JP7479921B2

JP7479921B2 - Endoscopic treatment tools

Info

Publication number: JP7479921B2
Application number: JP2020083642A
Authority: JP
Inventors: 真小林
Original assignee: Individual
Current assignee: Individual
Priority date: 2020-05-12
Filing date: 2020-05-12
Publication date: 2024-05-09
Anticipated expiration: 2040-05-12
Also published as: JP2021177848A

Description

本発明は、内視鏡のチャネル内に挿脱され、内視鏡の視野内で病変部位の処置を行う先端処置具を有する内視鏡用処置具に関する。 The present invention relates to an endoscopic treatment tool having a distal end treatment tool that is inserted into and removed from the channel of an endoscope to treat a lesion within the field of view of the endoscope.

内視鏡用処置具は、シースの先端部に先端処置具を有し、シースを内視鏡のチャネル内に挿脱可能に収容され、内視鏡の挿入部とともに体腔内に挿入され、内視鏡の視野内で内視鏡の挿入部の先端より延出する先端処置具により、体腔内の病変部位の直接診察や治療（生体組織の患部の除去、サンプル採取、切除、止血等）を低侵襲で行うために使用される。一般に、内視鏡は医師が操作し、処置具は別の医師また技師が連繋操作する。 Endoscopic treatment tools have a tip treatment tool at the tip of a sheath, and the sheath is removably housed in the channel of the endoscope and inserted into the body cavity together with the insertion part of the endoscope. The tip treatment tool extends from the tip of the insertion part of the endoscope within the field of view of the endoscope and is used to perform direct examination and treatment of diseased areas in the body cavity (removal of diseased areas of biological tissue, sampling, excision, hemostasis, etc.) in a minimally invasive manner. Generally, the endoscope is operated by a doctor, and the treatment tool is operated in conjunction with another doctor or technician.

以下の特許文献１－６の内視鏡用処置具に関する説明で使用する符号は、各特許文献中で使用している符号である。 The symbols used in the descriptions of the endoscopic treatment tools in the following Patent Documents 1-6 are the same as those used in each patent document.

特許文献１に示される内視鏡用鋏（内視鏡用処置具）１００は、一対の鋏片１２，２２が所要最大開き角度に開いたときに、一方の鋏片１２の基端部に設けられた２つのストッパー１５，１６と、他方の鋏片２２の基端部の刃側端縁とが当接するように構成されている。ストッパー１５，１６は、一方の鋏片１２に穿設された小孔に差し込み固定される小径部である支持部１５ｂ，１６ｂと、小径部の一端に設けられ一方の鋏片１２に密着される大径部である係合部１５ａ，１６ａとからなる。一対の鋏片１２，２２とストッパー１５，１６は鋏片刃部を除いて絶縁性被膜が形成され焼灼された生体組織が付着しないようになっている。 The endoscopic scissors (endoscopic treatment tool) 100 shown in Patent Document 1 is configured so that when the pair of scissors pieces 12, 22 are opened to the required maximum opening angle, two stoppers 15, 16 provided at the base end of one of the scissors pieces 12 come into contact with the blade side edge of the base end of the other scissors piece 22. The stoppers 15, 16 consist of support parts 15b, 16b, which are small diameter parts that are inserted and fixed into small holes drilled in one of the scissors pieces 12, and engagement parts 15a, 16a, which are large diameter parts provided at one end of the small diameter parts and are in close contact with one of the scissors pieces 12. An insulating coating is formed on the pair of scissors pieces 12, 22 and the stoppers 15, 16, except for the scissors blade parts, to prevent cauterized biological tissue from adhering to them.

特許文献２に示される内視鏡用鋏（内視鏡用処置具）は、一対の鋏片１０，１１が所要最大開き角度に開いたときに、一方の鋏片１１の基端部に設けられた直方体形状のストッパー１４の１つの広幅な面と、他方の鋏片１０の基端部の刃側端縁とが当接するように構成されている。内視鏡用鋏は、内視鏡用電気焼灼切開鋏であり、一対の鋏片１０，１１とストッパー１４は鋏片刃部を除いて絶縁性被膜が形成されている。また、直方体形状のストッパー１４に替えて円柱状のストッパー２０が設けられる。 The endoscopic scissors (endoscopic treatment tool) shown in Patent Document 2 are configured so that when a pair of scissors pieces 10, 11 are opened to the required maximum opening angle, one wide surface of a rectangular parallelepiped stopper 14 provided at the base end of one of the scissors pieces 11 comes into contact with the blade side edge of the base end of the other scissors piece 10. The endoscopic scissors are endoscopic electric cauterization and incision scissors, and an insulating coating is formed on the pair of scissors pieces 10, 11 and the stopper 14 except for the scissors blade portion. In addition, a cylindrical stopper 20 is provided in place of the rectangular parallelepiped stopper 14.

特許文献３に示される内視鏡用処置具は、コイルシース１１の先端部に連結用筒状部１６の筒内径が大きい後部が被嵌し溶接され、そして、連結用筒状部１６の内径が小さい先部内に先端本体１５が強制嵌入されることにより、先端本体１５の外周面の先端部と後端部に設けられた鍔部１５ａと鍔部１５ｂとの間の小径部に連結用筒状部１６の内径が小さい先部が緩く嵌合している。 The endoscopic treatment tool shown in Patent Document 3 has the rear part of the connecting tubular part 16, which has a larger inner diameter, fitted over and welded to the tip part of the coil sheath 11, and the tip body 15 is forcibly fitted into the tip part with the smaller inner diameter of the connecting tubular part 16, so that the tip part with the smaller inner diameter of the connecting tubular part 16 fits loosely into the small diameter part between the flanges 15a and 15b provided at the tip and rear ends of the outer periphery of the tip body 15.

また、特許文献３に示される内視鏡用処置具は、先端処置片１３と支軸１４と先端本体１５のそれぞれに電気絶縁被膜が設けられているとともに、可撓性コイルシース１１の外周面に全長にわたり電気絶縁性の絶縁チューブ１８を被覆した構成であり、もって、操作ワイヤ１２を通じて先端処置片１３に高周波電流を通電し、先端処置片１３にて止血効果等を得る処置を行えるようになっている。 The endoscopic treatment tool shown in Patent Document 3 has an electrically insulating coating on each of the distal treatment piece 13, the support shaft 14, and the distal body 15, and the outer peripheral surface of the flexible coil sheath 11 is covered over its entire length with an electrically insulating insulating tube 18. This allows a high-frequency current to be passed through the operating wire 12 to the distal treatment piece 13, enabling treatment to be performed with the distal treatment piece 13 to achieve hemostasis or the like.

また、特許文献４に示される内視鏡用処置具は、先端支持枠４１の一対の腕部の間に一対の鋏片（先端処置片）３６ａ，３６ｂが配設され回動軸３５で串刺し状に連結され、先端支持枠４１の小径筒部に後端より細筒部材４０ａと抜け止め部材４１ｂが順に被嵌され、かつ抜け止め部材４１ｂが先端支持枠４１の小径筒部に溶接されているとともに、連結用筒状部４０の太筒部材４０ｂの後部がシース３１の先端部に被嵌され溶接され、次いで連結用筒状部４０の太筒部材４０ｂの先部が抜け止め部材４１ｂと細筒部材４０ａの中程にかけて被嵌され、太筒部材４０ｂと細筒部材４０ａとが溶接され連結用筒状部４０を構成している。もって、連結用筒状部４０は、先端支持部材４１とシース３１とを相対回転可能に連結している。 In addition, the endoscopic treatment tool shown in Patent Document 4 has a pair of scissors pieces (tip treatment pieces) 36a, 36b arranged between a pair of arms of the tip support frame 41 and connected in a skewered shape by a rotating shaft 35, a thin tube member 40a and a stopper member 41b are fitted in order from the rear end to the small diameter tube portion of the tip support frame 41, and the stopper member 41b is welded to the small diameter tube portion of the tip support frame 41, and the rear part of the thick tube member 40b of the connecting tube portion 40 is fitted and welded to the tip portion of the sheath 31, and then the tip part of the thick tube member 40b of the connecting tube portion 40 is fitted to the stopper member 41b and the middle of the thin tube member 40a, and the thick tube member 40b and the thin tube member 40a are welded to form the connecting tube portion 40. Thus, the connecting tube portion 40 connects the tip support member 41 and the sheath 31 so that they can rotate relative to each other.

特許文献５に示される内視鏡用処置具は、先端支持部材１４の一対の腕部の間に一対の鋏片（先端処置片）３６ａ，３６ｂが配設され回動軸３５で串刺し状に連結され、コイルシース３１のリング４２が設けられた先端小径部が先端支持部材１４の筒部内に挿入された状態で、一対の半割リング４３が先端支持部材１４の後端面に重ねられ溶接されてなる。もって、先端支持部材１４とコイルシース３１は、相対回転可能であり、かつ軸方向に相対移動可能であり、さらにリング４２と一対の半割リング４３とにより離脱不能である。 The endoscopic treatment tool shown in Patent Document 5 has a pair of scissors pieces (tip treatment pieces) 36a, 36b arranged between a pair of arms of a tip support member 14 and connected in a skewered shape by a rotating shaft 35, and a pair of half rings 43 are overlapped and welded to the rear end face of the tip support member 14 with the small diameter tip part with the ring 42 of the coil sheath 31 inserted into the cylindrical part of the tip support member 14. Thus, the tip support member 14 and the coil sheath 31 can rotate relative to each other and can move relative to each other in the axial direction, and furthermore, they cannot be separated due to the ring 42 and the pair of half rings 43.

特許文献６に示される内視鏡用処置具は、内視鏡用電気焼灼切開鋏であり、開閉可能な一対の鉗子片３ａを有する鉗子部３が生理食塩水を送水可能なシース２の先端の先端カバー３０より突出状態に設けられ、シース２内に挿通された操作部材４ｄを前進後退により鉗子片３ａが開閉するようになっており、先端カバー３０内に、貫通孔７ａを有しかつ貫通孔７ａに操作部材４ｄが挿通した状態に流路形成部材７を備え、操作部材４ｄには大径部４ｄ２を備えてなり、操作部材４ｄと貫通孔７ａとの環状の隙間を第１の送液孔９とされ、操作部材４ｄと先端カバー３０の先端部内周面との環状の隙間を第２の送液孔８とされ、操作部材４ｄが前進し大径部４ｄ２が流路形成部材７に当接するときは、第１の送液孔９を閉塞するよう構成されている。一対の鉗子片３ａを有する鉗子部３は、鉗子片刃部を除いて絶縁性被膜が形成されている。 The endoscopic treatment tool shown in Patent Document 6 is an endoscopic electric cauterization and incision scissors, in which a forceps section 3 having a pair of openable and closable forceps pieces 3a is provided in a protruding state from a tip cover 30 at the tip of a sheath 2 capable of supplying physiological saline water, and the forceps pieces 3a are opened and closed by advancing and retreating an operating member 4d inserted into the sheath 2, and a flow path forming member 7 having a through hole 7a is provided in the tip cover 30 with the operating member 4d inserted into the through hole 7a, and the operating member 4d has a large diameter portion 4d2, and the annular gap between the operating member 4d and the through hole 7a is the first liquid supply hole 9, and the annular gap between the operating member 4d and the inner surface of the tip of the tip cover 30 is the second liquid supply hole 8, and when the operating member 4d advances and the large diameter portion 4d2 abuts against the flow path forming member 7, the first liquid supply hole 9 is blocked. The forceps section 3 having a pair of forceps pieces 3a is formed with an insulating coating except for the forceps one blade portion.

特開２０１６－８７１７１号公報JP 2016-87171 A 特許第５４６３３６３号公報Japanese Patent No. 5463363 特開２００７－２８９５９３号公報JP 2007-289593 A 特開２０１８－３３５０１号公報JP 2018-33501 A 特開２０１８－６８４７４号公報JP 2018-68474 A 再表２０１７－１３４７５７号公報Relisted No. 2017-134757

特許文献１に示される内視鏡用鋏は、極小の先端処置片の基端側の所要の２カ所に２つの小孔を穿設し、さらに２つの小さいリベット形状のストッパーを差し込み嵌着する構成であり、ストッパーの製作が難しく、一対の先端処置片が開いてストッパーが先端処置片と当接したときにストッパーが大径部と小径部との連結部に剪断力が加わり剪断する恐れがある。 The endoscopic scissors shown in Patent Document 1 are constructed by drilling two small holes at two required locations on the base end side of a very small distal treatment piece, and then inserting and fitting two small rivet-shaped stoppers. The stoppers are difficult to manufacture, and when the pair of distal treatment pieces open and the stoppers come into contact with the distal treatment pieces, a shear force is applied to the connection between the large diameter section and the small diameter section of the stopper, which may cause it to shear off.

特許文献２に示される内視鏡用鋏は、極小の先端処置片にさらに小さい直方体形状のストッパーを載せて位置をずらさずにレーザー溶接することは非常に困難である。他方、先端処置片にストッパーを一体に形成する削り出し加工は、普通の機械ではできず、５軸のマシニングを使うことで実現できるものである。したがって、加工が難しいことに加え時間とコストがかかるという課題がある。 In the endoscopic scissors shown in Patent Document 2, it is extremely difficult to place an even smaller rectangular parallelepiped stopper on the extremely small distal treatment piece and laser weld it without shifting its position. On the other hand, the machining process to integrally form the stopper on the distal treatment piece cannot be performed with ordinary machines, but can only be achieved using five-axis machining. Therefore, in addition to the difficulty of machining, there are issues of time and cost involved.

特許文献３に示される内視鏡用処置具は、先端本体１５と連結用筒状部１６との嵌合が難しい。すなわち、先端本体１５の鍔部１５ｂの外径が連結用筒状部１６の先部の内径よりも大きく、かつ先端本体１５の鍔部１５ａ，１５ｂ間の外径が連結用筒状部１６の先部の内径がよりも小さいことが条件になっており、加えて極小部品であるため、寸法管理や組立が難しく、一対の先端処置片１３を開くときに鍔部１５ｂが連結用筒状部１６の先部に嵌入してしまうと連結用筒状部１６に対して先端本体１５が回転不能になり、したがって、一対の先端処置片１３の開閉方向を患部に適切に対応させることができない恐れがある。そこで、鍔部１５ｂの寸法を十分大きく取れて組み付けが容易であり、先端本体１５がコイルシース１１に対して円滑に相対回転可能である構成に改良し、できれば連結用筒状部１６を無くし部品点数を減らし、組付性を向上し製造コストを低減したいという課題がある。 In the endoscopic treatment tool shown in Patent Document 3, it is difficult to fit the tip body 15 and the connecting tubular portion 16. That is, the outer diameter of the flange portion 15b of the tip body 15 is larger than the inner diameter of the tip of the connecting tubular portion 16, and the outer diameter between the flange portions 15a and 15b of the tip body 15 is smaller than the inner diameter of the tip of the connecting tubular portion 16. In addition, since it is an extremely small part, it is difficult to manage the dimensions and assemble it. If the flange portion 15b fits into the tip of the connecting tubular portion 16 when opening the pair of tip treatment pieces 13, the tip body 15 cannot rotate relative to the connecting tubular portion 16, and therefore the opening and closing direction of the pair of tip treatment pieces 13 may not be able to appropriately correspond to the affected area. Therefore, there is a need to improve the configuration so that the dimensions of the flange 15b are large enough to facilitate easy assembly and the tip body 15 can rotate smoothly relative to the coil sheath 11, and if possible, to eliminate the connecting tubular portion 16 to reduce the number of parts, improve assembly, and reduce manufacturing costs.

特許文献４に示される内視鏡用処置具では、部品点数が多く、組付工数が多い。一対の半割リング４３が極小部品であり、組み付けが難しい。そこで、細筒部材４０ａと太筒部材４０ｂと抜け止め部材４１ｂとを無くすことができる構成に改良し、部品点数を減らし、組付性を向上し製造コストを低減したいという課題がある。 The endoscopic treatment tool shown in Patent Document 4 has a large number of parts and requires a large number of assembly steps. The pair of half-split rings 43 are extremely small parts and difficult to assemble. There is therefore a need to improve the configuration to eliminate the thin tube member 40a, the thick tube member 40b, and the retaining member 41b, reduce the number of parts, improve assembly, and reduce manufacturing costs.

特許文献５に示される内視鏡用処置具は、一対の半割リング４３が極小部品であり、組み付けが難しい。そこで、リング４２と一対の半割リング４３とを無くすことができる構成に改良し、部品点数を減らし、組付性を向上し製造コストを低減したいという課題がある。 The endoscopic treatment tool shown in Patent Document 5 has a pair of split rings 43 that are extremely small parts and difficult to assemble. Therefore, there is a need to improve the configuration to eliminate the ring 42 and the pair of split rings 43, reduce the number of parts, improve assembly, and reduce manufacturing costs.

特許文献６に示される内視鏡用処置具は、液流量と流れ方向が切り変わるが、いずれの場合も、鉗子片３ａの先端から第２の送液孔８までの距離が長いこと、および液流が先端カバー３０の内部で絞られかつ曲がりくねって流れるので、第２の送液孔８から流出する液流が大きく広がり、流速が無いので、生体の被処置部位の流血や淀み、濁りを効果的に洗い除けることができず、焼灼切開に効果を発揮が十分であるとは言えないという課題がある。 The endoscopic treatment tool shown in Patent Document 6 switches between the liquid flow rate and flow direction, but in either case, the distance from the tip of the forceps piece 3a to the second liquid supply hole 8 is long, and the liquid flow is constricted and meanders inside the tip cover 30, so the liquid flow out of the second liquid supply hole 8 spreads widely and has no flow velocity, so blood, stagnation, and turbidity at the treatment site of the living body cannot be effectively washed away, and it cannot be said to be fully effective in cauterizing incision.

本発明は、このような課題を解決するためになされたもので、一対の先端処置片の最大開度を所定角度に制限できるとともに、簡素な連結構造の実現と、組立の容易化、コスト低減が実現できる内視鏡用処置具を提供することを目的とする。 The present invention was made to solve these problems, and aims to provide an endoscopic treatment tool that can limit the maximum opening angle of a pair of distal treatment pieces to a specified angle, realizes a simple connecting structure, facilitates assembly, and reduces costs.

本発明の第１の態様に係る内視鏡用処置具は、上記目的を達成するため、可撓性を有するコイルシースと、前記コイルシース内に進退可能に配置された操作ワイヤと、前記コイルシースの後端部に設けられ前記操作ワイヤを進退操作する操作部と、前記コイルシースの先端部または当該先端部に設けられた連結用筒状部に連結された筒部と前記筒部より先端側に延在し対向する一対の腕部とを有する先端処置具支持部材と、一対の先端処置片よりなり当該一対の先端処置片が前記一対の腕部間でＸ状に交差し交差部が前記一対の腕部に軸支され開閉して生体患部の処置を行う先端処置具と、前記一対の先端処置片の各基端部と前記操作ワイヤの先端部に設けられた進退伝動リンクの先端部とを連結するように介設され前記操作ワイヤの進退動作力を受け前記一対の先端処置片に伝達する一対の開閉作動用リンクとを備え、前記先端処置具支持部材が前記腕部間で前記筒部が半割にされた一対の半割体を有し、各前記半割体には前記腕部の対向面の先端側の所要位置に凸設され前記一対の先端処置片が所要開度になるときに一対の開閉作動用リンクと当接する開度制限用突起を有し、前記一対の半割体が前記コイルシースの先端部または前記連結用筒状部の先端部に被嵌した状態に重ね合わせ一体に設けられていることを特徴とする。
In order to achieve the above object, an endoscopic treatment tool according to a first aspect of the present invention includes a flexible coil sheath, a manipulation wire arranged to be able to advance and retreat within the coil sheath, an operation section provided at the rear end of the coil sheath for manipulating the manipulation wire to advance and retreat, a distal treatment tool support member having a tubular section connected to the distal end of the coil sheath or to a connecting tubular section provided at the distal end and a pair of opposing arm sections extending distally from the tubular section, a distal treatment tool comprising a pair of distal treatment pieces which cross in an X-shape between the pair of arm sections and have crossing sections pivotally supported by the pair of arm sections and which open and close to treat an affected part of a living body, and and a pair of opening/closing operation links which are interposed to connect the base end and the tip end of an advance/retract transmission link provided at the tip end of the operating wire and which receive the advance/retract operating force of the operating wire and transmit it to the pair of tip treatment pieces, the tip treatment tool support member has a pair of half bodies in which the tubular portion is split in half between the arms, and each of the half bodies has an opening limiting protrusion which is protruded at a required position on the tip side of the opposing surfaces of the arms and comes into contact with the pair of opening/closing operation links when the pair of tip treatment pieces reach a required opening degree, and the pair of half bodies are overlapped and integrally provided in a state where they are fitted over the tip end of the coil sheath or the tip end of the connecting tubular portion.

本発明の第２の態様に係る内視鏡用処置具は、第１の態様の構成に加え、前記コイルシースの先端部に前記先端処置具支持部材の前記筒部が固定状態に被嵌されていることを特徴とする。 The endoscopic treatment tool according to the second aspect of the present invention is characterized in that, in addition to the configuration of the first aspect, the tubular portion of the distal treatment tool support member is fixedly fitted over the distal end of the coil sheath.

本発明の第３の態様に係る内視鏡用処置具は、第１の態様の構成に加え、前記コイルシースの先端部に前記先端処置具支持部材の前記筒部が回動可能に被嵌されていることを特徴とする。 The endoscopic treatment tool according to the third aspect of the present invention is characterized in that, in addition to the configuration of the first aspect, the tubular portion of the distal treatment tool support member is rotatably fitted over the distal end of the coil sheath.

本発明の第４の態様に係る内視鏡用処置具は、第３の態様の構成に加え、前記コイルシースまたは前記連結用筒状部に先端部を避けて先端小径部が設けられ、各前記半割体の内周面後端部より筒内方へ突出して設けられ前記先端小径部に被嵌する半円環状の軸受部を有することを特徴とする。 The endoscopic treatment tool according to the fourth aspect of the present invention is characterized in that, in addition to the configuration of the third aspect, a small-diameter tip portion is provided on the coil sheath or the connecting tubular portion, avoiding the tip portion, and has a semicircular ring-shaped bearing portion that protrudes from the rear end of the inner circumferential surface of each of the half bodies toward the inside of the tube and fits over the small-diameter tip portion.

本発明の第５の態様に係る内視鏡用処置具は、第１ないし４のいずれか一態様の構成に加え、前記コイルシースに樹脂製シースが被覆されているとともに、前記操作部に前記コイルシース内に処置液を注入する注液口を有し、各前記半割体の前記腕部の対向面の幅中央部に処置液が流れるよう液送用凹条部を有することを特徴とする。 The endoscopic treatment tool according to the fifth aspect of the present invention is characterized in that, in addition to the configuration of any one of the first to fourth aspects, the coil sheath is covered with a resin sheath, the operating section has a liquid injection port for injecting treatment liquid into the coil sheath, and each half body has a liquid delivery groove portion at the center of the width of the opposing surface of the arm portion so that the treatment liquid flows.

本発明の第６の態様に係る内視鏡用処置具は、第５の態様の構成に加え、前記液送用凹条部は、前記先端処置具を前記先端処置具支持部材に支持する支持軸の両側に処置液が迂回して流れる幅広部を有していることを特徴とする。 The endoscopic treatment tool according to the sixth aspect of the present invention is characterized in that, in addition to the configuration of the fifth aspect, the fluid delivery groove has wide portions on both sides of the support shaft that supports the distal treatment tool on the distal treatment tool support member, through which the treatment fluid flows in a detouring manner.

本発明の第７の態様に係る内視鏡用処置具は、第１ないし６のいずれか一態様の構成に加え、前記一対の半割体には、半割面に位置決め用の凹部と凸部とが分配して設けられていることを特徴とする。 The seventh aspect of the present invention is characterized in that, in addition to the configuration of any one of the first to sixth aspects, the pair of halves has positioning recesses and protrusions distributed on the halves.

本発明によれば、一対の先端処置片の最大開度を所定角度に制限できるとともに、簡素な連結構造の実現と、組立の容易化、コスト低減が実現できる内視鏡用処置具を提供することができる。 The present invention provides an endoscopic treatment tool that can limit the maximum opening angle of a pair of distal treatment pieces to a specified angle, realizes a simple connection structure, facilitates assembly, and reduces costs.

本発明の実施形態１に係る内視鏡用処置具を含む内視鏡システムを説明するための図である。1 is a diagram for explaining an endoscopic system including an endoscopic treatment tool according to a first embodiment of the present invention. FIG. 本発明の実施形態１に係る内視鏡用処置具の全体図である。1 is an overall view of an endoscopic treatment tool according to a first embodiment of the present invention. 本発明の実施形態１の内視鏡用処置具に係り、図３（Ａ）は先端処置具が閉じた状態の処置具先端部を示す正面図、図３（Ｂ）は先端処置具が閉じた状態の処置具先端部を示す縦断正面図、図３（Ｃ）は先端処置具が開いた状態の処置具先端部を示す縦断正面図、図３（Ｄ）は図３（Ａ）におけるＩＩＩｄ－ＩＩＩｄ矢視縦断図である。FIG. 3(A) is a front view showing the tip of the treatment tool when the distal end treatment tool is closed, FIG. 3(B) is a longitudinal front view showing the tip of the treatment tool when the distal end treatment tool is closed, FIG. 3(C) is a longitudinal front view showing the tip of the treatment tool when the distal end treatment tool is open, and FIG. 3(D) is a longitudinal cross-sectional view taken along the line IIId-IIId in FIG. 3(A). 本発明の実施形態１の内視鏡用処置具の先端処置具支持部材に係り、図４（Ａ）は先端処置具支持部材を構成する一対の半割体が重なった状態を示す正面図、図４（Ｂ）は先端処置具支持部材を構成する一方の半割体の分割面側から視た図、図４（Ｃ）は先端処置具支持部材を構成する他方の半割体の斜視図、図４（Ｄ）は一方の半割体の斜視図である。FIG. 4A is a front view showing a pair of half bodies constituting the distal treatment tool support member overlapping each other, FIG. 4B is a view from the split surface side of one of the half bodies constituting the distal treatment tool support member, FIG. 4C is an oblique view of the other half body constituting the distal treatment tool support member, and FIG. 4D is an oblique view of one of the half bodies. 本発明の実施形態１の内視鏡用処置具の先端処置具支持部材に係り、図５（Ａ）は一対の先端処置片が最大開度に制限される状態の正面図、図５（Ｂ）は一対の先端処置片が中開度に制限される状態の正面図、図５（Ｃ）は一対の先端処置片が小開度に制限される状態の正面図である。FIG. 5(A) is a front view of a state in which a pair of distal treatment pieces are limited to a maximum opening degree, FIG. 5(B) is a front view of a state in which a pair of distal treatment pieces are limited to a medium opening degree, and FIG. 5(C) is a front view of a state in which a pair of distal treatment pieces are limited to a small opening degree, relating to a distal treatment tool support member of an endoscopic treatment tool of embodiment 1 of the present invention. 本発明の実施形態２に係る内視鏡用処置具の先端処置具が開いた状態の先端部を示す縦断正面図である。10 is a longitudinal front view showing a distal end portion of an endoscopic treatment tool according to a second embodiment of the present invention in a state where the distal end treatment tool is open. FIG. 本発明の実施形態３に係る内視鏡用処置具の全体図である。FIG. 11 is an overall view of an endoscopic treatment tool according to a third embodiment of the present invention. 本発明の実施形態３の内視鏡用処置具の先端部に係り、図８（Ａ）は閉じた状態の先端処置具の正面図、図８（Ｂ）は最大開度になる手前の開いた状態の先端処置具の縦断正面図、図８（Ｃ）は最大開度となるように開いた状態の先端処置具の縦断正面図、図８（Ｃ）は図８（Ａ）におけるＶＩＩＩｄ－ＶＩＩＩｄ矢視縦断図である。FIG. 8(A) is a front view of the distal end treatment tool in a closed state, FIG. 8(B) is a longitudinal front view of the distal end treatment tool in an open state just before reaching the maximum opening degree, FIG. 8(C) is a longitudinal front view of the distal end treatment tool in a state opened to reach the maximum opening degree, and FIG. 8(C) is a longitudinal sectional view taken along the line VIIId-VIIId in FIG. 8(A). 本発明の実施形態３の内視鏡用処置具の先端処置具支持部材に係り、図９（Ａ）は先端処置具支持部材を構成する一対の半割体が重なった状態を示す正面図、図９（Ｂ）は先端処置具支持部材を構成する一方の半割体の分割面側から視た図、図９（Ｃ）は先端処置具支持部材を構成する他方の半割体の斜視図、図９（Ｄ）は一方の半割体の斜視図である。FIG. 9(A) is a front view showing a pair of half bodies constituting the distal treatment tool support member overlapping each other, FIG. 9(B) is a view from the split surface side of one of the half bodies constituting the distal treatment tool support member, FIG. 9(C) is an oblique view of the other half body constituting the distal treatment tool support member, and FIG. 9(D) is an oblique view of one of the half bodies.

以下、本発明に係る内視鏡用処置具に係る実施形態について図面を参照して説明する。なお、以下の説明において、先端処置具が位置する側を先端側、操作部が位置する側を基端側と呼ぶ。 Hereinafter, an embodiment of an endoscopic treatment tool according to the present invention will be described with reference to the drawings. In the following description, the side where the distal treatment tool is located will be called the distal end side, and the side where the operating section is located will be called the proximal end side.

［実施形態１］
［内視鏡システム］
図１は実施形態１に係る内視鏡用処置具が適用される内視鏡システム１を示す。内視鏡システム１は、生体の体腔内に挿入するための挿入部２と、基端部に設けられ挿入部２の先端を上下左右方向に湾曲操作するためのダイヤルを有する内視鏡操作部３と、挿入部２と内視鏡操作部３との間を接続するように配置された処置具導入部４とを備え、処置具導入部４から挿入部２の先端に向かって長手方向に形成された内視鏡チャネル５が形成され、内視鏡チャネル５内に、後述する内視鏡用処置具１０の生体患部の処置を行う先端処置具としての一対の先端処置片（鋏片）１５，１６およびシース１１を挿通し操作部１３より操作するように構成されている。 [Embodiment 1]
[Endoscope system]
1 shows an endoscope system 1 to which an endoscopic treatment tool according to embodiment 1 is applied. The endoscope system 1 includes an insertion section 2 for insertion into a body cavity of a living body, an endoscope operation section 3 provided at a base end and having a dial for bending the tip of the insertion section 2 in up, down, left and right directions, and a treatment tool introduction section 4 arranged to connect between the insertion section 2 and the endoscope operation section 3. An endoscope channel 5 is formed in the longitudinal direction from the treatment tool introduction section 4 to the tip of the insertion section 2, and a pair of distal treatment pieces (scissors pieces) 15, 16 and a sheath 11 as distal treatment tools for treating an affected part of a living body of an endoscopic treatment tool 10 described later are inserted into the endoscope channel 5 and configured to be operated by the operation section 13.

［内視鏡用処置具の基本的構成］
図２は実施形態１に係る内視鏡用処置具１０を示す。内視鏡用処置具１０は、内視鏡用電気焼灼切開鋏であり、一対の先端処置片１５，１６で体腔内の生体組織を挟みつつ所要の電流を通電し生体組織を焼灼し止血しつつ切開するものである。 [Basic configuration of an endoscopic treatment tool]
2 shows the endoscopic treatment tool 10 according to embodiment 1. The endoscopic treatment tool 10 is an endoscopic electric cauterizing and incising scissors, which clamps biological tissue in a body cavity with a pair of distal treatment pieces 15, 16 and applies a required current thereto to cauterize the biological tissue and stop bleeding while incising it.

内視鏡用処置具１０は、内視鏡チャネル５に挿脱される可撓性を有する細長いシース１１と、シース１１内に進退可能に配置された操作ワイヤ１２と、操作ワイヤ１２を進退操作および回転操作する操作部１３と、シース１１の先端に設けられた先端処置具支持部材１４と、先端処置具支持部材１４に支持軸１８で回動可能に支持される先端処置具としての一対の先端処置片１５，１６とを備える。 The endoscopic treatment tool 10 includes a flexible, elongated sheath 11 that is inserted into and removed from the endoscope channel 5, an operating wire 12 that is arranged within the sheath 11 so that it can be advanced and retreated, an operating section 13 that advances and retreats the operating wire 12 and rotates it, a distal treatment tool support member 14 provided at the tip of the sheath 11, and a pair of distal treatment pieces 15, 16 as distal treatment tools that are rotatably supported by a support shaft 18 on the distal treatment tool support member 14.

シース１１は、長さが５００～２０００ｍｍの、可撓性を有しかつ適度の腰の強さ（屈曲耐性）を有する細長筒状体である。本実施形態のシース１１は、コイルシース１１ａと、コイルシース１１ａの外面に被さる樹脂製外被１１ｂとで構成されている。樹脂製外被１１ｂは、ＰＴＦＥ、ＰＥＥＫ、ＰＰＳ、ポリエチレン、またはポリイミド、等よりなり可撓性・電気絶縁性を有する。コイルシース１１ａは、例えば断面形状が矩形であるステンレス線等の金属材を密着巻きしてなるコイルシースが用いられることが好ましい。 The sheath 11 is a thin, tubular body with a length of 500 to 2000 mm that is flexible and has a suitable degree of stiffness (resistance to bending). In this embodiment, the sheath 11 is composed of a coil sheath 11a and a resin outer jacket 11b that covers the outer surface of the coil sheath 11a. The resin outer jacket 11b is made of PTFE, PEEK, PPS, polyethylene, polyimide, or the like, and has flexibility and electrical insulation. It is preferable to use a coil sheath 11a made by tightly winding a metal material, such as a stainless steel wire, having a rectangular cross-sectional shape.

内視鏡用処置具１０は、コイルシース１１ａの内面と、先端処置具支持部材１４の外面に電気絶縁被膜が形成されている。樹脂製外被１１ｂが設けられない構成では、コイルシース１１ａの内外面に電気絶縁被膜が形成されていてもよい。 In the endoscopic treatment tool 10, an electrically insulating coating is formed on the inner surface of the coil sheath 11a and the outer surface of the distal treatment tool support member 14. In a configuration in which the resin outer jacket 11b is not provided, an electrically insulating coating may be formed on the inner and outer surfaces of the coil sheath 11a.

操作ワイヤ１２は、シース１１内に進退可能に緩く配置され、導電性であって回転追従性が大きなトルクワイヤからなる。操作ワイヤ１２は、例えば、全長がステンレス製であるか、またはステンレス製の基端側部分とナイチノール（ニッケルチタン合金）製の先端側部分とをステンレスパイプで接続してなるものであっても良い。 The operating wire 12 is loosely arranged within the sheath 11 so that it can be advanced and retreated, and is made of a conductive torque wire with high rotational tracking. For example, the entire length of the operating wire 12 may be made of stainless steel, or the operating wire 12 may be made of a stainless steel base end portion and a nitinol (nickel-titanium alloy) tip end portion connected by a stainless steel pipe.

操作部１３は操作部本体１３ａとスライダ１３ｂとを有する。操作部本体１３ａはコイルシース１１ａの基端に先端部が連結されている。スライダ１３ｂは、操作部本体１３ａの側面部に設けられたスリットに対応する範囲で操作部本体１３ａに被嵌してスライドするように設けられ、操作部本体１３ａの先端面から内部に導入された操作ワイヤ１２の基端と連結されている。 The operating unit 13 has an operating unit body 13a and a slider 13b. The operating unit body 13a has a tip connected to the base end of the coil sheath 11a. The slider 13b is fitted over and slides over the operating unit body 13a within a range corresponding to a slit provided on the side of the operating unit body 13a, and is connected to the base end of the operating wire 12 introduced from the tip surface of the operating unit body 13a into the interior.

操作部１３は、操作部本体１３ａとスライダ１３ｂとを相対的にスライド操作（進退操作）することによって、操作ワイヤ１２をコイルシース１１ａに相対移動させることができ、スライダ１３ｂを図中の左方向（先端側）に移動させることにより操作ワイヤ１２を先端側にコイルシース１１ａに相対移動させ一対の先端処置片１５，１６を開くことができ、また、スライダ１３ｂを図中の右方向（基端側）に移動させることにより操作ワイヤ１２を基端側にコイルシース１１ａに相対移動させ一対の先端処置片１５，１６を閉じることができるように構成されている。もって、操作部１３は、操作ワイヤ１２をコイルシース１１ａに相対的に進退操作および回転操作すること、さらに、一対の先端処置片１５，１６を開閉することができるよう構成されている。 The operation unit 13 is configured so that the operation wire 12 can be moved relative to the coil sheath 11a by sliding the operation unit body 13a and the slider 13b relative to each other (advancing and retreating operation), the operation wire 12 can be moved relative to the coil sheath 11a toward the tip side by moving the slider 13b to the left in the figure (tip side) to open the pair of tip treatment pieces 15, 16, and the operation wire 12 can be moved relative to the coil sheath 11a toward the base end by moving the slider 13b to the right in the figure (base end) to close the pair of tip treatment pieces 15, 16. Thus, the operation unit 13 is configured so that the operation wire 12 can be advanced and retreated and rotated relative to the coil sheath 11a, and further the pair of tip treatment pieces 15, 16 can be opened and closed.

なお、操作ワイヤ１２とコイルシース１１ａは、基端部同士が一体に回転可能である構成と、操作ワイヤ１２が全長にわたりコイルシース１１ａに対し回転可能である構成のいずれであっても良い。 The operating wire 12 and the coil sheath 11a may be configured so that their base ends are rotatable together, or so that the operating wire 12 is rotatable relative to the coil sheath 11a over its entire length.

図３（Ａ）に示すように、先端処置具支持部材１４は、コイルシース１１ａの先端部に被嵌・連結された筒部１４ａと、筒部１４ａより先端側に延在する対向一対の腕部１４ｂとを有する。一対の先端処置片１５，１６は先端処置具支持部材１４に開閉可能に支持される。一対の先端処置片１５，１６は、中程（交差部）１５ａ，１６ａと基端側部分１５ｂ，１６ｂと先側部分１５ｃ，１６ｃとに区分される形状を有する。先端側部分１５ｃ，１６ｃは弓形でかつ先端外側に角状の突出部がある形状である。先端側部分１５ｃ，１６ｃを閉じた状態で針状メスやマーカーとして使用でき、開閉すると鋏として使用できる。 As shown in FIG. 3(A), the distal treatment tool support member 14 has a tubular portion 14a fitted and connected to the distal end of the coil sheath 11a, and a pair of opposing arms 14b extending distally from the tubular portion 14a. The pair of distal treatment pieces 15, 16 are supported by the distal treatment tool support member 14 so as to be openable and closable. The pair of distal treatment pieces 15, 16 have a shape divided into a middle portion (intersection) 15a, 16a, a base end portion 15b, 16b, and a tip portion 15c, 16c. The tip portions 15c, 16c are arched and have an angular protrusion on the outer tip. When the tip portions 15c, 16c are closed, they can be used as a needle scalpel or a marker, and when opened and closed, they can be used as scissors.

図３（Ｂ），（Ｃ），（Ｄ）に示すように、一対の先端処置片１５，１６の中程（交差部）１５ａ，１６ａには軸孔を有し、２つの軸孔は合わされて先端処置具支持部材１４の一対の腕部１４ｂ，１４ｂの先端部間に位置され、かつ一対の腕部１４ｂ，１４ｂの先端部に一軸上に設けられた一対の軸受用孔に合わされ、一方の軸受用孔より他方の軸受用孔まで支持軸１８が通されてなる。支持軸１８は一対の腕部１４ｂ，１４ｂの軸受用孔に強制嵌着されてなるか、嵌着後にレーザー溶接により固着されている。支持軸１８は、一対の先端処置片１５，１６の中程（交差部）１５ａ，１６ａの軸孔に緩く嵌着されている。したがって、一対の先端処置片１５，１６は、中程（交差部）１５ａ，１６ａが先端処置具支持部材１４の一対の腕部１４ｂ，１４ｂ間に軸支され、先側部分１５ｃ，１６ｃが開閉可能である。先側部分１５ｃ，１６ｃが開閉側縁には鋏刃を有する鋏片として形成されている。なお、先側部分１５ｃ，１６ｃは生検鉗子と形成されても良い。 3B, 3C, and 3D, the pair of distal end treatment pieces 15, 16 have axial holes in the middle (intersection) 15a, 16a, and the two axial holes are aligned and positioned between the distal ends of the pair of arms 14b, 14b of the distal end treatment tool support member 14, and are aligned with a pair of bearing holes provided on one axis at the distal ends of the pair of arms 14b, 14b, and a support shaft 18 is passed from one bearing hole to the other bearing hole. The support shaft 18 is forcibly fitted into the bearing holes of the pair of arms 14b, 14b, or is fixed by laser welding after fitting. The support shaft 18 is loosely fitted into the axial holes in the middle (intersection) 15a, 16a of the pair of distal end treatment pieces 15, 16. Therefore, the pair of distal treatment pieces 15, 16 are supported at their middles (intersections) 15a, 16a between a pair of arms 14b, 14b of the distal treatment tool support member 14, and the distal portions 15c, 16c can be opened and closed. The distal portions 15c, 16c are formed as scissors pieces with scissors blades on the opening and closing side edges. The distal portions 15c, 16c may also be formed as biopsy forceps.

一対の先端処置片１５，１６の各基端部は、一対の開閉作動用リンク１９，２０の各先端部とピン軸２２，２３で連結され、さらに一対の開閉作動用リンク１９，２０の各基端部は進退伝動リンク２１の先端部とピン軸２４で連結され、進退伝動リンク２１は操作ワイヤ１２と連結されている。 The base ends of the pair of distal treatment pieces 15, 16 are connected to the respective tips of a pair of opening/closing operation links 19, 20 by pin shafts 22, 23, and the base ends of the pair of opening/closing operation links 19, 20 are further connected to the respective tips of an advance/retract transmission link 21 by pin shafts 24, and the advance/retract transmission link 21 is connected to the operating wire 12.

詳細には、一方の先端処置片１５の基端側部分１５ｂに設けられたピン軸孔と一方の開閉作動用リンク１９の先端部に設けられたピン軸孔とにピン軸２２が通され止着されることにより、一方の先端処置片１５と一方の開閉作動用リンク１９とが連結されているとともに、他方の先端処置片１６の基端側部分１６ｂに設けられたピン軸孔と他方の開閉作動用リンク２０の先端部に設けられたピン軸孔とが重ね合され、これらピン軸孔にピン軸２３が通され止着されることにより、他方の先端処置片１６と他方の開閉作動用リンク２０とが連結されている。したがって、先端処置片１５，１６の基端側部分１５ｂ，１６ｂと開閉作動用リンク１９，２０は菱形に連鎖している。 In detail, the pin shaft 22 is passed through and fixed to the pin shaft hole provided in the base end portion 15b of one of the distal treatment pieces 15 and the pin shaft hole provided at the tip of one of the opening and closing operation links 19, thereby connecting one of the distal treatment pieces 15 and one of the opening and closing operation links 19, and the pin shaft hole provided in the base end portion 16b of the other distal treatment piece 16 and the pin shaft hole provided at the tip of the other opening and closing operation link 20 are overlapped, and the pin shaft 23 is passed through and fixed to these pin shaft holes, thereby connecting the other distal treatment piece 16 and the other opening and closing operation link 20. Therefore, the base end portions 15b, 16b of the distal treatment pieces 15, 16 and the opening and closing operation links 19, 20 are linked in a diamond shape.

さらに、一対の開閉作動用リンク１９，２０の各基端部に設けられたピン軸孔が進退伝動リンク２１の先端部に設けられたピン軸孔の両側に重ね合され、これら軸孔にピン軸２４が通され止着されることにより、かつ一対の開閉作動用リンク１９，２０と開閉作動用リンク１９とが連結されている。進退伝動リンク２１は、外形がロッド状であり、基端面より軸方向に内方にワイヤ受け入れ穴を有し、ワイヤ受け入れ穴に操作ワイヤ１２の先端部が嵌入され進退伝動リンク２１の側面より締め付けねじをねじ込むか、あるいは銀ロウ付け、ハンダ付け、カシメ、等により連結固定され、もって、進退伝動リンク２１と操作ワイヤ１２とが連結されている。 Furthermore, the pin shaft holes provided at the base ends of the pair of opening and closing operation links 19, 20 are overlapped on both sides of the pin shaft holes provided at the tip end of the forward and backward transmission link 21, and the pin shaft 24 is passed through and fixed in these shaft holes, thereby connecting the pair of opening and closing operation links 19, 20 and the opening and backward operation link 19. The forward and backward transmission link 21 has a rod-shaped outer shape and has a wire receiving hole axially inward from the base end face, and the tip end of the operation wire 12 is inserted into the wire receiving hole and connected and fixed by screwing a tightening screw from the side of the forward and backward transmission link 21, or by silver brazing, soldering, caulking, etc., thereby connecting the forward and backward transmission link 21 and the operation wire 12.

したがって、操作ワイヤ１２がシース１１に対して基端方向に相対移動されると、開閉作動用リンク１９，２０の交差角が小さくなると、先端処置片１５，１６の基端側部分１５ｂ，１６ｂの交差角も小さくなり、これにより、先端処置片１５，１６の先側部分１５ｃ，１６ｃが閉じていき（図３（Ｂ））、また、開閉作動用リンク１９，２０の交差角が大きくなると、先端処置片１５，１６の基端側部分１５ｂ，１６ｂも交差角が大きくなり、これにより、先端処置片１５，１６の先側部分１５ｃ，１６ｃが開いていく（図３（Ａ））。もって、操作ワイヤ１２がシース１１に対して相対移動されると、先端処置片１５，１６の先側部分１５ｃ，１６ｃが開閉するようになっている。 Therefore, when the operating wire 12 is moved relative to the sheath 11 in the proximal direction, the crossing angle of the opening and closing operation links 19, 20 becomes smaller, and the crossing angle of the base end portions 15b, 16b of the distal treatment pieces 15, 16 also becomes smaller, so that the distal portions 15c, 16c of the distal treatment pieces 15, 16 close (Fig. 3(B)). Also, when the crossing angle of the opening and closing operation links 19, 20 becomes larger, the crossing angle of the base end portions 15b, 16b of the distal treatment pieces 15, 16 also becomes larger, so that the distal portions 15c, 16c of the distal treatment pieces 15, 16 open (Fig. 3(A)). Thus, when the operating wire 12 is moved relative to the sheath 11, the distal portions 15c, 16c of the distal treatment pieces 15, 16 open and close.

その他の基本的構成を説明する。一対の先端処置片１５，１６はステンレス製またはナイチノール（ニッケルチタン合金）製である。一対の先端処置片１５，１６は、刃部同士が閉じ合さるときに刃部間を電流が流れるようになっている。さらに、先端処置具支持部材１４の外面の電気絶縁被膜と、シース１１の樹脂製外被１１ｂとに親水性被膜が形成され、もって、先端処置片１５，１６からシース１１までが体腔内に引き攣りなく円滑に導入できるようになっている。 Other basic components are described below. The pair of distal treatment pieces 15, 16 are made of stainless steel or nitinol (nickel-titanium alloy). The pair of distal treatment pieces 15, 16 are designed so that an electric current flows between the blades when the blades are closed together. In addition, a hydrophilic coating is formed on the electrical insulating coating on the outer surface of the distal treatment tool support member 14 and on the resin outer sheath 11b of the sheath 11, so that the distal treatment pieces 15, 16 to the sheath 11 can be smoothly introduced into the body cavity without cramping.

したがって、操作ワイヤ１２を進退操作することにより、一対の先端処置片１５，１６の先端側部分１５ｃ，１６ｃが閉じるときに、電流を通電して体腔内の生体組織を焼灼し止血することや、生体組織の切除等の処置を行うよう構成されている。 Therefore, by moving the operating wire 12 back and forth, when the distal end portions 15c, 16c of the pair of distal treatment pieces 15, 16 close, an electric current is passed through the tissue in the body cavity to cauterize and stop bleeding, or to perform treatment such as resection of the tissue.

［内視鏡用処置具の特徴的構成］
図３（Ａ），（Ｄ）に示すように、先端処置具支持部材１４は、筒部１４ａと、筒部１４ａの線端面より先方に延在する対向一対の腕部１４ｂとを有する。そして、図４（Ａ）－（Ｄ）に示すように、先端処置具支持部材１４は、腕部１４ｂ間で筒部１４ａを半割した一対の半割体１４Ａ，１４Ｂを合わせてなる。したがって、一方の半割体１４Ａは半筒部１４ａ１と腕部１４ｂとの一体形状であり、他方の半割体１４Ｂは半筒部１４ａ２と腕部１４ｂとの一体形状である。 [Characteristic configuration of an endoscopic treatment tool]
As shown in Figures 3(A) and (D), the distal end treatment tool support member 14 has a tubular portion 14a and a pair of opposing arm portions 14b extending forward from the linear end surface of the tubular portion 14a. As shown in Figures 4(A) to (D), the distal end treatment tool support member 14 is formed by joining together a pair of half bodies 14A and 14B obtained by splitting the tubular portion 14a in half between the arm portions 14b. Therefore, one half body 14A is an integral shape of a half tubular portion 14a1 and an arm portion 14b, and the other half body 14B is an integral shape of a half tubular portion 14a2 and an arm portion 14b.

各半割体１４Ａ，１４Ｂは、腕部１４ｂに、支持軸１８の端部を支持するための支持軸用軸受部１４ｃが設けられ、各半筒部１４ａ１，１４ａ２の内周面後端部に内方に突出する半円環状の軸受部１４ｄが設けられ、また内周面先端部に内方に突出する内側凸壁１４ｇが設けられ、各腕部１４ｂの対向面の先端側の所要位置に開度制限用突起１４ｊまたは１４ｋが設けられ、筒部１４ａの各半割面に位置決め用の凸部１４ｅと凹部１４ｆとが分配して設けられている。 Each half body 14A, 14B has a support shaft bearing 14c on the arm 14b for supporting the end of the support shaft 18, a semicircular ring-shaped bearing 14d protruding inward is provided at the rear end of the inner circumferential surface of each half cylinder 14a1, 14a2, an inner convex wall 14g protruding inward is provided at the tip of the inner circumferential surface, an opening limiting protrusion 14j or 14k is provided at a required position on the tip side of the opposing surface of each arm 14b, and positioning convex portions 14e and concave portions 14f are distributed on each half surface of the cylinder 14a.

図示の支持軸用軸受部１４ｃは貫通孔として設けられているが、半割面側から設けられた円筒凹部（未貫通穴）であってもよい。 The illustrated support shaft bearing portion 14c is provided as a through hole, but it may be a cylindrical recess (non-through hole) provided from the half-split surface side.

筒部１４ａ１または１４ａ２を構成する一対の半割体１４Ａ，１４Ｂは、ステンレス製またはナイチノール（ニッケルチタン合金）製の微細粒子をＭＩＭ方式（金属粉末射出成形）にて焼成されており、精密な形状・寸法が得られる。 The pair of halves 14A, 14B that make up the cylindrical portion 14a1 or 14a2 are made of fine particles of stainless steel or Nitinol (nickel-titanium alloy) that are sintered using the MIM method (metal powder injection molding), resulting in precise shape and dimensions.

開度制限用突起１４ｊ，１４ｋは、各半割体１４Ａ，１４ＢがＭＩＭ方式（金属粉末射出成形）にて形成される。 The opening limiting protrusions 14j, 14k are formed by using the MIM method (metal powder injection molding) to form each half body 14A, 14B.

図５（Ａ），（Ｂ），（Ｃ）に示す開度制限用突起１４ｊ，１４ｋは、一対の先端処置片１５，１６のそれぞれの最大開度時の角度が１１０度、７０度、４５度になるときに、一対の開閉作動用リンク１９，２０が当接するように設けられている。 The opening limiting protrusions 14j, 14k shown in Figures 5(A), (B), and (C) are arranged so that a pair of opening/closing actuation links 19, 20 come into contact with each other when the maximum opening angles of the pair of distal end treatment pieces 15, 16 are 110 degrees, 70 degrees, and 45 degrees, respectively.

このように、一対の先端処置片１５，１６のそれぞれの最大開度時の角度の設定は、開度制限用突起１４ｊ，１４ｋの設け方次第で適宜決定することができる。 In this way, the angle at which each of the pair of distal treatment pieces 15, 16 is opened to its maximum extent can be appropriately determined depending on how the opening limiting protrusions 14j, 14k are provided.

図５（Ｃ）に示すように、開度制限用突起１４ｊ，１４ｋは、支持軸１８の両側に２つに分かれて設けられてもよい。開度制限用突起１４ｊ，１４ｋがそれぞれ２つに分かれて設けられる場合、開閉作動用リンク２０に対応している方の開度制限用突起１４ｊと、開閉作動用リンク１９に対応している方の開度制限用突起１４ｋとがストッパー機能を有する。なお、開度制限用突起１４ｊ，１４ｋのいずれか一方が設けられていれば足りる。 As shown in FIG. 5(C), the opening limiting protrusions 14j, 14k may be provided in two on either side of the support shaft 18. When the opening limiting protrusions 14j, 14k are each provided in two, the opening limiting protrusion 14j corresponding to the opening/closing operation link 20 and the opening limiting protrusion 14k corresponding to the opening/closing operation link 19 have a stopper function. It is sufficient to provide either one of the opening limiting protrusions 14j, 14k.

したがって、コイルシース１１ａへの一対の半割体１４Ａ，１４Ｂおよび一対の先端処置片１５，１６の第１段階の組立手順は、一対の先端処置片１５，１６をＸ状に交差させ、交差部１５ａ，１６ａの軸孔に支持軸１８の中央部を嵌合し、次に、一対の先端処置片１５，１６の基端部と一対の開閉作動用リンク１９，２０の先端部とをピン軸２２，２３で連結し、さらに一対の開閉作動用リンク１９，２０の後端と進退伝動リンク２１とをピン軸２４で連結し、さらにまた進退伝動リンク２１と操作ワイヤ１２とを連結する。 Therefore, the first stage of assembly of the pair of half bodies 14A, 14B and the pair of distal treatment pieces 15, 16 to the coil sheath 11a is to cross the pair of distal treatment pieces 15, 16 in an X-shape, fit the center of the support shaft 18 into the axial hole of the crossing portion 15a, 16a, then connect the base ends of the pair of distal treatment pieces 15, 16 to the distal ends of the pair of opening/closing operation links 19, 20 with pin shafts 22, 23, further connect the rear ends of the pair of opening/closing operation links 19, 20 to the forward/backward transmission link 21 with pin shaft 24, and further connect the forward/backward transmission link 21 to the operating wire 12.

続く第２段階の組立手順は、一対の先端処置片１５，１６の交差部１５ａ，１６ａの軸孔に嵌合させた支持軸１８の両端に、一対の半割体１４Ａ，１４Ｂの支持軸用軸受部１４ｃを被嵌させ（図３（Ｄ））、凸部１４ｅと凹部１４ｆとを契合させ（図４（Ａ））、これと同時に、一対の半円環状の軸受部１４ｄでコイルシース１１ａの先端部の脱出防止用凸部１１ａ１を避けて形成された先端小径部１１ａ２を挟み、もって、一対の半割体１４Ａ，１４Ｂを重ね合わせ（図３（Ｂ）－（Ｄ））、半筒部１４ａ１同士の外周面の両側の重ね合わせ線１４ｉの全長を固着（レーザー溶接）されている（図４（Ａ））。このレーザー溶接により、半筒部１４ａ１同士の外周面の重ね合わせ線に沿う領域の電気絶縁被膜が剥離するが、一対の先端処置片１５，１６の刃部から離間した位置であることから、電流を通電し生体組織を焼灼し止血しつつ切開する際の支障になることはない。一対の内側凸壁１４ｇは、進退伝動リンク２１を通すようになる。 The second assembly step involves fitting the support shaft bearings 14c of the pair of half-bodies 14A, 14B onto both ends of the support shaft 18 fitted into the axial holes of the intersections 15a, 16a of the pair of distal treatment pieces 15, 16 (Fig. 3(D)), engaging the convex portion 14e with the concave portion 14f (Fig. 4(A)), and at the same time, sandwiching the small-diameter tip portion 11a2 formed to avoid the escape-prevention convex portion 11a1 at the distal end of the coil sheath 11a with the pair of semicircular ring-shaped bearings 14d, thereby overlapping the pair of half-bodies 14A, 14B (Figs. 3(B)-(D)), and fastening (laser welding) the entire length of the overlap line 14i on both sides of the outer circumferential surfaces of the semi-cylindrical portions 14a1 to each other (Fig. 4(A)). This laser welding causes the electrical insulation coating in the area along the overlap line of the outer circumferential surface of the half-cylindrical portions 14a1 to peel off, but because this is a position away from the blades of the pair of distal treatment pieces 15, 16, it does not interfere with passing an electric current through the tissue to cauterize it and stop bleeding while cutting it. The pair of inner convex walls 14g allow the forward and backward transmission link 21 to pass through.

一対の半円環状の軸受部１４ｄは、コイルシース１１ａの先端部１１ａ１を避けて形成された先端小径部１１ａ２を相対回転可能に被嵌することになり、先端部１１ａ１は先端処置具支持部材１４のコイルシース１１ａからの脱出を防止する役目を果たす。なお、先端小径部１１ａ２を設ける場合に、先端まで含めて研磨加工を行い、先端部１１ａ１に相当するリングを被嵌しレーザー溶接あるいは銀ロウ付け、等で固定してもよい。 The pair of semicircular ring-shaped bearings 14d are fitted with the small-diameter tip portion 11a2, which is formed to avoid the tip portion 11a1 of the coil sheath 11a, so that the small-diameter tip portion 11a2 can rotate relative to the coil sheath 11a. When providing the small-diameter tip portion 11a2, the small-diameter tip portion 11a2 can be polished all the way up to the tip, and a ring equivalent to the tip portion 11a1 can be fitted over the small-diameter tip portion 11a2 and fixed by laser welding, silver brazing, or the like.

上記のように組み立てることができるので、支持軸１８を中央部が大径となる段軸形状に形成して、一対の先端処置片１５，１６を安定した開閉を保障することもできる。また、凸部１４ｅと凹部１４ｆとを契合させるので、一対の半割体１４Ａ，１４Ｂの軸方向の位置合わせを迅速容易かつ正確に行えて、支持軸１８の両側の端部を支持する一対の半割体１４Ａ，１４Ｂの支持軸用軸受部１４ｃが精密な一軸線上に位置し、一対の先端処置片１５，１６の中程１５ａ，１６ａと一対の腕部１４ｂとが平行状態に接触し、もって、一対の一対の腕部１４ｂが一対の先端処置片１５，１６を円滑な回転を保障するように保持することができる。 Since it can be assembled as described above, the support shaft 18 can be formed into a stepped shaft shape with a large diameter in the center, ensuring stable opening and closing of the pair of distal end treatment pieces 15, 16. In addition, since the convex portion 14e and the concave portion 14f are engaged, the axial positioning of the pair of half bodies 14A, 14B can be performed quickly, easily and accurately, the support shaft bearing portions 14c of the pair of half bodies 14A, 14B supporting both ends of the support shaft 18 are positioned on a precise axis line, and the middle portions 15a, 16a of the pair of distal end treatment pieces 15, 16 and the pair of arms 14b are in contact in a parallel state, so that the pair of arms 14b can hold the pair of distal end treatment pieces 15, 16 to ensure smooth rotation.

一対の先端処置片１５，１６の先端側部分１５ｃ，１６ｃは、長手方向に垂直な断面形状が矩形であって、電気絶縁性の不活性被膜がなく金属面が露出している。先端側部分１５ｃ，１６ｃの各対向面の先端部に形成された凸部同士が当接することで、先端側部分１５ｃ，１６ｃが閉じた状態になるときに、粘膜剥離処理の際に、対向面同士の間隔が例えば１ｍｍ程度に保持され、対向面同士間に泡を発生させつつ血管を圧迫して切断することが無く、生体組織を安全に切開する機能を有する。 The distal end portions 15c, 16c of the pair of distal treatment pieces 15, 16 have a rectangular cross-sectional shape perpendicular to the longitudinal direction, and the metal surface is exposed without any electrically insulating inert coating. When the distal end portions 15c, 16c are closed by the protrusions formed at the tip of each opposing surface of the distal end portions 15c, 16c abutting against each other, the distance between the opposing surfaces is maintained at, for example, about 1 mm during mucosal dissection treatment, and the function is to safely incise biological tissue without compressing and cutting blood vessels while generating bubbles between the opposing surfaces.

上記構成の内視鏡用処置具１０によれば、先端処置具支持部材１４をＭＩＭ方式（金属粉末射出成形）にて焼成することができる一対の半割体１４Ａ，１４Ｂで構成し、各半割体１４Ａ，１４Ｂに開度制限用突起１４ｊまたは１４ｋを設けたので一対の先端処置片１５，１６の最大開度を所定角度に制限できるとともに、コイルシース１１ａに形成する先端小径部１１ａ２に先端処置具支持部材１４を離脱不能・回転可能に直接連結する構成をコイルシース１１ａの先端部に連結部品に介在しない簡素な構成として実現することができ、もって、簡素な連結構造の実現と、組立の容易化、コスト低減が実現できる。なお、先端小径部１１ａ２に先端処置具支持部材１４を回転不能に連結してもよい。
また、開度制限用突起１４ｊ，１４ｋを先端処置具支持部材１４に設けたことにより、開度制限用突起を先端処置片に設ける場合に比べ大きくすることができ、また開度制限用突起１４ｊ，１４ｋと開閉作動用リンク１９，２０とを当接させて開度を制限するため破損しにくい。 According to the endoscopic treatment tool 10 having the above-mentioned configuration, the distal end treatment tool support member 14 is composed of a pair of half-split bodies 14A, 14B that can be sintered by the MIM method (metal powder injection molding), and each half-split body 14A, 14B is provided with an opening limiting protrusion 14j or 14k, so that the maximum opening degree of the pair of distal end treatment pieces 15, 16 can be limited to a predetermined angle, and the distal end treatment tool support member 14 can be directly and non-detachably and rotatably connected to the distal end small diameter portion 11a2 formed in the coil sheath 11a as a simple configuration without any connecting parts at the distal end of the coil sheath 11a, thereby realizing a simple connection structure, facilitating assembly, and reducing costs. The distal end treatment tool support member 14 may be non-rotatably connected to the distal end small diameter portion 11a2.
In addition, by providing the opening limiting protrusions 14j, 14k on the distal treatment tool support member 14, the opening limiting protrusions can be made larger than when they are provided on the distal treatment piece, and since the opening limiting protrusions 14j, 14k are abutted against the opening/closing operation links 19, 20 to limit the opening, they are less likely to be damaged.

また、先端処置具支持部材１４が一対の半割体１４Ａ，１４Ｂよりなるから、支持軸１８の両端部と一対の半割体１４Ａ，１４Ｂの支持軸用軸受部１４ｃとの嵌合を半割面側から行うことができる。さらに、支持軸１８の両端部を一対の半割体１４Ａ，１４Ｂを嵌合する構成であるから、支持軸１８について中央部を大径に、両端部を小径に形成できるから、半割体の軸受部として貫通孔を設けて支持軸１８の両端部を嵌合して両者をレーザー溶接する構成とした場合には溶接個所が小さくて済み（電気絶縁被膜が剥がれる部位が極小に抑えられる）、また、半割体の軸受部として軸孔（非貫通）を設けて支持軸１８の両端部を嵌合する構成とした場合には溶接を半割面側から行うことができる。 In addition, since the distal end treatment tool support member 14 is composed of a pair of half bodies 14A, 14B, the fitting of both ends of the support shaft 18 with the support shaft bearing parts 14c of the pair of half bodies 14A, 14B can be performed from the half surface side. Furthermore, since both ends of the support shaft 18 are configured to fit the pair of half bodies 14A, 14B, the center part of the support shaft 18 can be formed with a large diameter and both ends with a small diameter. Therefore, when a through hole is provided as the bearing part of the half body and both ends of the support shaft 18 are fitted and laser welded, the welding part can be small (the part where the electrical insulation coating peels off is kept to a minimum), and when a shaft hole (non-through) is provided as the bearing part of the half body and both ends of the support shaft 18 are fitted, welding can be performed from the half surface side.

［実施形態２］ [Embodiment 2]

図６は実施形態２に係る内視鏡用処置具１０Ａの先端処置具を含む先端部分を示す図である。 Figure 6 shows the distal end portion of the endoscopic treatment tool 10A according to embodiment 2, including the distal treatment tool.

内視鏡用処置具１０Ａは、内視鏡用電気焼灼切開鋏として用いられる。内視鏡用処置具１０Ａの基本的構成は、実施形態１に係る内視鏡用処置具１０の基本的構成と略同一の構成である。内視鏡用処置具１０Ａの実施形態１に係る内視鏡用処置具１０と相違する構成は、コイルシース１１ａの先端部に延長するように連結用筒状部２５を有し、連結用筒状部２５の先端部に先端処置具支持部材１４が連結されていることが特徴的構成である。 The endoscopic treatment tool 10A is used as an endoscopic electric cauterization and incision scissors. The basic configuration of the endoscopic treatment tool 10A is substantially the same as the basic configuration of the endoscopic treatment tool 10 according to embodiment 1. The endoscopic treatment tool 10A differs from the endoscopic treatment tool 10 according to embodiment 1 in that it has a connecting tubular portion 25 that extends to the tip of the coil sheath 11a, and the tip of the connecting tubular portion 25 is connected to the tip of the tip treatment tool support member 14.

内視鏡用処置具１０Ａは、連結用筒状部２５を備えていることだけが、実施形態１の内視鏡用処置具１０と相違しているので、図３（Ｃ）と同一の符号を付して詳細な構成、作用・効果の説明を省略する。 The endoscopic treatment tool 10A differs from the endoscopic treatment tool 10 of embodiment 1 only in that it is equipped with a connecting tubular portion 25, so the same reference numerals as in FIG. 3(C) are used and detailed descriptions of the configuration, action, and effect are omitted.

連結用筒状部２５は、コイルシース１１ａの先端部に被嵌されレーザー溶接、銀ロウ付け、ハンダ付け、等により固定された大径筒部２５ａと、大径筒部２５ａの先端から延在していて先端処置具支持部材１４の半円環状の軸受部１４ｄが被嵌している先端小径筒部２２ｂと、先端小径筒部２５ｂの先端部に径方向外方に突出して設けられ先端処置具支持部材１４の軸受部１４ｄの離脱を防止する脱出防止用凸部２５ｃとを有している。 The connecting tubular portion 25 has a large diameter tubular portion 25a that is fitted over the tip of the coil sheath 11a and fixed by laser welding, silver brazing, soldering, etc., a tip small diameter tubular portion 22b that extends from the tip of the large diameter tubular portion 25a and is fitted over the semicircular ring-shaped bearing portion 14d of the tip treatment tool support member 14, and an escape prevention protrusion 25c that is provided at the tip of the tip small diameter tubular portion 25b and protrudes radially outward to prevent the bearing portion 14d of the tip treatment tool support member 14 from coming off.

連結用筒状部２５を設けていることにより以下の利点がある。実施形態１では、コイルシース１１ａの先端小径部１１ａ２を設けることで部品省略できるが、コイルシース１１ａの先端部の外周面を円筒研磨加工することは加工が難しく、高コストになる。これに対し、連結用筒状部２５を設ける場合には、連結用筒状部２５についてはステンレス製またはナイチノール（ニッケルチタン合金）製の微細粒子をＭＩＭ方式（金属粉末射出成形）にて焼成されており、精密な形状・寸法が得られるので低コストになる。 Providing the connecting tubular portion 25 has the following advantages. In the first embodiment, the provision of the small diameter portion 11a2 at the tip of the coil sheath 11a allows parts to be omitted, but cylindrical grinding of the outer circumferential surface of the tip of the coil sheath 11a is difficult and expensive. In contrast, when the connecting tubular portion 25 is provided, the connecting tubular portion 25 is made of fine particles made of stainless steel or Nitinol (nickel-titanium alloy) that are sintered using the MIM method (metal powder injection molding), and precise shapes and dimensions can be obtained, resulting in low costs.

この実施形態２の先端処置具支持部材１４も、開度制限用突起１４ｊ，１４ｋを有しているので、一対の先端処置片１５，１６のそれぞれの最大開度時の角度の設定が行える。先端処置具支持部材１４は、連結用筒状部２５の先端小径筒部２２ｂに対して先端処置具に求める機能に合致するよう固定、回転可能のいずれか１つの関係に設けられる。 The distal treatment tool support member 14 of this second embodiment also has opening limiting protrusions 14j, 14k, so that the angle at which each of the pair of distal treatment pieces 15, 16 is at its maximum opening can be set. The distal treatment tool support member 14 is provided in either a fixed or rotatable relationship with respect to the distal small diameter cylindrical portion 22b of the connecting cylindrical portion 25 so as to match the functionality required of the distal treatment tool.

［実施形態３］
［内視鏡用処置具の基本的構成］
図７は実施形態３に係る電気焼灼切開鋏として使用される内視鏡用処置具１０Ｂを示す。内視鏡用処置具１０Ｂは、生理食塩水等の液体をシース１１内に通流させて先端処置具支持部材１４の先端から噴き出して生体組織の血液を押し流す機能を有することが、図２に示す実施形態１に係る内視鏡用処置具１０と相違している。内視鏡用処置具１０Ｂは、内視鏡用処置具１０に替えて図１に示す内視鏡システム１の内視鏡チャネル５内に進退可能である。 [Embodiment 3]
[Basic configuration of an endoscopic treatment tool]
Fig. 7 shows an endoscopic treatment tool 10B used as electric cautery incision scissors according to embodiment 3. The endoscopic treatment tool 10B differs from the endoscopic treatment tool 10 according to embodiment 1 shown in Fig. 2 in that it has a function of passing a liquid such as physiological saline through the sheath 11 and ejecting it from the tip of the distal treatment tool support member 14 to flush away blood from living tissue. The endoscopic treatment tool 10B can be advanced and retreated into the endoscope channel 5 of the endoscope system 1 shown in Fig. 1 in place of the endoscopic treatment tool 10.

図７に示す内視鏡用処置具１０Ｂに関し、図２に示す内視鏡用処置具１０と相違する構成部分、および相違する構成部分から生じる作用・効果を説明する。内視鏡用処置具１０Ｂの内視鏡用処置具１０と同一の構成部分、および同一の構成部分から生じる作用・効果については説明をする。 With regard to the endoscopic treatment tool 10B shown in FIG. 7, the components that differ from the endoscopic treatment tool 10 shown in FIG. 2 and the actions and effects resulting from the different components will be explained. The components of the endoscopic treatment tool 10B that are the same as those of the endoscopic treatment tool 10 and the actions and effects resulting from the same components will be explained.

内視鏡用処置具１０Ｂの操作部１３は、操作部本体１３ａと、スライダ１３ｂと、液注入部１３ｃと、接続キャップ１３ｄとを備えてなる。 The operating section 13 of the endoscopic treatment tool 10B comprises an operating section main body 13a, a slider 13b, a liquid injection section 13c, and a connection cap 13d.

操作部本体１３ａは、両側面部に直線ガイドを有する長矩形枠部１３ａ１と、矩形枠部１３ａ１の基端に延在する指掛け孔を有するハンドル部１３ａ２と、矩形枠部１３ａ１の先端に延在する雄型接続部１３ａ３とを有し、円錐状の雄型接続部１３ａ３には貫通孔を有する。スライダ１３ｂは、中央部が長矩形枠部１３ａ１の直線ガイドに摺動可能に嵌着され、両側部に指掛け孔を有する。したがって、ハンドル部１３ａ２に親指を掛け、指かけ孔に人差し指及び中指を掛けて、操作部本体１３ａ及びスライダ１３ｂを相対的に移動させることができる。 The operating unit main body 13a has a rectangular frame 13a1 with linear guides on both side surfaces, a handle 13a2 with a finger hole extending to the base end of the rectangular frame 13a1, and a male connector 13a3 extending to the tip of the rectangular frame 13a1, with a through hole in the conical male connector 13a3. The slider 13b is slidably fitted in the linear guide of the rectangular frame 13a1 at its center, and has finger holes on both sides. Therefore, the operating unit main body 13a and the slider 13b can be moved relative to each other by placing the thumb on the handle 13a2 and the index finger and middle finger in the finger holes.

また、スライダ１３ｂを矩形枠部１３ａに対して移動することにより操作ワイヤ１２をシース１１に対して進退可能である。操作ワイヤ１２とコイルシース１１ａは、基端部同士が一体に回転可能である構成である。したがって、スライダ１３ｂを保持し矩形枠部１３ａの周りに回動し操作ワイヤ１２とシース１１とを一体に回転することにより、シース１１の先端側でシース１１と操作ワイヤ１２とを一体に回転することができる。 In addition, the operation wire 12 can be advanced and retreated relative to the sheath 11 by moving the slider 13b relative to the rectangular frame portion 13a. The operation wire 12 and the coil sheath 11a are configured so that their base ends can rotate together. Therefore, by holding the slider 13b and rotating it around the rectangular frame portion 13a to rotate the operation wire 12 and sheath 11 together, the sheath 11 and operation wire 12 can be rotated together at the tip side of the sheath 11.

なお、雄型接続部１３ａ３を矩形枠部１３ａに一体に延設するのではなく、雄型接続部１３ａ３を矩形枠部１３ａと分離して長く設けて回らないように保持部を付設し、この雄型接続部１３ａ３を矩形枠部１３ａの先端部に相対回転可能に連結する構成とすれば、スライダ１３ｂを保持し矩形枠部１３ａの周りに回動すると、操作ワイヤ１２とコイルシース１１ａが先端側において相対回転可能になる。 In addition, instead of extending the male connector 13a3 integrally with the rectangular frame 13a, the male connector 13a3 is separated from the rectangular frame 13a and is provided with a holding section to prevent it from rotating. If this male connector 13a3 is connected to the tip of the rectangular frame 13a so that it can rotate relatively, then when the slider 13b is held and rotated around the rectangular frame 13a, the operating wire 12 and the coil sheath 11a can rotate relatively at the tip.

液注入部１３ｃは、貫通孔１３ｃ１と、貫通孔１３ｃ１の中途部に連通するように送液接続口１３ｃ２と、貫通孔１３ｃ１の基端部に形成され操作部本体１３ａの雄型接続部１３ａ３に螺着している円錐状の雌ねじ部（符号なし）と、貫通孔の先端部に形成され接続キャップ１３ｄが螺着している円錐状の雄ねじ部（符号なし）とを有する。送液接続口１３ｃ２には、送液手段６が接続される。送液手段６は、シリンジあるいはポンプ等であり、生理食塩水等の液体をシース２の流路２ａに送り込むことができるようになっている。 The liquid injection section 13c has a through hole 13c1, a liquid supply connection port 13c2 that communicates with the middle of the through hole 13c1, a conical female threaded portion (no reference number) formed at the base end of the through hole 13c1 and screwed into the male connector 13a3 of the operation section main body 13a, and a conical male threaded portion (no reference number) formed at the tip of the through hole and screwed into the connector cap 13d. A liquid supply connection port 13c2 is connected to the liquid supply connection port 13c2. The liquid supply means 6 is a syringe or a pump, etc., and is capable of supplying a liquid such as saline to the flow path 2a of the sheath 2.

そして、シース１１内に挿通された操作ワイヤ１２が、接続キャップ１３ｄと液注入部１３ｃの貫通孔１３ｃ１と操作部本体１３ａの貫通孔に挿通され、操作ワイヤ１２の基端が、矩形枠部１３ａの枠内に通され、スライダ１３ｂに連結されており、スライダ１３ｂを保持して矩形枠部１３ａに対して移動すると、操作ワイヤ１２を進退可能となっている。操作ワイヤ１２と操作部本体１３ａの貫通孔基端部の環状隙間を埋めるように液封リング（不図示）が設けられている。 The operating wire 12 inserted into the sheath 11 is inserted through the connection cap 13d, the through hole 13c1 of the liquid injection section 13c, and the through hole of the operating section main body 13a, and the base end of the operating wire 12 is passed through the rectangular frame section 13a and connected to the slider 13b. When the slider 13b is held and moved relative to the rectangular frame section 13a, the operating wire 12 can be advanced and retreated. A liquid sealing ring (not shown) is provided to fill the annular gap between the operating wire 12 and the base end of the through hole of the operating section main body 13a.

また、シース１１の基端部を液注入部１３ｃの先端にフレアに当接され接続キャップ１３ｄにより固定されている。送液手段６の液体は、送液接続口１３ｃ２からシース１１内の操作ワイヤ１２の周囲空間を通ってシース１１先端に送液される。 The base end of the sheath 11 is flared and abuts against the tip of the liquid injection section 13c and is fixed by a connection cap 13d. The liquid from the liquid delivery means 6 is delivered from the liquid delivery connection port 13c2 through the space around the operating wire 12 inside the sheath 11 to the tip of the sheath 11.

図８に示す先端処置具支持部材１４に関し、図３に示す先端処置具支持部材１４と相違する構成部分、および相違する構成部分から生じる作用・効果を説明する。内視鏡用処置具１０Ｂの内視鏡用処置具１０と同一の構成部分、および同一の構成部分から生じる作用・効果については説明をする。 With regard to the distal end treatment tool support member 14 shown in FIG. 8, the components that differ from the distal end treatment tool support member 14 shown in FIG. 3 and the actions and effects resulting from the different components will be explained. The components of the endoscopic treatment tool 10B that are the same as those of the endoscopic treatment tool 10 and the actions and effects resulting from the same components will be explained.

図９は実施形態３に係る内視鏡用処置具１０Ｂを示す。内視鏡用処置具１０Ｂは、先端処置具支持部材１４に図３に示す先端処置具支持部材１４と相違する特徴がある。 Figure 9 shows an endoscopic treatment tool 10B according to embodiment 3. The distal end treatment tool support member 14 of the endoscopic treatment tool 10B has features that differ from those of the distal end treatment tool support member 14 shown in Figure 3.

先端処置片１５Ｂ，１６Ｂの先端部１５ｃ、１６ｃは、後述する液送用凹条部２６と、開度制限用突起１４ｊ，１４ｋを除き、実施形態１と同一に構成される。 The distal end portions 15c and 16c of the distal treatment pieces 15B and 16B are configured in the same manner as in embodiment 1, except for the fluid delivery groove portion 26 and the opening limiting protrusions 14j and 14k, which will be described later.

図８（Ａ），（Ｃ）に示すように、先端処置具支持部材１４Ｂは、半割体１４Ａ，１４Ｂの各腕部１４ｂの対向面の幅中央部を流れ先端より噴き出すように生理食塩水等の液体を通流させる液送用凹条部２６を有する。 As shown in Figures 8(A) and (C), the distal treatment tool support member 14B has a fluid-transporting groove 26 that allows a liquid such as saline to flow through the center of the width of the opposing faces of each arm 14b of the half-split bodies 14A and 14B and be sprayed out from the distal end.

図８（Ｄ）に示すように、支持軸は中央が大径部とされ両側が小径部とされ、段差面が液送用凹条部２６に当接するように段軸状に形成されている。また、各腕部１４ｂの先端側対向面より突出するよう設けられている開度制限用突起１４ｊ，１４ｋは先端処置片１５Ｂ，１６Ｂの中央部１５ａ，１６ａに当接している。 As shown in FIG. 8(D), the support shaft has a large diameter in the center and small diameter on both sides, and is formed in a stepped shaft shape so that the stepped surface abuts against the fluid transfer groove 26. In addition, the opening limiting projections 14j, 14k that protrude from the distal end facing surface of each arm 14b abut against the central portions 15a, 16a of the distal treatment pieces 15B, 16B.

液送用凹条部２６は、内側凸壁１４ｇおよび開度制限用突起１４ｊ，１４ｋを切り欠いて各腕部１４ｂ，１４ｂの対向面の幅中央部に設けられ、支持軸１８の両側に処置液が迂回して流れる幅広部を有している。 The fluid delivery groove 26 is provided at the center of the width of the opposing faces of the arms 14b, 14b by cutting out the inner convex wall 14g and the opening limiting protrusions 14j, 14k, and has wide sections on both sides of the support shaft 18 through which the treatment fluid flows in a detouring manner.

この実施の形態では、先端処置具支持部材１４を構成する一対の半割体１４Ａ，１４Ｂの各腕部１４ｂに開度制限用突起１４ｊ，１４ｋおよび液送用凹条部２６が設けられているので、先端処置片１５Ｂ，１６Ｂを開くときには開度制限用突起１４ｊ，１４ｋに一対の開閉作動用リンク１９，２０が当接するストッパー機能（開度制限機能）により一対の開閉作動用リンク１９，２０の最大開度が決まる。 In this embodiment, the opening limiting projections 14j, 14k and the fluid delivery grooves 26 are provided on each arm 14b of the pair of halves 14A, 14B that make up the distal treatment tool support member 14, so that when the distal treatment pieces 15B, 16B are opened, the maximum opening of the pair of opening/closing actuation links 19, 20 is determined by the stopper function (opening limiting function) in which the opening limiting projections 14j, 14k abut the pair of opening/closing actuation links 19, 20.

液送用凹条部２６を通流し一対の腕部１４ｂ，１４ｂ間の先端から噴き出す生理食塩水等の液体は、図８（Ａ）に示すように、先端処置片１５Ｂ，１６Ｂが閉じた状態であるときには先端処置具支持部材１４Ｂの内部（液送用凹条部２６）を通流する液体が先端から真直ぐ１本で流出する状態となり、先端処置片１５Ｂ，１６Ｂが最大角度よりも僅かに小さい角度に開いた状態（図８（Ｂ）に示す開度より僅かに小さい開度の状態）であるときには真直ぐに噴き出す状態を僅かな時間保持してから表面張力が作用して一対の先端処置片１５，１６に沿って広がって流れさらに下流側で再び集まるように流れとなり、さらに、図８（Ｃ）に示すように、先端処置片１５Ｂ，１６Ｂが最大角度に開いた状態になるときに先端処置具支持部材１４の内部を通流する液体が先端処置具支持部材の先端から２本に分かれて流出する状態となる。 When the distal treatment pieces 15B, 16B are closed, as shown in FIG. 8(A), the liquid such as saline solution flows through the fluid delivery groove 26 and spurts out from the tip between the pair of arms 14b, 14b. The liquid flows through the inside of the distal treatment tool support member 14B (fluid delivery groove 26) in a straight line from the tip. When the distal treatment pieces 15B, 16B are open at an angle slightly smaller than the maximum angle (slightly smaller than the opening shown in FIG. 8(B)), the liquid remains in a straight line for a short time, and then spreads out along the pair of distal treatment pieces 15, 16 due to the action of surface tension, and then gathers again downstream. Furthermore, when the distal treatment pieces 15B, 16B are open at the maximum angle, as shown in FIG. 8(C), the liquid flowing through the inside of the distal treatment tool support member 14 flows out in two lines from the tip of the distal treatment tool support member.

したがって、先端処置片１５Ｂ，１６Ｂを開閉することにより、先端処置具支持部材１４の先端から噴き出す生理食塩水等の液体の流れを自在に変化させることができて、これにより切開部に生じる血を生理食塩水で効果的に押し流すことができる。 Therefore, by opening and closing the distal treatment pieces 15B and 16B, the flow of liquid such as saline sprayed from the tip of the distal treatment tool support member 14 can be freely changed, and the saline can be used to effectively flush away blood that has formed at the incision site.

［実施形態１－３の変形例］
先端処置具支持部材１４－１４Ｂが、コイルシース１１ａの先端部または当該先端部に設けられた連結用筒状部２２の先端部に脱出防止用リングが被嵌されレーザー溶接により固定されていてもよい。 [Modifications of Embodiments 1-3]
The distal end treatment tool support member 14-14B may have an anti-dislodgement ring fitted over the distal end of the coil sheath 11a or the distal end of the connecting tubular portion 22 provided at the distal end and fixed by laser welding.

本発明によれば、一対の先端処置片の最大開度を所定角度に制限できるとともに、簡素な連結構造の実現と、組立の容易化、コスト低減が実現できるという効果を有し、優れた内視鏡用処置具を提供することができる。 The present invention has the effect of limiting the maximum opening angle of a pair of distal treatment pieces to a predetermined angle, realizing a simple connecting structure, facilitating assembly, and reducing costs, thereby providing an excellent endoscopic treatment tool.

１…内視鏡システム、
２…挿入部、
３…内視鏡操作部、
４…処置具導入部、
５…内視鏡チャネル、
６…送液手段、
１０，１０Ａ，１０Ｂ…内視鏡用処置具、
１１…シース、
１１ａ…コイルシース、
１１ａ１…先端部（脱出防止用凸部）、
１１ａ２…先端小径部、
１１ｂ…樹脂製外被、
１２…操作ワイヤ、
１３…操作部、
１３ａ…操作部本体、
１３ａ１…長矩形枠部、
１３ａ２…ハンドル部、
１３ａ３…雄型接続部、
１３ｂ…スライダ、
１３ｃ…液注入部、
１３ｃ１…貫通孔、
１３ｃ２…送液接続口、
１３ｄ…接続キャップ、
１４…先端処置具支持部材、
１４Ａ，１４Ｂ…半割体、
１４ａ…筒部、
１４ａ１…半筒部、
１４ｂ，１４ｂ…腕部、
１４ｃ…支持軸用軸受部、
１４ｄ…軸受部、
１４ｅ…凸部、
１４ｆ…凹部、
１４ｇ…内側凸壁、
１４ｈ…先端肉厚部、
１４ｉ…重ね合わせ線、
１４ｊ，１４ｋ…開度制限用突起、
１５，１５Ａ，１５Ｂ…先端処置片（先端処置具）、
１５ａ，１６ａ…中程（交差部）、
１５ｂ，１６ｂ…基端側部分、
１５ｃ，１６ｃ…先端側部分、
１５ｄ，１６ｄ…開閉作動用リンク、
１５ｅ…円孔、
１８…支持軸、
１９，２０…開閉作動用リンク、
２１…進退伝動リンク、
２２，２３，２４…ピン軸、
２５…連結用筒状部、
２５ａ…大径筒部、
２５ｂ…先端小径筒部、
２５ｃ…脱出防止用凸部、
２６…液送用凹条部。 1...endoscope system,
2...insertion part,
3...endoscope operation unit,
4...Treatment tool introduction section,
5...endoscope channel,
6...liquid delivery means,
10, 10A, 10B...endoscopic treatment tool,
11...sheath,
11a...coil sheath,
11a1...tip portion (escape prevention protrusion),
11a2...tip small diameter portion,
11b...resin outer cover,
12...operation wire,
13...Operation unit,
13a...operation unit main body,
13a1...Rectangular frame portion,
13a2...handle portion,
13a3...male connector,
13b...slider,
13c...liquid injection section,
13c1...through hole,
13c2: liquid supply connection port,
13d...connection cap,
14... Distal end treatment tool support member,
14A, 14B...half body,
14a...Cylindrical portion,
14a1...semi-cylindrical portion,
14b, 14b...Arm portion,
14c...support shaft bearing portion,
14d...bearing portion,
14e...protruding portion,
14f...recess,
14g…inner convex wall,
14h: thick tip part,
14i...overlap line,
14j, 14k...opening degree limiting protrusions,
15, 15A, 15B...tip treatment piece (tip treatment tool),
15a, 16a...middle (intersection),
15b, 16b...base end portion,
15c, 16c...tip side portion,
15d, 16d...opening and closing operation links,
15e...circular hole,
18...support shaft,
19, 20...Opening and closing operation links,
21...forward and backward transmission link,
22, 23, 24...pin shaft,
25...Connecting cylindrical portion,
25a...large diameter cylindrical portion,
25b...tip small diameter cylindrical portion,
25c: protrusion for preventing escape,
26...Concave portion for liquid transport.

Claims

可撓性を有するコイルシースと、
前記コイルシース内に進退可能に配置された操作ワイヤと、
前記コイルシースの後端部に設けられ前記操作ワイヤを進退操作する操作部と、
前記コイルシースの先端部または当該先端部に設けられた連結用筒状部に連結された筒部と前記筒部より先端側に延在し対向する一対の腕部とを有する先端処置具支持部材と、
一対の先端処置片よりなり当該一対の先端処置片が前記一対の腕部間でＸ状に交差し交差部が前記一対の腕部に軸支され開閉して生体患部の処置を行う先端処置具と、
前記一対の先端処置片の各基端部と前記操作ワイヤの先端部に設けられた進退伝動リンクの先端部とを連結するように介設され前記操作ワイヤの進退動作力を受け前記一対の先端処置片に伝達する一対の開閉作動用リンクとを備え、
前記先端処置具支持部材が前記腕部間で前記筒部が半割にされた一対の半割体を有し、各前記半割体には前記腕部の対向面の先端側の所要位置に凸設され前記一対の先端処置片が所要開度になるときに一対の開閉作動用リンクと当接する開度制限用突起を有し、前記一対の半割体が前記コイルシースの先端部または前記連結用筒状部の先端部に被嵌した状態に重ね合わせ一体に設けられている
ことを特徴とする内視鏡用処置具。 A flexible coil sheath;
An operating wire arranged in the coil sheath so as to be capable of advancing and retreating;
an operation unit provided at a rear end of the coil sheath and configured to move the operation wire forward and backward;
a distal end treatment tool support member having a tubular portion connected to a distal end portion of the coil sheath or a connecting tubular portion provided at the distal end portion, and a pair of arm portions extending from the tubular portion toward the distal end side and facing each other;
A distal end treatment tool comprising a pair of distal end treatment pieces, the pair of distal end treatment pieces crossing in an X shape between the pair of arms, the crossing parts being pivotally supported by the pair of arms, and opening and closing to treat an affected part of a living body;
A pair of opening and closing operation links are provided to connect the base ends of the pair of distal end treatment pieces and the distal end of a forward and backward transmission link provided at the distal end of the operation wire, and receive the forward and backward operating force of the operation wire and transmit it to the pair of distal end treatment pieces,
The distal end treatment tool support member has a pair of half bodies in which the tubular portion is split in half between the arms, and each of the half bodies has an opening limiting protrusion that is protruded at a required position on the distal end side of the opposing surfaces of the arms and abuts against a pair of opening/closing operation links when the pair of distal end treatment pieces reach a required opening degree, and the pair of half bodies are overlapped and integrally provided in a fitted state over the distal end of the coil sheath or the distal end of the connecting tubular portion.

前記コイルシースの先端部に前記先端処置具支持部材の前記筒部が固定状態に被嵌されている
ことを特徴とする請求項１に記載の内視鏡用処置具。 2. The endoscopic treatment tool according to claim 1, wherein the cylindrical portion of the distal end treatment tool support member is fixedly fitted over the distal end portion of the coil sheath.

前記コイルシースの先端部に前記先端処置具支持部材の前記筒部が回動可能に被嵌されている
ことを特徴とする請求項１に記載の内視鏡用処置具。 2. The endoscopic treatment tool according to claim 1, wherein the cylindrical portion of the distal end treatment tool support member is rotatably fitted onto the distal end portion of the coil sheath.

前記コイルシースまたは前記連結用筒状部に先端部を避けて先端小径部が設けられ、
各前記半割体の内周面後端部より筒内方へ突出して設けられ前記先端小径部に被嵌する半円環状の軸受部を有する
ことを特徴とする請求項３に記載の内視鏡用処置具。 a small-diameter tip portion is provided on the coil sheath or the connecting tubular portion, avoiding a tip portion;
4. The endoscopic treatment tool according to claim 3, further comprising a semicircular ring-shaped bearing portion which is provided on a rear end of an inner peripheral surface of each of the half bodies and protrudes inwardly from the inside of the cylinder and fits over the small diameter tip portion.

前記コイルシースに樹脂製シースが被覆されているとともに、前記操作部に前記コイルシース内に処置液を注入する注液口を有し、
各前記半割体の前記腕部の対向面の幅中央部に処置液が流れるよう液送用凹条部を有する
ことを特徴とする請求項１ないし４のいずれかに記載の内視鏡用処置具。 The coil sheath is covered with a resin sheath, and the operation portion has a liquid injection port for injecting a treatment liquid into the coil sheath,
5. The endoscopic treatment tool according to claim 1, wherein each of the half bodies has a fluid-transporting groove at a widthwise center of the opposing surfaces of the arm portions for allowing a treatment fluid to flow.

前記液送用凹条部は、前記先端処置具を前記先端処置具支持部材に支持する支持軸の両側に処置液が迂回して流れる幅広部を有している
ことを特徴とする請求項５に記載の内視鏡用処置具。 The endoscopic treatment tool according to claim 5, wherein the fluid transport groove portion has wide portions on both sides of a support shaft that supports the distal end treatment tool on the distal end treatment tool support member, through which the treatment fluid flows in a detouring manner.

前記一対の半割体には、半割面に位置決め用の凹部と凸部とが分配して設けられている
ことを特徴とする請求項１ないし６のいずれかに記載の内視鏡用処置具。
7. The endoscopic treatment tool according to claim 1, wherein the pair of half bodies are provided with positioning recesses and protrusions distributed on the half surfaces.