JP2006325809A - High frequency treatment tool - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a high frequency treatment tool which is constituted to perform safe operation without exposing a diathermic knife outside when the treatment is not administered and efficiently delivers a fluid to desired positions. <P>SOLUTION: The needle-shaped knife 13 of a main body 10 of the treatment tool provided in a flexible sheath 2 is led to an insertion hole 31 by being guided by first and second guide surfaces 21, 32 respectively provided on first and second guide collars 20, 30 provided in the flexible sheath 2. Grooves 33 for feeding a fluid are equally spaced in three places circumferentially on the second guide collar 30. The needle-shaped knife 13 is prevented from getting in the grooves 33 and being locked when moving slidably along the first and second guide surfaces 21, 32. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention is a high-frequency treatment instrument that is inserted into a treatment instrument insertion channel of an endoscope and used for performing treatment such as incision and peeling of a lesioned mucosa, and has a fluid supply passage formed in a flexible sheath. It is about.

  Endoscopic submucosal dissection (ESD) is an example of endoscopic treatment. This procedure is performed by endoscopy on the mucosal part of the inner wall of the body cavity such as the esophagus, stomach, duodenum, and large intestine. When a lesion such as a tumor is found, the lesioned mucosa is removed. For this purpose, a high-frequency treatment instrument is inserted into a treatment instrument insertion channel provided in the endoscope, and the lesioned mucosa is excised. In this ESD treatment, the lesioned mucosa is usually bulged by local injection, the mucous membrane is incised using a high-frequency treatment tool, and then the lesioned mucosa is excised.

  The high-frequency treatment instrument used for the above treatment is configured by mounting a high-frequency knife made of an electrode member having a rod-shaped portion in a flexible sheath. An operating means is connected to the proximal end portion of the flexible sheath, and the high-frequency knife is protruded from the distal end of the flexible sheath by remote operation by the operating means, and the mucosa is incised by energizing the high-frequency knife. And then peel off. As a high-frequency treatment tool used for this ESD, for example, the one shown in Patent Document 1 is conventionally known.

The high-frequency knife according to Patent Document 1 has a hook portion formed by connecting a large-diameter electrode portion at the tip of a rod-shaped electrode member or bending the tip into a substantially L shape. The tissue is hooked by the hook portion at the distal end and operated so as to be pulled into the endoscope, and then a high-frequency current is passed through the hook knife, whereby the mucous membrane is incised or peeled off. Further, the hook knife projects a predetermined length from the flexible sheath when energized, but the difference in diameter between the hole diameter of the through hole and the outer diameter of the electrode member is minimized, and the flexible sheath A stopper member is provided inside, and the protruding length of the electrode member is restricted. Thus, the electrode member is configured to be stably held. Moreover, in order to ensure the safety of the treatment, at least the hook portion is set to be captured in the observation visual field by the endoscope when the electrode member is in the most protruding state. Furthermore, since the operation of the hook knife is performed while observing with an endoscope, the hook knife can be operated so as not to contact the muscle layer in the energized state. Further, the high-frequency knife of Patent Document 1 is provided with a liquid feeding means, and when bleeding occurs when performing mucosal incision or peeling, the bleeding part can be washed away by the liquid feeding means.
JP 2004-313537 A

  As described above, in the high-frequency knife having the hook portion, the electrode member at the tip cannot be completely drawn into the flexible sheath, and the hook portion is always exposed to the outside. Therefore, when this electrode member should not be energized, there is a problem such as damage to the inner wall of the treatment instrument insertion channel if a current flows by mistake before insertion into the treatment instrument insertion channel or during insertion, for example. . Further, in order to regulate the protruding length of the electrode member, the stopper is provided when the inside of the flexible sheath is used as the liquid feeding path because of the relationship of providing a stopper at the base end portion of the electrode member or in the vicinity thereof. There is also a problem that the liquid cannot be efficiently fed toward a desired position because it gets in the way.

  The present invention has been made in view of the above points, and the object of the present invention is that when a treatment is not performed, the high-frequency knife is not exposed to the outside and can be operated safely, Another object of the present invention is to provide a high-frequency treatment instrument that can efficiently deliver liquid to a desired position.

  In order to achieve the above-described object, the present invention provides a flexible sheath that can be inserted into a treatment instrument insertion channel of an endoscope, and a flexible sheath provided inside the flexible sheath. A high-frequency treatment instrument comprising a treatment instrument body provided with a high-frequency knife to which a high-frequency current is applied, wherein the first and the second are each made of an electrically insulating member in order to guide the high-frequency knife into the flexible sheath. A second guide collar is mounted, and the distal end surface of the second guide collar is disposed at substantially the same position as the distal end surface of the flexible sheath, and the first guide collar is the second guide collar. The first guide collar is disposed on the base end side of the guide collar, and the first guide collar guides the first high-frequency knife from the inner surface of the flexible sheath in a direction toward the central axis of the flexible sheath. Have The second guide collar is formed with an insertion hole through which the high-frequency knife protrudes and has a second guide surface for guiding the high-frequency knife toward the insertion hole. The guide surfaces are spaced apart from each other by a spacer portion, and the second guide collar is formed with a fluid supply passage leading to the inside of the flexible sheath at a position on the outer peripheral side of the first guide surface. A stopper member for restricting the protruding length from the insertion hole is attached to the treatment instrument body, and the protruding length of the high-frequency knife by the stopper member is longer than the thickness of the mucosal layer, This is characterized in that it is shorter than the total thickness.

  The first and second guide collars mounted in the flexible sheath and made of an electrically insulating member can be formed of, for example, a synthetic resin, but it is preferable that the first and second guide collars are formed of ceramic in consideration of heat resistance and the like. . The high-frequency knife does not cause any particular trouble even if it is energized by an erroneous operation by being pulled to the proximal end side from the first guide collar in the flexible sheath. The high-frequency knife is inserted through an insertion hole provided in the second guide collar and protrudes to the outside. In order to stably hold the high-frequency knife derived from the insertion hole, the difference in diameter between the hole diameter of the insertion hole and the outer diameter of the high-frequency knife is made as small as possible to minimize the gap therebetween.

  It is necessary to guide the high frequency knife from the state pulled to the base end side of the insertion hole toward the insertion hole, but if you want to demonstrate the function of only guiding the high frequency knife, use a single guide collar, It is conceivable to form a tapered guide surface from the outer peripheral side to the insertion hole. However, since a fluid supply passage is formed in the guide collar, the high-frequency knife enters the fluid supply passage while the tip of the high-frequency knife is in contact with the guide surface and is locked at that position. There is a risk that it will not be able to lead to. In order to prevent the occurrence of such a situation, the electrode member is guided in two steps toward the insertion hole. First, the inner peripheral edge portion of the first guide surface formed in the first guide collar is the same as or inside the position of the fluid supply passage formed in the second guide collar in the longitudinal section of the flexible sheath. Is located. The fluid supply passage can be formed as a through hole provided in the second guide collar, but in order to increase the flow path area, it is formed by one or a plurality of grooves having a predetermined depth from the outer peripheral side. desirable. In any case, in the longitudinal section of the flexible sheath, the fluid supply passage is formed at a position overlapping the first guide surface.

  The second guide surface formed on the second guide collar is for the tip of the electrode member guided along the first guide surface to contact and shift to the insertion hole. Therefore, it is desirable that the outer peripheral edge portion of the second guide surface substantially coincides with the inner peripheral edge portion of the first guide surface, or that both guide surfaces overlap to some extent. However, depending on the shape of the high-frequency knife, even if there are some gaps in the first and second guide surfaces, the first guide surface can be shifted to the second guide surface.

  Spacer portions for separating the first and second guide surfaces in the axial direction are provided to form a predetermined space between the end surfaces of the first and second guide collars. The spacer portion can be formed of an independent member, but for example, the spacer portion is provided integrally with the first guide collar so as to protrude from the end face of either the first guide collar or the second guide collar. be able to. As the shape of the spacer portion, the structure is simple, and it is desirable to form an annular shape in order to maintain high strength, and it is desirable to continuously connect to the outer peripheral surface of the first guide collar. However, the configuration is not particularly limited to the above-described configuration as long as the first guide surface and the second guide surface are separated from each other. When the spacer portion is formed on the outer peripheral surface of the first guide collar and the fluid supply passage is formed with a groove on the outer peripheral surface of the second guide collar, the spacer portion overlaps the fluid supply passage. Become. In this case, the groove has a depth from the spacer part to the inside.

  The stopper member is disposed at the proximal end portion of the high frequency knife or in the vicinity thereof, but can be formed of a ring member having a larger diameter than the high frequency knife. The outer diameter of the stopper member needs to be smaller than the inner circumference of the first guide surface. The stopper member may be configured so as to be in contact with and away from the tapered second guide surface of the second guide collar, but from the inner periphery of the first guide surface to the outer side of the second guide surface. When the peripheral edge is smaller, the stopper member can be brought into contact with or separated from the flat surface formed outside the second guide surface in the second guide collar.

  By adopting the above configuration, when the high frequency treatment tool is not used, the high frequency knife is not exposed to the outside so that it can be operated safely, and if necessary, physiological saline, etc. The fluid can be efficiently supplied.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. First, FIG. 1 shows the overall configuration of the high-frequency treatment instrument, and FIG. Further, FIGS. 3 to 5 show cross sections of the distal end portion of the high-frequency treatment device in different operating states.

  First, in FIGS. 1 and 2, reference numeral 1 denotes a high-frequency treatment instrument. The high-frequency treatment instrument 1 has a long flexible sheath 2, and a connection pipe is connected to a proximal end portion of the flexible sheath 2. 3 is connected, and the operation means 4 is connected to the other end of the connection pipe 3. The operating means 4 includes a main body shaft 4a connected to the connection pipe 3, and a slider 4b fitted to the main body shaft 4a and provided to be slidable in the axial direction of the main body shaft 4a. A base end portion of a flexible cord 11 constituting the treatment instrument main body 10 is connected to the slider 4b.

  As is apparent from FIG. 3, the flexible cord 11 is formed, for example, by inserting the outer peripheral portion of the conductive wire portion 11a into the insulating coating 11b, and has flexibility in at least the bending direction. The base end portion of the conductive wire portion 11a in the flexible cord 11 protrudes from the connecting portion to the slider 4b by a predetermined length, and a contact portion 12 is formed. The contact portion 12 is detachably connected to a high frequency power supply device (not shown).

  The flexible cord 11 constituting the treatment instrument main body 10 extends from the attachment portion to the slider 4b through the inside of the connection pipe 3 into the flexible sheath 2. A needle-like knife 13 is provided so as to protrude from the tip of the flexible cord 11. The needle knife 13 is preferably made of a hard rod-like member, and is electrically connected to the conducting wire portion 11a of the flexible cord 11. The predetermined length is exposed to the outside, and this portion is exposed to the body when energized. It acts on the tissue, and the tissue can be cauterized to perform treatment such as incision and mucosal detachment.

  Reference numeral 20 denotes a first guide collar, and 30 denotes a second guide collar. Of these first and second guide collars 20 and 30, at least the second guide collar 22 is formed of an electrically insulating member, particularly ceramic. On the other hand, the first guide collar 20 does not necessarily have to be an electrically insulating member, but may be formed of an electrically insulating member such as ceramic or synthetic resin, or may be formed of a conductive member such as metal. . The first guide collar 20 has an outer diameter that is slightly larger than the inner diameter of the flexible sheath 2. The first guide collar 20 is attached to the inside of the flexible sheath 2, and the second guide collar 20 has the second outer diameter. The guide collar 30 is located on the distal end side of the first guide collar 20 in the flexible sheath 2. The distal end surface of the second guide collar 30 is configured to be disposed at substantially the same position as the distal end surface of the flexible sheath 2.

  A first guide surface 21 is formed on the first guide collar 20. The first guide surface 21 is a taper surface inclined obliquely inward at a predetermined angle from the proximal end side to the distal end side of the flexible sheath 2, and the first guide surface 21 is The first guide collar 20 is formed in an annular shape having a predetermined width from the outer periphery to the inside. A spacer portion 22 is continuously provided on the distal end side of the portion where the first guide surface 21 is formed. The spacer portion 22 is a thin ring-shaped member having the same outer diameter as the outer peripheral portion of the first guide collar 20 and having an outer diameter larger than the inner peripheral edge of the first guide surface 21.

  The second guide collar 30 is provided with an insertion hole 31 at a position that becomes the central axis of the flexible sheath 2. The needle knife 13 provided at the tip of the flexible cord 11 can be inserted into and removed from the insertion hole 31. Accordingly, the inner diameter of the insertion hole 31 is larger than the outer diameter of the needle knife 13, but by reducing the difference in diameter, a gap is not substantially formed. The protruding length from the insertion hole 31 is set to several mm or less, for example, about 1 to 3 mm. As a result, when the needle knife 13 is protruded from the insertion hole 31, the needle knife 13 is held in a straight state and stable, and is not bent or deformed by the action of an external force or the like. . Furthermore, the axial length of the second guide collar 30 of the needle knife 13 is also an important factor for stabilizing the needle knife 13 protruding from the insertion hole 31. Therefore, the length of the insertion hole 31 is set to a dimension necessary for the stability of the needle knife 13. Furthermore, a second guide surface 32 that guides the needle knife 13 toward the insertion hole 31 is formed on the end surface of the second guide collar 30 on the side facing the first guide collar 20.

  The outer peripheral portion of the second guide surface 32 is flexible so that the distal end portion of the needle knife 13 can be transferred from the first guide surface 21 of the first guide collar 20 to the second guide collar 30 with certainty. When viewed from the axial direction of the sheath 2, it is desirable to extend outside the inner peripheral edge of the first guide surface 21. However, since the tip of the needle knife 13 has a substantially hemispherical shape as illustrated, the needle knife 13 is provided between the inner peripheral edge of the first guide surface 21 and the outer peripheral portion of the second guide surface 32. A gap equal to or less than the radius may be generated.

  In the treatment instrument main body 10 including the flexible cord 11 and the needle-like knife 13, a stopper member 14 is provided at a transition portion between the needle-like knife 13 and the flexible cord 11. The stopper member 14 is formed of a ring-shaped member having a diameter larger than the outer diameter of the needle knife 13 and the inner diameter of the insertion hole 31, and is provided on the outer periphery of the needle knife 13 and fixed to the tip of the insulating coating 11b. It has been. The stopper member 14 is preferably capable of coming into contact with and separating from the flat portion of the second guide collar 30 that moves from the outer peripheral portion of the second guide surface 32. The outer diameter of the stopper member 14 is such that the inner peripheral edge of the first guide surface 21 in the first guide collar 20 can pass through.

  The stopper member 14 regulates the protruding length of the needle knife 13 from the distal end surface of the flexible sheath 2 (which forms substantially the same surface as the second guide collar 30). As will be described later, the protruding length is equal to or greater than the thickness of the mucosal layer when the distal end surface of the flexible sheath 2 is brought into contact with the mucosal surface, and less than the total thickness of the mucosal layer and the submucosal layer. It is said. Accordingly, the preferred protruding length of the needle knife 13 varies depending on the part to be treated by the high-frequency treatment instrument 1.

  Furthermore, the high-frequency treatment instrument 1 has a fluid supply means such as physiological saline. This fluid supply means has a pipe connection part 3a provided in the connection pipe 3, and a liquid supply pipe 6 from the liquid supply tank 5 is detachably connected to the pipe connection part 3a. A switching means 7 for opening and closing the flow path, such as a foot switch, is provided in the middle of the liquid supply pipe 6 so that physiological saline supply control is performed. Therefore, between the inside of the flexible sheath 2 connected to the connection pipe 3, that is, between the inner surface of the flexible sheath 2 and the outer surface of the treatment instrument main body 10 inserted into the inside of the flexible sheath 2. An annular gap formed in the plate functions as a liquid feeding passage. Further, the flexible cord 11 in the treatment instrument main body 10 passes through the connection pipe 3 and is inserted into the main body shaft 4 a, and a sealing member 15 is provided around the flexible cord 11 in the connection pipe 3. It is attached so that fluid does not leak to the operation means 4 side.

  The distal end of the fluid supply passage opens at a joint portion between the flexible sheath 2 and the second guide collar 30. That is, the outer circumferential surface of the second guide collar 30 is provided with a groove 33 that extends over the entire length in the axial direction. The groove 33 is formed in one or more places in the circumferential direction of the second guide collar 30, for example, three places at equal intervals in the circumferential direction as shown in FIG. 6. The depth of the groove 33 extends to the inside from the inner peripheral surface of the spacer portion 22 formed in the first guide collar 20, and the inner portion of the groove 33 from the spacer portion 22 is a flexible sheath. 2 is always open. However, the groove bottom portion of the groove 33 is substantially the same as the inner peripheral edge of the first guide surface 21, or further to the inner side than the inner peripheral edge of the first guide surface 21 by a dimension corresponding to the radius of the needle knife 13. By extending, the passage sectional area of the fluid supply passage can be increased.

  Furthermore, it is necessary to hold the first and second guide collars 20 and 30 so as not to fall off the flexible sheath 2. In particular, when the needle knife 13 protrudes from the insertion hole 31, the tip of the needle knife 13 is pressed against the guide collars 20 and 30, so that the guide collars 20 and 30 are pushed. The two guide collars 20 and 30 are stably held. For this reason, the outer diameter of the first guide collar 20 is slightly larger than the inner diameter of the flexible sheath 2, and the first guide collar 20 is attached so as to spread the flexible sheath 2. Will be. In addition, the outer peripheral surface of the second guide collar 30 has the largest diameter at the proximal end side, the smallest diameter at the distal end side, and the intermediate portion having an outer diameter in the middle thereof, thereby forming an outer surface of the second guide collar 30. Are formed with vertical step portions 30a, 30b. The outer diameter of the minimum diameter portion of the second guide collar 30 is at least equal to or larger than the diameter of the inner peripheral surface of the flexible sheath 2 in the free state. In addition, in order to fix these 1st, 2nd guide collars 20 and 30 firmly with the flexible sheath 2, it can also adhere between them using an adhesive agent. Further, a threaded portion may be provided on the outer peripheral surface of these guide collars 20 and 30 and screwed into the flexible sheath 2.

  With this configuration, a force in a direction in which the first guide collar 20 and the second guide collar 30 are pushed out toward the distal end of the flexible sheath 2 acts when the needle knife 13 is operated. As a result of the tightening force by the flexible sheath 2 acting on the first and second guide collars 20 and 30, and the stepped portions 30a and 30b bite into the inner surface of the flexible sheath 2, It is possible to reliably prevent the second guide collar 30 from falling off.

  The high-frequency treatment instrument 1 in the present embodiment is configured as described above. As shown in FIG. 7, the treatment instrument insertion channel C provided in the endoscope insertion section S having the observation section W is provided. When inserted into a body cavity such as the esophagus, stomach, duodenum, large intestine, etc., and when there is a diseased mucosa on the inner wall of the body cavity, it is used to perform a treatment to remove and remove the lesioned mucosa. It is done. Here, when it is discovered by observation through the observation unit W of the endoscope insertion unit S that a lesion is present on the mucous membrane, the mucous membrane in a predetermined region including the lesion is removed. However, as a previous step, the mucosa is preferably bulged by local injection of the lesioned mucosa.

  At a stage before the treatment is started after the high-frequency treatment instrument 1 is inserted into the treatment instrument insertion channel C, the needle-like knife 13 constituting the treatment instrument body 10 is at least the first inside of the flexible sheath 2. The guide collar 20 is drawn to a position on the base end side, preferably inwardly to the inside. Thus, even if the high-frequency treatment instrument 1 is wound in a loop shape and the endoscope insertion portion S is curved, the high-frequency treatment instrument 1 is inserted into the treatment instrument insertion channel C, whereby the treatment instrument main body 10 is Even if a relative positional shift occurs in the flexible sheath 2, the needle knife 13 is reliably positioned inside the flexible sheath 2 and held so as not to be exposed to the outside. Therefore, even if a high-frequency power supply is accidentally turned on and a high-frequency current flows through the needle knife 13, it is safe because it does not come into contact with other objects.

  When the distal end portion of the high-frequency treatment instrument 1 is led out from the treatment instrument insertion channel C, the operating means 4 of the high-frequency treatment instrument 1 is operated to cause the needle knife 13 to protrude from the distal end of the flexible sheath 2. At this time, when the needle knife 13 is most offset with respect to the central axis of the flexible sheath 2, the tip of the needle knife 13 comes into contact with the inner surface of the flexible sheath 2. When the operation means 4 is operated so that the needle knife 13 is led out from the distal end of the treatment instrument insertion channel C in this state, the distal end portion of the needle knife 13 slides along the inner surface of the flexible sheath 2. Then, as shown in FIG. 3, the first guide collar 21 contacts the first guide surface 21. Since the first guide surface 21 is inclined inward as it goes forward, the tip of the needle knife 13 slides on the first guide surface 21 to ensure the flexible sheath 2. It will be brought toward the center. Since the first guide surface 21 is a tapered surface formed in an annular shape from the inner surface of the flexible sheath 2 toward the inside, the first guide surface 21 smoothly slides and moves on the first guide surface 21.

  When the tip of the needle-shaped knife 13 passes the inner peripheral edge of the first guide surface 21 in the first guide collar 20, the needle-shaped knife 13 moves toward the second guide collar 30. Here, a second guide surface 32 is formed on the second guide collar 30, and the second guide surface 32 overlaps the first guide surface 21, or the needle-like knife 13 therebetween. As shown in FIG. 4, the tip of the needle knife 13 is reliably guided by the second guide surface 32 and is drawn into the insertion hole 31.

  The first guide surface 21 of the first guide collar 20 does not have a chipped portion over the entire circumference, but since the groove 33 is formed in the second guide collar 30, the needle knife 13 is formed in the groove 33. You must avoid getting inside. However, since the groove 33 is located on the outer peripheral side from the inside of the first guide surface 21, the tip of the needle knife 13 does not enter the groove 33 and be locked. Thus, the needle knife 13 is inserted through the first and second guide surfaces 21 and 32 from the inner peripheral surface of the flexible sheath 2 only by operating the needle knife 13 by the operating means 4. Guided into the hole 31, it can be reliably guided to the insertion hole 31. Therefore, it is possible to provide a minimum diameter difference between the inner diameter of the insertion hole 31 and the outer diameter of the needle knife 13 so that almost no gap is generated therebetween. The lead-out portion from the flexible sheath 2 can be stably held and can be prevented from being bent or deformed.

  As shown in FIG. 5, the needle-shaped knife 13 is located at a position where the stopper member 14 provided on the needle knife 13 abuts on a portion around the insertion hole 31, more specifically, on a flat surface outside the second guide surface 32. Proceeds until contact, but does not protrude further. The protruding length of the needle knife 13 at this time is that the mucosal layer penetrates when the flexible sheath 2 of the high-frequency treatment instrument 1 and the distal end surface of the second guide collar 30 are brought into contact with the mucosal surface. The length does not reach the muscle layer located below the submucosa.

  Therefore, as shown in FIG. 8, physiological saline or the like is pre-injected into the submucosal layer so that the submucosal layer bulges and the mucosal layer is largely separated from the muscle layer. As described above, the needle-like knife 13 constituting the treatment instrument body 10 is flexible with the distal end of 2 and the distal end surface of the second guide collar 30 provided therein in contact with the mucosal layer. Derived from the sheath 2 and inserted into the mucosal layer. Since the needle knife 13 is inserted so that there is almost no gap with respect to the insertion hole 31 in the second guide collar 30, even if the needle knife 13 is thin, it does not break or bend. . Then, the needle knife 13 is inserted into the mucous membrane layer, and then the mucous membrane layer is cauterized by flowing a high-frequency current. However, as long as the distal end surface of the flexible sheath 2 is in contact with the mucosal surface. Even if the needle knife 13 is energized, the muscle layer is not damaged, and the mucosal layer can be reliably incised.

  After incising the mucosal layer in this way, in order to peel the mucosal layer from the muscle layer, the mucosal layer is peeled by cutting the fibers of the submucosal layer with a needle knife 13 protruding from the distal end of the flexible sheath 2. Do. And, when performing the incision and peeling of the mucous membrane layer described above, if there is bleeding, a liquid such as physiological saline is jetted from the liquid feeding pipe 6 connected to the pipe connecting part 3a toward the bleeding part, and bleeding is performed. Try to wash away the part. As a result, the observation visual field from the observation part W in the endoscope insertion part S is improved.

  In addition, the mucous membrane portion where the lesion is present is bulged with physiological saline, but the bulging portion contracts because the physiological saline supplied during incision flows out or is absorbed into the body. . Therefore, in order to keep this submucosa in a bulging state, mucosal detachment can be performed while supplying physiological saline through the same route as described above. That is, the needle-like knife 13 is pulled into the insertion hole 31 provided in the second guide collar 30, and the pipe connection portion 3a of the connection pipe 3 is brought into contact with the distal end surface of the flexible sheath 2 against the submucosa. By supplying physiological saline to the flexible sheath 2 at a high pressure, liquid can be directly fed toward the submucosa. As a result, the submucosa layer to be peeled can be maintained in a bulging state. In addition, by bringing the tip surface into contact with the submucosal layer and supplying physiological saline toward the necessary location, the submucosal layer can be reliably kept in the bulging state, and the mucosal detachment by the needle knife 13 can be prevented. It can be done safely.

1 is an overall configuration diagram of a high-frequency treatment tool showing an embodiment of the present invention. It is a principal part expanded sectional view of FIG. It is an expanded sectional view of the front-end | tip part of a treatment tool main body, Comprising: It is a figure which shows the state which the needle-shaped knife moved to the position of the 1st guide collar. FIG. 4 is a cross-sectional view similar to FIG. 3 showing an operating state in which the needle knife has advanced from the state of FIG. 3 to the position of the second guide collar through the position of the first guide collar. It is sectional drawing similar to FIG. 3 which shows the operation state by which the needle-shaped knife was derived | led-out from the penetration hole of the 2nd guide collar. It is XX sectional drawing of FIG. 1 is an external view showing a state in which a high-frequency treatment instrument showing an embodiment of the present invention is derived from a treatment instrument insertion channel of an endoscope. It is effect | action explanatory drawing which shows the state which is incising using a high frequency treatment tool.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 High frequency treatment tool 2 Flexible sheath 3 Connection pipe 4 Operation means 10 Treatment tool main body 11 Flexible cord 13 Needle knife 14 Stopper member 20 First guide collar 21 First guide surface 22 Spacer part 30 Second Guide collar 31 Insertion hole 32 Second guide surface 33 Groove

Claims (3)

A treatment tool provided with a flexible sheath that can be inserted into a treatment tool insertion channel of an endoscope, and a high-frequency knife that is provided inside the flexible sheath and that applies a high-frequency current to the distal end of the flexible cord In a high-frequency treatment instrument comprising a main body,
In order to guide the high-frequency knife in the flexible sheath, first and second guide collars each made of an electrically insulating member are mounted,
The distal end surface of the second guide collar is disposed at substantially the same position as the distal end surface of the flexible sheath, and the first guide collar is disposed closer to the proximal end side than the second guide collar. ,
The first guide collar has a first guide surface that guides the high-frequency knife from the inner surface of the flexible sheath in a direction toward the central axis of the flexible sheath,
The second guide collar has an insertion hole through which the high-frequency knife protrudes and has a second guide surface that guides the high-frequency knife toward the insertion hole.
The first and second guide surfaces are separated from each other by a spacer portion, and the second guide collar has a fluid communicating with the inside of the flexible sheath at a position on the outer peripheral side of the first guide surface. A supply passage is formed,
A stopper member for restricting the protruding length from the insertion hole is attached to the treatment instrument body, and the protruding length of the high-frequency knife by the stopper member is longer than the thickness of the mucosal layer, and the total of the mucosal layer and the submucosal layer. A high-frequency treatment instrument characterized in that it is configured to be shorter than the thickness. The spacer portion is provided continuously with the first guide collar, and the stopper member is attached to a base end portion of the high-frequency knife, and an outer diameter thereof is a ring shape smaller than an inner diameter of the first guide surface. The high-frequency treatment tool according to claim 1, wherein the high-frequency treatment tool is configured by a member. The fluid supply passage is configured by forming one or a plurality of grooves penetrating in the axial direction on the outer peripheral surface of the second guide collar, and at least a part of the groove is inside the spacer portion, 2. The high-frequency treatment instrument according to claim 1, wherein the high-frequency treatment instrument is configured to open outward from a contact portion of the stopper member to the second guide collar.

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