CN106913377A - HF surgery for flexible endoscope spectroscopy cuts ring - Google Patents

HF surgery for flexible endoscope spectroscopy cuts ring Download PDF

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Publication number
CN106913377A
CN106913377A CN201511036266.2A CN201511036266A CN106913377A CN 106913377 A CN106913377 A CN 106913377A CN 201511036266 A CN201511036266 A CN 201511036266A CN 106913377 A CN106913377 A CN 106913377A
Authority
CN
China
Prior art keywords
ring
cut
loop section
conduit
wire rod
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
CN201511036266.2A
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Chinese (zh)
Other versions
CN106913377B (en
Inventor
君特·费林
M·黑尔尼克
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Enduokesi Precision Instrument Technology Co Ltd
Endox Feinwerktechnik GmbH
Original Assignee
Enduokesi Precision Instrument Technology Co Ltd
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Enduokesi Precision Instrument Technology Co Ltd filed Critical Enduokesi Precision Instrument Technology Co Ltd
Priority to CN201511036266.2A priority Critical patent/CN106913377B/en
Priority to CN202110880575.7A priority patent/CN114041871A/en
Publication of CN106913377A publication Critical patent/CN106913377A/en
Application granted granted Critical
Publication of CN106913377B publication Critical patent/CN106913377B/en
Active legal-status Critical Current
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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00107—Coatings on the energy applicator
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00482—Digestive system
    • A61B2018/00494—Stomach, intestines or bowel
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00601—Cutting
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1405—Electrodes having a specific shape
    • A61B2018/1407—Loop

Abstract

The present invention relates to a kind of including two polypectomy rings of loop section, the polypectomy ring is with a loop section being electrically insulated completely and with another loop section that is being electrically insulated only in proximal end region and not being electrically insulated in remote area.

Description

HF surgery for flexible endoscope spectroscopy cuts ring
Technical field
Ring is cut for apparatus or as the HF surgery of the part of apparatus the present invention relates to a kind of, for endoscope The polypoid of control ground removal intestines and stomach or the ill mucosal areas (so-called lesion) of flat growth.Additionally, these apparatuses It is referred to as polypus cutter or (being represented with part overall) polypectomy ring
Technical background
A kind of in first described apparatus illustrated in 1971 in the German Utility Patent of numbering 71115781 At present as at that time, these apparatuses consist essentially of the flexible about 2m conduits being made of plastics long, in the catheter may be used The control wire of the metal of motion, one end (so-called distal end) of control wire HF surgery metallic cutting ring and manipulate The operation handle of line and the conduit other end (so-called near-end).Since more than 40 years, the conduit of these apparatuses passes through soft with ring is cut Property endoscope so-called instrument channel or service aisle applied, so as to this using HF surgery remove intestines and stomach Mucosa infection, to prevent human primary gastrointestinal cancers.
If such as these apparatuses were formerly only available the relatively small lesion (＜ 2cm) of removal in about 20 years, deposit at present The trend of big lesion (＞ 2cm) is being can remove with this.Certainly, to face some problems lesions bigger for this trend, then in the lesion Middle to there is a possibility that the bigger of obvious tumour therefore, oncologist requires particularly to remove the big lesion in health tissues, also I.e. until on pathology in order to reliably check in neighbouring health tissues：In whether eliminating health tissues really Lesion, if there is tumour (cancerous tissue) in removed lesion, and if so, if the tumour is The risk being transferred in other organs is penetrated into lymphatic vessel and/or vein blood vessel that is, has existed, virologist is required disease Become monoblock removal, that is, it is blocking ground and including the submucosa below lesion, at least submucosa upper 1/3rd (so-called sm1) in order to meet virologist this requirement, meet, such as by physiological saline to submucosa In so that the submucosa expands due to absorbing physiological saline that is, thickening is certain, the specific conductance energy of submucosa Therefore power also can become big, make so-called initially to cut during this initial cutting phase for being particularly when HF surgery cuts off Cut time delay adversely elongated.Since it is considered that the above-mentioned requirements of oncologist must be removed with surrounding's safe distance of about 5mm Lesion, so for example when lesion size is 3cm the mucous membrane area with 4cm diameters must be removed by HF surgery monoblock Domain.
Additionally, cut ring or polypectomy ring using HF surgery removes big lesion by HF surgery monoblock (＞ 2cm) is problematic in following scope, i.e. for HF surgery cutting during initial cutting phase that is, In polypectomy ring and tissue necessary to activating high-frequency current generator and activating for HF surgery cutting tissue Between electricity orphan between time in, per cm HF surgeries, effective ring length needs at least 0.5AEffectivelyHigh frequency electric, with Just the cutting with time delay (so-called initial cut time delay) as small as possible can be produced in the long feelings of initial cut time delay There is following risk under condition, i.e. the organ walls below lesion are partially damaged by heat and the postoperative so-called breath there may be organ walls Is perforated after meat excision because the radio-frequency generator that be can be used in endoscopy can only provide maximum 1.5 to 2.0AEffectivelyHeight Frequency electric current, so being just enough to only when effectively to ring length as 3 to 4cm (this diameter corresponding approximately to 1 to 1.5cm) with this Lesion is removed no-delayly, be result in：Monoblock can not remove particularly big lesion (＞ 2cm) completely.Therefore, big lesion or profit Cut off (so-called to nibble technology) in the way of multiple is smaller certainly with polypectomy ring usable so far, or using in Japan Above-mentioned the wanting that (ESD) method technologies of nibbling are unsatisfactory for the monoblock removal lesion of virologist is peeled off under the endoscope mucosal of research and development Ask.ESD is in the application difficult and very time-consuming
Electronic surgery apparatus, the electrosurgical hand are disclosed in the A1 of German laid-open document DE 100 28 413 Art apparatus includes electrode, additionally including ring electrode, its insulation for including so-called electrode cores and part overlaid electrode cores respectively Set here, ring tip at, the exposure electrode area of electrode cores symmetrically through with it is multiple be open or aperture insulation sleeve or Person reduces by surrounding the insulation sleeve of electrode cores only in an arc section
Therefore, should reduce for cutting required current strength.
Although the ring electrode can be utilized to exclude the long problem of above-mentioned initial cut time delay, the ring electricity in theory The manufacture of pole is that is expending very much and being therefore costliness
Another problem in all usable so far polypectomy rings of application is：No matter endoscopy doctor Or its assistant (such as endoscopy nurse) is particularly can not be observed or visually during HF surgery cutting guiding Ground control：HF surgery cuts whether ring closes, and if it does, how soon closes.Due to one side long duct With the more or less big elasticity of another aspect control wire, and the sizable friction between conduit and control wire, and Also due to the big axial dead paths (delayed) in polypectomy usable so far in operation handle and between cutting ring, Reliably the closure of control ring is not typically possible at operation handle.Particularly in the case of big lesion (＞ about 2cm), no Pipe endoscopy doctor or assistant can not reliably control：After high-frequency current generator is activated, ring cutting cuts still Do not cut, and if ring cutting cuts, ring cutting cut how soon still, the closure of control ring and the speed of control cutting guiding It is very important to spend in terms of cut quality and be particularly in terms of the synchronous sealing blood vessels of cutting.
The U1 of DE 20 2,010 008 674 disclose a kind of surgical operating instrument, and the surgical operating instrument discloses not exhausted The loop section 7 (top in Figure 14 a) of edge and loop section 7 (lower section in Figure 14 a) of insulation are additionally, two strut leg 6 and lead Draw element 10 be insulation by using the mode for strutting leg 6 being made up of resilient metal strip, obtain the relative of arrangement Big cross section so that the arrangement can only use with being connected with the conduit of major diameter
The content of the invention
Task of the invention is to research and develop for apparatus or cut ring as the HF surgery of the part of apparatus, is used The polypoid of intestines and stomach or the ill mucosal areas (so-called lesion) of flat growth, the height are removed in endoscope control Frequency operation does not exist above mentioned problem in cutting ring.
Task of the invention particular in that, ring is cut in the such operation of research and development, and when ring is cut described in application, initial cut is prolonged Shi Keneng is very short, and the characteristic that ring is cut in operation will not be due to cutting during HF surgery cutting guiding for HF surgery Cut required very hot electric arc and change, and even so, the ring of cutting is remained able to as simply as possible and with small consumption Take manufacture.Additionally, ring should be able to be used together with relatively thin, preferably diameter≤2.3mm conduit
Additionally, task of the invention is also resided in, the HF surgery that research and development are particularly used for flexible endoscope spectroscopy is cut Ring, in the HF surgery cuts ring, even if when (this is particularly and draws in cutting it cannot be seen that being wrapped in the ring of perilesional It is very unfavorable during leading), endoscopy doctor and/or assistant (such as endoscopy nurse) also can visually control Or the opening and closure of observation ring
Task of the invention is cut ring and is addressed by the HF surgery according to rights to independence section requirement 1.Other Implementation method is described in the dependent claims.
HF surgery cuts ring includes the first loop section and the second loop section.The two loop sections include metal wire Material, preferably solid wire rod, particularly preferably it is made up of steel or Nitinol, and the loop section has proximally and distally respectively.Institute State loop section and ring tip is constituted with its distal end here, two loop sections can optionally be connected with each other in its distal end and turn into ring Preferably, each loop section is maximum to include that one piece of wire rod, due to saving connection, can greatly improve stability and use to sophisticated Alternatively, ring can also be configured to single type to life-span, wherein, two loop sections are made up of two loop sections of a part and exist Near-end is connected with the operation wire rod that can be guided in the catheter, wherein, the operation wire rod is preferably configured so that so that therefore two Loop section can be pulled into the conduit and/or be removed from the conduit.Operation wire rod is preferably provided for the second ring Part electrically connects additionally, the first loop section is electrically insulated completely with HF surgery generator, and the second loop section is then in near-end It is electrically insulated in region and is not electrically insulated (towards ring tip) in remote area.
Electric insulation is complete that is, radially observes the wire rod that loop section is surrounded in 360 ° of angular range, and described Electric insulation can be insulating coating, jacket and/or flexible pipe, preferably heat-shrink plastic's flexible pipe
Due to simple structure, ring only has the first loop section and the second loop section, and the loop section can be with side by side parallel ground It is pulled into conduit.Two loop sections can be structured as the wire rod of relatively thin, preferably be configured to a thin wire simultaneously single type And the position of very little is thus only needed in the catheter.Therefore, have less than or equal to 23mm using the conduit of relatively thin, for example The conduit of external diameter is also possible
Lot of experiments series has confirmed：It is of the invention to cut ring (wherein, compared with above-mentioned ring of the prior art Do not insulate completely a part of completely insulated and only cutting wire rod a short part of ring) even if being cut in HF surgery Cut it is more long in the case of and even also hardly change its HF surgery characteristic in the case where repeatedly making to apply, and root Ring according to prior art has rapidly changed due to thermic arc or has even lost its high-frequency surgical during first time is applied Operation characteristic, thermoelectricity orphan perforation or partial insulation division is melted or even burn up of the invention to cut ring bright Aobvious to resist the lonely high temperature of the electricity produced when HF surgery cuts much betterly thus, first loop section preferably exists Surrounded completely by electric insulation part in its whole length, and second loop section is only wrapped completely in proximal end region by electric insulation part Enclose and do not insulated in remote area that is, herein be referred to along loop section without insulation division concepts " surrounding completely " Wire rod periphery encirclement therefore, electric insulation part should definitely without hole or slit.
Measurement in the different HF surgery generator of application has confirmed：Even if in big lesion, according to this The ring of invention also shows that much shorter or even negligible short initial cut time delay because mainly may be used in endoscopy Using 1.5A can be providedEffectivelyThe high-frequency current generator of high frequency electric, and because for largely no-delay initial Cutting needs at least about 0.5AEffectivelyHigh frequency electric, so ring of the invention be not electrically insulated ring region section it is (so-called Cutting wire rod) preferably simply 1 to 3cm is long.
During cutting process, ring is pulled into conduit by operation wire rod so that ring closes in fact, being cut into group Ring in knitting always is covered by the tissue being cut through so that cutting process be endoscope it is sightless and be therefore also can not Control.In order that cutting process endoscope is visible and controllable, at least one of described loop section loop section and/or operation Wire rod has at least one mark.Therefore the mark preferably alternately includes black and white or different colours circle, The circle of black can be applied in the electric insulation part of colored (such as yellow, green, blueness, red) preferably, such as black Circle with 0.3 to 1cm length and same 0.3 to 1cm it is mutual self-evident away from, the length and spacing can be any Ground design replaces the circle of black, it is also possible to select the circle of another color, the color preferably deviates considerably from the color of electric insulation part Can also select different circle colors on the insulation division of ring, for example to Marking ring opening width therefore, it is black at each four The 5th circle of red can be for example set between the circle of color can also be by different circle or the different spacing by circle (such as according to the type of bar code) provide position on ring or the information that opens width therefore, conduit preferably include it is transparent Material so that the mark can also see additionally, conduit can also have colour in the distal end of conduit by endoscope Mark, the mark of these colours particularly provides other information it may be thus possible, for example, to more accurate in combination with the mark on ring The interference of multiple patterns is shown or loop section position description in the catheter is also showed that alternatively into additionally, mark can With including numerical value and/or character they can particularly show ring opening opening width girth therefore, maximum is visible If numerical value can provide girth or open width rings to continue to close, the numerical value in conduit disappears and keeps corresponding to change The situation that the visible of next fractional value of small opening is opposite is that the situation marks disclosed herein for opening ring can not be applied only In the ring with SI semi-insulation portion specifically, the mark can be removed in it can be pulled into conduit and/or from conduit All types of HF surgeries cut used in ring
In an advantageous manner, uninsulated ring region section can equip antiskid coating or small relative to loop wire material radial directed Tooth, this simplifies in wet and slippery lesion or around application and prevent or at least hinder slippage of the ring from wet and slippery mucous membrane.
In an advantageous manner, all above-named rings of the invention can be equipped with or be equipped with according to WO Operation handle described in 2013/064576.
Another aspect of the present invention is related to cut ring and conduit as described above, and the operation lines are guided in the conduit Material.Preferably, the ring of cutting can be pulled into the conduit by the operation wire rod and remove from the conduit
Brief description of the drawings
Fig. 1 shows ring of the invention in the on-state
Fig. 2 shows the ring of the invention under partially closed position.
Specific embodiment
Figure 1 illustrates according to the present invention ring 1 is cut for the HF surgery of flexible endoscope spectroscopy.The high-frequency surgical Ring is cut in operation includes the first loop section 2 and the second loop section 3 that are made up of the circular wire rod and/or flat wire of metal.This A little loop sections can also be total to including the near-end that these loop sections of metallic twisted wire have near-end 11 and the loop section of distal end 10. respectively The near-end 11 of isomorphism cyclization and can connect mechanically and conductively for example by the operation wire rod 8 in connecting element 12 and conduit 6 Connect.Preferably, wire rod much harder compared with loop wire material is operated.
The distal end of loop section 2 and 3 collectively forms the distal end 10 of ring 1, and the distal end can be structured as ring protuberance ring in other words Tip 7. needs the ring tip being constructed so as to, so as to ring is pulled completely into the distal end 9 of conduit 6 and by ring therefrom Again is removed
First loop section 2 the second loop sections of 3 that are preferably completely electrically insulated are electrically insulated and in distal area in proximal end region 5a Be not electrically insulated in the 5b of domain loop sections 3 the region not being electrically insulated preferably with 1 to 3cm length
In order to cut the endoscope control of the opening and closing of ring 1, at least one loop section 2 and/or 3 and/or in behaviour Make to be provided with wire rod 8 mark 13a, 13b. preferably, these marks constitute visual black and white contrasts obvious toward each other or Color contrast so that can see that these indicate by this way using endoscope by transparent conduit, operate wire rod and marked Axial movement of the loop section of note within transparent conduit can be by endoscopic observation and control.Fig. 2 shows that part is pulled into Ring of the invention marks 13a and 13b in the distal end 9 of conduit 6 can see therefore, conduit 6 is included thoroughly by conduit 6 Bright material.
By this way, not only endoscopy doctor but also assistant can on a video monitor observe and control： Operation wire rod and/or labeled loop section whether in conduit 6 axially movable, and if it does, how soon move. By this way, it is also possible to judge cutting speed, the cutting speed is it is known that to cut quality, the disease particularly to being cut off The unexpected fire damage tool of the organ walls below change and the lesion in being cut off has a significant impact additionally, cutting speed is also right Generally intentional synchronous closing is cut off blood vessel tool to have a significant impact.
Reference numerals list
1 cuts ring
2 first loop sections
3 second loop sections
The uninsulated regions of 5a
The region of 5b electric insulations
6 conduits
7 catheter tips
8 operation wire rods
9 distal end of catheter
10 distal ends for cutting ring
11 near-ends for cutting ring
12 connecting elements
13a, 13b correlation marker.

Claims (13)

1. HF surgery cuts ring (1), and the HF surgery cuts ring includes the first loop section (2) and the second loop section (3), First loop section and second loop section its distal end (10) constitute ring tip (7) and its near-end (11) with can be Operation wire rod (8) connection of guiding in conduit (6),
Characterized in that,
First loop section (2) is surrounded completely by electric insulation part,
Second loop section (3) is surrounded and in remote area (5a) completely only in proximal end region (5b) by electric insulation part Do not insulate
2. it is according to claim 1 to cut ring, it is characterised in that uninsulated region (5b) has the restriction of 10 to 30mm Length.
3. it is according to claim 1 and 2 to cut ring, it is characterised in that at least in the electric insulation part of first loop section (2) It is upper to there is visually recognizable mark (13a, 13b)
4. it is according to claim 3 to cut ring, it is characterised in that the mark is circle
5. it is according to claim 4 to cut ring, it is characterised in that the circle has at least two different color
6. it is according to claim 3 to cut ring, it is characterised in that the mark is the week that ring is shown at different ring openings The numerical value and/or character of long or A/F
7. ring is cut according to any one of the claims, it is characterised in that in the loop section (2,3) at least one Individual loop section has spring, metal twisted wire and/or spring, metal circular wire rod and/or flat line Material
8. ring is cut according to any one of the claims, it is characterised in that cutting ring (1) can be logical in its near-end (11) Cross operation wire rod and in the conduit is removed and/or be pulled into from the conduit
9. ring is cut according to any one of the claims, it is characterised in that uninsulated region (5b) includes antiskid Coating or the small tooth being radially directed preferably with respect to loop wire material
10. ring is cut according to any one of the claims, it is characterised in that the operation wire rod (8) and conduit (6) Near-end include according to the operation handle described in WO 2013/064576.
11. cut ring according to any one of the claims, it is characterised in that the operation wire rod is provided for being electrically connected Connect second loop section (3) and HF surgery generator.
12. surgical devices for including being cut any one of the claims ring and conduit, guide in the conduit The operation wire rod
13. surgical devices according to claim 12, it is characterised in that the ring of cutting can be by the operation lines Material is pulled into the conduit (6) and is removed from the conduit.
CN201511036266.2A 2015-12-28 2015-12-28 High frequency surgical cutting ring for flexible endoscopy Active CN106913377B (en)

Priority Applications (2)

Application Number Priority Date Filing Date Title
CN201511036266.2A CN106913377B (en) 2015-12-28 2015-12-28 High frequency surgical cutting ring for flexible endoscopy
CN202110880575.7A CN114041871A (en) 2015-12-28 2015-12-28 High frequency surgical cutting ring for flexible endoscopy

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
CN201511036266.2A CN106913377B (en) 2015-12-28 2015-12-28 High frequency surgical cutting ring for flexible endoscopy

Related Child Applications (1)

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CN106913377B CN106913377B (en) 2021-08-24

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DE3220940A1 (en) * 1982-06-03 1983-12-08 Harald 7200 Tuttlingen Maslanka Diathermy instrument
US5078716A (en) * 1990-05-11 1992-01-07 Doll Larry F Electrosurgical apparatus for resecting abnormal protruding growth
CN1767869A (en) * 2003-04-03 2006-05-03 伊西康内外科公司 Guide wire having bending segment
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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN114041871A (en) * 2015-12-28 2022-02-15 君特·费林 High frequency surgical cutting ring for flexible endoscopy

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