JP4855765B2 - Endoscopic treatment device - Google Patents

Description

  The present invention relates to an endoscope treatment apparatus that guides a treatment tool into a body cavity through an introduction guide tube with a bending function and treats the treatment tool under observation with an endoscope.

  2. Description of the Related Art In recent years, endoscope treatment apparatuses are known in which a treatment tool is guided into a body cavity through a flexible introduction guide tube and treated with the treatment tool under observation by an endoscope. The introduction guide tube used in this endoscope treatment apparatus is also called a channel tube.

  Such an endoscope treatment apparatus, for example, as described in Patent Document 1, is provided with a bending portion in the vicinity of the distal end of the tube, and has a bending portion that can be bent by the proximal side operation portion. Tubes have been proposed. In this endoscope treatment apparatus, the treatment tool is guided into a body cavity through a plurality of introduction guide tubes with a bending function, and the direction of the treatment tool in the body cavity is adjusted by bending the bending portion of the introduction guide tube. It is like that.

  There are various types of such endoscopic treatment apparatuses and treatment tools, and an example thereof will be briefly described with reference to FIGS. 38 to 43. 38 is an external view of an introduction guide tube which is a conventional endoscope treatment apparatus, FIG. 39 is an external view of a grasping forceps, FIG. 40 is a partial cross-sectional view showing an internal structure of the grasping forceps, and FIG. It is a figure which shows the holding part of forceps. FIG. 42 and FIG. 43 are diagrams for explaining the operation of the endoscope and the introduction guide tube for treatment using various treatment tools.

  As shown in FIG. 38, an insertion tool 200, which is a conventional endoscope treatment apparatus, includes an elongated insertion tool insertion portion 211 and an operation portion 212 that also serves as a gripping portion. The insertion tool insertion portion 211 of the insertion tool 200 is introduced into the body cavity together with the endoscope insertion portion of the endoscope.

  The insertion tool insertion portion 211 is configured by connecting a distal end portion 213, a bending portion 214, and a long and flexible flexible tube portion 215 in order from the distal end side. The distal end surface of the distal end portion 213 is provided with a treatment instrument opening 213a through which a treatment instrument such as a grasping forceps 300 is led out.

  The bending portion 214 includes a plurality of bending portions, specifically, a first bending portion 216 and a second bending portion 217. The first bending portion 216 is provided on the distal end side of the insertion tool insertion portion 211, and is configured to be able to bend in a direction indicated by an arrow a and a direction indicated by an arrow b by connecting a plurality of bending pieces, for example.

  On the other hand, the second bending portion 217 is connected to the base end portion of the first bending portion 216, and is configured to be able to bend in the direction indicated by the arrow a by connecting a plurality of bending pieces. ing. In addition, the bending part 214 provided in the insertion tool insertion part 211 of the insertion tool 200 is not limited to two, the 1st bending part 216 and the 2nd bending part 217, There may be one.

The operation unit 212 includes a main bending operation unit 218 and a sub bending operation unit 219 provided on the base end side from the main bending operation unit 218.
The main bending operation portion 218 is provided with two first bending portion operation knobs 218a and 218b. These two first bending knobs 218a, 218b are knobs for bending the first bending portion 216.

  Reference numeral 221 denotes a treatment instrument insertion port into which a treatment instrument such as a grasping forceps 300 as a treatment instrument is inserted. The treatment instrument insertion port 221 communicates with a treatment instrument opening 213a provided at the distal end portion 213 constituting the insertion instrument insertion portion 211 via a treatment instrument insertion channel tube (not shown).

  On the other hand, the secondary bending operation portion 219 is provided with a second bending portion operation lever 219a. The second bending portion operating lever 219a is a lever for operating the second bending portion 217 to bend.

Next, the configuration of the grasping forceps 300 that is a treatment tool used in combination with the insertion tool 200 described above will be described with reference to FIGS. 39 to 41.
As shown in FIG. 39, the grasping forceps 300 has, for example, a mouthpiece-shaped grasping portion 302 on the distal end side and a handle portion 303 on the proximal end side. The grasping portion 302 and the handle portion 303 are an insertion portion. It becomes the structure connected by the elongate sheath 301 which becomes. The handle portion 303 of the grasping forceps 300 includes a ring-shaped finger hook portion 305 for hooking a predetermined finger of a user who is a doctor at the proximal end, a slider operation portion 304 for opening and closing the grip portion 302, and a sheath 301 from the finger hook portion 305. And a slide guide 306 that guides the movement of the slider operation unit 304.

  The slider operation unit 304 of the handle unit 303 has a substantially drum shape with flanges at both ends, and one end of an operation wire 307 inserted into the sheath 301 shown in FIG. 40 is connected. The slider operation unit 304 is slidable in the long axis direction of the slide guide 306 of the handle unit 303. The slide of the slider operation unit 304 causes the operation wire 307 to be pulled and relaxed in the long axis direction.

  As shown in FIG. 41, the operation wire 307 is inserted into the sheath 301 up to the grip portion 302, and the other end is connected to the grip portion 302. The gripper 302 has a link mechanism. As described above, when the operation wire 307 is pulled by the slide of the slider operation unit 304, the mouth of the gripper 302 is closed and the operation wire 307 is relaxed. In this structure, the mouth of the gripper 302 is opened.

The above-described conventional insertion tool 200 is used for the treatment of an affected area in a body cavity, as shown in FIGS. 42 and 43, together with the grasping forceps 300 and the endoscope 350.
As an example, as shown in FIG. 42, the user picks up and lifts the lesion 401 in the stomach 400 of the patient by the grasping portion 302 of the grasping forceps 300, and moves it to the treatment instrument channel of the endoscope 350. A physiological saline or the like is injected into the lesion 401 by the inserted puncture needle 370.

  In addition, as shown in FIG. 43, the user grasps the lesion 401 in the large intestine 410 of the patient with the grasping portion 302 of the grasping forceps 300 that passes through the one inserter 200 using the two inserters 200. The lesion 401 is excised with an electric knife 380 that is lifted and inserted through the other insertion tool 200.

During these procedures, the user operates the bending operation knobs 218a, 218b, and 219a of the operation unit 212 while observing the endoscopic image of the endoscope 350, so that the bending unit 214 of the insertion tool 200 is desired. While curving in a direction, predetermined operations of various treatment tools are performed. Reference numeral 360 in the drawing is a holding ring that holds the insertion tool 200 in the endoscope 350.
JP 2000-33071 A

  However, in the above-described insertion tool with a bending function, the user operates a treatment tool such as a grasping forceps, and at the same time, bends the bending part provided in the operation unit at the hand in order to bend the bending part of the insertion tool in a desired direction. It is necessary to operate the operation knobs simultaneously. In addition, as described above, there are cases where various treatments and the like are performed on a patient by combining a plurality of insertion tools with an endoscope in combination with an endoscope.

  Therefore, when the user performs the bending operation of the insertion tool and the operation of the treatment tool such as the grasping forceps at the same time, there is a problem that these operations become complicated. Furthermore, since the operation of the endoscope is also added, there has been a problem that a desired operation during various treatments is difficult.

  Therefore, the present invention has been made in view of the above problems, and provides an endoscope treatment apparatus that can easily perform the bending operation of the insertion tool with a bending function and the operation of various treatment tools and has good operability. There is to do.

An endoscope treatment apparatus according to an aspect of the present invention includes an observation unit for observing the inside of a body cavity, and in the endoscope treatment apparatus used together with an endoscope that can be inserted into a body cavity, a bending portion, And a flexible insertion section having a channel through which the treatment instrument is inserted, a first operation section that is connected to the insertion section and includes a treatment instrument operation means for operating the treatment instrument, and a user A second operation part provided with a grip part to be gripped by an operation part, an operation part for performing a bending operation of the bending part, and a first operation part provided to fix the slider of the treatment instrument. A first fixing portion, and a fixing means provided on the second operation portion and having a second fixing portion for fixing the finger-hanging portion of the treatment instrument, and fixing the handle portion of the treatment instrument; I have .

  According to the present invention, it is possible to easily perform a bending operation and a treatment instrument operation, and to realize an endoscope treatment apparatus with good operability.

  Hereinafter, the endoscope treatment apparatus of the present invention will be described.

(First embodiment)
First, an endoscope treatment apparatus will be described with reference to FIGS.
1 to 9 relate to a first embodiment of the present invention, FIG. 1 is a plan view showing an introduction guide tube, FIG. 2 is a perspective view of the introduction guide tube as seen from the base end side, and FIG. FIG. 4 is a schematic configuration diagram showing the internal structure of the introduction guide tube for explaining the bending operation, FIG. 5 is a cross-sectional view explaining the slider of the slider operation unit, and FIG. FIG. 7 is a cross-sectional view showing an example in which a spring member is provided in the slider operation portion, FIG. 7 is a view for explaining a state where the slide operation lever of the grasping forceps is grasped and fixed to the lever fixing portion of the slider, and FIG. FIG. 9 is a diagram illustrating a state in which the gripping unit is mounted, and FIG. 9 is a diagram illustrating a modification in which the grip portion of the bending operation unit rotates.

  As shown in FIGS. 1 and 2, an introduction guide tube 1 which is an endoscope treatment apparatus according to the present embodiment is connected to an insertion portion 2 made of an elongated flexible tube and a proximal end of the insertion portion 2. And an operation unit 3 provided.

The insertion portion 2 is a tube body having a bending portion 4 at a distal end portion and a flexible tube portion 5 extending from the base end of the bending portion 4 to the operation portion 3.
The operation unit 3 includes a bend preventing unit 3a connected to the proximal end of the flexible tube unit 5, and a slider operation unit 6 that is a tubular first operation unit connected to the proximal end of the bend preventing unit 3a. And a main bending operation section 7 which is a second operation section connected to the base end of the slider operation section 6.

  A treatment instrument insertion portion 13 having a treatment instrument insertion port 13a for inserting various therapeutic instruments, for example, grasping forceps, is disposed on the side of the distal end portion of the slider operation section 6. Moreover, the slider operation part 6 has the middle part of the base end side of the treatment tool insertion part 13, and the annular | circular shaped stopper parts 10a and 10b used as an outward flange in the main curve operation part 7 side, These stopper parts 10a, Between 10b, the slider 11 which is one of the treatment tool operation means is slidably fitted. The slider 11 has a substantially drum shape, and of the two outward flanges 11a and 11b provided at both ends, the slider 11 protrudes in a direction along the flange surface from a part of the outer peripheral portion of the outward flange 11b on the proximal end side. The treatment instrument lever fixing portion 12 is a first fixing portion.

  The treatment instrument lever fixing portion 12 is made of an elastic member and has a holding portion 12a having a protruding end formed in a substantially U shape. As will be described later, the treatment instrument lever fixing portion 12 has a handle portion of various treatment tools fitted into the holding portion 12a, and the handle portion can be held and fixed by an elastic force.

  The main bending operation portion 7 is a so-called gun grip shape including a grip portion 7 a extending in a direction substantially orthogonal to the axis of the slider operation portion 6, and performs a bending operation of the bending portion 4 of the insertion portion 2. Two bending operation levers 8 (8a and 8b shown in FIG. 2) and a second one of fixing means protruding from the side opposite to the extending side of the grip portion 7a and for hooking the finger ring of the treatment instrument. It has the latching | locking part 9 which is a fixing | fixed part. As shown in FIG. 2, the main bending operation section 7 is provided with a fixing lever 7b for holding and fixing the bending operation levers 8a and 8b at desired operation positions. Is maintained in a predetermined curved state.

Next, the internal structure of the distal end portion of the insertion portion 2 will be described with reference to FIG.
As shown in FIG. 3, a treatment instrument insertion channel 14 through which grasping forceps or the like as a treatment instrument is inserted along the longitudinal axis direction is provided at a substantially central portion of the insertion section 2. A through hole 15 a constituting the treatment instrument insertion channel 14 is formed at the distal end portion of the insertion portion 2. That is, in the introduction guide tube 1, the treatment instrument insertion channel 14 for inserting the treatment instrument is provided as the only built-in object.

  The treatment instrument insertion channel 14 includes a through hole 15b provided at the distal end portion of the insertion portion 2, and a treatment instrument insertion channel tube that is arranged to communicate with the through hole 15b and the treatment instrument insertion port 13a (see FIGS. 1 and 2). (Hereinafter abbreviated as a treatment instrument tube) 16. The distal end portion of the treatment instrument tube 16 is communicated with the through hole 15b via a metal distal end side connecting tube 17, and the proximal end portion is disposed on the treatment instrument insertion port 13a via a metal proximal end connecting tube (not shown). It is communicated to. As a result, the treatment instrument inserted from the treatment instrument insertion port 13a is inserted through the treatment instrument tube 16 and led out from the treatment instrument opening 15a provided at the distal end of the insertion portion 2.

  The bending portion 4 provided in the insertion portion 2 is covered with a net tube 18 and a bending rubber 19. The net tube 18 covers the curved portion 4, and the curved rubber 19 further covers the net tube 18. A plurality of substantially annular bending pieces 20 are rotatably connected in the bending portion 4, and the bending portion 4 is moved in four directions by rotating the bending operation lever 8 of the main bending operation portion 7. Curved operation.

  Specifically, two pulleys 21 are provided in the main bending operation section 7 (only one is shown in FIG. 4), and these pulleys 21 are connected correspondingly to the bending operation levers 8 (8a, 8a, 8). The angle wires 22 inserted into the coil pipe 23 are respectively pulled and loosened by being rotated by 8b). Further, the angle wire 22 is inserted into a wire guide (not shown) of each bending piece 20, and the tip is connected to the most advanced piece.

  The angle wire 22 is linearly inserted so that each end portion extends from the pulley 21 toward the distal end side and is parallel to a wire guide located at a point-symmetrical position with respect to the center of the bending piece 20. The bending portion 4 is bent in two directions by one pulley 21 and one angle wire 22 by pulling and loosening of the angle wire 22.

  In other words, in the present embodiment, the angle wire 22 is pulled and loosened by the two pulleys 21 that are rotated in response to the two bending levers 8a and 8b in the main bending operation portion 7, and the bending portion 4 Is bent in four directions. The four directions are set to four directions that divide the circumferential direction of the insertion portion 2 viewed from the distal end direction into approximately four parts.

  As shown in FIG. 5, the slider 11 is movable back and forth between the two stopper portions 10 a and 10 b along the axial direction of the slider operation portion 6. The two outward flanges 11a and 11b of the slider 11 are for a user who is a doctor to put a finger on it, and are intended to make the slider 11 easier to operate. As shown in FIG. 6, a spring member 24 may be disposed between the stopper portion 10 b of the slider operation portion 6 and the outward flange 11 b of the slider 11 so as to be externally inserted into the slider operation portion 6.

In the introduction guide tube 1 of the present embodiment configured as described above, a sheath 301 of, for example, a grasping forceps 300 that is a treatment instrument when used is inserted into the treatment instrument insertion channel 14. Specifically, first, the user inserts the sheath 301 of the grasping forceps 300 from the treatment instrument insertion port 13a of the treatment instrument insertion section 13 of the introduction guide tube 1 from the grasping section 302 side. Next, as shown in FIG. 7, the user grasps the slider operation unit 304 of the grasping forceps 300 so as to be sandwiched by the treatment instrument lever fixing unit 12 of the slider 11 of the introduction guide tube 1, and as shown in FIG. The hook 9 of the main bending operation section 7 of the introduction guide tube 1 is inserted into the finger hook 305 of the grasping forceps 300.
The user grasps the sheath 301 so that the grasping portion 302 of the grasping forceps 300 protrudes from the treatment instrument opening 15a at the distal end of the introduction guide tube 1 by a desired lead-out amount and moves back and forth to adjust the insertion amount.

  As shown in FIG. 8, the user holds the grip portion 7a of the main bending operation portion 7 of the introduction guide tube 1, and turns the two bending operation levers 8a and 8b with, for example, the thumb, thereby bending the user. The part 4 can be easily bent in four directions. Further, the user can easily open and close the grasping portion 302 of the grasping forceps 300 by moving the slider 11 back and forth on the slider operation portion 6 of the introduction guide tube 1 with, for example, an index finger or a middle finger.

  That is, in the grasping forceps 300, the handle portion 303 is fixed to the main bending operation portion 7 of the introduction guide tube 1 by inserting the hook portion 305 of the main bending operation portion 7 of the introduction guide tube 1 into the finger hanging portion 305. The slider operation unit 304 is held and fixed to the treatment instrument lever fixing unit 12 of the slider 11 of the introduction guide tube 1. Accordingly, when the user operates the slider 11 of the introduction guide tube 1 back and forth, the gripping forceps 300 causes the slider operation unit 304 to move back and forth on the slide guide 306 of the handle unit 303 as the slider 11 moves. Moving. Thereby, the holding part 302 of the holding forceps 300 is opened and closed.

  As a result of the above, the introduction guide tube 1 of the present embodiment allows the user to easily perform the bending operation of the bending portion 4 and the operation of the grasping forceps 300, for example, the treatment tool, with only one hand (one hand). Can do.

  As shown in FIG. 9, the introduction guide tube 1 may have a structure in which the grip portion 7 a of the main bending operation portion 7 can freely change the angle with respect to the axis of the slider operation portion 6. That is, the grip portion 7a can be varied between the longitudinal axis of the operation portion 3 and an axis substantially orthogonal to the longitudinal axis.

(Second Embodiment)
Next, the introduction guide tube according to the second embodiment will be described with reference to FIGS. In the introduction guide tube of the present embodiment, the same reference numerals are used for the same configurations as those described in the first embodiment, and detailed description thereof is omitted. 10 to 12 relate to a second embodiment of the present invention, FIG. 10 is a perspective view of the introduction guide tube as seen from the base end side, and FIG. 11 is a partial cross-sectional view showing the inside of the operation unit. FIG. 12 is a diagram illustrating a state in which the grasping forceps are attached to the introduction guide tube.

  As shown in FIG. 10, the introduction guide tube 1 of the present embodiment has a cylindrical body 25 that is slidable relative to a cylindrical body 25 that is connected to the treatment instrument insertion portion 13 so as to extend to the proximal end side. In place of the slide tube 26, which is one of the treatment instrument operating means inserted into the device, and the latching portion 9 of the first embodiment, the upper portion of the main bending operation portion 7 (the main bending extending from the grip portion 7a) And a slide guide fixing portion 28 which is one fourth fixing portion of the fixing means provided on the opposite side of the operation portion 7. In the introduction guide tube 1 of the present embodiment, a spring member 24 is provided in the slider operation portion 6 between the stopper portion 10b and the slider 11, and the spring member 24 attaches the slider 11 to the front side. Rush.

  As shown in FIG. 11, the distal end of the cylindrical body 25 is connected to the treatment instrument tube 16 of the treatment instrument insertion channel 14 in the treatment instrument insertion portion 13.

  The slide tube 26 is integrally fitted to the slider 11 by fixing portions 11c and 11d protruding from the side surfaces of the outward flanges 11a and 11 of the slider 11 along the flange surface. The slide tube 26 is provided with a lock lever 27 (see FIG. 10) for fixing or releasing the treatment instrument to be inserted, for example, the sheath 301 of the grasping forceps 300 described in the first embodiment.

  When the lock lever 27 is rotated, the substantially elliptic stopper member 27a provided in the slide tube 26 is eccentrically rotated, and the sheath 301 of the grasping forceps 300 is slid with the side surface of the stopper member 27a. The inner wall of the tube 26 is pressed and fixed. Thereby, the sheath 301 of the grasping forceps 300 is fixed to the slide tube 26. Further, the user can insert and remove the sheath 301 of the grasping forceps 300 from the treatment instrument insertion channel 14 by releasing the lock lever 27. In the present embodiment, the slide tube 26 serves as one third fixing portion of fixing means for fixing the sheath 301 of the lock lever 27 grasping forceps 300.

  Further, the slide tube 26 advances and retreats so as to slide with respect to the cylindrical body 25 as the user moves the slider 11 back and forth. The cylinder 25 and the slide tube 26 constitute the cylinder mechanism of the present embodiment.

  Therefore, the sheath 301 of the grasping forceps 300 fixed to the slide tube 26 moves back and forth as the slide tube 26 advances and retreats, and an advance / retreat operation is performed in the cylinder 25 and the treatment instrument tube 16. As a result, the amount of the gripper 302 positioned at the distal end of the sheath 301 from the distal end of the insertion portion 2 of the introduction guide tube 1 is changed within the range of the forward / backward movement amount of the slide tube 26. That is, as the user moves the slider 11 back and forth, the grip portion 302 protrudes from the distal end of the insertion portion 2 of the introduction guide tube 1 or is accommodated in the insertion portion 2.

  The user inserts the sheath 301 of the grasping forceps 300 into the treatment instrument insertion channel 14 in advance until the grasping portion 302 is positioned at the distal end of the insertion portion 2 of the introduction guide tube 1, and the sheath 301 is moved by the lock lever 27. Fix to the slide tube 26.

  The slide guide fixing portion 28 has a substantially C-shaped holding portion 28a formed of an elastic member. The holding portion 28a is fitted with the slide guide 306 of the handle portion 303 of the grasping forceps 300, and the slide guide 306 can be held and fixed by its elastic force.

  As shown in FIG. 12, the introduction guide tube 1 of the present embodiment configured as described above has a main bending operation portion so that the finger hooking portion 305 of the handle portion 303 of the grasping forceps 300 faces the front side. The slide guide fixing portion 28 is set so as to hold and fix the slide guide 306 between the finger hooking portion 305 and the slider operating portion 304, and the sheath 301 of the grasping forceps 300 is inserted from the slide tube 26. At this time, the grasping forceps 300 is installed such that the grasping portion 302 is led out from the distal end of the insertion portion 2 or positioned within the distal end portion. As described above, the sheath 301 of the grasping forceps 300 is fixed to the slide tube 26 by rotating the lock lever 27 of the slide tube 26.

  The user grasps the operation unit 3 of the introduction guide tube 1 and, for example, moves the slider 11 forward and backward in the axial direction of the slider operation unit 6 with the index finger, the middle finger, etc. 26 in conjunction with each other, the sheath 301 of the grasping forceps 300 can be moved back and forth. That is, in accordance with this operation, the sheath 301 fixed to the slide tube 26 moves forward and backward in the treatment instrument insertion channel 14, and the grasping portion 302 of the grasping forceps 300 is moved relative to the distal end of the insertion portion 2 in FIG. Derived or introduced in the direction of the arrow A ′ shown.

  Further, for example, the user performs an opening / closing operation (in the direction of arrow B ′ in FIG. 12) of the grip unit 302 by moving the slider operation unit 304 of the gripping forceps 300 in the direction of arrow B shown in FIG. Can do. Further, the user turns the two bending operation levers 8a and 8b in the operation portion 3 of the introduction guide tube 1 to bend the bending portion 4 of the insertion portion 2 in the directions of arrows a and b shown in FIG. Can be operated.

  As a result, in addition to the effects of the first embodiment, the introduction guide tube 1 of the present embodiment uses a hand holding the grip portion 7a of the main bending operation portion 7 to hold the grasping forceps as a treatment tool. The sheath 301 of 300 can be advanced and retracted, and the lead-out operation or introduction operation of the grip portion 302 with respect to the insertion portion 2 can be easily performed.

(Third embodiment)
Next, the introduction guide tube according to the third embodiment will be described with reference to FIGS. In the introduction guide tube of the present embodiment, the same components as those described in the first and second embodiments are denoted by the same reference numerals, and detailed description thereof is omitted. 13 is a plan view of the bending operation portion of the introduction guide tube as viewed from the side, FIG. 14 is a cross-sectional view taken along the line XIV-XIV in FIG. 15 is a partial cross-sectional view of the bending operation section cut along the line XV-XV in FIG.

As shown in FIG. 13, the introduction guide tube 1 a of the present embodiment has a treatment instrument operation means using a rack and pinion mechanism in the operation unit 3.
Specifically, the operation section 3 of the introduction guide tube 1a includes a gripping section 3b that the user grips on the proximal end side of the treatment instrument insertion section 13, and a first treatment instrument that is connected to the proximal end side of the gripping section 3b. It has a bending operation section 31 and a second treatment instrument bending operation section 35 connected to the proximal end of the first treatment instrument bending operation section 31.

  The first treatment instrument bending operation portion 31 protrudes from a first operation lever 32 provided on one surface so as to be rotatable and a lower surface viewed from the paper surface of FIG. There are two stoppers 34a and 34b for restricting the rotation range.

  The first operation lever 32 is formed with a pinion 33 constituting a pinion on one side surface. The pinion 33 of the first operation lever 32 meshes with a rack 41 that constitutes a rack formed on one surface of a sheath advance / retreat movement unit 40 that is provided so as to be able to advance and retreat with respect to the first treatment instrument bending operation unit 31. Yes. Accordingly, when the first operating lever 32 is turned by the user, the pinion 33 engages with the rack 41, and the sheath advance / retreat moving unit 40 moves forward / backward.

  Similar to the first treatment instrument bending operation section 31, the second treatment instrument bending operation section 35 is provided with a second operation lever 36 that is rotatably provided on one surface, and toward the paper surface of FIG. 13. Each of the stoppers 38a and 38b protrudes from the viewed lower surface and restricts the rotation range of the second operation lever 36.

  The second operation lever 36 has a pinion 37 forming a pinion on one side surface. The pinion 37 of the second operation lever 36 is attached to a rack 46 that constitutes a rack formed on one surface of a slide operation lever advance / retreat moving portion 45 provided to be movable back and forth with respect to the second treatment instrument bending operation portion 35. I'm engaged. Accordingly, when the second operation lever 36 is rotated by the user, the pinion 37 engages with the rack 46 and the slide operation lever advance / retreat moving portion 45 moves forward / backward.

  A substantially L-shaped hooking portion 48 for hooking the finger hooking portion 305 of the grasping forceps 300 is provided at the proximal end of the second treatment instrument bending operation portion 35. The latching portion 48 has an engaging portion 48 a that is engaged with the finger hanging portion 305 of the grasping forceps 300.

  The sheath advancing / retreating portion 40 described above has a sheath insertion tube 40a inserted into the cylindrical body 29 on the distal end side, and the sheath insertion tube 40a slides back and forth with respect to the cylindrical body 29 as it advances and retracts. To do. The sheath 301 of the grasping forceps 300 as a treatment tool is inserted into the sheath insertion tube 40a and fixed inside the sheath insertion tube 40a by a fixing screw 42 disposed on the sheath advancement / retraction movement unit 40.

  Therefore, when the first operating lever 32 is turned, the sheath 301 of the grasping forceps 300 fixed to the sheath insertion tube 40a moves forward and backward together with the sheath advance / retreat movement unit 40, and the treatment tool insertion of the introduction guide tube 1a is performed. It moves forward and backward in the channel 14 (not shown in FIG. 13), and the gripping portion 302 of the gripping forceps 300 is led out or introduced into the distal end of the insertion portion 2 as in the second embodiment.

  A connecting body 29 a is provided at the distal end of the cylindrical body 29, and the connecting body 29 a is connected to the treatment instrument insertion port 13 a of the treatment instrument insertion portion 13. Further, in this state, the cylindrical body 29 is bent in a dogleg shape so that a gap is formed between the cylindrical body 29 and the grip portion 3 b of the operation unit 3. Therefore, the user can easily grasp the grasping portion 3b without getting in the way of the tubular body 29 and the sheath advancing / retreating moving portion 40 that moves forward and backward when the finger enters the gap.

  The above-described slide operation lever advance / retreat moving unit 45 includes a slide operation lever holding unit 47 that protrudes upward as viewed from the front end side toward the paper surface. As shown in FIG. 14, the slide operation lever holding portion 47 has a substantially semicircular cutout from the upper center, and as shown in FIG. 15, the two holding bodies 47a and 47b have a predetermined gap. It is arranged like this.

  That is, as shown in FIG. 13, of the two flange portions 304 a and 304 b of the slider operation unit 304 of the grasping forceps 300, in this embodiment, the flange portion 304 a on the distal end side is held by the slide operation lever holding portion 47. The slider operation unit 304 is held and fixed to the slide operation lever holding unit 47 by being sandwiched between the bodies 47a and 47b.

  As shown in FIG. 15, the second treatment instrument bending operation section 35 has a support plate section 35a provided so as to protrude upward as viewed toward the paper surface. A long hole 35b having a long axis set in the front-rear direction is formed at the center of the support plate 35a, and the engaging portion 45a of the slide operation lever advance / retreat moving portion 45 is inserted into the long hole 35b. Accordingly, the slide operation lever advance / retreat moving portion 45 is arranged so that the engagement portion 45a is restricted in the front and back movement range within the long hole 35b of the support plate portion 35a and can be moved forward and backward to the second treatment instrument bending operation portion 35. It is installed.

  Therefore, when the second operation lever 36 is rotated, the slide operation lever advance / retreat moving unit 45 moves forward / backward, and the slider operation unit 304 of the grasping forceps 300 is moved forward / backward along the axis of the slide guide 306, As in the first and second embodiments, the grasping portion 302 of the grasping forceps 300 is opened and closed.

Although not shown, the sheath advance / retreat moving unit 40 is disposed in the first treatment instrument bending operation unit 31 so as to be able to advance and retreat with the same configuration as the slide operation lever advance / retreat movement unit 45.
Further, the first and second treatment instrument bending operation portions 31 and 35 of the present embodiment are arranged on the surface opposite to the surface on which the operation levers 32 and 36 are provided, on the first and second embodiments. A substantially L-shaped bending operation lever for performing the bending operation of the bending portion 4 of the insertion portion 2 described in 1 is provided. FIG. 14 illustrates a bending operation lever 8 d provided in the second treatment instrument bending operation unit 35.

  The introduction guide tube 1a of the present embodiment configured as described above has the first and second treatment instrument bending operation sections which are treatment instrument operation mechanisms in the operation section 3 in the same manner as the above-described embodiments. By providing 31 and 35, it becomes the structure which can advance / retreat the sheath 301 of the grasping forceps 300 and the opening / closing operation of the grasping part 302 with only one hand of the user. In addition, the introduction guide tube 1a is provided with a bending operation lever (8d) on the opposite side to which the operation levers 32 and 36 of the first and second treatment instrument bending operation portions 31 and 35 are provided. The bending operation of the unit 4 can be performed with only one hand of the user.

(Fourth embodiment)
Next, a fourth embodiment of the present invention will be described with reference to FIGS. 16 and 17. The present embodiment is a description of a treatment tool operation assisting tool 50 that is a treatment tool operation means for operating a treatment tool that is detachable from the endoscope 350 or the conventional insertion tool 200. Here, the treatment tool operation assisting tool is described. Although the state where 50 is attached to the endoscope 350 will be described, it is also applicable to the conventional insertion tool 200.

  FIG. 16 is a perspective view showing the treatment instrument operation assisting tool 50 for operating the grasping forceps 300 as the treatment instrument. FIG. 17 is a side view showing a state where the treatment instrument operation assisting tool 50 is attached to the endoscope 350. It is the top view seen from.

  As shown in FIG. 16, the treatment instrument operation assisting instrument 50 includes two rod bodies 51 and 52 that are connected so as to be juxtaposed by connecting members 58 and 61 on the distal end side and the proximal end side, respectively. The first operation unit 65 that is connected to the proximal end of the rod 51 and that operates the slider operation unit 304 of the grasping forceps 300 that is a treatment tool, and the second operation unit that moves the sheath 301 of the grasping forceps 300 forward and backward. 53.

  The first operation unit 65 includes an operation box 66 having an open upper surface, a plate-like rack body 67 in which holding bodies 68a and 68b for holding the slider operation unit 304 are extended upward from the tip, A gear portion 69 that is rotatably disposed in the operation box 66 and acts on the rack body 67, an operation lever 70 that rotates the gear portion 69, and a side surface on the base end side of the operation box are provided. A substantially U-shaped holding part 71 provided with an engaging part 71a that is inserted into and held by the finger hooking part 305 of the grasping forceps 300.

  A long hole 66a into which the side portion 67a of the rack body 67 is fitted is formed on the side surface of the operation box 66 so as to be a long axis in the front-rear direction. That is, the rack body 67 can move back and forth within the range of the long hole 66a of the operation box 66, and the forward / backward movement of the rack body 67 is interlocked with the rotation operation of the operation lever 70 and rotates. The portion 69 engages with the rack 67b (see FIG. 17) of the rack body 67 and acts. Accordingly, the holding bodies 68 a and 68 b provided integrally with the rack body 67 move back and forth as the rack body 67 moves forward and backward.

  Each of the holding bodies 68a and 68b is cut out in a substantially semicircular shape at the upper end, and either one of the flanges 304a and 304b of the slider operation unit 304 of the grasping forceps 300 is inserted between the holding bodies 68a and 68b. The slider operation unit 304 is held. In the present embodiment, as shown in FIG. 17, the flange 304b of the slider operation unit 304 is fitted between the holding bodies 68a and 68b. At this time, the movement of the handle portion 303 is restricted by inserting the engaging portion 71a of the holding portion 71 into the finger hooking portion 305 of the grasping forceps 300.

  Therefore, the user can move the slider operation unit 304 of the grasping forceps 300 forward and backward in the axial direction of the slide guide 306 by rotating the operation lever 70 of the first operation unit 65. 302 can be opened and closed.

  On the other hand, the second operating portion 53 is a plate body 55 that is connected by a hinge portion 55 a so as to be rotatable about the axis of the rod body 52 so as to sandwich the coupling portion 61 between the proximal end side of the rod body 52. An operation dial 54 that is provided on one surface of the plate body 55 and is connected to the gear 53a so as to sandwich the plate body 55, a pinion 53b that meshes with the gear 53a, and a rod 52 that can be moved forward and backward. A substantially cylindrical rack body 56 having a rack 56a (see FIG. 17) that meshes with 53b, and a cylinder body that is inserted in the rod body 51 so as to be able to advance and retreat, and is integrally connected by the rack body 56 and connecting members 59 and 60. 57 and a moving tube 62 connected to the sheath fixing portion 59a of the connecting member 59 so as to extend forward.

  In addition, the connecting members 59 and 60 connect the rack body 56 and the cylindrical body 57 with the connecting member 59 on the front side and the connecting portion 60 in the middle. The connecting member 59 is provided so that the above-described sheath fixing portion 59a protrudes upward as viewed from the end on the cylindrical body 57 side toward the paper surface, and the sheath fixing portion 59a has a substantially C-shaped cross section at the protruding end. The sheath fixing screw 59b is provided on the upper end surface. The aforementioned moving tube 62 is connected to the protruding end of the sheath fixing portion 59a.

  When the operation dial 54 is rotated, the second operation unit 53 rotates the pinion 53b in conjunction with the gear 53a. The rotated pinion 53 b meshes with the rack body 56 to move the rack body 56 forward and backward in the axial direction of the rod body 52. Accordingly, as the rack body 56 moves forward and backward, the cylinder 57 connected to the rack body 56 moves forward and backward in the axial direction of the rod body 51 together with the moving pipe 62. The moving tube 62 is inserted into the cylinder 29 connected to the treatment instrument insertion port 355a of the treatment instrument insertion portion 355 of the endoscope 350 by the connection body 29a, and moves forward and backward with respect to the cylinder 29. To do.

  The sheath 301 of the grasping forceps 300 is inserted into the treatment instrument channel of the endoscope 350 until the grasping portion 302 (not shown) reaches the distal end portion of the endoscope 350 through the moving tube 62 and the cylindrical body 29. Inserted. Then, the sheath 301 of the grasping forceps 300 is fixed by being pressed against the inner peripheral surface of the sheath fixing portion 59a by the fixing screw 59b of the sheath fixing portion 59a.

  Accordingly, the user turns the operation dial 54 of the second operation unit 53 to rotate the sheath 301 of the grasping forceps 300 with the endoscope 350 as the sheath fixing unit 59a and the moving tube 62 move forward and backward. It can move back and forth in the treatment instrument channel. As a result, the user can derive or introduce the grasping portion 302 of the grasping forceps 300 from the distal end portion of the endoscope 350.

The treatment tool operation assisting tool 50 of the present embodiment configured as described above is attached to the bending operation part 352a of the endoscope 350 as shown in FIG. Therefore, the user can attach the treatment tool operation assisting tool 50 in the vicinity of the bending knobs 353 and 354 that perform the bending operation of the bending portion 351 (not shown) of the endoscope 350, so that the user can hold the endoscope 350 with one hand. The operation of the operation lever 70 of the first operation unit 65 and the operation dial 53a of the second operation unit 53 for performing the desired operation of the grasping forceps 30 as the treatment tool can be performed with only the bending portion 351. Can also be done.
In addition to the effects of the above-described embodiments, the treatment tool operation assisting tool 50 can be used in the existing endoscope 350 or the conventional insertion tool 200 by being detachable.

(Fifth embodiment)
Next, the introduction guide tube according to the fifth embodiment will be described with reference to FIGS. 18 is a view showing the entire introduction guide tube, FIG. 19 is a schematic configuration view showing the inside of the operation portion of the introduction guide tube, FIG. 20 is a view showing various gears provided in the operation portion of the introduction guide tube, and FIG. The figure which shows the operation part of the introduction guide tube of a 1st modification, FIG. 22 is the figure which shows the operation part of the introduction guide tube of a 2nd modification, FIG. 23 is sectional drawing which shows the operation part of the introduction guide tube of a 2nd modification FIG. 24 and FIG. 24 are views of the wheel gear provided on the end surface of the bending operation portion of the second modification as seen from one surface.

  As shown in FIG. 18, the introduction guide tube 100 of the present embodiment has an elongated flexible insertion portion 102 and a bending operation portion 103 connected to the proximal end side of the insertion portion 102. ing.

  The insertion portion 102 includes a first bending portion 102a, a second bending portion 102b, and a flexible tube portion 102c from the distal end side. Although not shown, a treatment instrument channel into which a treatment instrument such as grasping forceps is inserted is provided inside the insertion portion 102. The treatment instrument channel is opened at a distal end surface of the insertion section 102 and a treatment instrument insertion port (not shown) disposed in the bending operation section 103.

  Each of the bending portions 102a and 102b includes a plurality of bending pieces that are rotatably connected to each other, and each of the bending portions described later in the directions of arrows X ′, Y ′, and Z ′ in FIG. The operation levers 104 to 105 are bent along with the turning operation.

  The bending operation unit 103 includes, in order from the base end, a bending operation unit 103a that performs bending operation of each of the bending units 102a and 102b of the insertion unit 102, a gripping unit 103b that the user holds, and a flexible tube unit 102c of the insertion unit 102. And a bend-preventing portion 103c provided with a base end thereof.

  The bending operation unit 103a is provided on each of two side surfaces orthogonal to the longitudinal direction of the bending operation unit 103, and includes a first bending operation lever 104 and a second bending operation lever 105 corresponding to the first bending unit 102a, A third bending operation lever 106 corresponding to the second bending portion 102 b is provided on the base end surface that is the upper end surface of the operation portion 103.

  The first bending operation lever 104 is rotatable in the direction of the arrow X in the drawing with respect to the bending operation portion 103a, and bends the first bending portion 102a of the insertion portion 102 in the direction of the arrow X ′ in the drawing. The lever. Further, the second bending operation lever 105 can be rotated in the arrow Y direction in the drawing with respect to the bending operation portion 103a, and the first bending portion 102a of the insertion portion 102 is bent in the arrow Y ′ direction in the drawing. It is a lever to do. Note that the mechanisms in the bending operation portion 103a and the insertion portion 102 in which the first bending levers 104 and 105 bend the first bending portion 102a are the same as those in the first embodiment, and the description thereof is omitted. Is omitted.

  The third bending operation lever 106 has a shape in which a finger hooking portion 106a protrudes from the substantially disk-shaped member in the outer circumferential direction, and is in the Z direction in the drawing, which is the direction around the axis of the bending operation portion 103 and the insertion portion 102. It can be rotated. As shown in FIG. 19, the third bending operation lever 106 includes a rotating shaft 107 extending from the center of the back surface, and a gear 107 a provided at an extending end portion of the rotating shaft 107. Yes.

  As shown in FIGS. 19 and 20, inside the bending operation unit 103, two rectangular column bodies 111a and 111b are provided on the inner wall of the gripping unit 103b so that one surface thereof faces each other. The square pillars 111a and 111b are provided with screw hole portions 112a and 112b, respectively.

  Further, bending wires 110 a and 110 b for pulling and loosening a plurality of bending pieces (not shown) provided in the second bending portion 102 b of the bending portion 102 are inserted from the insertion portion 102 to the bending operation portion 103. At the respective ends of the bending wires 110a and 110b on the bending operation unit 103 side, gears 108a and 108b meshing with the gear 107a and worm gears 109a and 109b connected to the gears 108a and 108b are provided. Yes. The worm gears 109a and 109b are inserted into the screw hole portions 112a and 112b of the quadrangular column bodies 111a and 111b, respectively, are rotated and held, and mesh with the screw portions formed on the inner peripheral surfaces of the screw holes 112a and 112b. . The worm gears 109a and 109b are set so as to be reverse screws.

  The introduction guide tube 100 of the present embodiment configured as described above has the worm gear 109a, the gear 108a, 108b meshing with the gear 107a being rotated by the rotation of the third bending operation lever 106, respectively. 109b moves up and down (in the axial direction of the screw hole portions 112a and 112b) with respect to the screw hole portions 112a and 112b of the quadrangular column bodies 111a and 111b. As a result, the bending wires 110a and 110b are also moved in the longitudinal direction of the insertion portion 102 and the bending operation portion 103, pulled and relaxed, and turn the bending piece in the second bending portion 102b. As a result, the second bending portion 102b is bent in a predetermined direction by rotating the bending piece in the second bending portion 102b.

  The bending direction of the second bending portion 102b with respect to the rotation direction of the third bending operation lever 106 is set by the threading direction of the worm gears 109a and 109b, and is not particularly limited.

  The introduction guide tube 100 of the present embodiment described above includes the first and second bending portions 102a and 102b, and the first and second bending portions 102a and 102b are connected to the bending levers 104 to 104 of the bending operation unit 103. The bending operation of 106 can be performed with only one hand operation, and the bending portion 102 can be in various bending states while improving operability.

  As shown in FIG. 21, the introduction guide tube 100 rotates the bending operation unit 103 a itself around the axis of the bending operation unit 103 (Z direction in the drawing) without providing the third bending operation lever 106. Thus, the second bending portion 102b may be configured to bend. Specifically, in the bending operation unit 103a, the shaft body 114 is rotatably held by the gripping unit 103b. The shaft body 114 has a configuration in which a gear 107a is provided instead of the rotating shaft 107 of the third bending operation lever 106 described above.

  Also, as shown in FIGS. 22 to 24, the same operation is performed to turn the second bending portion 102b by rotating the bending operation portion 103a itself around the axis of the bending operation portion 103 (Z direction in the drawing). It is also good.

  Specifically, the bending operation unit 103a is rotated around the axis of the bending operation unit 103 (Z direction in the drawing) as shown in FIG. 22 by a bearing 121 arranged at the inner peripheral end of the gripping unit 103b shown in FIG. It is free to rotate.

  In the bending operation portion 103a, two pulleys 115 (only one is shown in the drawing) are arranged to be rotated by the first and second bending operation levers 104 and 105, respectively. The two operation wires 116 are correspondingly pulled and loosened by the rotation of the pulley 115, whereby the bending piece in the first bending portion 102a is rotated, and the first bending portion 102a is rotated in four predetermined directions ( Depending on the operation of the first and second bending operation levers 104 and 105, the insertion portion 102 is bent in the direction of 360 degrees around the axis. These two operation wires 116 are covered with four wire guards 116a which are tube bodies, and these wire guards 116a are inserted from the flexible tube portion 102c of the insertion portion 102 to the bending operation portion 103. ing.

  Further, a plate body 117 for holding the end portions of the four wire guards 116a is provided in the bending operation portion 103a, and the end surface of the bending operation portion 103a in the grip portion 103b is as shown in FIG. Further, the above-described gear 107a, which is a substantially annular wheel gear, is provided. That is, by using the gear 107a as a wheel gear, the four wire guards 116a can be accessed in the bending operation portion 103a.

  Even in such a configuration, by rotating the bending operation unit 103a around the axis of the bending operation unit 103 (Z direction in the drawing), the gears 108a and 108b meshing with the gear 107a are respectively rotated. The worm gears 109a and 109b move up and down (in the axial direction of the screw hole portions 112a and 112b) with respect to the screw hole portions 112a and 112b of the quadrangular column bodies 111a and 111b. As a result, the bending wires 110a and 110b are also moved in the longitudinal direction of the insertion portion 102 and the bending operation portion 103, pulled and relaxed, and turn the bending piece in the second bending portion 102b. As a result, the second bending portion 102b is bent in a predetermined direction by rotating the bending piece in the second bending portion 102b.

  With the two modified configurations as described above, the bending operation unit 103a can be rotated with the finger placed on the first and second bending operation levers 104 and 105. Therefore, the user can easily perform the bending operation of the third bending portion 102b while performing the bending operation of the first and second bending portions 102a.

(Sixth embodiment)
The sixth embodiment will be described below with reference to FIGS. In this embodiment, it is difficult to apply the technique for bending the second bending portion 102b of the introduction guide tube 100 of the fifth embodiment described above to the first to fourth embodiments described above. Therefore, the second bending portion (4a) can be configured to be bent by a technique as described below. Therefore, the description of the configurations described in the first to fourth embodiments will be omitted by using the same reference numerals, and only different configurations will be referred to.

  25 is a configuration diagram showing the insertion portion 2 to the operation portion 3 of the introduction guide tube 1 of the present embodiment, and FIG. 26 is a cross-sectional view showing the internal structure from the insertion portion 2 to the operation portion 3 of the introduction guide tube 1 of FIG. 27 is a view for explaining a cam mechanism showing a modification, and FIG. 28 is a sectional view of the cam mechanism of FIG.

  As shown in FIG. 25, the insertion portion 2 of the introduction guide tube 1 is provided with a second bending portion 4 a between the bending portion (first bending portion) 4 and the flexible tube portion 5. The second bending portion 4a is subjected to a bending operation (C ′ direction in the drawing) by a turning operation (direction C in the drawing) of a bending operation grip 75 disposed at the base end of the folding preventing portion 3a.

  As shown in FIG. 26, a plurality of bending pieces 80 are rotatably connected to the second bending portion 4a. One end of the bending operation wire 79 is connected to a piece at the tip of the plurality of bending pieces 80, and an annular wire (not shown) through which the bending operation wire 79 is inserted is connected to the remaining pieces. Each guide is provided.

  One end of the spiral coil wire guard 79a is connected to the proximal end of the plurality of bending pieces 80, and the bending operation wire 79 is inserted into the wire guard 79a.

  The proximal end portion of the bending operation wire 79 extends from the proximal end portion of the wire guard 79a, and a stopper 78 is welded to the other end. The extended portion of the bending operation wire 79 is fixed to the fixing portion 77. The fixing portion 77 is provided with a cam pin 77a. Although not shown, the fixed portion 77 is guided in a straight line in the axial direction of the operation portion 3 and is held slidable in the axial direction of the operation portion 3.

  The bending operation grip 75 is substantially cylindrical and is rotatable around the axis of the operation unit 3. On the inner peripheral side of the bending operation grip 75, a cam ring 76 is integrally disposed by a fixing screw 75a. The cam ring 76 is formed with a cam groove 76 a into which the cam pin 77 a of the fixing portion 77 is engaged. That is, in the present embodiment, the cam ring 76 having the cam groove 76 a and the cam pin 77 a of the fixing portion 77 constitute a cam mechanism.

  In the introduction guide tube 1 of the present embodiment configured as described above, when the bending operation grip 75 is rotated, the cam ring 76 is interlocked and the cam pin 77a moves along the cam groove 76a. The fixing part 77 is slid in the axial direction of the operation part 3 (in the direction indicated by the arrow E in the figure). As a result, the bending operation wire 77 fixed to the fixing portion 77 is pulled and relaxed, and the second bending portion 4a is bent in one direction. The bending direction of the second bending portion 4a is preferably the same direction as the UP (upward) direction of the first bending portion 4.

  By adopting a configuration in which the bending operation grip 75 described above is rotated, the introduction guide tube 1 of the present embodiment can bend the second bending portion 4a by the cam mechanism.

  As shown in FIGS. 27 and 28, the introduction guide tube 1 can bend and operate the second bending portion 4a in two directions by pulling and loosening the two bending operation wires 79 by the cam mechanism. It may be configured.

  Specifically, the two bending operation wires 79 are provided with cam pins 77a and 77b at their respective ends. The cam pins 77a and 77b are engaged with cam grooves 76a and 76b formed in a cam ring 76 fixed to the bending operation grip 75, respectively. An annular member 81 is provided inside the cam ring 76 so as to form a gap that allows the cam pins 77a and 77b to move smoothly.

  That is, the two bending operation wires 79 are pulled and loosened by the rotation of the bending operation grip 75 by the cam mechanism constituted by the cam ring 76, the annular member 81, and the cam pins 77a and 77b. 2 A plurality of bending pieces 80 in the bending portion 4a are rotated. As a result, the introduction guide tube 1 can be configured such that the second bending portion 4a can be bent in two directions by pulling and loosening as the bending operation grip 75 rotates.

(Seventh embodiment)
In the present embodiment, a flexible overtube, which is one of endoscopic treatment apparatuses, will be described.
By the way, a soft overtube having a suture instrument at the tip is known. The flexible overtube is provided with a suturing device at the tip in order to perform, for example, endoscopic gastrostomy surgery for the cardia of the patient for GERD treatment. In this way, an endoscope is inserted into the flexible overtube that treats the body cavity tissue of the patient with the suture instrument, and the operation is performed under the observation of the endoscope. Such a soft overtube is provided with a curved portion.

  However, when a soft overtube and an endoscope are used in combination, there is a problem that the bending portions of the soft overtube and the endoscope interfere with each other depending on the bending angle, thereby hindering operability. Therefore, there is a problem that it is difficult to treat the affected area under the field of view of the endoscope.

  Therefore, in this embodiment, a flexible overtube that can be surely placed under the field of view of an endoscope so as to easily approach an affected area where a suture instrument is operated will be described.

  First, based on FIGS. 29-33, the flexible overtube of this Embodiment in which the suture instrument was provided in the front-end | tip is demonstrated. FIG. 29 is a view showing an endoscope and an overtube provided with a suture instrument inserted in the stomach of the subject, and FIG. 30 is an over-inserted endoscope shown in FIG. The figure which showed the front-end | tip part of a tube, FIG. 31 is a figure which shows the front-end | tip part of the overtube with which the suturing device which is a modification was provided in the front-end | tip, FIG. 32 is the front-end | tip part of the overtube of the state curved from the state of FIG. FIG. 33 is a view showing the distal end portion of the suture instrument.

  As shown in FIG. 29, the flexible overtube 130 is a flexible tube body having a suturing device 131, a bending portion 132, and an insertion portion 133 from the distal end side. An endoscope insertion portion 352 is inserted into the soft overtube 130.

  As shown in FIG. 30, an endoscope insertion portion 352 to a distal end side bending portion 351, and a distal end portion 351a having various optical systems are provided at the distal end portion of the insertion portion 133 of the flexible overtube 130. Derived from the mirror derivation unit 134.

  From the endoscope lead-out portion 134, a bending portion 132 extends, and an endoscope channel 135 into which the endoscope is inserted opens at the distal end surface.

  The flexible overtube 130 configured as described above has a curvature R2 at which the bending portion 132 is bent at a maximum and a curvature R1 at which the bending portion 351 of the endoscope is bent at a maximum (R1> R2). Is set. Even if the length in the longitudinal direction of the bending portion 132 of the soft overtube 130 is set shorter than the length in the longitudinal direction of the bending portion 351 of the endoscope, the relationship between the curvatures of the angles of curvature similar to the above. (R1> R2) can be set.

  With such a configuration, the flexible overtube 130 can be reliably placed under the field of view of the endoscope so as to easily approach the affected area where the suture instrument 131 is operated.

  In addition, the soft overtube 130 preferably has a small diameter in order to ensure more reliable and easy insertion. Therefore, as shown in FIG. 31 and FIG. 32, the cross section along the outer peripheral shape of the bending portion 351 and the distal end portion 351 a of the endoscope from the bending portion 132 of the flexible overtube 130 to the suture instrument 131 at the distal end. A concave shape with a curved shape may be used.

  The concave shape from the curved portion 132 of the flexible overtube 130 to the suture instrument 131 at the distal end is set so that the shape of the inner surface is substantially the same as or larger than the outer diameter of the curved portion 351 and the distal end portion 351a of the endoscope. Yes. That is, as shown in FIG. 31, when the bending portion 132 is in a substantially straight state, the flexible overtube 130 has the bending portion 132 and the suturing device 131 along the axial direction of the distal end portion 351a from the bending portion 351 of the endoscope. Can be brought into a substantially fitted state.

  Therefore, in the flexible overtube 130 of the present embodiment, when the bending portion 132 is in a substantially straight state, the bending portion 132 and the suturing device 131 can be substantially integrated from the bending portion 351 to the distal end portion 351a of the endoscope. Therefore, the overall diameter can be reduced, and the insertability can be improved.

  As shown in FIG. 33, a stopper 131a that is a convex portion formed by an elastic member that abuts the distal end surface of the distal end portion 351a of the endoscope may be provided on the inner surface of the suturing device 131. By providing the stopper 131a on the suturing device 131, the flexible overtube 130 can be inserted into the body cavity of the subject while the endoscope is inserted.

  Next, based on FIGS. 34 to 37, the flexible overtube 160 not provided with the suturing device 131 and the introduction guide tube that can be inserted into the channel of the endoscope will be described. FIG. 34 is a view showing the operation section of the soft overtube held by the user, and FIG. 35 is a view showing the soft overtube, the endoscope, and the introduction guide tube inserted into the body cavity. FIG. 36 and FIG. 37 show the endoscope inserted in the body cavity and the introduction guide tube, and are diagrams for explaining a method of using the endoscope.

  The soft overtube 160 shown in FIGS. 34 and 35 includes an insertion portion 161 in which a bending portion 161a and a flexible tube portion 161b are connected in order from the distal end, and an operation portion 162 that a user holds and performs various operations. ,have.

The insertion portion 161 is a flexible tube body having a channel through which the insertion portion 352 of the endoscope 350 can be inserted.
In addition, the operation unit 162 includes an anti-bending unit 162a connected to the proximal end of the flexible tube unit 161b of the insertion unit 161, a gripping unit 162b held by the user, and a bending operation knob 163 that performs the bending operation of the bending unit 161a. And a main operation part 162c provided with the. Note that the anti-bending portion 162a is provided with an insertion portion insertion portion 165 having an insertion port 165a through which the insertion portion 352 of the endoscope 350 communicating with the channel of the insertion portion 161 can be inserted from the distal end portion 351a.

  Here, since the gripping part 162b of the operation part 162 is usually gripped by the user's left hand, the flexible overtube 160 of the present embodiment has the insertion opening 165a of the insertion part insertion part 165 having a bending operation knob. It is arranged on the surface side of the operation unit 162 provided with 163.

  That is, when the user operates the bending operation knob 163, in consideration of operability, the user often holds the grip 162 b of the operation unit 162 with his left hand so that the user can easily operate with the thumb. The insertion part 352 of the endoscope 350 is inserted with the right hand from the insertion port 165a.

  Therefore, the flexible overtube 160 according to the present embodiment has the right hand batting on the left hand when the insertion portion 352 of the endoscope 350 is inserted while the user is grasping with the left hand for a bending operation or the like. In order to avoid this, the insertion opening 165a of the insertion portion insertion portion 165 is provided on the right side when viewed from the user.

  In addition, as shown in FIG. 35, by using the introduction guide tube 1 described in the above-described embodiment set to an outer diameter that can be inserted into the channel of the endoscope 350, the small intestine having a very small body cavity diameter is used. The insertion property of the endoscope 350 can be improved in the case of a body cavity or the like where observation and bending are extremely tight.

  More specifically, the user guides the introduction guide to a deep part of a body cavity such as the small intestine while observing the endoscopic image of the endoscope 350 with the guide wire 170 inserted into the introduction guide tube 1 and led out from the distal end. Tube 1 is inserted. At this time, the user can change the direction of the distal end of the introduction guide tube 1 according to the bending of the body cavity by bending the bending portion 4 of the introduction guide tube 1. Therefore, the user can insert the guide wire 170 into the introduction guide tube 1 and lead out from the distal end to insert the guide wire 170 into the deep part of the small intestine.

  Then, the user advances and inserts the flexible tube portion 5 of the introduction guide tube 1 along the guide wire 170, and then the bending portion of the endoscope 350 along the flexible tube portion 5 of the introduction guide tube 1. The insertion part 352 can be inserted into the deep part of the small intestine while curving 351.

  In other words, the user can use the flexible overtube 160 and the introduction guide tube 1 of the present embodiment to observe the small intestine with a very small body cavity diameter, even when the body cavity is very tightly bent, etc. 350 can be easily inserted.

  In addition, as shown in FIG. 36, in the introduction guide tube 1 set to an outer diameter that can be inserted into the channel of the endoscope 350, the bending portion 4 is bent so that the treatment force from the sheath 301 of the treatment tool of the grasping forceps 300 to the treatment portion. Since the direction of a certain gripping portion 302 and the like can be changed, the affected area can be more easily treated, and the burden on the patient can be reduced by shortening the treatment time.

  Further, as shown in FIG. 37, the introduction guide tube 1 can use the curvature of the bending portion 4 to scrape the folds of the body cavity wall when the endoscope 350 advances and retreats, or pulls the body cavity to bend. The insertion property of the endoscope 350 can be improved by various techniques such as linearization.

  The invention described in the above embodiment is not limited to each embodiment, and various modifications can be made without departing from the scope of the invention in the implementation stage. Further, the above embodiments include inventions at various stages, and various inventions can be extracted by appropriately combining a plurality of disclosed constituent elements.

  For example, even if some constituent requirements are deleted from all the constituent requirements shown in the embodiment, the problem described in the column of the problem to be solved by the invention can be solved, and the effect described in the effect of the invention can be obtained. In such a case, a configuration in which this configuration requirement is deleted can be extracted as an invention.

It is a top view which shows the introduction guide tube which is a therapeutic apparatus for endoscopes which concerns on 1st Embodiment. It is the perspective view which looked at the introduction guide tube from the base end side. It is sectional drawing which shows the inside of the front-end | tip part of an insertion part equally. It is a schematic block diagram which shows the internal structure of the introduction guide tube for demonstrating bending operation similarly. It is sectional drawing explaining the slider of a slider operation part similarly. It is sectional drawing which shows the example which provided the spring member in the slider operation part similarly. FIG. 6 is a view for explaining a state in which the slide operation lever of the grasping forceps is grasped and fixed to the lever fixing portion of the slider. It is a figure explaining the state by which the grasping forceps was mounted | worn with the introduction guide tube similarly. It is a figure which shows the modification which the grip part of a bending operation part rotates similarly. It is the perspective view which looked at the introduction guide tube which is the treatment apparatus for endoscopes which concerns on 2nd Embodiment from the base end side. It is a fragmentary sectional view showing the inside of an operation part same as the above. It is a figure explaining the state by which the grasping forceps was mounted | worn with the introduction guide tube similarly. The top view which looked at the bending operation part of the introduction guide tube which is a treatment apparatus for endoscopes which concerns on 3rd Embodiment from the side. FIG. 14 is a cross-sectional view taken along the line XIV-XIV in FIG. 13 and viewing the bending operation unit from the base end direction. It is the fragmentary sectional view of the bending operation part cut | disconnected along the XV-XV line | wire of FIG. The perspective view which shows the treatment tool operation assistance tool which operates the grasping forceps which is a treatment tool which is the treatment apparatus for endoscopes which concerns on 4th Embodiment, FIG. 17 is a plan view seen from the side showing a state where the treatment tool operation assisting tool is attached to the endoscope. It is a figure which shows the whole introduction guide tube which concerns on 5th Embodiment. It is a schematic block diagram which shows the inside of the operation part of an introduction guide tube equally. It is a figure which shows the various gears provided in the operation part of an introduction guide tube equally. It is a figure which shows the operation part of the introduction guide tube of a 1st modification similarly. It is a figure which shows the operation part of the introduction guide tube of a 2nd modification similarly. It is sectional drawing which shows the operation part of an introduction guide tube equally. It is the figure which looked at the wheel gear provided in the end surface of the bending operation part from the one surface similarly. It is a block diagram which shows an operation part from the insertion part of the introduction guide tube which concerns on 6th Embodiment. FIG. 26 is a cross-sectional view showing the internal structure from the insertion portion of the introduction guide tube of FIG. 25 to the operation portion. It is a figure for demonstrating the cam mechanism which shows a modification similarly. It is sectional drawing of the cam mechanism of FIG. FIG. 20 is a diagram illustrating a flexible overtube and an endoscope in which a suture instrument inserted into the stomach of a subject is provided at a distal end according to the sixth embodiment. FIG. 30 is a view showing a distal end portion of the flexible overtube into which the endoscope shown in FIG. 29 is inserted. It is a figure which shows the front-end | tip part of the soft overtube in which the suture device which is a modification is provided in the front-end | tip. It is a figure which shows the front-end | tip part of the soft overtube of the state bent from the state of FIG. It is a figure which shows the front-end | tip part of a suture instrument similarly. It is a figure which shows the operation part of the soft overtube of the state hold | gripped by the user similarly. It is the figure which showed the soft overtube of the state inserted in the body cavity, the endoscope, and the introduction guide tube. It is a figure for showing the endoscope of the state inserted in the body cavity, and the introduction guide tube, and explaining the usage method. It is a figure for showing the endoscope of the state inserted in the body cavity, and the introduction guide tube, and explaining the usage method. It is an external view of the introduction guide tube which is the conventional treatment apparatus for endoscopes. It is an external view of a grasping forceps. It is a fragmentary sectional view which shows the internal structure of a grasping forceps. It is a figure which shows the holding part of holding forceps. It is a figure explaining operation | movement of an endoscope and an introduction guide tube which treats using various treatment tools in the conventional therapeutic apparatus for endoscopes. It is a figure explaining operation | movement of an endoscope and an introduction guide tube treated using various treatment tools.

Explanation of symbols

1 ... Introduction guide tube (endoscopic treatment device)
2 ... Insertion unit 3 ... Operation unit 4 ... Bending unit 6 ... Slider operation unit (first operation unit)
7: Bending operation part (second operation part)
7a: Grip part 9: Hook (fixing means, second fixing part)
11 ... Slider (treatment instrument operation means)
12 ... Treatment instrument lever fixing part (fixing means, first fixing part)
14 ... Treatment instrument insertion channel (channel)

Claims (8)

An endoscopic treatment apparatus that includes an observation means for observing the inside of a body cavity and is used in combination with an endoscope that can be inserted into the body cavity.
A flexible insertion portion including a bending portion and a channel through which the treatment instrument is inserted;
The curve comprising: a first operation unit that is connected to the insertion unit and that is provided with a treatment instrument operating means for operating the treatment instrument; and a second operation unit that is provided with a grip part that is gripped by a user. An operation unit for performing bending operation of the unit;
A first fixing portion provided in the first operation portion and fixing a slider of the treatment instrument; and a second fixing portion provided in the second operation portion and fixing a finger hook portion of the treatment instrument. A fixing means for fixing the handle portion of the treatment instrument,
An endoscopic treatment device comprising: The first fixing portion is provided in the treatment instrument operation means,
The treatment instrument operating means is disposed so as to be movable forward and backward with respect to the first operation section so that the treatment section of the treatment instrument can be operated by moving the slider forward and backward with respect to the handle section. The endoscope treatment apparatus according to claim 1, wherein the treatment apparatus is an endoscope. The grip portion, the relative first operating portion longitudinal axis of the endoscopic treatment apparatus of claim 1 or claim 2, characterized in that it is extended in a direction substantially orthogonal. The grip portion includes a longitudinal axis of the shaft is the first operation section, any one of claim 1, wherein the variable freely be between an axis substantially perpendicular to the longitudinal axis of claims 3 The endoscope treatment apparatus according to claim 1.   The endoscope treatment apparatus according to claim 1, wherein the treatment instrument operation means is detachable from the operation unit.   The operation unit includes a bending operation lever that is provided on a base end surface of the operation unit and that rotates the bending unit around the longitudinal axis of the operation unit to bend the bending unit. Item 16. The endoscope treatment apparatus according to Item 1.   The endoscopic treatment device for an endoscope according to claim 1, wherein the operation unit bends the bending portion by rotating about a longitudinal axis. The operation unit has a bending operation grip that is rotatable about a longitudinal axis.
The endoscopic treatment device for an endoscope according to any one of claims 1 to 5 , wherein the bending portion is bent by rotation of the bending operation grip.

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