WO2011001996A1

WO2011001996A1 - Forceps for endoscope

Info

Publication number: WO2011001996A1
Application number: PCT/JP2010/061101
Authority: WO
Inventors: 鈴木一郎
Original assignee: 株式会社スズケン
Priority date: 2009-06-30
Filing date: 2010-06-30
Publication date: 2011-01-06

Abstract

A forceps for an endoscope, having a blood stanching function, the forceps being capable of treatment such as blood stanching without being extracted from a forceps channel. A forceps (1) for an endoscope, comprising: a flexible elongated insertion section (10) having a double structure in a cross-section thereof and comprising a first insertion member (11) and a second insertion member (12); a pair of forceps elements (21) held at the tip of the first insertion member (11); and a ring-shaped annular member (30) which is separable by being advanced in the axial direction in response to the advance of the second insertion member (12), which faces the first insertion member (11), and then extruded to the tip side after being brought to a state in which the annular member (30) is fitted over the pair of forceps elements (21). In a state before the annular member (30) is separated, the pair of forceps elements (21) can be set only to a state in which the pair is in an incompletely closed state in which the pair can hold an organism tissue without cutting the organism tissue, while in a state in which the second insertion section (12) is advanced in the axial direction to a position at which the annular member (30) becomes separated, the pair of forceps elements (21) is in a completely closed state in which the pair can cut the organism tissue.

Description

Endoscopy forceps

The present invention relates to an endoscopic forceps used for endoscopic tissue collection, treatment, hemostasis, treatment site marking, and the like.

Conventionally, for example, an endoscopic forceps for performing various treatments on a living tissue in a body cavity has been provided (see, for example, Patent Document 1). An endoscopic forceps is a medical device that is inserted into a body cavity through a forceps channel of an endoscope. As shown in FIG. 20, a general endoscope forceps includes a coil 92 having a cup holding portion 91 at the tip, a pair of forceps pieces 93 rotatably supported by the cup holding portion 91, and a coil 92. There is known an endoscopic forceps 9 including two operation wires 94 inserted through and an operation unit (not shown) operated by an operator.

In this endoscopic forceps 9, a pair of forceps pieces 93 are rotatably supported by the pins 910 of the cup holding portion 91 like scissors. The distal end of the operation wire 94 is locked to each of the arm portions 931 corresponding to the rear end portion of the forceps piece 93. When the operation wire 94 is advanced and retracted by operating the operation unit, the pair of forceps pieces 93 open and close like scissors.

On the surface where the pair of forceps pieces 93 in a closed state contact each other, a cup shape 930 that is depressed leaving the outer peripheral edge portion 932 is formed. After the biological tissue is positioned in the gap between the pair of forceps pieces 93, the biological tissue can be cut according to the engagement of the outer peripheral edge portion 932 by closing the forceps piece 93. The cut biological tissue is accommodated in the cup shape 930 and can be collected as it is.

In addition, an endoscopic hemostatic clip (not shown) is known as an instrument for performing hemostasis, marking, and the like after collection or treatment of living tissue using endoscopic forceps. As a general endoscopic hemostatic clip, a clip that exhibits an expanded shape in a freely deformed state like tweezers, a clip closing member that opens and closes in response to axial advancement and retraction, and an insertion of the clip closing member There is an endoscopic hemostatic clip provided with a possible cylindrical sheath (see, for example, Patent Document 2). In the hemostatic clip for endoscope, the clip and the clip closing member are supported in a detachable state.

In the inserted state into the forceps channel, the clip closed by elastic deformation is inserted and arranged in the sheath together with the clip closing member. In treating the cut portion of the living tissue, first, the clip closing member is retracted so that the clip protrudes, so that the clip is opened by free deformation. After the cut portion is positioned inside the open clip, the clip closing member is advanced to close the clip and perform hemostasis or the like. After treatment such as hemostasis, the sheath can be extracted from the forceps channel by separating the clip and the clip closing member.

When performing the endoscopic forceps and endoscopic hemostasis clip as described above to collect biological tissue, etc., endoscopically, the internal tissue is quickly extracted from the forceps channel after the biological tissue is collected. It is necessary to remove the forceps for endoscope and insert a hemostatic clip for endoscope instead. Furthermore, it is necessary to promptly execute a series of operations in which the hemostatic clip for endoscope is inserted into the body cavity, the clip is opened, and then the clip is closed to stop bleeding.

However, there are the following problems with the above-described conventional instrument for collecting a bioendoscopic tissue. In other words, there are cases where bleeding and bleeding must be performed as the tissue is collected. In such cases, the above-mentioned endoscopic forceps are removed, and the endoscopic hemostatic clip is quickly inserted. There is a problem that the insertion of the hemostatic clip for an endoscope, which requires a person or has a total length exceeding 1 m, must be performed quickly without taking time.

JP 2005-58344 A JP 2000-254143 A

The present invention has been made in view of the above-described conventional problems, and an object of the present invention is to provide an endoscopic forceps that can perform hemostasis, marking, and the like without being extracted from the forceps channel.

The present invention is a flexible cross-sectional structure composed of a first insertion member located on the inner peripheral side and a cylindrical second insertion member that can advance and retract in the axial direction relative to the first insertion member. An elongated insertion part exhibiting sex;
A pair of forceps pieces held on the distal end side of the first insertion member;
An operation unit coupled to the rear end side of the first and second insertion members;
The first insertion member and the pair of forceps pieces can be extrapolated and moved forward in the axial direction in accordance with the advancement of the second insertion member facing the first insertion member. An annular member configured to be separable by being pushed to the distal end side through a state of being extrapolated to the forceps piece,
The second insertion member is capable of advancing and retreating in the axial direction relative to the first insertion member between a position where the pair of forceps pieces is accommodated and a position where the second insertion member protrudes toward the distal end side.
While the pair of forceps pieces are in an open state in a free deformation state, the pair of forceps pieces are deformed according to a force acting from the second insertion member side when housed on the inner peripheral side of the second insertion member. Closed,
In addition, until the annular member is separated, it is possible to set only an incompletely closed state in which the living tissue is grasped without being cut, while the second member is separated to the position where the annular member is separated. An endoscope forceps is configured such that when the insertion member advances in the axial direction, a state in which the living tissue is completely closed is set to such an extent that the living tissue can be cut.

The endoscope forceps of the present invention has the annular member that can be separated by being pushed out as the second insertion member advances. Before the annular member is separated, the pair of forceps pieces can be set only in an incompletely closed state in which the biological tissue is grasped without being cut. On the other hand, when the annular member is pushed out and separated from the distal end side of the pair of forceps pieces, the pair of forceps pieces are in the completely closed state capable of cutting the living tissue.

The annular member pushed through the pair of forceps pieces in the state of grasping the living tissue and pushed to the distal end side is extrapolated to the root of the cut living tissue. According to the said annular member, it fixes to a biological tissue, maintaining the state extrapolated by the cut | disconnected biological tissue. If the annular member is transferred to the living tissue in this way, bleeding from the cut portion can be stopped or the cut portion can be marked. Further, the annular member is transferred to the living tissue almost simultaneously with the cutting of the living tissue. Therefore, if it is a cyclic | annular member provided with the hemostatic effect, the bleeding accompanying the cutting | disconnection of a biological tissue can be suppressed to the minimum. Moreover, if it is an annular member for marking, a cutting location can be accurately marked with high positional accuracy.

Thus, according to the forceps for endoscope of the present invention, treatments such as collection and treatment of living tissue and treatments such as hemostasis and marking after treatment can be performed almost simultaneously. Therefore, it is not necessary to remove the forceps from the endoscope after a procedure such as collection of a living tissue and reinsert another instrument for hemostasis into the endoscope. According to the forceps for endoscope, the necessary number of insertions of the treatment tool into the endoscope can be reduced, and the treatment can be executed relatively efficiently and relatively easily.

The forceps piece and the annular member in the present invention can be formed of various materials such as an elastic metal such as elastic stainless steel, a shape memory alloy, a shape memory resin, and a biodegradable resin. In particular, when an annular member made of a shape memory alloy or a shape memory resin is employed, a configuration for heating the forceps piece is preferably provided. In this case, it becomes possible to enhance the hemostatic effect by heating the annular member with the forceps piece to exhibit the shape memory effect.

The second insertion member is preferably formed so as to ensure a load resistance in the compression direction. If the load resistance in the compression direction is ensured, the reliability of the operation of moving the second insertion member forward relative to the first insertion member can be increased. The second insertion member can be formed of carbon fiber or a resin material alone, but may be formed of a combination of carbon fiber and a resin material. Furthermore, a metal may be disposed at the tip portion of the second insertion member, that is, the portion in contact with the annular member.

In addition, the pair of forceps pieces are connected to each other via an elastically deformable connecting portion, and the incompletely closed state and the completely closed state according to the elastic deformation of the connecting portion. It is preferable that a closed state can be set.
In this case, for example, the opening / closing structure of the pair of forceps pieces can be simplified compared to an opening / closing structure including a shaft that supports the forceps pieces in a rotatable state. If the mechanical structure can be configured simply, the possibility of trouble occurring during use can be suppressed and the reliability can be improved. The pair of forceps pieces and the connecting portion may be integrally formed of a metal material, a resin material, or the like.

The pair of forceps pieces, the connecting portion, and the first insertion member may be integrally formed.
For example, if molding is integrally performed with a resin material, a resin composite material, or the like, assembly work is not necessary, and production efficiency can be improved.

Further, at least one of the pair of forceps pieces is formed with a convex portion protruding toward the outer peripheral side in the radial direction, and the pair of forceps pieces is formed by the second insertion member. It is preferable that the completely closed state is set in accordance with the contact load that acts on the convex portion from the inner peripheral surface.
In this case, the pair of forceps pieces can be completely closed according to the contact between the convex portion and the inner peripheral surface of the second insertion member. According to the convex portion formed at the distal end portion of the forceps piece, the contact load from the inner peripheral surface of the second insertion member is directly applied to the meshing position located at the distal end portion of the pair of forceps pieces. And can work efficiently.

Moreover, it is preferable that the said annular member is provided with elasticity, and the inner peripheral cross-sectional area in a free deformation state is smaller than the inner peripheral cross-sectional area in the extrapolation state with respect to a pair of forceps piece.
Generally, when a living tissue is grasped by the pair of forceps pieces, the diameter of the living tissue corresponding to the root is often the same as the diameter of a circumscribed circle formed by the pair of forceps pieces at that time. Therefore, when configured as described above, the annular member is firmly fixed to the living tissue by the elastic restoring force of the annular member and the living tissue that is to return to the original shape.

Moreover, it is preferable that a drop-off preventing structure for preventing drop-out from the living tissue is formed on the inner peripheral surface of the annular member.
In this case, dropping from the living tissue can be prevented in advance, and treatments such as hemostasis and marking can be realized with higher certainty. As the drop-off preventing structure, for example, a structure including a protrusion having a sharp shape in a certain direction like a saw tooth can be considered. Further, the annular member provided with the protrusion may be formed of a shape memory alloy or the like, and the protrusion may be configured to stand depending on the shape memory effect. In this case, a high dropout prevention effect can be exhibited according to the shape memory effect.

According to the forceps for endoscope of the present invention, in a series of actions such as hemostasis and marking after collecting or treating a living tissue, the forceps for endoscope from the forceps channel of the endoscope, etc. The number of times of inserting and removing can be reduced and efficient work is possible. Therefore, with this endoscopic forceps, the required skill level of the procedure can be suppressed, and the safety of the procedure can be improved.

The side view which shows the accommodation structure of the forceps piece in Example 1. FIG. FIG. 3 is a top view illustrating a forceps piece housing structure according to the first embodiment. Explanatory drawing which shows the endoscope and forceps for endoscopes in Example 1. FIG. The front view which shows the cyclic | annular member of the free deformation state in Example 1. FIG. Sectional drawing which shows the cross-sectional structure of the annular member in Example 1 (AA arrow cross section.). The perspective view which shows the accommodation structure of the forceps piece in Example 1. FIG. FIG. 3 is a perspective view illustrating an operation unit in the first embodiment. Sectional drawing which shows the cross-section of the operation part in the unused state in Example 1. FIG. The side view which shows the forceps piece of the open state in Example 1. FIG. FIG. 3 is a top view showing a forceps piece in an open state according to the first embodiment. Explanatory drawing which shows a mode that the forceps piece of the state closed incompletely in Example 1 hold | maintains a biological tissue. Explanatory drawing which shows the cross-section of an operation part when the forceps piece is in the incompletely closed state in Example 1. FIG. Explanatory drawing which shows the moment in which the forceps piece of the completely closed state cut | disconnects a biological tissue in Example 1. FIG. Explanatory drawing which shows the cross-section of an operation part when the forceps piece is in the completely closed state in Example 1. FIG. Explanatory drawing which shows a mode that the cyclic | annular member in Example 1 binds a biological tissue. FIG. 3 is an explanatory diagram for explaining the mechanical superiority over the conventional forceps in the first embodiment. The front view which shows the other annular member in Example 1. FIG. The side view which shows the other annular member in Example 1. FIG. The figure which shows the other outer sheath in Example 1. FIG. The side view which shows the forceps for endoscopes in a prior art example.

The embodiment of the present invention will be specifically described with reference to the following examples.
Example 1
This example is an example relating to an endoscopic forceps 1 having a hemostatic function. The contents will be described with reference to FIGS.
As shown in FIGS. 1 to 3, the endoscope forceps 1 of this example is advanced and retracted in the axial direction relative to the first insertion member 11 located on the inner peripheral side and the first insertion member 11. A long and narrow insertion portion 10 having a double-section flexible structure composed of a cylindrical second insertion member 12, a pair of forceps pieces 21 held on the distal end side of the first insertion member 11, The first and

second insertion members

11 and 12 can be extrapolated with respect to the operation portion 4 to which the rear ends of the first and

second insertion members

11 and 12 are connected, and the first insertion member 11 and the pair of forceps pieces 21. And an annular member 30 that can be separated by being pushed forward through the pair of forceps pieces 21 after being advanced in the axial direction in accordance with the advancement of the second insertion member 12 opposite to the first insertion member 12. .
The second insertion member 12 can advance and retreat in the axial direction relative to the first insertion member 11 between a position where the pair of forceps pieces 21 are accommodated and a position where the second insertion member 12 protrudes toward the distal end side.
The pair of forceps pieces 21 are in an open state in a freely deformed state, while the force acting from the inner peripheral surface of the second insertion member 12 is accommodated in the second insertion member 12 on the inner peripheral side. Accordingly, it is deformed and closed.
Further, the pair of forceps pieces 21 can be set only in an incompletely closed state in which the living tissue is grasped without being cut until the annular member 30 is separated, while the annular member 30 is separated. When the second insertion member 12 moves forward in the axial direction to a position where the living tissue is located, the living tissue is completely closed to the extent that it can be cut.
This will be described in detail below.

The endoscopic forceps 1 of this example is a medical device used in combination with the endoscope 100 as shown in FIG. The endoscope 100 includes a tubular insertion tube 102 having flexibility, and an operation unit 103 connected to the rear end of the insertion tube 102. An imaging element (not shown) for capturing an endoscopic image is disposed at the distal end of the insertion tube 102. The insertion tube 102 is inserted with a control line of the imaging device, a tube for sending and sucking air and water, and a tube called a forceps channel 101 for inserting the forceps for endoscope 1. It is inserted.

The endoscopic forceps 1 of this example is a medical device that is inserted into a body cavity through the forceps channel 101. In particular, the endoscopic forceps 1 of this example has a hemostatic function. Therefore, if this endoscopic forceps 1 is used, hemostasis can be performed without removing the forceps from the forceps channel 101 after the biological tissue is cut. That is, it is possible to treat biological tissue cutting and hemostasis after cutting almost simultaneously.

As shown in FIGS. 1 to 3, the endoscopic forceps 1 includes an insertion portion 10 to be inserted into the forceps channel 101 and an operation portion 4 connected to the rear end of the insertion portion 10.
The insertion part 10 has a double cross-sectional structure of an inner sheath that is the first insertion member 11 and an outer sheath that is the second insertion member 12. The inner sheath 11 is a cylindrical elongated tube made of a resin material. The outer sheath 12 is a thin, cylindrical, elongated tube made of a carbon composite material. The insertion portion 10 in which the inner sheath 11 is inserted and disposed with respect to the outer sheath 12 has flexibility.

As shown in FIGS. 1 and 2, a treatment portion 20 including a pair of forceps pieces 21 is integrally formed at the distal end of the inner sheath 11.

The outer sheath 12 is formed so that the inner sheath 11 and the treatment portion 20 can be inserted. The inner diameter of the outer sheath 12 is set larger than the outer diameter of the inner sheath 11 so that the outer sheath 12 can smoothly advance and retreat in an extrapolated state with respect to the inner sheath 11. According to the outer sheath 12 of this example made of a carbon composite material, it is easy to set a high load resistance in the compression direction, and an operation force for advancing in the axial direction relative to the inner sheath 11 can be efficiently transmitted. Furthermore, the outer sheath 12 of this example has a convex portion 121 that protrudes to the inner peripheral side on the inner peripheral surface that is a predetermined distance from the tip.

The annular member 30 is a component that is placed in the body cavity for hemostasis at the cut site. The annular member 30 is an annular component having elasticity made of a resin material. As shown in FIG. 4, the annular member 30 in a freely deformed state has a shape such that a circular ring is crushed sideways, and its inner peripheral shape has a slit shape. The annular member 30 extrapolated to the living tissue is elastically deformed so as to approach a circular shape, and is fixed to the living tissue with high certainty by an elastic restoring force for returning to the original shape.

As shown in FIG. 5, a drop-off preventing structure is formed on the inner peripheral surface of the annular member 30. The drop-off prevention structure of this example is a structure in which a plurality of protrusions 31 having a sharp shape in a certain direction like saw teeth are formed. In the annular member 30 inserted in the direction opposite to the certain direction (in the drawing direction, in the drawing), the protrusion 31 bites into the living tissue, and the effect of preventing the dropout is effectively exhibited.

In the endoscope forceps 1 in the unused state, as shown in FIGS. 1, 2, and 6, a T bar 251 for retracting the annular member 30 is engaged with the distal end surface of the annular member 30. The T bar 251 is connected to the operation unit 4 via an operation wire 252 inserted and disposed in the inner sheath 11. The T bar 251 is formed of a resin material having appropriate flexibility so that it can be bent. Note that an insertion hole (not shown) is drilled in the outer peripheral wall corresponding to the middle in the axial direction of the inner sheath 11. The operation wire 252 is taken out into the gap between the outer sheath 12 and the inner sheath 11 through the insertion hole.

As shown in FIGS. 1 and 2, the treatment unit 20 is a part that cuts a living tissue. Similar to the inner sheath 11, the treatment portion 20 of this example is made of a resin material and is integrally formed at the tip of the inner sheath 11. The treatment portion 20 is shaped such that a pair of forceps pieces 21 are connected via a connecting portion 23. The forceps piece 21 has a cup shape 215 that is obtained by vertically dividing a hollow cylindrical shape along the axial direction into two parts. The outer peripheral edge of the cup shape 215 in the forceps piece 21 forms a cutting tooth 210.

The connecting portion 23 has a shape that is obtained by bending a substantially rectangular flat plate. The forceps pieces 21 are connected so as to extend from the portions corresponding to both ends of the connecting portion 23. The distal end of the inner sheath 11 is coupled to the coupling portion 23. In the treatment portion 20 in the free deformation state, the pair of forceps pieces 21 are opened at an angle of about 90 degrees.

The connecting portion 23 made of a resin material can be elastically deformed so that the opening angle of the bent portion varies. If the opening angle of the bent portion is elastically deformed until it becomes substantially zero, the pair of forceps pieces 21 face each other with a substantially constant gap therebetween, and the gap is closed incompletely so that the living tissue can be grasped. Can be set (to be described later with reference to FIG. 11). The connecting portion 23 in the incompletely closed state can be further elastically deformed so as to bring the forceps pieces 21 closer to each other. Thus, according to the elastic deformation that causes the forceps pieces 21 to approach each other, a completely closed state in which the living tissue can be cut by the engagement of the cutting teeth 210 can be set (described later with reference to FIG. 13).

Of the outer peripheral surface of the distal end portion of the forceps piece 21, a convex portion 211 protruding toward the outer peripheral side in the radial direction is formed on a portion located in the opening / closing direction (vertical direction in FIG. 1). In addition, the connecting portion 23 is formed with a slope 232 that smoothly extends to the outer peripheral surface of the forceps piece 21 as the width corresponding to the opening and closing direction gradually approaches the forceps piece 21 side. The convex portion 211 is formed so as to come into contact with the inner peripheral surface when the outer sheath 12 advances to a predetermined position. The inclined surface 232 is formed so as to contact the convex portion 121 disposed on the inner peripheral surface of the outer sheath 12 when the convex portion 211 contacts the inner peripheral surface of the outer sheath 12. By pressing the convex portion 211 and the inclined surface 232 in the opening / closing direction, the pair of forceps pieces 21 can be brought close to each other and the completely closed state can be set.

As shown in FIGS. 3, 7, and 8, the operation unit 4 includes a substantially cylindrical shaft portion 41, and a bottomed substantially cylindrical slider that is extrapolated in a state in which the shaft portion 41 can advance and retreat in the axial direction. 42 and a biasing spring 43 that biases the slider 42 toward the forward side so as to push the slider 42 against the shaft portion 41. At the rear end of the shaft portion 41, an operation ring 410 on which an operator places a finger is extended.

The rear end of the inner sheath 11 is fixed to the shaft portion 41, while the rear end of the outer sheath 12 is fixed to the slider 42. By moving the slider 42 forward and backward with respect to the shaft portion 41, the outer sheath 12 can be advanced and retracted in the axial direction relative to the inner sheath 11. If the outer sheath 12 is retracted relative to the inner sheath 11, the treatment portion 20 can be projected to open the pair of forceps pieces 21. If the outer sheath 12 is advanced relative to the inner sheath 11, the treatment portion 20 can be accommodated in the outer sheath 12 and the pair of forceps pieces 21 can be closed.

The urging spring 43 is disposed in a compressed state in the gap between the bottom 427 of the slider 42 and the tip end surface 411 of the shaft portion 41. The biasing spring 43 is arranged in a state of being extrapolated to the inner sheath 11. The urging spring 43 urges the slider 42 forward with respect to the shaft portion 41. This urging force is a reaction force against the backward operation of the slider 42 that attempts to open the forceps piece 21. According to the urging spring 43, an appropriate operating force can be set when the forceps piece 21 is opened by the backward operation of the slider 42.

The rear end of the inner sheath 11 is fixed to a front end surface 411 that is opposite to the operation ring 410 in the end surface of the shaft portion 41. On the outer peripheral surface of the shaft portion 41, a groove 415 having a rectangular cross section extends along the axial direction. The groove 415 opens on the rear end surface 412 on the operation ring 410 side, but does not reach the opposite end surface 411, and the groove end 416 is positioned in front of the groove 415.

As shown in FIGS. 3, 7 and 8, a pair of two operation rings 420 are installed on the outer peripheral surface of the slider 42 so as to protrude on both sides in the radial direction. A through hole 426 for inserting the inner sheath 11 is formed in the bottom 427 of the slider 42. To the bottom 427, the rear end of the outer sheath 12 and the rear end of the operation wire 252 extending from the T bar 251 are fixed. As described above, the operation wire 252 is taken out to the outer peripheral side of the inner sheath 11 from an insertion hole (not shown) drilled in the outer peripheral surface of the inner sheath 11.

On the inner peripheral surface of the slider 42,

convex portions

421 and 422 that engage with the groove 415 of the shaft portion 41 are formed at two locations along the axial direction. The convex portion 421 is a convex portion that always engages with the groove portion 415 regardless of the advance / retreat position of the slider 42. The slider 42 is restricted from rotating relative to the shaft portion 41 in accordance with the engagement between the convex portion 421 and the groove 415. The convex portion 422 is a convex portion for separating from the groove 415 when the slider 42 is advanced with respect to the shaft portion 41 and positioned at the tip side of the shaft portion 41, and then restricting the slider 42 from retreating. is there.

The convex portion 422 is formed at the tip of a rectangular piece 423 that forms part of the outer peripheral wall of the slider 42. The rectangular piece 423 is a portion connected to the main body side of the slider 42 through only one side of the root like a diving plate. The rectangular piece 423 is separated from the surroundings by a substantially U-shaped slit 424 formed in the outer peripheral wall of the slider 42. The rectangular piece 423 can be rotated by elastic deformation around one side of the base located on the bottom 427 side. The convex portion 422 has a protruding shape formed by an inclined surface 422T located on the front end surface 411 side and a right-angle surface 422V located on the rear end surface 412 side.

The rectangular piece 423 is formed with a protruding portion 425 that protrudes in a dome shape toward the inner peripheral side, similar to the protruding portion 422. The protruding portion 425 is arranged closer to the base side of the rectangular piece 423 than the convex portion 422. The position where the protruding portion 425 engages with the groove end 416 is the urging position of the slider 42 by the urging spring 43. The urging spring 43 is set so as to urge the slider 42 until the protruding portion 425 reaches the groove end 416 in an unused state, and to generate an urging force such that the protruding portion 425 does not exceed the groove end 416.

Here, the relationship between the position of the protrusion part 425 or the convex part 422 and the state of the treatment part 20 will be described.
The state in which the protrusion 425 is positioned at the groove end 416 as shown in FIG. 8 corresponds to the unused state shown in FIGS. 1, 2, and 6. In the treatment portion 20 in the unused state, the distal end surface of the outer sheath 12 is located deeper on the retreat side by the width of the annular member 30 than the convex portion 211. Further, in this unused state, as described above, the T bar 251 connected to the distal end of the operation wire 252 is locked to the distal end surface of the annular member 30.

The state where the convex portion 422 is positioned at the groove end 416 (FIG. 12) corresponds to a state where the living tissue is incompletely closed to the extent that the living tissue can be grasped, as will be described later with reference to FIG.
The state in which the convex portion 422 is positioned on the distal end side of the shaft portion 41 beyond the groove end 416 (FIG. 14) corresponds to a state in which the living tissue is completely closed to the extent that it can be cut as described later with reference to FIG. is doing.

Next, a method of using the endoscope forceps 1 configured as described above will be described. As shown in FIGS. 1, 2, and 6, the unused endoscope forceps 1 can be inserted into a body cavity through the forceps channel 101 of the endoscope 100.
After the treatment portion 20 of the endoscopic forceps 1 is brought close to the biological tissue to be cut, the operation portion 4 is operated so as to retract the slider 42 with respect to the shaft portion 41. The relative position between the slider 42 and the shaft portion 41 in the unoperated state is such that the convex portion 422 is accommodated in the groove 415 as shown in FIG. Since the projecting portion 422 can be retracted along the groove 415, the retracting of the slider 42 with respect to the shaft portion 41 is allowed.

The slider 42 is connected to the rear end of the outer sheath 12 and the operation wire 252. Therefore, if the slider 42 is retracted as described above, the outer sheath 12 and the operation wire 252 can be retracted with respect to the inner sheath 11. If the operation wire 252 is retracted, the annular member 30 can be retracted by the T bar 251 connected to the tip.

If the annular member 30 and the outer sheath 12 are retracted according to the retreat operation of the slider 42, the pair of forceps pieces 21 can be protruded. The pair of forceps pieces 21 protruding from the annular member 30 and the outer sheath 12 are opened according to the free deformation of the connecting portion 23 as shown in FIGS. On the other hand, the T bar 251 is accommodated so as to be bent and deformed and dragged into the inner sheath 11. Thereby, the locking relationship between the annular member 30 and the T bar is released.

The slider 42 is advanced with respect to the shaft portion 41 in a state where the living tissue is positioned in the gap between the pair of forceps pieces 21. Accordingly, the outer sheath 12 can be advanced relative to the inner sheath 11 and the forceps piece 21 can be closed. If the outer sheath 12 is advanced to the front of the convex portion 211, as shown in FIG. 11, the pair of forceps pieces 21 returns to the incompletely closed state. In the incompletely closed state, the living tissue can be grasped with high reliability by the pair of forceps pieces 21. At this time, in the operation part 4, as shown in FIG. 12, the convex part 422 contacts the groove end 416, and an axial reaction force is generated. The operator of the operation unit 4 can grasp with high certainty that the incompletely closed state is set according to the reaction force in the axial direction.

Note that, unlike the outer sheath 12, the operation wire 252 does not have axial rigidity. Therefore, the operation wire 252 sags as the slider 42 advances with respect to the shaft portion 41. The T bar 251 connected to the distal end of the operation wire 252 is left as it is inside the inner sheath 11.

When the incompletely closed state is reached, the annular member 30 is positioned on the outer periphery of the living tissue grasped by the forceps piece 21. If the slider 42 is further advanced, the outer sheath 12 can be advanced beyond the convex portion 211. In the endoscopic forceps 1 of this example, as shown in FIG. 13, the convex portion 121 comes into contact with the inclined surface 232 of the treatment portion 20 at the same time as the distal end of the outer sheath 12 gets over the convex portion 211. Yes. At this time, a contact load that acts on the convex portion 211 from the inner peripheral surface of the outer sheath 12 and a contact load that acts on the slope 232 from the convex portion 121 are generated. These contact loads act as a force for bringing the pair of forceps pieces 21 closer to each other. With these forces, the pair of forceps pieces 21 are completely closed, and the living tissue is cut.

At this time, as shown in FIG. 14, the operation unit 4 is in a state in which the convex portion 422 has moved forward over the groove end 416. In this state, since the right-angle surface 422V of the convex portion 422 is engaged with the tip surface 411 of the shaft portion 41, the retreat of the slider 42 is restricted. The state in which the pair of forceps pieces 21 are completely closed is firmly maintained, and the cut biological tissue can be held with high reliability.

As shown in FIG. 15, the separated annular member 30 is extrapolated to the living tissue corresponding to the root portion of the cut living tissue. The living tissue that hits the root portion is bound by the annular member 30. On the inner peripheral surface of the annular member 30, a drop-off preventing structure including the protrusion 31 (FIG. 5) is formed as described above. The protrusion 31 bites into the living tissue, and the annular member 30 can be fixed with high reliability.

Furthermore, the inner peripheral shape of the annular member 30 in a state where the root portion is tightly bound is close to a circular shape with respect to the slit-shaped inner peripheral shape (FIG. 4) in a freely deformed state. At this time, an elastic force is generated in the annular member 30 to return to the original shape. In addition, an elastic force is generated to return the bound biological tissue to its original state. The elastic force of the annular member 30 and the elastic force of the biological tissue work effectively because the annular member 30 is firmly fixed to the biological tissue.

The endoscopic forceps 1 accommodates a living tissue in a cup shape 215 inside a pair of forceps pieces 21. If the insertion part 10 of the forceps 1 for endoscope is extracted from the forceps channel 101, the cut biological tissue can be collected. On the other hand, the annular member 30 is firmly fixed to the cut portion in the body cavity as described above. Therefore, bleeding from the cut surface of the living tissue can be suppressed with high certainty.

As described above, the endoscopic forceps 1 of this example is an endoscopic forceps having a hemostatic function. If this endoscopic forceps 1 is used, cutting of a living tissue and hemostasis and hemostasis can be performed almost simultaneously, so that bleeding and the like can be suppressed to a minimum and the burden on the human body side can be suppressed. Furthermore, since it is not necessary to quickly remove the endoscopic forceps 1 from the forceps channel 101 after cutting the living tissue and immediately insert the hemostatic clip for endoscope to stop the hemostasis, it is possible to suppress the burden on the treatment side.

In addition, it can replace with this example and can also mark using the annular member 30. FIG. Similarly to this example, it is not necessary to quickly remove the endoscopic forceps 1 from the forceps channel 101 after cutting the living tissue and immediately insert another instrument to perform marking, so that the burden on the treatment side can be suppressed.

Next, the mechanical superiority of the endoscopic forceps 1 of this example will be described in comparison with the conventional endoscopic forceps 9 with reference to FIG. In the conventional endoscopic forceps 9, a fulcrum is set on the pin 910, an action point is set on the tip of the forceps piece 93, and a force point is set on the arm portion 931. Due to the demand for a smaller diameter, it is difficult to ensure a long length between the pin 910 and the arm portion 931, and in general, there is a tendency to be shorter than the length between the forceps piece 93 and the pin 910. Therefore, it is necessary to apply a force larger than that required for the forceps piece 93 to the arm portion 931. In the conventional endoscopic forceps 9, the load acting on the engagement structure between the operation wire 252 and the arm portion 931, the pin 910 that is a fulcrum, and the like is increased, causing a mechanical trouble.

On the other hand, in the endoscopic forceps 1 of this example, the positional relationship among the force point set at the convex portion 211, the action point set at the tip of the forceps piece 21, and the fulcrum set at the connecting portion 23 is the same as in the conventional endoscope. It is completely different from the forceps for mirrors. That is, in the endoscopic forceps 1 of this example, the force point and the action point are arranged on the same side with respect to the fulcrum and at substantially the same position. Therefore, the force acting on the force point can be directly transmitted to the action point. Unlike the conventional case, since there is no possibility that an excessive load acts on the fulcrum or the like, the possibility of causing a mechanical trouble is extremely reduced.

In this example, the annular member 30 in which the inner peripheral shape in the free deformation state exhibits a linear slit shape is employed. However, as shown in FIG. 17, the annular member 30 in which the inner peripheral shape in the free deformation state exhibits a cross shape is used. It can also be adopted. Moreover, as shown in FIG. 18, the annular member 30 provided with the side wall which exhibits the mesh structure like knitting is also employable. In general, the mesh structure is an effective structure for ensuring strength. If the annular member 30 has a mesh structure, it is possible to secure the strength that can withstand the pushing force when extrapolated into the living tissue while suppressing dimensions such as thickness.

As the material of the annular member 30, various materials such as elastic stainless steel, shape memory alloy, shape memory resin, and biodegradable resin can be adopted. In particular, when an annular member made of a shape memory alloy or a shape memory resin is employed, a configuration for heating the forceps piece 21 is preferably provided. In this case, the shape memory effect can be exhibited by heating the annular member with the forceps piece 21. If the protrusion 31 is configured to stand on the inner peripheral side due to the shape memory effect, the effect of the drop-off prevention mechanism is further enhanced.
Further, the annular member 30 may be formed of a biodegradable resin. Since it is decomposed in nature after being discharged from the body, the impact on the environment can be suppressed.

A metal ring may be disposed at the tip of the outer sheath 12. In this case, the strength of the distal end portion of the outer sheath 12 can be secured high. If the strength of the outer sheath 12 is ensured, a force can be applied to the forceps piece 21 more efficiently.

This example is an example in which the treatment portion 20 is integrally formed at the tip of the inner sheath 11. Instead of this, the treatment portion may be formed separately from the inner sheath 11. As a method for fixing a separate treatment portion to the distal end of the inner sheath, for example, there are a method for fixing via a support pin or the like, a method for bonding, and the like. As a method of joining, there are various methods such as adhesive joining, welding joining, caulking joining, and fitting.

Further, this example is an example in which the outer sheath 12 advances in accordance with the pushing operation of the slider 42 with respect to the shaft portion 41, that is, the advancement of the slider 42 with respect to the shaft portion 41. Instead of this, the outer sheath 12 may be configured to advance in accordance with the pushing operation of the shaft portion 41 with respect to the slider 42, that is, with the advancement of the shaft portion 41 with respect to the slider 42. If the outer sheath 12 and the rear end of the operation wire 252 are connected to the shaft portion 41 and the rear end of the inner sheath 11 is connected to the slider 42, the outer sheath 12 is moved according to the pushing operation of the shaft portion 41 as described above. The annular member 30 can be pushed out and separated by being advanced.

In addition, as shown in FIG. 19, the groove 120 may be disposed opposite to the inner peripheral surface of the outer sheath 12. The groove 120 extends along the axial direction and opens at the distal end surface of the outer sheath 12. In this case, by rotating the outer sheath 12 by 90 degrees relative to the inner sheath 11, the circumferential position of the groove 120 can be matched with the convex portion 211 of the forceps piece 21, and the convex portion 121 of the outer sheath 12 can be It can be located on both sides of the connecting portion 23. In this state, when the outer sheath 12 is advanced in the axial direction relative to the inner sheath 11, the incompletely closed state is only realized. The annular member 30 can be pushed out and separated while picking up without cutting the living tissue. It can be applied to treatments such as hemostasis and marking of a living body site where bleeding has occurred like a hemostatic forceps.

An endoscopic forceps in which the convex portion 211 of the forceps piece 21 and the convex portion 121 of the outer sheath 12 are omitted and the right-angle surface 422V of the convex portion 422 of the slider 42 is changed to an inclined surface is also useful. This endoscopic forceps is an instrument in which the cutting function is omitted from the endoscopic forceps of the present invention. In this endoscopic forceps, the living tissue is picked up by the pair of forceps pieces 41 by advancing the outer sheath 12 in the axial direction relative to the inner sheath 11 by the advancement of the slider 42 relative to the shaft portion 41. The annular member 30 can be moved without being cut. Furthermore, if the inclined surface is a divergent slope instead of the right-angled surface 422V, the slider 42 is allowed to move backward with respect to the shaft portion 41, and the pinched biological tissue can be released. Such endoscopic forceps are useful for procedures such as hemostasis and marking.

Although specific examples of the present invention have been described in detail as in the first embodiment, these specific examples merely disclose an example of the technology included in the scope of the claims. Needless to say, the scope of the claims should not be construed as limited by the configuration, numerical values, or the like of the specific examples. The scope of the claims includes techniques obtained by variously modifying or changing the above specific examples using known techniques, knowledge of those skilled in the art, and the like.

DESCRIPTION OF SYMBOLS 1 Endoscopic forceps 10 Insertion part 100 Endoscope 101 Forceps channel 11 1st insertion member, inner sheath 12 2nd insertion member, outer sheath 20 Treatment part 21 Forceps piece 211 Convex part 23 Connection part 232 Slope 251 T Bar 252 Operation wire 30 Annular member 31 Protrusion 4 Operation part 41 Shaft part 415 Groove 416 Groove end 43 Energizing spring 42

Slider

421, 422 Protrusion part 425 Projection part

Claims

A slender body having a flexible double-section structure composed of a first insertion member located on the inner peripheral side and a cylindrical second insertion member that can advance and retreat relative to the first insertion member in the axial direction. An insertion part;
A pair of forceps pieces held on the distal end side of the first insertion member;
An operation unit coupled to the rear end side of the first and second insertion members;
The first insertion member and the pair of forceps pieces can be extrapolated and moved forward in the axial direction in accordance with the advancement of the second insertion member facing the first insertion member. An annular member configured to be separable by being pushed to the distal end side through a state of being extrapolated to the forceps piece,
The second insertion member is capable of advancing and retreating in the axial direction relative to the first insertion member between a position where the pair of forceps pieces is accommodated and a position where the second insertion member protrudes toward the distal end side.
While the pair of forceps pieces are in an open state in a free deformation state, the pair of forceps pieces are deformed according to a force acting from the second insertion member side when housed on the inner peripheral side of the second insertion member. Closed,
In addition, until the annular member is separated, it is possible to set only an incompletely closed state in which the living tissue is grasped without being cut, while the second member is separated to the position where the annular member is separated. An endoscopic forceps configured to set a state in which the insertion member is completely closed to an extent that allows cutting of a living tissue when the insertion member advances in the axial direction.
2. The pair of forceps pieces according to claim 1, wherein the pair of forceps pieces are connected to each other via an elastically deformable connecting portion, and the incompletely closed state according to the elastic deformation of the connecting portion and An endoscopic forceps characterized in that the completely closed state can be set.
3. The endoscope forceps according to claim 2, wherein the pair of forceps pieces, the connecting portion, and the first insertion member are integrally formed.
4. The projection of claim 1, wherein at least one of the pair of forceps pieces has a protruding portion that protrudes toward a radially outer peripheral side. The forceps piece is configured so that the completely closed state is set according to the contact load acting on the convex portion from the inner peripheral surface of the second insertion member. Mirror forceps.
5. The annular member according to claim 1, wherein the annular member has elasticity, and an inner peripheral cross-sectional area in a freely deformed state is smaller than an inner peripheral cross-sectional area in an extrapolated state with respect to the pair of forceps pieces. An endoscopic forceps characterized by the above.
The endoscopic forceps according to any one of claims 1 to 5, wherein a drop-off preventing structure is formed on the inner peripheral surface of the annular member for preventing the drop-off from the living tissue. .