JP4426256B2 - Endoscopic high-frequency treatment instrument for endoscope - Google Patents

Description

  The present invention relates to an endoscopic saddle-shaped high-frequency treatment instrument that is inserted into and removed from a treatment instrument insertion channel of an endoscope and used for incision or excision of a living tissue by applying a high-frequency current.

Endoscopic high-frequency treatment instruments for endoscopes are generally connected to a high-frequency power source at the distal end of a sheath that is inserted into and removed from the treatment instrument insertion channel of the endoscope, and are opened and closed in a hook shape by remote control from the proximal end side of the sheath A pair of saddle-shaped electrodes are arranged (for example, Patent Document 1).
JP 2000-271128 A

When incising a living tissue with an endoscopic saddle-shaped high-frequency treatment instrument, the living tissue is sandwiched and cut by a scissor-shaped electrode in a state where a high-frequency current is applied, and then the saddle-shaped electrode is opened for a while. Repeatedly pushing forward, then closing and tearing again.

  However, when the saddle-shaped electrode is open or closed during such high-frequency treatment, the patient coughs or the surgeon turns the bending knob of the endoscope. If the positional relationship between the tip of the endoscope and the human tissue is moved unexpectedly by operating it by mistake, it takes time and effort to accurately return the saddle electrode to the incision site of the affected area. In some cases, incision and excision of living tissue cannot be performed smoothly.

  In view of this, the present invention makes it possible to smoothly perform the high-frequency treatment even if the positional relationship between the endoscope tip and the human tissue suddenly changes greatly during the high-frequency treatment, and the saddle electrode does not leave the affected area. An object of the present invention is to provide an endoscopic saddle-shaped high-frequency treatment instrument that can be performed.

  In order to achieve the above-mentioned object, the scissors-like high-frequency treatment instrument for an endoscope of the present invention is connected to a high-frequency power source at the tip of an electrically insulating sheath that is inserted into and removed from the treatment instrument insertion channel of the endoscope. An endoscopic saddle-shaped high-frequency treatment instrument in which a pair of saddle-shaped electrodes that are opened and closed in a saddle-like manner by remote operation from the proximal end of the sheath is electrically insulated with respect to the pair of saddle-shaped electrodes. A wire loop that spreads from the vicinity of the distal end of the sheath so as to surround the space in front of the electrodes can be expanded and contracted independently of the opening / closing operation of the pair of hook-shaped electrodes by an operation from the proximal end side of the sheath It is a thing.

  In addition, a through hole penetrating in the opening / closing direction is formed in each of the pair of saddle-shaped electrodes, and the base portion of the wire constituting the wire loop is drawn into the sheath through the inside of the saddle-shaped electrode from each through hole. You may do it.

  Alternatively, a pair of through holes may be formed in the side wall near the distal end of the sheath, and the base portion of the wire constituting the wire loop may be drawn into the sheath from each through hole.

  According to the present invention, a wire loop that is electrically insulated from a pair of saddle-shaped electrodes and extends from the vicinity of the distal end of the sheath so as to surround a space in front of the saddle-shaped electrodes is operated from the proximal end side of the sheath. Therefore, it is possible to perform high-frequency treatment with the hook-shaped electrodes in a state where the mucous membrane around the affected area is fastened with a wire loop by being able to expand and contract independently of the opening / closing operation of the pair of hook-shaped electrodes. Even when the positional relationship between the tip of the endoscope and the human tissue changes unexpectedly during the high frequency treatment of the mucous membrane with the saddle electrode, the saddle electrode does not move away from the affected area and the high frequency treatment is performed. It can be done smoothly.

  A pair of hook-shaped electrodes are electrically operated with respect to the pair of hook-shaped electrodes, and a wire loop extending from the vicinity of the distal end of the sheath so as to surround a space in front of the hook-shaped electrodes is opposed to the pair of hook-shaped electrodes. It can be expanded and contracted independently of the opening / closing operation.

Embodiments of the present invention will be described with reference to the drawings.
FIG. 1 shows a distal end portion of an endoscopic saddle-shaped high-frequency treatment instrument according to a reference example of the present invention. For example, the flexible portion is formed of an electrically insulating flexible tube such as a tetrafluoroethylene resin tube. A distal end supporting body 2 made of an electrically insulating material such as ceramic is connected to the distal end of the conductive sheath 1.

  A pair of scissors formed in a biopsy forceps cup shape with a conductive metal such as stainless steel is provided at a position near the tip of the slit portion 2a formed over the entire length except for a portion near the rear end of the tip support body 2. The electrode 3 is supported by a support shaft 4 so as to be openable and closable in the form of a bowl, and a drive arm portion 3 a formed integrally with each of the bowl-shaped electrodes 3 is a slit located behind the support shaft 4. It arrange | positions in the part 2a.

  An electrode opening / closing operation wire 5 made of a conductive material for opening / closing the rod-shaped electrode 3 is inserted into the flexible sheath 1 over the entire length thereof so as to be movable back and forth in the axial direction. A pair of conductive drive wires 5a connected in two hands via 6 are respectively connected to the drive arm portion 3a.

  Accordingly, when the electrode opening / closing operation wire 5 is moved back and forth from the proximal end side of the flexible sheath 1, the pair of hook-shaped electrodes 3 opens and closes in a hook shape around the support shaft 4, and the electrode opening / closing operation wire A high-frequency current can be passed through each bowl-shaped electrode 3 via 5. In FIG. 1, the state in which the bowl-shaped electrode 3 is closed is shown by a solid line, and the state in which the bowl-shaped electrode 3 is opened is shown by a two-dot chain line.

  The portions corresponding to the back and buttocks of the pair of saddle-shaped electrodes 3 have through holes 3b and 3c, respectively, and have both heat resistance and electrical insulation, such as polyester fiber and fluororesin. The base portion of the wire loop 7 made of a synthetic resin wire is drawn into the hook-like electrode 3 from the back through-hole 3b of each hook-like electrode 3, and is further flexible through the through-hole 3c of the hip. It is drawn into the sheath 1.

  Note that the wire constituting the wire loop 7 may be electrically insulated with respect to the bowl-shaped electrode 3, and for example, a stainless steel wire covered with a fluororesin tube or the like may be used.

  The proximal end (both ends) of the wire loop 7 is connected to the distal end of a wire loop opening / closing operation wire 8 which is arranged in the flexible sheath 1 along with the electrode opening / closing operation wire 5 so as to be movable back and forth in the axial direction. 9 are connected.

  The wire loop opening / closing operation wire 8 can be moved forward and backward independently from the electrode opening / closing operation wire 5 from the proximal end side of the flexible sheath 1, and the wire loop 7 can be moved forward and backward by the wire loop opening / closing operation wire 8. Expands and contracts.

  In FIG. 1, a state in which the wire loop 7 is contracted is indicated by a solid line, and a state in which the wire loop 7 is expanded is indicated by a two-dot chain line, and the wire loop 7 extends from a through hole 3 b formed in each bowl-shaped electrode 3. The pair of bowl-shaped electrodes 3 spreads in a state surrounding a front space facing each other.

FIG. 2 shows an operation unit 20 provided on the proximal end side of the endoscopic saddle-shaped high-frequency treatment instrument of this reference example. The operation unit main body 21 connected to the proximal end of the flexible sheath 1 is shown in FIG. The electrode opening / closing operation piece 22 for advancing / retracting the electrode opening / closing operation wire 5 and the wire loop opening / closing operation piece 24 for advancing / retreating the wire loop opening / closing operation wire 8 slide independently of each other. It is arranged so that it can be operated.

  A connection terminal 23 to which a high-frequency power cord (not shown) is connected projects from the electrode opening / closing operation piece 22, and the base end of the electrode opening / closing operation wire 5 is connected to the base of the connection terminal 23. Therefore, by connecting a high frequency power cord to the connection terminal 23, a high frequency current can be applied to the bowl-shaped electrode 3 via the electrode opening / closing operation wire 5.

  With such a configuration, when the electrode opening / closing operation piece 22 is advanced / retracted, the pair of hook-shaped electrodes 3 is opened / closed via the electrode opening / closing operation wire 5, and when the wire loop opening / closing operation piece 24 is advanced / retreated, the wire loop opening / closing operation piece 22 is opened / closed. The wire loop 7 expands and contracts via the operation wire 8, and each operation can be performed independently of each other.

  When performing mucosal resection treatment endoscopically with the endoscopic saddle-shaped high-frequency treatment instrument configured as described above, as shown in FIG. 3, the treatment instrument insertion channel 51 of the endoscope 50 is used. While observing the distal end portion of the protruding high-frequency treatment instrument for endoscope through the observation window 52, the affected area 100 to be excised is surrounded by the wire loop 5 and lightly tightened, and the affected area 100 is sandwiched between the pair of hook-shaped electrodes 3. Apply high-frequency current in the state.

  As a result, the tissue mucous membrane of the portion sandwiched between the saddle-shaped electrodes 3 is torn, and when the pair of saddle-shaped electrodes 3 are completely closed or subsequently, the saddle-shaped electrodes 3 are opened. Even if the operator touches the bending operation knob of the endoscope or the patient coughs up or the like, the positional relationship between the distal end of the endoscope 50 and the affected part 100 greatly changes (or even changes). ) Since the wire loop 7 tightens the affected part 100, the position of the saddle electrode 3 with respect to the affected part 100 does not change, and the high frequency excision treatment can be smoothly continued by pushing the saddle electrode 3 forward and closing it. .

Figure 4 shows the actual施例of the present invention, and bored obliquely from the front of each pair of through holes 1a to the position of approximately 180 ° symmetry of the side wall near the tip of the flexible sheath 1, wire loop 7 is drawn into the flexible sheath 1 from each through hole 1a. Even if comprised in this way, the effect | action and effect similar to the above-mentioned reference example can be acquired.

  In this embodiment, the pair of hook-shaped electrodes 3 are formed in a hook-like shape without a blade and are electrically insulated from each other, and one hook-shaped electrode 3 is connected to the positive electrode side of the high-frequency power source, and the other The saddle-shaped electrode 3 is connected to the negative electrode side.

Thus, the present invention, the shape of the beak-like electrode 3 is not permissible whatever, monopolar type endoscope beak frequency treatment instrument such as a reference example, as及BiMinoru施例The present invention can be applied to any of bipolar type saddle-shaped high-frequency treatment instruments for endoscopes.

It is side surface sectional drawing of the front-end | tip part of the saddle-shaped high frequency treatment tool for endoscopes of the reference example of this invention. It is a side view of the operation part of the saddle-like high frequency treatment tool for endoscopes of the reference example of the present invention. It is a perspective view of the state which is performing the high frequency treatment with the saddle-like high frequency treatment tool for endoscopes of the reference example of the present invention. It is a side sectional view of a distal portion of the endoscopic beak high-frequency treatment instrument of the real施例of the present invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Flexible sheath 1a Through-hole 3 Corrugated electrode 3b, 3c Through-hole 4 Support shaft 5 Electrode opening / closing operation wire 7 Wire loop 8 Wire loop opening / closing operation wire 20 Operation section

Claims (1)

A pair of hook-shaped electrodes connected to a high-frequency power source and opened and closed in a hook shape by remote control from the proximal end side of the sheath are attached to the distal end of an electrically insulating sheath inserted into and removed from the treatment instrument insertion channel of the endoscope. In the placed endoscopic saddle-shaped high-frequency treatment instrument,
A wire loop that is electrically insulated from the pair of saddle-shaped electrodes and extends from the vicinity of the distal end of the sheath so as to surround a space in front of which the saddle-shaped electrodes face each other is operated by operation from the proximal end side of the sheath. Provided so that it can be expanded and contracted independently of the opening and closing operation of the pair of bowl-shaped electrodes ,
A pair of through-holes are drilled obliquely forward at approximately 180 ° symmetrical positions on the side wall near the distal end of the sheath, and the base of the wire constituting the wire loop passes through the through-holes. And the wire loop expands to surround the pair of saddle-shaped electrodes in a cross section along the opening and closing direction of the pair of saddle-shaped electrodes. High frequency treatment tool.

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