JP2002028166A - Treatment device for nasal cavity - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a treatment device for a nasal cavity capable of improving workability in work of piercing an electrode part into an organism tissue in a nasal cavity as an insert part is inserted into the nasal cavity, shortening work time for reducing burden on an operator and a patient, correctly positioning the electrode part to a lesion part in the nasal cavity, and cauterizing a relatively large range at a time. SOLUTION: An operation part 3 on the hand side is connected to a base end part of an insert part 2 to be inserted into a nasal cavity H1, and two needle electrodes 4a, 4b of a bipolar electrode 4 to be protruded from/retracted into the insert part 2 are disposed at a tip part of the insert part 2.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a nasal cavity treatment tool for performing coagulation treatment by puncturing a living tissue in a nasal cavity with a high-frequency electrode provided at an insertion portion inserted into the nasal cavity.

[0002]

2. Description of the Related Art In general, a treatment tool for a nasal cavity has been developed which has an insertion portion to be inserted into a nasal cavity and punctures a living tissue in the nasal cavity with a high-frequency electrode provided in the insertion portion to perform coagulation treatment. . For example, as a treatment for allergic rhinitis, coagulation treatment in which a high-frequency electrode is punctured into the inferior turbinate while an insertion portion is inserted into a nasal cavity has been conventionally performed.

[0003] Further, as a nasal treatment instrument, for example, USP
No. 5,733,282 discloses a surgical instrument in which a single needle-like electrode is fixed to the distal end of an insertion portion to be inserted into a nasal cavity, and a lesion in the nasal cavity is resected and treated with high frequency from this electrode. I have.

In this surgical instrument, the insertion portion is formed in a substantially straight shape. Further, in a conventional surgical instrument, a relatively thick electrode having an electrode diameter φ of about 0.75 mm is used so that the electrode does not bend when the electrode is inserted into a living tissue in a nasal cavity.

In US Pat. No. 5,823,197, three or more nasal electrodes are provided side by side in a portion of an insertion portion to be inserted into the nasal cavity, the electrodes being protruded and retracted in a direction perpendicular to the insertion direction in the nasal cavity. A surgical instrument configured to penetrate each electrode into a living tissue in a nasal cavity is disclosed.

[0006]

By the way, when a treatment tool for nasal cavity is used, a coagulation treatment is performed by piercing a lower nasal turbinate with a high-frequency electrode with an insertion portion inserted into the nasal cavity. At this time, when the puncture needle is punctured into the lower turbinate, if the electrode touches the turbinate bone, bone necrosis and rot may occur, and the lower turbinate may continue to expand. Furthermore, cauterization of the mucosal surface may result in loss of mucosal function. Therefore, it is necessary to accurately puncture the high-frequency electrode into the submucosal tissue between the mucosal surface of the lower turbinate and the turbinate bone during the work of puncturing the lower turbinate with the high-frequency electrode and performing coagulation treatment. It is difficult, time-consuming, and burdens the operator and the patient.

Further, in the surgical instrument of US Pat. No. 5,733,282, a single needle-shaped electrode is fixed to the distal end portion, so that there is a problem that a wide range cannot be cauterized at once. Therefore, in the case of cauterizing a wide area with one needle-shaped electrode, it is necessary to puncture the affected part many times, which takes a long time and has a problem that the burden on the operator and the patient is great.

Further, since one needle-like electrode fixed to the distal end of the insertion portion is bent in a direction substantially perpendicular to the insertion direction of the insertion portion, the insertion portion is inserted into the nasal cavity. The insertion direction is different from the direction in which the needle electrode is inserted into the living tissue in the nasal cavity. Therefore, there is a problem that it is difficult to accurately determine a position at which the needle electrode is punctured into the lesion in the nasal cavity, and also difficult to insert the needle electrode into a living tissue in the nasal cavity.

In the case of a surgical instrument in which the insertion portion is formed in a substantially straight shape, when the insertion portion is inserted into the nasal cavity, the operation portion itself (or the operator's hand) of the surgical instrument causes the intranasal cavity to be inserted. There is a possibility that the field of view of the insertion part of the insertion part into the endoscope may be obstructed, and when used in combination with the endoscope, it may interfere with the endoscope.

Furthermore, in the conventional surgical instrument, when inserting the electrode into the nasal cavity, a relatively thick electrode having an electrode diameter φ of about 0.75 mm is used, so that bleeding occurs at the punctured portion. It should be noted that the electrode diameter φ is set to 0.
When the thickness is reduced to 5 or less, bleeding is reduced, but the electrode is easily bent, and there is a possibility that the electrode cannot be punctured accurately.

Further, in the surgical instrument of US Pat. No. 5,823,197, three or more electrodes for nasal cavity are configured to protrude and retract in the direction perpendicular to the insertion direction of the insertion portion. The direction in which the insertion portion is inserted into the nasal cavity is different from the direction in which each nasal electrode is inserted into a living tissue in the nasal cavity.
Therefore, also in this case, it is difficult to accurately position the puncturing position of each nasal electrode into a lesion in the nasal cavity, and
The operation itself of inserting each nasal electrode into a living tissue in the nasal cavity also has a problem.

Furthermore, even with this surgical instrument, it is necessary to increase the number of electrodes in order to cauterize a wider area, so that there is a problem that the invasion to the patient becomes large.

[0013] The present invention has been made in view of the above circumstances, and its object is to provide a state in which an insertion portion is inserted into a nasal cavity.
The workability of inserting the electrode into the living tissue in the nasal cavity can be improved, the work time can be shortened, and the burden on the operator and the patient can be reduced. It is an object of the present invention to provide a nasal cavity treatment tool capable of accurately positioning a position for puncturing a part and cauterizing a relatively wide area at a time.

[0014]

According to a first aspect of the present invention, a proximal operating portion is connected to a proximal end portion of an insertion portion to be inserted into a nasal cavity, and a front end of the insertion portion is connected to a distal end portion of the insertion portion. A treatment device for a nasal cavity, wherein an electrode portion that protrudes and retracts is disposed on the treatment device. According to the first aspect of the present invention, the insertion direction for inserting the insertion portion into the nasal cavity and the operation direction of the electrode portion for causing the electrode portion to protrude and retract in front of the insertion portion are directed substantially in the same direction. With the insertion part inserted inside, the work of inserting the electrode part into the living tissue in the nasal cavity is facilitated, and the insertion amount when inserting the insertion part into the nasal cavity is reduced. is there.

According to a second aspect of the present invention, there is provided an electrode in which a proximal operating portion is connected to a proximal end of an insertion portion to be inserted into a nasal cavity, and an electrode which protrudes and retracts forward of the insertion portion at a distal end of the insertion portion. A portion is provided, and a bent portion bent in a direction deviating from a projecting direction of the electrode portion is provided in the insertion portion, and a center line direction of the electrode portion and a center line direction of the operation portion are offset. The treatment instrument for nasal cavity, wherein the treatment instrument for a nasal cavity is provided. According to the second aspect of the present invention, the insertion direction for inserting the insertion portion into the nasal cavity and the operation direction of the electrode portion for projecting and retracting the electrode portion in front of the insertion portion are directed substantially in the same direction. In the state where the insertion portion is inserted into the inside, the operation of inserting the electrode portion into the living tissue in the nasal cavity is facilitated, and the insertion amount when inserting the insertion portion into the nasal cavity is reduced. Furthermore, when the insertion portion is inserted into the nasal cavity by the bent portion of the insertion portion bent in a direction deviated from the protruding direction of the electrode portion, the operation portion itself (or the operator's hand) causes the insertion portion to be inserted into the nasal cavity. This prevents the field of view of the insertion portion from being obstructed, and prevents interference with the endoscope when used in combination with the endoscope.

[0016]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Hereinafter, a first embodiment of the present invention will be described with reference to FIGS. FIG. 1 shows a treatment tool 1 for a nasal cavity according to the present embodiment. In the treatment tool for nasal cavity 1, an operation unit 3 on a hand side is connected to a base end of an insertion unit 2 inserted into the nasal cavity. Further, a bipolar electrode (electrode portion) 4 for high-frequency treatment, which protrudes and retracts in front of the insertion portion 2, is provided at a distal end portion of the insertion portion 2. As shown in FIG. 2, the bipolar electrode 4 has two needle electrodes 4a,
4b is provided.

As shown in FIG. 2, the insertion portion 2 has two insertion holes 5 through which these two needle electrodes 4a and 4b are inserted.
a, 5b are formed. The two needle electrodes 4 a and 4 b of the bipolar electrode 4 are inserted into the respective insertion holes 5 of the insertion portion 2.
a, 5b so as to be able to advance and retreat, and to be able to protrude and retract in front of the insertion portion 2. Here, the main body of the insertion section 2 is formed of an insulating material. Therefore, the two needle electrodes 4a, 4b inserted into the respective insertion holes 5a, 5b of the insertion portion 2
The space is kept insulated.

As shown in FIG. 1, a substantially straight distal end straight portion 2a is formed at the distal end side of the insertion portion 2. Further, the rear end portion of the front straight portion 2a has a direction deviating from the protruding direction of the two needle electrodes 4a and 4b of the bipolar electrode 4 (the center line direction of the front straight portion 2a). A substantially linear bent portion 2b bent obliquely rearward of the portion 2a is formed.

The distal end of the operation unit 3 on the hand side is connected to the rear end of the bent portion 2b. A substantially linear operating portion main body 6 is formed in the operating portion 3 on the hand side.
The center line direction of the operation unit main body 6 is disposed substantially parallel to the center line direction of the distal end straight portion 2a of the insertion unit 2. As a result, the two needle electrodes 4a and 4b of the bipolar electrode 4 are disposed at positions where the center line directions of the projecting portions and the center line direction of the operation unit 3 are offset.

The cross section of the insertion portion 2 is formed in a substantially elliptical flat shape as shown in FIG. And
An insertion hole 5a for inserting one needle electrode 4a of the bipolar electrode 4 on one side of the flat shape of the insertion portion 2, and an insertion hole 5b for inserting the other needle electrode 4a of the bipolar electrode 4 on the other side.
Are arranged respectively.

Further, as shown in FIG. 3, the operation part 3 on the hand side communicates with two insertion holes 5a and 5b of the insertion part 2.
Communication holes 7a and 7b are formed respectively. These communication holes 7 a and 7 b extend in the direction of the center line of the operation unit 3.

Further, as shown in FIG.
Elastic wires 8 are provided at the base ends of the two needle electrodes 4a and 4b.
The tips of a and 8b are fixed respectively. The base end sides of these elastic wires 8a, 8b extend toward the operation unit 3 on the hand side, and the two insertion holes 5a, 5 of the operation unit 3 on the hand side.
b.

Further, a slider 9 which is movable in the direction of the center line of the operation unit 3 is provided on the operation unit 3 on the hand side. The proximal ends of the elastic wires 8a and 8b are connected to the slider 9. Here, the slider 9 is formed with an extension (not shown) that extends into the two insertion holes 5 a and 5 b of the operation unit 3. Note that a guide groove 21 (see FIG. 6) for guiding the movement of the extension portion of the slider 9 is formed in the operation portion main body 6. And this slider 9
The two needle electrodes 4a and 4b of the bipolar electrode 4 are caused to protrude and retract forward of the insertion section 2 via the elastic wires 8a and 8b in accordance with an operation of moving the needle electrode 4 in the center line direction of the operation section 3. .

Further, one end of a connection cord 10 is connected to the rear end of the operation section main body 6. This connection code 10
Is connected to the high-frequency power supply 11 as shown in FIG. Further, inside the connection cord 10, two lead wires (not shown) connected to the elastic wires 8a and 8b are provided. When the nasal cavity treatment tool 1 is used, a high-frequency current flows from the high-frequency power supply device 11 to the two needle electrodes 4a and 4b of the bipolar electrode 4 via the two lead wires and the elastic wires 8a and 8b in the connection cord 10 sequentially. It is being supplied.

Next, the operation of the above configuration will be described.
When coagulation treatment is performed on a lesion in the nasal cavity using the nasal cavity treatment tool 1 of the present embodiment, the following operation is performed. First,
The two needle electrodes 4a and 4b of the bipolar electrode 4 of the treatment device for nasal cavity 1 are set in a retracted state in which the two needle electrodes 4a and 4b are retracted into the insertion holes 5a and 5b of the insertion section 2 in advance. Further, an injection needle is inserted into a patient's nasal cavity, and an anesthetic is injected into a living tissue to be treated.

In this state, the nasal cavity treatment tool 1 is inserted into the nasal cavity H1 of the patient as shown in FIG. At this time, the distal end straight portion 2a on the distal end side of the insertion portion 2 of the nasal cavity treatment instrument 1 is inserted into the nostril H3 from the nostril H2 of the patient. Then, the distal end surface of the distal end straight portion 2a is set in a state of being pressed against the front end surface of the lower turbinate H4.

Thereafter, the slider 9 of the operation unit 3 is slid forward along the center line direction of the operation unit 3. When the slider 9 is operated, the elastic wire 8 is moved.
a, 8b, the two needle electrodes 4 of the bipolar electrode 4
a and 4b are pushed forward. At this time, the two needle electrodes 4a and 4b of the bipolar electrode 4 are punctured from the front end face of the inferior turbinate H4 into the mucous membrane between the mucosal surface and the turbinate.

When the insertion amount of the two needle electrodes 4a and 4b of the bipolar electrode 4 inserted into the lower turbinate H4 reaches the set amount, the high-frequency power supply device 11 sends the connection cord 10 in the connection cord 10. Two lead wires and elastic wires 8a, 8
b, the two needle electrodes 4a of the bipolar electrode 4,
4b is supplied with a high-frequency current, and the two needle electrodes 4a, 4b
Coagulation treatment is performed on the living tissue at the insertion site. At this time, the nasal endoscope 12 is inserted into the patient's nasal cavity H1 as needed, and the treatment site in the patient's nasal cavity H1 is observed. In addition,
FIG. 5 shows a nasal endoscope 1 for performing coagulation therapy by puncturing the bipolar electrode 4 of the nasal cavity treatment tool 1 into a treatment site in the nasal cavity H1.
2 shows an observation image by No. 2, where H5 is the nasal septum.

Therefore, the above configuration has the following effects. That is, the nasal cavity treatment tool 1 of the present embodiment
Since the two needle electrodes 4a and 4b of the bipolar electrode 4 are configured to protrude and retract from the tip of the insertion portion 2, the lower turbinate H4
The two needle electrodes 4a and 4b of the bipolar electrode 4 can be protruded from the state where the tip of the insertion portion 2 is pressed against the front surface of the electrode. Therefore, the two needle electrodes 4 of the bipolar electrode 4
Since the insertion positions of a and 4b can be accurately positioned, the two needle electrodes 4a and 4b of the bipolar electrode 4 can be accurately punctured under the mucous membrane between the mucosal surface and the turbinate.

Further, in the treatment tool for nasal cavity 1 according to the present embodiment, the insertion direction and the insertion direction of the insertion portion 2 into the nasal cavity H1.
The operation directions of the needle electrodes 4a and 4b for causing the two needle electrodes 4a and 4b of the bipolar electrode 4 to protrude and retract are substantially in the same direction, so that the two needle electrodes 4a and 4b of the bipolar electrode 4 are oriented in the same direction. There is an effect that it is easy to intuitively confirm the insertion direction of 4b. Therefore, the position at which the two needle electrodes 4a and 4b of the bipolar electrode 4 are punctured into the lesion in the nasal cavity H1 is more accurately positioned than when the insertion direction of the insertion section 2 and the insertion direction of the nasal cavity electrode are different. Can be easily performed.

Further, in the nasal cavity treatment tool 1 of the present embodiment, the insertion amount when the insertion portion 2 is inserted into the nasal cavity H1 can be reduced, so that the operability of the nasal cavity treatment device 1 is improved.
With the insertion section 2 inserted into the nasal cavity H1, the work of inserting the needle electrodes 4a and 4b into the living tissue in the nasal cavity H1 can be easily performed.

Further, in the treatment tool for nasal cavity 1 of the present embodiment, even if the two needle electrodes 4a and 4b of the bipolar electrode 4 are thinner than the conventional electrodes, the puncture can be performed, and the needle electrodes 4a and 4b can be punctured.
This has the effect of reducing bleeding at the site where b is inserted.

In the nasal cavity treatment tool 1 of the present embodiment, the two needle electrodes 4a and 4b of the bipolar electrode 4 are projected from a state where the tip of the insertion portion 2 is pressed against the front surface of the lower turbinate H4. So that the insertion portion 2 is inserted into the nasal cavity H1.
During the insertion operation, the two needle electrodes 4a and 4b of the bipolar electrode 4 can be held in a retracted state while being pulled into the insertion holes 5a and 5b of the insertion section 2. Therefore, it is possible to reliably prevent the proximal side of the needle electrodes 4a and 4b from touching the living tissue other than the treatment target site such as the nostril H3.

In the present embodiment, the protruding direction of the two needle electrodes 4a and 4b of the bipolar electrode 4 (the front end) is provided at the front end of the insertion portion 2 at the rear end of the substantially straight front linear portion 2a. When the insertion portion 2 is inserted into the nasal cavity H1, since the substantially straight bent portion 2b bent obliquely rearward of the tip straight portion 2a, which is a direction deviated from the center line direction of the straight portion 2a), is formed. The nasal cavity H by the operation unit 3 itself (or the operator's hand)
It is possible to prevent the field of view of the insertion part of the insertion part 2 from being obstructed. Further, the nasal endoscope 12 inserted into the nasal cavity H1 of the patient and the nasal cavity treatment instrument 1 of the present embodiment
When using in combination with the bending portion 2 of the insertion portion 2
By b, it is possible to prevent the nasal cavity treatment tool 1 of the present embodiment from interfering with the nasal endoscope 12.

Further, in this embodiment, the cross section of the insertion portion 2 is formed in a substantially elliptical flat shape as shown in FIG. 2, and one insertion hole is formed in one side of the flat shape of the insertion portion 2. 5
a) Since the other insertion holes 5b are arranged on the other side, respectively, there is an effect that it is easy to secure a visual field in the nasal cavity H1 when the insertion portion 2 is inserted into the nasal cavity H1.

FIG. 6 shows a second embodiment of the present invention. In the present embodiment, the configuration of the nasal cavity treatment tool 1 of the first embodiment (see FIGS. 1 to 5) is changed as follows.

That is, in the present embodiment, the scale 22 is provided along the guide groove 21 for guiding the movement of the slider 9 of the operation unit 3. In the present embodiment, by visually checking the graduations 22 of the operation unit 3, the amount of movement of the slider 9 is confirmed, and the insertion amounts of the two needle electrodes 4 a and 4 b of the bipolar electrode 4 can be known at hand. Like that.

Therefore, the above configuration has the following effects. That is, in the present embodiment, the insertion amount of the two needle electrodes 4a, 4b can be determined by visually checking the scale 22 when the two needle electrodes 4a, 4b of the bipolar electrode 4 are inserted. When the two needle electrodes 4a and 4b of the electrode 4 are punctured, it is possible to prevent the needle tip from being inserted deep enough to penetrate the lower turbinate H4.

FIGS. 7 and 8A and 8B show a third embodiment of the present invention. In the present embodiment, the configuration of the nasal cavity treatment tool 1 of the first embodiment (see FIGS. 1 to 5) is changed as follows.

That is, in this embodiment, as shown in FIG. 8 (A), a channel 31 capable of supplying air, supplying liquid, or suctioning between the two insertion holes 5a and 5b in the insertion portion 2 of the treatment tool 1 for a nasal cavity. Are formed. The distal end of the channel 31 is opened at the distal end surface of the insertion section 2. further,
The base end of the channel 31 extends toward the operation unit 3 on the hand side.

A tube connector 32 protrudes from the operation unit 3 on the hand side. The proximal end of the channel 31 is directly connected to the inner end of the tube connector 32. Further, an external air supply tube, liquid supply tube or suction tube (not shown) is connected to the outer end of the tube connector 32, and is connected to an air supply / liquid supply source or a suction pump. Then, air supply, liquid supply, or suction can be performed from the channel 31.

The cross-sectional shape of the insertion section 2 is shown in FIG.
As shown in the figure, the substantially elliptical flat shape (the length dimension D1 of the major axis of the ellipse and the dimension D2 of the minor axis is D1> D
2) is formed. An insertion hole 5a through which one needle electrode 4a of the bipolar electrode 4 is inserted into one side of the flat shape of the insertion portion 2, and an insertion hole 5b through which the other needle electrode 4a of the bipolar electrode 4 is inserted into the other side. Each is arranged,
The channel 3 is located at a central position between these insertion holes 5a and 5b.
1 is arranged.

Next, the operation of the present embodiment having the above configuration will be described. In the nasal cavity treatment device 1 of the present embodiment, the nasal cavity treatment device 1 of the present embodiment is used in substantially the same manner as the nasal cavity treatment device 1 of the first embodiment. Here, when coagulation treatment is performed on a lesion in the nasal cavity using the nasal cavity treatment tool 1 of the present embodiment, the two needle electrodes 4a of the bipolar electrode 4,
4b is supplied with a high-frequency current, and the two needle electrodes 4a, 4b
When the living tissue at the insertion site is subjected to coagulation treatment, mist generated during the high-frequency treatment of the living tissue can be sucked out from the channel 31 of the insertion section 2 and removed to the outside.

Thus, the treatment device for nasal cavity 1 according to the present embodiment having the above-described configuration has the following effects. That is, since the cross-sectional shape of the insertion portion 2 is formed into a substantially elliptical flat shape as shown in FIG. 8A, a narrow and long narrow cavity such as the nasal cavity H1 as shown in FIG. When the insertion section 2 of the nasal cavity treatment instrument 1 is inserted into the nasal cavity H1, the ratio of the insertion section 2 of the nasal cavity treatment instrument 1 in the nasal cavity H1 can be reduced. Therefore, the operability of the insertion portion 2 of the treatment tool for nasal cavity 1 in a narrow cavity, particularly in a long narrow cavity such as the nasal cavity H1 is improved. further,
The nasal endoscope 12 can be inserted into the nasal cavity H1 together with the insertion portion 2 of the nasal cavity treatment tool 1.

The two insertion holes 5 in the insertion portion 2
Since a channel 31 capable of air supply, liquid supply or suction is formed between a and 5b, mist generated during high-frequency treatment of a living tissue can be removed from the channel 31 of the insertion section 2 by suction. it can. Therefore, the visual field of the nasal endoscope 12, which is inserted into the nasal cavity H1 together with the insertion portion 2 of the nasal cavity treatment tool 1, is prevented from being obstructed by mist generated during the high-frequency treatment, and the nasal endoscope 12 It is possible to keep the field of view in a state that is easy to see.

Further, there is an effect that it is also possible to supply liquid for cleaning the operative field of the nasal endoscope 12, air supply for blowing out bleeding, and suction of bleeding from the channel 31 of the insertion section 2.

Further, since the proximal side of the insertion section 2 is offset, the observation of the operation field is not hindered by the operation section 3, and when the operation section 3 is used together with the nasal endoscope 12, the operation of the operation section 3 is performed. The interference of the part 3 can be prevented, and the cautery treatment can be performed safely and reliably.

FIG. 9 shows a fourth embodiment of the present invention. In the present embodiment, the configuration of the nasal cavity treatment tool 1 of the third embodiment (see FIGS. 7 and 8A and 8B) is changed as follows.

That is, in the present embodiment, the cross-sectional shape of the insertion portion 2 of the treatment instrument 1 for a nasal cavity is formed in a substantially triangular shape, and the two needle electrodes 4a and 4b of the bipolar electrode 4 are located near the positions of two apexes of the triangle. Through holes 5a and 5b are provided respectively, and the channel 31 is located near another vertex position.
Is arranged.

In the present embodiment, the length d1 of the substantially triangular long diameter portion of the insertion portion 2 of the nasal cavity treatment tool 1 is set.
And the length d2 of the short diameter portion are the length D1 of the long diameter portion of the oval shape and the length D2 of the short diameter portion in the insertion portion 2 of the treatment tool for nasal cavity 1 according to the third embodiment. D1> d
1, D2 <d2.

Therefore, the same effects as those of the third embodiment can be obtained even with the above configuration. Note that a plurality of channels 31 may be provided to perform air supply, water supply, and suction using respective individual channels.

Further, the shape of the offset of the insertion portion 2 of the nasal cavity treatment tool 1 may be formed in a shape other than the crank shape, and the electrodes for high frequency treatment are two needle electrodes 4a,
4b is not limited.

FIGS. 10A and 10B show a fifth embodiment of the present invention. This embodiment is the first
The configuration of the nasal cavity treatment tool 1 of the embodiment (see FIGS. 1 to 5) is changed as follows.

That is, in this embodiment, FIG.
As shown in FIG. 5, a channel 43 is formed between the two insertion holes 5a and 5b in the insertion section 2 of the treatment instrument 1 for a nasal cavity, through which the insertion section 42 of the small-diameter endoscope 41 can be inserted.

An eyepiece 44 is provided at the base end of the insertion portion 42 of the endoscope 41, and a light guide connection portion 45 is provided so as to protrude. In addition, a TV camera head (not shown) is connected to the eyepiece 44, and a light guide cable (not shown) is connected to the light guide connector 45.

In this embodiment, the same effects as those of the first embodiment can be obtained.
Two insertion holes 5a in the insertion portion 2 of the treatment tool 1 for a nasal cavity,
The insertion portion 4 of the small-diameter endoscope 41 is inserted into the channel 43 between 5b.
2 through the insertion portion 2 of the nasal cavity treatment tool 1.
The space occupied by the instrument inserted into the nasal cavity H1 of the patient can be reduced as compared with the case where a nasal endoscope is inserted outside the device, and the burden on the patient can be reduced.

FIG. 11 shows a sixth embodiment of the present invention. In the present embodiment, the configuration of the nasal cavity treatment tool 1 of the first embodiment (see FIGS. 1 to 5) is changed as follows.

That is, in this embodiment, two sliders 51a and 51b movable in the direction of the center line of the operation unit 3 are provided on the operation unit 3 at the hand side of the treatment tool 1 for the nasal cavity. Here, the base end of one elastic wire 8a is connected to one slider 51a, and the base end of the other elastic wire 8b is connected to the other slider 51b.

Further, guide grooves 52a, which guide the movement of the two sliders 51a, 51b, are provided in the operation section main body 6.
52b are formed. Here, two sliders 5
1a and 51b can be operated independently of each other. When one slider 51a is moved along the guide groove 52a in the direction of the center line of the operation part 3, one needle electrode 4 of the bipolar electrode 4 is connected via the elastic wire 8a.
a is moved forward and backward in front of the insertion section 2. Similarly, the other slider 51b is connected to the guide groove 52b.
The other needle electrode 4b of the bipolar electrode 4 is caused to protrude and retract in front of the insertion portion 2 via the elastic wire 8b in accordance with the operation of moving the operation portion 3 in the direction of the center line along.

Further, one needle electrode 4 of the bipolar electrode 4
“a” is formed by a pipe-shaped injection needle 53. Further, a tube connector 54 protrudes from the operation unit 3 on the hand side. The lumen of the injection needle 53 communicates with the inner end of the tube connector 54.

One end of an outer tube 55 is connected to the outer end of the tube connector 54. A syringe 56 is connected to the other end of the outer tube 55. Then, a drug solution, such as an anesthetic, injected from the syringe 56 is supplied from the external tube 55 to the tube connector 5.
4, it is supplied to a pipe-shaped injection needle 53 which is one needle electrode 4 a of the bipolar electrode 4. Note that, also in the present embodiment, the scale 57 is provided along the guide grooves 52a and 52b.

Next, the operation of the present embodiment having the above configuration will be described. When coagulation treatment is performed on a lesion in the nasal cavity using the nasal cavity treatment tool 1 of the present embodiment, the following operation is performed. In the present embodiment, similarly to the first embodiment, the two needle electrodes 4 of the bipolar electrode 4 of the nasal treatment tool 1 are previously set.
a, 4b are set in the retracted state in which they are retracted into the respective insertion holes 5a, 5b of the insertion section 2.

In this state, the nasal cavity treatment tool 1 is inserted into the nasal cavity H1 of the patient. At this time, the distal end surface of the insertion portion 2 of the nasal cavity treatment tool 1 is set in a state of being pressed against the front end surface of the lower turbinate H4.

Thereafter, one of the sliders 51 of the operation unit 3
is moved in the forward direction along the guide groove 52a. With this operation, one needle electrode 4a of the bipolar electrode 4 is caused to protrude forward of the insertion portion 2 via the elastic wire 8a, and the one needle electrode 4a is inserted into the lower turbinate H4. In this state, an anesthetic is injected from the syringe 56.
At this time, the anesthetic injected from the syringe 56 is supplied from the external tube 55 to the pipe-shaped injection needle 53, which is one of the needle electrodes 4a of the bipolar electrode 4, via the tube connector 54, and the inside of the lower turbinate H4. Is injected.

After a certain period of time during which the injected anesthesia acts on the human body, the other slider 51b is moved in the forward direction along the guide groove 52b. With this operation, the other needle electrode 4b of the bipolar electrode 4 is caused to protrude forward of the insertion portion 2 via the elastic wire 8b, and the other needle electrode 4b is inserted into the lower turbinate H4. In this state, a high-frequency current is supplied to the two needle electrodes 4a and 4b of the bipolar electrode 4, and the living tissue at the insertion site of the two needle electrodes 4a and 4b is coagulated.

Therefore, the above configuration has the following effects. That is, in this embodiment, the same effect as that of the first embodiment is obtained. In addition, in this embodiment, one needle electrode 4a of the bipolar electrode 4 is formed by the pipe-shaped injection needle 53, and the syringe is used. The anesthetic injected from 56 is connected to the tube connector 5 from the external tube 55.
4 and can be injected into the inferior turbinate H4, so that the injection during anesthesia and the puncture of the needle electrode 4a for high-frequency power supply can be used. . Therefore, it is possible to reduce the number of times of puncturing of the patient with the injection needle or the needle electrode 4a, so that the burden on the patient can be reduced and bleeding due to the puncturing of the needle can be reduced, thereby reducing invasion. There is also an effect that can be done.

The present invention is not limited to the above embodiment. For example, the electrode that protrudes and retracts in front of the insertion section 2 may be a monopolar electrode instead of the bipolar electrode 4 for high-frequency treatment. Further, it goes without saying that various modifications can be made without departing from the spirit of the present invention. next,
Other characteristic technical matters of the present application are additionally described as follows. (Additional item 1) An electrode section at the tip and an operation section at the hand side,
In a puncture needle for a nasal cavity having an insertion portion made of an insulating material for fixing a center axis of the electrode portion and the operation portion at an offset position, a bipolar electrode having a structure in which the electrode portion moves forward and backward with respect to the insertion portion.

(Additional Item 2) The bipolar electrode according to Additional Item 1, wherein the operating portion is provided with a scale on the operating portion so that the amount of advance / retreat of a slider for operating the forward / backward movement of the electrode portion can be visually recognized.

(Additional Item 3) The bipolar electrode according to Additional Item 1, wherein the cross section of the insertion portion has a flat shape.

(Additional Item 4) A bipolar electrode having a plurality of electrodes at a tip portion, wherein the cross section of the insertion portion is formed in an irregular shape.

(Additional Item 5) A bipolar electrode according to Additional Item 4, wherein at least one or more channels that are open at the distal end are provided.

(Prior Art in Additional Items 1-3) USP 5,
733, 282 discloses an electrode for ablating and treating a lesion in the nasal cavity at a high frequency, but ablation treatment cannot be performed on a wide area at a time just because the electrode is fixed at the tip.
When cauterizing a wide area, it is necessary to puncture the lesion many times.

US Pat. No. 5,823,197 discloses a nasal electrode in which three or more electrodes are inserted in a direction perpendicular to the direction of insertion into the nasal cavity. The numbers need to be increased, and the invasion is greater.

(Problems to be Solved by Additional Items 1 to 3)
When inserting an electrode into the nasal cavity, the insertion section and the operation section need to be offset since the visual field is vignetted by the operation section (or the operator's hand) or interferes with the endoscope in the straight shape. is there. Further, by making the insertion portion flat, a visual field in the nasal cavity can be secured.

The conventional electrode has a large diameter of φ0.75 so that the electrode does not bend when inserted, and bleeding occurs at the punctured portion. When the electrode diameter is reduced to φ0.5 or less with the conventional structure, bleeding is reduced, but the electrode is easily bent and cannot be punctured accurately.

As a treatment for allergic rhinitis, coagulation treatment for puncturing the lower turbinate with a high-frequency electrode has been conventionally performed.
However, it is said that when the electrode comes into contact with the puncture needle with the puncture needle, bone necrosis and rot occur, and the inflation of the inferior turbinate continues. Further, cauterization of the mucosal surface loses the function of the mucous membrane.
Therefore, it is necessary to accurately puncture the submucosal tissue between the mucosal surface of the inferior turbinate and the turbinate.

(Effects of Supplementary Items 1 to 3) Since the needle electrode is configured to protrude and retract from the distal end of the insertion portion, the surface of the mucous membrane and the concha are protruded from the state in which the distal end of the insertion portion is pressed against the front surface of the lower turbinate. Accurate puncture under the mucosa between bones. Further, even if the needle is thinner than the conventional needle electrode, the needle can be punctured, and bleeding at the insertion site can be reduced.

[0078]

According to the first aspect of the present invention, the proximal end of the insertion portion to be inserted into the nasal cavity is connected to the operation portion on the hand side, and the distal end of the insertion portion is moved forward and backward in front of the insertion portion. Since the electrode portion is provided, the workability of inserting the electrode portion into the living tissue in the nasal cavity can be improved while the insertion portion is inserted into the nasal cavity, and the work time can be reduced. The burden on the operator and the patient can be reduced, and the position where the electrode portion is punctured into the lesion in the nasal cavity can be accurately positioned, so that a relatively wide range can be cauterized at a time.

According to the second aspect of the present invention, the proximal end of the insertion portion to be inserted into the nasal cavity is connected to the operation portion on the hand side, and the distal end of the insertion portion is configured to protrude and retract in front of the insertion portion. Since the bent portion bent in a direction deviating from the protruding direction of the electrode portion was provided in the insertion portion, and the central axis of the electrode portion and the central axis of the operation portion were arranged at offset positions, respectively. With the insertion part inserted into the nasal cavity, the workability of inserting the electrode part into the living tissue in the nasal cavity can be improved, shortening the work time and reducing the burden on the operator and the patient In addition, the position at which the electrode section is punctured into the lesion in the nasal cavity can be accurately positioned, and a relatively wide range can be cauterized at a time. Furthermore, when the insertion portion is inserted into the nasal cavity by the bent portion of the insertion portion bent in a direction deviated from the protruding direction of the electrode portion, the operation portion itself (or the operator's hand) causes the insertion portion to be inserted into the nasal cavity. It is possible to prevent the field of view of the insertion portion from being obstructed, and to prevent interference with the endoscope when used in combination with the endoscope.

[Brief description of the drawings]

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

FIG. 2 is a front view of the nasal cavity treatment tool according to the first embodiment.

FIG. 3 is a vertical cross-sectional view showing a configuration of a main part of the nasal cavity treatment tool according to the first embodiment.

FIG. 4 is an explanatory diagram for explaining a use state of the nasal cavity treatment tool according to the first embodiment.

FIG. 5 is a diagram showing an image observed by a nasal endoscope when a coagulation treatment is performed by puncturing a treatment site in the nasal cavity with a bipolar electrode of the nasal cavity treatment tool according to the first embodiment.

FIG. 6 is a side view showing a treatment tool for nasal cavity according to a second embodiment of the present invention.

FIG. 7 is a side view showing a treatment tool for nasal cavity according to a third embodiment of the present invention.

8A is a cross-sectional view taken along line AA of FIG. 7, and FIG. 8B is an explanatory diagram for explaining a use state of the nasal cavity treatment tool according to the third embodiment.

FIG. 9 is a cross-sectional view of a main part showing a treatment tool for nasal cavity according to a fourth embodiment of the present invention.

FIG. 10 shows a nasal cavity treatment tool according to a fifth embodiment of the present invention, wherein (A) is a side view of the nasal cavity treatment device and (B).
3A is a cross-sectional view taken along line BB of FIG.

FIG. 11 is a side view showing a treatment tool for nasal cavity according to a sixth embodiment of the present invention.

[Explanation of symbols]

 H1 nasal cavity 2 insertion part 2b bending part 3 operation part 4 bipolar electrode (electrode part)

Claims (2)

[Claims] 1. An operation part on the proximal side is connected to a base end of an insertion part to be inserted into a nasal cavity, and an electrode part which operates to protrude and retract in front of the insertion part is disposed at a tip part of the insertion part. A nasal cavity treatment tool, characterized in that: 2. An operation part on the proximal side is connected to a base end of an insertion part to be inserted into a nasal cavity, and an electrode part which operates to protrude and retract in front of the insertion part is provided at a tip part of the insertion part. At the same time, a bent portion bent in a direction deviating from the projecting direction of the electrode portion is provided in the insertion portion, and the bent portion is disposed at a position where the center line direction of the electrode portion and the center line direction of the operation portion are offset. A nasal cavity treatment tool, characterized in that: