JP2001170069A - Medical treatment instrument - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a medical treatment instrument preventing the sliding of a tissue to jaws and surely closing the blood vessel presenting in the tissue by firmly holding the tissue by the jaws. SOLUTION: This medical treatment instrument 1 is provided with a pair of opening/closing jaws 8a, 8b holding and coagulating the tissue. This instrument is characterized to have a closing part 22 formed of planes 20, 21 provided in the respective jaws 8a, 8b and holding the tissue between the planes 20, 21 so as to close the blood vessel presenting in the holding tissue, sliding prevention means 23, 24 provided in at least one jaw and preventing the tissue held between the jaws from sliding relative to the jaws, and a heat degeneration means provided in at least one jaw and heat-degenerating the tissue held between the jaws.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a medical treatment tool for grasping a living tissue and performing a medical treatment such as coagulation and incision.

[0002]

2. Description of the Related Art Generally, a medical treatment tool for grasping a living tissue and performing a medical treatment such as coagulation or incision is provided with a pair of jaws for grasping a living tissue, and a living body grasped between these jaws. The tissue can be treated by electrically or thermally coagulating (obstructing blood vessels). This type of treatment tool is generally used in various cases such as hemostasis of blood vessels contained in living tissue, cauterization of a lesion or bleeding point on the surface of living tissue, occlusion of a fallopian tube for contraception, and the like.

For example, Japanese Patent Application Laid-Open No. 10-127654 discloses an ultrasonic treatment device (medical treatment device) for coagulating a living tissue with frictional heat generated by ultrasonic vibration. The ultrasonic treatment instrument includes a rod-shaped probe to which ultrasonic vibration is transmitted, and the tip of the probe forms one of jaws for gripping a living tissue. Also,
The grip member forming the other jaw is rotatably attached to the distal end of the sheath through which the probe is inserted. On both sides of the gripping member, serrated portions are formed to prevent the tissue from sliding against the jaws (so that the tissue does not escape from between the jaws), and the gripping surface of the gripping member is a flat surface. It is formed as.

[0004] Japanese Patent Application No. 10-295372 discloses that
A bipolar forceps has been disclosed in which a high-frequency current is applied between a pair of jaws for gripping a living tissue to coagulate the living tissue between the jaws. In this case, the incision electrode provided on one jaw has a wire shape, and the wire-shaped incision electrode comes into contact with a flat insulating gripping surface of the other jaw having a coagulated electrode. I have.

[0005] Japanese Patent Application Laid-Open No. 11-70123 and U.S. Pat.
SP57776130 and the like disclose a bipolar forceps for obstructing a blood vessel (haemostasis).

[0006]

However, Japanese Patent Application Laid-Open No.
In the bipolar forceps disclosed in -70123,
Because the serrated serration is not provided on the jaw,
If the tissue is gripped strongly by the jaws, the tissue may slip against the jaws, and the tissue may not be firmly and reliably gripped.

On the other hand, in the ultrasonic treatment device disclosed in Japanese Patent Application Laid-Open No. Hei 10-127654, since the serrated portions are formed on both sides of the gripping member, the tissue is prevented from escaping from between the jaws. Is done. However, JP
In JP-A-127654, when the jaws are closed, the flat gripping surface of the gripping member and the distal end of the rod-shaped probe come into substantially line contact. That is, the living tissue is gripped by the pair of jaws that make line contact with each other. Therefore, the grasping force (occlusive force) of the living tissue by the grasping member and the tip of the probe
Is weaker than the gripping force at the surface contact where the living tissue is gripped between the flat gripping surfaces, and still firmly grips the tissue to reliably occlude the blood vessels present in the tissue,
There is room for improvement.

[0008] Japanese Patent Application No. 10-295372 also has the same problem as Japanese Patent Application Laid-Open No. 10-127654. That is, in Japanese Patent Application No. 10-295372, a wire-shaped incision electrode as one jaw is brought into line contact with the flat gripping surface of the other jaw.
The grasping force (obstruction force) of the tissue by the pair of jaws is weaker than the grasping force at the surface contact where the living tissue is grasped between the flat grasping surfaces, and the blood vessel existing in the tissue by firmly grasping the tissue There is room for improvement in that it reliably blocks the air.
US Pat. No. 5,776,130 has a similar problem.

SUMMARY OF THE INVENTION The present invention has been made in view of the above circumstances. It is an object of the present invention to prevent a tissue from slipping with respect to a jaw, and to firmly grip the tissue with the jaw to cause a blood vessel existing in the tissue. It is an object of the present invention to provide a medical treatment tool capable of reliably closing a medical treatment device.

[0010]

In order to solve the above-mentioned problems, a medical treatment instrument according to the present invention comprises a pair of openable and closable jaws for grasping tissue and performing a coagulation treatment. An obstruction formed by planes provided on the jaws, and closing a blood vessel existing in the grasped tissue by grasping the tissue between these planes,
Anti-slip means provided on at least one jaw for preventing the tissue gripped between the jaws from slipping against the jaw; heating provided on at least one jaw for heating and denaturing the tissue gripped between the jaws Denaturing means.

[0011]

Embodiments of the present invention will be described below with reference to the drawings.

FIGS. 1 to 3 show a first embodiment of the present invention. As shown in FIG. 1, a bipolar forceps 1 as a medical treatment tool of the present embodiment includes an insertion portion 2 that can be inserted into a body endoscopically, and a treatment disposed at a distal end portion of the insertion portion 2. Part 3 and operating part 4 connected to the base end of insertion part 2
Consisting of

The operating section 4 includes an operating section main body 9, a fixed handle 11 provided integrally with the operating section main body 9, and a movable handle rotatably supported by the operating section main body 9 via a pivot pin 12. 13. The operation unit main body 9 is provided with a rotatable operation body 5 rotatably, and a connector connection unit 15 to which a connector of a power supply cable (not shown) is detachably connected.

The insertion section 2 comprises a sheath 6 supported by a rotary operation body 5 of the operation section 4. The sheath 6 rotates together with the rotary operation body 5 with respect to the operation unit main body 9 by rotating the rotary operation body 5. A drive shaft 7 is inserted into the sheath 6 so as to be able to advance and retreat. The base end side of the drive shaft 7
It extends inside the operation section main body 9 and is connected to the movable handle 13. Therefore, when the movable handle 13 is rotated, the drive shaft 7 advances and retreats in the sheath 6 accordingly.

The treatment section 3 comprises a pair of openable and closable jaws 8a and 8b located opposite each other. Joe 8a,
The drive shaft 8b is connected to the distal end of the drive shaft 7 via an opening / closing mechanism (not shown) such as a link mechanism driven by the forward / backward movement of the drive shaft 7. In this case, when the movable handle 13 is rotated in the direction of arrow B (see FIG. 1A) and the drive shaft 7 is advanced in the sheath 6, the jaws 8a and 8b are opened via the opening / closing mechanism. (See FIG. 1B). When the movable handle 13 is rotated in the direction of arrow A and the drive shaft 7 is retracted in the sheath 6,
The jaws 8a, 8b are closed via the opening / closing mechanism (see FIG. 1A).

Each of the jaws 8a and 8b is formed of a conductive material, and is provided in the sheath 6 when a high-frequency current is supplied from a high-frequency power source (not shown) to the connector connection portion 15 via an energizing cable. A high-frequency current flows between the jaws 8a and 8b via conductive means (not shown). That is, each jaw 8a, 8b
Form heat denaturing means for heat denaturing the tissue gripped between the jaws 8a and 8b.

As shown in an enlarged manner in FIG. 2, each jaw 8a (8b) has a flat surface 20 (21) on the side facing the other jaw 8b (8a). Each plane 20, 2
Numeral 1 forms a gripping surface for gripping tissue, and extends flat along the longitudinal direction and the width direction of the jaws 8a, 8b. Each of the planes 20 and 21 holds the tissue between them, thereby uniformly compressing the grasped tissue and closing the blood vessel existing in the grasped tissue.
2 are formed.

The jaws 8a and 8b are provided with
A non-slip means is provided for preventing the tissue gripped between a and 8b from slipping against the jaws 8a and 8b.
The anti-slip means includes a convex portion 23 provided at the tip of one jaw 8a and a convex portion 2 provided at the other jaw 8b.
3 and a recess 24 meshing with the recess 3. In order to prevent an electric short circuit, each of the protrusions 23 and the recesses 24 has an insulating material
5 are coated.

In the present embodiment, the dimensions of the concavo-convex portions 23 and 24 and the closing portion 22 are set so that the inconvenience that a sufficient closing force cannot be obtained at the closing portion due to the presence of the non-slip means does not occur. I have. For example, Joe 8a,
8b, when the tissue is grasped, the closed portion 22 is applied to the tissue before the uneven portions 23 and 24 are applied to the tissue (or closed before the tissue is locked by the uneven portions 23 and 24). The dimensions of the concavo-convex portions 23, 24 and the closing portion 22 are set so that the tissue is compressed by the portion 22). Specifically, for example, a predetermined gap is formed between the concave and convex portions 23 and 24 in a state where the jaws 8a and 8b are closed and the flat surfaces 20 and 21 of the closing portion 22 are in contact with each other.

Next, a description will be given of a case where a living tissue is treated with the bipolar forceps 1 having the above configuration.

First, the insertion section 2 of the bipolar forceps 1 is introduced endoscopically into the body, and the treatment section 3 is positioned near the tissue to be treated. In this state, by rotating the movable handle 13 in the direction B, the drive shaft 7 is advanced in the sheath 6 to open the jaws 8a and 8b, and the jaws 8a and 8b are opened.
Place tissue in between.

After the tissue is positioned between the jaws 8a and 8b, the movable handle 13 is rotated in the direction A to move the drive shaft 7 backward in the sheath 6 and close the jaws 8a and 8b. The tissue is firmly gripped between the jaws 8a and 8b. This state is shown in FIG. In this state, the plane 2 provided on each of the jaws 8a and 8b
The tissue 30 is firmly grasped between 0 and 21, and the blood vessel 32 existing in the grasped tissue 30 is closed. That is, the tissue 30 is uniformly crushed by the closing part 22 and the blood vessel 32 is closed. In this state, the projection 23 provided at the tip of the jaw 8a bites into the tissue 30, and the tissue 30 is inserted into the recess 24 provided at the tip of the jaw 8b.
Bites. That is, the tissue 30 is hooked so as to engage with the uneven portions 23 and 24. Therefore, the jaws 8a, 8b
The tissue 30 grasped between the two is prevented from slipping with respect to the jaws 8a and 8b.

In this manner, the tissue 30 is crushed by the closing portion 22 to close the blood vessel 32, and the tissue 30 is prevented from coming off between the jaws 8a and 8b by the uneven portions 23 and 24. This time, the connector connection portion 15 is connected from a high-frequency power supply (not shown) via an energizing cable.
To supply high frequency current. Accordingly, a high-frequency current flows between the jaws 8a and 8b via the conductive means provided in the sheath 6, and the tissue 30 gripped between the jaws 8a and 8b.
Is coagulated. In this case, even if the irregularities 23 and 24 may temporarily contact each other, since the irregularities 23 and 24 are covered with the insulating material 25, an electrical short circuit does not occur and reliable A coagulation procedure is performed.

As described above, the bipolar forceps 1 of the present embodiment has both the anti-slip means and the closing part 22, so that the jaws 8a, 8b can be prevented while the tissue slides against the jaws 8a, 8b. Thus, the tissue can be firmly grasped, and the blood vessels existing in the tissue can be reliably closed. That is, in the present embodiment, the closing portion 22
Grips tissue by surface contact between the plane 20 and the plane 21, the gripping force is sufficiently stronger than the gripping force when gripping the tissue by line contact or point contact, and therefore the tissue is crushed firmly. Thus, the blood vessels existing in the tissue can be reliably occluded. The concave and convex portions (slip prevention means) 23 and 24 that can be engaged with each other prevent the tissue from slipping against the jaws 8a and 8b by locking the tissue to these portions, thereby grasping the tissue by the closing portion 22 and preventing the blood vessel from moving. Ensure occlusion.

FIG. 4 shows a second embodiment of the present invention. Note that, in this embodiment, the same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted.

As shown, one jaw 8a of a bipolar forceps 1A as a medical treatment tool according to the present embodiment.
Has a protruding portion 36 that forms one side of the closing portion 22 on the side facing the other jaw 8b. This protrusion 36
Extends along the longitudinal direction of the jaw 8a on the base end side of the convex portion 23 as a non-slip means provided at the distal end of the jaw 8a. In addition, the other jaw 8 is
A plane 36a is formed on the side facing b. The flat surface 36a forms a grip surface for gripping the tissue, and extends flat along the longitudinal direction and the width direction of the protrusion 36.

The other jaw 8b has a long groove 37 on the side facing the one jaw 8a. This long groove 3
Numeral 7 is set to a size that is opposed to the protruding portion 36 and that the protruding portion 36 can engage with and engage with, and forms the other side of the closing portion 22. That is, the long groove 37 is provided in the recess 2 as a non-slip means provided at the tip of the jaw 8b.
The base 4 extends along the longitudinal direction of the jaw 8b. The bottom surface of the long groove 37 is formed by a flat surface 36 a of the protrusion 36.
A gripping surface for gripping the tissue is formed between them, and the entire surface is formed as a flat plane 37a that can abut on the plane 36a. The other configuration is the same as that of the first embodiment.

In the bipolar forceps 1A having such a structure, the tissue is grasped by the surface contact between the plane 36a and the plane 37a in the closing portion 22, whereby the tissue is crushed firmly, and the blood vessels existing in the tissue are crushed. It is reliably closed. Further, the tissue is locked to the concave and convex portions (slip prevention means) 23 and 24 which can be engaged with each other, and the jaws 8a and 8b
Slip of the tissue with respect to is prevented. That is, the same operation and effect as those of the first embodiment can be obtained. In particular, in the present embodiment, the slippage of the tissue is restricted not only by the concave and convex portions 23 and 24 but also by the engagement between the protruding portion 36 and the long groove 37. That is, the tissue is sandwiched between the protruding portion 36 and the long groove 37 around the flat surfaces 36a and 37b and is crushed, whereby the sliding of the tissue with respect to the jaws 8a and 8b is regulated. Therefore, the tissue can be grasped strongly.

FIG. 5 shows a first modification of the second embodiment. Note that, in the present modification, the same components as those of the second embodiment are denoted by the same reference numerals, and description thereof will be omitted.

As shown in the drawing, in this modification, the jaw 8a includes a main body 40 formed of an electrically insulating material and a first denatured heating means fitted to the main body 40 so as to form the protrusion 36. Of the electrode 42. On the other hand, the jaw 8b has a main body 41 formed of an electrically insulating material,
A second electrode 43 as a heat denaturing means is embedded in the main body 41 so as to form the long groove 37. A flat surface 36a is formed on the first electrode 42 on the side facing the second electrode 43. The second electrode 43 has a flat surface 37 a on the side facing the first electrode 42. The other configuration is the same as that of the second embodiment.

Therefore, even with such a configuration,
The same operation and effect as those of the second embodiment can be obtained.

FIG. 6 shows a second modification of the second embodiment. Note that, in the present modification, the same components as those of the second embodiment are denoted by the same reference numerals, and description thereof will be omitted.

As shown, in the present modification, the jaw 8a comprises a jaw body 45 and a first electric insulator 46 fitted to the jaw body 45 so as to form the projection 36. In the first electric insulator 46, two electrodes 50 and 51 as heat denaturing means are buried with their surfaces exposed to the outside. In addition, each electrode 50, 51
Extends along the longitudinal direction of the jaw 8a. Also,
The electrodes 50 and 51 are arranged in parallel at a predetermined distance from each other in the width direction of the jaw 8a.

On the other hand, the jaw 8b has a jaw main body 47,
A second electric insulator 48 is embedded in the jaw body 47 so as to form the long groove 37. In this case, the second electric insulator 48 is provided to prevent a short circuit between the electrodes 50 and 51.

The first electric insulator 46 has a flat surface 36a on the side facing the second electric insulator 48. In this case, the exposed surfaces of the electrodes 50 and 51 are flat surfaces 36a.
And it is located flush. The second electric insulator 48
Has a flat surface 37a on the side facing the first electrical insulator 46.
Are formed. The other configuration is the same as that of the second embodiment.

Therefore, even with such a configuration,
The same operation and effect as those of the second embodiment can be obtained.

FIG. 7 shows a third modification of the second embodiment. Note that, in the present modification, the same components as those of the second embodiment are denoted by the same reference numerals, and description thereof will be omitted.

As shown, in this modification, the jaw 8a is formed by joining an outer member 53 made of a heat insulating material and an inner member 54 made of a heat conducting member. The inner member 54 has, on the side facing the other jaw 8b, a protruding portion 36 that forms one side of the closing portion 22. Further, a first heater 55 as a heating and denaturing means is embedded in the inner member 54. The first heater 55 extends along the longitudinal direction of the jaw 8a, and has a width substantially equal to (or slightly smaller than) the width of the protrusion 36.

On the other hand, the jaw 8b is formed by joining an outer member 57 made of a heat insulating material and an inner member 56 made of a heat conducting member. The inner member 56 has a long groove 37 that forms the other side of the closing portion 22 on the side facing the other jaw 8a. In addition, in the inner member 56,
A second heater 58 as a heat denaturing means is embedded. The second heater 58 extends along the longitudinal direction of the jaw 8b, and has a width substantially equal to (or slightly smaller than) the width of the long groove 37. The first and second heaters 55 and 58 are made of, for example, a ceramic heater or a PTC heater.

Further, the other jaw 8b is
A flat surface 36a is formed on the side facing. Further, the bottom surface of the long groove 37 is formed as a flat plane 37a that can abut on the entire surface 36a. The other configuration is the same as that of the second embodiment.

Therefore, even with such a configuration,
The same operation and effect as those of the second embodiment can be obtained.
However, in the present embodiment, unlike the above-described embodiments and modified examples, the tissue is thermally coagulated by the heaters 55 and 58.

FIGS. 8 and 9 show a third embodiment of the present invention. Note that, in this embodiment, the same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted.

As shown in FIG. 8, the jaw 8a on one side of the bipolar forceps 1B according to the present embodiment has teeth 60 (rows of triangular teeth: serrate portions) 60 on both sides thereof. Each tooth row 60 extends along the longitudinal direction of the jaw 8a on the side facing the jaw 8b on the other side.
Anti-slip means is formed to prevent the tissue gripped between the jaws 8b from slipping against the jaws 8a, 8b. Also,
The central portion of the jaw 8 a located between the tooth rows 60 is formed as a flat surface 20. This plane 20
Forms a gripping surface for gripping tissue, and extends flat along the longitudinal direction and the width direction of the jaw 8a. In this case, the flat surface 20 is retracted to the inner side of the jaw 8a with respect to the tooth tips of the tooth rows 60, 60.

A jaw 8b on the other side has a flat surface 21 that can contact the flat surface 20 on a side facing the jaw 8a on the one side.
have. The jaws 8b located on both sides of the plane 21 are provided with the tooth row 6 when the planes 20 and 21 abut against each other.
Notches 61, 61 for allowing 0, 60 to escape are formed. In addition, similarly to the first embodiment, each of the planes 20, 2
1 forms an occluded portion 22 that grips the tissue between them to uniformly compress the gripped tissue and occlude a blood vessel existing in the gripped tissue.

In the present embodiment, the dimensions of the tooth rows 60, 60 and the closing portion 22 are set so that the inconvenience that a sufficient closing force cannot be obtained at the closing portion due to the presence of the anti-slip means does not occur. I have. For example, jaws 8a, 8
b, when the tissue is grasped, the occlusion 22 is applied to the tissue before the dentition 60, 60 is applied to the tissue (or closed before the tissue is locked by the dentition 60, 60). The dimensions of the dentition 60, 60 and the closure 22 are set so that the tissue is compressed by the section 22).
Specifically, for example, in the state where the jaws 8a and 8b are closed and the planes 20 and 21 of the closing portion 22 are in contact with each other,
A predetermined gap is formed between the 0 tooth tip and the jaw 8b (notch 61). The other configuration is the same as that of the first embodiment.

FIG. 9 shows a state in which the tissue is firmly grasped between the jaws 8a and 8b. In this state, each jaw 8
The tissue 30 is firmly gripped between the planes 20 and 21 provided at the centers of the a and 8b, respectively.
Is closed. That is, the closing part 2
2, the tissue 30 is uniformly crushed and the blood vessel 32 is closed. Further, in this state, the tooth rows 60, 60 provided on both sides of the jaw 8a bite into the tissue 30, so that the tissue 30 gripped between the jaws 8a, 8b becomes jaw 8a, 8b.
Is prevented from slipping.

In this manner, the tissue 30 is crushed by the closing portion 22 to close the blood vessel 32, and the tissue 30 is prevented from coming off between the jaws 8a and 8b by the uneven portions 23 and 24. This time, the connector connection portion 15 is connected from a high-frequency power supply (not shown) via an energizing cable.
To supply high frequency current. Accordingly, a high-frequency current flows between the jaws 8a and 8b via the conductive means provided in the sheath 6, and the tissue 30 gripped between the jaws 8a and 8b.
Is coagulated.

As described above, the bipolar forceps 1B of the present embodiment has both the anti-slip means and the closing portion 22 as in the first embodiment, so that the jaw 8
a, 8b while preventing tissue slippage.
By means of a and 8b, the tissue can be firmly grasped and the blood vessels existing in the tissue can be reliably closed.

FIG. 10 shows a first modification of the third embodiment. Note that, in the present modification, the same components as those of the third embodiment are denoted by the same reference numerals, and description thereof will be omitted.

As shown in the drawing, in this modification, the distal end surface (tooth tip) of the tooth row 60 of the jaw 8 a is positioned flush with the flat surface 20. That is, in the third embodiment, the tip of the tooth row 60 is located on the plane offset downward from the plane 20. However, in this modification, the plane 20 of the closing portion 22 is The jaw 8 is formed flush with the tip surface.
a, 8b are completely closed, and the plane 20 and the teeth 6
The two end surfaces of the zero contact the flat surface 21. The other configuration is the same as that of the third embodiment.

Therefore, even with such a configuration,
The same operation and effect as in the third embodiment can be obtained.

FIG. 11 shows a second modification of the third embodiment. Note that, in the present modification, the same components as those of the third embodiment are denoted by the same reference numerals, and description thereof will be omitted.

As shown in the drawing, in this modification, the tip end surface (tooth tip) of the tooth row 60 of the jaw 8a is located on a plane offset upward from the plane 20. Specifically, the jaw 8a is located on the side facing the opposing jaw 8b,
It has a protruding portion 36 that forms one side of the closing portion 22. The protruding portion 36 is a central portion of the jaw 8a located between the tooth rows 60, and extends along the longitudinal direction of the jaw 8a. The protruding portion 36 has a flat surface 36a on the side facing the other jaw 8b.
The flat surface 36a forms a grip surface for gripping the tissue, and extends flat along the longitudinal direction and the width direction of the protrusion 36.

The jaw 8b has a long groove 37 on the side facing the jaw 8a. The long groove 37 is opposed to the protruding portion 36 and is set to a size that allows the protruding portion 36 to engage with and engage with the protruding portion 36, and forms the other side of the closing portion 22. The bottom surface of the long groove 37 forms a gripping surface for gripping the tissue with the flat surface 36a of the protruding portion 36, and a flat flat surface 37 that can abut the flat surface 36a on the entire surface.
a. The other configuration is the third
This is the same as the embodiment.

Therefore, even with such a configuration,
The same operation and effect as in the third embodiment can be obtained.

FIG. 12 shows a fourth embodiment of the present invention. Note that, in this embodiment, the same components as those in the first embodiment are denoted by the same reference numerals, and description thereof is omitted.

As shown in detail in FIG.
The jaw 8a on one side of the bipolar forceps 1C according to the present embodiment has a flat surface 20 on the side facing the jaw 8b on the other side.
Are formed. A plurality of convex portions 65 extending along the width direction of the jaw 8a are formed on the plane 20. These projections 65 are provided at predetermined intervals along the longitudinal direction of the jaw 8a, and divide the plane 20 into a plurality of plane parts 20a to 20d.

On the other hand, a flat surface 21 is formed on the other jaw 8b on the side facing the one jaw 8a.
A plurality of concave portions 66 that mesh with the convex portions 65 are formed on the flat surface 21. These recesses 66 extend along the width direction of the jaw 8b, and are provided at predetermined intervals along the longitudinal direction of the jaw 8b, and divide the plane 21 into a plurality of plane portions 21a to 21d. .

In such a configuration, each flat portion 20a
20d, together with the corresponding (opposing) flat portions 21a to 21d, form closed portions 22A to 22D for uniformly compressing and gripping the tissue and closing the blood vessels existing in the gripped tissue. That is, the first flat portion 20a and the second flat portion 21
a forms a first closing portion 22A, and the second flat portion 20b and the second flat portion 21b form a second closing portion 22B. Similarly, the third plane portion 2
0c and the third flat portion 21c to form the third closing portion 22
C is formed, and the fourth flat portion 20d and the fourth flat portion 21 are formed.
and d forms a fourth closing portion 22D. That is, a plurality of closed portions 20A to 20D are formed along the longitudinal direction of the jaws 8a and 8b. Further, in the above configuration, the uneven portions 65 and 66 sandwiched between the two closing portions are non-slip means for preventing the tissue gripped between the jaws 8a and 8b from slipping on the jaws 8a and 8b. To form

In the present embodiment, the dimensions of the concavo-convex portions 65 and 66 and the closing portions 22A to 22D are set so that the inconvenience that a sufficient closing force cannot be obtained at the closing portion due to the presence of the anti-slip means does not occur. Is set. For example, when the tissue is gripped by the jaws 8a and 8b, the closing portion 22 may be closed before the tissue is locked by the uneven portions 65 and 66.
The irregularities 6 are used so that the tissue is compressed by A to 22D.
5, 66 and the dimensions of the closed portions 22A to 22D are set. Specifically, for example, the jaws 8a and 8b are closed and the planes 20a to 20d and 21a of the closing portions 22A to 22D are closed.
21d, the convex portion 65 and the concave portion 66
And a predetermined gap is formed between them. The other configuration is the same as that of the first embodiment.

As described above, since the bipolar forceps 1C of the present embodiment has both the non-slip means and the closing portion 22, similarly to the first embodiment, the jaws 8a, 8b
The tissue can be firmly grasped by the jaws 8a and 8b while the slip of the tissue with respect to the tissue is prevented, and the blood vessel existing in the tissue can be reliably closed.

In this embodiment, the uneven portions 65 and 66 are provided.
Are formed so as to extend along the width direction of the jaws 8a and 8b, but the uneven portions 65 and 66 may be formed only on both sides of the jaws 8a and 8b.

FIG. 13 shows a fifth embodiment of the present invention. As shown, the medical treatment tool according to the present embodiment is a surgical forceps 70 used in a laparotomy, and a forceps 7.
Reference numeral 0 denotes two handles 71 rotatable about a support shaft 70,
72. Jaws 8a, 8b are integrally provided at the tips of the handles 71, 72, respectively. When the handles 71, 72 are rotated to be gripped, the jaws 8a, 8b are closed.

Each of the jaws 8a and 8b is formed of a conductive material, and is provided in the handles 71 and 72 when a high-frequency current is supplied from a high-frequency power source (not shown) to the connector connection portion 75 via a power supply cable 76. A high-frequency current flows between the jaws 8a and 8b via the provided conductive means (not shown). That is, each jaw 8
a and 8b form heat denaturation means for heat denaturing the tissue gripped between the jaws 8a and 8b.

Each jaw 8a (8b) has a flat surface 20 (21) on the side facing the other jaw 8b (8a). Each of the planes 20, 21 forms a gripping surface for gripping tissue, and extends flat along the longitudinal direction and the width direction of the jaws 8a, 8b. And each plane 20,
The gripper 21 grips the tissue between them, thereby uniformly compressing the gripped tissue, and forming an occlusion portion 22 that blocks a blood vessel existing in the gripped tissue.

The jaws 8a and 8b have jaws 8
A non-slip means is provided for preventing the tissue gripped between a and 8b from slipping against the jaws 8a and 8b.
The anti-slip means includes a convex portion 23 provided at the tip of one jaw 8a and a convex portion 2 provided at the other jaw 8b.
3 and a recess 24 meshing with the recess 3.

As described above, since the bipolar forceps 1C of the present embodiment has both the non-slip means and the closing portion 22, similarly to the first embodiment, the jaws 8a, 8b
The tissue can be firmly grasped by the jaws 8a and 8b while the slip of the tissue with respect to the tissue is prevented, and the blood vessel existing in the tissue can be reliably closed.

According to the technical contents described above, the following various configurations can be obtained.

1. In a medical treatment tool having a pair of openable and closable jaws for performing a coagulation treatment by gripping a tissue, the medical treatment tool is formed by planes respectively provided on the jaws, and grips the tissue between the planes to form the gripped tissue. An obstructing portion for obstructing an existing blood vessel, anti-slip means provided on at least one of the jaws to prevent the tissue grasped between the jaws from slipping against the jaw, and an anti-slip means provided on at least one of the jaws; And a heat denaturing means for heat denaturing the grasped tissue.

2. 2. The medical treatment tool according to claim 1, wherein the non-slip means is provided around the closing part.

3. The medical treatment tool according to claim 1, wherein the tissue gripped by the closing portion is uniformly compressed.

4. 2. The medical treatment tool according to claim 1, wherein the non-slip means comprises an uneven portion formed on a jaw.

5. 5. The medical treatment tool according to claim 4, wherein, when the jaws are closed, the flat surfaces of the closing portion come into contact with each other before the irregularities come into contact with each other.

6. 5. The medical treatment tool according to claim 4, wherein the concave and convex portions are formed of substantially triangular teeth.

7. The medical treatment tool according to claim 4, wherein the uneven portion is provided at a tip of a jaw.

8. The medical treatment tool according to claim 4, wherein the uneven portion is provided on both sides of the closing portion.

10. The medical treatment tool according to claim 4, wherein the uneven portion is located between two closing portions.

11. The medical treatment tool according to claim 4, wherein the uneven portion is provided on a surface offset from a plane of the closing portion.

12. 2. The medical treatment tool according to claim 1, wherein the heat denaturing means comprises a bipolar electrode.

13. 13. The medical treatment tool according to claim 12, wherein the non-slip means is electrically insulated from the closing part.

14. 14. The medical treatment tool according to claim 13, wherein the non-slip means is covered with an insulating material.

15. 14. The medical treatment tool according to claim 13, wherein a part of the slip stopper is formed of an insulating material.

16. 2. The medical treatment tool according to claim 1, wherein the heating and denaturing means comprises a heater.

17. 17. The medical treatment tool according to claim 16, wherein the heater comprises a ceramic heater.

18. 17. The medical treatment device according to claim 16, wherein the heater comprises a PTC heater.

19. The medical treatment tool according to claim 1, wherein the jaws are integrally provided at respective distal ends of handles that open and close with each other.

20. 2. The medical treatment tool according to claim 1, wherein each of the jaws is provided at a distal end of an elongated insertion portion, and is opened and closed by a drive shaft that advances and retreats in the insertion portion.

By the way, the technical contents described above are as follows.
By providing both the closing portion and the non-slip means, the conventional drawbacks are solved, and an attempt is made to ensure reliable and sufficient coagulation. However, the configuration was such that the closing portion and the non-slip means were separately provided on the jaws. In particular, in the case of a high-frequency treatment device that electrically coagulates tissue, in addition to problems such as closing force and non-slip, electric problems must be taken into consideration in performing reliable and sufficient coagulation. It is a problem that should not be done. Therefore, in the following, both functions of the closing portion and the non-slip means are obtained by one component provided on the jaw (one component has both functions of the closing portion and the non-slip means). A high-frequency treatment tool which improves the coagulation treatment in view of electrical problems will be described.

Conventionally, in a treatment using a high-frequency treatment instrument, an attempt has been made to improve the coagulation treatment by applying an electric current in an over-energized state or a strongly compressed hemostasis state. However, when such an electric current is applied, excessive coagulation occurs, causing problems such as tissue sticking to the jaws and scorching of the tissue.

As means for solving the above problems, it is conceivable to appropriately control the output of the high-frequency power supply or to improve the jaws of the forceps. However, if an attempt is made to improve excessive coagulation by controlling the output of a high-frequency power supply, it will not be possible to cope with various high-frequency treatment tools having different jaw shapes. Therefore,

2. Description of the Related Art As disclosed in the publications (applications) cited in the section of the Related Art, various techniques for improving the solidification ability by providing a flat gripping surface and a serrated portion on a jaw have been proposed. It has been.

However, when the serrated portion is provided in the energized portion, there is a problem that the current density is locally increased, the solidification of a part is promoted, and the jaw is easily burnt. Further, when an excessive force is applied to the handle, there is also a problem that the tissue is crushed or damaged by the serrated portion. On the other hand, if the serrate portion or the like is not provided, the force for grasping the tissue is weakened, and the function as a non-slip is impaired.

[0092] Further, in a configuration in which a gap is formed between the jaws when the jaws are completely closed, a sufficient coagulation ability cannot be obtained. For example, in the technology disclosed in Japanese Patent Application No. 10-248873, in order to prevent an electrical short circuit,
A gap is formed between the jaws in a state where the jaws are completely closed. However, in such a configuration, solidification may not be sufficiently performed in some cases. Also,
A similar problem exists in the technology disclosed in Japanese Patent Application Laid-Open No. 8-238255.

The above problem can be solved by the high-frequency treatment device shown in FIGS. Hereinafter, each embodiment will be described.

FIGS. 14 to 17 show a first embodiment for solving the above problem. The high-frequency treatment instrument 101 according to this embodiment includes an insertion portion 10 that can be inserted into a body through an endoscope.
2 and the treatment section 1 disposed at the distal end of the insertion section 102
03 and an operation unit (not shown) connected to the base end of the insertion unit 102.

The insertion section 102 is composed of a long sheath 106 that can be inserted into a channel of the endoscope. This sheath 1
For example, a drive shaft is inserted in 06 so as to be able to move forward and backward.
When the operation unit is operated, the drive shaft advances and retreats in the sheath 106 accordingly.

The treatment section 103 is composed of a pair of openable and closable jaws 108a and 108b located opposite to each other.
The jaws 108a and 108b are connected to the drive shaft via an opening / closing mechanism (not shown) such as a link mechanism driven by the forward / backward movement of the drive shaft. Therefore, the operation unit is operated in one direction, and the drive shaft is moved to the sheath 10.
The jaws 108a and 108b are opened via the opening / closing mechanism, for example, when the jaws 108 are moved forward within 6 (see FIG. 14A). Further, when the operation unit is operated in the other direction and the drive shaft is retracted in the sheath 106, for example, the jaws 108a and 108b are closed via the opening / closing mechanism.

Each of the jaws 108a and 108b is formed of a conductive material (metal or the like). Jaws 108a, 108 via conductive means (not shown) provided in
A high-frequency current flows between 8b.

Each jaw 108a (108b) has a flat surface 12 on the side facing the other jaw 108b (108a).
0 (121). Each plane 120, 121
A grasping surface for grasping tissue is formed, and the jaws 10 are formed.
8a and 108b extend flat along the longitudinal direction and the width direction. An elastic body 110 made of silicon or the like is provided on the plane 121 of the jaw 8b. The surface (grip surface) of the elastic body 110 is formed as a flat surface.

Next, a case where a living tissue is treated by the high-frequency treatment instrument 101 having the above-described configuration will be described.

First, the insertion portion 102 of the high-frequency treatment instrument 101
Is introduced endoscopically into the body, and the treatment section 103 is positioned near the tissue to be treated. In this state, by operating the operation unit in one direction, the drive shaft is advanced, for example, in the sheath 106, the jaws 108a and 108b are opened, and the tissue is positioned between the jaws 108a and 108b.

After the tissue is positioned between the jaws 108a and 108b, the operating section is operated in the other direction, whereby the drive shaft is retracted in the sheath 106, for example, to close the jaws 108a and 108b, and the jaws 108a and 108b are closed. 108b
Grasp the tissue between. This state is shown in FIG. Then, from this state, the jaws 108a, 10
As shown in FIG. 17, the elastic members 110 are elastically deformed and the jaws 108a, 108a are compressed so that the tissue 130 is crushed by the restoring force of the elastic members 110, as shown in FIG.
It is pressed into contact with the planes 120 and 121 of 108b. As a result, the frictional force between the elastic body 110 and the tissue 130 is enhanced,
Slip of the tissue 130 against the jaws 108a, 108b is prevented, and the tissue 13
0 is firmly grasped, and the blood vessel existing in the tissue 130 is occluded. Also, when the elastic body 110 is deformed in this way,
The distance between the jaws (electrodes) 108a and 108b also decreases.

In this way, the tissue 130 is crushed to occlude the blood vessel, and the jaws 108a, 108
In this state, in which the tissue 130 is prevented from being pulled out from between the areas b, a high-frequency current is supplied from a high-frequency power source (not shown) to, for example, the operation unit via a power supply cable. As a result, the jaw 108 is connected to the jaw 108 through the conductive means provided in the sheath 106.
a, 108b, a high-frequency current flows between the jaws 108a,
The tissue 130 grasped during the period 108b is solidified. In this case, the jaw (electrode) accompanies the elastic deformation of the elastic body 110.
Since the distance between 108a and 108b is reduced, FIG.
The coagulation ability is improved as compared with the case where the coagulation treatment is performed in the state of No. 6.

As described above, in the high-frequency treatment instrument 101 of this embodiment, the elastic body 110 elastically deformed by the grasping force for grasping the tissue between the jaws 8a and 8b is formed by the jaw 8b.
Are provided on the flat gripping surface 121. That is,
The high-frequency treatment instrument 101 of the present embodiment has the elastic body 110 having both functions of the closing portion 22 and the non-slip means in each of the above-described embodiments. So Joe 1
The tissue can be firmly grasped by the jaws 108a and 108b, and the blood vessels existing in the tissue can be reliably closed while preventing the tissue from slipping on the 08a and 108b.

In this embodiment, the jaws 108a, 1
08b is not provided with a serrated portion (the elastic body 110b).
Therefore, there is no need to provide a serrate portion), so that the possibility that the current density locally increases and the jaws are scorched or the tissue is crushed or damaged by a large operating force is extremely low. Also, the jaws 108a, 10
In a state where the elastic body 110 is deformed by closing the elastic body 8b, there is no gap between the jaws 108a and 108b, so that a sufficient solidifying ability can be obtained. In particular, the elastic body 110
Since it can function as a means for varying the distance between the jaws (electrodes) 108a and 108b, the solidification ability can be changed by adjusting the degree of deformation of the elastic body 110.

In this embodiment, the elastic member 110 is used.
Can function as an electrical insulator or as a conductive rubber by varying the silicon content. When the elastic body 110 functions as an electric insulator, an effect that an electric short circuit can be prevented can be obtained. Further, when the elastic body 110 functions as a conductive rubber, it is possible to obtain an effect that a large energizing area is secured and a solidifying force is improved.

FIGS. 18 to 20 show a second embodiment. Note that, in this embodiment, the same components as those in the first embodiment are denoted by the same reference numerals, and description thereof will be omitted.

As shown in FIG. 18, in the high-frequency treatment instrument 101A of this embodiment, the elastic body
25 is provided on the plane 121 of the jaw 8b. The uneven portion is formed to be flat by elastically deforming (crushing) the elastic body 125 by a predetermined amount. The other configuration is the same as that of the first embodiment.

FIG. 19 shows the jaws 108a, 10
The initial stage of grasping the tissue 130 between 8b is shown.
In this initial stage, the uneven portion on the surface of the elastic body 125 functions as a serrate portion. However, when the jaws 108a and 108b are further closed from this state, as shown in FIG. 20, the elastic body 125 is elastically deformed, and the uneven portion on the surface of the elastic body 125 becomes flat. This state is similar to the state in FIG. 17 in the first embodiment.
Therefore, according to this embodiment, the same operation and effect as those of the first embodiment can be obtained, and the gripping force is strengthened by the uneven portions of the elastic body 125.

If the tooth row 60 in the third embodiment shown in FIG. 8 is formed of an elastic body, the same operation and effect as in this embodiment can be obtained.

FIG. 21 shows a third embodiment. In this embodiment, the plane 12 of both jaws 108a and 108b
Elastic body 110 is provided on 0,121. In addition,
The other configuration is the same as that of the first embodiment. According to such a configuration, the gripping force is further enhanced.

According to the technical contents of the first to third embodiments described above, the following various configurations can be obtained.

21. In a high-frequency treatment instrument having a pair of openable and closable jaws for grasping tissue to perform a treatment, at least a part of at least one jaw has at least a part of a contact surface with tissue in a state where the jaws are closed. A high-frequency treatment instrument, wherein an elastic body that elastically deforms is provided on the high-frequency treatment instrument.

22. 22. The high-frequency treatment instrument according to claim 21, wherein the energizing portion of each jaw is formed with a flat surface.

23. 22. The high frequency treatment device according to claim 21, wherein the contact surface of the elastic body that comes into contact with the tissue is formed in an uneven shape.

24. 24. The high frequency treatment device according to claim 23, wherein the uneven surface of the elastic body becomes a flat surface when the jaw is closed.

25. 22. The high-frequency treatment device according to claim 21, wherein the elastic body is made of silicon.

26. The second elastic member functions as a means that can change the distance between the jaws (electrodes).
2. The high-frequency treatment device according to item 1.

27. 22. The high-frequency treatment device according to claim 21, wherein the elastic body functions as an electrical insulator.

28. 22. The high frequency treatment device according to claim 21, wherein the elastic body functions as a conductive rubber.

[0120]

As described above, according to the medical treatment instrument of the present invention, the slip of the tissue with respect to the jaw can be prevented, and the tissue is firmly grasped by the jaw to reliably remove the blood vessel existing in the tissue. Can be closed.

[Brief description of the drawings]

FIG. 1 is a side view of a medical treatment tool according to a first embodiment of the present invention.

2A is an enlarged side view of a distal treatment section of the medical treatment tool in FIG. 1, and FIG. 2B is a cross-sectional view taken along line AA in FIG.

FIG. 3 is a diagram showing a state where a tissue is grasped between jaws of the medical treatment tool in FIG. 1;

FIG. 4A is an enlarged side view of a distal treatment section of a medical treatment device according to a second embodiment of the present invention, and FIG. 4B is a cross-sectional view of the distal treatment section of FIG.

FIG. 5 is a cross-sectional view of a treatment section according to a first modification of the second embodiment.

FIG. 6 is a cross-sectional view of a treatment section according to a second modification of the second embodiment.

FIG. 7 is a cross-sectional view of a treatment unit according to a third modification of the second embodiment.

FIG. 8A is an enlarged side view of a distal treatment section of a medical treatment tool according to a third embodiment of the present invention, and FIG. 8B is a view B of FIG.
It is sectional drawing which follows the -B line.

FIG. 9 is a view showing a state where the tissue is grasped between the jaws of the medical treatment tool in FIG. 8;

FIG. 10 is a cross-sectional view of a treatment section according to a first modification of the third embodiment.

FIG. 11 is a cross-sectional view of a treatment section according to a second modification of the third embodiment.

FIG. 12 (a) is a side view of a treatment section of a medical treatment tool according to a fourth embodiment of the present invention in a closed state, and FIG. 12 (b) is a side view of an open state of the treatment section in FIG. .

FIG. 13 is a side view of a medical treatment tool according to a fifth embodiment of the present invention.

14A is a perspective view showing a first embodiment of the high-frequency treatment device, FIG. 14B is a plan view of a first jaw of the treatment device of FIG. 14A, and FIG. 14C is a treatment of FIG. FIG. 5 is a plan view of a second jaw of the tool.

FIG. 15 is a sectional view of a jaw of the treatment tool of FIG. 14;

FIG. 16 is a cross-sectional view showing an initial stage of grasping tissue between jaws of the high-frequency treatment device of FIG. 14;

17 is a cross-sectional view showing a state where the jaw is further closed from the state of FIG. 16 to deform the elastic body.

FIG. 18 is a perspective view showing a second embodiment of the high-frequency treatment instrument.

FIG. 19 is a cross-sectional view showing an initial stage of grasping tissue between jaws of the high-frequency treatment device of FIG. 18;

20 is a cross-sectional view showing a state where the jaw is further closed from the state of FIG. 19 to deform the elastic body.

FIG. 21 is a sectional view showing a third embodiment of the high-frequency treatment instrument.

[Explanation of symbols]

1, 1A, 1B, 1C: Bipolar forceps (medical treatment tool) 8a, 8b: Jaw 20, 21, ... Flat surface 22: Closed part 23, 65 ... Convex part (anti-slip means) 24, 66 ... Concave part (anti-slip means) 42, 43, 50, 51 ... electrodes (heat denaturing means) 55, 58 ... heaters (heat denaturation means) 60 ... tooth rows (anti-slip means) 70 ... surgical forceps (medical treatment tools)

 ────────────────────────────────────────────────── ─── Continued on the front page (72) Inventor Naoki Sekino F-term (reference) 4C060 DD22 KK03 KK04 KK10 KK15 in Olympus Optical Co., Ltd. 2-34-2 Hatagaya, Shibuya-ku, Tokyo

Claims (1)

[Claims] 1. A medical treatment tool having a pair of openable and closable jaws for performing a coagulation treatment by grasping a tissue, the medical treatment tool being formed by a plane provided on each jaw,
An occlusion portion for obstructing a blood vessel existing in the grasped tissue by grasping the tissue between these planes, and provided on at least one jaw to prevent the tissue grasped between the jaws from slipping on the jaw A medical treatment instrument comprising: a non-slip means; and a heat denaturing means provided on at least one of the jaws for heat denaturing the tissue held between the jaws.