JP6104118B2 - Treatment tool - Google Patents

Description

  The present invention relates to a treatment instrument that is inserted into a forceps port of an endoscope and used for attaching a covering material to an affected part in the body.

  Conventionally, when a lesioned part such as a tumor is found in a mucosal part in the body such as the esophagus, stomach, and duodenum by endoscopy, a treatment for peeling the lesioned mucous membrane from the muscle layer is performed under the endoscope. With this procedure, delayed bleeding or perforation may occur several days after the procedure. Therefore, a treatment for preventing bleeding and perforation is performed by covering the affected part with a covering material after the treatment. In performing this preventive treatment, since there is no dedicated treatment tool, for example, a treatment tool for an endoscope for other uses as disclosed in Patent Document 1 is used, and a covering material is applied to the affected part. It is attached.

  The endoscope treatment tool disclosed in Patent Document 1 is inserted into a forceps port of an endoscope, and a pair of forceps disposed at the distal end of the sheath by advancing and retracting a wire inserted into the sheath. The cup opens and closes like a bowl. When a covering material is attached to an affected area using this treatment tool, the following operations are performed.

  First, a pair of forceps cups is opened by performing a wire advance / retreat operation. Then, the wire is advanced and retracted while the covering material is inserted between the pair of forceps cups to close the pair of forceps cups. Thereby, the edge part of a coating | covering material is inserted | pinched between a pair of forceps cups, and it will be in the state by which the coating | covering material was hold | maintained at the forceps cup.

  Next, the treatment instrument is inserted into the body through the forceps port of the endoscope until the forceps cup reaches the vicinity of the affected part.

  Then, after the forceps cup reaches the vicinity of the affected area, the covering material of the portion not held by the forceps cup is expanded by the operation of the distal end of the endoscope or the back and forth operation of the treatment tool by the insertion operation to the forceps port. Placed in.

  Next, the forceps cup is opened by advancing and retracting the wire. Thereby, the sandwiching of the covering material by the forceps cup is released, and the covering material is separated from the forceps cup. Furthermore, the covering material is affixed to the affected part while pressing the covering material against the affected part on the surface of the forceps cup.

  In recent years, a treatment tool for applying a covering material to an affected area has been studied. For example, Patent Document 2 discloses a treatment that is inserted into a forceps port of an endoscope and a protective sheet for hemostasis is applied to the affected area. Ingredients have been proposed.

  In this treatment tool, the protective sheet is attached to the first linear member fixed to the inner sheath in a roll shape, and one end of the protective sheet is fixed to the second linear member that passes through the inner sheath. It is inserted into the outer sheath. In this treatment tool, after projecting the inner sheath relative to the outer sheath in accordance with the affected area, when the second linear member is pulled, one end of the protective sheet is separated from the second linear member, The protective sheet attached to the first linear member is attached to the affected area while being pulled out.

JP 2009-125418 A JP2012-040135A

  However, in the treatment tool for other purposes as described in Patent Document 1, the covering material is simply sandwiched between the pair of forceps cups, and the work of attaching the covering material is easy, but the holding device is held by the forceps cup. It is not easy to spread the portion of the covering material that is not, and the size of the covering material that can be expanded is as small as about 5 mm × 10 mm square. Further, when the covering material is wetted by body fluid, it becomes more difficult to spread the covering material.

  In the treatment tool described in Patent Document 2, since the covering material (protective sheet) is attached in a roll shape, a covering material having a large size can be attached to the affected area. However, the operation for attaching the covering material to the treatment instrument is not easy. Moreover, since it is a structure which draws out a roll-shaped coating | covering material only with the adhesive force of an affected part and a coating | covering material, there exists a possibility that it cannot stick well.

  The present invention has been made to solve the above-described problems, and an object of the present invention is to provide a treatment instrument that is inserted into a forceps port of an endoscope and used to attach a covering material to an affected part in the body. It is an object of the present invention to provide a treatment tool capable of easily spreading a covering material and capable of spreading a covering material having a large size.

A treatment tool according to the present invention is a treatment tool that is inserted into a forceps port of an endoscope and used to attach a covering material to an affected part in a body, and a first ring member having a through hole is provided on one side. An outer cylinder fitted into the end of the inner cylinder, an inner cylinder inserted into the outer cylinder so as to freely advance and retreat, and a second ring member having a through hole fitted into the one end,
A wire that is inserted into the inner cylinder so as to be able to advance and retreat, and a thick part on one side are located outside the outer cylinder, projecting in one direction outward of the diameter of the outer cylinder, and on the other side A thin bar is connected to the wire and passes through the through hole of the first ring member and the through hole of the second ring member, and the thick part on one side is outside the outer cylinder. Located on the outside of the outer cylinder and projecting in two directions opposite to the one direction, and the thin part on the other side is connected to or integrally formed with the second ring member, A second bar that passes through the through hole of the first ring member, and retracts the wire and the inner cylinder to move the first and second bars to the other side, thereby One end or a part of the covering material along the surface of the thick part of the first and second bars is the thickness of the first bar. And the other end or part of the covering material can be sandwiched between the thick portion of the second bar and the first ring member. In a state where the covering material is sandwiched, the wire is advanced and the first bar is moved to one side, whereby the thick portion of the first bar of the covering and the first It is possible to release the sandwiching material between the ring member and the first bar member that extends to one side of the second bar member, and then to extend the covering member. By moving the tube forward and moving the second bar to one side, the sandwiching between the thick part of the second bar of the covering and the first ring member is released, The covering material can be separated from the first bar and the second bar.

Preferably, by moving the wire forward and backward, the first bar has a first position where the thick part of the first bar contacts the first ring member, and the thick part of the first bar. The thickness of the first bar is equal to or greater than the second position of the first ring member at least the length of the thick part of the first bar. The second ring member and the second bar can be moved to a third position away from the member, and the thick portion of the second bar can be moved to the first ring. The fourth position in contact with the member and the thick part of the second bar are movable to the fifth position away from the first ring member by the thickness of the covering material,
When the first bar is in the first position and the second bar is in the fourth position, the covering material along the surfaces of the thick portions of the first and second bars One end or part thereof is sandwiched between the thick part of the first bar and the first ring member, and the other end or part of the covering member is placed between the thick part of the second bar and the first part. It is possible to be sandwiched between one ring member and the wire is advanced in a state where the covering material is sandwiched, and the first bar is moved to the second position and the third position. By sequentially moving, one end or a part of the covering material is released, and then the covering material can be pushed out by the first bar material extending to one side of the second bar material. In the state where the covering material is extended, the inner cylinder is advanced, and the second bar is 5 by moving the position, to release the pinching of the other end or a part of the dressing, are the covering material can be separated from the first bar and the second bar.

  According to the treatment tool of the present invention, the first bar can be extended to one side of the second bar by a simple operation of moving the wire forward, and as a result, the first bar can be used as the covering material. Is stretched to spread the covering. Therefore, the covering material can be easily spread. Moreover, the covering material of a large dimension can be expanded by enlarging the length which the said 1st bar extends to one side rather than the 2nd bar.

It is a schematic side view which shows the operation | work which affixes a coating | covering material to an affected part using the treatment tool which concerns on embodiment of this invention. It is a schematic side view which shows the operation | work which affixes a coating | covering material to an affected part using the treatment tool which concerns on embodiment of this invention. It is a schematic side view which shows the operation | work which affixes a coating | covering material to an affected part using the treatment tool which concerns on embodiment of this invention. It is a schematic side view which shows the operation | work which affixes a coating | covering material to an affected part using the treatment tool which concerns on embodiment of this invention. It is a schematic side view which shows the operation | work which affixes a coating | covering material to an affected part using the treatment tool which concerns on embodiment of this invention. It is a schematic side view which shows the operation | work which affixes a coating | covering material to an affected part using the treatment tool which concerns on the modification of this invention.

  Embodiments of the present invention will be described below with reference to the drawings. 1-5 has shown the operation | work which affixes the coating | covering material H to the affected part K using the treatment tool 1 which concerns on embodiment of this invention.

  The treatment tool 1 according to the present embodiment is used by being inserted into a forceps port of an endoscope, and is used for attaching a sheet-shaped covering material H to an affected part K in the body. As the covering material H, for example, a suture reinforcing felt of polyglycolic acid (Neoval (registered trademark)) manufactured by Gunze Corporation can be used.

  As shown in FIGS. 1 to 5, the treatment instrument 1 includes an outer cylinder 2, an inner cylinder 3, a wire 4, a first bar 5, and a second bar 6.

  The outer cylinder 2 and the inner cylinder 3 are hollow flexible sheaths each composed of a tightly wound coil. A first ring member 7 having a through hole 7a is fitted into one end of the outer cylinder 2.

  The inner cylinder 3 is inserted into the outer cylinder 2 so as to freely advance and retract. A second ring member 8 having a through hole 8 a is fitted into one end of the inner cylinder 3.

  The wire 4 is inserted into the inner cylinder 3 so as to freely advance and retract. The other end (not shown) of the inner cylinder 3 and the wire 4 is connected to an operation section (not shown) for moving the inner cylinder 3 and the wire 4 forward and backward. The user can advance the inner cylinder 3 or the wire 4 to one side or retreat to the other side by operating the operation unit.

  The first bar 5 extends in the axial direction of the outer cylinder 2 and has a thick portion 5a on one side and a thin portion 5b on the other side. The thick part 5 a is located outside the outer cylinder 2 and protrudes in one direction outward of the diameter of the outer cylinder 2. The thin portion 5 b is connected to the wire 4 through the through hole 7 a of the first ring member 7 and the through hole 8 a of the second ring member 8.

  The second bar 6 extends in the axial direction of the outer cylinder 2 and is back-to-back with the first bar 5. The second bar 6 has a thick portion 6a on one side and a thin portion 6b on the other side. The thick part 6a is located outside the outer cylinder 2 and projects outward in the radial direction of the outer cylinder 2 and in two directions opposite to the one direction. The thin portion 6 b passes through the through hole 7 a of the first ring member 7 and is connected to the second ring member 8. The second ring member 8 and the second bar 6 may be formed integrally (that is, the second ring member 8 and the thin portion 6b are formed integrally. Is also good).

  In the treatment instrument 1, by moving the wire 4 forward and backward, the first bar 5 is moved to the first position shown in FIG. 1, the second position shown in FIG. 2, and the third position shown in FIGS. 3 and 4. It can be moved to. In the first position shown in FIG. 1, the thick part 5 a contacts the first ring member 7. In the second position shown in FIG. 2, the thick portion 5 a is separated from the first ring member 7 by the thickness of the covering material H. The third position shown in FIG. 3 and FIG. 4 is a position where the first bar 5 is further moved to one side from the second position, and the first bar 5 is at least thicker than the second bar 6. It extends to one side more than the length of 5a. Note that, in each of the first to third positions shown in FIGS. 1 to 4, the other end of the first bar 5 (the tip of the thin portion 5 b) is inside the inner cylinder 3.

  Moreover, in said treatment tool 1, the 2nd rod 6 is enabled to move to the 4th position shown in FIGS. 1-3, and the 5th position shown in FIG. 1 to 3, the thick portion 6 a contacts the first ring member 7, and the second ring member 8 is separated from the first ring member 7 by the thickness of the covering material H. In the fifth position shown in FIG. 4, the thick portion 6 a is separated from the first ring member 7 by the thickness of the covering material H, and the second ring member 8 is in contact with the first ring member 7.

  Next, the operation of attaching the covering material H to the affected area K using the treatment instrument 1 will be described.

  First, an operation of attaching the covering material H to the treatment instrument 1 is performed. In this case, first, the first bar 5 and the second bar 6 are advanced to one side, so that the thick part 5a and the first ring member 7 or the thick part 6a and the first ring 7 are moved forward. A gap is generated between the member 7 and the member 7. Next, the covering material H is disposed along the surfaces of the thick portions 5a and 6a. Next, the wire 4 and the inner cylinder 3 are retracted, the first bar 5 is moved to the first position (position shown in FIG. 1), and the second bar 6 is moved to the fourth position (position shown in FIG. 1). Move. Thereby, one end Ha of the covering material H is sandwiched between the thick portion 5a and the first ring member 7, and the other end Hb of the covering material H is between the thick portion 6a and the first ring member 7. It is possible to maintain the state in which the covering material H is disposed along the surfaces of the first bar 5 and the second bar 6 by being sandwiched therebetween. Thus, the operation of attaching the covering material H to the treatment instrument 1 is completed.

  After the attachment of the covering material H is completed, as shown in FIG. 1, the treatment tool 1 until the range Hc of the covering material H along the thick portion 6 a of the second bar 6 reaches the vicinity of the affected area K. Is inserted into the body. In a state where the treatment tool 1 is inserted into the body, the user can move the inner cylinder 3 and the wire 4 forward and backward by operating the operation unit.

  Next, as shown in FIG. 2, the first bar 5 is moved to the second position by advancing the wire 4 to one side. Thereby, the thick part 5a of the 1st rod 5 leaves | separates from the 1st ring member 7, and pinching of the end Ha of the coating | covering material H by the thick part 5a and the 1st ring member 7 is cancelled | released.

  Next, as shown in FIG. 3, the wire 4 is further advanced to one side, so that the first bar 5 is moved to the third position and extends to the one side from the second bar 6. As a result, the first bar 5 extends the covering material H, and the range Hd of the covering material along the surface of the first bar 5 slides on the surface of the first bar 5 to cover the surface. The material H is spread so that the substantially whole is opposed to the affected part K. At this time, the other end Hb of the covering material H is sandwiched between the thick portion 6a and the first ring member 7, so that the covering material H is extended by the first bar 5. The covering material H can be reliably spread, and the positioning of the covering material H with respect to the affected part K is facilitated.

  Next, as shown in FIG. 4, the second rod 6 is moved to the fifth position by moving the inner cylinder 3 forward. Thereby, the thick part 6a of the second bar 6 is separated from the first ring member 7, and the sandwiching of the other end Hb of the covering material H by the thick part 6a and the first ring member 7 is released. As a result, the covering material H is separated from the first bar 5 and the second bar 6 and attached to the affected part K.

  Next, as shown in FIG. 5, the covering material H may be extended by moving the treatment tool 1 forward and backward while pressing the treatment tool 1 against the covering material H. As a result, the covering material H is reliably attached to the affected area K (FIG. 5 shows an example in which the covering material H is extended by pressing the corners of the second bar 6 against the covering material H).

  According to the treatment instrument 1 of the present embodiment, the first bar 5 can be extended to one side from the second bar 6 by a simple operation of moving the wire 4 forward, and as a result, the first bar The covering material H is extended by the material 6, and the covering material H is spread. Therefore, the covering material H can be easily spread. Further, by increasing the length of the first bar 5 extending to one side of the second bar 6, the covering material H having a large size can be expanded.

  Further, the covering material H is arranged along the surfaces of the first bar 5 and the second bar 6 (the surfaces of the thick parts 5a and 6a), or the thick parts 5a and 6a and the first ring member 7 The covering material H can be attached to the treatment instrument 1 by a simple operation of sandwiching the ends Ha and Hb of the covering material H between them. For this reason, attachment of the covering material H is easy.

  In addition, this invention is not limited to the said embodiment, A various change can be made.

  For example, instead of the covering material H shown in FIGS. 1 to 5, a covering material having a larger dimension may be prepared. In this case, by covering a part of the covering material between the thick part 5a and the first ring member 7 and between the thick part 6a and the first ring member 7, the covering having a large size described above is provided. The material can be attached to the treatment instrument. Moreover, after performing this attachment, the covering material with the said large dimension can be spread along the affected part K by performing operation corresponding to FIGS. In order to expand the covering material H reliably, it is preferable that the end portion of the covering material H is sandwiched between the thick wall portion 6 a and the first ring member 7.

  In the above embodiment, when the first bar 5 is in the first position and the second bar 6 is in the fourth position (when in the state shown in FIG. 1), the tip of the first bar 5 The position of the second bar 6 coincides with the position of the tip of the second bar 6, the step position of the first bar 5 (boundary position of the thick part 5a and the thin part 5b), and the step of the second bar 6 (thick part). Although the configuration in which the boundary position between 6a and the thin portion 6b matches is shown, such a configuration is not necessarily required.

  For example, when the first bar 5 is in the first position and the second bar 6 is in the fourth position (when in a state corresponding to FIG. 1), the step position (thickness) of the second bar 6 The boundary position between the thick part 6a and the thin part 6b may be shifted to the other side of the step position of the first bar 5 (the boundary position between the thick part 5a and the thin part 5b). In this case, the moving distance of the wire 4 can be shortened.

  Further, as shown in FIG. 6, the first bar 5 is in the first position (position where the thick part 5a is in contact with the first ring member 7), and the second bar 6 is in the fourth position (thick part 5b). Is located at a position where the first bar member 7 is in contact with the first ring member 7, the tip of the second bar 6 is slightly less than the step position of the first bar 5 (the boundary position between the thick part 5 a and the thin part 5 b). It may be shifted to the side and the thick part 5a of the first bar 5 may be configured to protrude in one direction and two directions.

DESCRIPTION OF SYMBOLS 1 Treatment tool 2 Outer cylinder 3 Inner cylinder 4 Wire 5 1st bar 5a Thick part of 1st bar 5b Thin part of 1st bar 6 2nd bar 6a Thick part of 2nd bar 6b 2nd Thin portion of bar 7 First ring member 7a Through hole of first ring member 8 Second ring member 8a Through hole of second ring member K Affected part H Covering material Ha One end of coating Hb Other end of coating

Claims (2)

A treatment instrument that is inserted into a forceps port of an endoscope and used to apply a covering material to an affected part in the body,
An outer cylinder in which a first ring member having a through hole is fitted into an end on one side;
An inner cylinder that is inserted into the outer cylinder so as to be able to advance and retreat, and a second ring member having a through hole is fitted into an end on one side;
A wire that is inserted into the inner cylinder so as to freely advance and retract;
A thick part on one side is located outside the outer cylinder and protrudes in one outward direction of the outer cylinder, and a thin part on the other side is connected to the wire, and the first ring A first bar that passes through the through hole of the member and the through hole of the second ring member;
A thick part on one side is located outside the outer cylinder, protrudes in two directions opposite to the one direction and radially outward of the outer cylinder, and the thin part on the other side A second rod member connected to or integrally formed with the two ring member and passing through the through hole of the first ring member;
The covering material along the surface of the thick part of the first and second rods by moving the first and second rods to the other side by retracting the wire and the inner cylinder One end or a part of the first bar is sandwiched between the thick part of the first bar and the first ring member, and the other end or part of the covering is connected to the thick part of the second bar It can be sandwiched between the first ring member,
In a state where the covering material is sandwiched, the wire is advanced and the first bar is moved to one side, so that the thick part of the first bar of the covering material and the first bar It is possible to release the sandwiching with the ring member, and to push the covering material by the first bar material that extends to one side of the second bar material. By moving the second bar to one side to release the sandwiching between the thick part of the second bar of the covering and the first ring member, and A treatment instrument capable of separating a material from the first bar and the second bar. By moving the wire forward and backward, the first bar has a first position in which the covering material can be sandwiched between the thick portion of the first bar and the first ring member, and the first bar The thickness of the first bar is equal to or greater than the second position where the thick part of the one bar is separated from the first ring member by the thickness of the covering, and at least the length of the thick part of the first bar. The thick part is movable to the third position away from the first ring member,
By moving the inner cylinder back and forth, the second ring member and the second bar can sandwich the covering material between the thick part of the second bar and the first ring member. The fourth position and the thick portion of the second bar are movable to the fifth position away from the first ring member by the thickness of the covering material,
When the first bar is in the first position and the second bar is in the fourth position, the covering material along the surfaces of the thick portions of the first and second bars One end or part thereof is sandwiched between the thick part of the first bar and the first ring member, and the other end or part of the covering member is placed between the thick part of the second bar and the first part. It can be sandwiched between one ring member,
In a state where pinching is performed before Symbol dressing, the wire is moved forward and the first bar by making successively moved to the second position and the third position, one end or portion of the coating material After releasing the pinching of, it is possible to extend the covering material by the first bar extending to one side than the second bar,
In a state where the covering material is extended, the inner cylinder is advanced, and the second bar is moved to the fifth position to release the other end or part of the covering material. The treatment instrument according to claim 1, wherein the covering material can be separated from the first bar and the second bar.