Endoscopic treatment apparatus

The present invention relates to an endoscopic treatment device and an introduction guide tube thereof that guide a treatment tool into a body cavity through an introduction guide tube having a bending function and perform treatment under observation with an endoscope.

Conventionally, there is known an endoscopic treatment device that guides a treatment tool into a body cavity through a flexible introduction guide tube and treats the treatment tool with the treatment tool under observation with an endoscope. The introduction guide tube used in this type of endoscopic treatment device is also called a channel tube. Recently, in this type of introduction guide tube, an introduction guide tube having a bending function in which a curved portion is provided near the tip of the tube and the curved portion can be curved by a hand-side operating portion has been proposed (Patent Document 1). reference). In this endoscopic treatment device, the treatment tool is guided into the body cavity through an introduction guide tube having a plurality of bending functions, and the curved portion of the introduction guide tube is curved to adjust the orientation of the treatment tool in the body cavity. It has become.<patcit num="1"><text>Japanese Unexamined Patent Publication No. 2000-33071</text></patcit>

<p> Since the flexible introduction guide tube with a bending function as described above can move freely in the body cavity, when treating with a treatment tool guided by the introduction guide tube, when a load is applied to the flexible introduction guide tube, the introduction is performed. The guide tube itself may move, limiting treatment with treatment tools. In particular, when the living tissue is grasped and moved by a treatment tool so as to raise the living tissue or expand the living tissue, a large load due to the reaction of the traction force is applied to the flexible introduction guide tube, and the introduction guide tube itself becomes It moves easily and runs away. When the flexible introduction guide tube is used in this way, the treatment tool may not be operated as desired, and the treatment with the treatment tool may be restricted.</p><p> The present invention has been made by paying attention to the above-mentioned problems, and an object of the present invention is to provide an endoscopic treatment apparatus capable of reducing restrictions when treating with a plurality of treatment tools guided by a plurality of flexible introduction guide tubes. To do.</p>

<p> The invention according to claim 1 is an endoscopic treatment device 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, each of which can be operated from the hand side. A plurality of introduction guide tubes having at least one curved portion are provided, and the vicinity of the end closer to the hand side than at least one of the curved portions of the plurality of introduction guide tubes is connected and fixed. It is a characteristic endoscopic treatment device. The invention according to claim 2 is an endoscopic treatment device 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, each of which can be operated from the hand side. A plurality of introduction guide tubes having at least one curved portion are provided, and at least a part of the insertion portions in the plurality of introduction guide tubes including the vicinity of the hand side end of the at least one curved portion is integrally connected. It is an endoscopic treatment device characterized by being formed into a structure. The invention according to claim 3 is characterized in that, among the curved portions of the plurality of introduction guide tubes, the vicinity of the hand side end of the curved portion is connected and fixed by a connecting tool. The endoscopic treatment device described. The invention according to claim 4 is at least one that can be operated from the hand side in an endoscopic treatment device that guides a treatment tool into a body cavity through a flexible introduction guide tube and treats it under observation with an endoscope. A plurality of introduction guide tubes having the above-mentioned curved portions are provided, and the vicinity of the hand side end of at least one of the curved portions of the plurality of introduction guide tubes and the insertion portion of the endoscope are connected. It is an endoscopic treatment device characterized in that it is detachably connected and fixed by a tool. The invention according to claim 5 is an endoscopic treatment device 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, each of which can be operated from the hand side. A plurality of introduction guide tubes having at least one curved portion are provided, and the insertion portion of the plurality of introduction guide tubes is assembled to a flexible overtube so as to be closer to the hand than at least one curved portion of the curved portions. The endoscopic treatment apparatus according to claim 1 or 2, wherein the vicinity of the side end is fixed to the overtube. The invention according to claim 6 comprises a plurality of treatment devices having a curved portion that can be curved, including an introduction guide tube that is introduced into a body cavity and a treatment tool is inserted therein, from the curved portion of the introduction guide tube. Is also a therapeutic device connector characterized by providing a fixing portion for fixing the vicinity of the hand side end. The invention according to claim 7 is an overtube provided with a bending portion capable of bending operation and capable of inserting a treatment tool inside and inserting a plurality of introduction guide tubes introduced into a body cavity, wherein the introduction guide tube is curved. It is an overtube characterized by providing a fixing portion for fixing the vicinity of the hand side end rather than the portion. The invention according to claim 8 is the overtube according to claim 7, further comprising a plurality of insertion guide holes formed so that the plurality of introduction guide tubes can be individually inserted. The invention according to claim 9 is characterized in that the tip of the introduction guide tube is provided with an operation mechanism for holding the tip of the treatment tool inserted through the introduction guide tube and operating the tip of the treatment tool. The thing described in any one of claims 1 to 8. According to a tenth aspect of the present invention, in an introduction guide tube through which a treatment tool used for treatment in a body cavity is inserted, a tip portion of the treatment tool inserted through the introduction guide tube is held at the tip of the introduction guide tube. The introduction guide tube for an endoscope is provided with an operation mechanism for operating the tip of the treatment tool.</p>

<p> According to the present invention, restrictions on treatment with a plurality of treatment tools guided by a plurality of flexible introduction guide tubes can be reduced.</p>

An endoscopic treatment apparatus according to an embodiment of the present invention will be described with reference to FIGS. 1 to 7.

FIG. 1 shows the introduction guide tube unit 1 for the treatment tool and the flexible endoscope 2, and the introduction guide tube unit 1 for the treatment tool is inserted into the insertion portion 3 of the endoscope 2 as shown in FIG. On the other hand, it can be assembled detachably.

The introduction guide tube unit 1 for the treatment tool includes a plurality of introduction guide tubes 4a and 4b for the treatment tool as a manipulator for operating the surgical instrument including the treatment tool such as forceps, and two introduction guide tubes 4a for the treatment tool. , 4b are integrated. The middle portions of the insertion portions 5 of the introduction guide tubes 4a and 4b for each treatment tool are integrally connected, and the portion of the connecting portion 6 is soft.

As shown in FIG. 6, the insertion portions 5 of the introduction guide tubes 4a and 4b for each treatment tool have a tip portion 10 located at the most advanced portion, a first curved portion 11 located on the hand side of the tip portion 10, and the insertion portion 11. A second curved portion 12 located on the hand side of the first curved portion 11 and a soft portion 13 provided after the second curved portion 12 are provided.

As shown in FIG. 7, a flexible tube 15 forming a treatment tool guiding channel 14 is arranged inside the insertion portion 5 of each of the introduction guide tubes 4a and 4b over the entire length thereof. The treatment tool guiding channel 14 is open to the outside at the tip of the insertion portion 5 through the channel hole 16 of the tip portion 10.

As shown in FIG. 7, the first curved portion 11 has a configuration in which a plurality of curved pieces 17 are rotatably connected and curved in the vertical direction and the horizontal direction by pulling the plurality of operation wires 18. The operating wire 18 is curved in the towing direction. Further, the second curved portion 12 is also configured to be curved by using a plurality of curved pieces in the same manner, but the second curved portion 12 is configured to be curved only in the vertical direction.

As shown in FIG. 6, a hand operation part 20 is provided at the hand end of the insertion part 5 of each of the introduction guide tubes 4a and 4b. The hand operation unit 20 is provided with a grip portion 21, an insertion port 22 leading to the treatment tool guiding channel 14, and a plurality of operating bodies for bending the curved portions 11 and 12, respectively. As the bending operation body, two angle knobs 23a and 23b for operating the first bending portion 11 and one angle handle 24 for operating the second bending portion 12 are provided.

As described above, the introduction guide tubes 4a and 4b for each treatment tool are connected in a state where the intermediate portion of the insertion portion 5 is integrally fixed by the flexible connecting hood 26 as shown in FIGS. 1 and 2. Has been done. Further, instead of using such a connecting hood 26, at least a part of the two insertion portions, for example, the intermediate portion shown in FIG. 1 may be formed as one flexible tube having an elliptical cross-sectional shape, for example. .. In this case as well, the insertion portions 5 of the plurality of introduction guide tubes 4a and 4b are integrally connected to form a fixed structure.

The second curved portion 12 is provided so as to start from the tip of the connecting portion 6. That is, in the introduction guide tubes 4a and 4b for each treatment tool, the proximal end portion in the movable region including the curved portions 11 and 12 is fixedly supported by the connecting hood 26. That is, in the present embodiment, the fixing portions (fixing) of the introduction guide tubes 4a and 4b are fixed in the vicinity of the hand side ends of the curved portions 11 and 12 respectively, and are fixed in the vicinity of the hand side ends of the curved portions 11 and 12 respectively. Means). Further, the connecting hood 26 constitutes a therapeutic device connecting tool for connecting a plurality of introduction guide tubes 4a and 4b.

Then, the tip portion of the connecting hood 26 that supports both the movable regions of the introduction guide tubes 4a and 4b for each treatment tool serves as a common fulcrum 27. Therefore, the movable region portions including the curved portions 11 and 12 can move with each other with respect to the common fulcrum 27. The fulcrum 27 is also a fixed point that is common to the movable region portions of the introduction guide tubes 4a and 4b.

On the other hand, as shown in FIG. 1, the insertion portion 3 of the endoscope 2 has a tip portion 31 located at the most advanced portion, a curved portion 32 located on the hand side of the tip portion 31, and the curved portion 32. It is provided with a flexible portion 33 located on the hand side. The endoscope 2 is provided with an observation window 34, an illumination window 35, a channel port 36, and the like on the tip surface of the tip portion 31, so that the endoscope 2 has an observation function and the like like a general endoscope. Further, the curved portion 32 is curved by an operation portion (not shown) provided at the base end of the insertion portion 3.

As shown in FIGS. 3 and 4, the introduction guide tube unit 1 for the treatment tool is assembled to the insertion portion 3 of the endoscope 2 by the connector 40 in a state of being arranged along the insertion portion 3 of the endoscope 2. Be done. The connector 40 is arranged near the tip of the flexible portion 33, avoiding the curved portion 32 of the endoscope 2. Since the portion near the tip of the introduction guide tube unit 1 is connected by the connecting tool 40, as shown in FIG. 3, the movable region portion including the curved portions 11 and 12 of the introduction guide tubes 4a and 4b for each treatment tool is It is arranged corresponding to the curved portion 32 of the endoscope 2 so that they can move relatively.

As shown in FIGS. 4 and 5, the connecting tool 40 forms an insertion hole 41 into which the connecting portion 6 of the introduction guide tube unit 1 can be inserted and an insertion hole 42 into which the insertion portion 3 of the endoscope 2 can be inserted. The band member 43 is composed of a band member 43, and the band member 43 is openable and closable so that the other end side can be opened around the hinge portion 44 at one end. Further, a protrusion 45 is formed on one of the other end edges of the band member 43 that can be opened, and a hole 46 is formed on the other side to which the protrusion 45 fits and engages.

Next, a case where this endoscopic treatment device is used will be described. As shown in FIG. 3, the introduction guide tube unit 1 is assembled to the insertion portion 3 of the endoscope 2 and guided into the body cavity as one unit. When guiding the unit assembled as one in this way into the body cavity, a tracal or an overtube or the like may be used as a guide body (not shown) to guide the unit into the body cavity.

Then, while observing the inside of the body cavity with the endoscope 2, various treatment tools (including suction tools) are passed through the introduction guide tubes 4a and 4b in the introduction guide tube unit 1 assembled to the insertion portion 3 of the endoscope 2. ) Is introduced into the body cavity and the necessary treatment is performed. Other treatment tools may be introduced through the channel provided in the endoscope 2 for treatment at the same time.

FIG. 3 shows the situation when the biological tissue 47 is lifted. In such a treatment example, the living tissue 47 is lifted by using the grasping forceps 48 introduced through one introduction guide tube 4a, and the living tissue 47 is suppressed by using the grasping forceps 49 introduced through the other introduction guide tube 4b. , Move each treatment tool in the opposite direction. That is, the curved portions 11 and 12 of the introduction guide tubes 4a and 4b are curved, respectively, and the gripping forceps 48 and 49 are moved in the opposite directions to raise the biological tissue 47.

Here, since the movable region portion of each introduction guide tube 4a, 4b that guides each gripping forceps 48, 49 moves in the opposite direction with respect to the fulcrum 27, the bearing forces applied to the fulcrum 27 cancel each other out, and each introduction guide tube The movable region portion of 4a and 4b is moved with the fulcrum 27 as a reference point and this as a fixed point. Therefore, the force applied to the grasping forceps 48 and 49 does not escape, and the force can be applied to the living tissue 47 as it is. Such behavior is not limited to the case of raising the living tissue 47, but is the same in the surgical operation such as the case of expanding the living tissue 47.

By the way, when it is assumed that the flexible introduction guide tube or the flexible endoscope is used alone, the flexible insertion portion floats in the space inside the body cavity due to the reaction received from the grasping forceps and can move freely. Become in a state. Therefore, the force due to the reaction escapes to the flexible insertion portion, and the force applied to the living tissue tends to be extremely small.

However, in the present embodiment, since the movable region portion of each of the introduction guide tubes 4a and 4b for guiding and operating the grasping forceps 48 and 49 is fixedly supported by the common fulcrum 27, the reaction applied to the fulcrum 27 is supported. The forces cancel each other out at the fulcrum 27 part, and the movable region part of the introduction guide tubes 4a and 4b can be stably supported. That is, the introduction guide tubes 4a and 4b themselves do not move and the force does not escape. In addition, the fulcrum 27 can be regarded as a fixed point, and the grasping forceps 48 and 49 can be guided as desired with the fulcrum 27 as a reference to perform a quick treatment operation. Even in the case of grasping two parts of the living tissue with two treatment tools and moving the two parts in the opposite direction, such as when raising the living tissue or expanding the living tissue in this way, I think. It will be possible to treat with a strong force.

In the above-described embodiment, the case where the introduction guide tube unit 1 is used by being assembled to the insertion portion 3 of the endoscope 2 has been described. However, the same effect can be obtained even when the introduction guide tube unit 1 is used alone. However, when the introduction guide tube unit 1 is used by assembling it to the insertion part 3 of the endoscope 2, the positional relationship with the endoscope 2 is related during use, and the situation can be easily grasped, and the entire unit is used. Since a stable support balance can be obtained, operational stability is further increased and it is easy to use.

Further, when the treatment tool is used through the channel provided in the endoscope 2, the above-mentioned supporting function can be obtained, and various other usage patterns can be assumed.

Next, the endoscopic treatment apparatus according to another embodiment of the present invention will be described with reference to FIGS. 8 to 11. Those similar to the above-described embodiment will be described with the same reference numerals.

As shown in FIG. 8, the introduction guide tube unit 1 for the treatment tool in the present embodiment is integrated by inserting the introduction guide tubes 4a and 4b for the treatment tool into the overtube 61 formed of the soft material. It is designed to be assembled in. Here, the introduction guide tubes 4a and 4b for the treatment tool are the same as in the case of the previous embodiment.

As shown in FIG. 9, the overtube 61 is provided with two insertion holes 62a and 62b in parallel for inserting the two introduction guide tubes 4a and 4b for treatment tools separately, and each insertion is provided. The holes 62a and 62b are separated from each other by the partition wall 63 and guide the introduction guide tubes 4a and 4b separately, but some of them are communicated with each other and are formed in close proximity to each other.

Further, as shown in FIGS. 9 and 10, a fixing screw 64 is screwed into the side wall located in one of the insertion holes 62b, and the introduction guide tube 4b inserted into the insertion hole 62b by this screw 64 is inserted. It can be tightened to fix the introduction guide tube 4b. Further, the introduction guide tube 4a inserted into the other insertion hole 62a is simultaneously tightened by elastically deforming the overtube 61 itself when the introduction guide tube 4b is tightened by the screw 64, and the insertion hole 62b is tightened at the same time. Is fixed to. That is, in the present embodiment, this is a fixing portion (fixing means) for fixing the vicinity of the hand side ends of the introduction guide tube 61 closer to the hand side ends than the curved portions 11 and 12, respectively, and fixing the vicinity of the hand side ends of the introduction guide tube 61 closer to each other than the curved portions 11 and 12. To configure. Further, the overtube 61 itself constitutes a treatment device connector for connecting a plurality of introduction guide tubes 61.

Further, as shown in FIG. 8, when each of the two introduction guide tubes 4a and 4b for the treatment tool is attached to the overtube 61, the region portion of the tip portion 10 and the curved portions 11 and 12 is the overtube 61. It is exposed from the tip and protrudes forward. Normally, the tip portion of the soft portion 13 is also attached so as to protrude at least slightly.

Next, a case where this endoscopic treatment device is used will be described. First, as shown in FIG. 11, two introduction guide tubes 4a and 4b for treatment tools are attached to the overtube 61 to form one unit, and this is made into one unit by using a guide means such as a tracal in the body cavity. Induce to. Here, since the introduction guide tubes 4a and 4b protruding from the tip of the overtube 61 are held with the tip of the overtube 61 as a fulcrum 27, the movement of the introduction guide tubes 4a and 4b becomes stable and smooth. Further, when the grasping forceps 48 and 49 as treatment tools are operated in the opposite directions by the introduction guide tubes 4a and 4b, the force components in the opposite directions applied to the fulcrum 27 cancel each other out. Therefore, the movable operation region portion of the introduction guide tubes 4a and 4b moves with the fulcrum 27 as a reference point, and the force applied to the grasping forceps 48 and 49 can be directly applied to the biological tissue 47.

Although different from this, only the first bending portion 11 is projected from the overtube 61 while the region portion of the second bending portion 12 of each of the introduction guide tubes 4a and 4b is positioned in the overtube 61, and the first bending portion 11 is formed. The vicinity of the boundary between the portion 11 and the second curved portion 12 may be fixed on the overtube 61 by the screw 64 or the like. At this time, only the first curved portion 11 bends with the vicinity of the boundary between the first curved portion 11 and the second curved portion 12 as a fulcrum. That is, the present invention is not limited to the vicinity of the hand side of the second curved portion 12 on the most hand side, and may be in the form of fixing a portion located in the middle of the curved portion.

Further, in the present embodiment, the endoscope 2 is a separate body from the unit, and as shown in FIG. 11, the state of being guided into the body cavity 65 along the overtube 61 of the unit and being treated can be observed. , Another treatment tool such as a high frequency knife 66 can be guided. FIG. 11 shows a situation in which a living tissue 47 raised by grasping forceps 48 and 49 is incised by a high-frequency knife 66 introduced through the endoscope 2.

Next, the endoscopic treatment apparatus according to still another embodiment of the present invention will be described with reference to FIGS. 12 and 13. The same reference numerals are given to those similar to the above-described embodiments.

In this embodiment, the two introduction guide tubes 4a and 4b for the treatment tool and the endoscope 2 described above are connected by the connecting tool 71. As shown in FIG. 12, the connector 71 has a hole 72 for fitting the insertion portion 5 of the introduction guide tube 4a, a hole 73 for fitting the insertion portion 5 of the introduction guide tube 4b, and an insertion portion of the endoscope 2. An elastic member 75 is provided in which holes 74 into which 3 is fitted are arranged in a radial pattern. Further, slits 76 for inserting and removing members from the middle are formed in the holes 72, 73, 74 of the connector 71.

FIG. 13 shows the usage status of this embodiment. Insert the insertion part 5 of the introduction guide tube 4a, the insertion part 5 of the introduction guide tube 4b, and the insertion part 3 of the endoscope 2 corresponding to the holes 72, 73, 74 of the connector 71, respectively. There is. Further, the connector 71 is attached and fixed to the tip portion 31 of the endoscope 2. Since the portion near the tip of the flexible portion 13 of the introduction guide tubes 4a and 4b is fixedly held at this position, the supporting portion serves as the fulcrum 27 of the introduction guide tubes 4a and 4b. Therefore, as shown in FIG. 13, when the introduction guide tubes 4a and 4b and the endoscope 2 are connected by the connector 71, the introduction guide tubes 4a and 4b are arranged at close positions surrounding the insertion portion 3 of the endoscope 2. To. Then, it can be used in the same manner as in the case described above.

Next, the endoscopic treatment apparatus according to still another embodiment of the present invention will be described with reference to FIG. Those similar to the above-described embodiment will be described with the same reference numerals.

In this embodiment, a flexible overtube 80 with a bending function is used. The tip end side portion of the overtube 80 is a curved portion 81, and the curved portion 81 is curved by an operation portion (not shown) arranged on the hand side of the overtube 80. The overtube 80 has a hole 83 for inserting the introduction guide tube 82, two holes 85 for inserting the two suction tubes 84a and 84b separately, and a hole for inserting the insertion portion 3 of the endoscope 2. It is formed by partitioning with 86.

Then, as shown in FIG. 14, the introduction guide tube 82, the suction tubes 84a, 84b, and the insertion portion 3 of the endoscope 2 corresponding to the holes 83, 85, 86 of the overtube 80 are inserted, respectively. These are unitized into one. The introduction guide tube 82 and the suction tubes 84a and 84b attached to the overtube 80 are attached so as to be able to move forward and backward without swaying in the radial direction. In the introduction guide tube 82 and the suction tubes 84a and 84b, the same curved portion 87 is formed in the movable region portion protruding from the tip of the overtube 80. The base end side portion of the curved portion 87 protruding from the tip of the overtube 80 is supported by the overtube 80, and the vicinity of the tip of the overtube 80 serves as a fulcrum of the movable region portion protruding further.

When this is used, as shown in FIG. 14, the introduction guide tube 82, the suction tubes 84a and 84b, and the insertion portion 3 of the endoscope 2 are projected from the tip of the overtube 80. Then, for example, the tips of the two suction tubes 84a and 84b are applied to the living tissue 47 to adsorb the living tissue 47. Further, the curved portion 87 of the suction tubes 84a and 84b protruding from the tip of the overtube 80 can be appropriately curved to pull up the living tissue 47. Further, when the curved portions 87 of the suction tubes 84a and 84b are curved in directions away from each other, the living tissue 47 can be expanded.

Even in these uses, since the movable region portion of each suction tube 84a, 84b is fixedly supported by a common fulcrum, the reaction forces applied to the suction tubes 84a, 84b cancel each other out and the overtube 80 With the tip of the fulcrum as a fulcrum, the suction tubes 84a and 84b can be operated reliably with a strong force as desired. In addition, the treatment tool can be projected from the introduction guide tube 82 for treatment.

The introduction guide tube 82 may be used as a suction tube. The suction tubes 84a and 84b may be replaced with the same treatment tool introduction guide tubes as described above.

Next, the endoscopic treatment apparatus according to still another embodiment of the present invention will be described with reference to FIG. Those similar to the above-described embodiment will be described with the same reference numerals.

In this embodiment, a flexible overtube 90 is used, and a plurality of manipulators 91a and 91b are integrally provided at the tip of the flexible overtube 90. One manipulator 91a is provided with a tip working portion 92 having a degree of freedom similar to the movement of a human finger, and the other manipulator 91b has a bending function having a degree of freedom similar to the movement of a human wrist. A curved portion 93 is provided. The manipulators 91a and 91b are remotely controlled separately by an operation input means (not shown). As the operation input means, for example, a glove type input device in which the movement of a human hand is input as it is.

An insertion channel 95 for introducing the insertion portion 3 of the endoscope 2 is formed in the flexible overtube 90. The endoscope 2 here is that of an extra-fine insertion part 3 having only an observation function.

When using this endoscopic treatment device, as shown in FIG. 15, the treatment is performed by grasping the treatment tool using the left and right manipulators 91a and 91b, which provide a degree of freedom similar to the movement of human fingers. Take measures such as directly picking the living tissue. In this treatment mode, the movement is similar to the movement of a human wrist, and it can be used with the same feeling of use as a hand, so that the operability can be further improved. It is also easy to learn how to use it.

Further, the left and right manipulators 91a and 91b are attached to the tip portion of the flexible overtube 90 and are integrally and fixedly supported. Therefore, this support portion serves as a fulcrum of the manipulators 91a and 91b as the movable region portion. Therefore, in the case where the manipulators 91a and 91b are used in opposite directions, the forces applied to the manipulators 91a and 91b cancel each other out, and the manipulators 91a and 91b are operated with the tip of the overtube 90 as a fulcrum. You can operate it with as strong a force as you want.

Next, with reference to FIGS. 16 to 18, another treatment device in which the portion of the introduction guide tube as described above is improved will be described. As shown in FIG. 17, the introduction guide tube 100 in this treatment device includes a flexible insertion portion 101 and an operation portion 102, and the operation portion 102 includes a grip portion 103 and a curved portion 104 of the insertion portion 101. It is provided with a plurality of angle knobs 105 for bending operation, an insertion port 107 leading to channel 106 of the insertion portion 101, a treatment tool operation lever 109 for operating the treatment tool operation mechanism 108 described later, and the like. The angle knob 105 is provided with a brake knob 105a that locks the operating position. Further, the treatment tool operating lever 109 may also be provided with a brake knob.

Then, as shown in FIGS. 18A and 18B, the insertion portion 110a of the treatment tool 110 such as grasping forceps is inserted into the channel 106 from the insertion port 107 of the operation portion 102 of the introduction guide tube 100. It can be projected into the body cavity from the tip opening 106a of the channel 106.

As shown in FIGS. 16 and 18 (a) and 18 (b), the treatment tool operating mechanism 108 is incorporated in the tip of the insertion portion 101. In the treatment tool operating mechanism 108 here, a ring-shaped mover 115 that allows the insertion portion 110a of the treatment tool 110 to be inserted is provided in the tip portion of the insertion portion 101 so as to be linearly movable in the front-rear axial direction. .. The tip of the operation wire 116 inserted into the insertion portion 110 is connected to the mover 115. Then, by operating the treatment tool operation lever 109 of the operation unit 102 described above, the operation wire 116 is moved back and forth in the front-rear axial direction to move the mover 115 in the front-rear axial direction, and the mover 115 of the treatment tool operation mechanism 108 is moved. The movement operation mechanism is configured to move the tip of the treatment tool back and forth by moving the handle in the front-back direction. Further, the mover 115 selectively locks and releases the gripping arm 117 as a locking member that is locked to a part of the insertion portion 110a of the treatment tool 110 by the operation wire 116 operated from the hand side. We are building a mechanism to perform operations.

As shown in FIGS. 18A and 18B, a plurality of gripping arms 117 as locking members that lock to a part of the insertion portion 110a of the treatment tool 110 project forward from the mover 115. The tip end side portion of each gripping arm 117 is elastically urged so as to spread outward in the free state shown in FIG. 18 (b). Further, a pressing portion 118 is integrally formed at the tip of each gripping arm 117. A fastener 121 is mounted on the outside of each gripping arm 117, which is slidable within a range between the mover 115 and the retainer 118. Further, a guide rail 122 for linearly guiding the fastener 121 in the front-rear direction is formed in the tip portion of the insertion portion 101. Positioning stoppers 123a and 123b formed of rising walls are formed at the front end and the rear end of the guide rail 122 to define the front and rear moving end positions of the fastener 121, respectively.

The fastener 121 includes a slide portion 124 guided by a guide rail 122, and a tightening ring portion 125 that slides on the outer circumference of the gripping arm 117. Then, as shown in FIG. 18A, when the fastener 121 is retracted, each gripping arm 117 is tightened by the fastener 121, and the holding portion 118 of each gripping arm 117 is inserted into the treatment tool 110. The treatment tool 110 is gripped by the mover 115 pressed against the outer circumference of the 110a.

If the mover 115 is moved in the front-rear direction by the operation wire 116 in the treatment tool restraint state as shown in FIG. 18A, the treatment tool 110 can be moved together in the front-rear direction. In this way, since the operation of directly grasping the tip portion of the treatment tool 110 and moving the tip portion in the front-rear direction is performed, the introduction guide tube is used as in the case of manually pushing and pulling the hand side portion of the treatment tool 110. It is not necessary to take a hand off the operation unit of the endoscope or the operation unit, and the moving / retreating operation of the treatment tool 110 can be easily performed without taking the hand off the operation unit.

Further, as shown in FIG. 18B, when the fastener 121 is advanced, the tip end side portion of each gripping arm 117 opens, and the treatment tool 110 is released. That is, the holding portion 118 of each gripping arm 117 retracts from the insertion portion 110a of the treatment tool 110, and the grip of the treatment tool 110 is released. Therefore, only the treatment tool 110 can be freely moved in the front-rear direction or the rotation direction, and the operability of the treatment tool 110 is improved.

This introduction guide tube 100 is used as an introduction guide tube in the device of the treatment system described above, and can be used for introduction of various treatment tools and the like. Of course, it can be similarly applied to the unit form in which the bearing forces applied to the movable region portions of the plurality of introduction guide tubes 100 are connected so as to cancel each other at the common fulcrum. In the existing general introduction guide tube, the treatment tool is simply inserted, but in the introduction guide tube 100 here, the treatment tool 110 can be actively rotated and moved forward and backward. It can be operated reliably. In addition, an excellent effect can be obtained when the introduction guide tube 100 is used independently of the endoscope 2.

Next, a modified example of the introduction guide tube described above will be described with reference to FIGS. 19 (a) and 19 (b). The introduction guide tube 130 of this type has a different treatment tool advancing / retreating mechanism from the introduction guide tube 100 described above. That is, this treatment tool advancing / retreating mechanism comprises supporting the cutting-edge member 132 of another member on the tip portion 131 of the introduction guide tube 130 so as to be movable in the front-rear direction via a plurality of push rods 133, and the introduction guide tube 130. By operating the treatment tool operation lever 109 provided on the operation unit 102 in the above, the push rod 133 is moved forward and backward, and the state-of-the-art member 132 is moved in the front-rear direction.

FIG. 19 (a) shows the state-of-the-art member 132 standing by at a normal position retracted backward, and FIG. 19 (b) shows the state-of-the-art member 132 moving forward.

Further, as shown in FIGS. 19A and 19B, a ring-shaped elastic member 135 as an elastic member is arranged on the peripheral edge of the tip opening 106a of the channel 106 formed in the state-of-the-art member 132. The ring-shaped elastic member 135 grips the insertion portion 110a of the treatment tool 110 protruding from the tip opening 106a of the channel 106 by tightening it with an elastic force. The treatment tool 110 is held by the elastic tightening force of the ring-shaped elastic member 135 and follows the movement of the state-of-the-art member 132. However, when the insertion portion 110a of the treatment tool 110 is pushed or pulled from the hand side, the ring-shaped elastic member 135 Only the treatment tool 110 is held by a movable force against the holding force. The treatment tool 110 may be held with an immovable strength.

In the case of such an introduction guide tube 130, it can be used as the above-mentioned introduction guide tube and can be used for introduction of treatment tools, etc., and of course, it has a common bearing capacity applied to a movable region portion of a plurality of introduction guide tubes 130. The same can be applied to a unit type that is connected so as to cancel each other at a fulcrum.

Next, a modified example of the introduction guide tube described above will be described with reference to FIGS. 20 to 26. As shown in FIG. 20, the introduction guide tube 140 includes a flexible insertion portion 141 and an operation portion 142. The operation portion 142 includes a grip portion 143, a plurality of angle knobs 145 for bending the curved portion 144 of the insertion portion 141, an insertion port 147 leading to the channel 146 of the insertion portion 141, and a procedure described later. A treatment tool rotation operation knob 149 for operating the tool rotation mechanism 148 is provided. Brake knobs 145a and 149a for locking the operation position are attached to the angle knob 145 and the treatment tool rotation operation lever 149. Further, as shown in FIG. 20, the operation unit 142 is provided with an operation button 137 for performing an operation such as suction or air supply using the channel 146.

Then, as shown in FIGS. 25 and 26, by inserting the insertion portion 150a of the treatment tool 150 such as the gripping forceps into the channel 146 from the insertion port 147 of the operation portion 142 of the introduction guide tube 140, the channel 146 The treatment tool 150 is projected into the body cavity from the tip opening 146a.

The treatment tool rotation operation mechanism 148 is incorporated in the tip end portion of the insertion portion 141, and is configured as shown in FIGS. 21 to 26. That is, a tubular connection base 153 to which the tip of the flexible tube 152 forming the channel 146 is connected is provided in the tip portion 151 of the insertion portion 141 of the introduction guide tube 140, and the connection base 153 is the tip portion. It is fixed to the support member 154 fixed to 151. As shown in FIG. 22, a tubular rotating member 156 is arranged over the connection base 153 and the tip wall 155 of the tip portion 151, and the rotating member 156 is around the longitudinal axis of the channel 146 or an axis parallel to the longitudinal axis thereof. It is rotatably supported. The rotating member 156 is open to the tip surface of the tip 151 of the introduction guide tube 140 to form the tip opening 146a of the channel 146.

As shown in FIG. 22, a bevel gear 157 as a driven gear is coaxially formed on the outer circumference of the rotating member 156. A bevel gear 158 as a driving gear meshes with the bevel gear 157. The axis of the bevel gear 158 is arranged orthogonal to the axis of the bevel gear 157 as the driven gear. As shown in FIG. 22, the bevel gear 158 as the driving gear is pivotally supported in the tip portion of the insertion portion 141. A pinion gear 159 is coaxially and integrally formed on the bevel gear 158. Then, as shown in FIG. 23, the pinion gear 159 is arranged so that a pair of racks 160a and 160b mesh with each other from both sides. The racks 160a and 160b are linearly guided by a guide (not shown) in the tip of the insertion portion 141 of the introduction guide tube 140.

Further, the tips of the operation wires 161a and 161b are separately connected to the racks 160a and 160b, and the racks 160a and 160b can be moved back and forth by pushing and pulling the operation wires 161a and 161b from the hand side. As a result, the pinion gear 159 can be rotated.

The operation wires 161a and 161b are towed by operating the treatment tool rotation operation knob 149 provided on the operation unit 142 to move the racks 160a and 160b. Then, when the racks 160a and 160b move, the pinion gear 159 rotates together with the bevel gear 158, and the bevel gear 158 rotates the bevel gear 157 as a driven gear. When the bevel gear 157 as the driven gear rotates, the rotating member 156 rotates together with the bevel gear 157.

On the other hand, as shown in FIGS. 22 and 25, an elastic member 165 such as rubber is attached to the peripheral edge of the tip of the rotating member 156. The elastic member 165 is exposed to the outside from the tip portion 151 of the insertion portion 141 of the introduction guide tube 140. Then, the elastic member 165 hits the tip portion of the treatment tool inserted through the channel 146, engages with the tip portion of the treatment tool by frictional force or deformation with the treatment tool, and rotates together with the rotating member 156. It is a means of engagement. The treatment tool inserted through the introduction guide tube 140 can be rotated by the treatment tool rotation operation mechanism 148.

When the treatment tool 150 such as gripping forceps is inserted into the introduction guide tube 140 and used, as shown in FIGS. 25 and 26, the insertion portion 150a of the treatment tool 150 is inserted into the channel 146, and the treatment tool 150 is used. The tip grip portion 150b is projected from the tip of the introduction guide tube 140.

Then, the link mechanism 168 that is opened and closed is operated to open the tip grip portion 150b, and the tip grip portion 150b is slightly retracted in this open state, and the member of the link mechanism 168 is pressed against the elastic member 165 to engage the elastic member 165. That is, the tip grip portion 150b of the treatment tool 150 is connected to the rotating member 156 by the frictional force or the engaging force between the elastic member 165 and the member of the link mechanism 168, and rotates together with the rotating member 156. ..

Therefore, when the treatment tool 150 is rotated to change the direction, the tip grip portion 150b of the treatment tool 150 can be rotated together with the rotating member 156. That is, since the tip grip portion 150b of the treatment tool 150 is directly rotated, it is possible to maintain an accurate correspondence with the rotation operation amount and to quickly rotate the tip grip portion 150b of the treatment tool 150. .. The long insertion portion 150a of the treatment tool 150 may be twisted from the hand side to assist the rotation of the tip grip portion 150b of the treatment tool 150.

Next, a modified example of the introduction guide tube provided with the treatment tool rotation operation mechanism as described above will be described with reference to FIGS. 27 and 28.

As shown in FIG. 27, in the treatment tool rotation operation mechanism of the introduction guide tube 170, the driven gear provided on the outer circumference of the rotating member 156 is a spur gear 171. A spur gear 172 as a driving gear meshes with the spur gear 171. The spur gear 172 as a drive gear is pivotally supported in the tip of the insertion portion 141. The tip of a torque transmission wire 173 configured to transmit rotational torque is connected to the shaft of the spur gear 172.

Then, by twisting and rotating the torque transmission wire 173 from the hand side, the spur gear 172 as the driving gear is rotated, and the spur gear 171 as the driven gear is rotated. As the spur gear 171 rotates, the rotating member 156 rotates together with the spur gear 171.

Further, as shown in FIG. 28, the operation unit 142 of the introduction guide tube 170 is provided with a rotation operation lever 175, and the torque transmission wire 173 is rotated by operating the rotation operation lever 175. There is. Further, the operation direction of the rotation operation lever 175 of the operation mechanism on the hand side is substantially parallel to the rotation axis at the tip of the insertion portion of the rotation operation mechanism. It should be noted that other configurations of the treatment tool rotation operation mechanism can be configured substantially in the same manner as those of the above-described embodiment.

Even in this case, it can be used to change the rotation direction of the treatment tool 150 in the same manner as in the case of the above-described embodiment. Further, since the driven gear is a spur gear 171 and the driving gear is a spur gear 172 and the spur gear 172 is rotated by the torque transmission wire 173, the mechanism to be incorporated into the tip of the introduction guide tube 170 is simplified. it can.

In the above description, the treatment tool operating mechanism for advancing / retreating or rotating the treatment tool was introduced, and the treatment tool was incorporated in the tip of the guide tube. However, the treatment tool can be moved forward / backward and rotated by combining both configurations. It is also possible to incorporate a treatment tool operation mechanism to be used.

As described above, the following problems can be solved by the introduction guide tube in the form of incorporating the treatment tool operation mechanism that advances / retreats / / rotates the treatment tool.

That is, when the direction or position of the tip of the treatment tool guided into the body cavity by the flexible introduction guide tube is changed as in the conventional case, the hand part of the treatment tool is twisted or moved forward or backward on the hand side of the introduction guide tube. Was.

However, the insertion part of the treatment tool guided through the introduction guide tube is long and flexible, and the insertion part of the treatment tool is in contact with the inner wall of the introduction guide tube and meanders in various places. Often. In particular, when the curved portion of the introduction guide tube is curved, the insertion portion of the treatment tool comes into pressure contact with the inner wall of the introduction guide tube in the curved portion.

In such a situation, even if the insertion part of the treatment tool located in the introduction guide tube is pushed or pulled from the hand side or rotated, the operating force is applied in the middle due to meandering or twisting of the insertion part of the treatment tool. It is easily absorbed, and it is difficult for the operating force from the hand side to be transmitted to the tip of the treatment tool.

However, as described above, there is no such inconvenience in the form in which the operation mechanism for advancing and retreating the treatment tool and the operation mechanism for rotating the treatment tool are incorporated in the tip of the introduction guide tube, and the operation amount is accurate. It is possible to maintain a good correspondence and operate quickly. In addition, unlike the case of pushing and pulling the hand side part of the treatment tool by hand, there is no need for complicated operations to operate by releasing the hand from the introduction guide tube or the operation part of the endoscope, and the treatment tool can be moved forward and backward. This can be done easily without taking your hands off the operation unit.

The present invention is not limited to the above-mentioned one, and can be applied to other forms. Further, according to the above description, the following items or items obtained by appropriately selecting and combining the following items can be obtained.

&lt;Additional Note&gt; 1. In the introduction guide tube through which the treatment tool used for treatment in the body cavity is inserted, the tip of the treatment tool inserted into the introduction guide tube is held at the tip of the introduction guide tube. An introduction guide tube for endoscopes, which is characterized by being provided with an operation mechanism for operating the tip of the treatment tool. 2. The introduction guide tube for an endoscope according to Item 1, wherein the operating mechanism includes a locking member that locks a part of the insertion portion of the treatment tool. 3. The introduction guide tube for an endoscope according to Item 2, further comprising a mechanism for selectively locking and releasing the locking member from the hand side. 4. The introduction guide tube for an endoscope according to Item 1, Item 2 or Item 3, wherein the operation mechanism is a movement operation mechanism that moves the tip of the treatment tool back and forth. 5. The introduction guide tube for an endoscope according to Item 1, Item 2 or Item 3, wherein the operation mechanism is a rotation operation mechanism that rotates the tip of the treatment tool. 6. The endoscopic treatment apparatus according to Item 5, wherein the rotation operation mechanism is rotatable in a rotation direction with the longitudinal axis of the treatment tool insertion channel or an axis parallel to the longitudinal axis as the rotation axis. .. 7. The endoscopic treatment device according to Item 5, wherein the rotation operation mechanism can rotate in the same direction as the operation direction of the operation mechanism on the hand side. 8. The endoscopic treatment device according to Item 5, wherein the rotation operation mechanism is characterized in that the operation direction of the operation mechanism on the hand side is substantially parallel to the rotation axis at the tip of the insertion portion of the rotation operation mechanism.

<figref num="1">The perspective view of the endoscopic treatment apparatus which concerns on one Embodiment of this invention.</figref><figref num="2">The cross-sectional view of the connecting part in the endoscopic treatment apparatus which also concerns on the said Embodiment.</figref><figref num="3">The explanatory view of the use state of the endoscopic treatment apparatus which also concerns on the said Embodiment.</figref><figref num="4">A perspective view showing an enlarged view of a connecting portion in a state where the introduction guide tube unit for a treatment tool of the endoscopic treatment device according to the above embodiment is assembled to the endoscope.</figref><figref num="5">FIG. 5 is a perspective view showing a connecting tool for assembling the introduction guide tube unit for the treatment tool of the endoscopic treatment device according to the above embodiment to the endoscope.</figref><figref num="6">The perspective view which shows the introduction guide tube in the introduction guide tube unit for the treatment tool of the endoscopic treatment apparatus which also concerns on the said embodiment.</figref><figref num="7">The vertical sectional view of the introduction guide tube in the introduction guide tube unit for the treatment tool of the endoscopic treatment apparatus which also concerns on the said embodiment.</figref><figref num="8">The perspective view of the endoscopic treatment apparatus which concerns on other embodiment of this invention.</figref><figref num="9">The perspective view which shows the overtube of the endoscopic treatment apparatus which also concerns on the said embodiment.</figref><figref num="10">The cross-sectional view of the fixed part which attached the introduction guide tube to the over tube of the endoscopic treatment apparatus which also concerns on the said embodiment.</figref><figref num="11">The explanatory view of the use state of the endoscopic treatment apparatus which also concerns on the said Embodiment.</figref><figref num="12">The developed perspective view of the endoscopic treatment apparatus which concerns on still another Embodiment of this invention.</figref><figref num="13">The explanatory view of the use state of the endoscopic treatment apparatus which also concerns on the said Embodiment.</figref><figref num="14">The perspective view which shows the tip part of the endoscopic treatment apparatus which concerns on still another Embodiment of this invention.</figref><figref num="15">The perspective view which shows the tip part of the endoscopic treatment apparatus which concerns on still another Embodiment of this invention.</figref><figref num="16">The perspective view which shows the operation part of the introduction guide tube in the endoscopic treatment apparatus which concerns on still another Embodiment of this invention.</figref><figref num="17">The plan view of the operation part of the introduction guide tube in the endoscopic treatment apparatus which also concerns on the said embodiment.</figref><figref num="18">The vertical sectional view of the tip part of the introduction guide tube in the endoscopic treatment apparatus which also concerns on the said embodiment.</figref><figref num="19">The perspective view which shows the tip part of the introduction guide tube in the endoscopic treatment apparatus which concerns on still another Embodiment of this invention.</figref><figref num="20">The perspective view which shows the operation part of the introduction guide tube in the endoscopic treatment apparatus which concerns on still another Embodiment of this invention.</figref><figref num="21">The perspective view which shows the treatment tool rotation mechanism incorporated in the tip part of the introduction guide tube in the endoscopic treatment apparatus which also concerns on the said embodiment.</figref><figref num="22">The vertical cross-sectional view of the treatment tool rotation mechanism incorporated in the tip part of the introduction guide tube in the endoscopic treatment apparatus which also concerns on the said embodiment.</figref><figref num="23">The plan view which shows the gear row of the treatment tool rotation mechanism incorporated in the tip part of the introduction guide tube in the endoscopic treatment apparatus which also concerns on the said embodiment.</figref><figref num="24">The perspective view which shows the gear row of the treatment tool rotation mechanism incorporated in the tip part of the introduction guide tube in the endoscopic treatment apparatus which also concerns on the said embodiment.</figref><figref num="25">The perspective view of the tip part at the time of using the introduction guide tube of the endoscopic treatment apparatus which also concerns on the said embodiment.</figref><figref num="26">The vertical sectional view of the tip portion at the time of using the introduction guide tube of the endoscopic treatment apparatus which also concerns on the said embodiment.</figref><figref num="27">The perspective view which shows the treatment tool rotation mechanism incorporated in the tip part of the introduction guide tube in the endoscopic treatment apparatus which also concerns on the said embodiment.</figref><figref num="28">The side view of the operation part of the introduction guide tube in the endoscopic treatment apparatus which also concerns on the said embodiment.</figref>

Code description

1 ... Introduction guide tube unit for treatment tools, 4a ... Introduction guide tube for treatment tools 4b ... Introduction guide tube for treatment tools 11 ... 1st curved part 12 ... 2nd curved part 27. ..fulcrum