JP4726014B2 - Endoscopic high-frequency treatment instrument for endoscope - Google Patents

Description

  The present invention relates to a scissors-type high-frequency treatment instrument for an endoscope which is introduced into a body through a treatment instrument guide tube of an endoscope and in which a high-frequency current is passed through a pair of scissors to incise or cut a living tissue. .

In general, a scissors-type high-frequency treatment instrument for an endoscope is moved forward at the distal end of the sheath inserted into and removed from the treatment instrument guide tube of the endoscope, with the rear end side as a pivotal fulcrum by an operation from the proximal end side of the sheath. A pair of scissors that open and close is disposed, and the opposing surfaces of the pair of scissors or the entire scissors are electrode blades (for example, Patent Document 1).
JP 2003-299667 A

When incising or cutting biological tissue with the scissors-type high-frequency treatment instrument for endoscope, first, a pair of scissors pieces are opened, and the biological tissue to be treated is positioned therebetween. Then, a closing force is applied to the sepal piece so that the living tissue is picked with the sepal piece (that is, with the electrode blade), and then the living body tissue is incised or cut by closing the electrode blade while applying a high-frequency current. It can be performed.
When performing so-called submucosal dissection, etc., which removes the mucous membrane from the underlying muscle layer, after incising the surface mucosa, the fibrous muscles connected in a fibrous form between the mucosa and the underlying muscle layer are removed. It will be cut off.

However, such a fibrous streak is difficult to pick and slippery, so even if the operation is simply picked with a pair of scissors, the scissors can slip well on the surface of the fibrous streaks and be picked well. First, the operation may be repeated, and the treatment may take a long time.
Also, if you are crazy about cutting such fibrous streaks, you will not notice that the electrode blade touches the surrounding normal tissue other than the fibrous streaks, and the normal tissue is unnecessarily cauterized with high-frequency current. May be damaged.

  The present invention has been made in order to solve such a problem, and can reliably hold and hold the fibrous streak with a pair of scissors before energizing the electrode blade with the high-frequency current. An object of the present invention is to provide a scissors-type high-frequency treatment instrument for an endoscope which can safely and smoothly perform a submucosal layer peeling treatment in a short time without causing unnecessary tissue damage or the like due to energization.

In order to achieve the above object, the present invention provides a sheath inserted into and removed from a treatment instrument guide tube of an endoscope, and a distal end side having an arc shape with a rear end side as a rotation fulcrum by an operation from the proximal end side of the sheath. And a pair of scissors arranged opposite to each other so that the entire outer surface of the scissors is covered with an electrical insulating material. Is formed in a shape that is curved in a direction perpendicular to the plane formed by the arc-shaped opening and closing trajectory of a pair of flange pieces, and is electrically insulated at a position near the inner edge of the curve along the longitudinal direction of each flange piece. The electrode blade has a conductive portion exposed by peeling the material, and a hook-shaped protrusion protruding from the electrode blade toward the closing direction at one end of the pair of hooks.

The electrode edge formed at each of the scissor pieces of a pair may be arranged in a positional relationship facing when closed a pair of scissor pieces. In addition, the electrode blade may be formed so as to protrude in the closing direction from the opposing surface of the hook piece, and the tip of the electrode blade formed on the hook piece on which the hook-like protrusion is not formed is the tip of the hook piece. The surface of the part between the tip of the electrode blade and the tip of the collar piece may be electrically insulated.

The end wall of the hook-like projections may be formed on the inclined surfaces of saving backwards toward the tip side of the hook-like projection, the tip of the distal end support frame sheath supports the scissor pieces of a pair A pair of flanges may be rotated around the axis together with the tip support frame by rotating the operation wire around the axis. Further, the hook-shaped protrusion may cover the tip end side of the other electrode blade.

  According to the scissors-type high-frequency treatment instrument for an endoscope of the present invention, a hook-shaped protrusion whose surface is electrically insulated with respect to the electrode blade is disposed on the tip of only one of the pair of scissors. By projecting and forming in a state of projecting from the blade, the fibrous streaks can be easily pulled before passing a high-frequency current through the electrode blade, and can be securely held by a pair of scissors. The piece is formed in a shape that is curved in a direction perpendicular to the opening and closing direction, and the elongated electrode blades are exposed on both opposing surfaces of the pair of hook pieces along the longitudinal direction of each hook piece, Since the electrode blade is unlikely to contact the surrounding normal tissue or the like, unnecessary tissue damage or the like is not caused by energization of the high frequency current, and the submucosal layer peeling treatment or the like can be performed safely and smoothly in a short time.

Embodiments of the present invention will be specifically described below with reference to the drawings.
FIG. 2 is a side partial sectional view of the vicinity of the distal end of the scissors-type high-frequency treatment instrument for endoscopes according to the first embodiment of the present invention, FIG. 3 is a plan partial sectional view, and FIG. FIG. In addition, although a pair of collar pieces 6A and 6B arranged facing each other are formed in a curved shape as shown in FIG. 3, it is schematically shown straight in FIG. FIG. 3 shows only one flange piece 6B.

  A flexible sheath 1 that can be inserted into and removed from a treatment instrument guide tube of an endoscope is formed of a coil pipe that is tightly wound with a stainless steel wire or the like, and a sheath made of an electrically insulating flexible tube on the outer peripheral surface thereof. The outer skin 2 is covered over the entire length. The distal end of the sheath sheath 2 is covered and fixed to the outer periphery of the distal end cap 3 fixedly attached to the distal end of the flexible sheath 1. 4 is a conductive operation wire that is loosely inserted into the flexible sheath 1, and advances and retracts in the axial direction by an operation from an operation unit (not shown) connected to the base end of the flexible sheath 1. And can be rotated about an axis.

  Reference numeral 5 denotes a tip support frame which cannot be moved in the axial direction with respect to the tip cap 3 but is connected to the tip cap 3 so as to be rotatable around the axis, and is formed of a highly rigid electrically insulating plastic material or the like. Has been. At the tip of the slit 7 formed in the tip support frame 5, a pair of flanges 6A and 6B made of a conductive metal are arranged around a support shaft 8 made of a highly rigid electrically insulating plastic material or the like. With the end side as a fulcrum, it is supported so as to be openable and closable forward. 9 is a known link mechanism for opening and closing the pair of collar pieces 6A and 6B, and the tip of the operation wire 4 is connected to a link mechanism 9 made of conductive metal. However, the pair of flange pieces 6A and 6B may be opened and closed by a mechanism other than the link mechanism 9.

  With such a configuration, when the operation wire 4 is moved back and forth in the operation portion, the pair of hook pieces 6A and 6B rotate around the support shaft 8 to open and close forward, and the operation wire 4 is rotated around the axis. If the rotation operation is performed, the distal end support frame 5 and the flange pieces 6A and 6B and the like are integrally rotated around the axis of the distal end cap 3. Then, by connecting the operation wire 4 to a high-frequency power source (not shown) on the operation unit side, a high-frequency current can be supplied to each of the pieces 6A and 6B via the operation wire 4. In FIG. 2, a state in which the pair of collars 6A and 6B are opened is shown by a solid line, but a closed state is also shown by a two-dot chain line.

  As shown in FIGS. 1 and 3, the pair of collar pieces 6A and 6B are formed in a shape curved in a direction perpendicular to the opening and closing direction at the intermediate portion. In this embodiment, as shown in FIG. 3, the center line of the distal end portion of the flexible sheath 1 (that is, the center of the distal end support frame 5) as each flange piece 6 </ b> A, 6 </ b> B moves forward from the distal end support frame 5. It is formed in a shape that gradually goes away from the extension line C of the line) and reaches the opposite side across the extension line C of the center line at a position forward from the curved portion. As a result, if the outer wall surface of the curved shape is brought into contact with the body tissue surface 30, the electrode blades 10A and 10B are unlikely to contact the body tissue surface 30. In addition, the bending amount of the collar pieces 6A and 6B can be reduced without causing the collar pieces 6A and 6B to jump out of the extended line of the outer edge of the distal end support frame 5 (thus, it can be easily inserted into and removed from the treatment instrument guide tube of the endoscope). It can be taken big. The curved shapes of the two flange pieces 6A and 6B are the same, and therefore the pair of flange pieces 6A and 6B open and close in a state of facing each other.

  As shown in FIGS. 1 to 3, long and narrow electrode blades 10 </ b> A and 10 </ b> B are exposed and formed along the longitudinal direction of each of the flanges 6 </ b> A and 6 </ b> B on the opposing surfaces of the flanges 6 </ b> A and 6 </ b> B. . However, the widths of the electrode blades 10A and 10B may be changed at the front and rear ends or in the middle thereof. The pair of electrode blades 10A and 10B are exposed and formed in a positional relationship facing each other when the pair of collar pieces 6A and 6B are closed, projecting in the closing direction from the facing surfaces of the collar pieces 6A and 6B. That is, as shown in FIG. 4 illustrating a cross section taken along the line AA shown in FIG. 2, the opposing portions of the flange pieces 6A and 6B have a convex cross-sectional shape protruding toward the opposing surface. It is formed, and the projecting end surfaces are electrode blades 10A and 10B.

  Each of the flanges 6A and 6B has a metal surface exposed only on the surfaces of the electrode blades 10A and 10B, which are the opposed surfaces of the protrusions, and the other surfaces are connected to the entire surface, such as a fluororesin. Further, an electrically insulating coating 11 made of a so-called inert synthetic resin material having high chemical and thermal stability is coated. The portion of the electrically insulating coating 11 is displayed in a grainy manner for all drawings. With such a configuration, only a living tissue necessary for high-frequency treatment is cauterized and its surroundings are not unnecessarily cauterized, so that incision or cutting can be performed safely.

  As shown in FIG. 2, the tip of the electrode blade 10A formed on the flange 6A on which the hook-like protrusion 12 described below is not formed is retracted backward from the tip of the flange 6A. The surface of the portion F between the tip of the electrode blade 10 </ b> A and the tip of the collar piece 6 </ b> A is electrically insulated by the electrically insulating coating 11. As a result, when the pair of electrode blades 10A and 10B are closed and a high-frequency current is applied while sandwiching the body tissue, the surrounding normal tissue or the like is not damaged.

  As shown in FIGS. 1 to 3, the hook-shaped protrusion 12 is closed in the most distal end portion of one of the pair of collar pieces 6A and 6B (that is, the tip direction of the other collar piece 6A). The surface of the hook-shaped protrusion 12 is electrically insulated by the electrically insulating coating 11. However, you may attach the hook-shaped protrusion 12 formed with the electrical insulating material to the front-end | tip of the collar piece 6B.

  As shown in FIG. 2, the front end surface wall S of the hook-shaped protrusion 12 is formed in a slope shape that retracts backward as it goes toward the protruding end side of the hook-shaped protrusion 12. As a result, when the pair of hook pieces 6A and 6B are closed, the locus Z on the protruding end side of the distal end surface wall S of the hook-shaped protrusion 12 is in a position retracted inward from the locus Y on the proximal end side. The protrusion 12 does not get caught in the living tissue against the intention, and can be operated safely.

Further, the rear wall of the hook-shaped protrusion 12 is also formed in a sloped shape with the protruding end side gradually approaching rearward, and the width of the hook-shaped protrusion 12 is formed in a narrowed shape on the protruding end side. As a result, when performing submucosal detachment or the like, it is possible to easily perform operations such as moving a fibrous muscle or the like by hooking it on a hook-like projection.
FIG. 5 shows a state in which the scissors-type high-frequency treatment instrument for an endoscope configured as described above is passed through a treatment instrument guide tube (not shown) of the endoscope and used in the body for a submucosal layer peeling treatment or the like. After the incision treatment of the surface mucous membrane is completed, the fibrous muscle 31 between the surface mucosa and the underlying muscle layer is easily hooked on the hook-shaped protrusion 12 before applying the high-frequency current. It can be picked up and held securely by the pair of hooks 6A and 6B. Since the hook-shaped projection 12 is formed only on one of the pair of collar pieces 6A and 6B, the hook / projection operation can be easily performed (the hook-shaped projection 12 is a pair of collar pieces 6B). If it is formed on both 6A and 6B, the other hook-like projection 12 will obstruct and the hooking operation cannot be easily performed). And the filamentous streak 31 can be easily cut | disconnected by closing a pair of collar pieces 6A and 6B, and supplying a high frequency current.

At that time, the electrode blades 10A and 10B are applied to the surrounding normal body tissue surface 30 and the like by performing high-frequency treatment with the curved outer wall surfaces of the collar pieces 6A and 6B in contact with the body tissue surface 30. Since the contact is difficult, unnecessary tissue damage or the like does not occur due to energization of the high-frequency current.
The present invention is not limited to the first embodiment, and the portions other than the intermediate bent portions of the flange pieces 6A and 6B are formed straight as in the second embodiment shown in FIG. However, the same effect can be obtained. Further, as in the third embodiment shown in FIG. 7, the electrode blades 10A and 10B are displaced not to the center line of the collar pieces 6A and 6B but to the position closer to the inside of the curvature of the collar pieces 6A and 6B. If the electrode blades 10A and 10B are arranged away from the body tissue surface 30, the electrode blades 10A and 10B are less likely to come into contact with the normal body tissue surface 30, which may cause unnecessary tissue damage. Is further reduced. The present invention can also be applied to a so-called bipolar high-frequency treatment instrument in which a pair of electrode blades 10A and 10B are electrically separated and connected to a positive electrode and a negative electrode of a high-frequency power source.

The perspective view of the high frequency heel part of the scissors type | mold high frequency treatment tool for endoscopes which concerns on the 1st Embodiment of this invention. The side surface fragmentary sectional view near the front-end | tip of the scissors type | mold high frequency treatment tool for endoscopes which concerns on the 1st Embodiment of this invention. The plane fragmentary sectional view near the front-end | tip of the scissors type | mold high frequency treatment tool for endoscopes which concerns on the 1st Embodiment of this invention. The end view of the cross section cut | disconnected in the AA of FIG. 2 of the scissors type | mold high frequency treatment tool for endoscopes which concerns on the 1st Embodiment of this invention. The use condition figure of the scissors type high frequency treatment tool for endoscopes concerning a 1st embodiment of the present invention. The plane fragmentary sectional view near the front-end | tip of the scissors type | mold high frequency treatment tool for endoscopes which concerns on the 2nd Embodiment of this invention. The plane fragmentary sectional view near the front-end | tip of the scissors type | mold high frequency treatment tool for endoscopes which concerns on the 3rd Embodiment of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 ... Flexible sheath 2 ... Sheath outer skin 4 ... Operation wire 6A, 6B ... Gutter piece 8 ... Support shaft 10A, 10B ... Electrode blade 11 ... Electrical insulating coating 12 ... Hook-like protrusion S ... Tip surface wall

Claims (7)

A pair of sheaths that are inserted into and removed from the treatment instrument guide tube of the endoscope , and a pair that is arranged so that the distal end side is opened and closed in a circular arc shape with the rear end side as a rotation fulcrum by operation from the proximal end side of the sheath A scissors-type high-frequency treatment instrument for an endoscope, wherein the entire outer surface of the scissors is covered with an electrical insulating material,
The pair of flanges is formed in a shape that is curved in a direction perpendicular to a plane formed by an arc-shaped opening / closing locus of the pair of flanges,
An electrode blade in which the conductive portion is exposed by stripping the electrical insulating material at a position near the inner edge of the curve along the longitudinal direction of each flange;
A hook-like protrusion protruding from the electrode blade toward the closing direction at one end of the pair of hook pieces;
A scissors-type high-frequency treatment instrument for an endoscope, comprising: 2. The scissors-type high-frequency treatment instrument for an endoscope according to claim 1, wherein electrode blades formed on each of the pair of scissors are arranged in a positional relationship facing each other when the pair of scissors are closed. Endoscopic high-frequency treatment tool for endoscopes. The scissors-type high-frequency treatment tool for endoscopes according to claim 1 or 2, wherein the electrode blades are formed so as to protrude from a facing surface of the scissors in a closing direction . 4. The scissors-type high-frequency treatment instrument for endoscope according to claim 3 , wherein the tip of the electrode blade formed on the scissors on which the hook-shaped protrusion is not formed is retracted backward from the tip of the scissors. A scissors-type high-frequency treatment instrument for an endoscope, which is formed at the position where the surface of the portion between the tip of the electrode blade and the tip of the scissors is electrically insulated . 5. The scissors-type high-frequency treatment instrument for an endoscope according to claim 1 , wherein a distal end surface wall of the hook-shaped protrusion has a slope shape that retreats backward toward the protruding end side of the hook-shaped protrusion. An endoscopic saddle-type high-frequency treatment tool that is formed . 6. A scissors-type high-frequency treatment instrument for an endoscope according to claim 1, wherein a distal end support frame that supports the pair of scissors pieces is connected to the distal end of the sheath so as to be rotatable about an axis. , by rotating the operating wire around the axis, endoscopic scissors frequency treatment instrument of the pair of scissor pieces are you rotated around the axis together with the tip support frame. The scissors-type high-frequency treatment tool for endoscopes according to any one of claims 1 to 6, wherein the hook-shaped protrusion covers a tip end side of a scissors piece of the other electrode blade .

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