持片のそれぞれの刃に設けられたシュート内を貫通した固定ピンが往復運動することで第１把持片が開閉するシュート機構であり、駆動ワイヤ(51)をシース(50)に対して遠位側にスライドさせることにより第１外刃(61)及び中刃(63)を開き、駆動ワイヤ(51)をシース(50)に対して近位側にスライドさせることにより第１外刃(61)及び中刃(63)が閉じる。 The first outer blade (61) and the middle blade (63) are a pair of first gripping pieces that can be opened and closed, and can grip the mucous membrane of an ulcer after endoscopic submucosal dissection, for example. The opening/closing part (60) is a chute mechanism that opens and closes the first gripping piece by reciprocating a fixed pin passing through a chute provided on each blade of the first gripping piece. The first outer blade (61) and middle blade (63) are opened by sliding distally relative to the sheath (50), and the drive wire (51) is slid proximally relative to the sheath (50). As a result, the first outer blade (61) and the middle blade (63) are closed.

具体的には、開閉部(60)は、第１外刃(61)及び中刃(63)の末端を接続する可動ピン(73)と、第１外刃(61)及び中刃(63)の中部にそれぞれ設けられたシュート(61s,63s)と、シュート(61s,63s)を貫通する固定ピン(72)と、を有する。 Specifically, the opening/closing part (60) includes a movable pin (73) connecting the ends of the first outer blade (61) and the middle blade (63), and the first outer blade (61) and the middle blade (63). chutes (61s, 63s) respectively provided in the middle of the chutes (61s, 63s), and a fixing pin (72) passing through the chutes (61s, 63s).

図示しない内視鏡ハンドル部を操作して駆動ワイヤ(51)を遠位端側に移動させると押圧力が可動ピン(73)に伝達され、固定ピン(72)が第１外刃(61)及び中刃(63)の中部にそれぞれ設けられたシュート(61s,63s)内を近位側に移動することで第１鉗子片が開かれるようになっている。 When the endoscope handle (not shown) is operated to move the drive wire (51) to the distal end side, the pressing force is transmitted to the movable pin (73), and the fixed pin (72) is moved to the first outer blade (61). The first forceps piece is opened by moving proximally in chutes (61s, 63s) respectively provided in the center of the middle blade (63).

図６は本発明にかかる内視鏡処置具(910)の概略を説明する図であって、第１外刃(61)及び中刃(63)からなる第１把持片が閉じている状態を説明する図である。図示しない内視鏡ハンドル部を操作して駆動ワイヤ(51)を近位側に移動させると、牽引力が可動ピン(73)を介してシュート機構である開閉部(60)に伝達され、固定ピン(72)が第１外刃(61)及び中刃(63)の中部にそれぞれ設けられたシュート(61s,63s)内を遠位側に移動することで第１鉗子片が閉じられる。 FIG. 6 is a diagram for explaining the outline of the endoscopic treatment instrument (910) according to the present invention, showing a state in which the first gripping piece consisting of the first outer blade (61) and the middle blade (63) is closed. It is a figure explaining. When the endoscope handle (not shown) is operated to move the drive wire (51) to the proximal side, the pulling force is transmitted to the chute mechanism (60) through the movable pin (73), and the fixed pin The first forceps piece is closed by moving the (72) distally in the chutes (61s, 63s) provided in the middle portions of the first outer blade (61) and the middle blade (63), respectively.

第１実施形態と同様に、第２外刃(62)は例えば金属製の弾性体からなり、第２外刃(62)は第１外刃(61)に対して付勢力により先端に行くに従って略Ｖ状に開脚している。第１外刃(61)及び第２外刃(62)は開閉可能な一対の第２把持片であり、駆動ワイヤ(51)をシース(50)に対して遠位端側にスライドさせることによりシース(50)の遠位端から突出して第１外刃(61)及び第２外刃(62)を開き、一方、駆動ワイヤ(51)をシース(50)に対して近位端側にスライドさせることによりシース(50)内に埋没して第１外刃(61)及び第２外刃(62)が閉じる。 As in the first embodiment, the second outer cutter (62) is made of, for example, a metal elastic body, and the second outer cutter (62) is biased against the first outer cutter (61) as it goes toward the tip. The legs are open in a roughly V shape. The first outer cutter (61) and the second outer cutter (62) are a pair of second gripping pieces that can be opened and closed. Protrudes from the distal end of the sheath (50) to open the first outer blade (61) and the second outer blade (62), while the drive wire (51) slides proximally relative to the sheath (50). As a result, the first outer cutter (61) and the second outer cutter (62) are closed by being buried in the sheath (50).

図７は本発明にかかる内視鏡処置具(910)の概略を説明する図であって、第１外刃(61)及び中刃(63)からなる第１把持片が閉じており、且つ、第１外刃(61)及び第２外刃(62)からなる第２把持片も閉じている状態を説明する図である。第１把持片が閉じている状態で、更に、図示しない内視鏡ハンドル部を操作して駆動ワイヤ(51)を近位側に移動させると、略Ｖ状に開脚している第２把持片がシース(50)内に埋没して第１外刃(61)及び第２外刃(62)が閉じる。 FIG. 7 is a diagram for explaining the outline of the endoscopic treatment instrument (910) according to the present invention, in which the first gripping piece consisting of the first outer blade (61) and the middle blade (63) is closed, and 8 is a view for explaining a state in which a second gripping piece consisting of a first outer cutter (61) and a second outer cutter (62) is also closed; FIG. When the endoscope handle portion (not shown) is operated to move the drive wire (51) to the proximal side while the first gripping piece is closed, the second gripping piece which is open in a substantially V shape is opened. The first outer blade (61) and the second outer blade (62) are closed with the strip embedded in the sheath (50).

次に第２実施形態にかかる内視鏡処置具(910)の使用態様について説明する。 Next, the mode of use of the endoscope treatment instrument (910) according to the second embodiment will be described.

図８(a)に示されるように、例えば開口面が略楕円形の粘膜欠損部(44)がある場合、駆動ワイヤ(51)をシース(50)に対して近位側にスライドさせることにより第１外刃(61)及び中刃(63)が閉じることで粘膜欠損部の一端を軽く把持する。即ち、一回目の把持は、第１外刃(61)及び中刃(63)が閉じることによる粘膜欠損部の一端側の把持である。 As shown in FIG. 8( a ), for example, when there is a mucosal defect ( 44 ) whose opening surface is substantially oval, by sliding the drive wire ( 51 ) proximally with respect to the sheath ( 50 ), By closing the first outer blade (61) and the middle blade (63), one end of the mucosal defect is lightly grasped. That is, the first gripping is gripping of one end side of the mucosal defect by closing the first outer cutter (61) and the middle cutter (63).

次に図８(b)に示されるように、第１外刃(61)及び中刃(63)が閉じて粘膜欠損部の一端を軽く把持した状態にて、粘膜欠損部の他端側へ移動させる。駆動ワイヤ(51)を近位側に移動させると牽引力が可動ピン(73)を介してシュート機構である開閉部60に伝達され、固定ピン(72)が第１外刃(61)及び中刃(63)の中部にそれぞれ設けられたシュート(61s,63s)内を遠位側に移動することで第１鉗子片が閉じる。 Next, as shown in FIG. 8(b), with the first outer blade (61) and the middle blade (63) closed and lightly gripping one end of the mucosal defect, the blade is moved toward the other end of the mucosal defect. move. When the driving wire (51) is moved proximally, the pulling force is transmitted to the chute mechanism 60 via the movable pin (73), and the fixed pin (72) moves the first outer blade (61) and the middle blade. The first forceps piece closes by moving distally in chutes (61s, 63s) respectively provided in the middle of (63).

次に図８(c)に示されるように、第１把持片が閉じている状態から、更に、駆動ワイヤ51を近位側に移動させると、略Ｖ状に開脚している第２把持片がシース(50)内に埋没して第１外刃(61)及び第２外刃(62)が閉じて、粘膜欠損部の一端側と他端側とを把持する。即ち、二回目の把持は、第１外刃(61)及び第２外刃(62)が閉じることによる粘膜欠損部の一端側と他端側との把持である。 Next, as shown in FIG. 8(c), when the drive wire 51 is further moved to the proximal side from the state in which the first gripping piece is closed, the second gripping piece which is open in a substantially V shape is opened. The piece is buried in the sheath (50) and the first outer cutter (61) and the second outer cutter (62) are closed to grasp one end and the other end of the mucosal defect. That is, the second grasping is grasping of one end side and the other end side of the mucosal defect by closing the first outer cutter (61) and the second outer cutter (62).

これによりかなり大きめの粘膜欠損の場合であっても、引き寄せた粘膜欠損部の一端側が外れることなく簡易且つ確実に縫縮することができる。 As a result, even in the case of a fairly large mucosal defect, one end side of the drawn mucosal defect can be easily and reliably sutured without coming off.

内視鏡的粘膜下層剥離術後潰瘍治療に利用できる。 It can be used for ulcer treatment after endoscopic submucosal dissection.

１０,５０：シース
１１,５１：駆動ワイヤ
２１,６１：第１外刃
２２,６２：第２外刃
２３,６３：中刃
３１：第１揺動軸
３２：第２揺動軸
３３：ブラケット
３４：第１脚部
３５：第２脚部
３０：開閉部
６１ｓ,６３ｓ：シュート
７２：固定ピン
７３：可動ピン
９００,９１０：内視鏡処置具 10, 50: Sheath 11, 51: Drive wire 21, 61: First outer blade 22, 62: Second outer blade 23, 63: Middle blade 31: First swing shaft 32: Second swing shaft 33: Bracket 34: First leg 35: Second leg 30: Opening/closing part 61s, 63s: Chute 72: Fixed pin 73: Movable pin 900, 910: Endoscope treatment instrument

Claims (2)

内視鏡のチャネル内に挿入可能なチューブ状のシース(10)と、
前記シース(10)に挿通された駆動ワイヤ(11)と、
前記駆動ワイヤ(11)の遠位端に取り付けられた第１外刃(21)、第２外刃(22)、及び、中刃(23)と、を有し、前記第２外刃(22)は弾性体からなり、前記第２外刃(22)は前記第１外刃(21)に対して付勢力により先端に行くに従って略Ｖ状に開脚しており、
前記第１外刃(21)及び前記中刃(23)は開閉可能な一対の第１把持片であり、前記駆動ワイヤ(11)を前記シース(10)に対して遠位側にスライドさせることにより前記第１外刃(21)及び中刃(23)を開き、前記駆動ワイヤ(11)を前記シース(10)に対して近位側にスライドさせることにより前記第１外刃(21)及び中刃(23)を閉じる開閉部(30)と、を備え、
前記第１外刃(21)及び前記第２外刃(22)は開閉可能な一対の第２把持片であり、前記駆動ワイヤ(11)を前記シース(10)に対して遠位端側にスライドさせることにより前記シース(10)の遠位端から突出して第１外刃(21)及び第２外刃(22)を開き、前記駆動ワイヤ(11)を前記シース(10)に対して近位端側にスライドさせることにより前記シース(10)内に埋没して第１外刃(21)及び第２外刃(22)を閉じ、
前記開閉部(30)は、第１把持片を揺動可能に支持するブラケット(33)と、前記ブラケット(33)に設けられた第１揺動軸(31)と、前記第１外刃(21)の末端部と前記第１揺動軸(31)とを接続する第１脚部(34)と、前記中刃(23)の末端部と前記第１揺動軸(31)とを接続する第２脚部(35)と、前記第１外刃(21)と前記中刃(23)と貫通して揺動可能に支持する第２揺動軸(32)と、を備える、
ことを特徴とする内視鏡処置具(900)。 a tubular sheath (10) insertable within a channel of an endoscope;
a driving wire (11) inserted through the sheath (10);
a first outer blade (21), a second outer blade (22) and a middle blade (23) attached to the distal end of the drive wire (11); ) is made of an elastic material, and the second outer cutter (22) spreads in a substantially V shape as it goes toward the tip by a biasing force against the first outer cutter (21),
The first outer blade (21) and the middle blade (23) are a pair of first gripping pieces that can be opened and closed, and the drive wire (11) is slid distally with respect to the sheath (10). to open the first outer blade (21) and the middle blade (23), and slide the drive wire (11) proximally with respect to the sheath (10) to open the first outer blade (21) and the an opening/closing part (30) for closing the middle blade (23),
The first outer blade (21) and the second outer blade (22) are a pair of second gripping pieces that can be opened and closed, and the drive wire (11) is pushed to the distal end side of the sheath (10). By sliding, the first outer blade (21) and the second outer blade (22) are protruded from the distal end of the sheath (10), and the drive wire (11) is moved closer to the sheath (10). The first outer blade (21) and the second outer blade (22) are closed by being buried in the sheath (10) by sliding to the proximal side ,
The opening/closing part (30) includes a bracket (33) that swingably supports the first gripping piece, a first swing shaft (31) provided on the bracket (33), and the first outer cutter ( 21) and the first oscillating shaft (31), and connecting the end of the middle blade (23) and the first oscillating shaft (31). and a second swing shaft (32) penetrating through and swingably supporting the first outer blade (21) and the middle blade (23),
An endoscope treatment instrument (900) characterized by: 前記第１外刃及び前記第２外刃の長さは同じであり、前記中刃の長さは前記第１外刃及び前記第２外刃の長さよりも短いことを特徴とする請求項１に記載の内視鏡処置具。 2. The length of said first outer cutter and said second outer cutter are the same, and the length of said middle cutter is shorter than the length of said first outer cutter and said second outer cutter . The endoscope treatment tool according to .
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Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20110077668A1 (en) 2009-09-25 2011-03-31 Lindsay Gordon Devices for approximating tissue and related methods of use
WO2014034254A1 (en) 2012-08-30 2014-03-06 オリンパスメディカルシステムズ株式会社 Opening closer

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20110077668A1 (en) 2009-09-25 2011-03-31 Lindsay Gordon Devices for approximating tissue and related methods of use
JP2013505777A (en) 2009-09-25 2013-02-21 ボストン サイエンティフィック サイムド，インコーポレイテッド Device for approaching tissue and related methods of use
WO2014034254A1 (en) 2012-08-30 2014-03-06 オリンパスメディカルシステムズ株式会社 Opening closer

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