WO2014050233A1 - Treatment tool - Google Patents

Treatment tool Download PDF

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Publication number
WO2014050233A1
WO2014050233A1 PCT/JP2013/067351 JP2013067351W WO2014050233A1 WO 2014050233 A1 WO2014050233 A1 WO 2014050233A1 JP 2013067351 W JP2013067351 W JP 2013067351W WO 2014050233 A1 WO2014050233 A1 WO 2014050233A1
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WO
WIPO (PCT)
Prior art keywords
tube
lumen
treatment tool
dent
incision
Prior art date
Application number
PCT/JP2013/067351
Other languages
French (fr)
Japanese (ja)
Inventor
小林　司
柴木　謙二
Original Assignee
オリンパスメディカルシステムズ株式会社
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by オリンパスメディカルシステムズ株式会社 filed Critical オリンパスメディカルシステムズ株式会社
Publication of WO2014050233A1 publication Critical patent/WO2014050233A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003—Steerable
    • A61B2017/00305—Constructional details of the flexible means
    • A61B2017/00309—Cut-outs or slits
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003—Steerable
    • A61B2017/00318—Steering mechanisms
    • A61B2017/00323—Cables or rods

Definitions

  • the present invention relates to a treatment tool.
  • This application claims priority based on provisional application 61 / 707,264 filed in the United States on September 28, 2012, the contents of which are incorporated herein by reference.
  • Japanese Patent Application Laid-Open No. 2003-24346 discloses a high-frequency incision tool for an endoscope.
  • a high-frequency incision tool for an endoscope disclosed in Japanese Patent Application Laid-Open No. 2003-24346 has an electrically insulating flexible tube and a conductive wire. This conductive wire is inserted through a pair of holes formed in the vicinity of the distal end of the flexible tube at intervals in the longitudinal direction of the flexible tube.
  • the flexible tube has a V-shaped cut formed between the pair of holes and having a depth that intersects the inner diameter of the flexible tube.
  • the operation of pulling the conductive wire to bend the incision portion is performed for the purpose of separating the conductive wire from the flexible tube and pressing the conductive wire against the living tissue. For this reason, the bending operation of the incision is not an operation optimized for adjusting the position of the tip of the incision.
  • An object of the present invention is to provide a treatment tool that can easily adjust the tip of an incision portion in a desired direction.
  • the treatment instrument is disposed along a flexible tube having a distal end portion and a proximal end portion, and a central axis of the tube, and one end is fixed to the distal end portion.
  • a traction member The tube has a pair of holes communicating with the inside and outside of the tube and spaced apart in the direction of the central axis of the tube, and a dent.
  • the pulling member is inserted through the pair of holes.
  • the traction member is arranged outside the tube between a first hole located on the distal end side and a second hole located on the proximal end side.
  • the indented portion is disposed at a position closer to the tip than an intermediate point between the pair of holes.
  • a region located between the pair of holes in the tube is curved by advancing and retracting the pulling member in the central axis direction of the tube.
  • the tube may be provided with a plurality of indentations.
  • the plurality of indentations may all be arranged at positions closer to the tip than the intermediate point.
  • the dent portion arranged at a position closer to the distal end portion of the plurality of dent portions is more proximal than the base end.
  • similar to a part may be sufficient.
  • At least two of the plurality of dents may have the same shape and size.
  • the pulling member may be a wire.
  • the tube may have a lumen through which the wire is inserted.
  • the dent may communicate with the lumen.
  • the tube may have a second lumen through which a fluid flows.
  • the dent may be out of communication with the second lumen.
  • the tube may have a third lumen through which a medical guide wire is inserted.
  • the dent may be out of communication with the third lumen.
  • the dent in the treatment instrument according to the first aspect, may be a notch formed by notching a part of the tube.
  • the tube may have a third lumen through which the medical guide wire is inserted.
  • the radial cross section of the tube is viewed from the proximal end to the distal end of the tube, the left side of the tube when the direction from the center of the tube toward the center of the third lumen is the downward direction of the tube
  • the dent may open toward a part of a range in which the direction is 0 degree and the clockwise angle is 0 degree or more and 90 degrees or less.
  • the user can easily adjust the orientation of the distal end of the incision portion of the treatment tool, so that, for example, the position can be easily adjusted when the treatment tool is inserted into a lumen tissue or the like. Can be done.
  • FIG. 3 is a cross-sectional view taken along line AA in FIG. 2. It is explanatory drawing which shows one process at the time of use of the treatment tool which concerns on one Embodiment of this invention. It is a figure for demonstrating the effect
  • FIG. 1 is an overall view showing a treatment instrument according to an embodiment of the present invention.
  • FIG. 2 is a cross-sectional view showing an incision portion in the treatment instrument.
  • 3 is a cross-sectional view taken along line AA in FIG.
  • FIG. 2 corresponds to a cross section taken along line BB in FIG.
  • the treatment tool 10 according to the present embodiment is used together with the endoscope apparatus 100 (see FIG. 4).
  • the configuration of the endoscope apparatus 100 to which the treatment tool 10 according to the present embodiment is applied is not particularly limited.
  • the endoscope apparatus 100 to which the treatment tool 10 according to the present embodiment is applied includes an insertion unit 101, a treatment tool channel 102, and an operation unit 103, as shown in FIG.
  • the insertion unit 101 is inserted into the body.
  • the treatment instrument channel 102 is disposed in the insertion portion 101.
  • the operation unit 103 is provided at the proximal end of the insertion unit 101.
  • a bending portion 104 At the distal end of the insertion portion 101, a bending portion 104, an imaging portion 105, and an opening portion 102a are provided.
  • the bending portion 104 can be bent.
  • the imaging unit 105 observes a treatment target site and the like.
  • the opening 102 a is an opening on the distal end side in the treatment instrument channel 102.
  • the operation unit 103 is provided with a knob 106 and an opening 102b.
  • the knob 106 performs an operation for bending the bending portion 104.
  • the opening 102 b is an opening on the proximal end side in the treatment instrument channel 102.
  • the imaging visual field of the imaging unit 105 is directed in a direction that intersects the longitudinal axis of the insertion unit 101.
  • the endoscope apparatus 100 is a so-called side-view type endoscope apparatus.
  • the endoscope apparatus 100 to which the treatment tool 10 according to the present embodiment is applied is not limited to the side view type, and may be a so-called direct view type.
  • the treatment instrument 10 shown in FIG. 1 is a high-frequency incision instrument that incises a living tissue by bringing a wire (knife wire (traction member) 19, see FIG. 2) through which a high-frequency current is passed into contact with the living tissue.
  • the treatment instrument 10 includes a flexible tube (tube) 11 and an operation unit 30.
  • the flexible tube portion 11 is a flexible long member, and has a distal end portion 11a and a proximal end portion 11b.
  • the flexible tube portion 11 includes an incision portion 12 and a sheath portion 25.
  • the incision unit 12 incises a living tissue.
  • the sheath part 25 guides the incision part 12 to a site to be incised.
  • the incision 12 has a multi-lumen tube 13.
  • Three lumens are formed in the multi-lumen tube 13.
  • the inner diameters of the three lumens formed in the multi-lumen tube 13 are different from each other.
  • a conductive knife wire 19 for incising a living tissue is inserted into the lumen having the smallest inner diameter (first lumen 14).
  • the lumen having the second smallest inner diameter (second lumen 15) is used as a conduit for supplying a fluid such as a contrast medium.
  • the lumen having the largest inner diameter is used as a conduit through which the guide wire W is inserted.
  • Two slits (first holes) 17 and slits (second holes) 18 communicating with the inside of the first lumen 14 are formed on the side wall on the distal end side of the multi-lumen tube 13.
  • the two slits 17 and 18 are spaced apart in the longitudinal direction of the multi-lumen tube 13.
  • a knife wire 19 is inserted into each of the slits 17 and 18. That is, a part of the distal end side of the knife wire 19 passes through slits 17 and 18 formed on the side wall of the multi-lumen tube 13 and is arranged outside the multi-lumen tube 13 at the incision portion 12.
  • dents 13a and 13b are formed at a part on the tip side of the intermediate point PM between the slit 17 and the slit 18.
  • the intermediate point PM is a portion located in the middle between the slit 17 and the slit 18 in the longitudinal direction of the multi-lumen tube 13.
  • the recessed portions 13a and 13b have a shape in which a part of the outer wall of the multi-lumen tube 13 is cut off.
  • the recessed portions 13a and 13b are, for example, V-shaped or U-shaped grooves extending in a direction orthogonal to the knife wire 19 extending from the slit 17 and the slit 18.
  • the indented portions 13 a and 13 b may be simple cuts, holes that penetrate the tube, or grooves or holes that are parallel to the knife wire 19.
  • the recesses 13a and 13b preferably have a shape in which the opening diameter gradually increases as the knife wire 19 is approached.
  • the indented portions 13a and 13b may be grooves or cuts having a shape in which the opening diameter is maintained.
  • the dent portions 13 a and 13 b are formed at positions closest to the knife wire 19 on the outer peripheral surface of the multi-lumen tube 13.
  • the dents 13a and 13b are formed at positions separated from each other in the central axis direction of the multi-lumen tube 13.
  • the recessed portions 13a and 13b have the same shape.
  • the indented portions 13a and 13b are formed on the front end side with respect to the intermediate point PM of the slits 17 and 18.
  • the depth of the dent 13 a is a depth that reaches the first lumen 14 formed in the multi-lumen tube 13. Further, the depth of the dent 13 a is a depth that does not reach either the second lumen 15 or the third lumen 16 formed in the multi-lumen tube 13. As a result, the path of the fluid, guide wire, and the like introduced into the second lumen 15 and the third lumen 16 is held in a continuous tubular shape at the incision portion 12. In the region between the slit 17 and the slit 18, the knife wire 19 is not inserted through the first lumen 14. For this reason, even if the depth of the dent 13 a reaches the first lumen 14, the action and effect of the treatment instrument 10 are not adversely affected.
  • the portion of the multi-lumen tube 13 where the dent portion 13a is formed is more flexible than the portion of the multi-lumen tube 13 where the dent portion 13a is not formed, and is easily bent. For this reason, in the incision part 12, the part in which the dent part 13a was formed is the part where it bends most easily. Further, the multi-lumen tube 13 tends to bend in the indentation direction of the indentation portion 13a in the radial cross section. In the multi-lumen tube 13 according to this embodiment, when the multi-lumen tube 13 is viewed from the proximal end side toward the distal end side, the direction from the center of the multi-lumen tube 13 toward the center of the third lumen 16 is downward ( 3 is indicated as “DOWN” in FIG.
  • the angle in the clockwise direction with the direction toward the left side of the multi-lumen tube 13 (indicated as “LEFT” in FIG. 3) being 0 degrees.
  • the opening of the recess 13a is directed toward a part where ⁇ is in the range of 0 ° to 90 °, more preferably in the range of 60 ° to 80 °.
  • the direction toward the left side of the multi-lumen tube 13 (shown as “LEFT” in FIG. 3) is 0 degree, and the clockwise angle ⁇ is around 70 degrees.
  • a knife wire 19 is arranged at a certain position.
  • the direction of the dent 13a viewed from the center line of the multi-lumen tube 13 and the direction of the knife wire 19 in the radial cross-sectional view of the multi-lumen tube 13 are substantially the same as a result ( Including exact match).
  • the direction of the dent 13a and the direction of the knife wire 19 may be different depending on the layout of the lumen and the cutting direction of the wire.
  • the incision portion 12 is curved in a region between the slit 17 and the slit 18.
  • the midpoint PM of the slits 17 and 18 coincides with the midpoint of the incision portion 12.
  • the knife wire 19 is disposed along the central axis of the flexible tube portion 11, and one end thereof is fixed to the distal end portion 11 a of the flexible tube portion 11.
  • the knife wire 19 has a conductive wire 20 and an insulating coating 21 that covers a part of the wire 20.
  • a knife tip 22 for fixing the knife wire 19 to the distal end portion of the first lumen 14 is connected to the distal end of the knife wire 19.
  • the knife tip 22 is press-fitted into the slit 17 located on the distal end side of the two slits 17 and 18 formed in the multi-lumen tube 13.
  • the knife tip 22 is fixed in the first lumen 14.
  • a part of the proximal end side of the knife tip 22 in the knife wire 19 constitutes an exposed portion 23 that does not have the insulating coating 21.
  • the exposed portion 23 is set in a range located outside the multi-lumen tube 13 in the entire length of the knife wire 19.
  • the insulating coating 21 is provided on the proximal end side of the exposed portion 23 in the knife wire 19.
  • the insulating coating 21 is formed on the outer peripheral surface of the strand 20 of the knife wire 19 by a coating intended for insulation.
  • the proximal end side of the exposed portion 23 of the knife wire 19 extends toward the proximal end side of the flexible tube portion 11.
  • the proximal end of the knife wire 19 is connected to the operation part 30 (refer FIG. 1). Although details will be described later, the knife wire 19 is pulled to the proximal end side by the operation unit 30. As a result, the distal end of the knife wire 19 moves the distal end portion 11a of the flexible tube portion 11 toward the proximal end side to bend the region that becomes the incision portion 12 in the multi-lumen tube 13.
  • the sheath portion 25 is provided on the proximal end side of the incision portion 12.
  • the sheath portion 25 is provided by extending the multi-lumen tube 13 constituting the incision portion 12 toward the proximal end side. That is, in the treatment instrument 10 according to the present embodiment, the incision portion 12 and the sheath portion 25 have the multi-lumen tube 13. Similar to the incision portion 12, the sheath portion 25 is formed with a first lumen 14, a second lumen 15, and a third lumen 16.
  • the operation section 30 is branched into a first operation section 32 and a second operation section 45 by a first branch section 31 connected to the multi-lumen tube 13 constituting the sheath section 25. .
  • the first operation part 32 is pulled out from the first branch part 31.
  • the first operation portion 32 includes a flexible guide wire tube 33 and a guide wire insertion portion 34 for inserting the guide wire W.
  • the side connected to the sheath portion 25 in the operation unit 30 is the distal end side of the operation unit 30.
  • the distal end portion of the guide wire tube 33 communicates with the third lumen 16 in the first branch portion 31.
  • the proximal end portion of the guide wire tube 33 is fixed to the guide wire insertion portion 34.
  • the guide wire insertion part 34 has a wire insertion port 35, a first connection part 36, and a second connection part 42.
  • the wire insertion port 35 is formed in a cylindrical shape and communicates with the guide wire tube 33.
  • the first connection part 36 connects the guide wire insertion part 34 to the second operation part 45.
  • the second connection part 42 connects the guide wire insertion part 34 to the endoscope apparatus 100.
  • the first connection portion 36 is formed so as to protrude from the outer surface of the wire insertion port 35 in the radial direction of the wire insertion port 35.
  • the 1st connection part 36 and the 2nd operation part 45 are connected so that attachment or detachment is possible.
  • the 1st connection part 36 and the 2nd operation part 45 can be attached or detached as needed.
  • the second connection portion 42 is formed in a C shape having an arc shape in the same plane passing through the axis of the guide wire insertion portion 34.
  • the second connection part 42 has elasticity and engages with the operation part 103 of the endoscope apparatus 100.
  • the second operation part 45 is connected to the base end of the multi-lumen tube 13 drawn through the first branch part 31 via a connector 46.
  • the connector 46 has a cylindrical shape that is coaxial with the multi-lumen tube 13.
  • the connector 46 has a connected portion 47 to which the first connecting portion 36 formed in the guide wire insertion portion 34 is connected.
  • the connected portion 47 has irregularities to which the first connecting portion 36 is fitted.
  • the connector 46 is provided with a deforming portion 48 that freely deforms in the axial direction.
  • the deformable portion 48 is provided with a second branch portion 50.
  • the second branch portion 50 is provided to branch the first lumen 14 and the second lumen 15 provided in the multi-lumen tube 13.
  • the second branch portion 50 is provided with a slide portion 51 that communicates with the first lumen 14 and a liquid feeding portion 57 that communicates with the second lumen 15.
  • the slide part 51 extends in a direction inclined with respect to the axis of the connector 46.
  • the slide portion 51 has a substantially rod-shaped main body 52 and a slider 54 that can slide in the longitudinal axis direction of the main body 52.
  • the main body 52 is provided with a scale serving as an index for confirming the amount of movement of the slider 54 and a ring 53 for finger attachment.
  • the base end of the knife wire 19 is fixed to the slider 54.
  • the slider 54 is provided with a plug 55 for passing a high-frequency current through the knife wire 19.
  • the plug 55 is electrically connected to the knife wire 19 inside the slider 54.
  • the slider 54 is provided with a finger ring 56.
  • An operator of the treatment instrument 10 puts a finger into each of the ring 53 provided on the main body 52 and the ring 56 provided on the slider 54 to operate the slide unit 51. That is, the knife wire 19 can be moved in the longitudinal axis direction of the main body 52 by moving the slider 54 forward and backward with respect to the main body 52. For example, when the slider 54 is moved toward the base end side of the main body 52, the distal end of the multi-lumen tube 13 is pulled to the base end side by the knife wire 19 at the incision portion 12 of the flexible tube portion 11. The tip of 13 is curved.
  • the liquid feeding part 57 has a liquid feeding base 58 and a pipe line 59.
  • the liquid feeding cap 58 can be connected to a syringe.
  • the pipe line 59 communicates with the liquid feeding base 58 and the second lumen 15.
  • a liquid flows inside the pipe 59.
  • the liquid feeding base 58 may be formed with a protrusion adapted to a lock type syringe or a surface on which a slip tip type syringe can be frictionally engaged.
  • FIG. 4 is an explanatory diagram showing a process during the use of the treatment instrument 10.
  • FIG. 5 is a view for explaining the operation of the treatment instrument 10.
  • FIG. 6 is a view for explaining the action and effect of the treatment instrument 10.
  • the flexible tube portion 11 When the treatment instrument 10 is used, the flexible tube portion 11 is inserted into the treatment instrument channel 102 of the endoscope apparatus 100 by, for example, manual operation by the user.
  • the incision portion 12 disposed at the distal end portion 11a of the flexible tube portion 11 protrudes from the opening portion 102a on the distal end side of the treatment instrument channel 102 (see FIG. 4).
  • the incision portion 12 and the treatment target site can be observed using the endoscope apparatus 100.
  • the user adjusts the position of the tip of the incision 12 as necessary.
  • the operation of adjusting the position of the tip of the incision 12 is performed for the purpose of inserting the incision 12 into the lumen, for example.
  • the user moves the insertion unit 101 of the endoscope apparatus 100 shown in FIG. 5 in the direction of the central axis of the insertion unit 101 or rotates the insertion unit 101 around the central axis of the insertion unit 101. You may move itself.
  • the user adjusts the protruding length of the flexible tube portion 11 from the distal end of the insertion portion 101 of the endoscope apparatus 100, or rotates the flexible tube portion 11 around the central axis of the flexible tube portion 11. May be.
  • the user may change the curved shape of the incision 12 by pulling or loosening the knife wire 19. By these operations, the user can adjust the position and orientation of the tip of the incision portion 12.
  • the portions where the recessed portions 13a and 13b are formed are first curved.
  • the entire incision 12 is curved.
  • the portions where the recessed portions 13a and 13b are formed have a larger curvature (that is, the curvature radius is smaller) than the portions where the recessed portions 13a and 13b are not formed in the incised portion 12.
  • the recessed portions 13a and 13b are formed on the distal end side with respect to the intermediate point PM in the incision portion 12.
  • the region on the distal end side from the intermediate point PM in the incision portion 12 has a larger curvature than the region on the proximal end side from the intermediate point PM in the incision portion 12.
  • the state shown with the dashed-two dotted line in FIG. 6 has shown the state which the incision part 12 curved with the uniform curvature, when the dent parts 13a and 13b are not provided.
  • the incision 12 when the region on the distal end side from the intermediate point PM is curved with a larger curvature than the region on the proximal end side from the intermediate point PM, the incision is compared with the case where the incision 12 is curved with a uniform curvature.
  • the direction of the tip of the incision portion 12 changes greatly for a small amount of movement of the tip of the twelve. For this reason, the tip of the incision portion 12 is unlikely to deviate from the observation field of view of the endoscope apparatus 100. Even when the work space near the treatment target site is narrow, the user can easily adjust the direction of the tip of the incision 12.
  • the operation of pulling the knife wire and bending the incision portion is performed for the purpose of separating the knife wire from the multi-lumen tube and pressing the knife wire against the living tissue.
  • the above-described bending operation in the conventional treatment instrument is not the bending operation of the incision portion optimized for adjusting the position of the tip of the incision portion.
  • the curvature of the incision part 12 is large at the position where the recesses 13a and 13b are provided, and at other positions in the incision part 12.
  • the curvature is small.
  • the direction of the tip of the incision 12 can be greatly changed even if the amount of movement of the tip of the incision 12 is small.
  • the user can easily adjust the tip of the incision portion 12 in a desired direction by adjusting the pulling amount of the knife wire 19. For this reason, for example, it is easy to adjust the position of the incision 12 when the incision 12 is inserted into the lumen tissue.
  • the luminal tissue to be inserted into the incision portion 12 is not particularly limited.
  • the insertion target of the incision 12 is a duodenal papilla or a bile duct.
  • the direction of the tip of the incision 12 can be greatly changed even if the amount of movement of the tip of the incision 12 is small. For this reason, for example, when performing selective insertion such as inserting the incision 12 into the bile duct at the bifurcation of the bile duct and pancreatic duct, the tip of the incision 12 is easily inserted.
  • the incision portion 12 is provided with two dent portions 13 a and 13 b that are separated in the central axis direction of the multi-lumen tube 13. For this reason, compared with the case where there is one dent part, the way of bending that the multi-lumen tube 13 is bent is less likely to occur.
  • another dent may be provided in the multi-lumen tube 13.
  • FIG. 7 is a cross-sectional view showing a configuration of a part of the treatment tool of the present modification.
  • the dent 13 a disposed on the distal end side of the multi-lumen tube 13 is larger than the dent 13 b disposed on the proximal end side of the multi-lumen tube 13.
  • the tube 13 is cut out. With such a configuration, the distal end side of the incision 12 is curved with a larger curvature.
  • FIG. 8 is a cross-sectional view showing a configuration of a part of the treatment tool of the present modification.
  • the recesses 13 a and 13 b have a depth that does not reach the lumen of the first lumen 14. That is, none of the indentations 13 a and 13 b communicate with the first lumen 14. Even with such a configuration, the same effects as those of the above-described embodiment can be obtained.
  • FIG. 9 is a cross-sectional view showing a partial configuration of the treatment tool of the present modification.
  • the multi-lumen tube 13 is opposed to the dents 13 a and 13 b in the radial direction of the multi-lumen tube 13.
  • Recessed portions 13c and 13d are formed at the positions where they are located. Even with such a configuration, the same effects as those of the above-described embodiment can be obtained.
  • This modification is different in that the dents 13 a and 13 b are groove-shaped extending in the circumferential direction of the multi-lumen tube 13. Even with such a configuration, the same effects as those of the above-described embodiment can be obtained.
  • the multi-lumen tube 13 has a dent 13a and does not have a dent 13b. Further, the indented portion 13 a is located on the tip side with respect to the intermediate point PM of the slits 17 and 18.
  • the user can easily adjust the orientation of the distal end of the incision portion of the treatment tool, so that, for example, the position can be easily adjusted when the treatment tool is inserted into a lumen tissue or the like. Can be done. For this reason, it is possible to provide a treatment tool that is easy for the user to use.

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Abstract

A treatment tool is provided with a flexible tube, and a pulling member disposed along the central axis of the tube. The tube has one pair of holes which provide communication between the interior and exterior of the tube and are spaced apart in the central axis direction of the tube, and recess portions. The pulling member is inserted into the one pair of holes. Between the one pair of holes, the pulling member is disposed on the exterior side of the tube. The recess portions are disposed at positions that are closer to the distal end of the tube than the midpoint between the one pair of holes. An area positioned between the one pair of holes on the tube is bent by protracting and retracting the pulling member.

Description

処置具Treatment tool
　本発明は、処置具に関する。
　本願は、２０１２年９月２８日に、米国に出願された仮出願第６１／７０７，２６４号に基づき優先権を主張し、その内容をここに援用する。 The present invention relates to a treatment tool.
This application claims priority based on provisional application 61 / 707,264 filed in the United States on September 28, 2012, the contents of which are incorporated herein by reference.
　従来、体内で処置をするための処置具が知られている。例えば、日本国特開２００３－２４３４６号公報には、内視鏡用高周波切開具が開示されている。日本国特開２００３－２４３４６号公報に開示された内視鏡用高周波切開具は、電気絶縁性の可撓性チューブと、導電ワイヤとを有している。この導電ワイヤは、可撓性チューブの先端近傍に可撓性チューブの長手方向に間隔を開けて形成された一対の孔に挿通されている。また、この可撓性チューブには、前記一対の孔の間に可撓性チューブの内径を横切る深さのＶ字状の切り込みが形成されている。 Conventionally, treatment tools for performing treatment in the body are known. For example, Japanese Patent Application Laid-Open No. 2003-24346 discloses a high-frequency incision tool for an endoscope. A high-frequency incision tool for an endoscope disclosed in Japanese Patent Application Laid-Open No. 2003-24346 has an electrically insulating flexible tube and a conductive wire. This conductive wire is inserted through a pair of holes formed in the vicinity of the distal end of the flexible tube at intervals in the longitudinal direction of the flexible tube. The flexible tube has a V-shaped cut formed between the pair of holes and having a depth that intersects the inner diameter of the flexible tube.
日本国特開２００３－２４３４６号公報Japanese Unexamined Patent Publication No. 2003-24346
　従来の処置具では、導電ワイヤを牽引して切開部を湾曲させる動作は、可撓性チューブから導電ワイヤを離間させ、導電ワイヤを生体組織に押し付ける目的で行なわれている。このため、この切開部の湾曲動作は、切開部の先端の位置を調整するために最適化された動作ではない。 In the conventional treatment tool, the operation of pulling the conductive wire to bend the incision portion is performed for the purpose of separating the conductive wire from the flexible tube and pressing the conductive wire against the living tissue. For this reason, the bending operation of the incision is not an operation optimized for adjusting the position of the tip of the incision.
　本発明は、切開部の先端を所望の向きに容易に調整することができる処置具を提供することを目的とする。 An object of the present invention is to provide a treatment tool that can easily adjust the tip of an incision portion in a desired direction.
　本発明の第一の態様によれば、処置具は、先端部と基端部とを有する可撓性のチューブと、前記チューブの中心軸線に沿って配され、一端が前記先端部に固定された牽引部材と、を備える。前記チューブは、前記チューブの内外を連通し、前記チューブの中心軸線方向に離間する一対の孔と、へこみ部と、を有する。前記一対の孔には前記牽引部材が挿通される。前記一対の孔のうち前記先端部側に位置する第一の孔と前記基端部側に位置する第二の孔との間では、前記牽引部材は前記チューブの外側に配される。前記へこみ部は、前記一対の孔の中間点よりも前記先端部に近い位置に配される。前記チューブのうち前記一対の孔の間に位置する領域は、前記牽引部材を前記チューブの中心軸線方向に進退させることにより湾曲する。 According to the first aspect of the present invention, the treatment instrument is disposed along a flexible tube having a distal end portion and a proximal end portion, and a central axis of the tube, and one end is fixed to the distal end portion. A traction member. The tube has a pair of holes communicating with the inside and outside of the tube and spaced apart in the direction of the central axis of the tube, and a dent. The pulling member is inserted through the pair of holes. Of the pair of holes, the traction member is arranged outside the tube between a first hole located on the distal end side and a second hole located on the proximal end side. The indented portion is disposed at a position closer to the tip than an intermediate point between the pair of holes. A region located between the pair of holes in the tube is curved by advancing and retracting the pulling member in the central axis direction of the tube.
　本発明の第二の態様によれば、前記第一の態様に係る処置具において、前記チューブには複数のへこみ部が設けられてもよい。前記複数のへこみ部は、全て前記中間点よりも前記先端部に近い位置に配されてもよい。 According to the second aspect of the present invention, in the treatment instrument according to the first aspect, the tube may be provided with a plurality of indentations. The plurality of indentations may all be arranged at positions closer to the tip than the intermediate point.
　本発明の第三の態様によれば、前記第二の態様に係る処置具において、前記複数のへこみ部のうち、前記先端部に近い位置に配されたへこみ部は、自身よりも前記基端部に近い位置に配されたへこみ部よりも大きく前記チューブを切り欠いた形状であってもよい。 According to the third aspect of the present invention, in the treatment instrument according to the second aspect, the dent portion arranged at a position closer to the distal end portion of the plurality of dent portions is more proximal than the base end. The shape which notched the said tube larger than the dent part distribute | arranged to the position close | similar to a part may be sufficient.
　本発明の第四の態様によれば、前記第二の態様に係る処置具において、前記複数のへこみ部のうち少なくとも二つのへこみ部は、互いに形状および大きさが同じであってもよい。 According to the fourth aspect of the present invention, in the treatment tool according to the second aspect, at least two of the plurality of dents may have the same shape and size.
　本発明の第五の態様によれば、前記第一の態様に係る処置具において、前記牽引部材はワイヤであってもよい。前記チューブは、前記ワイヤが挿通されるルーメンを有してもよい。前記へこみ部は前記ルーメンと連通してもよい。 According to the fifth aspect of the present invention, in the treatment instrument according to the first aspect, the pulling member may be a wire. The tube may have a lumen through which the wire is inserted. The dent may communicate with the lumen.
　本発明の第六の態様によれば、前記第五の態様に係る処置具において、前記チューブは、流体が流れる第二ルーメンを有してもよい。前記へこみ部は、前記第二ルーメンとは非連通状態であってもよい。 According to a sixth aspect of the present invention, in the treatment instrument according to the fifth aspect, the tube may have a second lumen through which a fluid flows. The dent may be out of communication with the second lumen.
　本発明の第七の態様によれば、前記第五または前記第六の態様に係る処置具において、前記チューブは、医療用ガイドワイヤを挿通する第三ルーメンを有してもよい。前記へこみ部は、前記第三ルーメンとは非連通状態であってもよい。 According to a seventh aspect of the present invention, in the treatment instrument according to the fifth or sixth aspect, the tube may have a third lumen through which a medical guide wire is inserted. The dent may be out of communication with the third lumen.
　本発明の第八の態様によれば、前記第一の態様に係る処置具において、前記へこみ部は、前記チューブの一部を切り欠くことで形成された切り欠きであってもよい。 According to the eighth aspect of the present invention, in the treatment instrument according to the first aspect, the dent may be a notch formed by notching a part of the tube.
　本発明の第九の態様によれば、前記第一の態様に係る処置具において、前記チューブは、医療用ガイドワイヤを挿通する第三ルーメンを有してもよい。前記チューブの径方向断面を前記チューブの基端から先端へ向かって見たときに、前記チューブの中心から前記第三ルーメンの中心へ向かう方向を前記チューブの下方向としたときの前記チューブの左方向を０度として時計回り方向の角度が０度以上９０度以下となる範囲のうちの一部へ向かって、前記へこみ部は開口してもよい。 According to the ninth aspect of the present invention, in the treatment instrument according to the first aspect, the tube may have a third lumen through which the medical guide wire is inserted. When the radial cross section of the tube is viewed from the proximal end to the distal end of the tube, the left side of the tube when the direction from the center of the tube toward the center of the third lumen is the downward direction of the tube The dent may open toward a part of a range in which the direction is 0 degree and the clockwise angle is 0 degree or more and 90 degrees or less.
　上記した処置具を用いることによって、ユーザは、処置具の切開部の先端の向きを容易に調整することができるため、例えば管腔組織の内部等に処置具を挿入する際の位置調整を容易に行うことができる。 By using the above-described treatment tool, the user can easily adjust the orientation of the distal end of the incision portion of the treatment tool, so that, for example, the position can be easily adjusted when the treatment tool is inserted into a lumen tissue or the like. Can be done.
本発明の一実施形態に係る処置具を示す全体図である。It is a general view which shows the treatment tool which concerns on one Embodiment of this invention. 本発明の一実施形態に係る処置具における切開部を示す断面図である。It is sectional drawing which shows the incision part in the treatment tool which concerns on one Embodiment of this invention. 図２のＡ－Ａ線における断面図である。FIG. 3 is a cross-sectional view taken along line AA in FIG. 2. 本発明の一実施形態に係る処置具の使用時の一過程を示す説明図である。It is explanatory drawing which shows one process at the time of use of the treatment tool which concerns on one Embodiment of this invention. 本発明の一実施形態に係る処置具の作用を説明するための図である。It is a figure for demonstrating the effect | action of the treatment tool which concerns on one Embodiment of this invention. 本発明の一実施形態に係る処置具の作用及び効果を説明するための図である。It is a figure for demonstrating the effect | action and effect of a treatment tool which concern on one Embodiment of this invention. 本発明の一実施形態に係る処置具の変形例の構成を示す断面図である。It is sectional drawing which shows the structure of the modification of the treatment tool which concerns on one Embodiment of this invention. 本発明の一実施形態に係る処置具のさらに他の変形例の構成を示す断面図である。It is sectional drawing which shows the structure of the further another modification of the treatment tool which concerns on one Embodiment of this invention. 本発明の一実施形態に係る処置具のさらに他の変形例の構成を示す断面図である。It is sectional drawing which shows the structure of the further another modification of the treatment tool which concerns on one Embodiment of this invention.
　本発明の一実施形態に係る処置具について説明する。図１は、本発明の一実施形態に係る処置具を示す全体図である。図２は、前記処置具における切開部を示す断面図である。図３は、図２のＡ－Ａ線における断面図である。図２は、図３のＢ－Ｂ線における断面に相当する。 A treatment tool according to an embodiment of the present invention will be described. FIG. 1 is an overall view showing a treatment instrument according to an embodiment of the present invention. FIG. 2 is a cross-sectional view showing an incision portion in the treatment instrument. 3 is a cross-sectional view taken along line AA in FIG. FIG. 2 corresponds to a cross section taken along line BB in FIG.
　図１に示す処置具１０は、体内で処置をするための医療器具である。本実施形態に係る処置具１０は、内視鏡装置１００（図４参照）とともに使用される。本実施形態に係る処置具１０が適用される対象となる内視鏡装置１００の構成は特に限定されない。例えば、本実施形態に係る処置具１０が適用される対象となる内視鏡装置１００は、図４に示すように、挿入部１０１と、処置具チャンネル１０２と、操作部１０３とを備える。挿入部１０１は、体内に挿入される。処置具チャンネル１０２は、挿入部１０１内に配される。操作部１０３は、挿入部１０１の基端に設けられる。挿入部１０１の先端には、湾曲部１０４と、撮像部１０５と、開口部１０２ａとが設けられている。湾曲部１０４は、湾曲可能である。撮像部１０５は、処置対象部位等を観察する。開口部１０２ａは、処置具チャンネル１０２における先端側の開口部である。操作部１０３には、ノブ１０６と、開口部１０２ｂとが設けられている。ノブ１０６は、湾曲部１０４を湾曲させるための操作を行う。開口部１０２ｂは、処置具チャンネル１０２における基端側の開口部である。本実施形態で説明する内視鏡装置１００において、撮像部１０５の撮像視野は、挿入部１０１の長手軸に対して交差する方向に向けられている。すなわち、内視鏡装置１００は、所謂側視型の内視鏡装置である。なお、本実施形態に係る処置具１０が適用される対象となる内視鏡装置１００は側視型には限られず、所謂直視型であってもよい。 1 is a medical instrument for performing treatment in the body. The treatment tool 10 according to the present embodiment is used together with the endoscope apparatus 100 (see FIG. 4). The configuration of the endoscope apparatus 100 to which the treatment tool 10 according to the present embodiment is applied is not particularly limited. For example, the endoscope apparatus 100 to which the treatment tool 10 according to the present embodiment is applied includes an insertion unit 101, a treatment tool channel 102, and an operation unit 103, as shown in FIG. The insertion unit 101 is inserted into the body. The treatment instrument channel 102 is disposed in the insertion portion 101. The operation unit 103 is provided at the proximal end of the insertion unit 101. At the distal end of the insertion portion 101, a bending portion 104, an imaging portion 105, and an opening portion 102a are provided. The bending portion 104 can be bent. The imaging unit 105 observes a treatment target site and the like. The opening 102 a is an opening on the distal end side in the treatment instrument channel 102. The operation unit 103 is provided with a knob 106 and an opening 102b. The knob 106 performs an operation for bending the bending portion 104. The opening 102 b is an opening on the proximal end side in the treatment instrument channel 102. In the endoscope apparatus 100 described in the present embodiment, the imaging visual field of the imaging unit 105 is directed in a direction that intersects the longitudinal axis of the insertion unit 101. That is, the endoscope apparatus 100 is a so-called side-view type endoscope apparatus. Note that the endoscope apparatus 100 to which the treatment tool 10 according to the present embodiment is applied is not limited to the side view type, and may be a so-called direct view type.
　図１に示す処置具１０は、高周波電流が通電される電線（ナイフワイヤ（牽引部材）１９、図２参照）を生体組織に接触させることによって生体組織を切開する高周波切開具である。処置具１０は、可撓管部（チューブ）１１と、操作部３０とを有する。 The treatment instrument 10 shown in FIG. 1 is a high-frequency incision instrument that incises a living tissue by bringing a wire (knife wire (traction member) 19, see FIG. 2) through which a high-frequency current is passed into contact with the living tissue. The treatment instrument 10 includes a flexible tube (tube) 11 and an operation unit 30.
　図１に示すように、可撓管部１１は、柔軟な長尺部材であり、先端部１１ａと基端部１１ｂとを有する。また、可撓管部１１は、切開部１２と、シース部２５とを有する。切開部１２は、生体組織を切開する。シース部２５は、切開対象となる部位まで切開部１２を案内する。 As shown in FIG. 1, the flexible tube portion 11 is a flexible long member, and has a distal end portion 11a and a proximal end portion 11b. The flexible tube portion 11 includes an incision portion 12 and a sheath portion 25. The incision unit 12 incises a living tissue. The sheath part 25 guides the incision part 12 to a site to be incised.
　図２及び図３に示すように、切開部１２は、マルチルーメンチューブ１３を有する。マルチルーメンチューブ１３には、３つのルーメンが形成されている。ここで、マルチルーメンチューブ１３に形成された３つのルーメンの内径は、互いに異なる。本実施形態に係るマルチルーメンチューブ１３では、最も内径の小さなルーメン（第一ルーメン１４）には、生体組織を切開するための導電性のナイフワイヤ１９が挿通されている。３つのルーメンのうち内径が２番目に小さなルーメン（第二ルーメン１５）は、造影剤等の流体を供給するための管路として使用される。３つのルーメンのうち内径が最も大きなルーメン（第三ルーメン１６）は、ガイドワイヤＷが挿通される管路として使用される。 As shown in FIGS. 2 and 3, the incision 12 has a multi-lumen tube 13. Three lumens are formed in the multi-lumen tube 13. Here, the inner diameters of the three lumens formed in the multi-lumen tube 13 are different from each other. In the multi-lumen tube 13 according to the present embodiment, a conductive knife wire 19 for incising a living tissue is inserted into the lumen having the smallest inner diameter (first lumen 14). Of the three lumens, the lumen having the second smallest inner diameter (second lumen 15) is used as a conduit for supplying a fluid such as a contrast medium. Of the three lumens, the lumen having the largest inner diameter (third lumen 16) is used as a conduit through which the guide wire W is inserted.
　マルチルーメンチューブ１３の先端側の側壁には、第一ルーメン１４内と連通する２つのスリット（第一の孔）１７、スリット（第二の孔）１８が形成されている。２つのスリット１７、１８はマルチルーメンチューブ１３の長手軸方向に離間して配置されている。各スリット１７、１８には、ナイフワイヤ１９が挿通されている。すなわち、ナイフワイヤ１９の先端側の一部は、マルチルーメンチューブ１３の側壁に形成されたスリット１７、１８を通って、切開部１２においてマルチルーメンチューブ１３の外側に配されている。 Two slits (first holes) 17 and slits (second holes) 18 communicating with the inside of the first lumen 14 are formed on the side wall on the distal end side of the multi-lumen tube 13. The two slits 17 and 18 are spaced apart in the longitudinal direction of the multi-lumen tube 13. A knife wire 19 is inserted into each of the slits 17 and 18. That is, a part of the distal end side of the knife wire 19 passes through slits 17 and 18 formed on the side wall of the multi-lumen tube 13 and is arranged outside the multi-lumen tube 13 at the incision portion 12.
　マルチルーメンチューブ１３の外周面において、スリット１７とスリット１８との中間点ＰＭよりも先端側の一部には、へこみ部１３ａ、１３ｂが形成されている。中間点ＰＭは、マルチルーメンチューブ１３の長手軸方向におけるスリット１７とスリット１８との間の中間に位置する部分である。へこみ部１３ａ、１３ｂは、マルチルーメンチューブ１３の外壁の一部が切り取られた形状を有する。へこみ部１３ａ、１３ｂは、例えば、スリット１７及びスリット１８から延出しているナイフワイヤ１９と直交する方向に延びるＶ字型あるいはＵ字型の溝である。なお、へこみ部１３ａ、１３ｂは、単なる切り込み、チューブに貫通した孔、もしくはナイフワイヤ１９と平行な溝あるいは孔であってもよい。へこみ部１３ａ、１３ｂは、ナイフワイヤ１９に近づくに従って開口径が漸次広がった形状が好ましい。なお、へこみ部１３ａ、１３ｂは、開口径が維持された形状の溝や切り込みでもよい。へこみ部１３ａ、１３ｂを含むマルチルーメンチューブ１３の径方向断面視において、へこみ部１３ａ、１３ｂは、マルチルーメンチューブ１３の外周面のうち最もナイフワイヤ１９に近い位置に形成されている。 On the outer peripheral surface of the multi-lumen tube 13, dents 13a and 13b are formed at a part on the tip side of the intermediate point PM between the slit 17 and the slit 18. The intermediate point PM is a portion located in the middle between the slit 17 and the slit 18 in the longitudinal direction of the multi-lumen tube 13. The recessed portions 13a and 13b have a shape in which a part of the outer wall of the multi-lumen tube 13 is cut off. The recessed portions 13a and 13b are, for example, V-shaped or U-shaped grooves extending in a direction orthogonal to the knife wire 19 extending from the slit 17 and the slit 18. The indented portions 13 a and 13 b may be simple cuts, holes that penetrate the tube, or grooves or holes that are parallel to the knife wire 19. The recesses 13a and 13b preferably have a shape in which the opening diameter gradually increases as the knife wire 19 is approached. The indented portions 13a and 13b may be grooves or cuts having a shape in which the opening diameter is maintained. In the radial cross-sectional view of the multi-lumen tube 13 including the dent portions 13 a and 13 b, the dent portions 13 a and 13 b are formed at positions closest to the knife wire 19 on the outer peripheral surface of the multi-lumen tube 13.
　へこみ部１３ａ、１３ｂは、マルチルーメンチューブ１３の中心軸線方向に互いに離間した位置に形成されている。本実施形態に係るマルチルーメンチューブ１３では、へこみ部１３ａ、１３ｂは、互いに同じ形状である。へこみ部１３ａ、１３ｂは、スリット１７、１８の中間点ＰＭよりも先端側に形成されている。 The dents 13a and 13b are formed at positions separated from each other in the central axis direction of the multi-lumen tube 13. In the multi-lumen tube 13 according to the present embodiment, the recessed portions 13a and 13b have the same shape. The indented portions 13a and 13b are formed on the front end side with respect to the intermediate point PM of the slits 17 and 18.
　へこみ部１３ａの深さは、マルチルーメンチューブ１３に形成された第一ルーメン１４に達する深さである。さらに、へこみ部１３ａの深さは、マルチルーメンチューブ１３に形成された第二ルーメン１５、及び第三ルーメン１６のいずれにも達しない深さである。これにより、第二ルーメン１５及び第三ルーメン１６内に導入される流体やガイドワイヤ等の進路は、切開部１２において切れ目のない管状に保持されている。なお、スリット１７とスリット１８との間の領域では、第一ルーメン１４にはナイフワイヤ１９が挿通されていない。このため、へこみ部１３ａの深さが第一ルーメン１４に達していても、処置具１０の作用及び効果に悪影響はない。 The depth of the dent 13 a is a depth that reaches the first lumen 14 formed in the multi-lumen tube 13. Further, the depth of the dent 13 a is a depth that does not reach either the second lumen 15 or the third lumen 16 formed in the multi-lumen tube 13. As a result, the path of the fluid, guide wire, and the like introduced into the second lumen 15 and the third lumen 16 is held in a continuous tubular shape at the incision portion 12. In the region between the slit 17 and the slit 18, the knife wire 19 is not inserted through the first lumen 14. For this reason, even if the depth of the dent 13 a reaches the first lumen 14, the action and effect of the treatment instrument 10 are not adversely affected.
　マルチルーメンチューブ１３のうちへこみ部１３ａが形成されている部分は、マルチルーメンチューブ１３のうちへこみ部１３ａが形成されていない部分と比較して柔軟であり、曲がりやすい。このため、切開部１２においては、へこみ部１３ａが形成された部分が最も曲がりやすい部分である。また、マルチルーメンチューブ１３は、その径方向断面においてへこみ部１３ａのへこみ方向に曲がりやすい傾向がある。本実施形態に係るマルチルーメンチューブ１３では、マルチルーメンチューブ１３を基端側から先端側へ向かって見た場合において、マルチルーメンチューブ１３の中心から第三ルーメン１６の中心へ向かう方向を下方向（図３に「ＤＯＷＮ」と示されている。）としたときに、マルチルーメンチューブ１３の左側（図３に「ＬＥＦＴ」と示されている。）へ向かう方向を０度として時計回り方向の角度θが０度以上９０度以下の範囲、より好ましくは６０度以上８０度以下の範囲にある一部へ向けてへこみ部１３ａの開口が向けられている。このような角度にへこみ部を位置させることによって、第二ルーメン１５の内径を十分に確保することで送液性能を維持することができる。さらに、マルチルーメンチューブ１３を胆管等の管腔内に挿入しやすい方向に曲げやすくする事ができる。なお、本実施形態に係る処置具１０では、マルチルーメンチューブ１３の左側（図３に「ＬＥＦＴ」と示されている。）へ向かう方向を０度として時計回り方向の角度θが７０度付近である位置にナイフワイヤ１９が配されている。 The portion of the multi-lumen tube 13 where the dent portion 13a is formed is more flexible than the portion of the multi-lumen tube 13 where the dent portion 13a is not formed, and is easily bent. For this reason, in the incision part 12, the part in which the dent part 13a was formed is the part where it bends most easily. Further, the multi-lumen tube 13 tends to bend in the indentation direction of the indentation portion 13a in the radial cross section. In the multi-lumen tube 13 according to this embodiment, when the multi-lumen tube 13 is viewed from the proximal end side toward the distal end side, the direction from the center of the multi-lumen tube 13 toward the center of the third lumen 16 is downward ( 3 is indicated as “DOWN” in FIG. 3), and the angle in the clockwise direction with the direction toward the left side of the multi-lumen tube 13 (indicated as “LEFT” in FIG. 3) being 0 degrees. The opening of the recess 13a is directed toward a part where θ is in the range of 0 ° to 90 °, more preferably in the range of 60 ° to 80 °. By positioning the dent portion at such an angle, the liquid feeding performance can be maintained by sufficiently securing the inner diameter of the second lumen 15. Furthermore, the multi-lumen tube 13 can be easily bent in a direction in which it can be easily inserted into a lumen such as a bile duct. In the treatment instrument 10 according to the present embodiment, the direction toward the left side of the multi-lumen tube 13 (shown as “LEFT” in FIG. 3) is 0 degree, and the clockwise angle θ is around 70 degrees. A knife wire 19 is arranged at a certain position.
　本実施形態に係る処置具１０では、マルチルーメンチューブ１３の径方向断面視においてマルチルーメンチューブ１３の中心線から見たへこみ部１３ａの向きとナイフワイヤ１９の向きとは、結果的に略一致（完全一致を含む）している。ただし、へこみ部１３ａの向きとナイフワイヤ１９の向きは、ルーメンのレイアウトやワイヤの切開方向に応じてそれぞれ異なる向きであってもよい。 In the treatment instrument 10 according to the present embodiment, the direction of the dent 13a viewed from the center line of the multi-lumen tube 13 and the direction of the knife wire 19 in the radial cross-sectional view of the multi-lumen tube 13 are substantially the same as a result ( Including exact match). However, the direction of the dent 13a and the direction of the knife wire 19 may be different depending on the layout of the lumen and the cutting direction of the wire.
　本実施形態に係る処置具１０では、切開部１２は、スリット１７とスリット１８との間の領域において湾曲する。スリット１７、１８の中間点ＰＭは、切開部１２の中間点と一致する。 In the treatment instrument 10 according to the present embodiment, the incision portion 12 is curved in a region between the slit 17 and the slit 18. The midpoint PM of the slits 17 and 18 coincides with the midpoint of the incision portion 12.
　ナイフワイヤ１９は、可撓性管部１１の中心軸線に沿って配され、その一端が可撓性管部１１の先端部１１ａに固定されている。ナイフワイヤ１９は、導電性を有する素線２０と、素線２０の一部を被覆する絶縁被覆２１とを有する。ナイフワイヤ１９の先端には、ナイフワイヤ１９を第一ルーメン１４の先端部に固定するためのナイフチップ２２が接続されている。ナイフチップ２２は、マルチルーメンチューブ１３に形成された２つのスリット１７、１８のうち先端側に位置するスリット１７内に圧入されている。ナイフチップ２２は、第一ルーメン１４内に固定されている。 The knife wire 19 is disposed along the central axis of the flexible tube portion 11, and one end thereof is fixed to the distal end portion 11 a of the flexible tube portion 11. The knife wire 19 has a conductive wire 20 and an insulating coating 21 that covers a part of the wire 20. A knife tip 22 for fixing the knife wire 19 to the distal end portion of the first lumen 14 is connected to the distal end of the knife wire 19. The knife tip 22 is press-fitted into the slit 17 located on the distal end side of the two slits 17 and 18 formed in the multi-lumen tube 13. The knife tip 22 is fixed in the first lumen 14.
　ナイフワイヤ１９においてナイフチップ２２の基端側の一部は、絶縁被覆２１を有していない露出部２３を構成している。露出部２３は、ナイフワイヤ１９の全長のうちマルチルーメンチューブ１３の外側に位置する範囲に設定されている。 A part of the proximal end side of the knife tip 22 in the knife wire 19 constitutes an exposed portion 23 that does not have the insulating coating 21. The exposed portion 23 is set in a range located outside the multi-lumen tube 13 in the entire length of the knife wire 19.
　絶縁被覆２１は、ナイフワイヤ１９において露出部２３よりも基端側に設けられている。絶縁被覆２１は、ナイフワイヤ１９の素線２０の外周面に絶縁を目的としたコーティングにより形成されている。 The insulating coating 21 is provided on the proximal end side of the exposed portion 23 in the knife wire 19. The insulating coating 21 is formed on the outer peripheral surface of the strand 20 of the knife wire 19 by a coating intended for insulation.
　ナイフワイヤ１９において露出部２３よりも基端側は、可撓管部１１の基端側に向かって延びている。ナイフワイヤ１９の基端は、操作部３０（図１参照）に接続されている。詳細は後述するが、操作部３０によって、ナイフワイヤ１９は基端側へと牽引される。これにより、ナイフワイヤ１９の先端は、可撓管部１１の先端部１１ａを基端側へと移動させ、マルチルーメンチューブ１３のうち切開部１２となる領域を湾曲させる。 The proximal end side of the exposed portion 23 of the knife wire 19 extends toward the proximal end side of the flexible tube portion 11. The proximal end of the knife wire 19 is connected to the operation part 30 (refer FIG. 1). Although details will be described later, the knife wire 19 is pulled to the proximal end side by the operation unit 30. As a result, the distal end of the knife wire 19 moves the distal end portion 11a of the flexible tube portion 11 toward the proximal end side to bend the region that becomes the incision portion 12 in the multi-lumen tube 13.
　図１に示すように、シース部２５は、切開部１２の基端側に設けられている。シース部２５は、切開部１２を構成するマルチルーメンチューブ１３が基端側に延ばして設けられたものである。すなわち、本実施形態に係る処置具１０では、切開部１２及びシース部２５はマルチルーメンチューブ１３を有する。シース部２５には、切開部１２と同様に第一ルーメン１４、第二ルーメン１５及び第三ルーメン１６が形成されている。 As shown in FIG. 1, the sheath portion 25 is provided on the proximal end side of the incision portion 12. The sheath portion 25 is provided by extending the multi-lumen tube 13 constituting the incision portion 12 toward the proximal end side. That is, in the treatment instrument 10 according to the present embodiment, the incision portion 12 and the sheath portion 25 have the multi-lumen tube 13. Similar to the incision portion 12, the sheath portion 25 is formed with a first lumen 14, a second lumen 15, and a third lumen 16.
　図１に示すように、操作部３０は、シース部２５を構成するマルチルーメンチューブ１３に接続された第一分岐部３１によって、第一操作部３２と第二操作部４５とに分岐されている。第一操作部３２は、第一分岐部３１から引き出される。第一操作部３２は、可撓性を有するガイドワイヤチューブ３３と、ガイドワイヤＷを挿入するためのガイドワイヤ挿入部３４とを有する。本実施形態に係る処置具１０では、操作部３０において、シース部２５に接続された側が操作部３０における先端側である。 As shown in FIG. 1, the operation section 30 is branched into a first operation section 32 and a second operation section 45 by a first branch section 31 connected to the multi-lumen tube 13 constituting the sheath section 25. . The first operation part 32 is pulled out from the first branch part 31. The first operation portion 32 includes a flexible guide wire tube 33 and a guide wire insertion portion 34 for inserting the guide wire W. In the treatment instrument 10 according to the present embodiment, the side connected to the sheath portion 25 in the operation unit 30 is the distal end side of the operation unit 30.
　ガイドワイヤチューブ３３の先端部は、第一分岐部３１内で第三ルーメン１６と連通している。ガイドワイヤチューブ３３の基端部は、ガイドワイヤ挿入部３４に固定されている。 The distal end portion of the guide wire tube 33 communicates with the third lumen 16 in the first branch portion 31. The proximal end portion of the guide wire tube 33 is fixed to the guide wire insertion portion 34.
　ガイドワイヤ挿入部３４は、ワイヤ挿入口３５と、第一接続部３６と、第二接続部４２とを有する。ワイヤ挿入口３５は、筒状に形成され、ガイドワイヤチューブ３３と連通している。第一接続部３６は、ガイドワイヤ挿入部３４を第二操作部４５に接続している。第二接続部４２は、ガイドワイヤ挿入部３４を内視鏡装置１００に接続している。 The guide wire insertion part 34 has a wire insertion port 35, a first connection part 36, and a second connection part 42. The wire insertion port 35 is formed in a cylindrical shape and communicates with the guide wire tube 33. The first connection part 36 connects the guide wire insertion part 34 to the second operation part 45. The second connection part 42 connects the guide wire insertion part 34 to the endoscope apparatus 100.
　第一接続部３６は、ワイヤ挿入口３５の径方向にワイヤ挿入口３５の外面から突出して形成されている。第一接続部３６と第二操作部４５とは着脱可能に連結されている。必要に応じて、第一接続部３６と第二操作部４５とを着脱することができる。 The first connection portion 36 is formed so as to protrude from the outer surface of the wire insertion port 35 in the radial direction of the wire insertion port 35. The 1st connection part 36 and the 2nd operation part 45 are connected so that attachment or detachment is possible. The 1st connection part 36 and the 2nd operation part 45 can be attached or detached as needed.
　第二接続部４２は、ガイドワイヤ挿入部３４の軸線を通る同一平面内に円弧形状を有するＣ字型に形成されている。第二接続部４２は、弾性を有し、内視鏡装置１００の操作部１０３に係合する。 The second connection portion 42 is formed in a C shape having an arc shape in the same plane passing through the axis of the guide wire insertion portion 34. The second connection part 42 has elasticity and engages with the operation part 103 of the endoscope apparatus 100.
　第二操作部４５は、第一分岐部３１を貫通して引き出されたマルチルーメンチューブ１３の基端にコネクタ４６を介して接続されている。コネクタ４６は、マルチルーメンチューブ１３と同軸をなす筒状形状を有する。コネクタ４６には、ガイドワイヤ挿入部３４に形成された第一接続部３６が接続される被接続部４７が形成されている。被接続部４７は、第一接続部３６が嵌合する凹凸を有している。 The second operation part 45 is connected to the base end of the multi-lumen tube 13 drawn through the first branch part 31 via a connector 46. The connector 46 has a cylindrical shape that is coaxial with the multi-lumen tube 13. The connector 46 has a connected portion 47 to which the first connecting portion 36 formed in the guide wire insertion portion 34 is connected. The connected portion 47 has irregularities to which the first connecting portion 36 is fitted.
　コネクタ４６には、軸線方向に対して自由に変形する変形部４８が設けられている。変形部４８には、第二分岐部５０が設けられている。 The connector 46 is provided with a deforming portion 48 that freely deforms in the axial direction. The deformable portion 48 is provided with a second branch portion 50.
　第二分岐部５０は、マルチルーメンチューブ１３に設けられた第一ルーメン１４と第二ルーメン１５とを分岐させるために設けられている。第二分岐部５０には、第一ルーメン１４と連通するスライド部５１と、第二ルーメン１５と連通する送液部５７とが設けられている。 The second branch portion 50 is provided to branch the first lumen 14 and the second lumen 15 provided in the multi-lumen tube 13. The second branch portion 50 is provided with a slide portion 51 that communicates with the first lumen 14 and a liquid feeding portion 57 that communicates with the second lumen 15.
　スライド部５１は、コネクタ４６の軸線に対して傾斜する方向に延びている。スライド部５１は、略棒状の本体５２と、本体５２の長手軸方向にスライド可能なスライダ５４とを有する。本体５２には、スライダ５４の移動量を確認できる指標となる目盛と、指掛け用のリング５３が設けられている。 The slide part 51 extends in a direction inclined with respect to the axis of the connector 46. The slide portion 51 has a substantially rod-shaped main body 52 and a slider 54 that can slide in the longitudinal axis direction of the main body 52. The main body 52 is provided with a scale serving as an index for confirming the amount of movement of the slider 54 and a ring 53 for finger attachment.
　スライダ５４には、ナイフワイヤ１９の基端が固定されている。スライダ５４には、ナイフワイヤ１９に高周波電流を通電させるためのプラグ５５が設けられている。プラグ５５は、スライダ５４の内部においてナイフワイヤ１９に対して電気的に接続されている。 The base end of the knife wire 19 is fixed to the slider 54. The slider 54 is provided with a plug 55 for passing a high-frequency current through the knife wire 19. The plug 55 is electrically connected to the knife wire 19 inside the slider 54.
　スライダ５４には、指掛け用のリング５６が設けられている。処置具１０の操作者は、本体５２に設けられたリング５３と、スライダ５４に設けられたリング５６とのそれぞれに指をいれて、スライド部５１の操作をする。すなわち、本体５２に対してスライダ５４を進退させることにより、本体５２の長手軸方向にナイフワイヤ１９を移動させることができる。たとえば、本体５２の基端側へ向かってスライダ５４を移動させると、可撓管部１１の切開部１２において、ナイフワイヤ１９によってマルチルーメンチューブ１３の先端が基端側に引かれ、マルチルーメンチューブ１３の先端が湾曲する。 The slider 54 is provided with a finger ring 56. An operator of the treatment instrument 10 puts a finger into each of the ring 53 provided on the main body 52 and the ring 56 provided on the slider 54 to operate the slide unit 51. That is, the knife wire 19 can be moved in the longitudinal axis direction of the main body 52 by moving the slider 54 forward and backward with respect to the main body 52. For example, when the slider 54 is moved toward the base end side of the main body 52, the distal end of the multi-lumen tube 13 is pulled to the base end side by the knife wire 19 at the incision portion 12 of the flexible tube portion 11. The tip of 13 is curved.
　送液部５７は、送液口金５８と、管路５９とを有する。送液口金５８は、シリンジに接続可能である。管路５９は、送液口金５８及び第二ルーメン１５と連通している。管路５９の内部に、液体が流れる。送液口金５８は、たとえば、ロックタイプのシリンジに適合する突起が形成されていたり、スリップチップタイプのシリンジが摩擦係合可能な面が形成されていたりしてよい。 The liquid feeding part 57 has a liquid feeding base 58 and a pipe line 59. The liquid feeding cap 58 can be connected to a syringe. The pipe line 59 communicates with the liquid feeding base 58 and the second lumen 15. A liquid flows inside the pipe 59. For example, the liquid feeding base 58 may be formed with a protrusion adapted to a lock type syringe or a surface on which a slip tip type syringe can be frictionally engaged.
　次に、処置具１０の作用について説明する。図４は、処置具１０の使用時の一過程を示す説明図である。図５は、処置具１０の作用を説明するための図である。図６は、処置具１０の作用及び効果を説明するための図である。 Next, the operation of the treatment tool 10 will be described. FIG. 4 is an explanatory diagram showing a process during the use of the treatment instrument 10. FIG. 5 is a view for explaining the operation of the treatment instrument 10. FIG. 6 is a view for explaining the action and effect of the treatment instrument 10.
　処置具１０の使用時には、例えばユーザによる手作業等により、可撓管部１１が、内視鏡装置１００の処置具チャンネル１０２内に挿入される。可撓管部１１の先端部１１ａに配された切開部１２が、処置具チャンネル１０２の先端側の開口部１０２ａから突出する（図４参照）。内視鏡装置１００を用いて切開部１２及び処置対象部位を観察することができる。 When the treatment instrument 10 is used, the flexible tube portion 11 is inserted into the treatment instrument channel 102 of the endoscope apparatus 100 by, for example, manual operation by the user. The incision portion 12 disposed at the distal end portion 11a of the flexible tube portion 11 protrudes from the opening portion 102a on the distal end side of the treatment instrument channel 102 (see FIG. 4). The incision portion 12 and the treatment target site can be observed using the endoscope apparatus 100.
　ユーザは、必要に応じて、切開部１２の先端の位置を調整する。切開部１２の先端の位置を調整する作業は、例えば切開部１２を管腔内に挿入する目的で行なわれる。このとき、ユーザは、図５に示す内視鏡装置１００の挿入部１０１を、挿入部１０１の中心軸線方向に進退させたり、挿入部１０１の中心軸線回りに回転させたりするなど、挿入部１０１自体を移動させてもよい。ユーザは、内視鏡装置１００の挿入部１０１の先端からの可撓管部１１の突出長さを調整したり、可撓管部１１の中心軸線回りに可撓管部１１を回転させたりしてもよい。ユーザは、ナイフワイヤ１９を牽引したり緩めたりすることによって、切開部１２の湾曲形状を変更してもよい。これらの操作により、ユーザは、切開部１２の先端の位置及び向きを調整することができる。 The user adjusts the position of the tip of the incision 12 as necessary. The operation of adjusting the position of the tip of the incision 12 is performed for the purpose of inserting the incision 12 into the lumen, for example. At this time, the user moves the insertion unit 101 of the endoscope apparatus 100 shown in FIG. 5 in the direction of the central axis of the insertion unit 101 or rotates the insertion unit 101 around the central axis of the insertion unit 101. You may move itself. The user adjusts the protruding length of the flexible tube portion 11 from the distal end of the insertion portion 101 of the endoscope apparatus 100, or rotates the flexible tube portion 11 around the central axis of the flexible tube portion 11. May be. The user may change the curved shape of the incision 12 by pulling or loosening the knife wire 19. By these operations, the user can adjust the position and orientation of the tip of the incision portion 12.
　図６に実線で示すように、ナイフワイヤ１９を基端側へ牽引した場合、切開部１２において、へこみ部１３ａ、１３ｂが形成された部分がまず湾曲する。さらにナイフワイヤ１９が牽引されると、切開部１２全体が湾曲する。このとき、へこみ部１３ａ、１３ｂが形成されている部分は、切開部１２においてへこみ部１３ａ、１３ｂが形成されていない部分に比べて曲率が大きい（すなわち曲率半径が小さい）。本実施形態に係る処置具１０では、へこみ部１３ａ、１３ｂは、切開部１２における中間点ＰＭよりも先端側に形成されている。このため、ナイフワイヤ１９が牽引されたときには、切開部１２における中間点ＰＭより先端側の領域は、切開部１２における中間点ＰＭより基端側の領域よりも曲率が大きい。なお、図６に二点鎖線で示された状態は、へこみ部１３ａ、１３ｂが設けられていない場合において切開部１２が一様な曲率で湾曲した状態を示している。 As shown by a solid line in FIG. 6, when the knife wire 19 is pulled to the proximal end side, in the incised portion 12, the portions where the recessed portions 13a and 13b are formed are first curved. When the knife wire 19 is further pulled, the entire incision 12 is curved. At this time, the portions where the recessed portions 13a and 13b are formed have a larger curvature (that is, the curvature radius is smaller) than the portions where the recessed portions 13a and 13b are not formed in the incised portion 12. In the treatment instrument 10 according to the present embodiment, the recessed portions 13a and 13b are formed on the distal end side with respect to the intermediate point PM in the incision portion 12. For this reason, when the knife wire 19 is pulled, the region on the distal end side from the intermediate point PM in the incision portion 12 has a larger curvature than the region on the proximal end side from the intermediate point PM in the incision portion 12. In addition, the state shown with the dashed-two dotted line in FIG. 6 has shown the state which the incision part 12 curved with the uniform curvature, when the dent parts 13a and 13b are not provided.
　切開部１２において、中間点ＰＭより先端側の領域が中間点ＰＭより基端側の領域よりも大きな曲率で湾曲すると、切開部１２が一様な曲率で湾曲する場合と比較して、切開部１２の先端の移動量が小さい割に切開部１２の先端の向きが大きく変化する。このため、切開部１２の先端が内視鏡装置１００の観察視野から外れにくい。処置対象部位の近傍の作業空間が狭い場合にも、ユーザは、切開部１２の先端の向きを容易に調整することができる。 In the incision 12, when the region on the distal end side from the intermediate point PM is curved with a larger curvature than the region on the proximal end side from the intermediate point PM, the incision is compared with the case where the incision 12 is curved with a uniform curvature. The direction of the tip of the incision portion 12 changes greatly for a small amount of movement of the tip of the twelve. For this reason, the tip of the incision portion 12 is unlikely to deviate from the observation field of view of the endoscope apparatus 100. Even when the work space near the treatment target site is narrow, the user can easily adjust the direction of the tip of the incision 12.
　従来の処置具では、ナイフワイヤを牽引して切開部を湾曲させる動作は、マルチルーメンチューブからナイフワイヤを離間させ、ナイフワイヤを生体組織に押し付ける目的で行なわれる。このため、従来の処置具における前述の湾曲動作は、切開部の先端の位置を調整するために最適化された切開部の湾曲動作ではなかった。 In the conventional treatment tool, the operation of pulling the knife wire and bending the incision portion is performed for the purpose of separating the knife wire from the multi-lumen tube and pressing the knife wire against the living tissue. For this reason, the above-described bending operation in the conventional treatment instrument is not the bending operation of the incision portion optimized for adjusting the position of the tip of the incision portion.
　本実施形態に係る処置具１０では、へこみ部１３ａ、１３ｂが設けられていることによって、へこみ部１３ａ、１３ｂが設けられた位置において切開部１２の曲率が大きく、切開部１２における他の位置において曲率が小さい。その結果、切開部１２の先端の移動量が小さくても切開部１２の先端の向きを大きく変化させることができる。このため、本実施形態に係る処置具１０によれば、ユーザは、ナイフワイヤ１９の牽引量を調節することにより切開部１２の先端を所望の向きに容易に調節することができる。このため、例えば管腔組織の内部等に切開部１２を挿入する際の切開部１２の位置調整が容易である。 In the treatment instrument 10 according to the present embodiment, since the recesses 13a and 13b are provided, the curvature of the incision part 12 is large at the position where the recesses 13a and 13b are provided, and at other positions in the incision part 12. The curvature is small. As a result, the direction of the tip of the incision 12 can be greatly changed even if the amount of movement of the tip of the incision 12 is small. For this reason, according to the treatment instrument 10 according to the present embodiment, the user can easily adjust the tip of the incision portion 12 in a desired direction by adjusting the pulling amount of the knife wire 19. For this reason, for example, it is easy to adjust the position of the incision 12 when the incision 12 is inserted into the lumen tissue.
　本実施形態に係る処置具１０において、切開部１２の挿入対象となる管腔組織は特に限定されない。一例を挙げると、切開部１２の挿入対象は、十二指腸乳頭や胆管である。 In the treatment instrument 10 according to the present embodiment, the luminal tissue to be inserted into the incision portion 12 is not particularly limited. For example, the insertion target of the incision 12 is a duodenal papilla or a bile duct.
　本実施形態に係る処置具１０では、切開部１２の先端の移動量が小さくても切開部１２の先端の向きを大きく変化させることができる。このため、例えば胆管と膵管との分岐部において胆管側に切開部１２を挿入するような選択的な挿入をする場合に、切開部１２の先端を挿入しやすい。 In the treatment instrument 10 according to the present embodiment, the direction of the tip of the incision 12 can be greatly changed even if the amount of movement of the tip of the incision 12 is small. For this reason, for example, when performing selective insertion such as inserting the incision 12 into the bile duct at the bifurcation of the bile duct and pancreatic duct, the tip of the incision 12 is easily inserted.
　マルチルーメンチューブ１３が折れるような曲がり方が起こると、マルチルーメンチューブ１３に形成された各ルーメン１４、１５、１６が潰れることによって各ルーメン１４、１５、１６が閉じてしまう可能性が考えられる。この場合、ガイドワイヤＷや流体の通路が塞がれることとなり、作業性が悪化する可能性がある。この点に鑑みて、本実施形態に係る処置具１０では、切開部１２には、マルチルーメンチューブ１３の中心軸線方向に離間する２つのへこみ部１３ａ、１３ｂが設けられている。このため、へこみ部が１つである場合と比較して、マルチルーメンチューブ１３が折れるような曲がり方が起こりにくい。 When bending is performed such that the multi-lumen tube 13 is bent, the lumens 14, 15, 16 formed in the multi-lumen tube 13 may be crushed, and the lumens 14, 15, 16 may be closed. In this case, the guide wire W and the fluid passage are blocked, and workability may be deteriorated. In view of this point, in the treatment instrument 10 according to the present embodiment, the incision portion 12 is provided with two dent portions 13 a and 13 b that are separated in the central axis direction of the multi-lumen tube 13. For this reason, compared with the case where there is one dent part, the way of bending that the multi-lumen tube 13 is bent is less likely to occur.
　へこみ部１３ａ、１３ｂに加えてさらに別のへこみ部がマルチルーメンチューブ１３に設けられていてもよい。 In addition to the dents 13a and 13b, another dent may be provided in the multi-lumen tube 13.
　（変形例１）
　次に、上述の実施形態に係る処置具の変形例について説明する。図７は、本変形例の処置具の一部の構成を示す断面図である。 (Modification 1)
Next, a modified example of the treatment tool according to the above-described embodiment will be described. FIG. 7 is a cross-sectional view showing a configuration of a part of the treatment tool of the present modification.
　図７に示すように、本変形例では、マルチルーメンチューブ１３の先端側に配されているへこみ部１３ａが、マルチルーメンチューブ１３の基端側に配されているへこみ部１３ｂよりも大きくマルチルーメンチューブ１３を切り欠いた形状である。
　このような構成であると、切開部１２において先端側がより大きな曲率で湾曲する。 As shown in FIG. 7, in this modification, the dent 13 a disposed on the distal end side of the multi-lumen tube 13 is larger than the dent 13 b disposed on the proximal end side of the multi-lumen tube 13. The tube 13 is cut out.
With such a configuration, the distal end side of the incision 12 is curved with a larger curvature.
　（変形例２）
　次に、上述の実施形態に係る処置具のさらに他の変形例について説明する。図８は、本変形例の処置具の一部の構成を示す断面図である。 (Modification 2)
Next, still another modification of the treatment tool according to the above-described embodiment will be described. FIG. 8 is a cross-sectional view showing a configuration of a part of the treatment tool of the present modification.
　図８に示すように、本変形例では、へこみ部１３ａ、１３ｂは、いずれも第一ルーメン１４の内腔に達しない深さである。すなわち、へこみ部１３ａ、１３ｂは、いずれも第一ルーメン１４と連通していない。
　このような構成であっても上述の実施形態と同様の効果を奏する。 As shown in FIG. 8, in this modified example, the recesses 13 a and 13 b have a depth that does not reach the lumen of the first lumen 14. That is, none of the indentations 13 a and 13 b communicate with the first lumen 14.
Even with such a configuration, the same effects as those of the above-described embodiment can be obtained.
　（変形例３）
　次に、上述の実施形態に係る処置具のさらに他の変形例について説明する。図９は、本変形例の処置具の一部の構成を示す断面図である。 (Modification 3)
Next, still another modification of the treatment tool according to the above-described embodiment will be described. FIG. 9 is a cross-sectional view showing a partial configuration of the treatment tool of the present modification.
　図９に示すように、本変形例では、上述の実施形態で説明したへこみ部１３ａ、１３ｂに加えて、マルチルーメンチューブ１３には、マルチルーメンチューブ１３の径方向においてへこみ部１３ａ、１３ｂと対向する位置にへこみ部１３ｃ、１３ｄが形成されている。
　このような構成であっても上述の実施形態と同様の効果を奏する。 As shown in FIG. 9, in this modification, in addition to the dents 13 a and 13 b described in the above embodiment, the multi-lumen tube 13 is opposed to the dents 13 a and 13 b in the radial direction of the multi-lumen tube 13. Recessed portions 13c and 13d are formed at the positions where they are located.
Even with such a configuration, the same effects as those of the above-described embodiment can be obtained.
　（変形例４）
　次に、上述の実施形態に係る処置具のさらに他の変形例について説明する。 (Modification 4)
Next, still another modification of the treatment tool according to the above-described embodiment will be described.
　本変形例では、へこみ部１３ａ、１３ｂが、マルチルーメンチューブ１３の周方向に延びる溝状である点が異なっている。
　このような構成であっても上述の実施形態と同様の効果を奏する。 This modification is different in that the dents 13 a and 13 b are groove-shaped extending in the circumferential direction of the multi-lumen tube 13.
Even with such a configuration, the same effects as those of the above-described embodiment can be obtained.
（変形例５）
　次に、上述の実施形態に係る処置具のさらに他の変形例について説明する。 (Modification 5)
Next, still another modification of the treatment tool according to the above-described embodiment will be described.
　本変形例では、マルチルーメンチューブ１３は、へこみ部１３ａを有しており、へこみ部１３ｂを有していない。さらに、へこみ部１３ａは、スリット１７，１８の中間点ＰＭよりも先端側に位置する。 In this modification, the multi-lumen tube 13 has a dent 13a and does not have a dent 13b. Further, the indented portion 13 a is located on the tip side with respect to the intermediate point PM of the slits 17 and 18.
　このような構成であっても上述の実施形態と同様の効果を奏する。また、本変形例では、へこみ部を１つのみマルチルーメンチューブ１３に形成するので、複数のへこみ部を形成する場合と比較して製造コストが安くできる。 Even with such a configuration, the same effects as those of the above-described embodiment can be obtained. Moreover, in this modification, since only one dent part is formed in the multi-lumen tube 13, manufacturing cost can be reduced compared with the case where a plurality of dent parts are formed.
　以上、本発明の好ましい実施形態を説明したが、本発明はこれら実施形態に限定されることはない。本発明の趣旨を逸脱しない範囲で、構成の付加、省略、置換、およびその他の変更が可能である。本発明は前述した説明によって限定されることはなく、添付のクレームの範囲によってのみ限定される。 The preferred embodiments of the present invention have been described above, but the present invention is not limited to these embodiments. Additions, omissions, substitutions, and other modifications can be made without departing from the spirit of the present invention. The present invention is not limited by the above description, but only by the scope of the appended claims.
　上記した処置具を用いることによって、ユーザは、処置具の切開部の先端の向きを容易に調整することができるため、例えば管腔組織の内部等に処置具を挿入する際の位置調整を容易に行うことができる。このため、ユーザにとって使いやすい処置具を提供することができる。 By using the above-described treatment tool, the user can easily adjust the orientation of the distal end of the incision portion of the treatment tool, so that, for example, the position can be easily adjusted when the treatment tool is inserted into a lumen tissue or the like. Can be done. For this reason, it is possible to provide a treatment tool that is easy for the user to use.
　ＰＭ　　中間点
　Ｗ　　ガイドワイヤ
　θ　　角度
　１０　　処置具
　１１　　可撓管部（チューブ）
　１１ａ　　先端部
　１１ｂ　　基端部
　１２　　切開部
　１３　　マルチルーメンチューブ
　１３ａ、１３ｂ、１３ｃ、１３ｄ　　へこみ部
　１４　　第一ルーメン
　１５　　第二ルーメン
　１６　　第三ルーメン
　１７　　スリット（第一の孔）
　１８　　スリット（第二の孔）
　１９　　ナイフワイヤ（牽引部材）
　２０　　素線
　２１　　絶縁被覆
　２２　　ナイフチップ
　２３　　露出部
　２５　　シース部
　３０　　操作部
　３１　　第一分岐部
　３２　　第一操作部
　３３　　ガイドワイヤチューブ
　３４　　ガイドワイヤ挿入部
　３５　　ワイヤ挿入口
　３６　　第一接続部
　４２　　第二接続部
　４５　　第二操作部
　４６　　コネクタ
　４７　　被接続部
　４８　　変形部
　５０　　第二分岐部
　５２　　本体
　５３、５６　　リング
　５４　　スライダ
　５５　　プラグ
　５７　　送液部
　５８　　送液口金
　５９　　管路
　１００　　内視鏡装置
　１０１　　挿入部
　１０２　　処置具チャンネル
　１０２ａ、１０２ｂ　　開口部
　１０３　　操作部
　１０４　　湾曲部
　１０５　　撮像部
　１０６　　ノブ PM intermediate point W guide wire θ angle 10 treatment instrument 11 flexible tube (tube)
11a distal end portion 11b proximal end portion 12 incision portion 13 multi-lumen tube 13a, 13b, 13c, 13d dent portion 14 first lumen 15 second lumen 16 third lumen 17 slit (first hole)
18 Slit (second hole)
19 Knife wire (traction member)
20 Wire 21 Insulation coating 22 Knife tip 23 Exposed part 25 Sheath part 30 Operation part 31 First branch part 32 First operation part 33 Guide wire tube 34 Guide wire insertion part 35 Wire insertion port 36 First connection part 42 Second connection Part 45 Second operation part 46 Connector 47 Connected part 48 Deformation part 50 Second branch part 52 Main body 53, 56 Ring 54 Slider 55 Plug 57 Liquid feed part 58 Liquid feed base 59 Pipe line 100 Endoscope apparatus 101 Insertion part 102 Treatment instrument channel 102a, 102b Opening portion 103 Operation portion 104 Bending portion 105 Imaging portion 106 Knob

Claims (9)

  1. 　先端部と基端部とを有する可撓性のチューブと、
    　前記チューブの中心軸線に沿って配され、一端が前記先端部に固定された牽引部材と、
    　を備え、
    　前記チューブは、
    　　前記チューブの内外を連通し、前記チューブの中心軸線方向に離間する一対の孔と、
    　　へこみ部と、
    　を有し、
    　前記一対の孔には前記牽引部材が挿通され、
    　前記一対の孔のうち前記先端部側に位置する第一の孔と前記基端部側に位置する第二の孔との間では、前記牽引部材は前記チューブの外側に配され、
    　前記へこみ部は、前記一対の孔の中間点よりも前記先端部に近い位置に配され、
    　前記チューブのうち前記一対の孔の間に位置する領域は、前記牽引部材を前記チューブの中心軸線方向に進退させることにより湾曲する
    　処置具。     A flexible tube having a distal end and a proximal end;
    A traction member disposed along the central axis of the tube and having one end fixed to the tip;
    With
    The tube
    A pair of holes communicating between the inside and outside of the tube and spaced apart in the direction of the central axis of the tube;
    The indentation,
    Have
    The pulling member is inserted into the pair of holes,
    Of the pair of holes, between the first hole located on the distal end side and the second hole located on the proximal end side, the traction member is disposed outside the tube,
    The indented portion is arranged at a position closer to the tip than the midpoint of the pair of holes,
    A region located between the pair of holes in the tube is curved by moving the pulling member forward and backward in the central axis direction of the tube.
  2. 　請求項１に記載の処置具であって、
    　前記チューブには複数のへこみ部が設けられ、
    　前記複数のへこみ部は、全て前記中間点よりも前記先端部に近い位置に配される
    　処置具。     The treatment tool according to claim 1,
    The tube is provided with a plurality of indentations,
    The plurality of indentations are all arranged at positions closer to the tip than the intermediate point.
  3. 　請求項２に記載の処置具であって、
    　前記複数のへこみ部のうち、前記先端部に近い位置に配されたへこみ部は、自身よりも前記基端部に近い位置に配されたへこみ部よりも大きく前記チューブを切り欠いた形状である
    　処置具。     The treatment tool according to claim 2,
    Of the plurality of indentations, the indentation portion arranged at a position close to the distal end portion has a shape in which the tube is cut out larger than the indentation portion arranged at a position closer to the base end portion than itself. Treatment tool.
  4. 　請求項２に記載の処置具であって、
    　前記複数のへこみ部のうち少なくとも二つのへこみ部は、互いに形状および大きさが同じである
    　処置具。     The treatment tool according to claim 2,
    A treatment tool, wherein at least two of the plurality of indentations have the same shape and size.
  5. 　請求項１に記載の処置具であって、
    　前記牽引部材はワイヤであり、
    　前記チューブは、前記ワイヤが挿通されるルーメンを有し、
    　前記へこみ部は前記ルーメンと連通している
    　処置具。     The treatment tool according to claim 1,
    The traction member is a wire;
    The tube has a lumen through which the wire is inserted,
    The dent is in communication with the lumen.
  6. 　請求項５に記載の処置具であって、
    　前記チューブは、流体が流れる第二ルーメンを有し、
    　前記へこみ部は、前記第二ルーメンとは非連通状態である
    　処置具。     The treatment tool according to claim 5,
    The tube has a second lumen through which fluid flows;
    The dent portion is in a non-communication state with the second lumen.
  7. 　請求項５または請求項６に記載の処置具であって、
    　前記チューブは、医療用ガイドワイヤを挿通する第三ルーメンを有し、
    　前記へこみ部は、前記第三ルーメンとは非連通状態である
    　処置具。     The treatment tool according to claim 5 or 6,
    The tube has a third lumen for inserting a medical guide wire;
    The dent portion is in a non-communication state with the third lumen.
  8. 　請求項１に記載の処置具であって、
    　前記へこみ部は、前記チューブの一部を切り欠くことで形成された切り欠きである
    　処置具。     The treatment tool according to claim 1,
    The said dent part is a notch formed by notching a part of said tube.
  9. 　請求項１に記載の処置具であって、
    　前記チューブは、医療用ガイドワイヤを挿通する第三ルーメンを有し、
    　前記チューブの径方向断面を前記チューブの基端から先端へ向かって見たときに、前記チューブの中心から前記第三ルーメンの中心へ向かう方向を前記チューブの下方向としたときの前記チューブの左方向を０度として時計回り方向の角度が０度以上９０度以下となる範囲のうちの一部へ向かって、前記へこみ部は開口する
    　処置具。     The treatment tool according to claim 1,
    The tube has a third lumen for inserting a medical guide wire;
    When the radial cross section of the tube is viewed from the proximal end to the distal end of the tube, the left side of the tube when the direction from the center of the tube toward the center of the third lumen is the downward direction of the tube The dent portion opens toward a part of a range in which the direction is 0 degree and the clockwise angle is 0 degree or more and 90 degrees or less.
PCT/JP2013/067351 2012-09-28 2013-06-25 Treatment tool WO2014050233A1 (en)

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Cited By (3)

* Cited by examiner, † Cited by third party
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WO2015133442A1 (en) * 2014-03-04 2015-09-11 オリンパス株式会社 Treatment instrument for endoscope
WO2020150257A1 (en) * 2019-01-15 2020-07-23 Boston Scientific Scimed, Inc. Sphincterotomes and methods for using sphincterotomes
WO2023172688A1 (en) * 2022-03-09 2023-09-14 Boston Scientific Medical Device Limited Devices and systems for catheter with actuating portion

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JPS6167710U (en) * 1984-10-09 1986-05-09
JP2001070316A (en) * 1999-07-08 2001-03-21 Olympus Optical Co Ltd High-frequency knife for endoscope
JP2003024346A (en) * 2001-07-18 2003-01-28 Pentax Corp High-frequency incising tool for endoscope
JP2009045451A (en) * 2007-08-17 2009-03-05 Olympus Medical Systems Corp Treatment device
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JP2010178934A (en) * 2009-02-06 2010-08-19 Hoya Corp Endoscope for treatment

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JPS6167710U (en) * 1984-10-09 1986-05-09
JP2001070316A (en) * 1999-07-08 2001-03-21 Olympus Optical Co Ltd High-frequency knife for endoscope
JP2003024346A (en) * 2001-07-18 2003-01-28 Pentax Corp High-frequency incising tool for endoscope
JP2009537280A (en) * 2006-05-19 2009-10-29 コンメッド エンドスコーピック テクノロジーズ インコーポレーテッド Mobile medical device
JP2009045451A (en) * 2007-08-17 2009-03-05 Olympus Medical Systems Corp Treatment device
JP2010178934A (en) * 2009-02-06 2010-08-19 Hoya Corp Endoscope for treatment

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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2015133442A1 (en) * 2014-03-04 2015-09-11 オリンパス株式会社 Treatment instrument for endoscope
JP5911652B2 (en) * 2014-03-04 2016-04-27 オリンパス株式会社 Endoscopic treatment tool
WO2020150257A1 (en) * 2019-01-15 2020-07-23 Boston Scientific Scimed, Inc. Sphincterotomes and methods for using sphincterotomes
WO2023172688A1 (en) * 2022-03-09 2023-09-14 Boston Scientific Medical Device Limited Devices and systems for catheter with actuating portion

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