JP2006325812A - High frequency treating implement - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To safely and efficiently perform treatment by using a needle-like knife when executing the treatment such as the incision of mucous membranes. <P>SOLUTION: A partition wall member 14 where an insertion hole 15 for making an electrode member 13 appear and disappear is perforated at a position set in from the distal end face of a flexible sheath 2 by a prescribed interval is fixed and provided, and a stopper member 16 for regulating the projection length of the electrode member 13 is provided. The partition wall member 14 and the stopper member 16 are interposed in the middle of a route for suction for which the flexible sheath 2 is a path, three communication grooves 21 are formed in a circumferential direction on the partition wall member 1 fixed to the inner surface of the flexible sheath 2, and a suction path groove 22 communicating with the communication groove 21 at an optional rotating position is formed on the stopper member 16 rotated relative to the flexible sheath 2. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to a high-frequency treatment instrument that is inserted into a treatment instrument insertion channel of an endoscope and used for performing a treatment such as an incision while sucking a mucous membrane of a lesion.

  When a lesion, such as a tumor, is found in the mucosa in the inner wall of a body cavity such as the esophagus, stomach, duodenum, and large intestine by endoscopy, a treatment is performed to remove the lesion mucosa using a high-frequency treatment tool. In this case, in order to ensure the safety of the treatment, the treatment is performed under observation by an endoscope, and the high-frequency treatment tool used for this purpose is inserted into the treatment tool insertion channel of the endoscope to be treated. To lead to. Here, on the inner wall of the body cavity, a submucosal layer exists below the mucosal layer, and the muscle layer is covered with the submucosal layer. The treatment of excising the lesioned mucosal layer using the high-frequency treatment tool must be performed so that the lesioned portion is not left behind and the muscle layer is not damaged.

  A high-frequency treatment instrument used for a treatment for incising a mucosal layer is configured by mounting a high-frequency knife made of an electrode member having a rod-shaped portion in a flexible sheath, and a proximal end portion of the flexible sheath The operation means is connected, and the high-frequency knife can be controlled so as to appear and disappear from the distal end of the flexible sheath by remote operation by this operation means. By energizing the high-frequency knife protruding from the flexible sheath, the mucous membrane can be cauterized and incised.

  The structure of the high-frequency knife includes a needle-like knife in which a rod-shaped electrode member extends straightly, and a large-diameter electrode portion connected to the tip of the rod-shaped electrode member, or the tip of the electrode member is bent in an approximate L shape. Thus, there is a hook knife in which a hook portion is formed. The needle knife is operated so as to pierce the mucous membrane, and the mucous membrane or the like can be incised by horizontally moving or swinging the electrode member. On the other hand, the hook knife is incised by hooking a tissue such as a mucous membrane with a hook portion at the tip and pulling it to the insertion portion side of the endoscope.

In any case, the tip portion of the high-frequency knife must be stabilized in order to smoothly and reliably perform a procedure for removing tissue such as mucous membranes. Patent Document 1 proposes a configuration including a mechanism for stabilizing the knife when performing a treatment when a hook knife is used. In the high-frequency treatment device of Patent Document 1, an electrical insulating member is attached to the distal end of a flexible sheath, a through hole is provided in the electrical insulating member, and a rod-shaped electrode portion is inserted through the through hole. The hook portion is configured to protrude from the outer surface of the front end of the electrical insulating member. When the high-frequency knife is not energized, the hook portion is stored in contact with the electrical insulating member. When the high-frequency knife is energized, the hook portion is predetermined from the distal end of the flexible sheath. The length is projected. In order to prevent the rod-like electrode portion from moving such as swinging during energization, the difference in diameter between the hole diameter of the through hole and the outer diameter of the rod-like electrode portion is minimized. In addition, a stopper member is provided on the rod-shaped electrode portion at a position proximal to the electrical insulating member, and the maximum protruding length from the flexible sheath of the high-frequency knife is set to a position where the stopper member contacts the electrical insulating member. Restricted to
JP 2004-313537 A

  By the way, when the high frequency knife is used as a hook knife, the mucosa and the submucosa are hooked by this hook knife and pulled into the treatment instrument insertion channel, and then the tissue is cut by energizing the hook knife, Next, the operation of drawing out the hook knife from the treatment instrument insertion channel is repeated. Therefore, the efficiency and speed of the operation cannot be obtained, and it takes a long time for the treatment to remove the lesioned mucous membrane, which increases the pain of the subject and the burden on the operator. . In addition, the hook portion is always exposed to the outside. For example, if the electrode member is accidentally energized while performing an operation of inserting into the treatment instrument insertion channel, the inner wall of the channel may be damaged. There is also a point.

  On the other hand, if a needle-like knife is used, the efficiency and speed of operation in performing treatment can be achieved. However, when using a needle knife, in order to ensure the safety and reliability of the treatment, except when performing the treatment with the needle knife, when placing it inside the flexible sheath and performing the treatment Must regulate the length of protrusion from the flexible sheath. Also, in order to avoid damaging healthy tissue with the tip of the needle knife, for example, when excising the mucosa of the lesion, it is necessary to operate the needle knife so that it does not contact the muscle layer located below the mucosa. .

  The present invention has been made in view of the above points, and an object of the present invention is to enable a safe and efficient treatment using a needle knife.

  In order to achieve the above-described object, the present invention comprises a treatment instrument body having a linear electrode member capable of applying a high-frequency current to the distal end of a flexible cord and mounted inside the flexible sheath. A high-frequency treatment instrument that is inserted into a body cavity via a treatment instrument insertion channel of an endoscope, and a partition member having an insertion hole through which the electrode member protrudes and retracts is fixedly fixed in the flexible sheath. A stopper member that restricts the protruding length of the electrode member from the insertion hole by contacting the proximal end side surface of the partition wall member is provided on the treatment instrument body, and is provided at the proximal end portion of the flexible sheath. A negative pressure generating source is connected, and the partition member is mounted at a position that enters a predetermined length from the distal end of the flexible sheath, thereby forming a negative pressure acting portion on the distal end side of the partition member, and Form at least one communication passage in the member Then, the negative pressure acting part and the inside of the flexible sheath are communicated with each other by the communication path, and the negative pressure generating source is communicated with the communication path at an arbitrary rotational position of the stopper member. The feature is that the suction passage is formed.

  As the electrode member, a linear shape, that is, a needle knife is used. The needle knife is inserted through the flexible sheath, and the electrode member is securely accommodated in the flexible sheath except when actually performing treatment with the high-frequency treatment instrument. When the treatment is performed, the electrode member is protruded, but the protruding length of the electrode member is restricted. A partition member is provided on the flexible sheath, and a stopper member is provided on the treatment instrument main body side on which the electrode member is provided, so that the electrode member protrudes only to a position where the stopper member contacts the partition member. Here, the partition member and the stopper member are both made of a hard member. Therefore, in order to smoothly insert the high-frequency treatment instrument into the treatment instrument insertion channel of the endoscope, the partition wall is fixed to the flexible sheath. The length of the member in the axial direction cannot be made too long. The high-frequency treatment instrument is a long flexible member. For example, the high-frequency treatment instrument is wound in a loop shape, and the high-frequency treatment instrument is inserted into the treatment instrument insertion channel while the endoscope insertion portion is curved. When the relative displacement between the flexible sheath and the treatment instrument main body occurs, the electrode member is displaced to the proximal end side from the partition member provided with the insertion hole. That is, the electrode member comes out of the insertion hole. Therefore, when performing the treatment, the electrode member is inserted into the insertion hole. When the electrode member protrudes from the partition wall member, in order to stably hold the electrode member, the inner diameter of the insertion hole and the outer diameter of the electrode member Reduce the diameter difference. The electrode member can be inserted into the insertion hole by providing a calling portion in the partition wall member, but in order to further ensure the insertion of the electrode member into the insertion hole, the outer diameter and flexibility of the stopper member The diameter difference from the inner diameter of the sheath is reduced, and the stopper member is operated to slide with respect to the inner wall of the flexible sheath. As a result, the electrode member is held substantially at the axial center position in the flexible sheath, so that the electrode member is reliably guided to the insertion hole.

  In order to perform the treatment more safely, a negative pressure acting part is formed on the distal end surface of the partition wall member, and a negative pressure suction force is applied to the negative pressure acting part to suck tissue such as a mucous membrane. It is composed. The negative pressure acting portion is a space having a predetermined volume defined by the inner peripheral surface of the distal end portion of the flexible sheath and the distal end surface of the partition wall member. The volume of this space depends on the tissue to be incised. For example, when incising a mucosal layer, when a negative pressure suction force is applied to the negative pressure acting part, the mucous membrane and the submucosal layer are accommodated, but the muscle layer may be drawn into the negative pressure acting part. The inner diameter of the flexible sheath and the depth position of the partition member are set so as not to be present. Therefore, in order to apply a negative pressure suction force to the negative pressure acting portion, a negative pressure generating source is connected to the proximal end portion of the flexible sheath, and the inside of the flexible sheath functions as a suction passage. In order to make this suction passage communicate with the negative pressure acting portion, one or a plurality of communication passages are formed on the outer peripheral surface of the partition wall member. The partition member must have a contact area necessary for being firmly fixed to the inner surface of the flexible sheath. For this reason, the size of the communication path is limited. On the other hand, a stopper member is provided on the base end side of the partition member. When the outer diameter of the stopper member is increased in order to stabilize the posture of the electrode member, the outer peripheral portion of the stopper member and the flexible sheath A flow path is not formed between the inner periphery of each of the two. Therefore, the stopper member is provided with a suction passage that communicates with the communication passage at an arbitrary rotational position.

  A communication groove is formed on the outer peripheral side of the partition member. The communication groove may be formed at one place, but is preferably formed at a plurality of places, at least three places. In addition, it can replace with this communicating groove | channel and can also be made into the communicating hole which consists of a through-hole. The suction passage formed in the stopper member may also be formed with a groove or a through hole. When the suction passage is formed by a through hole, its radial position is a position that overlaps with the communication groove of the partition wall member, and the circumferential pitch interval is the circumferential direction at the communication groove forming portion. The interval is smaller than the width of. The hole diameter of the through hole is desirably as large as possible. The suction passage can be formed by a groove formed in the outer peripheral portion of the stopper member. Here, since the stopper member only needs to stabilize the position of the electrode member in the axial direction inside the flexible sheath, the sliding area to the flexible sheath does not need to be so wide. . Accordingly, the depth of the suction passage may be substantially the same as the depth of the groove of the partition wall member, and the circumferential width of the suction passage may be made larger than the circumferential width of the gap between the communication grooves of the partition wall member. The number of communication grooves and suction passages may be the same, but different numbers, for example, three communication grooves and four suction passages may be provided.

  By adopting the above configuration, treatment such as incision of the mucous membrane can be safely performed using a needle knife, and the treatment can be performed smoothly, reliably and efficiently.

  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. In the figure, reference numeral 1 denotes a high-frequency treatment instrument. This high-frequency treatment instrument 1 has a long flexible sheath 2, and a connection pipe 3 is connected to the proximal end portion of the flexible sheath 2. Further, 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. The flexible cord 11 is formed by covering a conductive wire with an electrically insulating member. A base end portion of the flexible cord 11 protrudes a predetermined length from a connecting portion to the slider 4b, and a contact portion 12 is provided. Accordingly, the contact portion 12 is detachably connected to a high frequency power supply device (not shown).

  As is clear from FIG. 2, the flexible cord 11 constituting the treatment instrument body 10 extends from the connecting portion to the slider 4 b through the inside of the connecting pipe 3 and into the flexible sheath 2. A conductive wire extends in a straight line from the distal end portion of the flexible cord 11, and a lead-out portion of the conductive wire is an electrode member 13 constituting a needle knife. Further, a partition wall member 14 is inserted into the distal end portion of the flexible sheath 2 and fixed by means such as adhesion. The partition member 14 is made of ceramic or the like, and is fixed at a position that enters from the distal end surface of the flexible sheath 2 by a predetermined interval, as is apparent from FIGS. 3 and 4. The partition member 14 is provided with an insertion hole 15 that penetrates in the axial direction at the position of the central axis. The diameter of the insertion hole 15 is slightly smaller than the outer diameter of the electrode member 13. The dimensions are large. A calling taper portion 14 a that guides the electrode member 13 toward the insertion hole 15 is formed at the base end portion of the partition wall member 14.

  Furthermore, a stopper member 16 is attached to a transition portion from the flexible cord 11 to the electrode member 13 or a portion of the electrode member 13 in the treatment instrument body 10. The stopper member 16 has an outer diameter slightly smaller than the inner diameter of the flexible sheath 2. Therefore, when the treatment instrument body 10 is moved in the flexible sheath 2, the inner surface of the flexible sheath 2 is used. Almost slide. When the electrode member 13 at the distal end of the treatment instrument main body 10 is in a state of projecting a predetermined length from the distal end surface of the partition wall member 14, the stopper member 16 comes into contact with the partition wall member 14, and the electrode member 13 is further moved. It will be regulated not to protrude.

  As described above, by fixing the partition member 14 at a position recessed from the distal end of the flexible sheath 2, a predetermined volume is obtained from the distal end surface of the partition member 14 and the inner peripheral surface of the flexible sheath 2. A space is formed. This space is the negative pressure acting portion 17. The negative pressure acting part 17 forms a closed space having a predetermined volume formed in the distal end portion of the flexible sheath 2 by bringing the distal end of the flexible sheath 2 into contact with the mucous membrane or the like. And it is set as the structure which can make a negative pressure suction force act on the negative pressure action part 17 which consists of this obstruction | occlusion space. For this purpose, the connection pipe 3 has a connection port 3a, and a suction pipe 6 connected to the suction source 5 is detachably connected to the connection port 3a. A switching means 7 for opening and closing the flow path, such as a foot switch, is provided in the middle of the suction pipe 6 to control whether or not to generate a negative pressure suction force. Yes. Accordingly, a suction path for applying a negative pressure suction force to the inside of the flexible sheath 2 connected to the connection pipe 3 is provided. Further, the flexible cord 11 is led out to the outside through the seal member 20 at the proximal end portion of the connection pipe 3.

  A partition wall member 14 and a stopper member 16 are interposed in the middle of the suction path. In addition, the partition member 14 is fixed to the inner surface of the flexible sheath 2, and the stopper member 16 is almost in sliding contact with the inner surface of the flexible sheath 2. In this way, the outer diameter of the stopper member 16n and the inner diameter of the flexible sheath 2 have dimensions that are substantially the same, so that the straightness of the electrode member 13 is ensured. Therefore, a flow path between the inside of the flexible sheath 2 and the negative pressure acting portion 17 is opened through the partition member 14 and the stopper member 16.

  As shown in FIG. 5A, three communication grooves 21 are formed on the outer peripheral surface of the partition member 14 at equal intervals in the circumferential direction. These communication grooves 21 penetrate the partition wall member 14 in the axial direction. The partition member 14 must be fixed to the inner surface of the flexible sheath 2. For this purpose, the partition member 14 is inserted into the flexible sheath 2 and fixed with an adhesive, and the circumferential width of the communication groove 21 formed on the outer peripheral surface of the partition member 14 is determined by this partition wall. By increasing the width of the member 14 as much as possible within a range not impairing the fixing property of the member 14 to the flexible sheath 2, the flow path area is increased.

  Thus, although the partition member 14 is fixed to the flexible sheath 2, the position of the stopper member 16 provided on the treatment instrument body 10 side on the inner surface of the flexible sheath 2 is regulated in the rotational direction. Not. Therefore, on the outer peripheral surface of the stopper member 16, as shown in FIG. 5B, a larger number than the communication grooves 21 of the partition wall member 14, specifically, four suction passage grooves 22 are arranged in the circumferential direction. Form at equal intervals. In addition, the depth of the suction passage groove 22 is substantially the same as or deeper than that of the communication groove 21, and the length in the circumferential direction is greater than the interval between adjacent communication grooves 21 in the partition wall member 14. Make it wide. Accordingly, at least a part of the suction passage groove 22 of the stopper member 16 communicates with the communication groove 21 at an arbitrary rotational position. If the suction passage groove 22 is configured in this manner, the gap between the grooves is reduced, but the stopper member 16 is stably positioned so that the electrode member 13 is substantially aligned with the axis of the flexible sheath 2. Since the holding portion only needs to be held, the sliding contact portion with the inner surface of the flexible sheath 2 may be short.

  As a result, when the electrode member 13 is projected to the maximum projecting position and the stopper member 16 comes into contact with the partition wall member 14, the suction passage groove 22 overlaps with the communication groove 21 of the partition wall member 14, and negative pressure action is caused. A suction channel to the portion 17 is secured.

  FIG. 3 shows a state in which the electrode member 13 is most retracted into the flexible sheath 2, and FIG. 4 shows a state in which the electrode member 13 protrudes most from the partition member 14. As is clear from these drawings, when the electrode member 13 is drawn into the flexible sheath 2, the distal end of the electrode member 13 is disposed on the proximal end side with respect to the proximal end surface of the partition wall member 14. On the other hand, in the most projecting state of the electrode member 13, the electrode member 13 is inserted into the insertion hole 15 of the partition wall member 14, and the distal end thereof is projected to substantially the same position as the distal end of the flexible sheath 2. The push / pull operation of the electrode member 13 is performed by a remote operation by the operation means 4. Since the stopper member 13 connected to the electrode member 13 by this operation moves substantially straight along the inner peripheral surface of the flexible sheath 2, the partition member 14 is provided with a calling taper portion 14a. In addition, the electrode member 13 enters the insertion hole 15 smoothly and reliably.

  As shown in FIG. 6, the high-frequency treatment instrument 1 having the above configuration is inserted into a body cavity via a treatment instrument insertion channel C provided in an endoscope insertion part S having an observation part W, for example, the esophagus When the lesioned mucosa is present on the inner wall of a body cavity such as the stomach, duodenum, and large intestine, it is used to perform a treatment for peeling and removing the lesioned mucosa. First, the submucosal layer is bulged and raised by injecting physiological saline into the lesioned mucosa. Then, the high-frequency treatment instrument 1 is inserted into the treatment instrument insertion channel C, so that the high-frequency treatment instrument 1 cuts the mucous membrane.

  For this purpose, the distal end surface of the flexible sheath 2 is directly opposed to the mucosal layer and lightly pressed against the mucosal surface so that the distal end surface of the flexible sheath 2 is hermetically sealed and the pressing force is not applied as much as possible. To. The suction pipe 6 is connected to the connection port 3a of the connection pipe 3 in advance, and the switching means 7 is operated in a state where the distal end surface of the flexible sheath 2 is pressed against the mucous membrane layer. A negative pressure suction force is applied to 6. As a result, the negative pressure suction force reaches the negative pressure acting portion 17 from the inside of the flexible sheath 2 through the suction passage groove 22 of the stopper member 16 and the communication groove 21 of the partition wall member 14. As a result, as shown in FIG. 7, the mucosal layer inside the portion surrounded by the distal end surface of the flexible sheath 2 is formed by the inner peripheral surface of the flexible sheath 2 and the distal end surface of the partition wall member 14. Suction is performed by the negative pressure acting portion 17 formed with the compartment. By this suction, the surface of the mucosal layer comes into contact with the partition wall member 14 so that the entire mucosal layer completely enters the negative pressure acting part 17 and the mucosal lower layer partially enters the negative pressure acting part 17.

  As described above, since the mucous membrane layer is bulged by the local injection performed in advance during the suction of the body tissue, the muscle layer is not drawn into the negative pressure acting portion 17. In this way, the dimensions of the cross-sectional area of the negative pressure acting portion 17 due to the inner diameter of the flexible sheath 2 and the depth of the negative pressure acting portion 17 depending on the position of the flexible sheath 2 of the partition member 14 are appropriately set. In the body tissue, the entire mucous membrane layer is surely entered into the negative pressure acting portion 17.

  Further, by maintaining the negative pressure suction force for the negative pressure acting portion 17, excessive body tissue is not drawn into the negative pressure acting portion 17. Therefore, the operating means 4 is operated, and as shown in FIG. 8, the electrode member 13 is protruded from the insertion hole 15 to be inserted into the mucosal layer and the mucosal layer is cauterized by flowing a high-frequency current. At this time, since the stopper member 16 connected to the electrode member 13 slides on the inner surface of the flexible sheath 2, the electrode member 13 is held at the position of the central axis of the flexible sheath 2 and the partition wall. Since the calling taper portion 14 a is formed around the insertion hole 15 in the member 14, the electrode member 13 is smoothly and reliably inserted into the insertion hole 15 of the partition wall member 14. As a result, the electrode member 13 penetrates the mucous membrane layer while cauterizing, and is reliably inserted into the submucosal layer.

  In this state, the entire circumference of the lesion mucosa can be incised by operating the endoscope insertion portion S and moving the high-frequency treatment tool 1 along the outer periphery of the lesion mucosa. Further, the lesioned mucous membrane is excised from the incised portion using a treatment tool such as a high-frequency snare, and the excised mucosa is collected using grasping forceps or the like.

  As described above, instead of the suction passage groove 22 formed on the outer peripheral surface of the stopper member 16, as shown in FIG. 9, the stopper member 30 may be provided with a suction passage hole 31 formed of a through hole. . A plurality of the suction passage holes 31 are formed in the circumferential direction, and the pitch interval in the circumferential direction is equal to or less than the width in the circumferential direction of the communication groove 21 provided in the partition wall member 14, so that the stopper member 30. Regardless of the rotational position, at least some of the suction passage holes 31 communicate with the communication groove 21.

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 tip part of a treatment instrument main part. FIG. 4 is a cross-sectional view similar to FIG. 3, showing an electrode member protruding. It is a longitudinal cross-sectional view of the partition member and stopper member for demonstrating the positional relationship of the communicating groove | channel provided in the partition member, and the suction passage groove | channel provided in the stopper member. 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 sectional drawing which shows the state which is attracting | sucking a mucous membrane with a high frequency treatment tool. It is sectional drawing which shows the state which is incising with a high frequency treatment tool. It is a front view which shows the modification of the suction passage provided in a stopper member.

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 Electrode member 14 Partition member 15 Insertion hole 16, 30 Stopper member 17 Negative pressure action part 21 Communication groove 22 Suction passage groove 31 Suction passage hole

Claims (2)

A body cavity comprising a treatment instrument body equipped with a linear electrode member capable of applying a high-frequency current to the distal end of a flexible cord and mounted inside the flexible sheath, and via a treatment instrument insertion channel of an endoscope In the high-frequency treatment instrument inserted in,
A partition member having an insertion hole for allowing the electrode member to protrude and retract in the flexible sheath is fixedly attached,
A stopper member is provided on the treatment instrument body to regulate the protruding length of the electrode member from the insertion hole by contacting the proximal end side surface of the partition member.
A negative pressure source is connected to the proximal end of the flexible sheath, and the partition member is mounted at a position that enters a predetermined length from the distal end of the flexible sheath. A negative pressure acting part is formed on
Forming at least one communicating path in the partition member, and communicating the negative pressure acting part and the inside of the flexible sheath through the communicating path;
The high-frequency treatment instrument characterized in that the stopper member is formed with a suction passage for communicating the negative pressure generating source with the communication passage at an arbitrary rotational position. The high-frequency treatment device according to claim 1, wherein the communication passage and the suction passage are each formed by a plurality of grooves or through holes provided in outer peripheral portions of the partition wall member and the stopper member.

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