JP2014195538A - Bipolar-type high frequency treatment tool for endoscope - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a bipolar-type high frequency treatment tool for endoscope, capable of safely performing both treatments of incision and abrasion.SOLUTION: An electrode support member 31 disposed at a distal end of a sheath 11 is provided with a first electrode 32 and second electrode 33 each made of an electroconductive wire rod, and the electrode support member is formed of a substantially columnar insulating member whose longitudinal direction is along an axial-line direction of the sheath. The first electrode includes a pair of first axial-direction wires 32a and 32b that are substantially parallel to each other, and a radial-direction wire 32c that links the distal ends of the first axial-direction wires. The radial-direction wire is disposed along the distal end surface of the electrode support member. The second electrode includes a pair of second axial-direction wires disposed to be substantially parallel to each other. The first axial-direction wires and second axial-direction wires are disposed on a flank of the electrode support member so that they can be substantially parallel to each other with a substantially constant gap between them.

Description

  The present invention relates to a bipolar high-frequency treatment instrument for an endoscope that performs a treatment such as excision of a living tissue with a high-frequency current using an endoscope.

  ESD (endoscopic submucosal dissection) is generally performed according to the following procedure. That is, mark the part to be excised around the lesion, inject a fluid such as hyaluronic acid under the lesion, incise the outside of the marking, peel off the lesion with a scalpel, and collect the lesion . Among these procedures, high-frequency scalpels (knives) having various features have been developed as treatment tools for performing marking, incision, and peeling.

  A high-frequency knife has a high-frequency electrode disposed at the tip of a catheter sheath, and the shape of the high-frequency electrode is a tip system suitable for marking and incision (for example, Patent Document 1) or a blade system suitable for peeling. (For example, Patent Document 2) is known. However, if incision and peeling are performed with separate high-frequency scalpels, it takes time and cost, so these treatments are performed with a single high-frequency scalpel. It is requested to be able to do it. In addition, as the high frequency knife, there are a monopolar type (Patent Document 2) having a single electrode at the distal end portion of the catheter sheath and a bipolar type (Patent Document 1) having two electrodes. The bipolar type is advantageous in terms of safety because it is difficult to perforate the tube mucous membrane or the like (it is difficult to make a hole).

JP 2002-224135 A JP 2004-167081 A

  The present invention has been made in view of these points, and an object of the present invention is to provide a bipolar high-frequency treatment tool for an endoscope that can safely perform both incision and separation treatments.

  An endoscopic bipolar high-frequency treatment instrument according to the present invention includes a sheath part, an operation part provided at a proximal end of the sheath part, an electrode support member provided at a distal end of the sheath part, A first electrode made of a conductive wire provided on the electrode support member; and a second electrode, the electrode support member comprising a substantially columnar insulating member having a longitudinal direction in the axial direction of the sheath portion, The first electrode includes a pair of first axial line portions provided along a side surface of the electrode support member from the proximal end side to the distal end side of the electrode support member, and the pair of first electrodes. And connecting the distal ends of the axial line portions to each other, and having a first radial line portion disposed along the distal end surface of the electrode support member, wherein the second electrodes are respectively Of the electrode support member from the proximal end side to the distal end side of the electrode support member A pair of second axial line portions provided along the surface, wherein the first axial line portion and the second axial line portion are provided so as to be substantially parallel to each other with a substantially constant spacing. It is characterized by that.

  In the bipolar high-frequency treatment instrument for endoscope according to the present invention, the first radial line portion can be formed in a substantially arc shape that is convex toward the distal end side.

  In the bipolar high-frequency treatment instrument for an endoscope according to the present invention, the proximal end side is spaced apart from a portion where the first radial line portion of the first electrode is disposed near the distal end of the electrode support member. A through hole is formed, and the second electrode has a second radial line portion that connects the distal ends of the pair of second axial line portions to each other, and the second diameter A direction line part can be arrange | positioned so that the said through-hole of the said electrode support member may be penetrated.

  In the bipolar high-frequency treatment instrument for endoscope according to the present invention, the electrode support member can be supported so as to be rotatable around the axis of the sheath portion.

  According to the bipolar high-frequency treatment instrument for endoscopes according to the present invention, marking and incision are generated in the vicinity of the distal end of the treatment tool, that is, the first radial line portion provided on the distal end surface of the electrode support member. The peeling can be performed in the vicinity of the first axial line portion of the first electrode and the second axial line portion of the second electrode provided on the side surface of the treatment instrument, that is, the side surface of the electrode support member. This can be done by heat. Accordingly, marking, incision and peeling can be performed using a single treatment instrument, and the treatment time can be shortened and the cost can be reduced, and the bipolar type in which the first electrode and the second electrode are supported by the electrode support member. Therefore, the occurrence rate of perforation is small and high safety can be realized.

It is a top view which shows the whole structure of the bipolar knife of embodiment of this invention. It is sectional drawing along the AA line of FIG. It is a front view which shows the structure of the electrode part of the bipolar knife of embodiment of this invention. It is a side view which shows the structure of the electrode part of the bipolar knife of embodiment of this invention. It is a top view which shows the structure of the electrode part of the bipolar knife of embodiment of this invention. It is a partial cross section figure which shows the structure of the distal end vicinity of the bipolar knife of embodiment of this invention.

  Hereinafter, a bipolar knife (knife) as a bipolar high-frequency treatment instrument for endoscopes according to an embodiment of the present invention will be specifically described with reference to the drawings.

  As shown in FIG. 1, the bipolar knife of the present embodiment includes a sheath part 1, an operation part 2, and an electrode part 3. An operation portion 2 is provided at the proximal end of the sheath portion 1, and an electrode portion 3 is provided at the distal end of the sheath portion 1.

  The electrode unit 3 includes a pair of high-frequency electrodes (first electrode 32 and second electrode 33) provided in an electrically insulated state on the electrode support member 31.

  The operation unit 2 includes a first base 21, a second base 22, and a tip cap 23. The second base 22 is attached to the first base 21. The tip cap 23 is attached to the distal end (tip) of the first base 21. The 1st base 21, the 2nd base 22, and the tip cap 23 are formed from insulating resin. The operation unit 2 also includes a pair of electric wires (cables) 24a and 24b and a plug 24 provided at the tip thereof. These electric wires 24a and 24b are connected to a high-frequency power supply device (not shown) via the plug 24. It is electrically connected and is supplied with a high-frequency current. As will be described in detail later, the electric wire 24 a is electrically connected to the first electrode 32, and the electric wire 24 b is electrically connected to the second electrode 33.

  As shown in FIG. 2, the sheath portion 1 includes a tubular outer sheath 11, a tubular inner sheath 12, a drive wire 13, and an electric wire 14. The outer sheath 11 is made of a flexible hollow tube, and in this embodiment, a tube made of an insulating resin is used. The inner sheath 12 is formed of a flexible hollow tube, and in this embodiment, a tube formed of an insulating resin is used. The resin material for forming the outer sheath 11 and the inner sheath 12 is not particularly limited as long as it is an electrically insulating material, such as polyethylene, polypropylene, polyvinyl chloride, polyurethane, polyamide, polyester, polycarbonate, polyethersulfone, and fluororesin. Can be used.

  The drive wire 13 is inserted into the inner sheath 12, and the inner sheath 12 is inserted into the outer sheath 11. The drive wire 13 can rotate around its axis within the inner sheath 12.

  The drive wire 13 is made of a flexible and conductive wire (torque wire), and the drive wire 13 can be a single wire made of metal such as stainless steel. However, a wire rope or a wire tube may be used as the drive wire 13. Here, the wire rope is a rope made of a stranded wire formed by spirally twisting a plurality of wires made of a metal wire such as stainless steel. Moreover, a wire tube is a tube which consists of a hollow strand wire formed by twisting a plurality of wires made of metal wires such as stainless steel in a spiral shape so as to be hollow. The drive wire 13 is a power transmission member for transmitting a rotational force that rotates the electrode support member 31 around the axis of the sheath portion 1 (outer sheath 11) in order to adjust its posture. The proximal end of the drive wire 13 is electrically connected to the electric wire 24 a of the operation unit 2, and the distal end is electrically connected to the first electrode 32.

  An electric wire 14 made of a metal such as stainless steel having conductivity is inserted between the outer sheath 11 and the inner sheath 12. The proximal end of the electric wire 14 is electrically connected to the electric wire 24 b of the operation unit 2, and the distal end is electrically connected to the second electrode 33.

  The distal end cap 23 of the operation unit 2 includes a through hole opened at a distal end (tip end) thereof, and the sheath portion 1 including the outer sheath 11, the inner sheath 12, the drive wire 13, and the electric wire 14 from the opening. The proximal end of is inserted. By rotating the operating portion 2 with respect to the sheath portion 1 (outer sheath 11), the drive wire 13 can be rotated around its axis within the sheath portion 1.

  The electrode part 3 is provided in the electrode support member 31 provided in the distal end of the sheath part 1 (outer sheath 11), and the electrode support member 31, as enlarged and shown in FIGS. A pair of electrodes (first electrode 32 and second electrode 33) made of a conductive wire.

  The electrode support member 31 is made of a substantially columnar insulating member having a longitudinal direction in the axial direction of the sheath portion 1. As an insulating material constituting the electrode supporting member 31, a highly heat-resistant resin (for example, polyether ether ketone (PEEK) is used. ) Resin) or ceramic can be used. The electrode support member 31 includes a main body portion 31a formed in a substantially cylindrical shape, a tip guide portion 31b formed in a substantially semicircular shape protruding from a distal end portion (tip portion) of the main body portion 31a, and a main body portion. A substantially cylindrical neck portion 31c protruding from the proximal end portion (base end portion) of 31a is roughly included.

  Four guide grooves 34a, 34b, 34c, 34d are formed on the side surface of the main body 31a from the proximal end side toward the distal end side, substantially parallel to the central axis of the main body 31a. The four guide grooves 34a, 34b, 34c, and 34d are arranged on the side surface of the main body 31a at an angular interval of 90 degrees. A guide groove 34e is formed in the tip guide portion 31b along a distal end surface (tip surface) having a substantially arc shape. One end of the guide groove 34e of the tip guide portion 31b is connected to the guide groove 34a of the main body portion 31a, and the other end of the guide groove 34e of the tip guide portion 31b is connected to the guide groove 34b of the main body portion 31a. Further, a through hole 31d is formed in the tip guide portion 31b. The neck portion 31c is formed with an annular groove 31d that is recessed from the outside.

  The first electrode 32 is a pair of electrodes provided so as to be substantially parallel to each other along the guide grooves 34 a and 34 b on the side surface of the electrode support member 31 from the proximal end side to the distal end side of the electrode support member 31. The first axial line portions 32a and 32b and the distal ends of the pair of first axial line portions 32a and 32b are connected to each other, and the distal end surface (tip guide portion) of the electrode support member 31 is connected. It has a first radial line portion 32c arranged along the guide groove 34e) of 31b. The pair of first axial line portions 32 a and 32 b are disposed at positions that oppose each other approximately 180 degrees with respect to the central axis of the electrode support member 31. The first radial line portion 32c is formed in a substantially arc shape (substantially semicircular arc shape) that protrudes toward the distal end side. Therefore, the first electrode 32 has a substantially U-shape as a whole. doing.

  The second electrode 33 is a pair of electrodes provided so as to be substantially parallel to each other along the guide grooves 34 c and 34 d on the side surface of the electrode support member 31 from the proximal end side to the distal end side of the electrode support member 31. The second axial line parts 33a and 33b and the distal ends of the pair of second axial line parts 33a and 33b are connected to each other, and a through hole 31d formed in the tip guide part 31b is provided. It has the 2nd radial line part 33c arrange | positioned so that it may penetrate. The pair of second axial direction line portions 33 a and 33 b are disposed at positions facing each other by approximately 180 degrees with respect to the central axis of the electrode support member 31. The second radial line portion 33c is formed in a substantially arc shape (substantially semicircular arc shape) that protrudes toward the distal end side. Therefore, the second electrode 33 has a substantially U-shape as a whole. doing.

  As the first electrode 32 and the second electrode 33, a wire made of stainless steel having a diameter of about 0.2 mm can be used. Here, as the wire constituting the first electrode 32 and the second electrode 33, the wire having a circular cross-sectional shape is used, and each wire is manufactured by bending a single wire into a substantially U shape. However, a wire whose cross-sectional shape is rectangular (square or rectangular) may be used. Such a rectangular wire can be produced, for example, by cutting a stainless thin plate using a laser processing machine or the like. In addition, the first electrode 32 and the second electrode 33 may each be composed of a single wire, but in order to facilitate assembly (attachment to the electrode support member 31), appropriate portions (for example, the first radial direction) After the thing cut | disconnected by the electrode support member 31 after what was cut | disconnected by the center part of the line part 32c and the center part of the 2nd radial direction line part 33c may be made to adhere integrally by laser welding etc. in the said cut part. Good.

  Here, the tip guide portion 31b of the electrode support member 31 has a substantially semicircular shape, and the first radial line portion 32c of the first electrode 32 has a substantially arc shape that protrudes toward the distal end side. However, the shape of the electrode support member 31 and the first electrode 32 is not limited to this, and for example, the distal end guide portion 31b is formed in a triangular plate shape convex toward the distal end side, and the first radial line portion 32c is distant. It is good also as a structure made into the broken line shape which becomes convex toward the distal end side, and it is good also as a structure which made the front-end | tip guide part 31b into a rectangular plate shape, and made the 1st radial direction line part 32c into the linear form. In addition, here, the shape of the second electrode 33 is substantially the same as a pair of second axial line portions 33a and 33b connected by a substantially arc-shaped second radial line portion 33c that protrudes toward the distal end side. The second radial line portion 33c is inserted into the through hole 31d formed in the tip guide portion 31b of the electrode support member 31, but the shape of the electrode support member 31 and the second electrode 33 is the same. For example, the electrode support member 31 is provided with a tip guide portion for supporting the second axial line portions 33a and 33b, and the second axial line portions 33a and 33b are longer, The radial line portion 33c may be inserted into the through hole 31d in a straight line shape or a curved line shape or a bent line shape toward the proximal end side. Further, in the electrode support member 31, the through hole 31d is omitted, the second radial line portion 33c of the second electrode 33 is omitted, and the second axial line portions 33a and 33b that are not connected at the distal end side. It is good also as a form which comprises the 2nd electrode 33 only.

  The neck 31c of the electrode support member 31 is provided with a pair of connecting members (straight lines) 35a and 35b formed in a rod shape made of a conductive metal such as stainless steel. The connection members 35a and 35b are provided so that the proximal end side protrudes from the proximal end surface of the neck portion 31c, and the distal end side is buried in the neck portion 31c to reach a part of the proximal end side of the main body portion 31a. Each distal end is connected to a corresponding proximal end of the pair of first axial line portions 32a and 32b of the first electrode 32 in an electrically conductive state by laser welding or the like.

  Further, a substantially annular washer electrode 36 made of a conductive metal such as stainless steel is fitted and fixed in the annular groove 31d formed in the neck portion 31c of the electrode support member 31, and this washer electrode 36 is fixed. Are connected to the proximal ends of the pair of second axial line portions 33a and 33b of the second electrode 33 in a state of being electrically conducted by laser welding or the like. A configuration in which the first electrode 32 is connected to the washer electrode 36 and the second electrode 33 is connected to the connecting members 35a and 35b may be employed.

  A ring member 37 is loosely fitted in the annular groove 31d formed in the neck portion 31c of the electrode support member 31 so as to slidably contact the washer electrode 36 (see FIG. 6). The ring member 37 is composed of a pair of substantially semi-circular C rings made of a conductive metal such as stainless steel, and the pair of C rings are inserted into the annular groove 31d formed in the neck portion 31c so as to be sandwiched from both sides. The opposite end portions of both are fixed by laser welding or the like, so that they are loosely fitted to the neck portion 31c with a slight clearance (clearance), and the ring member 37 is attached to the annular groove 31d and contacts the washer electrode 36. In this state, the electrode support member 31 can be freely rotated.

  In addition, as the ring member 37, a substantially annular single C-ring formed so that both opposite ends face each other with a slight gap is fitted into the annular groove 31d of the neck 31c while being elastically deformed. May be adopted.

  As shown in FIG. 6, a fixing bracket 15 is attached to the distal end of the outer sheath 11. The fixture 15 is a substantially cylindrical member formed from a conductive metal such as stainless steel. The distal end of the inner sheath 12 is inserted and fixed to the inside of the fixture 15. The fixing fitting 15 is inserted inward from the distal end of the outer sheath 11 and is fixedly bonded to the outer sheath 11. Further, the distal end of the electric wire 14 wired in the portion between the outer sheath 11 and the inner sheath 12 is connected to the proximal end side end of the fixing bracket 15 in an electrically conductive state. Yes.

  The electrode support member 31 has its neck portion 31c inserted into the inside of the stepped portion formed on the distal end side of the fixing bracket 15, and the ring member 37 is brought into contact with the fixing member 15, and in this state, the fixing bracket The ring member 37 is fixed to the fixing bracket 15 by laser welding or the like. As a result, the electrode support member 31 can rotate around its axis with respect to the fixture 15, and the fixture 15 and the second electrode 33 are in contact with the washer electrode 36 and the ring member 37 regardless of the rotational position. An electrically conductive state can be maintained through the surface.

  The distal end of the drive wire 13 and the electrode support member 31 are connected to each other via the jumper metal member 16. The swallow metal member 16 is a substantially columnar member formed of a conductive metal, and the swallow metal member 16 is rotatably inserted in the vicinity of the distal end of the inner sheath 12. The joint metal member 16 has a hole 16a for inserting the distal end of the drive wire 13 on the proximal end side thereof, and the distal end of the drive wire 13 is inserted into the hole 16a to perform laser welding. The connection is fixed in a state of being electrically conducted by, for example. The metal jumper member 16 has a pair of holes 16b and 16c for inserting and fixing the pair of connecting members 35a and 35b on the distal end side thereof, and the connecting member 35a is inserted into these holes 16b and 16c. , 35b are inserted, and are connected and fixed in an electrically conductive state by laser welding or the like.

  With such a configuration, when the operating portion 2 is rotated around its axis with respect to the sheath portion 1 (outer sheath 11), the drive wire 13 is rotated accordingly, and the jumper metal member 16 and the connection members 35a and 35b are rotated. The first electrode 32 and the second electrode supported by the electrode support member 31 are transmitted to the electrode support member 31 evenly, and the rotational force (torque) is transmitted to the electrode support member 31 through rotation. 33 can be adjusted to a desired posture (rotational position).

  According to the embodiment described above, marking and incision can be performed by Joule heat generated in the vicinity of the tip end of the bipolar knife, that is, the first radial line portion 32c provided on the distal end surface of the electrode support member 31, and peeling is performed. Is generated in the vicinity of the first axial line portions 32a and 32b of the first electrode 32 and the second axial line portions 33a and 33b of the second electrode 33 provided on the side surface of the bipolar knife, that is, the side surface of the electrode support member 31. It can be performed by Joule heat. Accordingly, marking, incision, and peeling can be performed using a single treatment instrument, so that the operation time can be shortened and the cost can be reduced, and the first electrode 32 and the second electrode 33 are supported by the electrode support member 31. Because of the bipolar type, the occurrence rate of perforation is small, and high safety can be realized.

  Further, in the above-described embodiment, the electrode support member 31 that supports the first electrode 32 and the second electrode 33 is supported rotatably about the axis of the outer sheath 11, and is rotated by the operation unit 2 via the drive wire 13. Since the operation can be performed, the postures of the first electrode 32 and the second electrode 33 can be arbitrarily changed, and more delicate treatment can be performed according to the shape of the lesion and the content of the treatment.

  In the above-described embodiment, the substantially U-shaped first electrode 32 having the pair (two) of the first axial line portions 32a and 32b, and the pair of (two) second axial line portions 33a and 33b. Are arranged so as to be substantially orthogonal (at approximately 90 degrees), so that the first axial line portions 32a and 32b and the second axial line portions 33a and 33b are 90. The first electrode 32 and the second electrode 33 are arranged so as to intersect (for example, approximately 45 degrees), although they are alternately arranged on the side surfaces of the electrode support member 31 at an angular interval of a certain degree (a constant spacing interval). You may do it. In this case, the axial line portion is located at a portion between the first axial line portions 32a and 32b of the first electrode 32 and the second axial line portions 33a and 33b of the second electrode 33 on the wide side. The third electrode having the same configuration as that of the first electrode 32 and / or the fourth electrode having the same configuration as that of the second electrode 33 are additionally arranged so that the third electrode is disposed on the first electrode 32. The fourth electrode may be electrically connected to the second electrode 33. More electrodes having the same shape as the first electrode 32 or the second electrode 33 may be added. When an additional electrode is provided, each axial line portion is a side surface of the electrode support member 31 from the viewpoint that the sharpness of incision and peeling does not change depending on the direction when the electrode support member 31 abuts against a lesion or the like. In this case, it is preferable to arrange them so as to have uniform angular intervals (a constant interval from each other).

  The embodiment described above is described for facilitating the understanding of the present invention, and is not described for limiting the present invention. Therefore, each element disclosed in the embodiment described above is intended to include all design changes and equivalents belonging to the technical scope of the present invention.

1 ... sheath part,
11: outer sheath,
12 ... Inner sheath,
13 ... Drive wire,
14 ... Electric wire,
15 ... Fixing bracket,
16 ... jumper metal member,
2 ... operation part,
24 ... Plug,
24a, 24b ... electric wires,
3 ... electrode part,
31 ... Electrode support member,
31a ... main body,
31b ... tip guide part,
31c ... neck 31d ... annular groove,
32 ... 1st electrode,
32a, 32b ... 1st axial direction line part,
32c ... 1st radial direction line part,
33 ... second electrode,
33a, 33b ... second axial direction line part,
33c ... 2nd radial direction line part,
34a, 34b, 34c, 34d, 34e ... guide grooves,
35a, 35b ... connecting members,
36 ... washer electrode,
37 ... Ring member.

Claims (4)

A sheath part;
An operation portion provided at a proximal end of the sheath portion;
An electrode support member provided at a distal end of the sheath portion;
A first electrode and a second electrode made of a conductive wire provided on the electrode support member;
The electrode support member comprises a substantially columnar insulating member having a longitudinal direction in the axial direction of the sheath portion,
The first electrode includes a pair of first axial line portions provided along side surfaces of the electrode support member from the proximal end side to the distal end side of the electrode support member, and the pair of first electrode portions, respectively. A first radial line portion disposed along the distal end surface of the electrode support member, the distal ends of each of the one axial line portions being connected to each other;
Each of the second electrodes has a pair of second axial line portions provided along side surfaces of the electrode support member from the proximal end side to the distal end side of the electrode support member,
The bipolar high-frequency treatment instrument for an endoscope, wherein the first axial line portion and the second axial line portion are provided so as to be substantially parallel to each other with a substantially constant spacing.   The bipolar high-frequency treatment instrument for endoscope according to claim 1, wherein the first radial line portion is formed in a substantially arc shape that is convex toward the distal end side. In the vicinity of the distal end of the electrode support member, a through hole is formed apart from the portion where the first radial line portion of the first electrode is disposed to the proximal end side,
The second electrode has a second radial line portion that connects the distal ends of each of the pair of second axial line portions, and the second radial line portion is connected to the electrode support member. The bipolar high-frequency treatment instrument for endoscope according to claim 1 or 2, wherein the bipolar high-frequency treatment instrument for endoscope according to claim 1 or 2 is disposed so as to penetrate the through hole.   The bipolar high-frequency treatment instrument for endoscope according to any one of claims 1 to 3, wherein the electrode support member is supported so as to be rotatable around an axis of the sheath portion.

Images