JP2007313345A - High-frequency treatment instrument - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a high-frequency treatment instrument which credibly maintains protruded condition of the mucous membrane by supplying liquid to the submucous layer during treatment so as to carry out incision or abrasion of the mucous membrane safely. <P>SOLUTION: A treatment unit 10 having a linear electrode member 13 on the distal end of a flexible cord 11 is inserted within a flexible sheath 2. A stopper member 14 having an insertion hole 15 for regulating the length of the electrode member 13 projecting from the flexible sheath 2 is arranged on the distal part of the flexible sheath 2. The distal end of the stopper member 14 is arranged and fixed to a position in agreement with the position of the distal part 2 of the flexible sheath, and these distal faces act as a distal reference surface F. A connection pipe 3 having a connection port 3a is connected to an operation means 4, and a liquid supply pipe 6 from a liquid supply tank 5 is connected detachably to the connection port 3a. With such a configuration, physiological saline is injected to the mucous or submucous membrane from the distal end of the flexible sheath 2 connected to the liquid supply pipe 6 via grooves 21 formed on the circumference of the stopper member 14. <P>COPYRIGHT: (C)2008,JPO&INPIT

Description

  The present invention is inserted into a treatment instrument insertion channel of an endoscope, and can be used for performing a treatment such as incision and peeling to remove a lesioned mucosa, and includes physiological saline, sodium hyaluronate, and glyceol. The present invention relates to a high-frequency treatment instrument that can supply a biocompatible liquid such as the above.

  When a lesioned part such as a tumor is found in the mucosal part of the inner wall of a body cavity such as the esophagus, stomach, duodenum, and large intestine by endoscopy, a treatment for excising the mucous membrane is performed. As one of the treatments, there is a treatment called endoscopic submucosal dissection (ESD). This ESD treatment is usually performed as follows. First, the mucosa site to be excised is marked, and the site of the diseased mucosa is bulged by local injection. In this state, the mucous membrane is incised along the marking using a high-frequency treatment tool, the fibers constituting the submucosal layer are cut, and the mucosa is peeled off from the muscle layer.

  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 projects from the distal end of the flexible sheath by the operating means. Then, by energizing the high-frequency knife, the mucous membrane can be incised and peeled off. As a knife constituting the high-frequency treatment instrument used for ESD, a needle-like knife in which an electrode member extends straightly, and a large-diameter electrode portion is connected to the tip of a rod-like electrode member, or the tip is roughly L-shaped. There is a hook knife in which a hook portion is formed by bending it into a shape. The needle-shaped knife is optimal for use to pierce the mucous membrane, and the incision and peeling of the mucous membrane and the like can be performed by horizontally moving the electrode member or swinging the electrode member. On the other hand, the hook knife hooks the mucous membrane or the like with the hook portion at the tip and operates to pull it in, thereby performing incision and peeling of the mucous membrane.

  A muscle layer exists in the lower part of the mucous membrane, and when performing a treatment, the muscle layer must be operated so as not to be damaged, that is, not to contact the muscle layer when the high-frequency knife is energized. For this reason, the high-frequency knife, particularly the tip portion of the high-frequency knife, must always be captured within the observation field of the endoscope. However, since the needle knife is inserted into the mucous membrane, the tip of the needle knife does not enter the observation field of the endoscope depending on the situation. Therefore, the tip of the needle knife is completely in contact with the muscle layer. It is difficult to treat. On the other hand, when using a hook knife, the tissue is cut by hooking the hook knife onto the mucous membrane, etc. under observation with an endoscope, and then pulling it into the treatment instrument insertion channel. Or peeling. Therefore, since the hook knife can be operated under the observation of the endoscope and does not come into contact with the muscle layer in the energized state, the method using the hook knife is excellent from the viewpoint of the safety of the treatment.

Patent Document 1 proposes a hook knife having a mechanism for more stably holding the position of the tip portion of the hook knife when the hook knife is engaged. In the high-frequency treatment instrument of Patent Document 1, an electrical insulating member is attached to the distal end of a flexible sheath, and a through hole is provided in the electrical insulating member. Further, the hook portion at the tip can be brought into contact with and separated from the outer surface of the tip of the electrical insulating member. When energized, the electrode member is protruded from the flexible sheath by a predetermined length, but the diameter difference between the hole diameter of the through hole and the outer diameter of the electrode member is minimized, and the protrusion length of the electrode member is restricted. By doing so, the electrode member is configured to be stably held. In the most protruded state of the electrode member, at least the hook portion is set so as to be captured in the observation visual field by the endoscope.
JP 2004-313537 A

  As described above, by stably holding the portion of the electrode member that protrudes from the flexible sheath, the direction can be easily controlled, so that the operation of hooking the tissue can be performed safely. Is advantageous. However, the operation of hooking the mucous membrane or the submucosa with the hook knife constituting the electrode member, cutting the tissue by drawing it into the treatment instrument insertion channel while energizing, and then deriving the hook knife from the treatment instrument insertion channel. Since the operation is repeated, the efficiency and speed of the operation cannot be obtained. Therefore, a long time is required for the treatment for removing the mucous membrane of the lesion, and the pain on the subject and the burden on the operator increase accordingly.

  Here, in order to ensure the safety and smoothness of the treatment, a biocompatible liquid such as physiological saline is injected into the submucosa between the mucous membrane and the muscular layer to swell the submucosa. It is desirable to perform so-called topical injection in which the mucous membrane is separated from the muscle layer by protruding and protruding. This topical injection will occur before the mucosal removal procedure begins. However, with the passage of time, the locally injected liquid will flow out or be absorbed into the body, and the bulging portion will contract, and the function of separating the mucous membrane from the muscle layer will be reduced. . In particular, as described above, when a long time is required for the treatment for removing the lesioned mucosa, there is a possibility that a bulging portion almost disappears.

  The present invention has been made in view of the above points, and an object of the present invention is to replenish liquid to the submucosal layer during the treatment in order to safely perform the treatment such as incision and peeling of the mucous membrane. Thus, it is possible to reliably maintain the swelling state of the mucous membrane.

  In order to achieve the above-described object, the present invention is a high-frequency treatment instrument that is inserted into a body cavity via a treatment instrument insertion channel of an endoscope, and is flexible enough to be inserted into the treatment instrument insertion channel. A sheath, a treatment instrument body provided with a linear electrode member provided inside the flexible sheath and having a high-frequency current applied to the distal end of the flexible cord, and an electrically insulating member. By inserting a stopper member having an insertion hole to be inserted, and inserting the stopper member into the flexible sheath, and fixing the distal end position thereof at a position that coincides with the distal end portion of the flexible sheath, The distal end reference surface that can be pressed against the inner wall of the body cavity formed by the distal end surfaces of the stopper member and the flexible sheath, and the proximal end portion of the flexible cord, and the treatment within the flexible sheath Push and pull the tool body And operating means for reciprocating the electrode member between a state protruding from the tip reference surface via the insertion hole and a state of drawing into the insertion hole, and the connection to the operation means And a liquid supply means for ejecting liquid from a fluid flow path provided on the tip reference surface through the inside of the flexible sheath.

  When performing treatment such as mucosal detachment, local injection is performed before treatment. During the treatment, the state where the lesion mucosa is swollen can be maintained by appropriately replenishing the liquid by the liquid supply means. The liquid supplied from the liquid supply means is a biocompatible liquid such as physiological saline, sodium hyaluronate, or glyceol, and supplies the same liquid that is injected at the time of local injection before processing. It will be. Because of the topical injection, pre-injected saline or the like penetrates into the body during the operation or flows out, so that the bulging part contracts after a certain period of time and eventually the bulging state disappears. . Therefore, the supply of the liquid for maintaining the bulging state is performed from the operation means side. Specifically, for example, a pipe-like member is connected to the proximal end portion of the flexible sheath, and a connecting portion of the liquid feeding means is provided in the operating means to the connecting pipe. The liquid is ejected from a fluid flow path provided on the tip reference surface.

  For this reason, the inside of the flexible sheath is used as a liquid flow path, but the fluid flow path that opens to the tip reference surface can be formed around the insertion hole in the stopper member, for example, but is not limited thereto. Is not to be done. In any case, the tip reference surface is brought into contact with the mucous membrane or the submucosal layer exposed by incision of the mucous membrane, and injection is performed by spraying in a high-pressure state. Liquid can be replenished.

  Here, treatment such as mucosal peeling is performed by an electrode member constituting the treatment instrument main body, and this electrode member is inserted through the insertion hole so as to protrude outward from the tip reference surface. From the viewpoint of safety, it is desirable to limit the protruding length of the electrode member from the tip reference surface. In order to regulate the protruding length of the electrode member from the tip reference surface, the connection portion between the flexible cord and the electrode member or the vicinity thereof is smaller than the outer diameter of the stopper member, and the base end portion of the stopper member A restricting portion capable of contacting and separating can be provided. It is desirable that the diameter of the insertion hole provided in the stopper member is such that the electrode member is inserted so that there is substantially no gap, and in this case, the fluid flow path is formed at other portions.

  By adopting the above configuration, even when the mucosal detachment treatment is performed, even if the portion that has been inflated by injecting the liquid contracts, the bulging state can be maintained by replenishing the liquid. Therefore, the safety of the treatment is ensured.

  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 configured by covering the outer periphery of the conductive wire with an electrically insulating member by coating with a fluororesin or the like, and its base end portion protrudes a predetermined length from the connecting portion to the slider 4b, and contacts A 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. A stopper member 14 is inserted into the distal end portion of the flexible sheath 2 and is fixed by means such as adhesion. The stopper member 14 is made of ceramic, and the distal end surface thereof is disposed at the same position as the distal end surface of the flexible sheath 2. Therefore, the distal end reference between the distal end surface of the stopper member 14 and the distal end surface of the flexible sheath 2 is provided. Surface F is formed. An insertion hole 15 is formed at the position of the central axis of the stopper member 14 so as to penetrate in the axial direction. The diameter of the insertion hole 15 is slightly larger than the outer diameter of the electrode member 13. Yes. Then, the proximal end portion of the stopper member 14 is formed with a calling taper portion 14 a directed toward the insertion hole 15.

  A restricting member 16 as a restricting portion 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 restricting member 16 is a member having a diameter larger than at least the insertion hole 15. Therefore, the treatment instrument body 10 is advanced in the flexible sheath 2 so that the electrode member 13 protrudes from the distal end reference surface F by a predetermined length. If it will be in a state, the control member 16 will contact | abut to the stopper member 14, and the electrode member 13 will be controlled so that it may not protrude any more. That is, the most protruding position of the electrode member 13 is defined.

  3 shows a state in which the electrode member 13 is most retracted, and FIG. 4 shows a state in which the electrode member 13 protrudes most. The most protruding length of the electrode member 13 from the distal reference surface F depends on the thickness of the mucosa layer to be treated. As will be described later, a submucosal layer exists between the mucosal layer and the muscle layer. Since the incision and separation of the mucous membrane are performed, the protruding length of the electrode member 13 is equal to or greater than the thickness of the mucosal layer in a state where the tip reference surface F is in contact with the mucosal surface, and the tip of the electrode member 13 is the muscle layer. The length is not reached. Accordingly, when the tip reference surface F is brought into contact with the mucosal surface and the electrode member 13 is protruded to the maximum protruding state, the electrode member 13 surely penetrates the mucosal layer and reaches the muscle layer. There is nothing. This push-pull operation of the electrode member 13 can be performed by remote operation by the operation means 4.

  Further, the high-frequency treatment instrument 1 is provided with a biocompatible liquid, for example, physiological saline supply means. As apparent from FIG. 1, this supply means has a connection port 3a provided in the connection pipe 3, and a liquid supply pipe 6 from the liquid supply tank 5 is detachably connected to the connection port 3a. It has become. 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, the inside of the flexible sheath 2 connected to the connection pipe 3 becomes a liquid feeding passage. Here, the flexible cord 11 constituting the treatment instrument main body 10 is connected to the slider 4 b of the operating means 4 from the flexible sheath 2 through the connection pipe 3. A seal member 20 is mounted around 11 to prevent a reverse flow of physiological saline.

  The physiological saline is jetted forward from the distal end of the flexible sheath 2. To this end, as shown in FIG. 5, the outer peripheral surface of the stopper member 14 mounted inside the flexible sheath 2 has a plurality of locations (three locations in the drawing) at equal intervals in the circumferential direction. A groove 21 is formed. These grooves 21 have a length extending over the entire length of the stopper member 14 in the axial direction, and serve as a physiological saline injection passage. Here, when the electrode member 13 is protruded, the regulating member 16 comes into contact with the stopper member 14. Preferably, the outside diameter of the regulating member 16 is made smaller than the outside diameter of the stopper member 14. By setting the diameter so as to be almost the same as the circle connecting the groove bottom portions of the groove 21, the injection passage by the groove 21 is secured even if the regulating member 16 abuts against the stopper member 14.

  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 mucous membrane is present on the inner wall of a body cavity such as the stomach, duodenum, large intestine, etc., it is used for performing a treatment for peeling and removing the mucous membrane part. Therefore, a procedure for excising the lesioned mucosa will be described. This treatment is performed when it is confirmed as a result of endoscopy that a lesion is present in the mucous membrane.

  Therefore, first, as shown in FIG. 7, the mucous membrane in which the lesioned part D to be excised is marked so as to surround the lesioned mucosal region A. This marking area can completely remove the lesion, and does not damage the healthy mucosa as much as possible. The marking can be performed, for example, by applying an ablation spot B to a required portion around the lesioned mucosa region A, and the high-frequency treatment instrument 1 can be used to form the ablation spot B. That is, the distal end of the endoscope insertion portion S is faced with a predetermined distance from the outer edge of the lesioned mucosa region A, and the high-frequency treatment instrument 1 is inserted into the treatment instrument insertion channel C in this state. The part is brought into contact with the mucosal surface. At this time, the electrode member 13 is drawn into the insertion hole 15. No member protrudes from the distal reference surface F of the high-frequency treatment instrument 1, and the distal reference surface F is in surface contact with the mucosal surface.

  In this state, the operating means 4 of the high-frequency treatment instrument 1 is operated to project the electrode member 13 and apply a high-frequency current to the electrode member 13. As a result, the part of the mucous membrane where the electrode member 13 is in contact is cauterized and marking is applied. Here, when performing this marking, the electrode member 13 does not need to penetrate the mucosal layer, and the mucosal surface is cauterized to such an extent that it can be recognized from the image obtained from the observation part W by the endoscope insertion part S. It ’s fine. That is, if the electrode member 13 is in contact with the mucosal surface, a marking is formed. Of course, even if the operating means 4 is fully stroked and the electrode member 13 is in the position where it protrudes most from the flexible sheath 2, there is no possibility that the electrode member 13 contacts the muscle layer. Note that marking can be performed using other treatment tools, and if the region to be excised in the mucous membrane can be recognized by the observation unit W, the technique of cauterization as described above may not be used. .

  Next, as shown in FIG. 8, a saline solution is locally injected into the lesioned mucosa region A. For this purpose, the high-frequency treatment instrument 1 is once pulled out from the treatment instrument insertion channel, and instead of this, a local injection means provided with an injection needle N at the tip of the flexible tube is inserted into the treatment instrument insertion channel C. Here, the submucosa LM exists between the muscle layer LB and the mucosa layer LU, and the injection needle N penetrates the mucosa layer LU and penetrates into the submucosa LM to inject physiological saline. . As a result, the submucosa LM bulges and rises. The reason why the submucosal layer LM is thus bulged is to separate the mucosal layer LU from the muscle layer LB and perform a smooth and safe treatment.

  After sufficiently swelling the submucosa LM, the local injection means is extracted from the treatment instrument insertion channel C, and the high-frequency treatment instrument 1 is inserted again. Then, the distal reference surface F formed by the flexible sheath 2 of the high-frequency treatment instrument 1 and the distal end surface of the stopper member 14 is brought into contact with one of the outer edge portions of the lesion mucosa region A. Here, the front end reference surface F is directly opposed to the mucosal layer LM so that the front end reference surface F is lightly pressed against the mucosal surface and no pressing force is applied as much as possible.

  Then, the operating means 4 is operated to cause the electrode member 13 to protrude from the tip of the stopper member 14, and a high frequency current is passed through the electrode member 13 during this time. When the electrode member 13 reaches the maximum projecting state, as shown in FIG. 9, the electrode member 13 penetrates the mucosal layer LU and is guided to the submucosa LM, so that incision of the lesioned mucosa region A is started. Then, under the observation by the observation unit W, an incision is made along the ablation spot B by moving the endoscope insertion unit S or bending the angle unit. Here, the most protruding length of the electrode member 13 from the flexible sheath 2 is longer than the thickness dimension of the mucosal layer LU and shorter than the total thickness dimension of the mucosal layer LU and the submucosal layer LM. Since the lower layer LM is bulged, the mucosal layer LU can be reliably incised as long as the tip reference surface F does not extremely deform the mucosal surface, and any damage is caused to the muscular layer LB. Incision of the mucosal layer LU is performed without giving. At this time, it is not necessary to particularly confirm the position of the tip of the electrode member 13 by the observation part W of the endoscope insertion part S. As a result, as shown in FIG. 10, the mucosa layer LU is incised on the outer periphery of the lesioned mucosa region A, and the submucosa LM is exposed. In FIG. 10, the entire region of the lesioned mucosa region A is incised at a time. However, if the lesioned mucosa region A is wide, a part of the lesioned mucosa region A is incised to perform later-described peeling, It is desirable to repeat this operation a plurality of times.

  Even if the entire circumference of the lesioned mucosa region A is incised, the mucosal layer LU cannot be removed by itself. That is, since the mucosal layer LU and the muscle layer LB are connected by the fibrous submucosa LM, it is necessary to separate the fiber from the muscle layer LB by cutting the fibers. This mucosal detachment can also be performed using the high-frequency treatment instrument 1. That is, as shown in FIG. 11, the electrode member 13 protruding from the flexible sheath 2 of the high-frequency treatment instrument 1 enters the exposed portion of the submucosal layer LM generated by the incision, and the electrode member 13 is moved horizontally. Or by swinging, the submucosa LM is cut. This operation can be easily performed by an operation such as bending the distal end portion of the endoscope insertion portion S. As a result, mucosal detachment is performed quickly and efficiently. During the mucosal detachment and during the incision described above, there is a possibility that the treated portion or the like bleeds. For this purpose, physiological saline is supplied from the connection port 3a of the connection pipe 3 into the flexible sheath 2 at a high pressure. A groove 21 leading to the connection port 3a is opened on the end surface of the stopper member 14, and this groove 21 is not closed even when the regulating member 16 abuts against the stopper member 14, and is further in front of the groove 21. Since no member is arranged, the bleeding part can be quickly washed away by spraying physiological saline toward the bleeding site.

  When performing mucosal detachment, it is necessary to replenish physiological saline. The lesioned mucosa region A has already been bulged with physiological saline, but during the incision, especially when the mucosal layer LU is incised and the submucosal layer LM is exposed, the bulging by the locally administered physiological saline The part contracts rapidly. Further, the bulged portion may contract due to the supplied physiological saline being absorbed into the body. Therefore, in order to maintain the submucosa LM in the bulging state, the mucous membrane is peeled off while supplying physiological saline. The physiological saline is also replenished from a replenishment groove 21 provided on the outer peripheral portion of the stopper member 14. At this time, the flexible sheath 2 is preferably drawn from the connection port 3a of the connection pipe 3 in a state where the electrode member 13 is pulled into the insertion hole 15 of the stopper member 14 and the tip reference surface F is in contact with the submucosa LM. Inject physiological saline into the inside.

  Thereby, it can inject | pour directly toward submucosa LM. As a result, the submucosa LM to be peeled can be maintained in a bulging state. In this way, the additional supply of physiological saline does not require a troublesome operation of taking out the high-frequency treatment instrument 1 inserted through the treatment instrument insertion channel C and inserting the syringe in an exchangeable manner. There is no interruption. Therefore, the efficiency and speed of treatment can be improved. In addition, since no member protrudes from the tip reference surface F, the tip of the groove 21 can be brought into contact with the submucosa LM, and physiological saline can be accurately supplied toward a necessary location. . Thereby, the submucosal layer LM can be reliably maintained in the bulging state, and the mucosal separation by the electrode member 13 can be performed safely and promptly.

  Here, the stopper member is fixed at the distal end portion of the flexible sheath so that the distal end surface of the flexible sheath and the distal end surface of the stopper member are flush with each other. Therefore, like the stopper member 30 shown in FIG. 12, the base end side in the outer peripheral portion is enlarged to provide the step 30a, and the diameter is reduced from the step 30a toward the base end. The slope portion 30b is gentle. Accordingly, when the stopper member 30 is attached to the flexible sheath 31, the flexible sheath 31 is expanded by being inserted from the base end side having a small diameter. Then, the stopper member 30 can be mounted so as to be pushed to a position where the distal end surface of the stopper member 30 substantially coincides with the distal end surface of the flexible sheath 31. Of course, an adhesive having good heat resistance is applied in advance to at least one or both of the outer peripheral surface of the stopper member 30 and the inner peripheral surface of the flexible sheath 31 to fix the stopper member 30 to the inner surface of the flexible sheath 31. .

  As a result, when a force is applied in the direction in which the stopper member 30 is extracted from the flexible sheath 31, the stopper member 30 has a step 30a on its outer peripheral surface that bites into the inner surface of the flexible sheath 31, Demonstrate the function. Further, in order to more firmly fix the stopper member 30, the outer surface can be fixed to the inner peripheral surface of the flexible sheath 2 using an adhesive, and further, the screw can be attached to the outer peripheral surface of the stopper member 30. A part may be provided. In the figure, 32 is an insertion hole provided in the stopper member 30, and 33 is an electrode member. In this case, the fluid flow path is a gap formed between the inner peripheral surface of the insertion hole 32 and the outer peripheral surface of the electrode member 33.

  Further, as shown in FIG. 13, the diameter difference between the hole diameter of the insertion hole 42 provided in the stopper member 41 attached to the distal end of the flexible sheath 40 and the electrode member 43 of the treatment instrument body inserted through the hole. If G1 is set larger than the diameter difference G2 between the outer diameter of the regulating member 44 connected to the electrode member 43 and the inner diameter of the flexible sheath 40, a fluid flow path is formed, and the electrode member 43 and the insertion hole 42 can be aligned. Therefore, the electrode member 43 can be guided into the insertion hole 42 without providing a taper portion on the base end side surface of the stopper member 41 and only by providing a slight taper portion. Here, in the case of the configuration as shown in FIG. 13, in order to improve the alignment of the electrode member 43, the difference in diameter between the outer diameter of the regulating member 44 and the inner diameter of the flexible sheath 40 is reduced as much as possible. It is necessary to increase the length of the restricting member 44 in the axial direction.

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. FIG. 4 is a cross-sectional view similar to FIG. 3, showing an electrode member protruding. 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 a top view which shows the state which marked the lesioned-mucosa area | region. It is sectional drawing of the structure | tissue which shows the state which is performing local injection with respect to a lesioned mucosa area | region. It is sectional drawing of the structure | tissue which shows the state which is incising using a high frequency treatment tool. It is a top view including the lesioned mucosa area | region which shows the state which the incision by a high frequency treatment tool was complete | finished. It is sectional drawing of the structure | tissue which shows the state which is performing mucous membrane peeling. It is sectional drawing of the front-end | tip part of the treatment tool main body which shows the 2nd Embodiment of this invention. It is sectional drawing of the front-end | tip part of the treatment tool main body which shows the 3rd Embodiment of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 High frequency treatment tool 2, 31, 40, 52 Flexible sheath 3 Connection pipe 4 Operation means 10 Treatment tool main body 11 Flexible cord 13, 32, 43 Electrode member 14, 30, 41 Stopper member 15, 33, 42 Insertion Holes 16, 44 Restriction member 21 Groove 30a Step 30b Inclined portion

Claims (3)

A high-frequency treatment instrument that is inserted into a body cavity via a treatment instrument insertion channel of an endoscope,
A flexible sheath that can be inserted into the treatment instrument insertion channel;
A treatment instrument main body provided with a linear electrode member provided inside the flexible sheath and having a high-frequency current applied to the tip of the flexible cord;
A stopper member made of an electrically insulating member and having an insertion hole through which the electrode member is inserted;
The stopper member is inserted into the flexible sheath, and the distal end position of the stopper member and the flexible sheath is fixed by arranging and fixing the distal end position at a position corresponding to the distal end portion of the flexible sheath. A tip reference surface that can be pressed against the inner wall of the body cavity formed by the surface;
The electrode member is connected to the proximal end portion of the flexible cord and protrudes from the distal end reference surface through the insertion hole by pushing and pulling the treatment instrument main body within the flexible sheath. Operating means for reciprocating between the state and the state of being pulled into the insertion hole;
A high-frequency device comprising: a liquid supply unit that is connected to the operation unit and that ejects liquid from a fluid flow path that is provided in the distal end reference surface through the inside of the flexible sheath. Treatment tool. In order to regulate the protruding length of the electrode member from the tip reference surface, it is provided at or near the connecting portion of the flexible cord and the electrode member, and can be contacted and separated from the base end portion of the stopper member The high-frequency treatment instrument according to claim 1, further comprising a restricting portion. The hole diameter of the insertion hole provided in the stopper member allows the electrode member to be inserted substantially without a gap, and the fluid flow path is formed by one or a plurality of grooves formed on the outer peripheral surface of the stopper portion. The high-frequency treatment instrument according to claim 2, wherein an outer diameter dimension of the restricting portion is smaller than an outer diameter dimension of the stopper member.

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