JP2010268845A - High-frequency knife for endoscope - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a high-frequency knife for an endoscope which is capable of smoothly and safely carrying out precut, mucosa incision procedure, or the like of a mucosa face by high-frequency cautery by one treatment instrument without the risk of puncturing. <P>SOLUTION: An electrode 3 for incision formed from a pipe-shape electroconductive material is fixedly arranged while protruding forward at the distal end of a flexible sheath 1 made of an electroinsulative material, an electroinsulative body 4 having am outer diameter larger than the outer diameter of the electrode 3 for incision is fixedly arranged so as to cover the distal end part of the electrode 3 for incision, and the electrode 5 for precut protruded and retracted forward from the inside of the distal end of the electrode 3 for incision by the operation from the proximal end side of the flexible sheath 1 are arranged. <P>COPYRIGHT: (C)2011,JPO&INPIT

Description

  The present invention relates to an endoscope high-frequency knife.

  As a basic configuration of an endoscope high-frequency knife that is passed through a treatment instrument insertion channel of an endoscope and used for performing mucosal resection or the like, a rod-shaped incision electrode made of a conductive material is made of an electrically insulating material. A flexible sheath that protrudes forward from the distal end of the flexible sheath is known (for example, Patent Document 1).

  However, simply providing a bar-shaped incision electrode at the distal end of the flexible sheath may cause cauterization of the underlying tissue that should not be incised, resulting in perforation or the like. In view of this, an incision tip or the like is provided at the tip of the incision electrode so that the incision treatment can be performed more safely (for example, Patent Document 2).

JP-A-2005-270240 JP-A-8-299355

  In the invention described in Patent Document 2 and the like, the mucous membrane is not cauterized at the distal end portion of the incision electrode, so that the mucosal incision treatment can be performed safely without fear of perforation. However, since a small cut cannot be made in the mucous membrane prior to incision of the mucous membrane, it is necessary to make a cut (that is, pre-cut) in advance on the mucosal surface with another treatment tool for pre-cutting, which is troublesome for the operator. It was necessary to operate.

  An object of the present invention is to provide a high-frequency knife for an endoscope that can perform pre-cutting of the mucosal surface by high-frequency cauterization, mucosal dissection treatment, and the like smoothly and safely without the risk of perforation.

  In order to achieve the above object, the endoscope high-frequency knife of the present invention is fixed to a distal end of a flexible sheath made of an electrical insulating material so that a cutting electrode made of a pipe-like conductive material protrudes forward. The electrical insulator having an outer diameter larger than the outer diameter of the incising electrode is fixedly provided so as to cover the distal end portion of the incising electrode, and the operation from the proximal end side of the flexible sheath is performed. Thus, a precut electrode that protrudes forward from the tip of the incision electrode is provided.

  The precut electrode may be formed in a straight rod shape, and a conductive operation wire that advances and retreats in the axial direction by an operation from the proximal end side of the flexible sheath is inserted and arranged in the flexible sheath. In addition, the tip of the operation wire may be connected to the precut electrode.

  When the precut electrode protrudes from the tip of the incision electrode, the precut electrode and the operation wire are electrically connected, and the incision electrode and the operation wire are electrically insulated, and the precut electrode In the state where the electrode is immersed in the incision electrode, the incision electrode and the operation wire may be electrically connected. The precut electrode may be formed by extending the operation wire forward.

  In addition, a pair of protruding stoppers that come into contact with each other in order to regulate the maximum protruding length of the precut electrode protruding from the tip of the cutting electrode may be provided on the operation wire and the cutting electrode. In addition, when at least one of the pair of projecting stoppers is formed of an electrical insulating material and the precut electrode projects from the tip of the incision electrode and the pair of projecting stoppers come into contact with each other, the operation wire and the incision electrode The space may be electrically insulated.

  In addition, a pair of immersion stoppers that come into contact with each other to regulate the maximum immersion position of the precut electrode protruding from the tip of the incision electrode may be provided on the operation wire and the incision electrode. In a state where the pair of immersion stoppers are formed of a conductive material, and the precutting electrode is immersed in the incision electrode and the pair of immersion stoppers are in contact with each other, the operation wire and the incision electrode are electrically connected to each other. You may make it conduct | electrically_connect.

  According to the present invention, the electrical insulator is fixedly provided so as to cover the tip portion of the incision electrode, and the precut electrode that projects forward from the inside of the tip of the incision electrode is provided. The pre-cutting of the mucosal surface by high-frequency cauterization using the pre-cutting electrode and the mucosal dissection treatment by high-frequency cauterization using the incising electrode can be performed smoothly and safely without the risk of perforation.

In the high frequency knife for endoscopes of the example of the present invention, it is a side sectional view of the tip portion in the state where the precut electrode protrudes. In the high frequency knife for endoscopes of the example of the present invention, it is a side sectional view of the tip part in the state where the precut electrode was immersed. 1 is an overall configuration diagram of an endoscope high-frequency knife according to an embodiment of the present invention.

Embodiments of the present invention will be described below with reference to the drawings.
FIG. 3 shows the overall configuration of the endoscope high-frequency knife, and the flexible sheath 1 inserted into and removed from the endoscope treatment instrument insertion channel (not shown) is, for example, a tetrafluoroethylene resin tube or the like. It is formed of an electrically insulating flexible tube. Reference numeral 2 denotes an electrically insulating sheath tip cap fixedly attached to the tip of the flexible sheath 1.

  An incision electrode 3 made of a straight pipe-shaped conductive material is fixedly provided at the distal end of the flexible sheath 1 so as to protrude forward from the sheath distal end cap 2. An electrically insulating insulating chip 4 (electrical insulator) having a large outer diameter is fixedly attached so as to cover the most distal portion of the incision electrode 3.

  In addition, a precut electrode 5 formed in a straight rod shape by a conductive material is provided so as to be able to protrude forward from the inside of the tip of the incision electrode 3. A conductive operation wire 6 (operation wire) is inserted through the entire length of the flexible sheath 1 so as to be movable back and forth in the axial direction, and the tip of the operation wire 6 is mechanically and electrically connected to the precut electrode 5. Are connected to each other.

  A known operation portion 20 for advancing and retracting the operation wire 6 is connected to the proximal end 1 e of the flexible sheath 1. In addition, the operation unit 20 side is illustrated as being reduced compared to the distal end side of the flexible sheath 1.

  The base end 6 e of the operation wire 6 is connected and fixed to a slide operation member 22 that is slidably attached to the operation unit main body 21. Therefore, when the slide operation member 22 is slid, the operation wire 6 advances and retreats in the axial direction in the flexible sheath 1, and the precut electrode 5 protrudes and retracts from the tip of the incision electrode 3.

  The connection terminal 23 provided on the slide operation member 22 is electrically connected to the proximal end 6e of the operation wire 6. By connecting a high-frequency power cord (not shown) to the connection terminal 23, the connection terminal 23 passes through the operation wire 6. Thus, a high-frequency current can be applied to the precut electrode 5.

  Therefore, by cutting the precut electrode 5 from the tip of the incision electrode 3 and applying a high-frequency current to the precut electrode 5, a precut process for making a cut in the surface portion of the mucous membrane can be easily performed. Also, a marking process for forming spot-like marks on the mucosal surface can be easily performed.

  Then, by immersing the precutting electrode 5 in the incision electrode 3, a high-frequency current can be applied to the incision electrode 3 to perform mucosal incision or detachment treatment, and the tip of the incision electrode 3 is insulated. Since the tip 4 is provided, there is no danger that the mucosal cauterization due to the incision electrode 3 becomes too deep and perforates.

  FIGS. 1 and 2 are side cross-sectional views showing the distal end portion of the endoscope high-frequency knife in an enlarged state in a state where the precut electrode 5 protrudes to the maximum from the tip of the incision electrode 3 and a state where the electrode 5 is immersed. is there.

  The sheath distal end cap 2 has a portion near the distal end formed to have an outer diameter substantially the same as the outer diameter of the flexible sheath 1 and is exposed to the distal end portion of the flexible sheath 1. This portion is formed to have an inner diameter substantially the same as the inner diameter of the flexible sheath 1 and is press-fitted into the distal end of the flexible sheath 1, and a retaining projection formed on the outer periphery of the portion is the flexible sheath 1. It is fixed so as not to be detached from the flexible sheath 1 by biting into the inner peripheral surface.

  The incision electrode 3 is fixed to the sheath distal end cap 2 so as to penetrate the hole formed at the axial position of the sheath distal end cap 2 back and forth, and the rear end portion (8B) of the incision electrode 3 is the sheath distal end cap. 2 protrudes rearward from the rear end face and is located in a space in the flexible sheath 1.

  The insulating tip 4 is fixed to the incising electrode 3 so as to cover the outer peripheral surface and the leading end surface of the distal end portion of the incising electrode 3, and the precut electrode 5 is disposed at the axial position of the distal end portion of the insulating tip 4. A loose passage hole is formed.

  In this embodiment, the precut electrode 5 is formed by extending the core wire 6a of the operation wire 6 made of a stranded wire forward as it is. In the case where the precut electrode 5 is a stranded wire, the leading edge thereof is hardened by brazing or the like so as not to fray. However, there may be a configuration in which the precut electrode 5 formed of a member different from the operation wire 6 is connected and connected to the tip of the operation wire 6.

  The precut electrode 5 and the operation wire 6 connected to the precut electrode 5 are formed to have an outer diameter that does not contact the inner peripheral surface of the incision electrode 3, and the high frequency current supplied to the operation wire 6 is applied to the operation wire 6 or the precut electrode. There is no direct transmission from the electrode 5 to the incision electrode 3.

  The operation wire 6 and the incision electrode 3 are provided with a pair of projecting stoppers 8A and 8B that come into contact with each other in order to regulate the maximum projecting length of the precut electrode 5 projecting from the tip of the incision electrode 3. .

  The movable protrusion stopper 8A provided on the operation wire 6 is formed of an electric insulating material in a short cylinder shape surrounding the operation wire 6, and the fixed protrusion protrusion 8B is formed of the rear end surface of the incision electrode 3 itself. Yes. However, the fixed-side protruding stopper 8B may be formed of, for example, a pipe-like independent part and fixed to the incision electrode 3 or the like.

  The movable-side protruding stopper 8A may be fixed to the operation wire 6. However, when it is difficult to ensure the fixing strength, the movable-side protruding stopper 8A loosely fitted on the operating wire 6 as in this embodiment. May be configured to be pushed forward by a metal elongated stopper push tube 9 fitted and fixed to the operation wire 6.

  As shown in FIG. 1, when the movable side protruding stopper 8A pushed by the stopper pushing tube 9 comes into contact with the fixed side protruding stopper 8B which is the rear end surface of the cutting electrode 3, the precutting electrode 5 is used for cutting. The electrode 3 can no longer protrude from the tip of the electrode 3.

  In addition, a pair of immersion stoppers 10A and 10B that come into contact with each other to regulate the maximum immersion position of the precut electrode 5 protruding from the tip of the incision electrode 3 are provided on the operation wire 6 and the incision electrode 3. ing.

  Of the pair of immersion stoppers 10A and 10B, the movable-side immersion stopper 10A is fitted on the boundary portion between the distal end of the operation wire 6 and the base end of the precut electrode 5 and is soldered or silver brazed thereto. It is an elongated metal pipe-like member that is fixed, and the fixed-side immersion stopper 10B is a step portion formed on the inner surface side of the incision electrode 3 so that the rear end surface of the movable-side immersion stopper 10A abuts (FIG. 2).

  The movable-side immersion stopper 10A is formed with an outer diameter smaller than the inner diameter of the incision electrode 3 in the front region from the fixed-side immersion stopper 10B so that the outer peripheral surface does not contact the inner peripheral surface of the incision electrode 3. As shown in FIG. 1, when the precut electrode 5 protrudes maximally forward from the tip of the incision electrode 3, it fits loosely in a hole formed at the tip of the insulating chip 4.

  With such a configuration, as shown in FIG. 1, in a state where the pair of projecting stoppers 8 </ b> A and 8 </ b> B come into contact with each other and the precut electrode 5 projects from the tip of the incision electrode 3 to the maximum extent, And the incision electrode 3 are electrically insulated.

  In addition, as shown in FIG. 2, when the pair of immersing stoppers 10 </ b> A and 10 </ b> B are in contact with each other and the precutting electrode 5 is maximally immersed in the incising electrode 3, the operation wire 6 and the incising electrode 3 are used. Is electrically connected through the immersion stoppers 10A and 10B. In this embodiment, the operation wire 6 and the incision electrode 3 are electrically connected only when the pair of immersion stoppers 10A and 10B are in contact with each other.

  With such a configuration, when the precut electrode 5 is projected from the tip of the incision electrode 3 and the marking process is performed by high frequency cauterization, no high frequency current flows through the incision electrode 3. The pre-cut process and the marking process can be performed extremely safely without fear of causing cauterization.

  When the precutting electrode 5 is immersed in the incision electrode 3, the incision electrode 3 and the operation wire 6 are electrically connected. Therefore, the insulating tip 4 is provided at the tip, and the precutting electrode 5 is With the incision electrode 3 not protruding, it is possible to safely perform a mucosal dissection treatment or peeling treatment by high-frequency cauterization.

DESCRIPTION OF SYMBOLS 1 Flexible sheath 3 Incision electrode 4 Insulation tip (electrical insulator)
5 Precutting electrode 6 Operation wire (operation wire)
8A, 8B Protruding stopper 10A, 10B Immersion stopper

Claims (9)

  A cutting electrode made of a pipe-like conductive material is fixedly provided at the tip of a flexible sheath made of an electrically insulating material so as to protrude forward, and has an outer diameter larger than the outer diameter of the cutting electrode. An electrical insulator is fixedly provided so as to cover the distal end portion of the incision electrode, and is precut for projecting forward from the distal end of the incision electrode by an operation from the proximal end side of the flexible sheath. An endoscopic high-frequency knife provided with an electrode.   The high-frequency knife for an endoscope according to claim 1, wherein the precut electrode is formed in a straight bar shape.   A conductive operation wire that advances and retreats in the axial direction by an operation from the proximal end side of the flexible sheath is inserted through the flexible sheath, and the distal end of the operation wire is connected to the precut electrode. The high-frequency knife for an endoscope according to claim 1 or 2.   In a state where the precut electrode protrudes from the tip of the incision electrode, the precut electrode and the operation wire are electrically connected, and the incision electrode and the operation wire are electrically insulated. The high-frequency knife for endoscope according to claim 3, wherein the incision electrode and the operation wire are electrically connected to each other when the precut electrode is immersed in the incision electrode.   The endoscope high-frequency knife according to claim 3 or 4, wherein the precut electrode is formed by extending the operation wire forward.   The pair of projecting stoppers that come into contact with each other to regulate the maximum projecting length of the precut electrode projecting and retracting from the tip of the incising electrode is provided on the operating wire and the incising electrode. The high-frequency knife for an endoscope according to any one of Items 5 to 5.   In a state where at least one of the pair of protruding stoppers is formed of an electrical insulating material, and the precut electrode protrudes from the tip of the incising electrode and the pair of protruding stoppers come into contact with each other, the operation wire and the incision The high frequency knife for an endoscope according to claim 6, wherein the electrode is electrically insulated from the medical electrode.   A pair of immersion stoppers that come into contact with each other to regulate the maximum immersion position of the precut electrode protruding from the tip of the incision electrode are provided on the operation wire and the incision electrode. 8. A high-frequency knife for an endoscope according to any one of items 7 to 9.   In the state where the pair of immersion stoppers are formed of a conductive material, the precut electrode is immersed in the incision electrode, and the pair of immersion stoppers are in contact with each other, the operation wire and the incision electrode The high-frequency knife for an endoscope according to claim 8, wherein the gap is electrically connected.

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