JP2009095451A - Endoscope treatment tool - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To inhibit an invalid stroke to the minimum when a flexible cord member is inserted to the inside and moved by using a flexible sheath simply configured and manufactured at low cost. <P>SOLUTION: A treatment tool inserting channel 24 is mounted on the inserting part 22 of an endoscope 20 and a high-frequency treatment tool 1 is inserted and guided to the channel 24, and a flexible sheath 2 of the high-frequency treatment tool 1 is composed of the outer sheath 2a and the inner sheath 2b which is inserted to the inside, and the inside of the inner sheath 2b is inserted with a flexible cord 11 having a snare wire 14 at the tip part, and the external diameter of the flexible cord 11 is a little wider than the internal diameter of the inner sheath 2b, and it causes that the flexible cord 11 can be allowed to move in the inner sheath 2b in the axial direction but the movement to the other directions is limited. <P>COPYRIGHT: (C)2009,JPO&INPIT

Description

  The present invention relates to an endoscope treatment instrument that is inserted into a treatment instrument insertion channel of an endoscope and used for performing a predetermined treatment on a lesioned part.

  As typical treatment tools for endoscopes, there are high-frequency treatment tools such as a high-frequency knife and a high-frequency snare, and an injection needle and other treatment tools for injecting a drug solution into a necessary site are also used. These treatment tools are introduced into a body cavity by a guide member, and an endoscope is usually used as the guide member. As is well known, an endoscope has a main body operation unit that is operated and grasped by a hand by an operator, and an insertion unit that is inserted into a body cavity of a subject is connected to the main body operation. In addition, a universal cord having a connector connected to a light source device or a processor (video signal processing device) is provided to extend. The endoscope is provided with a treatment instrument introduction section in the main body operation section, and a treatment instrument insertion channel that opens from the treatment instrument introduction section to the distal end hard portion of the insertion section.

  The various treatment tools described above are inserted into the treatment tool insertion channel, and a treatment or the like is performed on the body cavity inner wall in a state where the treatment tool insertion channel protrudes a predetermined length from the distal end opening of the treatment tool insertion channel. For example, a high-frequency treatment tool is used to perform a treatment for excising a lesion portion generated on a body cavity inner wall such as the esophagus, stomach, duodenum, and large intestine. For example, as disclosed in Patent Document 1, this high-frequency treatment instrument is inserted into a body cavity using a treatment instrument insertion channel of an endoscope as a guide means, and a flexible sheath is led out from the distal end of the treatment instrument insertion channel. By causing the electrode member to be led out from the flexible sheath and energizing the electrode member, treatments such as mucosal cauterization and incision are performed.

  FIG. 7 shows a schematic configuration of the high-frequency treatment tool disclosed in Patent Document 1. In the figure, reference numeral 100 denotes a high-frequency treatment instrument, and the high-frequency treatment instrument 100 includes a flexible sheath 101 and an operation unit 102. As shown in FIG. 8, the flexible sheath 101 is made of a tube material, and includes a high-frequency electrode 103 and a flexible cord 104 connected to the high-frequency electrode 103 inside. Here, the illustrated flexible cord 104 is formed by inserting a wire 104b into a close contact coil 104a. The high frequency electrode 103 protrudes a predetermined length from the tip of the close contact coil 104a, and a gap is formed between the high frequency electrode 103 and the close contact coil 104a.

  A distal end stopper member 105 is attached to the distal end portion of the flexible sheath 101. The distal end stopper member 105 is formed of a hard cylindrical body. When the flexible cord 104 is operated to be pushed out, the high-frequency electrode 103 is pushed forward in the distal end stopper member 105, so that a flexible sheath is formed. Derived from the tip of 101. The lead-out length of the high-frequency electrode 103 reaches a position where the tip of the contact coil 104a of the flexible cord 104 contacts the tip stopper member 105, and the lead-out length of the high-frequency electrode 103 is regulated.

The operation unit 102 is for pushing and pulling the high-frequency electrode 103 in the flexible sheath 101, and the base end of the flexible cord 104 is connected to the shaft portion 106 to which the base end portion of the flexible sheath 101 is connected. It has a slider 107 connecting the parts. When the slider 107 is advanced along the shaft portion 106, the flexible cord 104 is displaced so as to be pushed out in the flexible sheath 101, and the high-frequency electrode 103 is led out from the distal end of the flexible sheath 101. Further, when the slider 107 is retracted, the flexible cord 104 connected to the high-frequency electrode 103 is drawn into the flexible sheath 101. In the figure, reference numeral 108 denotes a high frequency power cord for connection to a high frequency power source (not shown).
JP 2007-1111148 A

  By the way, in the above-described high-frequency treatment instrument, since the distal end stopper member 105 is inserted into the distal end of the flexible sheath 101, the inner diameter thereof is restricted to the outer diameter of the distal end stopper member 105. The distal end stopper member 105 is made of a hard cylinder and must have a predetermined strength, so that a certain thickness is required. For this reason, the inner diameter of the flexible sheath 101 is increased, and a diameter difference is generated between the flexible sheath 101 and the flexible cord 104 inserted therein.

  Here, when the flexible sheath 101 is bent at an intermediate position, if the slider 107 of the operation unit 102 is operated, the operation is ineffective due to the diameter difference between the flexible sheath 101 and the flexible cord 104 described above. A stroke will occur, and the operability will deteriorate. For example, as shown in FIG. 9, when the flexible sheath 101 is looped in the middle, if the flexible cord 104 is operated in the pushing direction as indicated by the arrow F, the flexible sheath 104 becomes flexible. The high-frequency electrode 103 does not move until the sex cord 104 contacts the outer inner wall 101F inside the flexible sheath 101. Further, as indicated by the arrow R, when the flexible cord 104 is operated in the retracting direction, the high-frequency electrode 103 is kept until the flexible cord 104 comes into contact with the inner wall 101R inside the flexible sheath 101. Will not move.

  As described above, when the flexible sheath 101 is bent, even if the slider 107 of the operation unit 102 is operated, the treatment action portion provided at the distal end of the flexible cord does not move, and a so-called invalid stroke for the operation occurs. In addition, this invalid stroke changes depending on the degree of bending of the flexible sheath 101, and the operability of the treatment instrument is poor.

  Here, the above-described invalid stroke occurs because there is a difference in diameter between the inner diameter of the flexible sheath and the outer diameter of the flexible cord. The larger the difference in diameter, the larger the invalid stroke. Become. Therefore, the smaller the difference between the inner diameter of the flexible sheath and the outer diameter of the flexible cord, the smaller the invalid stroke. For this purpose, it is conceivable to increase the outer diameter of the flexible cord. Here, when the high-frequency electrode is connected to the tip of the flexible cord, the flexible cord is formed of metal since at least the wire is required to be conductive. Therefore, when the diameter of the wire is increased, the rigidity is increased and the operability of inserting the endoscope into the treatment instrument insertion channel is deteriorated. On the other hand, it is conceivable to reduce the inner and outer diameters of the flexible sheath. However, as described above, it is difficult to attach the distal end stopper member, and the diameter difference from the inner diameter of the treatment instrument insertion channel increases. Therefore, the relationship between the treatment instrument insertion channel and the treatment instrument is the same as the relationship between the flexible sheath and the flexible cord described above, and an invalid stroke occurs when being derived from the treatment instrument insertion channel. The play at the treatment instrument insertion channel outlet becomes large, and it becomes difficult to control the sniper and position to the site to be treated.

  From the above, it is advantageous to increase the thickness of the flexible sheath in order to suppress the above-described invalid stroke. That is, as shown in FIG. 10, the thickness of the flexible sheath 101 is increased, and the diameter difference from the flexible cord 104 inserted therein is reduced. As a result, the invalid stroke at the time of the push-pull operation by the operation unit can be reduced by the amount that the diameter difference is reduced.

  However, it is necessary to secure a space for mounting the distal end stopper member 105 made of a hard cylindrical body at the distal end of the flexible sheath 101. For this purpose, a process for reducing the inner diameter of the distal end portion of the flexible sheath 101 is performed. Must. In addition, the flexible sheath 101 needs to be configured with a slippery member because it is inserted into the treatment instrument insertion channel. For this purpose, an expensive material such as a fluororesin is used. The cost is increased by the increase in the thickness of the flexible sheath 101.

  It is an object of the present invention to minimize an ineffective stroke during movement of a flexible cord member inserted therein by using a flexible sheath that can be manufactured at low cost with a simple configuration. .

  In order to achieve the above-mentioned object, the present invention is a flexible cord that is inserted and guided in a treatment instrument insertion channel provided in an insertion portion of an endoscope, and a treatment action portion is provided at the tip of the flexible sheath. An endoscopic treatment tool for inserting and retracting the treatment action portion from the distal end of the flexible sheath by inserting and pulling the flexible cord member, wherein the flexible sheath includes: An outer sheath and an inner sheath inserted into the outer sheath, with the distal end of the inner sheath positioned on the back side from the distal end of the outer sheath, an inner diameter enlarged portion is formed from the distal end of the inner sheath to the distal end of the outer sheath, The inner sheath has an inner diameter that allows movement of the flexible cord member in the axial direction and restricts movement in a direction other than the axial direction. It is.

  Here, the endoscopic treatment instrument is not limited to a high-frequency treatment instrument such as a high-frequency knife or a high-frequency snare, but also a forceps such as a biopsy forceps or a grasping forceps, an injection needle, a cytodiagnosis. It may be one that does not pass current, such as a brush. The flexible sheath is provided with an inner diameter enlarged portion at the distal end portion, but depending on the application used as a treatment instrument, some member may be attached to the inner diameter enlarged portion, and the inner diameter is increased. May be held as is. For example, when a stopper member for restricting the length of the treatment action portion from the flexible sheath at the distal end of the treatment instrument is attached and a high-frequency current flows, an electrical insulating member is attached. Further, when a clamp member is provided at the distal end of the flexible cord as in a high-frequency snare, this clamp member is used as a space that can be retracted.

  The flexible sheath includes an outer sheath and an inner sheath, and an inner diameter enlarged portion is formed between the end portion of the inner sheath and the end portion of the outer sheath. As described above, the inner diameter enlarged portion may be a large-diameter opening portion with a predetermined member attached thereto or no member attached thereto. The outer sheath is preferably formed of a low-friction material such as a fluororesin because it is inserted into the treatment instrument insertion channel of the endoscope. On the other hand, the flexible cord slides inside the inner sheath, but the sliding distance is extremely short. Accordingly, the inner sheath may be made of an inexpensive material such as polyethylene. Thereby, the price of the flexible sheath can be reduced. In addition, depending on the type of treatment instrument, for example, an electromagnetic shield function can be provided, and a necessary function can be provided on the inner surface side of the flexible sheath. Since the inner sheath has a long insertion portion with respect to the outer sheath, it is not necessary to fix the inner sheath in a state where the inner sheath is inserted. However, the inner sheath and the outer sheath are fixed to each other with an adhesive or the entire length. can do.

  The treatment tool is inserted into the body cavity via the treatment tool insertion channel of the endoscope. As an insertion portion of the endoscope, there are a flexible mirror that can be inserted into a bent insertion path, and a rigid endoscope that is configured by a hard cylindrical member as an insertion portion, and as long as it has a treatment instrument insertion channel, It can also be inserted into an endoscope. In the flexible mirror, the distal end portion of the insertion portion is a hard tip portion, a bending portion is connected to the hard tip portion, and the soft portion is connected to the bending portion. The bending portion is bent by a hand operation by the main body operation unit connected to the insertion portion, and is also operated to be greatly bent at an angle of 180 degrees or more, so the treatment instrument is used as a treatment instrument insertion channel. With respect to the portion located in the bending portion in the inserted state, the bending operation can be smoothly performed by configuring the inner sheath with a soft member. A portion of the inner sheath on the proximal end side thereof can be constituted by a member having a certain degree of waist in order to exert a pushing thrust during the insertion operation into the treatment instrument insertion channel.

  Since the flexible sheath is composed of the outer sheath and the inner sheath inserted into the outer sheath, the inner sheath is different from the outer sheath by arranging the inner sheath on the proximal side from the position of the outlet port with respect to the outer sheath. By using a material, etc., it becomes possible to manufacture with a simple structure and at a low cost, and by setting the inner sheath to a predetermined inner diameter, the flexible cord member inserted therein is ineffective at the time of movement. Stroke can be minimized.

  Hereinafter, a first embodiment of the present invention will be described with reference to the drawings. First, FIG. 1 shows a configuration of a high-frequency treatment tool as an endoscope treatment tool, and FIG. 2 shows an enlarged cross-sectional view of the main part of FIG. In the figure, 1 is a high-frequency treatment instrument. The high-frequency treatment instrument 1 has a long flexible sheath 2, and a connection pipe 3 is connected to a proximal end portion of the flexible sheath 2, and an operation means 4 is connected to the other end of the connection pipe 3. Are connected. The operating means 4 includes a main body shaft 4a connected to the connection pipe 3, and a slider 4b which is fitted to the main body shaft 4a and is slidable in the axial direction. A base end portion of a flexible cord 11 constituting the treatment instrument main body 10 is connected to the slider 4b. A base end portion of the flexible cord 11 protrudes a predetermined length from a connecting portion to the slider 4b, and a contact portion 12 is provided. Therefore, the contact portion 12 is detachably connected to a high frequency power supply device (not shown).

  As is clear from FIG. 2, the flexible cord 11 constituting the treatment instrument body 10 extends from the connecting portion to the slider 4 b through the inside of the connecting pipe 3 and into the flexible sheath 2. A predetermined length of the distal end portion of the flexible cord 11 is not subjected to insulation treatment, and is not folded back in the middle, and the folded end portion is fixed by the clamp member 13, whereby a loop-shaped snare wire portion is formed. 14 is formed. This snare wire part 14 is a treatment action part. In FIG. 2, the snare wire portion 14 is drawn into the flexible sheath 2 so that the loop is closed. When the portion where the clamp member 13 is provided is led out from the distal end of the flexible sheath 2. As shown in FIG. 3, the loop of the snare wire portion 14 is expanded. Therefore, when the snare wire portion 14 is drawn into the flexible sheath 2 while enclosing the affected area in the loop and applying a high-frequency current, the affected area can be excised.

  In order to make the snare wire portion 14 constituting the distal end of the flexible cord 11 protrude and retract from the flexible sheath 2, the flexible sheath 2 is coupled to the connection pipe 3, and the proximal end portion of the flexible cord 11 is It is connected to the slider 4b. Then, by sliding the slider 4b with respect to the main body shaft 4a with fingers, the snare wire portion 14 appears and disappears from the distal end of the flexible sheath 2. When the slider 4b is moved along the main body axis 4a to the connection side to the flexible sheath 2, the flexible cord 11 slides forward in the flexible sheath 2, and the snare wire portion 14 is flexible. Extruded from the sheath 2. On the other hand, when the slider 4 b is slid in the opposite direction, the snare wire portion 14 is drawn into the flexible sheath 2.

  As described above, when the slider 4b is moved, the snare wire portion 14 is moved in such a manner that the slider 4b is reliably moved, that is, the responsiveness is improved and the invalid stroke for the operation of the slider 4b is prevented. The flexible cord 11 must always be arranged on the central axis within the flexible sheath 2. For this purpose, that is, in order to center the flexible cord 11 inside the flexible sheath 2, the flexible sheath 2 is composed of an outer sheath 2a and an inner sheath 2b, and the inner sheath 2b is inserted into the outer sheath 2a. Like to do. The inner diameter of the inner sheath 2b is made slightly larger than the outer diameter of the flexible cord 11, and the difference in diameter between them is made as small as possible within a range that does not hinder the movement of the flexible cord 11. As a result, the flexible cord 11 can move only in the axial direction, and the movement in other directions is restricted.

  Here, the distal end portion of the inner sheath 2b in the flexible sheath 2 is positioned on the proximal end side, that is, the back side from the distal end portion of the outer sheath 2a. As a result, the flexible sheath 2 has a step structure between the inner sheath 2b and the outer sheath 2a in the vicinity of the distal end thereof, and the distal end side becomes the inner diameter enlarged portion 15. As shown in FIG. 2, the length of the inner diameter enlarged portion 15 in the axial direction is such that the snare wire portion 14 is completely flexible when the treatment instrument body 10 is drawn into the flexible sheath 2. 2 and the clamp member 13 attached to the tip of the flexible cord 11 is set so as to be located in the inner diameter enlarged portion 15.

  As shown in FIG. 4, the high-frequency treatment instrument 1 configured as described above is inserted into a body cavity of a subject using the endoscope 20 as an insertion guide means. Here, the endoscope 20 is provided by connecting a main body operation unit 21 with an insertion unit 22 into a body cavity, and the insertion unit 22 has a predetermined length from the connection unit to the main body operation unit 21. Is a flexible portion 22a, which has a curved portion 22b at the distal end of the flexible portion 22a and a hard distal portion 22c at the distal end of the curved portion 22b. The distal rigid portion 22c includes an illumination unit and an observation unit. Mirror observation means is attached.

  FIG. 5 shows a cross section of the distal end portion of the insertion portion 22. In this cross-sectional position, the configuration of the observation unit is shown, and the illumination units are usually provided on both the left and right sides of the observation unit. As is well known, the observation unit 23 is generally composed of an objective optical system 23a, a prism 23b, and a solid-state image sensor 23c. FIG. 5 also shows the treatment instrument insertion channel 24. The distal end portion of the treatment instrument insertion channel 24 opens as a treatment instrument outlet 24a at the distal end surface of the distal end hard portion 22c, and the proximal end portion of the treatment instrument insertion channel 24 is the main body as shown in FIG. It communicates with a treatment instrument introduction section 24b provided in the operation section 21.

  The flexible sheath 2 constituting the high-frequency treatment instrument 1 is inserted into the treatment instrument insertion channel 24 from the treatment instrument introduction part 24b and protrudes from the treatment instrument outlet 24a by a predetermined length, and various treatments are performed. Here, when the flexible sheath 2 is inserted into the treatment instrument insertion channel 24 and the distal end thereof is led out from the treatment instrument outlet 24a, the treatment instrument is surely prevented from being shaken or bent. The insertion channel 24 is directed in the axial direction. For this reason, it is necessary to reduce the difference in diameter between the outer diameter of the flexible sheath 2 and the inner diameter of the treatment instrument insertion channel 24. Therefore, the outer diameter of the flexible sheath 2, that is, the outer diameter of the outer sheath 2 a is made slightly smaller than the inner diameter of the treatment instrument insertion channel 24.

  Further, as described above, the inner diameter of the flexible sheath 2 is slightly larger than the outer diameter of the flexible cord 11. For this purpose, the flexible sheath 2 has a two-layer structure of an outer sheath 2a and an inner sheath 2b, and the inner diameter of the inner sheath 2b is reduced. Since the outer sheath 2a is inserted into the treatment instrument insertion channel 24, the outer sheath 2a is made of a low-friction material such as a slippery member such as a fluororesin. On the other hand, although the inner sheath 2b slides with the flexible cord 11, since the sliding stroke is short, an inexpensive material such as polyethylene is used although the sliding property is somewhat inferior.

  The outer sheath 2a and the inner sheath 2b can be fixed to each other using an adhesive, but can also be brought into a non-fixed state. When in a non-adhered state, the rigidity in the axial direction is high, but the flexibility in the bending direction is good. In other words, when the flexible sheath 2 is bent, the outer sheath 2a and the inner sheath 2b are bent while sliding, and compared with a single-layer tube of the same material and the same thickness, it is flexible in the bending direction. The property is good. However, it has substantially the same rigidity in the axial direction. Accordingly, when the flexible sheath 2 is inserted into the treatment instrument insertion channel 24, the flexible sheath 2 is pushed from the treatment instrument introduction portion 24b, but this pushing force is reliably transmitted to the distal end. Moreover, since the flexible sheath 2 has good flexibility in the bending direction, even if the insertion portion 22 is bent, the flexible sheath 2 smoothly follows this bending. Therefore, the operability of inserting the high-frequency treatment instrument 1 into the treatment instrument insertion channel 24 is improved.

  A bending portion 22b is provided in the vicinity of the distal end of the insertion portion 22, and the bending portion 22b may be bent by 180 degrees or more. The bending operation of the bending portion 22b is performed by turning the operation knob 26 of the main body operation portion 21 with fingers. When the operation knob 26 is bent in a state where the high-frequency treatment instrument 1 is inserted into the treatment instrument insertion channel 24 (but not protruding from the treatment instrument outlet 24a), the flexible sheath 2 becomes a resistance. A large load may act. Therefore, when inserted into the treatment instrument insertion channel 24 and the distal end of the flexible sheath 2 is positioned in the vicinity of the treatment instrument outlet 24a, the inner sheath 2b extends from the distal end beyond the curved portion 22b to the flexible portion. The portion up to 22a can be formed of a soft member, and the base end side can be formed of a member having a certain degree of rigidity. That is, the inner sheath 2b may be uniform over the entire length, but the distal end side can be constituted by a soft member and the proximal end side can be constituted by a member having rigidity. Thereby, the operability of the insertion operation of the treatment instrument body 10 into the treatment instrument insertion channel 24 is good, and the bending operation of the bending portion 22b is also good.

  Next, FIG. 6 shows a distal end portion of a high-frequency treatment instrument 30 showing a second embodiment of the present invention. This high-frequency treatment instrument 30 has a flexible cord 32 in a flexible sheath 31. The rod-shaped electrode 33 which comprises the treatment effect | action part is connected and provided in the front-end | tip of this flexible cord 32. Further, the connecting portion between the flexible cord 32 and the rod-shaped electrode 33 has a locking piece 34 having a diameter larger than those. A stopper member 35 is attached to the distal end portion of the flexible sheath 31. The stopper member 35 is composed of a hard cylinder, and the stopper member 35 is formed with a through hole 35a through which the rod-shaped electrode 33 is inserted so as to penetrate in the axial direction. The position where the locking piece 34 contacts the stopper member 35 is the most advanced position of the rod-shaped electrode 33.

  The flexible sheath 31 of the high-frequency treatment instrument 30 includes an outer sheath 31a and an inner sheath 31b inserted into the outer sheath 31a. And the front-end | tip of the inner sheath 31b is located in the back | inner side rather than the front-end | tip part of the outer sheath 31a, and it is the internal diameter enlarged part 36 between the level | step-difference part in the edge part of this inner sheath 31b to the front-end | tip of the outer sheath 31a. The stopper member 35 is located in the inner diameter enlarged portion 36, and the locking piece 34 provided between the flexible cord 32 and the rod-shaped electrode 33 is also located in the inner diameter enlarged portion 36. is doing. The inner sheath 31b has an inner diameter that is slightly larger than the outer diameter of the flexible cord 32, and can smoothly reciprocate within the inner sheath 31b of the flexible cord 32. By minimizing the difference in diameter with the flexible cord 32, the movement of the inner sheath 31b of the flexible cord 32 other than in the axial direction is restricted. Therefore, even if the flexible sheath 31 in the high-frequency treatment instrument 30 is bent, the position of the rod-shaped electrode 33 does not change, and the rod-shaped electrode 33 is led out from the flexible sheath 31. There is no invalid stroke in the operation of drawing into the sheath 31.

1 is an overall configuration diagram of an endoscope treatment tool showing one embodiment of the present invention. It is a principal part expanded sectional view of FIG. It is principal part sectional drawing of the treatment tool for endoscopes in the state where the snare wire part was led out from the flexible sheath. It is an external view which shows the state which penetrated the treatment tool penetration channel of the endoscope for the treatment tool for endoscopes which shows one Embodiment of this invention. It is sectional drawing of the front-end | tip part position of the insertion part of FIG. It is sectional drawing which shows the front-end | tip part of the treatment tool for endoscopes in the 2nd Embodiment of this invention. It is a whole block diagram of the treatment tool for endoscopes by a prior art. It is sectional drawing of the front-end | tip part of the treatment tool for endoscopes of FIG. FIG. 8 is an operation explanatory diagram illustrating the behavior of the flexible cord when the flexible sheath of the endoscope treatment tool in FIG. 7 is formed into a loop shape. FIG. 9 is a cross-sectional view similar to FIG. 8 showing one method for solving the problem of the endoscope treatment tool in FIG. 7.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1,30 Treatment tool 2,31 Flexible sheath 2a, 31a Outer sheath 2b, 31b Inner sheath 4 Operation means 4a Main body shaft 4b Slider 11, 32 Flexible cord 13 Clamp member 14 Snare wire part 15, 36 Inner diameter enlarged part 20 Inside Endoscope 22 Insertion section 22a Soft section 22b Bending section 22c Hard tip section 24 Treatment instrument insertion channel 33 Bar electrode 34 Locking piece 35 Stopper member

Claims (3)

Inserted and guided by a treatment instrument insertion channel provided in the insertion portion of the endoscope, a flexible cord member provided with a treatment action portion at the tip is inserted into the flexible sheath, and the flexible cord member is pushed. In an endoscopic treatment tool that causes the treatment action part to appear and disappear from the distal end of the flexible sheath by pulling operation,
The flexible sheath comprises an outer sheath and an inner sheath inserted into the outer sheath,
An inner diameter enlarged portion is formed from the tip of the inner sheath to the tip of the outer sheath, with the tip of the inner sheath positioned behind the tip of the outer sheath.
An endoscopic treatment instrument characterized in that an inner diameter of the inner sheath allows movement in the axial direction of the flexible cord member and restricts movement in a direction other than the axial direction. 2. The internal view according to claim 1, wherein a hard cylindrical member is attached to the inner diameter enlarged portion, and the treatment instrument operating portion can be projected and retracted through a through hole formed in the hard cylindrical member. Mirror treatment tool. The insertion portion of the endoscope is provided by connecting a bending portion capable of bending operation to a distal end hard portion where the distal end of the treatment instrument insertion channel opens, and a configuration in which a bending portion is connected to the bending portion is provided. When the flexible sheath is inserted into the treatment instrument insertion channel, at least the inner sheath of the portion located in the bending portion is formed of a member that is softer than the proximal end portion. The endoscope treatment tool according to claim 1 or 2.

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