JP2009125343A - High frequency snare for endoscope and its drive unit - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To improve operability for performing coagulation hemostasis relating to a high frequency snare for an endoscope and its drive unit. <P>SOLUTION: The high frequency snare includes a sheath 15, a snare loop 17 provided on the distal end of an operation wire 16 inserted into the through-hole 15a of the sheath 15, an electrode 18 for hemostasis attached to the distal end of the snare loop 17, and a hand operation part for operating the snare loop 17 through the operation wire 16. The electrode 18 for the hemostasis is formed into a columnar shape and its outer diameter D is larger than the diameter d of the through-hole 15a. When bleeding from an excised part after excising a diseased site, the hand operation part is operated and the operation wire 16 is pulled. By the pulling, the snare loop 17 is pulled into the through-hole 15a, whereby the electrode 18 for the hemostasis is abutted on the distal end of the sheath 15. <P>COPYRIGHT: (C)2009,JPO&INPIT

Description

  The present invention relates to an endoscopic high-frequency snare that is inserted into a subject in a transendoscopic manner and excises a raised lesion by energization of a high-frequency current, and a driving device thereof.

  In a medical examination using an electronic endoscope, various treatments such as collection and excision of a living tissue are performed using an endoscope treatment tool. As an endoscope treatment tool, for example, a high-frequency snare for excising a raised lesion (so-called polyp) is known. The high-frequency snare includes a sheath that is inserted into the forceps channel of the electronic endoscope, a snare loop provided at the distal end of the sheath, and a hand operation unit provided at the proximal end of the sheath.

  When excising a raised lesion using a high-frequency snare, first, the operator manipulated the hand manipulator and pushed the maneuver inserted through the sheath toward the tip, thereby being connected to the tip of the maneuver. The snare loop is pushed out from the tip of the sheath to inflate the loop, and the snare loop surrounds the raised lesion. Next, by operating the hand operation unit again and pulling the operation wire to the proximal end side of the sheath, the snare loop is drawn to the distal end of the sheath, and the raised lesion is bound by the snare loop. In this state, a high-frequency current is applied to the snare loop to remove the raised lesion.

  After removing the raised lesion, it is necessary to immediately stop bleeding from the excised part. Conventionally, when hemostasis is performed, a high-frequency snare is pulled out from the forceps channel, and a hemostatic treatment tool (hemostatic forceps) different from the high-frequency snare is inserted into the forceps channel. For this reason, it took time and effort to pull out and insert the treatment tool, and in some cases, the amount of bleeding was increased, and the patient was burdened.

In order to solve this problem, there are two types: a snare loop that can be projected and retracted from the distal end of the sheath, and a sleeve-shaped coagulation and hemostasis electrode that is inserted from the distal end of the sheath and covers the outer peripheral surface thereof A high-frequency snare provided with these electrodes has been proposed (Patent Document 1). According to this, since excision and hemostasis can be performed with one high-frequency snare, there is no need to replace the treatment tool. The electrode for coagulation and hemostasis is shifted from the distal end of the sheath to the proximal end side, and an insulating portion for preventing a short circuit between the snare loop and the electrode for coagulation and hemostasis is formed at the distal end of the sheath. .
JP 05-337130 A

  In the invention described in Patent Document 1, the electrode for coagulation and hemostasis is provided on the outer peripheral surface of the sheath, and an insulating portion is formed between the snare loop and the electrode for coagulation and hemostasis. After the lesion is excised, the electrode for coagulation and hemostasis is separated from the excised portion. For this reason, in order to bring the electrode for coagulation and hemostasis closer to the excision part, it is necessary to move the insertion part of the endoscope to the excision part or push out the sheath from the outlet of the forceps channel.

  However, when examining the inside of a conduit that is bent in a complicated manner, such as the large intestine and the small intestine, the insertion portion of the endoscope itself is bent. The electrode may not be moved to the desired location. Since the procedure takes time and effort, there is a risk of placing a heavy burden on the patient.

  The present invention has been made in view of the above problems, and an object of the present invention is to provide an endoscopic high-frequency snare capable of improving operability when performing coagulation and hemostasis, and a driving device thereof.

  In order to achieve the above object, an endoscope high-frequency snare according to the present invention has a sheath inserted into a forceps channel of an endoscope, and expands in a loop when pushed out from the distal end of the sheath, and from the distal end. A snare loop that is retractable from the distal end of the sheath so as to be constricted when drawn into the sheath, and is disposed at the distal end of the snare loop for cauterizing and removing a raised lesion by energization of a first high-frequency current. When the snare loop is drawn into the sheath, the snare loop is configured to be in contact with the distal end of the sheath and positioned immediately before the snare loop. And an electrode for coagulation and hemostasis for coagulation and hemostasis of bleeding after excision of the raised lesion when the current is applied.

  When the inner diameter of the sheath is d and the size of the coagulation hemostasis electrode is D, it is preferable that D> d is satisfied. The coagulation hemostasis electrode preferably has a cylindrical shape. The coagulation hemostasis electrode preferably has a tapered shape. The snare loop and the coagulation hemostasis electrode are preferably bipolar. The coagulation hemostasis electrode is preferably divided into bipolar electrodes by an insulator, and a wiring through which the second high-frequency current flows is connected to each electrode. The snare loop and the coagulation hemostasis electrode are preferably monopolar. It is preferable that the snare loop and the coagulation hemostasis electrode have a common wiring for passing the first and second high-frequency currents.

  An apparatus for driving a high-frequency snare for an endoscope according to the present invention as described above, wherein operation input means for selecting ablation excision by the snare loop or coagulation hemostasis by the coagulation hemostasis electrode, and the operation And switching means for switching a high-frequency current to be supplied to the snare loop and the coagulation hemostasis electrode in accordance with an operation of the input means.

  According to the present invention, when the snare loop is drawn into the distal end of the sheath, the coagulation hemostasis electrode for coagulating and stopping the hemostasis after excision of the raised lesion is located immediately before the distal end of the sheath. After excising the raised lesion, the coagulation hemostasis electrode is in the vicinity of the excision. For this reason, it is not necessary to move the insertion part of the endoscope to the excision part or push the sheath from the outlet of the forceps channel to approach the excision part of the coagulation hemostasis electrode. However, since the distance is very short, the operability when performing coagulation hemostasis can be improved. Therefore, the burden on the patient can be reduced without taking time and effort for the procedure.

  As shown in FIG. 1, the high-frequency snare 10 of the present invention is inserted into a body cavity of a patient P together with an endoscope 11 to excise an affected area such as a tumor (raised lesion) or to stop hemostasis after the affected area is excised. Used to do. The high-frequency snare 10 is provided at the sheath 15 inserted into the forceps channel 11 a of the endoscope 11, the operation wire 16 inserted through the through hole 15 a (see FIG. 2) in the sheath 15, and the distal end of the operation wire 16. A snare loop 17, a hemostatic electrode 18 attached to the tip of the snare loop 17, a hand operating section 19 for operating the snare loop 17 via the operating wire 16, an operating wire 16 and a high frequency power source 20. And a connection cord 21 to be connected. The snare loop 17 is formed of a conductive wire and functions as an electrode for excision of the affected area. The high-frequency snare 10 is used together with a counter electrode plate 22, and this counter electrode plate 22 is attached in the vicinity of the position of the affected part of the patient P. The counter electrode plate 22 is connected to the high frequency power supply 20 by a connection cord 23.

  The high frequency power supply 20 includes a snare connection portion 20a to which the connection cord 21 of the high frequency snare 10 is connected, and a counter electrode plate connection portion 20b to which the connection cord 23 of the counter electrode plate 22 is connected. The high-frequency current of the high-frequency power supply 20 is a switching current that alternately turns on and off the power supply. The switching current includes a high-frequency current for excision of a low-voltage affected part whose ON time is 100%, and ON There is a high voltage high frequency current for hemostasis with a time of 6% and an OFF time of 94%. Switching between the high frequency current for excision of the affected part and the high frequency current for hemostasis is performed by the current switching unit 24 in the high frequency power supply 20. The ratio of the ON and OFF times in the high frequency current for excision of the affected area and the high frequency current for hemostasis need not be limited to the above percentage.

  In addition, a foot switch 25 for operating the current switching unit 24 is connected to the high frequency power source 20. The foot switch 25 includes an affected part excision pedal 25a and a hemostasis pedal 25b. When the affected part excision pedal 25a is depressed, the current switching part 24 switches to the high frequency current for excising the affected part, and the high frequency current for excising the affected part flows to the snare loop 17 and the hemostasis electrode 18. On the other hand, when the hemostatic pedal 25 b is depressed, the high frequency current for hemostasis is switched, and the high frequency current for hemostasis flows to the snare loop 17 and the hemostatic electrode 18.

  The operation wire 16 is a conductive wire and sends a high-frequency current from the high-frequency power source 20 to the snare loop 17 and the hemostasis electrode 18. The snare loop 17 is also formed of a conductive wire and is used as a conducting wire for the hemostatic electrode 18. For this reason, there is no need to provide separate wires for each of the snare loop 17 and the hemostasis electrode 18, so that the wire passing through the sheath 15 is compared with the conventional example in which the hemostasis electrode is provided at the distal end of the sheath. The number is small, which is advantageous when the sheath is made thin.

  The high-frequency current flows through the human body of the patient P between the snare loop 17 and the hemostatic electrode 18 and the counter electrode plate 22 to generate a microwave. The affected part is dielectrically heated by this microwave, and excision and hemostasis are performed.

  As shown in FIG. 2A, when the operation wire 16 is pushed out from the through hole 15a of the sheath 15 by the operation of the hand operation unit 19, the snare loop 17 swells in a loop shape due to its own elasticity. Further, as shown in FIG. 2B, the snare loop 17 is housed in the through hole 15a while being narrowed when the operation wire 16 is pulled into the sheath 15 by the operation of the hand operation unit 19. The hemostasis electrode 18 advances and retreats along the axial direction of the sheath 15 as the snare loop 17 advances and retreats.

  As shown in FIG. 3, the hemostatic electrode 18 has, for example, a substantially cylindrical shape, and the corners are rounded so that the inner wall of the digestive tract is not inadvertently damaged. As shown in FIG. 2A, the outer diameter D of the hemostatic electrode 18 is formed larger than the inner diameter d of the through hole 15a of the sheath 15. In this way, when the hemostasis electrode 18 retracts toward the distal end of the sheath 15 as the snare loop 17 is retracted, the rear end surface of the hemostasis electrode 18 comes into contact with the distal end of the sheath 15, The hemostatic electrode 18 stops at the immediately preceding position. As long as the operation wire 16 is pulled, the hemostatic electrode 18 is pulled backward, so that the contact state with the tip of the sheath 15 is maintained, and the position and posture of the hemostatic electrode 18 are stabilized.

  If the outer diameter D of the hemostasis electrode 18 is smaller than the inner diameter d of the through-hole 15a, not only the hemostasis electrode 18 may be immersed in the sheath 15 but also the contact state with the sheath 15 is difficult to maintain. . If the hemostatic electrode 18 is not supported by contact with the sheath 15, the hemostasis electrode 18 hangs down near the distal end of the sheath 15, and the position and posture are not stable. The position of the hemostasis electrode 18 is adjusted by a technique and applied to a bleeding site that requires hemostasis. Therefore, if the position and posture are not stable, the position adjustment by the technique is difficult. By making the outer diameter D larger than the inner diameter d, the contact state between the hemostatic electrode 18 and the distal end of the sheath 15 can be easily maintained, and the position and posture of the hemostatic electrode 18 are stabilized. Improved operability.

  Next, the operation procedure of the procedure using the high frequency snare will be described. First, the inside of the body cavity of the patient P is observed with the endoscope 11, and when an affected part such as a lesion or a foreign body is found during the observation, the high-frequency snare 10 is inserted into the forceps channel 11a of the endoscope 11, The sheath 15 is protruded from the distal end portion of the endoscope 11. When the high-frequency snare 10 is inserted, the snare loop 17 is housed in the through hole 15a of the sheath 15 so that the snare loop 17 is not caught inside the forceps channel 11a.

  When the distal end of the sheath 15 reaches the vicinity of the affected area, the snare loop 17 is pushed out from the distal end of the sheath 15 and is expanded in a substantially elliptical shape. Then, as shown in FIG. 4, after surrounding the affected area 30 with the snare loop 17 swelled in a substantially elliptical shape, the operation wire 16 is drawn into the sheath 15, and the affected area 30 is tightened with the snare loop 17 and the hemostatic electrode 18. . In this state, the operator steps on the affected part excision pedal 25a of the foot switch 25. As a result, as shown in FIG. 5, the high frequency current for excision of the affected area flows through the snare loop 17 and the hemostatic electrode 18, and the affected area 30 is excised.

  At the time of excision of the affected part, since the operation wire 16 is pulled, when the affected part 30 is excised, the snare loop 17 is drawn into the sheath 15 with the momentum. Along with this, the hemostatic electrode 18 also moves backward toward the distal end of the sheath 15 and stops when it comes into contact with the distal end. After removing the affected part, as shown in FIG. 6, the position of the sheath 15 is adjusted by a procedure in order to apply the hemostatic electrode 18 to the bleeding site 32. Since the position and posture of the hemostatic electrode 18 are stable due to contact with the sheath 15, it is easy to adjust the position by a technique.

  Further, the hemostasis electrode 18 stops immediately before the distal end of the sheath 15 immediately after excision of the affected area, and therefore is located in the vicinity of the position immediately above the bleeding site 32. This position is closer to the bleeding site 32 as compared to the conventional example in which a hemostatic electrode is provided at the sheath tip. Therefore, the position adjustment amount for applying the hemostatic electrode 18 to the bleeding site 32 is small, and the operability is improved as compared with the conventional case. When the hemostasis electrode 18 comes into contact with the bleeding site 32, the operator steps on the hemostasis pedal 25 b to flow a hemostasis high-frequency current to the hemostasis electrode 18. As a result, the bleeding site 32 is coagulated and stopped.

  In the present embodiment, a switching current is used as the high-frequency current of the high-frequency power source. A high-frequency current that is continuously turned ON is supplied when the affected part is excised, and a high-frequency current that is repeatedly turned ON is supplied when hemostasis is performed. There is no need. For example, the current value of the high-frequency current may be different between the excision of the affected part and the hemostasis.

  In the present embodiment, a monopolar high-frequency snare using a counter electrode plate is used as the high-frequency snare. However, the present invention is not limited to this, and a bipolar high-frequency snare that does not use a counter electrode plate may be used. In this case, as shown in FIG. 7, the operation wire 16 is composed of a pair of conductive wires 16a and 16b, one base end portion 17a of the snare loop 17 is used as the operation wire 16a, and the other snare loop 17 is used. The base end portion 17b is connected to the operation wire 16b. The conductive wires 16a and 16b are insulated so as not to be short-circuited. Then, an insulator 35 is provided on the hemostasis electrode 18, and the hemostasis electrode 18 and the snare loop 17 are divided into two electrodes 36 and 37 with the insulator 35 as a boundary. When a high frequency current flows through the electrodes 36 and 37 and the snare loop 17, a microwave is generated in the loop of the snare loop 17.

  In this embodiment, the outer diameter of the hemostasis electrode is made larger than the inner diameter of the through hole of the sheath so that the hemostasis electrode abuts against the distal end of the sheath, but as shown in FIG. If a regulating member 40 that contacts the rear end surface of the hemostatic electrode 43 is provided near the opening of the through hole 42a of the sheath 42, the outer diameter D1 of the hemostatic electrode 43 may be made smaller than the inner diameter d1 of the through hole. . The regulating member 40 has, for example, a donut shape, and the snare loop 17 can be inserted through an opening 40a formed at the center. If the outer diameter D1 of the hemostatic electrode 43 is larger than the diameter d2 of the opening 40a, the rear end surface of the hemostatic electrode 43 comes into contact with the regulating member 40, so that the hemostatic electrode 43 is placed at a position immediately before the distal end of the sheath 15. Can be stopped.

  In the present embodiment, the shape of the hemostatic electrode has been described as a substantially cylindrical shape. However, the shape is not limited to this, and other shapes such as a warhead shape having a tapered tip, such as the hemostatic electrode 45 shown in FIG. Shape may be sufficient. In addition, since the hemostatic electrode generates heat when energized, a heat insulating material may be provided at the distal end of the sheath in order to prevent the sheath from melting due to contact with the hemostatic electrode.

  In this embodiment, the example in which the wiring for the hemostasis electrode is shared with the snare loop has been described. However, the wiring for the hemostasis electrode and the wiring for the snare loop may be provided separately. In this case, for example, a wiring covered with an insulating material is disposed along the snare loop and connected to the hemostatic electrode. The snare loop and the hemostatic electrode are also insulated. In this way, the high frequency current for hemostasis flows only to the hemostatic electrode, and the high frequency current for excision of the affected area flows only to the snare loop.

It is the schematic which shows the high frequency snare of this invention. (A) is the front view which shows the snare loop and the hemostatic electrode in the state which protruded from the front-end | tip of a sheath, and sectional drawing which shows the sheath front-end | tip, (B) is the snare loop and the hemostasis state in the state accommodated in the sheath It is sectional drawing which shows the front view which shows an electrode, and the sheath front-end | tip vicinity. It is a perspective view which shows the shape of the electrode for hemostasis. It is the schematic of the snare loop and the hemostatic electrode which show the state which clamped the affected part. It is the schematic of the snare loop and the hemostatic electrode which show the state which resected the affected part. It is explanatory drawing which shows the state which is bleeding and coagulating the bleeding part with the electrode for hemostasis. It is the schematic which shows a bipolar type high frequency snare. It is explanatory drawing which shows the state which block | closed the opening of the through-hole of a sheath with the control member. It is a top view which shows the electrode for hemostasis of a shape different from the shape of the electrode for hemostasis of this embodiment.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 High frequency snare 15, 42 Sheath 15a, 42a Through-hole 17 Snare loop 18, 43, 45 Electrostatic electrode 22 Counter electrode plate 35 Insulator

Claims (9)

A sheath inserted through the forceps channel of the endoscope;
Protruding from the distal end of the sheath so as to swell when it is pushed out from the distal end of the sheath and swelled when pulled from the distal end into the sheath, and is raised by energization of the first high-frequency current. A snare loop to cauterize the lesion;
A raised lesion caused by the snare loop, provided at the tip of the snare loop, and configured to be in contact with the tip of the sheath and positioned immediately before the snare loop is pulled into the sheath. An endoscopic high frequency snare comprising: a coagulation hemostasis electrode for coagulation and hemostasis of bleeding after excision of the raised lesion by applying a second high frequency current after the excision.   The high frequency snare for an endoscope according to claim 1, wherein D> d is satisfied, where d is an inner diameter of the sheath and D is a size of the coagulation hemostasis electrode.   The high-frequency snare for an endoscope according to claim 1 or 2, wherein the coagulation hemostasis electrode has a cylindrical shape.   The high frequency snare for an endoscope according to claim 1 or 2, wherein the coagulation hemostasis electrode has a tapered shape.   The high-frequency snare for an endoscope according to any one of claims 1 to 4, wherein the snare loop and the coagulation hemostasis electrode are bipolar.   6. The endoscope high-frequency device according to claim 5, wherein the coagulation hemostasis electrode is divided into bipolar electrodes by an insulator, and a wiring through which the second high-frequency current flows is connected to each of the electrodes. Snare.   The high-frequency snare for endoscope according to any one of claims 1 to 4, wherein the snare loop and the coagulation hemostasis electrode are monopolar.   The endoscope according to any one of claims 1 to 7, wherein the snare loop and the coagulation hemostasis electrode have a common wiring for passing the first and second high-frequency currents. For high frequency snare. An apparatus for driving the endoscope high-frequency snare according to any one of claims 1 to 8,
Operation input means for selecting cauterization by the snare loop or coagulation hemostasis by the coagulation hemostasis electrode;
An endoscopic high-frequency snare drive device comprising: switching means for switching a high-frequency current to be passed through the snare loop and the coagulation hemostasis electrode in accordance with an operation of the operation input means.

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