JP2012205618A - Bipolar treatment instrument - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a bipolar treatment instrument stopping bleeding in a surgery of a hypophysis or the like.SOLUTION: The bipolar treatment instrument includes a flexible core wire, and a holding device for holding the flexible core wire. In the bipolar treatment instrument, the flexible core wire includes a flexible tube 3, two cables 4 and 5 inserted into the flexible tube, and projecting portions 4a and 5a of naked wires of the two cables which project from a closed portion 6 made of an insulating material and located at the end of the flexible tube. The holding device includes two rods each having elongated grooves for housing the flexible core wire between them, and alternately slidably superposed in the extending direction of the elongated grooves, a cylindrical portion connected to the ends of the two rods with pins, swingable by the sliding of the two rods, and inserting therein the end of the flexible core wire in the elongated grooves, a grip provided at the rear ends of the two rods, and a slide operation portion for sliding the two rods, and the slide operation portion is operated to turn the flexible core wire inserted into the cylindrical portion together with the cylindrical portion.

Description

  The present invention relates to a bipolar treatment instrument that can be used for brain surgery or the like.

  For example, in brain surgery for removing a tumor of the pituitary gland, it is necessary to stop bleeding from thin blood vessels around the tumor in order to secure a surgical field. In this type of surgery, forceps and the like are inserted from the nostril to remove the tumor, so that the bipolar treatment tool for hemostasis must also have a thin structure that can be inserted from the nostril. As the structure, it is conceivable that two electric wires are passed through a thin pipe, and a portion where each protrudes from the tip of the pipe is defined as a + electrode and a − electrode (for example, see Patent Document 1). The blood vessel can be coagulated by bringing both electrodes close to a desired blood vessel and applying a high-frequency current between the electrodes.

  In general brain surgery, a curved treatment tool is required to operate a tumor or blood vessel on the side, but it is extremely difficult to insert a greatly bent treatment tool from a narrow space. is there. For this reason, attempts have been made to stop hemostasis by passing the flexible bipolar coagulator through the channel formed in the flexible part of the endoscope and feeding it into the brain together with the flexible part (for example, see Patent Document 2). .

JP 2004-160083 A Japanese Patent Laid-Open No. 10-127658

  Among the above prior arts, since the former is a straight pipe made of a hard material such as metal, it is extremely difficult to reach the electrode to an affected part such as a tumor existing in a narrow and complicated position in the skull. Also, since the electrode only protrudes from the tip of the pipe in the axial direction of the pipe, even if the tip of the pipe can reach the affected area, the electrode cannot be applied to a desired blood vessel in the affected area. There are many.

  In the latter case, since the flexible part of the endoscope is thick, the electrode cannot be sent from the nostril to the affected part. Moreover, even if the flexible part is bent with the maximum curvature, the radius of curvature is too large to bend around the pituitary gland, which is about the size of the tip of a human little finger, and the electrode is placed on the desired blood vessel or bleeding part. It is very difficult to get close.

  Therefore, an object of the present invention is to provide a bipolar treatment instrument that can solve the above-mentioned problems.

  In order to solve the above problems, the present invention employs the following configuration.

  In order to facilitate understanding of the present invention, reference numerals in the drawings are given in parentheses, but the present invention is not limited thereto.

  That is, the invention according to claim 1 is a bipolar treatment instrument comprising a flexible core wire (1) and a holder (2) for holding the flexible core wire (1), wherein the flexible core wire (1) is a flexible tube ( 3), two covered electric wires (4, 5) inserted into the flexible tube (3), and an insulator at the tip of the flexible tube (3) in the two covered electric wires (4, 5) And a protruding portion (4a, 5a) of a bare wire from the closing portion (6), and the holder (2) has a long groove (10a, 11a) in which the flexible core wire (1) can be accommodated. The two rods (10, 11) are slidably stacked on each other in the extending direction of the long grooves (10a, 11a), and a pin is connected to the tip of the two rods (10, 11). Is A cylindrical portion (12) through which the tip of the flexible core wire (1) in the long groove (10a, 11a) capable of swinging by sliding between the two rods (10, 11) is inserted, and the two A grip (13) provided at the rear end of the rods (10, 11); and a slide operation unit (14) for sliding the two rods (10, 11) together. A bipolar treatment instrument is adopted in which the flexible core wire (1) inserted into the cylinder part (12) by the operation of 14) is rotatable together with the cylinder part (12).

  As described in claim 2, in the bipolar treatment instrument according to claim 1, electrode pieces (4b, 5b) are respectively attached to the projecting portions (4a, 5a) made of the two bare wires. It can be.

  As described in claim 3, in the bipolar treatment instrument according to claim 1 or 2, the two rods (10, 11) may be tapered.

  According to the present invention, the two overlapping rods (10, 11) are inserted into the affected part with the grip (13), the distal end cylindrical part (12) is brought close to the affected part, and the slide operation part (14 ) To rotate the cylindrical portion (12), the protruding portion (4a, 5a) of the bare wire in the flexible core wire (1) protruding from the cylindrical portion (12) can be applied to a desired blood vessel. it can. Moreover, since the thin protrusion part (4a, 5a) of a bare wire is made into an electrode as it is, a high frequency current can be applied also to a minute location. Therefore, even if there is a narrow place or side where blood vessels and bleeding parts are intricate, a straight treatment tool is inserted from the nostril and flexed with a small radius of curvature at the desired location. The blood vessel can be coagulated easily and quickly after reaching the site to be treated.

(A) is a partially cutaway sectional view of a bipolar treatment instrument according to the present invention, and (B) is an enlarged view of a portion B in FIG. (A) is a front view at the time of making the flexible core wire of a bipolar treatment tool into an expansion | extension state, (B) is the B section enlarged view in figure (A). (A) is a front view at the time of making the flexible core wire of a bipolar treatment tool into a bending state, (B) is the B section enlarged view in figure (A). (A) is a partially cutaway perspective view of a flexible core wire, and (B) is an enlarged view of a portion B in FIG. It is a longitudinal cross-sectional view of the part shown to FIG. 4 (B). It is explanatory drawing which shows an example of a brain surgery. (A) is a perspective view which shows the front-end | tip part of the flexible core wire which concerns on other embodiment, (B) is a disassembled perspective view. It is a longitudinal cross-sectional view of the portion shown in FIG.

  Hereinafter, embodiments for carrying out the invention will be described with reference to the drawings.

<Embodiment 1>
As shown in FIGS. 1A, 1B, 3A, and 3B, this bipolar treatment instrument includes a flexible core wire 1 and a holder 2 that holds the flexible core wire 1.

  As shown in FIGS. 4A, 4B, and 5, the flexible core wire 1 includes a flexible tube 3, two covered electric wires 4 and 5 inserted into the flexible tube 3, and these two covered wires. Bare wire protrusions 4a and 5a from a closing portion 6 made of an insulator at the tip of the flexible tube 3 in the wires 4 and 5 are provided.

  The flexible tube 3 serves as a sheath of the flexible core wire 1 and is formed flexibly with synthetic resin, rubber or the like. The outer diameter of the flexible tube 3 is 2 mm, for example, and the length is 400 mm, for example.

  The two covered electric wires 4 and 5 are insulated from each other in the flexible tube 3 because their coverings are in contact with each other.

  The distal end of the flexible tube 3 is closed by a closing portion 6 made of synthetic resin. The closing part 6 is formed in a tapered streamline. The closing portion 6 is formed of a synthetic resin to be an insulator, from which the bare wire from which the covering of the two covered wires 4 and 5 is removed protrudes, and the protruding portions 4a and 5a are positive and negative. Electrode. For example, the diameter of each protrusion 4a, 5a is about 0.2 mmφ, the amount of protrusion is about 1 mm, and the interval between the protrusions 4 a, 5 a is about 0.5 mm. Further, each protrusion 4a, 5a is bent at a desired angle in the middle of each, the tip is cut on the slope, and the tip is cut off.

  Further, two covered electric wires 4 and 5 are drawn out from the rear end of the flexible tube 3, and plugs 7 and 8 are attached to the respective rear ends. These plugs 7 and 8 can be connected to the control unit 9 shown in FIG. The controller 9 is a commercially available device, and applies a high-frequency current suitable for blood vessel coagulation to the protruding portions 4a and 5a of the bare wire.

  As shown in FIGS. 1A, 1B and 3A, 3B, the holder 2 has long grooves 10a, 11a in which the flexible core wire 1 can be accommodated, and the long grooves 10a, 11a. The two rods 10 and 11 are slidably stacked in the extending direction of each other, and are pin-coupled to the tip portions of the two rods 10 and 11, and are swung by the slide of the two rods 10 and 11. A cylindrical part 12 through which the tip of the flexible core wire 1 in the operable long grooves 10a, 11a is inserted, a grip 13 provided at the rear part of the two rods 10, 11, and the two rods 10, 11 includes a slide operation unit 14 that slides the members 11 together.

  Each of the two rods 10 and 11 is formed of, for example, a stainless steel material, and is divided into a front portion, an intermediate portion, and a rear portion.

  For example, as shown in FIG. 6, the front portions of the rods 10 and 11 taper in a state where they overlap each other in order to facilitate the insertion into the back of a narrow passage, such as when inserted into the skull from the patient's nostril 15. It is formed in a shape.

  The intermediate portions of the rods 10 and 11 are connected to the front portion and the rear portion via two bent portions that are bent in opposite directions within a vertical plane.

  The two rods 10 and 11 are in contact with each other in the vertical direction through a substantially horizontal slidable contact surface at the front, and long grooves 10a and 11a extending in the length direction of the rod are formed on each slidable contact surface. The upper and lower long grooves 10a and 11a overlap to form a tunnel-shaped hole, and the flexible core wire 1 is accommodated in the hole. This hole communicates with a through hole 16 that penetrates the upper rod 10 rearward at the upper bent portion of the intermediate portion. The flexible core wire 1 is drawn out from the through hole 16 and its plugs 7 and 8 are connected to the control unit 9 as described above. There is some clearance between the long groove 10 a of the upper rod 10 and the flexible core wire 1, so that the upper rod 10 can slide in the front-rear direction on the lower rod 11. Some clearance is also provided between the long groove 11 a of the lower rod 11 and the flexible core wire 1.

  A cylindrical portion 12 is connected to the front ends of the front portions of the two rods 10 and 11. Specifically, as shown in FIGS. 1 (B), 2 (B), and 3 (B), the two ends on the diameter line at one end of the short cylindrical tube portion 12 are the tips of the rods 10 and 11, respectively. Are connected through pins 17 and 18 and true circular pin holes 17a and 18a, respectively. The distal end portion of the flexible core wire 1 housed in the grooves 10a and 11a is inserted into the cylindrical portion 12, and the closing portion 6, the protruding portions 4a and 5a, etc. are pulled out of the cylindrical portion 12.

  As a result, when the upper rod 10 slides back and forth on the lower rod 11, as shown in FIGS. 1 (B), 2 (B), and 3 (B), the cylindrical portion 12 swings. Then, along with this, the protruding portions 4a and 5a of the electric wire change the direction in a desired direction. The direction of the protrusions 4a and 5a can be changed, for example, by changing the positions of the pins 17 and 18 and the shapes of the pin holes 17a and 18a, so that the inclination angle θ in FIG. It is possible to change.

  A substantially cylindrical grip 13 is put on the rear portions of the two rods 10 and 11. The grip 13 is fixed to the lower rod 11 and slidably contacts the upper rod 10.

  A slide operation unit 14 is provided on the grip 13. The slide operation part 14 is fixed to the rear part of the upper rod 10 through the long hole 14a extending in the length direction of the rod formed at a position corresponding to the upper rod 10 of the grip 13 and the long hole 14a. It is comprised with the operation piece 14b.

  When the operation piece 14b is moved in the longitudinal direction in the elongated hole 14a with the finger of the hand holding the grip 13, the upper rod 10 slides on the lower rod 11, and as a result, the cylindrical portion 12 is moved as described above. Swinging is performed with the pins 17 and 18 as fulcrums, and the protruding portions 4a and 5a of the bare wires change their directions in a desired direction.

  Next, the operation of the bipolar treatment instrument having the above configuration will be described.

(1) The operation piece 14b of the bipolar treatment instrument is operated in the direction of arrow a in FIG. 1 to rotate the cylindrical portion 12 to the position shown in FIG. Therefore, the flexible core wire 1 is inserted into the grooves 10a and 11a between the upper and lower rods 10 and 11 from the through hole 16 in the middle portion of the upper rod 10, and into the cylindrical portion 12 as shown in FIGS. And pass.

  Further, the plugs 7 and 8 at the rear ends of the covered electric wires 4 and 5 are connected to the control unit 9.

(2) For example, as shown in FIG. 6, when performing surgery to remove the tumor formed in the pituitary gland A, the surgeon is in the state of FIG. 2 to stop bleeding from thin blood vessels around the tumor. Holding the grip 13 of the treatment instrument, the rods 10 and 11 are inserted from the patient's nostril 15 into the pituitary body A in the skull, and the distal end portion of the flexible core wire 1 protruding from the cylindrical body 12 is brought close to the pituitary body A. .

(3) The bare wire protruding portions 4a and 5a of the flexible core wire 1 are applied to a blood vessel or a bleeding portion from the blood vessel to stop blood flow, and a high-frequency current controlled by the control unit 9 is applied. As a result, the blood vessels coagulate, the blood flow to the tumor is stopped, or the blood is stopped and the surgical field is secured.

  Further, when there is a blood vessel or a tumor at a position where the treatment tool cannot be reached in a straight state, the operator pulls the operation piece 14b in the direction of the arrow b in FIG. 1 and moves it upward as shown in FIG. The rod 10 is slid backward on the lower rod 11. As a result, the cylindrical body 12 is bent to the angle θ as shown in FIG. 5B with the flexible core wire 1, and the protruding portions 4 a and 5 a of the bare wire protruding from the tip of the flexible core wire 1 serve as desired blood vessels or bleeding portions. To touch. Therefore, the blood vessel is coagulated by applying a high-frequency current to the two covered electric wires 4 and 5.

<Embodiment 2>
In the second embodiment, as shown in FIGS. 7A, 7B and 8, electrode pieces 4b and 5b are attached to the protruding portions 4a and 5a of the bare wires at the distal end of the flexible core wire 1 of the bipolar treatment instrument, respectively. It is done.

  The electrode pieces 4b and 5b are formed in a shape obtained by dividing a cone formed of a conductive material into two parts on a plane including its axis, and each of the two covered electric wires 4 and 5 is inserted into the flexible tube 3. Are joined to the protruding portions 4a and 5a of the bare wire by welding or the like. A spacer 19 made of a plate-like insulator is inserted between the two electrode pieces 4b and 5b.

  The distal end of the flexible core wire 1 has substantially the same configuration as the closing portion 6 in the first embodiment, and is a bonding portion made of synthetic resin. With this, the electrode pieces 4b and 5b, the spacer 19 and the like are integrated. It is fixed to the tip of the flexible core wire 1.

  The present invention is not limited to the above embodiment. In the above-described embodiment, the case where the bipolar treatment tool is used in the operation of the pituitary tumor has been described. However, it is also possible to use this bipolar treatment tool for other operations such as a herniated disc. In the holder, the upper rod is slidable with respect to the lower rod, but the lower rod can be slidable with respect to the upper rod. Further, a pipe or a half pipe can be used as the rod.

DESCRIPTION OF SYMBOLS 1 ... Flexible core wire 2 ... Holder 3 ... Flexible tube 4, 5 ... Covered electric wire 4a, 5a ... Projection part 4b, 5b ... Electrode piece 6 ... Closure part 10, 11 ... Rod 10a, 11a ... Long groove 12 ... Cylindrical part 13 ... Grip 14 ... Slide operation part

Claims (3)

  In a bipolar treatment instrument comprising a flexible core wire and a holder for holding the flexible core wire, the flexible core wire includes a flexible tube, two covered electric wires inserted into the flexible tube, and the two covered electric wires. And a protruding portion of the bare electric wire from the closing portion made of an insulator at the tip of the flexible tube in the above, and the holder has a long groove that can accommodate the flexible core wire in the extending direction of the long groove. Two rods slidably stacked on each other, and pin-coupled to the tip of these two rods, and the tip of the flexible core wire in the long groove that can swing by sliding between the two rods Slide the cylindrical part to be inserted, the grip provided at the rear end of the two rods, and the two rods. ; And a slide operation portion, the bipolar treatment tool, characterized in that inserted the flexible core to the tubular portion is rotatable with the cylindrical portion by the operation of the slide operating portion.   2. The bipolar treatment instrument according to claim 1, wherein an electrode piece is attached to each of the protruding portions made of the two bare wires.   3. The bipolar treatment instrument according to claim 1, wherein the two rods are formed in a tapered shape.

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