JP2009118891A - High frequency treatment instrument for endoscope - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a suction route with a wide path cross sectional area when a flexible sheath is inserted into a treatment instrument insertion channel of an endoscope without specially lowering the strength in the bend direction of the flexible sheath. <P>SOLUTION: The high frequency treatment instrument 1 is provided with the flexible sheath 2 where an electrode member 13 to which a high frequency current is to be applied can appear and disappear inside, and the flexible sheath 2 is inserted to the treatment instrument insertion channel 34 of the endoscope 30. The prescribed number of V-shaped grooves 8 whose cross section is a V shape are formed in an axial direction on the outer peripheral surface of the flexible sheath 2, and a projection part formed between the grooves is sharp at the distal end and is turned to a tip part 9 to be abutted to the inner peripheral surface of the treatment instrument insertion channel 34. <P>COPYRIGHT: (C)2009,JPO&INPIT

Description

  The present invention relates to an endoscopic high-frequency treatment instrument that is inserted into a treatment instrument insertion channel of an endoscope and used for performing a treatment such as incision and separation of a lesioned mucosa and removing it.

  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). In this ESD treatment, first, the site to be excised is marked out of the mucous membrane, the site of the lesioned mucosa is bulged by local injection, and then the mucous membrane is incised along the marking area using a high-frequency treatment tool. It is carried out by cutting the fibers constituting the lower layer and peeling the mucous membrane from the muscle layer.

  The high-frequency treatment instrument used for the ESD treatment described above is configured to mount 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 high-frequency knife constituting a high-frequency treatment instrument used for ESD, a needle-like knife in which an electrode member is extended straightly, and a large-diameter electrode portion is connected to the tip of a rod-like electrode member, or the tip is roughly L There is a hook knife in which a hook portion is formed by bending in a letter 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 it so as to pull it in, so that the mucous membrane is incised or peeled off.

  For example, in Patent Document 1, a high-frequency treatment instrument having a hook knife type high-frequency knife is inserted into a body cavity through a treatment instrument insertion channel of an endoscope, and the mucous membrane is incised or peeled off. What has been made is disclosed. The high-frequency knife attached to the flexible sheath is provided with a circular or triangular plate electrode functioning as a hook portion connected to the tip of the rod-like electrode, and the rod-like electrode is the tip of the flexible sheath. It extends through the tip provided in the. This high-frequency treatment instrument is inserted into a body cavity via a treatment instrument insertion channel of an endoscope. A flexible sheath is projected from the distal end opening of the treatment instrument insertion channel, and the flexible treatment instrument is inserted into the body cavity. By pushing and pulling the high-frequency knife inserted through the sheath, the mucous membrane and the like are hooked on the tip of the high-frequency knife and operated to pull into the treatment instrument insertion channel, and then the tissue is cut by energization, As a result, incision and detachment of the mucous membrane are performed. Moreover, in the structure of this patent document 1, the liquid supply path is formed in the flexible sheath, and if there is bleeding from the incised part, the liquid supply path is attached to the distal end of the flexible sheath. The physiological saline is ejected from the opening provided in the tip, and the bleeding part can be washed away, and then the plate electrode at the tip is pressed against the bleeding part to coagulate. It is possible to stop bleeding.

On the other hand, needle-shaped or rod-shaped high-frequency knives (hereinafter referred to as needle-shaped high-frequency knives) as shown in Patent Document 2 and Patent Document 3 are conventionally known. This type of high-frequency knife is configured to be inserted into a flexible sheath so that the high-frequency knife can be pushed and pulled through a flexible sheath that is inserted into a treatment instrument insertion channel of an endoscope. Then, it is the same as that of the hook knife structure mentioned above. However, in the case of a needle-shaped high-frequency knife, there is no portion that bulges at the tip. Therefore, when the flexible sheath is passed through the treatment instrument insertion channel, the entire needle-shaped knife is flexible sheath. It can be in a state of being completely drawn into the interior. In Patent Document 2, it is possible to supply liquid from around the needle knife. In Patent Document 3, a passage through which the needle knife is inserted into the flexible sheath, and the liquid supply For this reason, a separate passage is provided.
JP 2004-313537 A JP 2006-325785 A JP 2006-187474 A

  By the way, in order to accurately perform mucosal detachment, it is necessary to clearly capture the site of the lesioned mucosa to be treated in the field of view of the endoscope observation means. If the mucous membrane is contaminated with body fluid or the like, it is desirable to wash the mucosa to be treated by, for example, perfusion using physiological saline. Also, it is necessary to supply physiological saline in order to wash away the bleeding part that occurs during treatment. In addition to supplying water from the distal end of the flexible sheath, suction from the body is required. In an endoscope, suction is usually performed through a treatment instrument insertion channel. For example, there is a configuration in which two treatment instrument insertion channels are formed in the insertion portion. However, if the two-channel method is used, the insertion portion becomes thicker by that amount.

  From the above, it is desirable that the single treatment instrument insertion channel function not only as a high-frequency treatment instrument insertion path but also as a suction path. Here, in the endoscope for treatment, the inner diameter of the treatment instrument insertion channel is usually about 3.8 mm, and in the case of a general-purpose endoscope, the inner diameter of the treatment instrument insertion channel is 2. Generally, it is about 8 mm. On the other hand, the outer diameter of the flexible sheath is usually about 2.4 mm to 2.6 mm in both the hook knife type high frequency treatment tool and the needle knife type high frequency treatment tool. An annular gap due to the difference in diameter between the outer diameter and the inner diameter of the treatment instrument insertion channel can be used as a suction passage, but a sufficient passage cross-sectional area cannot always be obtained.

  When the thickness of the flexible sheath constituting the high-frequency treatment instrument is reduced, the difference in diameter between the high-frequency treatment instrument and the treatment instrument insertion channel can be increased. However, when the flexible sheath is thinned, the strength decreases. Here, the most necessary strength for the flexible sheath is the strength in the bending direction. If the strength of the flexible sheath in the bending direction is insufficient, not only the insertion operation into the treatment instrument insertion channel becomes difficult. Further, there is a problem in that the sniper property is deteriorated when it is derived from the treatment instrument insertion channel and is advanced toward the treatment target portion in the body cavity, and an accurate treatment cannot be performed. In addition, if the handling is not careful, there is also a problem that bending wrinkles easily occur.

  In particular, as in Patent Document 1, when performing the operation of hooking the lesioned mucosa or a portion in the vicinity thereof with the plate-like electrode constituting the hook portion, or the operation of pulling the hooked mucosa, these operations are accurately performed. If this is not the case, it will take a lot of time for the treatment, and it is impossible to deny the possibility that an unnecessarily wide range of mucous membranes will be incised, or that the site that should be removed by incision will be left behind. Moreover, in the needle-shaped knife system of Patent Document 2 and Patent Document 3, it is operated so as to pierce the mucous membrane with a needle-shaped or rod-shaped electrode member, and mucosal detachment moves the electrode member horizontally or swings it. Therefore, the necessity for the straightness of the flexible sheath and the strength maintenance in the bending direction is further strongly demanded.

  The present invention has been made in view of the above points, and an object of the present invention is to treat the flexible sheath with an endoscope without significantly reducing the strength in the bending direction of the flexible sheath. An object of the present invention is to provide a suction path having a wide passage cross-sectional area when inserted into the instrument insertion channel.

  In order to achieve the above-described object, according to the present invention, one end is connected to a treatment instrument introducing portion provided in the main body operation section, and the other end is connected to a treatment instrument outlet opening at the distal end of the insertion section. An electrode member that is inserted into a treatment instrument insertion channel of the endoscope that communicates with the suction path in the operation unit and to which a high-frequency current is applied is provided inside the flexible sheath, and this electrode member is provided at the distal end of the flexible sheath. A high-frequency treatment instrument that can be projected and retracted from an outer periphery of the flexible sheath, wherein an outer peripheral portion of the flexible sheath is formed with a contact portion that is slidable with respect to an inner peripheral surface of the flexible sheath, When one or more passages directed in the axial direction are formed between the outer peripheral surface of the sexual sheath and the inner peripheral surface of the treatment instrument insertion channel, and when a negative pressure suction force is applied to the suction path, The feature is that this passage is configured as a suction path. Than is.

  The high-frequency treatment instrument has a structure having a flexible sheath and a high-frequency knife made of an electrode member, and the electrode member has a needle-like knife type or plate-like shape made of a needle shape or a rod shape. It can be applied to any of the hook knife type in which the tip of the rod or bar is bent in an L shape or U shape. The flexible sheath may be provided with liquid supply means, or may not be provided with liquid supply means. For example, when the endoscope has another liquid supply path including an injection unit such as a water jet, the liquid supply unit may not be provided on the high-frequency treatment instrument side. The liquid supply means includes a liquid supply from the periphery of the electrode member lead-out portion, a configuration in which a liquid supply path separate from the electrode member insertion path is provided inside the flexible sheath, and the like. can do.

  The suction path formed between the inner peripheral surface of the treatment instrument insertion channel and the outer peripheral surface of the flexible sheath is an unevenness in which the thickness of the flexible sheath is changed in the circumferential direction and directed in the axial direction. It is formed by making it into a shape. Specifically, by forming one or a plurality of axially directed grooves on the outer peripheral surface of the flexible sheath, or by forming protrusions on the outer peripheral surface of the flexible sheath, this flexibility A suction passage is formed when the sheath is inserted into the treatment instrument insertion channel. The concavo-convex portion formed of a groove or a protrusion and formed on the outer peripheral surface of the flexible sheath can be formed over the entire length of the flexible sheath, but if the outer surface has an edge structure, the tip portion The length required when a treatment is performed from the outlet of the treatment instrument insertion channel by inserting the treatment instrument insertion channel through the distal end portion of the outer peripheral surface of the flexible sheath. It is desirable that the portion protruding from the outlet port when it is protruded as much as the smooth outer peripheral surface portion. Furthermore, when the treatment sheath is inserted into the proximal end side of the flexible sheath, the portion located in the treatment instrument introduction portion can be a smooth outer peripheral surface portion.

  On the outer surface of the flexible sheath, the protruding portion has a maximum thickness until it comes into contact with the inner peripheral surface of the treatment instrument insertion channel. When a groove is formed, the minimum thickness is the groove bottom. . Therefore, the projecting portion functions as a streak directed in the axial direction. In consideration of the fact that the electrode member and the flexible cord connected thereto are slidably inserted in the groove bottom portion, the groove bottom can be thin enough not to be damaged during sliding. As a result, the unevenness difference can be increased, a wide passage cross-sectional area can be secured as a suction path, a high suction ability is exhibited, and a muscle material in the axial direction is provided. The strength of the flexible sheath in the bending direction is increased, the operability of insertion into the treatment instrument insertion channel is improved, and the sniping performance toward the treatment target portion when derived from the treatment instrument insertion channel is improved. . Of course, no curl or deformation occurs.

  The cross-sectional shape of the groove may be any shape such as a V shape or a U shape, and may be a wide groove having an angle of 90 degrees or more in the circumferential direction. When the cross section is a V-shaped groove, a predetermined number of grooves are formed in the circumferential direction, but a pointed portion may be formed on the outer surface of the portion between the grooves. In this case, when the high-frequency treatment instrument is inserted into the treatment instrument insertion channel, the contact area is reduced by sliding the tip portion on the inner surface of the treatment instrument insertion channel. Sliding resistance can be reduced.

  When this flexible sheath is inserted into the treatment instrument insertion channel of the endoscope without significantly reducing the strength of the flexible sheath, a wide suction path can be secured and the flexible sheath can be treated. The operability of insertion into the instrument insertion channel and the sniping ability of the high frequency knife to be treated are improved, and smoothness, certainty, and stability of the operation of the high frequency treatment instrument can be obtained.

  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, 1 is a high-frequency treatment instrument. The high-frequency treatment instrument 1 has a long flexible sheath 2, and a connection pipe 3 is connected to a proximal end portion of the flexible sheath 2, and an operation means 4 is connected to the other end of the connection pipe 3. Are connected. The operating means 4 includes a main body shaft 4a connected to the connection pipe 3, and a slider 4b which is fitted to the main body shaft 4a and is slidable in the axial direction. 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 coating the outer periphery of the conductive wire with an electrically insulating member by coating with a fluororesin or the like, and its base end protrudes from the connecting portion to the slider 4b by a predetermined length, A portion 12 is provided. Therefore, 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 of the flexible cord 11, and a lead-out portion of the conductive wire serves as an electrode member 13 constituting a needle-like high-frequency knife. Further, a stopper member 14 is inserted into the distal end portion of the flexible sheath 2 and fixed by means such as adhesion. Here, the stopper member 14 is made of ceramic from the viewpoint of electrical insulation and heat resistance. The distal end surface of the stopper member 14 is disposed at the same position as the distal end surface of the flexible sheath 2, so that the distal end reference surface F is defined by the distal end surface of the stopper member 14 and the distal end surface of the flexible sheath 2. Forming. 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 regulating 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 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, that is, about 0.5 mm to 4 mm. Thus, when the electrode member 13 is protruded to the maximum protruding state with the tip reference surface F in contact with the mucosal surface, the electrode member 13 reliably penetrates the mucosal layer and reaches the muscle layer. There is no such thing. 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 supply means for a biocompatible liquid, for example, physiological saline, sodium hyaluronate. As is 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. A switching means 7 for opening and closing a flow path such as a foot switch is provided in the middle of the liquid feeding pipe 6 to perform liquid supply control. 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 body 10 is connected from the flexible sheath 2 to the slider 4b of the operating means 4 through the connection pipe 3, and the flexible cord 11 is inserted into the connection pipe 3. A seal member 20 is mounted around the liquid crystal to prevent backflow of the supply liquid.

  The physiological saline is sprayed forward from the distal end of the flexible sheath 2. Therefore, as shown in FIG. 5, the outer peripheral surface of the stopper member 14 mounted inside the flexible sheath 2 is provided at a plurality of locations (three locations in the drawing) at equal intervals in the circumferential direction. Grooves are formed, and these grooves are physiological saline injection passages 21, and the injection passage 21 has a length extending over the entire length of the stopper member 14 in the axial direction. Here, when the electrode member 13 is protruded, the regulating member 16 comes into contact with the stopper member 14. The outer diameter dimension of the regulating member 16 is made smaller than the outer diameter dimension of the stopper member 14. If the diameter is set to be almost the same as the circle connecting the bottoms of the grooves, even if the regulating member 16 abuts against the stopper member 14, the injection passage 21 is not blocked.

  As shown in FIG. 6, the high-frequency treatment instrument 1 having the above configuration is introduced into a body cavity such as the esophagus, stomach, duodenum, large intestine, and the like by an endoscope 30, and is applied to a mucosa portion constituting the inner wall of the body cavity. When the presence or absence of a lesion is inspected and it is determined that the lesion is a lesion, an incision, separation and removal, that is, an ESD treatment is performed only on the lesion mucosa.

  Here, the endoscope 30 is provided by connecting a main body operation unit 31 and an insertion unit 32 into a body cavity, and the insertion unit 32 is a predetermined length from the connection unit to the main body operation unit 31. Is a flexible portion 32a, which has a curved portion 32b at the distal end of the flexible portion 32a and a hard distal portion 32c at the distal end of the curved portion 32b. The distal rigid portion 32c includes an illumination unit and an observation unit. Mirror observation means is attached.

  FIG. 7 shows a cross section of the distal end portion of the insertion portion 32. In this cross-sectional position, the configuration of the observation unit is shown, and the illumination units are usually provided on both the left and right sides of the observation unit. As is well known, the observation unit 33 is generally composed of an objective optical system 33a, a prism 33b, and a solid-state image sensor 33c. FIG. 7 also shows a treatment instrument insertion channel 34. The distal end portion of the treatment instrument insertion channel 34 opens as a treatment instrument outlet 34a at the distal end surface of the distal end hard portion 32c, and as shown in FIG. 6, the proximal end portion of the treatment instrument insertion channel 34 is the main body. It communicates with a treatment instrument introduction section 34b provided in the operation section 31. Further, a branch portion is formed in the treatment instrument insertion channel 34 in the main body operation section 31, and a portion of the passage from the branch portion toward the treatment instrument introduction portion 34 b and the suction path 35 connected to the suction source are directed. Branches to the passage section.

  The flexible sheath 2 constituting the high-frequency treatment instrument 1 is inserted into the treatment instrument insertion channel 34 from the treatment instrument introduction part 34b and protrudes from the treatment instrument outlet 34a by a predetermined length to perform various treatments. Therefore, when the flexible sheath 2 is inserted into the treatment instrument insertion channel 34, the flexible sheath 2 advances smoothly and reliably in the treatment instrument insertion channel 34 without buckling or the like, and the flexible sheath 2 is inserted into the treatment instrument insertion channel 34. When inserted into the channel 34 and its distal end is led out from the treatment instrument outlet 34a, it will be sure to be directed in the direction of extension of the axis of the treatment instrument insertion channel 34 without causing vibration or bending. . For this purpose, it is necessary to reduce the diameter difference between the outer diameter of the flexible sheath 2 and the inner diameter of the treatment instrument insertion channel 34, but it is formed between the flexible sheath 2 and the treatment instrument insertion channel 34. This gap is used as a suction path.

  Therefore, in order to secure the suction path and stabilize the posture of the flexible sheath 2 when the high-frequency treatment instrument 1 is inserted from the treatment instrument insertion channel 34 into the treatment instrument outlet 34a, the flexible sheath 2 is flexible. The sheath 2 has the configuration shown in FIG. That is, a V-shaped groove 8 having a V-shaped cross section excluding a predetermined length at the distal end portion is formed on the outer peripheral surface of the flexible sheath 2 in the axial direction. A plurality of the V-shaped grooves 8 are formed at a predetermined pitch interval in the circumferential direction, and the protrusions formed between the grooves are pointed end portions 9 having pointed tips, and the pointed end portion 9 is the treatment instrument insertion channel 34. It comes to contact | abut to the internal peripheral surface. Accordingly, these V-shaped grooves 8 serve as passages constituting the suction path. Then, the circle connecting the tip end portions 9 can be maximally the same diameter as the inner diameter of the treatment instrument insertion channel 34. In addition, the flexible sheath 2 has a configuration in which a plurality of muscle materials centering on the pointed portion 9 are provided in the axial direction.

  Here, in the flexible sheath 2, the V-shaped groove 8 is not formed over the entire length of the flexible sheath 2. The outer peripheral surface has a smooth non-recessed shape by a predetermined length on each of the distal end side and the proximal end side. On the distal end side of the flexible sheath 2, a slight length from the distal end position is the smooth outer peripheral surface portion 2a. The smooth outer peripheral surface portion 2a has a dimension shorter than a length that is normally derived from the treatment instrument outlet 34a when the high-frequency treatment instrument 1 is inserted into the treatment instrument insertion channel 34 and various treatments are performed. As described above, the V-shaped groove 8 is for securing a suction path, and this suction is normally required when a treatment is being performed, and the treatment is performed by introducing the flexible sheath 2 into the treatment instrument. It carries out in the state led out from the exit 34a. Accordingly, if the treatment instrument lead-out port 34a is led out to the formation portion of the V-shaped groove 8 of the flexible sheath 2, the distal end portion is the smooth outer peripheral surface portion 2a, and the outside of the smooth outer peripheral surface portion 2a. Even if the diameter is substantially the same as the inner diameter of the treatment instrument insertion channel 34, the suction function is exhibited. If the distal end of the flexible sheath 2 has a smooth surface without irregularities, the mucous membrane or the like is not damaged even if the flexible sheath 2 is moved in the body cavity.

  On the other hand, on the proximal end side of the flexible sheath 2, as shown in FIG. 6, the high-frequency treatment instrument 1 is inserted into the treatment instrument insertion channel 34, and the distal end thereof is led out from the treatment instrument outlet 34a. When the treatment tool is inserted, the treatment tool insertion channel 34 extends from the branch portion to the suction path 35 to the midway position of the treatment tool introduction portion 34b. The outer diameter of the proximal end portion of the flexible sheath 2 on the operating means 4 side is a large-diameter portion 2b (FIG. 1) that matches the diameter of the circle connecting the pointed portions 9. Therefore, the flexible sheath 2 substantially coincides with the inner diameter of the treatment instrument introducing portion 34b, and there is substantially no gap therebetween. As a result, it is possible to prevent the aspirated material from overflowing from the treatment instrument introducing portion 34b during suction.

  The high-frequency treatment instrument 1 having the above configuration is connected to the endoscope 30 and inserted into the body cavity via the treatment instrument insertion channel 34 of the endoscope 30. And when a lesioned mucosa is present on the inner wall of a body cavity such as the esophagus, stomach, duodenum, large intestine, etc., it is used for performing a treatment for peeling and removing the lesioned mucosa. Therefore, in the following, an ESD treatment for excising the lesioned mucosa will be described. This treatment is performed when the inside of a body cavity is inspected with an endoscope, and as a result, there is a change in the color tone or shape of the mucous membrane, and it is confirmed that a lesion is present in the mucosa.

  First, as shown in FIG. 9, the mucous membrane in which the lesioned part W to be excised is marked so as to surround the lesioned mucosal region R. This marking area is set so that the lesion can be completely removed, and damage to the healthy mucous membrane is minimized. The marking is performed, for example, by applying an ablation spot S to a required portion around the lesioned mucosa region R. In order to form the ablation spot S, the high-frequency treatment tool 1 can be used. When marking is performed using the high-frequency treatment instrument 1, the electrode member 13 from the flexible sheath 2 protrudes at the same position as the distal end surface of the flexible sheath 2 or slightly from the viewpoint of safety. It is desirable that the position protrudes to the extent of specifically 0.1 mm or less.

  The distal end hard portion 32c of the insertion portion 32 of the endoscope 30 is opposed to the outer edge portion of the lesion mucosa region R with a predetermined distance, and in this state, the treatment tool insertion channel 34 is passed through the treatment tool introduction portion 34b with a high frequency. The treatment tool 1 is inserted. The flexible sheath 2 of the high-frequency treatment instrument 1 has a plurality of pointed ends 9 formed on the outer peripheral surface, and the portions of the pointed end 9 become a muscle material that exerts pushing thrust. The flexible sheath 2 can be smoothly and quickly inserted therein. The high-frequency treatment instrument 1 causes the distal end of the high-frequency treatment instrument 1 to be derived from the treatment instrument outlet 34a by a predetermined length to bring the distal end reference surface F into surface contact with the mucosal surface. At this time, the electrode member 13 is held in a state of being drawn into the insertion hole 15. Of course, at this time as well, since it has the muscle material in the axial direction including the tip 9, the flexible sheath 2 that has come out of the treatment instrument outlet 34 a is provided at the site to be treated and goes straight, and the swinging occurs. Or bend. Therefore, the sniping ability to the mucous membrane is enhanced, and it can be surely brought into contact with the intended position on the mucosa. Moreover, even if it is used repeatedly, bending wrinkles or the like do not occur over the entire length of the flexible sheath 2.

  From this state, the operating means 4 of the high-frequency treatment instrument 1 is operated, the electrode member 13 constituting the high-frequency knife is protruded, and a high-frequency current is applied 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. Alternatively, the electrode member 13 may be previously led out from the flexible sheath 2, and the electrode member 13 may be brought into contact with the mucosal surface so that a high-frequency current flows. When performing marking, the electrode member 13 does not need to penetrate the mucosal layer, and the mucosal surface may be cauterized to such an extent that it can be recognized by the image obtained from the observation unit 33 provided in the insertion unit 32. At least, if the tip of 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. The 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 33, the method of cauterization as described above may not be used. .

  Next, as shown in FIG. 10, topical injection of physiological saline, sodium hyaluronate, or the like is performed inside the lesioned mucosa region R. 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 end 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 R. Here, the front end reference surface F is directly opposed to the mucous membrane layer LM, and the front end reference surface F is lightly pressed against the mucosal surface so that the pressing force is not applied as much as possible.

  Next, 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 protruding state shown in FIG. 11, the electrode member 13 penetrates through the mucosa layer LU and is guided to the submucosa LM, and thus incision of the lesion mucosa region R is started. Here, incision of the lesioned mucosal region R is performed by moving the insertion portion 32 of the endoscope 30 in a desired direction while the electrode member 13 is observed by the observation unit 33 and appropriately operating the distal end of the high-frequency treatment instrument 1. Thus, the outer peripheral side of the lesioned mucosa region R is incised by the electrode member 13. That is, an incision is made along the ablation spot S by an operation such as bending the bending portion 32b of the insertion portion 32 by remote control. Further, the electrode member 13 is projected in advance into the treatment instrument insertion channel C, and the distal end portion of the high-frequency treatment instrument 1 is led out from the distal end of the treatment instrument insertion channel C when incision is started. It can also be operated.

  As already described, the high-frequency treatment instrument 1 is located on the extension line of the insertion portion 32, and the flexible sheath 2 is surely in a straight state due to the presence of the V-shaped groove 8 and the pointed portion 9 directed in the axial direction. Therefore, the high-frequency knife composed of the electrode member 13 projecting from the distal end of the flexible sheath 2 is controlled very accurately without causing vibration or bending at the treatment instrument outlet 34a or in the vicinity thereof. The mucous membrane can be incised quickly and reliably. In addition, the muscle layer is not damaged during this operation. As a result, as shown in FIG. 12, the mucosal layer LU is incised on the outer periphery of the lesioned mucosal region R, and the submucosal layer LM is exposed. In FIG. 12, the entire region of the lesioned mucosa region R is incised at once. However, when the lesioned mucosa region R is wide, a part of the lesioned mucosa region R 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 mucosal region R 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 a fibrous submucosa LM, it is necessary to separate the fiber from the muscle layer LB by cutting the fiber. This mucosal detachment can also be performed using the high-frequency treatment instrument 1. That is, as shown in FIG. 13, the electrode member 13 constituting the needle-shaped high-frequency knife protruding from the flexible sheath 2 of the high-frequency treatment instrument 1 is caused to enter the exposed portion of the submucosa LM generated by the incision, The electrode member 13 is operated to cut the submucosa LM by horizontally moving or swinging the electrode member 13. This operation is operated so as to bend the bending portion 32b of the insertion portion 32 in the endoscope insertion 30. The bending operation of the bending portion 32b ensures that the flexible sheath 2 of the high-frequency treatment instrument 1 is sure to make this movement. As a result, the mucous membrane is exfoliated quickly and efficiently.

  During the mucosal detachment or incision, the treated part may bleed. When there is bleeding as described above, an observation image of a portion to be treated from the observation unit 33 becomes unclear depending on the degree of the bleeding. Therefore, physiological saline is supplied into the flexible sheath 2 from the connection port 3a of the connection pipe 3 at a high pressure. An injection passage 21 leading to the connection port 3a is opened at the end face of the stopper member 14, and this injection passage 21 is not closed even when the regulating member 16 abuts against the stopper member 14, and this injection passage 21 is also closed. Since no member is arranged in front of the throat, the bleed portion can be quickly and efficiently washed away by injecting physiological saline toward the bleed portion.

  Also, when performing endoscopy, if the mucosal surface is soiled, accurate endoscopy cannot be performed, and it is possible to accurately detect whether there is a lesion on the mucous membrane. I can't. Furthermore, the mucosal surface must be in a clean state in order to confirm the marking performed by cauterization at the time of incision. For this reason, physiological saline is supplied.

  As described above, in order to wash away the bleeding site and perfuse the body, the physiological saline supplied to the body is aspirated from the body for collection. As is well known, the treatment instrument insertion channel 34 is also used as a suction path from inside the body. Even in the endoscope 30, the high-frequency treatment instrument 1 is mounted in the treatment instrument insertion channel 34. Suction is possible. As described above, the outer peripheral surface of the flexible sheath 2 is brought into contact with the inner peripheral surface of the treatment instrument insertion channel 34 in order to improve the snipability of the electrode member 13 of the high-frequency treatment instrument 1 to be treated. However, a plurality of V-shaped grooves 8 are formed on the outer peripheral surface of the flexible sheath 2, and these V-shaped grooves 8 function as suction passages.

  Therefore, when a negative pressure suction force is applied to the treatment instrument insertion channel 34 by connecting the suction path 35 to a negative pressure source, the liquid substance located in the body from the treatment instrument outlet 34 a enters the V-shaped groove 8. It flows toward the base end side of the insertion portion 32 and is fed into the suction path 35 from the branch portion, so that liquid contaminants in the body are sucked and removed. In addition, the V-shaped groove 8 is made as deep as possible on the condition that no damage is caused to the bottom portion of the groove, and the passage cross-sectional area in the suction path is increased so as to be negative in the treatment instrument insertion channel 34. The operability of the suction operation performed by applying the pressure suction force is remarkably good, the liquid substance in the body can be quickly and smoothly removed, and the observation visual field can be secured.

  Since the smooth outer peripheral surface portion 2a is formed at the distal end portion of the flexible sheath 2, the suction operation is performed in a state in which the flexible sheath 2 is led out from the treatment instrument outlet 34a. The suction from the body is usually performed when the high-frequency treatment tool 1 is led out from the treatment tool outlet 34a and an appropriate treatment is performed, such as when the physiological saline supplied into the body is collected. Since the flexible sheath 2 is sometimes led out from the treatment instrument outlet 34a, the smooth outer peripheral surface portion 2a is completely led out and the suction path formed by the V-shaped groove 8 is opened. Therefore, the suction operation can be performed without hindrance.

  Instead of the V-shaped groove 8 described above, the suction path may be formed with arc-shaped concave grooves 8A provided at several locations on the outer peripheral surface as shown in FIG. Even if the V-shaped groove 8 is formed or the arc-shaped recessed groove 8A is formed, the groove is not only formed in a straight state toward the axial direction of the flexible sheath 2, but also in a spiral shape. It can also be made into a crossing groove shape. Regardless of which configuration is employed, the stability of the flexible sheath 2 led out from the treatment instrument insertion channel 34 can be ensured, and the suction path for performing suction from within the body is ensured during that time. It is formed.

  Further, in order to secure the above-described suction path, a groove is not formed on the outer peripheral surface of the flexible sheath, but the outer peripheral surface of the flexible sheath 50 is attached to the treatment instrument insertion channel 34 as shown in FIG. The clearance is made sufficiently smaller than the inner diameter of the tube, and a clearance for use as a suction path therebetween is formed. Then, the outer peripheral surface of the flexible sheath 50 is brought into contact with the inner peripheral surface of the treatment instrument insertion channel 34 or a slight gap. You may make it form the protrusion part 51 which faces. The projecting portion 51 can be formed as a ridge extending in the axial direction of the flexible sheath 50, and is configured to form a large number of substantially hemispherical projections on the entire outer peripheral surface of the flexible sheath 50. You can also Thus, by forming the protruding portion 51 on the outer peripheral surface of the flexible sheath 50, the diameter difference between the outer peripheral surface of the flexible sheath 50 and the inner diameter of the treatment instrument insertion channel 34 is reduced, and the suction conduit And the flexible sheath 2 is biased in the treatment instrument insertion channel 34 and the suction route is not secured even if the insertion route is complicated and extremely bent as in an endoscope for the lower digestive tract. There is no such thing.

  Further, as shown in FIGS. 16 and 17, the high-frequency treatment instrument 101 may be configured to include a multi-lumen type flexible sheath 102 having penetrating paths 102 a and 102 b. That is, the treatment instrument body 110 provided with the electrode member 113 at the distal end of the flexible cord 111 is inserted into the through passage 102a of the flexible sheath 102, and the stopper member 114 is attached to the distal end portion of the through passage 102a. This stopper member 114 is provided with an insertion hole 115 but does not have an injection passage. Of course, the electrode member 113 is provided with a regulating member 116. On the other hand, the other through passage 102b formed in the flexible sheath 102 is an ejection passage for supplying liquid into the body cavity.

  In the above configuration, the outer diameter of the flexible sheath 102 is approximately the same as the inner diameter of the treatment instrument insertion channel 34 of the endoscope 30. A passage is formed on the outer peripheral surface of the flexible sheath 102. This passage can be the same as that of the first to third embodiments. Moreover, since the site | part between the formation part of the through-passage 102a and the formation part of the through-passage 102b is a thick part in this flexible sheath 102, the cross section shows the thickness of this thick part. By scraping off into a circular arc shape, it is possible to form concavely curved passages 108 and 108 that function as a suction path when inserted into the treatment instrument insertion channel 34.

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 AA sectional drawing of FIG. It is an external view which shows the state which made the high frequency treatment tool which shows one Embodiment of this invention penetrate the treatment tool penetration channel of an endoscope. It is sectional drawing of the front-end | tip part position of the insertion part of FIG. It is BB sectional drawing of FIG. 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 which shows the modification of a flexible sheath. It is sectional drawing which shows the other modification of a flexible sheath. It is sectional drawing of the front-end | tip part of the high frequency treatment tool which shows other embodiment of this invention. It is CC sectional drawing of FIG.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 High frequency treatment tool, 101 2,50,102 Flexible sheath 3 Connection pipe 4 Operation means 8 V-shaped groove 9 Pointed end part 10 Treatment tool main body 11 Flexible cord 13,113 Electrode member 14,114 Stopper member 15,115 Insertion hole 16,116 Restriction member 21 Injection passage 30 Endoscope 32 Insertion part 34 Treatment tool insertion channel 34a Treatment tool lead-out port 34b Treatment tool introduction part 35 Suction path 8A Groove 51 Projection part 102a, 102b Through path 108 Passage

Claims (4)

Endoscopic treatment in which one end is connected to a treatment instrument introducing section provided in the main body operation section, the other end is connected to a treatment instrument outlet opening at the distal end of the insertion section, and communicated with a suction path in the main body operation section An electrode member that is inserted into the instrument insertion channel and is applied with a high-frequency current inside the flexible sheath is provided, and this electrode member is a high-frequency treatment instrument that can be projected and retracted from the distal end of the flexible sheath,
A contact portion that is slidable with respect to the inner peripheral surface of the treatment instrument insertion channel is formed on the outer peripheral portion of the flexible sheath,
One or a plurality of passages directed in the axial direction are formed between the outer peripheral surface of the flexible sheath and the inner peripheral surface of the treatment instrument insertion channel, and a negative pressure suction force is applied to the suction path. A high-frequency treatment instrument for an endoscope, characterized in that the passage is sometimes configured as a suction path. When the distal end portion of the outer peripheral surface of the flexible sheath is inserted through the treatment instrument insertion channel and protrudes from the outlet of the treatment instrument insertion channel by a length to be treated, the flexible sheath protrudes from the outlet. The high-frequency treatment instrument for an endoscope according to claim 1, wherein a smooth outer peripheral surface portion is formed at a site where the endoscope is provided. The high-frequency treatment instrument for endoscope according to claim 1 or 2, wherein the passage is configured by a groove formed in an outer peripheral portion of the flexible sheath toward an axial direction. The groove formed on the outer peripheral portion of the flexible sheath is V-shaped, and a pointed end portion is formed on the outer surface contacting the inner peripheral surface of the treatment instrument insertion channel. Item 5. The endoscope high-frequency treatment instrument according to Item 3.

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