JP4512724B2 - Endoscopic treatment tool - Google Patents

Description

  The present invention relates to an endoscope treatment tool.

Many endoscope treatment tools are configured such that the distal treatment member protrudes from the distal end portion of the flexible sheath. For example, an endoscopic clip device, an endoscopic high-frequency snare device, an endoscopic high-frequency knife (wire type), and the like. In such an endoscopic treatment tool, the distal end of an operation wire that is slidable in the axial direction in the flexible sheath is connected to the distal treatment member, and the proximal end side of the flexible sheath is connected to the distal end of the flexible sheath. In the arranged operation portion, the distal treatment member protrudes from the distal end portion of the flexible sheath by sliding the manipulation wire in the axial direction with respect to the flexible sheath (for example, a patent) References 1, 2).
Japanese Utility Model Publication No.7-1905 Japanese Patent Publication No. 3-13898

  As an operation wire for an endoscope treatment instrument as described above, generally a plurality of ultrafine stainless steel wires are twisted to form an outer diameter of about 0.3 to 0.5 mm and a length of about 1 to 1.5 m. As the flexible sheath through which such an operation wire is passed, a flexible tube made of a fluororesin is often used. However, since such an operation wire and a flexible sheath both have a certain degree of flexibility in the length direction, even if the length of the operation wire and the flexible sheath are intended to be accurately incorporated during manufacture, The length relationship may become inaccurate. In addition, even if manufactured with the correct length, repeated use may cause expansion and contraction of each of the operation wire and the flexible sheath, resulting in a deviation in the relative length relationship. .

  And, if a deviation occurs in the relative length relationship between the operation wire and the flexible sheath, the positional relationship between the distal treatment member connected to the distal end of the operation wire and the distal end portion of the flexible sheath becomes out of order. Even if the operation wire is advanced and retracted to the maximum on the operation unit side, the distal treatment member does not sufficiently protrude from the distal end portion of the flexible sheath, or conversely, the distal treatment member cannot be sufficiently retracted into the flexible sheath. In the case of an endoscopic clip device, the clip, which is a distal treatment member, cannot be fully opened, or the clip becomes rattled at the distal end of the flexible sheath and the posture becomes unstable. Inconvenience occurred.

  The present invention has been made to solve such problems, and the user of the endoscopic treatment tool can arbitrarily set the relative length relationship between the operation wire and the flexible sheath as necessary. An object of the present invention is to provide an endoscopic treatment tool that can be adjusted.

The present invention includes a flexible sheath that is passed through the treatment instrument guide tube of the endoscope, and the distal end treatment member to project and retract from the distal end portion of the flexible sheath, the distal end coupled to the distal end treatment member flexible An operation wire passed through the sheath in an axially slidable manner, a first operation member connected to the proximal end of the flexible sheath, a second operation member connected to the proximal end of the operation wire , An outer tube that is slidable in the axial direction from the proximal end side of the first operating member and is loosely fitted to the flexible sheath, and the first operating member and the second operating member are connected to the flexible sheath. and by a Turkey are relatively moved in the axial direction of the operation wire, and project and retract the tip end treating member from the distal end portion of the flexible sheath, cannula is, in a state in which the flexible distal sheath is retracted to the rear When the tip treatment member is expanded and positioned within the flexible sheath, the tip treatment member is closed. The instrument for an endoscope configured to so that,
A position in which the movement of the second operating member relative to the first operating member is temporarily stopped at a predetermined neutral position, and the first operating member is pulled backward from the neutral position with respect to the second operating member; A position setting means for setting the second operating member and a position to draw the first operating member from, a connecting position of the proximal end of the flexible sheath with respect to the first operating member, and an operating wire for the second operating member characterized by providing the connecting position adjusting means which can be set to any one of the connecting position of the base end in the axial direction.

According to the present invention, in the endoscope treatment tool having the above characteristics, the position setting means includes a first slide cylinder coupled to the first operation member, and a first slide cylinder fitted to the first slide cylinder. The second slide cylinder, the compression spring that biases the elastic force in the direction of extending the distance between the first and second slide cylinders, and the movement of the second operation member relative to the first operation member at a predetermined neutral position. It is composed of a protrusion for temporarily stopping, and the connection position adjusting means is flexible so as to be screwed with the operation portion side screw portion formed on the first or second operation member and the operation portion side screw portion. A movable screw portion formed on the sheath or the operation wire, and the movement of the first operation member and the second operation member is stopped at the neutral position by the position setting means with respect to the operation portion side screw portion. The movable screw part around the axis By rotating, characterized in that the connecting position of the flexible sheath or operating wires with respect to the first operating member or the second operating member displaceably constructed in the axial direction.

  According to the endoscope treatment tool of the present invention, one of the connection position of the proximal end of the flexible sheath with respect to the first operation member and the connection position of the proximal end of the operation wire with respect to the second operation member is set in the axial direction. By providing the displaceable connecting position adjusting means, the user of the endoscopic treatment tool arbitrarily adjusts the relative length relationship between the operation wire and the flexible sheath as necessary. The treatment member can be used in an optimum state at the distal end portion of the flexible sheath.

Embodiments of the present invention will be specifically described below with reference to the drawings.
FIG. 1 is a plan sectional view of a distal end portion of an endoscope clip device to which the present invention is applied, and FIG. 2 is a side sectional view thereof (however, most of the portions other than the finger hooks 11 and 12 are the same section as the plan sectional view). In any case, the clip 1 is not attached. The clip 1 placed in a state where a living tissue is picked to perform hemostasis or the like is formed by bending a member having a spring property such as a stainless steel plate for a spring by pressing or the like, and a rear end thereof is formed. It is bent back into a substantially U-shaped half-loop shape, and is formed in a shape that expands forward from the middle portion when no external force is applied. Note that the clip 1 may have other shapes (for example, a shape in which the rear end portion is bent in an α shape or the like), and the clip 1 may be formed of a spring wire or the like.

  Reference numeral 2 denotes a clip closing ring for closing the clip 1 and forcibly maintaining the closed state. The clip closing ring 2 is formed in a cylindrical shape by a rigid body such as a stainless pipe material or a hard plastic. The clip 1 is attached so as to surround a portion slightly rearward from the intermediate portion, and the clip 1 is closed by moving the clip closing ring 2 in a direction approaching the distal end side of the clip 1.

  Reference numeral 3 denotes a flexible sheath for pushing the clip closing ring 2 toward the distal end of the clip 1 in order to force the clip 1 into a closed state. A flexible operation wire 4 made of, for example, a stainless steel wire or a coil, which is detachably connected, is loosely inserted over the entire length so as to be slidable in the axial direction. As the operation wire 4, for example, a twisted wire formed by twisting a plurality of ultrafine stainless steel wires and having an outer diameter of about 0.5 to 1 mm and a length of about 1.5 to 2 m is used.

  The flexible sheath 3 is formed of a flexible tube made of a synthetic resin such as a fluororesin tube or a PEEK (polyether ether ketone) resin. However, it may be formed by a coil pipe or the like in which a stainless fine wire is tightly wound. The most distal portion of the flexible sheath 3 is formed of a rigid body such as a sunless pipe material or a hard plastic material, but the detailed illustration thereof is omitted. As will be described later, the flexible sheath 3 Since the front end surface of 3 abuts on the rear end surface of the clip closing ring 2, the clip closing ring 2 can be pushed forward.

  A clip connecting member 4A that is detachable from the rear end of the clip 1 is connected to the tip of the operation wire 4 by a connecting ring 4B. The clip connecting member 4A is formed of a material having a spring property. When no external force is applied, the clip connecting member 4A expands forward as shown in FIG. And as shown in FIG. 2 etc., it is elastically deformed into a constricted state.

  Reference numeral 5 denotes an outer tube that comes into contact with the treatment instrument guide tube when being inserted into and removed from the treatment instrument guide tube of the endoscope, and is formed of, for example, a flexible fluororesin tube or the like, and is a flexible sheath. 3 is loosely fitted. Then, as shown in FIG. 8, when the outer tube 5 is pushed forward and covered with the clip 1, the clip 1 is elastically deformed in a closed state, and when the outer tube 5 is retracted rearward, FIG. 7. As shown, the clip 1 returns to its original expanded state.

  Returning to FIG. 1 and FIG. 2, the flexible sheath 3, the operation wire 4, and the outer tube 5 are slidably operated in the axial direction from the proximal end side. The base end portions of the operation wire 4 and the outer tube 5 are connected to the operation unit 10. The operation unit 10 is provided with a first finger hook 11 for engaging the operator's first finger and a second finger hook 12 for engaging the operator's second and third fingers. ing. The planar shape is illustrated in FIG. 1 and the like, but any shape may be used.

Reference numeral 13 denotes an elongated cylindrical operation unit main body having both ends opened, and a cylindrical sheath operation tube 14 formed integrally with the first finger hook 11 is slidable in the axial direction with respect to the operation unit main body 13. The operation unit main body 13 is fitted on the outer peripheral surface. However, a structure in which the sheath operation tube 14 is fitted to the inner peripheral surface of the operation unit main body 13 may be adopted.
The second finger hook 12 is slidably disposed along the outer peripheral surface of the sheath operation tube 14, and as shown in FIG. 2, the second finger hook 12 is connected to the rear end portion of the operation portion main body 13 (in each figure). It is connected by a connecting screw 15 in the vicinity of the upper end) and operates integrally. As shown in FIGS. 2 and 3, the sheath operating tube 14 is formed with a slit 16 that is elongated in the axial direction so that the connecting screw 15 can be freely slid in a lightly springed state. Has been.

  1 and 2, the proximal end of the operation wire 4 is connected to the central axis position of the operation wire mounting plate 18 integrally fixed to the rear end portion of the operation unit main body 13, and the operation unit body 13 is operated. The base end of the operation wire 4 is connected to the second finger hook 12 through the part main body 13. The vicinity of the proximal end of the operation wire 4 is reinforced by being fitted with a reinforcing pipe 4p for preventing hip breakage.

  At the proximal end of the outer tube 5, a cylindrical outer tube proximal end cap 20 whose rear end side is open is disposed so as to be fitted on the outer periphery of the operation portion main body 13. The outer tube base end cap 20 is locked by the locking mechanism 21 so that it cannot move in the axial direction relative to the operation portion main body 13 (that is, with respect to the second finger hook 12) in a normal state. . In other words, the proximal end of the operation wire 4 and the proximal end of the outer tube 5 are locked by the locking mechanism 21 so as not to move relative to each other in the axial direction. When the finger hook 11 is slid, the proximal end of the flexible sheath 3 moves forward and backward with respect to the proximal end of the operation wire 4 and the proximal end of the outer tube 5.

  A pair of circumferential grooves 22A and 22B are formed on the outer peripheral surface of the operation portion main body 13 with a space therebetween, and the distal end portion of the locking mechanism 21 urged by the coil spring 21s is the rear circumferential groove. The outer tube proximal end cap 20 is fixed to the operation portion main body 13 by engaging with 22B. Then, when the locking mechanism 21 is picked with a fingertip and pulled against the urging force of the coil spring 21s, the engagement of the locking mechanism 21 with respect to the circumferential grooves 22A and 22B is released. The outer tube 5 can be moved in the axial direction with respect to the flexible sheath 3 and the operation wire 4 by moving forward and backward in the axial direction with respect to the main body 13.

  Reference numeral 24 denotes a compression coil spring interposed between the rear end of the operation unit main body 13 and the first finger hook 11, and a pair of cylindrical slide cylinders 25 whose maximum axial length is regulated to be constant. It is mounted in a state where it is always compressed between both ends of 26. As a result, when the sheath operating tube 14 moves in the axial direction with respect to the operating portion main body 13 and shifts to the state in which the compression coil spring 24 is compressed, the change position greatly increases the operating resistance in the hand of the operator. The movement of the sheath operating tube 14 with respect to the operation portion main body 13 (that is, the movement of the first finger hook 11 with respect to the second finger hook 12) temporarily stops there. This position is called the neutral position. As shown in FIG. 1, in this state (neutral state), the clip connecting member 4A attached to the distal end of the operation wire 4 is slightly inward from the distal end of the flexible sheath 3, and the first The finger rest 11 and the second finger rest 12 can be relatively advanced and retracted in both the front and rear directions of the neutral state. Reference numerals 27 shown in FIG. 1 and FIG. 3 are click protrusions that are formed in two points on the outer peripheral surface of the sheath operation tube 14 at, for example, two 180 ° symmetrical positions. The sheath operation tube 14 is moved from the neutral state to the operation portion. When moving in the opposite direction to compressing the compression coil spring 24 relative to the main body 13, the second finger hook 12 gets over the click protrusion 27 with some elastic deformation, which is in the hand of the operator. It is felt as a change in operation resistance, and the operator can reliably detect the neutral position.

  Reference numeral 30 denotes a sheath connecting member made of a rigid pipe-like material for connecting the proximal end of the flexible sheath 3 and the first finger hook 11, and in order to avoid interference with the operation wire mounting plate 18 at the intermediate portion. The cylindrical body is formed in a bowl shape with a part of the cross section thereof being cut out, and the portion passes loosely through a semicircular arc-shaped passage hole 18 h formed in the operation wire mounting plate 18. A female screw cylinder 31 (connection position adjusting means) having a female screw formed on the inner peripheral surface is integrally formed at the most distal end portion of the sheath connecting member 30, and a male screw screwed with the female screw cylinder 31 is provided on the outer periphery. A male screw cylinder 32 (connection position adjusting means) formed on the surface is connected and fixed to the proximal end of the flexible sheath 3. As a result, as shown in FIGS. 4 and 5, by holding the first finger hook 11 or the sheath operating tube 14 or the like and rotating the flexible sheath 3 around the axis, a male screw for the female screw tube 31 is obtained. The axial position of the cylinder 32 moves. As a result, the connecting position of the proximal end of the flexible sheath 3 with respect to the first finger hook 11 and the sheath operation tube 14 is displaced in the axial direction, and the distal position of the flexible sheath 3 relative to the distal position of the operation wire 4 (that is, The length of the flexible sheath 3 with respect to the operation wire 4 is changed, and the position of the clip connecting member 4A with respect to the distal end of the flexible sheath 3 can be arbitrarily adjusted as necessary.

  When using the endoscope clip device of the embodiment configured as described above, first, as shown in FIG. 6, an operation of pulling the first finger hook 11 backward with respect to the second finger hook 12 is performed. Then, the distal end of the flexible sheath 3 is retracted, and the rear end of the clip 1 is engaged with the clip connecting member 4A that protrudes from the distal end of the flexible sheath 3 and opens by its own elasticity, as shown in FIG. As described above, when the position is returned to the original neutral state where the position is determined by the compression coil spring 24 and the click protrusion 27, the foremost portion of the flexible sheath 3 is engaged with the rear end portion of the clip closing ring 2 and opened. The clip 1 in the state is held at the tip of the flexible sheath 3.

  At this time, if the positional relationship of the clip connecting member 4A with respect to the distal end of the flexible sheath 3 is slightly out of order and the length of the flexible sheath 3 is too long, the clip 1 is placed in the clip closing ring 2. When the length of the flexible sheath 3 is relatively short, the clip closing ring 2 is engaged with the distal end portion of the flexible sheath 3. As a result, the clip 1 becomes loose and swings at the tip of the flexible sheath 3. Therefore, as described with reference to FIGS. 4 and 5, the flexible sheath 3 is rotated around the axis to adjust the relative length of the flexible sheath 3 to the operation wire 4 to the most preferable state. .

  When the clip 1 is adjusted to a state in which the clip 1 is fully opened and held in a stable state at the distal end of the flexible sheath 3 as shown in FIG. The mantle tube base end cap 20 is moved forward so as to engage with 22A so that the mantle tube 5 covers the clip 1 and the clip 1 is elastically deformed in the mantle tube 5 to be in a narrowed state. In this state, it is passed through a treatment instrument guide tube of an endoscope (not shown). When the clip 1 is positioned in the body, the outer tube base end cap 20 is returned to the original state so that the distal end of the outer tube 5 is retracted rearward, and the clip 1 is opened as shown in FIG. After returning to the state and guiding the clip 1 to a position where the affected part is sandwiched, an operation of pushing in the first finger hook 11 is performed as shown in FIG.

  Then, the compression coil spring 24 is compressed from the neutral state, and the pair of slide cylinders 25 and 26 are shortened to partially overlap each other, and the distal end of the flexible sheath 3 is pushed forward with respect to the clip connecting member 4A. Therefore, the clip closing ring 2 is pushed forward to a position closer to the front of the clip 1 so that the clip 1 is forcibly closed, and the bleeding part of the mucous membrane can be clipped. Therefore, the first finger hook 11 is returned to the neutral state. At this time, the compression coil spring 24 acts as a return spring. Then, as shown in FIG. 10, when the operation of pulling the first finger hook 11 further back from the neutral state is performed, the clip connecting member 4 </ b> A pops out from the distal end of the flexible sheath 3 and is opened by its own elasticity. Therefore, the clip 1 can be left in the body by disengaging the clip 1 from the clip connecting member 4A.

  FIG. 11 shows a second embodiment in which the present invention is applied to an endoscopic clip device. The flexible sheath 3 of this embodiment has a sheath operating tube 14 in which a first finger hook 11 is formed. Are fixedly connected to each other via a sheath connecting member 30. Then, a male screw is formed on the outer peripheral surface of the operation wire mounting plate 18 connected to the base end of the operation wire 4 through the reinforcing pipe 4p, and the female screw that is screwed with the male screw is the rear end of the operation unit main body 13. It is formed on the inner peripheral surface in the vicinity. With this configuration, the length of the flexible sheath 3 cannot be adjusted, but the tip position of the operation wire 4 with respect to the tip position of the flexible sheath 3 (that is, the length of the operation wire 4 with respect to the flexible sheath 3). Can be adjusted relative to each other, so that the same effect as the first embodiment can be obtained.

  FIG. 12 shows a third embodiment of the present invention, which is an example in which the present invention is applied to a high-frequency snare for an endoscope. A conductive operation wire 4 is passed through a flexible sheath 3 made of an electrically insulating flexible tube, and a snare loop 101 connected to the tip of the operation wire 4 is a tip of the flexible sheath 3. By going in and out, it expands and contracts with its own elasticity. However, when the positional relationship in the axial direction of the snare loop 101 with respect to the flexible sheath 3 is not appropriate, the snare loop 101 does not sufficiently protrude from the flexible sheath 3, so that the bulge becomes insufficient, or conversely Since the snare loop 101 is not sufficiently drawn into the flexible sheath 3, the tightening of the body tissue becomes insufficient.

  Therefore, in this embodiment, the male screw cylinder 132 is formed on the sheath base end cap 130 integrally connected to the base end of the flexible sheath 3, and the female screw cylinder 131 screwed with the male screw cylinder 132 is provided. A first finger hook 11 is formed at the distal end portion of the operation portion main body 103 formed at the rear end portion. The proximal end of the operation wire 4 is fixedly connected to a second finger hook 12 that is slidably attached to the operation unit main body 103. By comprising in this way, the length of the flexible sheath 3 with respect to the operation wire 4 can be adjusted arbitrarily arbitrarily, and the snare loop 101 can be in the optimal expansion / contraction state. Reference numeral 150 denotes a lock screw for fixing the adjusted state.

  FIG. 13 shows a fourth embodiment of the present invention, which is a second example in which the present invention is applied to an endoscope high-frequency snare. In this embodiment, a male screw cylinder 232 is formed at the most distal end portion of the operation section main body 103, and a female screw cylinder 231 screwed into the male screw cylinder 232 is integrally connected to the proximal end of the flexible sheath 3. The length of the flexible sheath 3 can be adjusted by forming the rotary knob 200. Further, a wide circumferential groove 251 with which the distal end of the lock screw 150 is loosely engaged is formed on the outer peripheral surface of the operation unit main body 103 to restrict the maximum adjustment range. The operational effects are the same as in the third embodiment.

  FIG. 14 shows a distal end portion of a high-frequency endoscope knife (wire type) suitable for application of the present invention, and a conductive operation wire passed through an electrically insulating flexible sheath 3. 4 is exposed to the outside of the flexible sheath 3 between a pair of holes formed in the side surface of the flexible sheath 3 at intervals in the longitudinal direction, and the exposed portion becomes the tip electrode 201. ing. Then, when the operation wire 4 is pulled from the operation unit side (not shown), the flexible sheath 3 is elastically deformed in a warped state as shown by a two-dot chain line in FIG. When the operation wire 4 is pushed in, the tip electrode 201 is swelled. In addition to such a high-frequency knife (wire type) for an endoscope, the present invention is applicable to an endoscopic basket-type gripping tool, an endoscopic curette forceps that is bent by a pulling operation, or various treatment tools with bending. Can be widely applied.

1 is a plan sectional view of an endoscope clip device according to a first embodiment of the present invention. The side sectional view of the clip device for endoscopes of the 1st example of the present invention. The partial top view of the operation part of the clip apparatus for endoscopes of the 1st Example of this invention. FIG. 3 is a plan sectional view showing an operation of adjusting the length of the flexible sheath of the endoscope clip device according to the first embodiment of the present invention. FIG. 3 is a plan sectional view showing an operation of adjusting the length of the flexible sheath of the endoscope clip device according to the first embodiment of the present invention. Side surface sectional drawing which shows the use condition of the clip apparatus for endoscopes of 1st Example of this invention in order. BRIEF DESCRIPTION OF THE DRAWINGS The plane sectional views which show the use condition of the clip device for endoscopes of the 1st example of the present invention in order. Side surface sectional drawing which shows the use condition of the clip apparatus for endoscopes of 1st Example of this invention in order. Side surface sectional drawing which shows the use condition of the clip apparatus for endoscopes of 1st Example of this invention in order. Side surface sectional drawing which shows the use condition of the clip apparatus for endoscopes of 1st Example of this invention in order. Side surface sectional drawing of the clip apparatus for endoscopes of the 2nd Example of this invention. Side surface sectional drawing of the high frequency snare for endoscopes of the 3rd Example of this invention. Side surface sectional drawing of the high frequency snare for endoscopes of the 4th Example of this invention. The side view of the front-end | tip part of the high frequency knife for endoscopes (wire type) of the 5th Example of this invention.

Explanation of symbols

1. Clip (tip treatment member)
2 ... Clip closing ring 3 ... Flexible sheath 4 ... Operation wire 10 ... Operation part 11 ... 1st finger hook (1st operation member)
12 ... 2nd finger hook (2nd operation member)
13 ... operation unit body (second operation member)
14: Sheath operation tube (first operation member)
18 ... Operation wire mounting plate 30 ... Sheath connection member 31 ... Female screw cylinder (connection position adjusting means)
32 ... Male screw cylinder (connection position adjusting means)
DESCRIPTION OF SYMBOLS 101 ... Snare loop 103 ... Operation part main body 131 ... Female screw cylinder (connection position adjustment means)
132 ... Male screw cylinder (connection position adjusting means)
231 ... Female thread cylinder (connection position adjusting means)
232 ... Male screw cylinder (connection position adjusting means)

Claims (2)

A flexible sheath that is passed through a treatment instrument guide tube of an endoscope, a distal treatment member that protrudes and retracts from a distal end portion of the flexible sheath, and a distal end that is connected to the distal treatment member to form the flexible sheath An operation wire that is axially slidable therein, a first operation member connected to the proximal end of the flexible sheath, and a second operation member connected to the proximal end of the operation wire; An outer tube slidable in the axial direction from the proximal end side of the first operating member and loosely fitted on the flexible sheath ;
By the Turkey moved relatively and the second operating member and the first operating member in the axial direction of the flexible sheath and the operating wire, a pre-Symbol distal end treatment member of the flexible sheath The distal treatment member expands when the outer tube protrudes from the distal end portion and the outer tube is retracted backward from the distal end of the flexible sheath, and the distal treatment member is disposed when the outer sheath tube is positioned within the flexible sheath. In an endoscope treatment instrument configured to be closed ,
The movement of the second operating member with respect to the first operating member is temporarily stopped at a predetermined neutral position, and the first operating member is pulled backward with respect to the second operating member from the neutral position. Position setting means for setting a position and a position for pulling the second operating member and the first operating member from the neutral position;
One of a connecting position of the proximal end of the flexible sheath with respect to the first operating member and a connecting position of the proximal end of the operating wire with respect to the second operating member can be arbitrarily set in the axial direction. endoscopic treatment tool characterized in that a adjustment means. 2. The endoscope treatment tool according to claim 1, wherein the position setting means is slidably fitted to the first slide cylinder connected to the first operation member, and the first slide cylinder. A second slide cylinder, a compression spring that urges an elastic force in a direction extending the distance between the first and second slide cylinders, and a movement of the second operation member relative to the first operation member in advance. A projection for temporarily stopping at a predetermined neutral position, and the connection position adjusting means includes an operation portion side screw portion formed on the first or second operation member, an operation portion side screw portion, and a screw. It consists of a movable screw portion formed on the flexible sheath or the operation wire so as to match, and the position setting means stops the movement of the first operation member and the second operation member at the neutral position. in a state of being, the By rotating the movable threaded portion around the relative axis with respect to work side thread portion, the connecting position of the flexible sheath or the operating wire relative to said first operating member or the second operating member A treatment instrument for an endoscope , characterized in that it can be displaced in the axial direction .

Images