JP2007236840A - Hemostatic instrument - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a hemostatic instrument which effectively performs the hemostasis with minimum damage, and is excellent in operability. <P>SOLUTION: The hemostatic instrument 2 comprises: a connector member 10; and a flexible tube 11 drawn out from the connector member 10. A ring shape electrode 12 is mounted and an insulating sleeve 13 is inserted and fitted into the distal end part of the flexible tube 11. The insulating sleeve 13 is exposed at the inner side of the ring shape electrode 12 for the portion of a prescribed width. When the ring shape electrode 12 is pressed against the inner wall of a celom, the exposure part of the insulating sleeve 13 is abutted on the inner wall of the celom so as to function as a protection wall member for mitigating the pressure force by the ring shape electrode 12. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to a hemostatic device that is inserted into a body cavity using guide means such as an endoscope, and is used for hemostasis by coagulating a bleeding site by cauterization.

  Typical treatment methods for hemostasis to bleeding sites in the body include coagulation by cauterization and ligation to blood vessels. For example, when a large blood vessel is damaged, hemostasis is performed by ligation. On the other hand, coagulation by cauterization is effective for hemostasis when the bleeding site is small, it is difficult to coagulate the large bleeding site, and the burden on the patient becomes extremely large. As a treatment tool for performing cauterization, that is, a hemostatic tool, a high-frequency treatment tool in which a high-frequency electrode is attached to the tip of an insertion member into the body is used. A high-frequency current is passed between the electrode of the high-frequency treatment tool and the patient, and the hemorrhage is cauterized by the heat generated at that time to stop the bleeding. However, if the electrode is brought into direct contact with the bleeding site, the tissue will evaporate without coagulation, and it may not be possible to effectively stop hemostasis. Here, when cauterizing around the bleeding part and when cauterizing the bleeding part, the electrode should be lightly pressed against the inner wall of the body cavity and should not be brought into contact with the body cavity for a very long time.

  From the above, in order to effectively stop hemostasis by reducing the number of cauterization sites, instead of directly pressing the electrode against the bleeding site, cauterization is performed around the bleeding site at about 4 points, for example. After that, if the electrode is brought into contact with the bleeding site and cauterized, the blood can be effectively stopped with minimal damage without causing transpiration. As a hemostatic tool, for example, as disclosed in Patent Document 1, an endoscope hood is made to function as a high-frequency treatment tool, but the hood is mounted so as to surround an insertion portion of the endoscope. As a result, cauterization is widespread and is not appropriate for stopping small bleeding sites.

Here, in order to stop a small bleeding site, it is advantageous to use a high-frequency treatment instrument that can be inserted through a treatment instrument insertion channel of an endoscope. Patent Document 2 discloses a hemostatic tool that can be inserted into a treatment instrument insertion channel of an endoscope. The hemostatic device of Patent Document 2 is configured such that a wire is inserted into an electrically insulating tube, and an electrode covered with an electrically insulating member is connected to the distal end of the wire and the distal end surface is exposed. With this configuration, when the electrode is pressed against the inner wall of the body cavity, that portion is cauterized. Therefore, when the light is pressed lightly around the bleeding part by about four places, and then the electrode is pressed against the bleeding part, the blood can be stopped smoothly and quickly without causing transpiration. Further, in the hemostatic device of this Patent Document 2, the electrode can be projected and retracted in the tube, and the washing water can be injected from the periphery of the electrode in the tube so that blood can be washed away. ing.
JP 10-328202 A JP 2002-125981 A

  By the way, the hemostatic device of Patent Document 2 is inserted / guided through a treatment instrument insertion channel of an endoscope and inserted into a body cavity, and this hemostatic device itself does not include a position control means. Therefore, when performing cauterization of about four places around the bleeding site and then cauterizing the bleeding site, the position of the hemostatic tool must be adjusted by operating the angle of the insertion portion of the endoscope. It is difficult to control the electrode so as to be displaced to an appropriate position, and it requires a high level of skill, and its operability needs to be improved. In addition, since the electrode is a thin rod, if a pressing force acts on the inner wall of the body cavity when it is pressed against the body cavity, there is a possibility that the electrode will greatly sink into the tissue. On the other hand, if the hood is an electrode as in Patent Document 1, it can be cauterized over a relatively wide range, but since the cautery range is too wide, it is difficult to perform the above-described minimally invasive treatment.

  The present invention has been made in view of the above points, and an object of the present invention is to provide a hemostatic device that can effectively stop hemostasis with minimal damage and has good operability. is there.

  In order to achieve the above-described object, the present invention connects an electrically insulating flexible tube to a connector member having a terminal portion connected to a high-frequency power source, and the terminal portion is connected to the distal end of the flexible tube. The ring-shaped electrode to be connected is mounted, and a protective wall member made of an electrical insulating member is mounted inside the ring-shaped electrode.

  Here, the flexible tube is inserted into a body cavity using, for example, a treatment instrument insertion channel of an endoscope as a guide means, and when a bleeding portion is detected as a result of endoscopic examination, the flexible tube is treated. The hemostasis treatment can be performed by being inserted into the body cavity through the instrument insertion channel. At the time of hemostasis, it is necessary to make it possible to clearly grasp the bleeding site by washing away the blood flowing out from the bleeding part and by sucking and removing the blood. It is also necessary to ensure that the tissue at the location can be cauterized. For this reason, the protective wall member can be formed in a cylindrical shape, a fluid passage can be formed inside, and the connector member can be provided with a connecting portion of a fluid supply / discharge mechanism in the flexible tube. In addition, the ring-shaped electrode is used as one electrode, and the counter electrode plate is brought into contact with the patient, or the ring-shaped electrode is formed in a pair of halved arcs, and an electric insulating member is interposed therebetween. The terminal portion may have a pair of terminals that can be connected to a bipolar terminal of a high-frequency power source.

  In order to minimize cauterization by using a relatively small ring electrode, hemostasis is performed by cauterizing around the bleeding part and then pressing the ring electrode against the bleeding part. The operation of the device is minimized, and hemostasis can be performed smoothly and easily.

    Hereinafter, embodiments of the present invention will be described with reference to the drawings. First, FIG. 1 shows the overall configuration of the hemostatic device. As is clear from the figure, the hemostasis device 1 is inserted into the body cavity of the patient P together with the endoscope 100, and hemostasis at the bleeding site is performed. Here, the hemostasis can be applied to any cases such as those caused by treatment of the endoscope 100 and bleeding caused by other causes. The hemostatic device 1 includes a hemostatic device 2 and a high frequency power supply device 3, and further includes a counter electrode plate 4.

  As shown in FIG. 2, the tourniquet 2 includes a connector member 10 and a flexible tube 11 drawn from the connector member 10. As shown in FIG. 3, a ring-shaped electrode 12 is attached to the distal end portion of the flexible tube 11. The ring-shaped electrode 12 is fixed to the distal end of the flexible tube 11, and at least The tip surface is exposed to the outside. The outer diameter of the ring electrode 12 is approximately the same as the outer diameter of the flexible tube 11, and the inner diameter is smaller than the inner diameter of the flexible tube 11, so that the tip surface of the ring electrode 12 is predetermined. It is a ring-shaped contact surface with a width. Further, the outer peripheral edge and the inner peripheral edge of the ring-shaped electrode 12 have an arc shape and have no edge.

  Further, an insulating sleeve 13 made of hard plastic with good heat resistance formed in a cylindrical shape is inserted into the distal end portion of the flexible tube 11 and fixed by means such as adhesion. The insulating sleeve 13 has an outer diameter of a predetermined length that is substantially the same as the inner diameter of the flexible tube 11, and a reduced diameter portion 13 a is formed at the distal end portion. It is fitted and fixed to the diameter portion 13a. Accordingly, the insulating sleeve 13 is exposed inside the ring-shaped electrode 12 by a predetermined width, and when the ring-shaped electrode 12 is pressed against the inner wall of the body cavity, the exposed portion of the insulating sleeve 13 also contacts the inner wall of the body cavity. Thus, it functions as a protective wall member for relaxing the pressing force by the ring-shaped electrode 12. Here, the end surface of the insulating sleeve 13 is recessed from the end surface of the ring-shaped electrode 12, but the step is very slight. A wiring 14 is connected to the ring-shaped electrode 12, and this wiring 14 passes between the flexible tube 11 and the insulating sleeve 13, and extends inside the flexible tube 11 toward the proximal end side. Yes.

  Next, FIG. 4 shows a configuration of the connector member 10 to which the flexible tube 11 is connected from the base end portion of the flexible tube 11. A connecting portion 15 is connected to one end side of the connector member 10, and a base end portion of the flexible tube 11 is fitted to the connecting portion 15. Further, the connecting portion 15 has a step structure, and inner and outer double protective sleeves 16 and 17 are fitted so as to cover the flexible tube 11, and these protective sleeves 16 and 17 cooperate with each other. Demonstrate the bending function of the flexible tube 11. Further, the wiring 14 in the flexible tube 11 is inserted into the wiring insertion pipe 18, and the inside of the wiring insertion pipe 18 is filled with a sealing material around the wiring 14, and the inside is sealed. Yes. The connection portion 15 is provided with an insertion hole 19, and the insertion hole 19 has an inner diameter larger than the outer diameter of the wiring insertion pipe 18. Accordingly, an annular gap is formed between the insertion hole 19 and the wiring insertion pipe 18, and this gap leads to the inside of the flexible tube 11 and is attached to the tip of the flexible tube 11. The fluid passage 20 communicates with the insulating sleeve 13.

  A fluid connecting portion 21 is connected to the connector member 10, and the fluid connecting portion 21 communicates with the fluid passage 20. The fluid connecting portion 21 is detachably connected to a fluid supply / discharge mechanism, for example, a device such as a syringe for supplying a chemical solution or performing suction, and the liquid supply pipe or the suction pipe can be attached or detached. It can be connected. Further, in the insertion hole 19, a seal member 22 is attached to the base end side from the attachment position of the fluid connection portion 21, and this seal member 22 is connected between the outer surface of the wiring insertion pipe 18 and the inside of the wiring insertion hole 19. The base end side of the flexible tube 11 has an airtight structure with a sealing material filled in the wiring insertion pipe 18.

  A wiring 14 is led out from the base end portion of the wiring insertion pipe 18, and the wiring 14 is connected to a conductive block 23 built in the connector member 10. A terminal portion 24 is electrically connected to the conductive block 23, and the terminal portion 24 partially protrudes from the connector member 10. The other end of the connection cord 25 connected to the high frequency power supply device 3 is detachably connected to the terminal portion 24 (see FIG. 1). Here, the connecting cord 25 is connected to the electrode connecting portion 3a provided in the high frequency power supply device 3, and the counter electrode plate 4 is connected to the counter electrode connecting portion 3b.

  The hemostatic device 2 of the hemostasis device 1 configured as described above is inserted into the endoscope 100 and guided into the body cavity of the patient P so that hemostasis can be performed by cauterization. That is, as is apparent from FIG. 1, the endoscope 100 includes a main body operation unit 101 and an insertion unit 102 into a body cavity, and a treatment instrument introduction unit 103 is formed in the main body operation unit 101. A treatment instrument insertion channel 104 is connected to the treatment instrument introduction portion 103, and the treatment instrument insertion channel 104 is open at the distal end of the insertion portion 102. Therefore, the hemostatic device 2 is inserted into the body cavity via the treatment instrument insertion channel 104. When hemostasis is performed, the counter electrode plate 4 is kept in contact with the patient P. Here, the insertion portion 102 of the endoscope 100 is composed of a soft portion, an angle portion, and a hard tip portion, and the angle portion is The direction of the hard tip portion can be controlled by appropriately performing a bending operation. Note that the configuration of the endoscope 100 is well known in the art and will not be specifically described and illustrated.

  In the case where a bleeding part is present in the body, in order to stop the hemostasis, the flexible tube 11 of the tourniquet 2 constituting the hemostasis device 1 is inserted into the treatment instrument insertion channel 104 from the treatment instrument introduction section 103, and The distal end portion is derived from the distal end of the insertion portion 102 by a predetermined length. The distal end surface of the flexible tube 11 led out from the insertion portion 102 is brought into contact with the site to be hemostatic, and a high frequency current is allowed to flow from the high frequency power supply device 3 between the ring electrode 12 and the counter electrode plate 4. The hemostasis treatment is performed. Here, as described above, since the insertion portion 102 of the endoscope 100 can be controlled in direction, the position of the distal end surface of the flexible tube 11 is controlled by controlling the insertion portion 102. be able to.

  Now, in FIG. 5, when the bleeding part is B, the ring-shaped electrode 12 attached to the distal end of the flexible tube 11 constituting the hemostatic device 2 is brought into contact with the bleeding part B. 12 is not brought into direct contact with the bleeding part B, but is lightly pressed around the bleeding part B as shown by the hatched lines in FIG. In this state, by passing a high-frequency current from the ring-shaped electrode 12 toward the counter electrode 4, no transpiration occurs in the bleeding part B, and an annular cautery part is formed around it.

  Here, the reason why the ring-shaped electrode 12 is lightly pressed against the inner wall of the body cavity is to perform cauterization without causing perforation in the body cavity. An insulating sleeve 13 is disposed inside the ring-shaped electrode 12, and an annular portion having a predetermined width is in contact with the inner wall of the body cavity on the inner peripheral side of the insulating sleeve 13. As a result, the surface pressure per unit area is reduced, and the insulating sleeve 13 functions as a protective wall. For this reason, there is no possibility that the inner wall of the body cavity is perforated when a high-frequency current is passed through the ring-shaped electrode 12, and a minimally invasive treatment is possible.

  When cauterization around the bleeding part B is performed as described above, the distal end of the flexible tube 11 of the hemostatic tool 2 led out from the treatment instrument insertion channel 104 is displaced by operating the insertion part 102. Then, a part of the ring-shaped electrode 12 is brought into contact with the bleeding part B. In this case, it is desirable that the ring-shaped electrode 12 is lifted from the inner wall of the body cavity at a site other than the bleeding part B, but the entire ring-shaped electrode 12 abuts against the inner wall of the body cavity unless an extreme pressing force is applied. Even so, the damage is not so great. Thus, after cauterizing around the bleeding part B once, the bleeding part B is directly cauterized, so that the blood can be stopped smoothly and quickly without causing transpiration.

  By the way, in the bleeding part B, a large amount of blood may flow out, and it may be difficult to specify the bleeding part. The inside of the insulating sleeve 13 is opened at the distal end of the flexible tube 11, and the fluid passage 20 communicating with the opening communicates with the fluid connecting portion 21. Therefore, the bleeding site can be washed away by supplying the cleaning water from the fluid connection portion 21. In addition, blood can be removed from the bleeding site by connecting a suction mechanism. When the fluid is not supplied or discharged, the fluid connection portion 21 is closed by attaching a plug member.

  Next, a second embodiment of the present invention will be described with reference to FIGS. In this embodiment, a bipolar hemostatic device 30 is configured. That is, as shown in FIGS. 6 and 7, the ring-shaped electrode 32 provided at the tip of the flexible tube 31 is composed of a pair of half-arc-shaped electrodes, one of which is a positive electrode 32a and the other is the other. Is a negative electrode 32b. An electrical insulating member 32c is interposed between the positive electrode 32a and the negative electrode 32b. An insulating sleeve 33 is inserted into the flexible tube 31. The outer diameter of the insulating sleeve 33 is a large-diameter portion fixed to the inner surface of the flexible tube 31, and a ring-shaped electrode. The second embodiment includes the small-diameter portion fixed to the inner side of 32 and has an inner diameter smaller than the inner diameter of the ring-shaped electrode 32 as in the first embodiment.

  Wirings 34a and 34b are connected to the positive electrode side electrode 32a and the negative electrode side electrode 32b, respectively, and both the wirings 34a and 34b are formed inside the flexible tube 31 as shown in FIGS. In addition, the flexible tube 31 is inserted into the connector member 36 connected to the proximal end portion of the flexible tube 31 by being inserted into the wiring insertion pipe 18 from an intermediate position. Conductive blocks 37a and 37b are provided at two locations inside the connector member 36, and the wirings 34a and 34b are connected to the conductive blocks 37a and 37b. Further, terminal portions 38 a and 38 b are connected to the conductive blocks 37 a and 37 b, and both the terminal portions 38 a and 38 b protrude from the connector member 36. Further, a connection cord (not shown) is detachably connected to the terminal portions 38a and 38b of the connector member 36, and the other end of the connection cord is connected to the high-frequency power supply device 3 shown in FIG. The bipolar connection portion 3c is connected. Note that members other than those described above, which are the same as or equivalent to those in the first embodiment described above, are given the same reference numerals and description thereof is omitted.

  As described above, when the bipolar hemostatic device 30 is used, a current flows between the positive electrode 32a and the negative electrode 32b constituting the ring-shaped electrode 32 in the body cavity of the patient P. The cauterization of the bleeding part can be performed by the action of heat. Therefore, it is not necessary to provide the counter electrode plate 4 in this case. Even when this bipolar hemostatic tool 30 is used, the periphery of the bleeding part can be cauterized in an annular shape as in the first embodiment described above. Further, the insulating sleeve 33 is exposed inside the ring-shaped electrode 32 by a predetermined width dimension, and this portion comes into contact with the body cavity inner wall when performing the treatment, so that the distal end of the flexible tube 31 is connected to the body cavity inner wall. When it is brought into contact with the body cavity, the inner wall of the body cavity is not strongly pressed.

1 is an overall configuration diagram showing a hemostasis device showing a first embodiment of the present invention together with an endoscope for introducing and guiding it into a body cavity. It is a front view which shows the site | part by the side of the connector of a hemostatic tool. It is sectional drawing of the front-end | tip part of a flexible tube. It is sectional drawing of a connector member. It is effect | action explanatory drawing which shows the state which is performing the cauterization for hemostasis. It is sectional drawing of the front-end | tip part of the flexible tube of the hemostatic tool which shows the 2nd Embodiment of this invention. FIG. 7 is a left side view of FIG. 6. It is a front view which shows the connector member side of a bipolar hemostatic device. It is sectional drawing of the connector part of a bipolar hemostatic device.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Hemostatic device 2 Hemostatic tool 3 High frequency power supply device 4 Counter electrode 10, 36 Connector member 11, 31 Flexible tube 12, 32 Ring-shaped electrode 13, 33 Insulation sleeve 14, 34a, 34b Wiring 20 Fluid passage 21 Fluid connection part 23 , 38a, 38b Terminal 30 Bipolar hemostatic device 32a Positive electrode side electrode 32b Negative electrode side electrode 32c Electrical insulation member 100 Endoscope 104 Treatment instrument insertion channel

Claims (3)

An electrically insulating flexible tube is connected to a connector member having a terminal portion connected to a high-frequency power source,
At the tip of the flexible tube, a ring electrode connected to the terminal portion is attached,
A hemostatic device characterized in that a protective wall member made of an electrically insulating member is mounted inside the ring-shaped electrode. The protective wall member is formed in a cylindrical shape, a fluid passage is formed therein, and the connector member is provided with a connection portion of a fluid supply / discharge mechanism in the flexible tube. The hemostatic device according to claim 1. The ring-shaped electrode is formed of a pair of halved arcs and a pair of electrodes with an electrical insulating member interposed therebetween, and the terminal portion is connected to the bipolar connection portion of the high-frequency power source. The hemostatic device according to claim 1, wherein the hemostatic device has a pair of terminal portions.

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