JP2015146911A - Energy treatment device, energy treatment method, and method for anastomosis of biological tissue - Google Patents

Energy treatment device, energy treatment method, and method for anastomosis of biological tissue Download PDF

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JP2015146911A
JP2015146911A JP2014021671A JP2014021671A JP2015146911A JP 2015146911 A JP2015146911 A JP 2015146911A JP 2014021671 A JP2014021671 A JP 2014021671A JP 2014021671 A JP2014021671 A JP 2014021671A JP 2015146911 A JP2015146911 A JP 2015146911A
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energy
living tissue
biological tissue
tissue
cut
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井上　晃
Akira Inoue
晃 井上
雅人 成澤
Masato Narusawa
雅人 成澤
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Olympus Corp
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Olympus Corp
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1477—Needle-like probes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
    • A61B2017/320093—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw additional movable means performing cutting operation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
    • A61B2017/320095—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw with sealing or cauterizing means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00607—Coagulation and cutting with the same instrument
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00619—Welding
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/0063—Sealing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B2018/1452—Probes having pivoting end effectors, e.g. forceps including means for cutting
    • A61B2018/1457—Probes having pivoting end effectors, e.g. forceps including means for cutting having opposing blades cutting tissue grasped by the jaws, i.e. combined scissors and pliers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1475—Electrodes retractable in or deployable from a housing

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  • Health & Medical Sciences (AREA)
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Abstract

PROBLEM TO BE SOLVED: To provide an energy treatment device, energy treatment method and method for anastomosis of biological tissue capable of easily and reliably executing sealing and anastomosis of biological tissue.SOLUTION: The energy treatment device includes: a cutter 7 for cutting biological tissue H; a pair of high frequency electrodes 16a and 16b which apply electrical and/or physical energy to the biological tissue H; and sealing means 24 that, when at least the cutter 7 has cut the biological tissue H and an extracellular matrix of the biological tissue H has been extruded onto cut surfaces Hc of the biological tissue H, actuates the pair of high frequency electrodes 16a and 16b so as to apply electrical and/or physical energy to the cut surfaces Hc of the biological tissue H, connect the cut surfaces to each other by anastomosis, and seal the cut surfaces Hc of the biological tissue H.

Description

本発明は、例えば血管や、脈管組織などを含む臓器及び生体組織の封鎖を行うエネルギー処置装置とエネルギー処置方法と生体組織の吻合方法に関する。   The present invention relates to an energy treatment apparatus, an energy treatment method, and a biological tissue anastomosis method for sealing, for example, an organ including a blood vessel, a vascular tissue, and a biological tissue.

特許文献１、２には、血管や、脈管組織などの生体組織の封止に使用する鋏型の処置具である電気外科鉗子が示されている。ここでは、一対の開閉可能なジョー部材間で生体組織を把持し、ジョー部材の把持面に熱、電気及び物理的エネルギーを印加し、生体組織の細胞外基質であるコラーゲン及びエラスチンの抽出を容易にすることで、血管及び脈管組織などの封鎖を行う構成になっている。   Patent Documents 1 and 2 show electrosurgical forceps that are scissors-type treatment tools used for sealing blood vessels and biological tissues such as vascular tissues. Here, a living tissue is grasped between a pair of jaw members that can be opened and closed, and heat, electricity, and physical energy are applied to the grasping surface of the jaw member to facilitate extraction of collagen and elastin that are extracellular substrates of the living tissue. By doing so, the blood vessel and the vascular tissue are sealed.

特開２０１２−１０５９８７号公報JP 2012-105987 A 特開２０１２−２３９８９９号公報JP 2012-239899 A

特許文献１、２の装置では、封鎖組織内に内容物（血管であれば血液、消化管であれば未消化物など）が存在する場合や、封鎖部の粘膜の存在や封鎖部の組織面に介在するコラーゲン及びエラスチンが少ない場合には、外科手術処置に期待される十分な封鎖強度を発現することが困難である。   In the devices of Patent Documents 1 and 2, when the contents (blood for blood vessels, undigested materials for digestive tract, etc.) exist in the sealed tissue, the presence of the mucous membrane in the sealed portion, and the tissue surface of the sealed portion When there are few collagens and elastin intervening in it, it is difficult to express sufficient sealing strength expected for a surgical procedure.

本発明は上記事情に着目してなされたもので、その目的は、生体組織の封鎖・吻合を簡単・確実に行うことができるエネルギー処置装置とエネルギー処置方法と生体組織の吻合方法を提供することにある。   The present invention has been made paying attention to the above circumstances, and an object thereof is to provide an energy treatment device, an energy treatment method, and a biological tissue anastomosis method capable of easily and reliably sealing and anastomosing biological tissue. It is in.

本発明の一局面の態様は、生体組織を切断するカッター部と、生体組織に電気的および／または物理的エネルギーを印加させるエネルギー印加部と、少なくとも前記カッター部で生体組織を切断して生体組織の切断面に前記生体組織の細胞外基質を抽出させた状態で、前記エネルギー印加部を動作させて前記生体組織の切断面に前記電気的および／または物理的エネルギーを印加して前記切断面同士を吻合させ、前記生体組織の切断面の封鎖を行う封鎖手段と、を具備することを特徴とするエネルギー処置装置である。   An embodiment of one aspect of the present invention includes a cutter unit that cuts a living tissue, an energy application unit that applies electrical and / or physical energy to the living tissue, and cuts the living tissue with at least the cutter unit. In a state where the extracellular matrix of the living tissue is extracted on the cutting surface of the living tissue, the energy application unit is operated to apply the electrical and / or physical energy to the cutting surface of the living tissue, and the cutting surfaces And a sealing means for sealing the cut surface of the biological tissue.

好ましくは、前記封鎖手段は、前記カッター部で切断した生体組織の切断面同士を動かして接触させる切断面移動部を有し、前記エネルギー印加部は、前記切断面移動部で動かして接触させた生体組織の切断面に対してエネルギーを印加する。   Preferably, the sealing means includes a cutting surface moving unit that moves and contacts the cutting surfaces of the biological tissue cut by the cutter unit, and the energy application unit moves and contacts the cutting surface moving unit. Energy is applied to the cut surface of the living tissue.

好ましくは、前記切断面移動部は、前記カッターに沿って移動可能なスリーブを有する。   Preferably, the cutting surface moving part has a sleeve movable along the cutter.

好ましくは、前記切断面移動部は、前記カッター部で切断した生体組織の切断面同士を密着させる稼動部を有する。   Preferably, the cut surface moving unit includes an operation unit that closely contacts the cut surfaces of the biological tissue cut by the cutter unit.

好ましくは、前記スリーブは、前記カッター部で切断した生体組織の切断面同士を内側に折り返すためのバルーンを有する。   Preferably, the sleeve has a balloon for folding back the cut surfaces of the biological tissue cut by the cutter unit.

本発明の他の局面の態様は、生体組織を切断して生体組織の切断面に前記生体組織の細胞外基質を抽出させた後、生体組織に電気的および／または物理的エネルギーを印加させるエネルギー印加部を動作させて前記生体組織の切断面に前記電気的および／または物理的エネルギーを印加して吻合させ、前記生体組織の切断面の封鎖を行う封鎖工程を設けたことを特徴とするエネルギー処置方法である。   In another embodiment of the present invention, the energy for applying electrical and / or physical energy to the living tissue after cutting the living tissue and extracting the extracellular matrix of the living tissue from the cut surface of the living tissue. An energy characterized by having a sealing step of operating the application unit to apply the electrical and / or physical energy to the cut surface of the living tissue and anastomosing to seal the cut surface of the living tissue It is a treatment method.

本発明の他の局面の態様は、把持部によって生体組織を把持して前記生体組織を押し潰して生体壁部を密着させる工程と、前記生体組織の密着部をカッターで切断して前記生体組織の切断面に前記生体組織の細胞外基質を抽出させる工程と、前記生体組織の切断面に前記生体組織の細胞外基質を抽出させた状態で、生体組織に電気的および／または物理的エネルギーを印加させるエネルギー印加部を動作させて前記生体組織の切断面に前記電気的および／または物理的エネルギーを印加して吻合させ、前記生体組織の切断面の封鎖を行う封鎖工程と、を具備することを特徴とする生体組織の吻合方法である。   According to another aspect of the present invention, the biological tissue is grasped by a grasping portion and the biological tissue is crushed to closely adhere the biological wall portion, and the biological tissue is cut by cutting the contact portion of the biological tissue with a cutter. Extracting the extracellular matrix of the living tissue from the cut surface of the living tissue, and extracting the extracellular matrix of the living tissue from the cutting surface of the living tissue, and applying electrical and / or physical energy to the living tissue. A sealing step of operating an energy application unit to be applied and applying the electrical and / or physical energy to the cut surface of the living tissue to cause anastomosis and sealing the cut surface of the living tissue. This is a method for anastomosis of biological tissue characterized by the following.

本発明によれば、生体組織の封鎖・吻合を簡単・確実に行うことができるエネルギー処置装置とエネルギー処置方法と生体組織の吻合方法を提供することができる。   According to the present invention, it is possible to provide an energy treatment device, an energy treatment method, and a biological tissue anastomosis method that can easily and reliably perform sealing and anastomosis of biological tissue.

本発明の第１の実施の形態のエネルギー処置装置の全体の概略構成を示す斜視図。The perspective view which shows the schematic structure of the whole energy treatment apparatus of the 1st Embodiment of this invention. 第１の実施の形態のエネルギー処置装置の先端部分を示す要部の側面図。The side view of the principal part which shows the front-end | tip part of the energy treatment apparatus of 1st Embodiment. 第１の実施の形態のエネルギー処置装置の先端部分の一部を断面にして示す平面図。The top view which shows a part of front-end | tip part of the energy treatment apparatus of 1st Embodiment in cross section. 図２のＩＶ−ＩＶ線断面図。IV-IV sectional view taken on the line of FIG. 第１の実施の形態のエネルギー処置装置の挾持部で血管を挟持した状態を示す横断面図。The cross-sectional view which shows the state which clamped the blood vessel with the holding part of the energy treatment apparatus of 1st Embodiment. 第１の実施の形態のエネルギー処置装置のカッター部で血管を切断した状態を示す横断面図。The cross-sectional view which shows the state which cut | disconnected the blood vessel with the cutter part of the energy treatment apparatus of 1st Embodiment. 第１の実施の形態のエネルギー処置装置のカッター部で血管を切断したのち切断面移動部を動作させた状態を示す横断面図。The cross-sectional view which shows the state which operated the cut surface moving part after cut | disconnecting the blood vessel with the cutter part of the energy treatment apparatus of 1st Embodiment. 第１の実施の形態のエネルギー処置装置の切断面移動部を動作を説明するもので、（Ａ）はバルーンを膨らませる前の状態を示す横断面図、（Ｂ）はバルーンを膨らませた後の状態を示す横断面図。The operation of the cut surface moving part of the energy treatment device according to the first embodiment will be described. (A) is a cross-sectional view showing a state before the balloon is inflated, and (B) is after the balloon is inflated. The cross-sectional view which shows a state. 第１の実施の形態のエネルギー処置装置の切断面の封鎖手段の第１の変形例を示す要部の横断面図。The transverse cross section of the important section showing the 1st modification of the sealing means of the cut surface of the energy treatment device of a 1st embodiment. 第１の実施の形態のエネルギー処置装置の切断面の封鎖手段の第２の変形例を示すもので、（Ａ）はカッター部で血管を切断した切断面の状態を示す要部の横断面図、（Ｂ）は切断面の接合状態を示す要部の横断面図。The 2nd modification of the sealing means of the cut surface of the energy treatment apparatus of 1st Embodiment is shown, (A) is a cross-sectional view of the principal part which shows the state of the cut surface which cut | disconnected the blood vessel with the cutter part. , (B) is a cross-sectional view of the main part showing the joined state of the cut surface. 第１の実施の形態のエネルギー処置装置の切断面の封鎖手段の第３の変形例を示す要部の横断面図。The transverse cross section of the important section showing the 3rd modification of the sealing means of the cut surface of the energy treatment device of a 1st embodiment. 第１の実施の形態のエネルギー処置装置の切断面の封鎖手段の第４の変形例を示す要部の横断面図。The transverse cross section of the important section showing the 4th modification of the sealing means of the cut surface of the energy treatment device of a 1st embodiment. 第１の実施の形態のエネルギー処置装置の切断面の封鎖手段の第４の変形例の動作状態を示す要部の横断面図。The transverse cross section of the important section which shows the operation state of the 4th modification of the sealing means of the cut surface of the energy treatment apparatus of a 1st embodiment. 第１の実施の形態のエネルギー処置装置の切断面の封鎖手段の第５の変形例を示すもので、（Ａ）は血管の切断前の状態を示す要部の横断面図、（Ｂ）は切断面の接合状態を示す要部の横断面図。The 5th modification of the sealing means of the cut surface of the energy treatment apparatus of 1st Embodiment is shown, (A) is a cross-sectional view of the principal part which shows the state before the cutting | disconnection of the blood vessel, (B) is The cross-sectional view of the principal part which shows the joining state of a cut surface.

［第１の実施の形態］
（構成）
図１乃至図８は、本発明の第１の実施の形態を示す。図１は治療用処置装置１のシステム全体の概略構成を示す斜視図である。図１の治療用処置装置１のシステムは、本実施の形態のエネルギー処置装置２と、制御装置３と、フットスイッチ４とを備えている。 [First Embodiment]
(Constitution)
1 to 8 show a first embodiment of the present invention. FIG. 1 is a perspective view showing a schematic configuration of the entire system of the therapeutic treatment apparatus 1. The system of the therapeutic treatment apparatus 1 in FIG. 1 includes the energy treatment apparatus 2, the control apparatus 3, and the foot switch 4 according to the present embodiment.

本実施の形態のエネルギー処置装置２は、術者が手で持つためのハンドル（操作部）５と、このハンドル５に取り付けられた筒状のシース６と、このシース６の先端に設けられたカッター部７とを有する。カッター部７は、開閉可能な一対のカッター部材、本実施の形態では上カッター８ａと、下カッター８ｂとを有する。   The energy treatment device 2 according to the present embodiment is provided with a handle (operation unit) 5 for an operator to hold by hand, a cylindrical sheath 6 attached to the handle 5, and a distal end of the sheath 6. And a cutter unit 7. The cutter unit 7 has a pair of cutter members that can be opened and closed, in the present embodiment, an upper cutter 8a and a lower cutter 8b.

図２は、第１の実施の形態のエネルギー処置装置２のカッター部７の周辺部分を示す側面図である。シース６の先端には、上カッター８ａの基端部が回動ピン９ａを介して回動可能に連結されているとともに、下カッター８ｂの基端部が回動ピン９ｂを介して回動可能に連結されている。   FIG. 2 is a side view showing a peripheral portion of the cutter unit 7 of the energy treatment device 2 according to the first embodiment. The base end portion of the upper cutter 8a is rotatably connected to the distal end of the sheath 6 via a rotation pin 9a, and the base end portion of the lower cutter 8b is rotatable via the rotation pin 9b. It is connected to.

また、図４の断面形状に示すように、上カッター８ａは、平板状のベースプレート８ａ１と、このベースプレート８ａ１の下面に下向きに突設された切り刃８ａ２とを有する。切り刃８ａ２の下端部には、ほぼ半円形状のスリーブガイド溝８ａ３が形成されている。   As shown in the cross-sectional shape of FIG. 4, the upper cutter 8a includes a flat base plate 8a1 and a cutting blade 8a2 projecting downward on the lower surface of the base plate 8a1. A substantially semicircular sleeve guide groove 8a3 is formed at the lower end of the cutting blade 8a2.

同様に、図４の断面形状に示すように、下カッター８ｂは、平板状のベースプレート８ｂ１と、このベースプレート８ｂ１の上面に上向きに突設された切り刃８ｂ２とを有する。切り刃８ｂ２の上端部には、ほぼ半円形状のスリーブガイド溝８ｂ３が形成されている。   Similarly, as shown in the cross-sectional shape of FIG. 4, the lower cutter 8b has a flat base plate 8b1 and a cutting blade 8b2 projecting upward on the upper surface of the base plate 8b1. A substantially semicircular sleeve guide groove 8b3 is formed at the upper end of the cutting blade 8b2.

そして、カッター部７が閉操作され、上カッター８ａの切り刃８ａ２と、下カッター８ｂの切り刃８ｂ２とで例えば血管及び脈管組織などの生体組織Ｈを挟むことで生体組織Ｈを切断するようになっている。このとき、かみ合わせ部分の上カッター８ａのスリーブガイド溝８ａ３と下カッター８ｂのスリーブガイド溝８ｂ３との間に円形状ガイド溝が形成される。   Then, the cutter unit 7 is closed, and the biological tissue H is cut by sandwiching the biological tissue H such as blood vessels and vascular tissue between the cutting blade 8a2 of the upper cutter 8a and the cutting blade 8b2 of the lower cutter 8b. It has become. At this time, a circular guide groove is formed between the sleeve guide groove 8a3 of the upper cutter 8a and the sleeve guide groove 8b3 of the lower cutter 8b.

また、シース６の内部には、シース６の内の収納位置からシース６の先端側に突出された突出位置まで移動可能で内部に管路を有する円筒状のスリーブ１５が設けられている。シース６の外部には、生体組織Ｈに熱エネルギーが供給可能なエネルギー印加部、例えばバイポーラ型の一対の高周波電極１６ａ、１６ｂが設けられている。一対の高周波電極１６ａ、１６ｂは、スリーブ１５と一緒に移動可能である。なお、エネルギー印加部は、生体組織Ｈに電気的および／または物理的エネルギーを印加させる部材であり、高周波電極以外の通電加熱されるヒータや、超音波振動が伝達可能なプローブなどであってもよい。   Further, inside the sheath 6, there is provided a cylindrical sleeve 15 that can move from a storage position in the sheath 6 to a protruding position that protrudes toward the distal end side of the sheath 6 and has a pipe line inside. Outside the sheath 6, an energy application unit capable of supplying thermal energy to the living tissue H, for example, a pair of bipolar high-frequency electrodes 16 a and 16 b is provided. The pair of high-frequency electrodes 16 a and 16 b can move together with the sleeve 15. The energy application unit is a member that applies electrical and / or physical energy to the living tissue H, and may be a heater that is energized and heated other than the high-frequency electrode, a probe that can transmit ultrasonic vibration, or the like. Good.

図１の説明に戻り、ハンドル５は、カッター部７を開閉操作するための複数の操作レバー１０と、後述するスライドレバー１７とを備えている。そして、操作レバー１０の操作時には、上カッター８ａの基端部が回動ピン９ａを中心に回動し、同時に下カッター８ｂの基端部が回動ピン９ｂを中心に回動することで、下カッター８ｂと上カッター８ａとが開閉駆動されるようになっている。   Returning to the description of FIG. 1, the handle 5 includes a plurality of operation levers 10 for opening and closing the cutter unit 7 and a slide lever 17 described later. When the operation lever 10 is operated, the base end portion of the upper cutter 8a rotates about the rotation pin 9a, and at the same time, the base end portion of the lower cutter 8b rotates about the rotation pin 9b, The lower cutter 8b and the upper cutter 8a are driven to open and close.

さらに、ハンドル５にはケーブル１１の一端が接続されている。このケーブル１１の他端は、制御装置３に接続されている。ここで、ケーブル１１と制御装置３とは、コネクタ１２によって着脱自在に接続されている。制御装置３には、フットスイッチ４と高周波電源２３とが接続されている。足で操作するフットスイッチ４は、手で操作するスイッチやその他のスイッチに置き換えてもよい。フットスイッチ４のペダルを術者が操作することにより、制御装置３からエネルギー処置装置２の一対の高周波電極１６ａ、１６ｂへのエネルギーの供給のＯＮ／ＯＦＦが切り換えられる。   Furthermore, one end of a cable 11 is connected to the handle 5. The other end of the cable 11 is connected to the control device 3. Here, the cable 11 and the control device 3 are detachably connected by a connector 12. A foot switch 4 and a high-frequency power source 23 are connected to the control device 3. The foot switch 4 operated with a foot may be replaced with a switch operated with a hand or other switches. When the operator operates the pedal of the foot switch 4, ON / OFF of the supply of energy from the control device 3 to the pair of high-frequency electrodes 16a, 16b of the energy treatment device 2 is switched.

スライドレバー１７は、ハンドル５にシース６の軸方向に沿って形成されたガイド溝１８に沿ってシース６の軸方向に移動可能に設けられている。このスライドレバー１７には、スリーブ１５の基端部側および一対の高周波電極１６ａ、１６ｂの基端部側が連結されている。そして、スライドレバー１７をガイド溝１８に沿ってスライド操作することによりスリーブ１５と一対の高周波電極１６ａ、１６ｂとが一緒に軸方向にスライド操作されるようになっている。   The slide lever 17 is provided so as to be movable in the axial direction of the sheath 6 along a guide groove 18 formed in the handle 5 along the axial direction of the sheath 6. The slide lever 17 is connected to the base end side of the sleeve 15 and the base end side of the pair of high-frequency electrodes 16a and 16b. By sliding the slide lever 17 along the guide groove 18, the sleeve 15 and the pair of high-frequency electrodes 16a and 16b are slid together in the axial direction.

また、図６または図８（Ａ）の断面形状に示すようにスリーブ１５の先端部の両側面には、バルーン用開口部１９ａ、１９ｂが形成されている。これらのバルーン用開口部１９ａ、１９ｂには、図７の断面形状に示すように膨張／縮小変形可能なバルーン（切断面移動部）２０ａ、２０ｂが縮小された状態で組み込まれている。   Further, as shown in the cross-sectional shape of FIG. 6 or FIG. 8A, balloon openings 19a and 19b are formed on both side surfaces of the distal end portion of the sleeve 15. In these balloon openings 19a and 19b, balloons (cutting surface moving portions) 20a and 20b that can be inflated / reduced and deformed are incorporated in a reduced state as shown in the cross-sectional shape of FIG.

スリーブ１５の基端部には、図３に示すように空気や、生理食塩水などの作動流体を供給する作動流体供給部２１が連結されている。この作動流体供給部２１は、ハンドル５の操作ボタン２２によってオンオフ操作されるようになっている。そして、操作ボタン２２のオン操作時には、スリーブ１５の内部管路を介してバルーン用開口部１９ａ、１９ｂからバルーン２０ａ、２０ｂ内に空気や、生理食塩水などの作動流体が供給されることにより、バルーン２０ａ、２０ｂが膨張するようになっている（図８（Ｂ）参照）。   As shown in FIG. 3, a working fluid supply unit 21 that supplies working fluid such as air or physiological saline is connected to the base end of the sleeve 15. The working fluid supply unit 21 is turned on and off by an operation button 22 of the handle 5. When the operation button 22 is turned on, air or a working fluid such as physiological saline is supplied from the balloon openings 19a and 19b into the balloons 20a and 20b through the internal conduits of the sleeve 15. The balloons 20a and 20b are inflated (see FIG. 8B).

また、本実施の形態のエネルギー処置装置２では、生体組織Ｈの切断面Ｈｃの封鎖を行う封鎖手段２４が設けられている。この封鎖手段２４は、カッター部７で血管などの生体組織Ｈを切断したのち、高周波エネルギーを印加して生体組織Ｈの切断面Ｈｃ同士を吻合させるものである。すなわち、封鎖手段２４は、例えばカッター部７と高周波電極１６ａ、１６ｂで構成される。カッター部７で血管及び脈管組織などの生体組織Ｈを切断した際には、この生体組織Ｈの露出した切断面Ｈｃに生体組織の細胞外基質であるコラーゲン及びエラスチンなどの組織吻合に必要なタンパク質が滲み出てくる（以降、この滲み出させることを抽出と呼ぶ）。この状態で、スライドレバー１７をガイド溝１８に沿ってスライド操作することによりスリーブ１５と一対の高周波電極１６ａ、１６ｂとを一緒に軸方向にスライド操作させる。これにより、図６の断面形状に示すように上カッター８ａのスリーブガイド溝８ａ３と下カッター８ｂのスリーブガイド溝８ｂ３との間の円形状ガイド溝にスリーブ１５が挿入されるとともに、生体組織Ｈの切断面Ｈｃの片側に一方の高周波電極１６ａ、生体組織Ｈの切断面Ｈｃの他方の片側に他方の高周波電極１６ｂがそれぞれ血管、もしくは脈管組織の側部から挿入される。   Moreover, in the energy treatment apparatus 2 of this Embodiment, the sealing means 24 which seals the cut surface Hc of the biological tissue H is provided. This sealing means 24 cuts the living tissue H such as a blood vessel by the cutter unit 7 and then applies high frequency energy to anastomoses the cut surfaces Hc of the living tissue H. That is, the sealing means 24 is comprised by the cutter part 7 and the high frequency electrodes 16a and 16b, for example. When the biological tissue H such as blood vessels and vascular tissues is cut by the cutter unit 7, it is necessary for tissue anastomoses such as collagen and elastin which are extracellular substrates of the biological tissue on the exposed cut surface Hc of the biological tissue H. Protein exudes (hereinafter, this exudation is called extraction). In this state, the slide lever 17 is slid along the guide groove 18 to slide the sleeve 15 and the pair of high frequency electrodes 16a and 16b together in the axial direction. Thereby, as shown in the cross-sectional shape of FIG. 6, the sleeve 15 is inserted into the circular guide groove between the sleeve guide groove 8a3 of the upper cutter 8a and the sleeve guide groove 8b3 of the lower cutter 8b, and the living tissue H One high-frequency electrode 16a is inserted into one side of the cut surface Hc, and the other high-frequency electrode 16b is inserted into the other side of the cut surface Hc of the living tissue H from the side of the blood vessel or vascular tissue.

この状態で、高周波電極１６ａ、１６ｂを動作させて生体組織Ｈの切断面Ｈｃに高周波エネルギーを印加して吻合させ、生体組織Ｈの切断面Ｈｃの封鎖を行なうようになっている。このとき、操作ボタン２２がオン操作され、スリーブ１５の内部管路を介してバルーン用開口部１９ａ、１９ｂからバルーン２０ａ、２０ｂ内に空気や、生理食塩水などの作動流体が供給される。これにより、図８（Ｂ）の断面形状に示すようにバルーン２０ａ、２０ｂが膨張することで、生体組織Ｈの切断面Ｈｃの端縁部が内側に折り返されるようになっている。そのため、生体組織Ｈの切断面Ｈｃ同士を内側に折り返す（内側に捲る）ことで接合面積を大きくすることができる。   In this state, the high-frequency electrodes 16a and 16b are operated to apply high-frequency energy to the cut surface Hc of the living tissue H to cause anastomosis, thereby sealing the cut surface Hc of the living tissue H. At this time, the operation button 22 is turned on, and working fluid such as air and physiological saline is supplied from the balloon openings 19a and 19b into the balloons 20a and 20b via the internal conduits of the sleeve 15. Thereby, as shown in the cross-sectional shape of FIG. 8B, the balloons 20a and 20b are inflated so that the edge of the cut surface Hc of the living tissue H is folded back inward. Therefore, the joining area can be increased by folding the cut surfaces Hc of the living tissue H inward (turning inward).

（作用）
次に、上記構成の本実施の形態のエネルギー処置装置２の作用について説明する。本実施の形態のエネルギー処置装置２の使用時には、エネルギー処置装置２のカッター部７及びシース６は、例えば、腹壁を通して腹腔内に挿入される。術者は、操作レバー１０を操作してカッター部７の下カッター８ｂと上カッター８ａとを開閉駆動させる。このとき、下カッター８ｂと上カッター８ａとを閉じる操作によって図５の断面形状に示すように処置対象の生体組織Ｈを押し潰す状態で把持する。これにより、処置対象の生体組織Ｈである血管、もしくは脈管組織の管内部に挿入されている血液などの内蔵物が生体組織Ｈの押し潰した管内部分から押し出される。 (Function)
Next, the operation of the energy treatment device 2 of the present embodiment having the above configuration will be described. When the energy treatment device 2 of the present embodiment is used, the cutter unit 7 and the sheath 6 of the energy treatment device 2 are inserted into the abdominal cavity through the abdominal wall, for example. The surgeon operates the operation lever 10 to open and close the lower cutter 8b and the upper cutter 8a of the cutter unit 7. At this time, as shown in the cross-sectional shape of FIG. 5 by the operation of closing the lower cutter 8b and the upper cutter 8a, the biological tissue H to be treated is gripped in a crushed state. Thereby, a built-in object such as a blood vessel, which is a living tissue H to be treated, or blood inserted into a tube of the vascular tissue is pushed out from the crushed inner portion of the living tissue H.

このようにカッター部７の下カッター８ｂと上カッター８ａとによって処置対象の生体組織Ｈを押し潰す状態で把持した後、さらに強い力で下カッター８ｂと上カッター８ａとを閉じる操作を行う。これにより、図６に示すように生体組織Ｈの押し潰した部分が下カッター８ｂの切り刃８ｂ２と上カッター８ａの切り刃８ａ２とによって切断される。このとき、生体組織Ｈの切断面Ｈｃには生体組織の細胞外基質である吻合組織界面のコラーゲン及びエラスチンなどの吻合組織内の分子的な絡み合いに必要な組織成分が強制的に抽出される。   After gripping the treatment target biological tissue H in a state of being crushed by the lower cutter 8b and the upper cutter 8a in this manner, the operation of closing the lower cutter 8b and the upper cutter 8a with a stronger force is performed. Thereby, as shown in FIG. 6, the crushed portion of the living tissue H is cut by the cutting blade 8b2 of the lower cutter 8b and the cutting blade 8a2 of the upper cutter 8a. At this time, tissue components necessary for molecular entanglement in the anastomotic tissue such as collagen and elastin at the interface of the anastomotic tissue, which is an extracellular matrix of the biological tissue, are forcibly extracted from the cut surface Hc of the biological tissue H.

その後、スライドレバー１７をガイド溝１８に沿ってスライド操作することによりスリーブ１５と一対の高周波電極１６ａ、１６ｂとが一緒に軸方向にスライド操作される。このとき、接合される上カッター８ａのスリーブガイド溝８ａ３と下カッター８ｂのスリーブガイド溝８ｂ３との間に円形状ガイド溝に沿ってスリーブ１５が前進し、図８（Ａ）の断面形状に示すように、生体組織Ｈの切断面Ｈｃにスリーブ１５の先端部のバルーン２０ａ、２０ｂが配置される。これと同時に、一対の高周波電極１６ａ、１６ｂが、生体組織Ｈの切断面Ｈｃの両側に血管、もしくは脈管組織の側部から挿入される。   Thereafter, by sliding the slide lever 17 along the guide groove 18, the sleeve 15 and the pair of high frequency electrodes 16a and 16b are slid together in the axial direction. At this time, the sleeve 15 advances along the circular guide groove between the sleeve guide groove 8a3 of the upper cutter 8a to be joined and the sleeve guide groove 8b3 of the lower cutter 8b, and is shown in the cross-sectional shape of FIG. As described above, the balloons 20a and 20b at the tip of the sleeve 15 are arranged on the cut surface Hc of the living tissue H. At the same time, the pair of high-frequency electrodes 16a and 16b are inserted from both sides of the cut surface Hc of the living tissue H from the side of the blood vessel or vascular tissue.

この状態で、フットスイッチ４を操作するとともに、操作ボタン２２をオン操作する。フットスイッチ４がＯＮに切り換えられると、制御装置３から、ケーブル１１を介して高周波電極１６ａ、１６ｂに電力が通電される。これにより、高周波電極１６ａ、１６ｂによって生体組織Ｈの切断面Ｈｃに高周波エネルギーを印加させることにより、生体組織Ｈの切断面Ｈｃを加熱し、蛋白変性させて吻合させることができる。   In this state, the foot switch 4 is operated and the operation button 22 is turned on. When the foot switch 4 is switched to ON, power is supplied from the control device 3 to the high-frequency electrodes 16a and 16b via the cable 11. Thus, by applying high-frequency energy to the cut surface Hc of the living tissue H by the high-frequency electrodes 16a and 16b, the cut surface Hc of the living tissue H can be heated, protein-denatured, and anastomosed.

このとき、操作ボタン２２のオン操作により、スリーブ１５の内部管路を介してバルーン用開口部１９ａ、１９ｂからバルーン２０ａ、２０ｂ内に空気や、生理食塩水などの作動流体が供給される。これにより、図８（Ｂ）に示すようにバルーン２０ａ、２０ｂが膨張することで、生体組織Ｈの切断面Ｈｃの端縁部が内側に折り返される。そのため、生体組織Ｈの切断面Ｈｃの接合面積を大きくすることができるので、生体組織Ｈの切断面Ｈｃの接合力を増大することができる。   At this time, when the operation button 22 is turned on, air or a working fluid such as physiological saline is supplied from the balloon openings 19a and 19b into the balloons 20a and 20b via the internal conduits of the sleeve 15. As a result, as shown in FIG. 8B, the balloons 20a and 20b are inflated, whereby the end edge portion of the cut surface Hc of the living tissue H is folded inward. Therefore, since the joining area of the cut surface Hc of the living tissue H can be increased, the joining force of the cutting surface Hc of the living tissue H can be increased.

（効果）
本実施の形態のエネルギー処置装置２では、生体組織Ｈを切断するカッター部７と、生体組織Ｈに電気的および／または物理的エネルギー、例えば高周波エネルギーを印加させる一対の高周波電極１６ａ、１６ｂと、少なくともカッター部７で生体組織Ｈを切断して生体組織Ｈの切断面Ｈｃに生体組織の細胞外基質を抽出させた状態で、一対の高周波電極１６ａ、１６ｂを動作させて生体組織Ｈの切断面Ｈｃに高周波エネルギーを印加して吻合させ、生体組織Ｈの切断面Ｈｃの封鎖を行う封鎖手段２４とを設けている。そのため、封鎖手段２４によって生体組織Ｈの封鎖・吻合を簡単・確実に行うことができるエネルギー処置装置を提供することができる。 (effect)
In the energy treatment device 2 of the present embodiment, the cutter unit 7 that cuts the living tissue H, a pair of high-frequency electrodes 16a and 16b that apply electrical and / or physical energy, for example, high-frequency energy, to the living tissue H, At least in a state where the biological tissue H is cut by the cutter unit 7 and the extracellular matrix of the biological tissue is extracted from the cut surface Hc of the biological tissue H, the pair of high-frequency electrodes 16a and 16b are operated to cut the biological tissue H cut surface. There is provided sealing means 24 for applying high-frequency energy to Hc to cause anastomosis and sealing the cut surface Hc of the living tissue H. Therefore, it is possible to provide an energy treatment device capable of easily and reliably sealing and anastomosing the living tissue H by the sealing means 24.

また、本実施の形態のエネルギー処置装置２では生体組織Ｈの切断面Ｈｃの吻合前もしくは生体組織Ｈの切断面Ｈｃの吻合の初期段階で生体組織Ｈを切断することにより、生体組織Ｈの切断面Ｈｃの吻合組織界面のコラーゲン及びエラスチンなどの吻合組織内の分子的な絡み合いに必要な組織成分が強制的に抽出される。そのため、生体組織Ｈの切断面Ｈｃの吻合に必要な一対の高周波電極１６ａ、１６ｂによる高周波エネルギーの印加量を低減することができ、エネルギー印加による生体組織Ｈの熱的変性を最小限に抑えることができる。
また、高周波エネルギーの印加による生体組織の封鎖・吻合した後、カッターなどにより切断するエネルギー処置装置が検討されているが、その場合、封鎖・吻合に必要な細胞外基質の抽出が不十分な場合、強固な封鎖・吻合を行えない可能性がある。しかし、本実施の形態のエネルギー処置装置では、吻合初期段階で生体組織を切断するため、切断部の細胞外基質が吻合面に十分に抽出され、吻合組織内での分子的な絡み合いを実現でき、強固な封鎖・吻合を行うことができる。 Further, in the energy treatment device 2 of the present embodiment, the biological tissue H is cut by cutting the biological tissue H before the anastomosis of the cut surface Hc of the biological tissue H or at the initial stage of the anastomosis of the cut surface Hc of the biological tissue H. Tissue components necessary for molecular entanglement in the anastomotic tissue such as collagen and elastin at the anastomotic tissue interface of the surface Hc are forcibly extracted. Therefore, the amount of high frequency energy applied by the pair of high frequency electrodes 16a and 16b necessary for anastomosis of the cut surface Hc of the living tissue H can be reduced, and thermal denaturation of the living tissue H due to energy application can be minimized. Can do.
In addition, an energy treatment device that is sealed and anastomosed by applying high-frequency energy and then cut with a cutter or the like is being studied, but in that case, extraction of the extracellular matrix necessary for sealing or anastomosis is insufficient There is a possibility that a strong blockade / anastomosis cannot be performed. However, in the energy treatment device of the present embodiment, the biological tissue is cut at the initial stage of anastomosis, so that the extracellular matrix of the cut portion is sufficiently extracted on the anastomosis surface, and molecular entanglement within the anastomosis tissue can be realized. Can perform strong blockage and anastomosis.

さらに、一対の高周波電極１６ａ、１６ｂを生体組織Ｈの血管もしくは脈管組織の側部から挿入する際に、生体組織Ｈを傷つけることになるが、生体組織Ｈから一対の高周波電極１６ａ、１６ｂを除去した後、この傷痕部分を一対の高周波電極１６ａ、１６ｂによりエネルギー吻合することができる。   Further, when the pair of high-frequency electrodes 16a and 16b are inserted from the side of the blood vessel or vascular tissue of the living tissue H, the living tissue H is damaged. After removal, this scar can be anastomosed with a pair of high-frequency electrodes 16a and 16b.

また、生体組織Ｈの切断面Ｈｃに高周波エネルギーを印加させる際に、図８（Ｂ）に示すようにバルーン２０ａ、２０ｂを膨張させることで、生体組織Ｈの切断面Ｈｃの端縁部を内側に折り返すことができる。そのため、生体組織Ｈの切断面Ｈｃの接合面積を大きくすることができるので、生体組織Ｈの切断面Ｈｃの接合力を増大することができる。   Further, when high frequency energy is applied to the cut surface Hc of the living tissue H, the balloons 20a and 20b are inflated as shown in FIG. Can be folded. Therefore, since the joining area of the cut surface Hc of the living tissue H can be increased, the joining force of the cutting surface Hc of the living tissue H can be increased.

なお、本実施の形態では、生体組織Ｈの切断面Ｈｃを一対の高周波電極１６ａ、１６ｂによる高周波加熱によって吻合させ、生体組織Ｈの切断面Ｈｃの封鎖を行う構成を示したが、一対の高周波電極１６ａ、１６ｂに変えてヒータ加熱、もしくは超音波などのエネルギーを単独もしくは複合して印加することも効果的である。   In the present embodiment, the configuration in which the cut surface Hc of the living tissue H is anastomosed by high-frequency heating by the pair of high-frequency electrodes 16a and 16b and the cut surface Hc of the living tissue H is sealed is shown. It is also effective to apply heater heating or energy such as ultrasonic waves alone or in combination instead of the electrodes 16a and 16b.

［変形例］
（第１の変形例）
図９は第１の実施の形態（図１乃至図８参照）のエネルギー処置装置２の切断面Ｈｃの封鎖手段２４の第１の変形例を示す要部の断面図である。本変形例は、生体組織Ｈの切断面Ｈｃの端縁部を内側に折り返す折り返し部Ｈ１の長さを大きくしたものである。これにより、生体組織Ｈの切断面Ｈｃ同士の接合面積を一層、大きくすることができる。なお、バルーン２０ａ、２０ｂを膨張させる大きさを調整することで、折り返し部Ｈ１の長さを調整することができる。 [Modification]
(First modification)
FIG. 9 is a cross-sectional view of the main part showing a first modification of the sealing means 24 of the cut surface Hc of the energy treatment device 2 of the first embodiment (see FIGS. 1 to 8). In this modification, the length of the folded portion H1 that folds the end edge portion of the cut surface Hc of the living tissue H inward is increased. Thereby, the junction area of the cut surfaces Hc of the living tissue H can be further increased. In addition, the length of the folding | returning part H1 can be adjusted by adjusting the magnitude | size which expands the balloons 20a and 20b.

（第２の変形例）
図１０（Ａ），（Ｂ）は第１の実施の形態（図１乃至図８参照）のエネルギー処置装置２の切断面Ｈｃの封鎖手段２４の第２の変形例を示す断面図である。本変形例は、上カッター８ａの切り刃８ａ２と、下カッター８ｂの切り刃８ｂ２の生体組織Ｈに対する角度を調整することにより、図１０（Ａ）に示すように生体組織Ｈの切断面Ｈｃの端縁部に血管の管壁の軸方向と直交する方向に対して斜めに切断した傾斜面Ｈ２を設けたものである。そして、図１０（Ｂ）に示すようにこの生体組織Ｈの切断面Ｈｃの傾斜面Ｈ２同士を接合することにより、生体組織Ｈの切断面Ｈｃ同士の接合面積を大きくするようにしたものである。 (Second modification)
FIGS. 10A and 10B are cross-sectional views showing a second modification of the sealing means 24 of the cut surface Hc of the energy treatment device 2 of the first embodiment (see FIGS. 1 to 8). In this modification, by adjusting the angle of the cutting blade 8a2 of the upper cutter 8a and the cutting blade 8b2 of the lower cutter 8b with respect to the living tissue H, the cutting surface Hc of the living tissue H is adjusted as shown in FIG. An inclined surface H2 cut obliquely with respect to a direction perpendicular to the axial direction of the blood vessel wall is provided at the end edge. Then, as shown in FIG. 10 (B), the joining surfaces of the cut surfaces Hc of the living tissue H are increased by joining the inclined surfaces H2 of the cutting surfaces Hc of the living tissue H to each other. .

（第３の変形例）
図１１は第１の実施の形態（図１乃至図８参照）のエネルギー処置装置２の切断面Ｈｃの封鎖手段２４の第３の変形例を示す断面図である。本変形例は、第２の変形例（図１０（Ａ），（Ｂ）参照）の生体組織Ｈの切断面Ｈｃの傾斜面Ｈ２を粗面にした粗面部Ｈ３を設けたものである。この粗面部Ｈ３は、例えばカッターの刃面にヤスリ状の細かい凹凸部を形成した上カッター８ａと下カッター８ｂとを使用することにより、切断面Ｈｃの傾斜面Ｈ２に粗面部Ｈ３を形成することができる。そして、この粗面部Ｈ３同士を接合することにより、生体組織Ｈの切断面Ｈｃ同士の接合面積を大きくするようにしたものである。 (Third Modification)
FIG. 11 is a cross-sectional view showing a third modification of the sealing means 24 of the cut surface Hc of the energy treatment device 2 of the first embodiment (see FIGS. 1 to 8). This modification is provided with a rough surface portion H3 in which the inclined surface H2 of the cut surface Hc of the biological tissue H of the second modification (see FIGS. 10A and 10B) is roughened. For example, the rough surface portion H3 is formed by forming the rough surface portion H3 on the inclined surface H2 of the cutting surface Hc by using an upper cutter 8a and a lower cutter 8b in which a fine uneven portion in a file shape is formed on the blade surface of the cutter. Can do. And by joining this rough surface part H3, the joining area of the cut surfaces Hc of the biological tissue H is enlarged.

（第４の変形例）
図１２および図１３は第１の実施の形態（図１乃至図８参照）のエネルギー処置装置２の切断面Ｈｃの封鎖手段２４の第４の変形例を示す断面図である。本変形例は、カッター部３１の上カッターと、下カッターとにそれぞれ図１２に示す待機位置と、図１３に示す回動位置との間でほぼ９０°の角度に回動可能な回転刃３２を設けたものである。 (Fourth modification)
12 and 13 are cross-sectional views showing a fourth modification of the sealing means 24 of the cut surface Hc of the energy treatment device 2 of the first embodiment (see FIGS. 1 to 8). In this modification, the rotary blade 32 is rotatable at an angle of approximately 90 ° between the standby position shown in FIG. 12 and the rotary position shown in FIG. Is provided.

また、生体組織Ｈには２つの押え棒３３が血管、もしくは脈管組織の側部から挿入されるようになっている。そして、これらの押え棒３３に沿って回転刃３２を回転させることにより、回転刃３２によって生体組織Ｈが切断されるとともに、生体組織Ｈの切断面Ｈｃの端縁部が回転刃３２と押え棒３３との間で挟まれて保持される状態で回転する。そのため、回転刃３２が図１３に示す回動位置まで回転した時点で、生体組織Ｈの切断面Ｈｃ同士を接合することができる。   In addition, two presser bars 33 are inserted into the living tissue H from the side of the blood vessel or vascular tissue. Then, by rotating the rotary blade 32 along these presser bars 33, the biological tissue H is cut by the rotary blade 32, and the edge portion of the cut surface Hc of the biological tissue H is the rotary blade 32 and the presser bar. It rotates in a state of being held between 33. Therefore, when the rotary blade 32 rotates to the rotation position shown in FIG. 13, the cut surfaces Hc of the living tissue H can be joined.

（第５の変形例）
図１４（Ａ），（Ｂ）は第１の実施の形態（図１乃至図８参照）のエネルギー処置装置２の切断面Ｈｃの封鎖手段２４の第５の変形例を示す断面図である。本変形例は、カッター部４１の上カッターと、下カッターとにそれぞれ図１４（Ａ）に示すようにほぼ山形の切り刃４２を設けたものである。 (Fifth modification)
14A and 14B are cross-sectional views showing a fifth modification of the sealing means 24 of the cut surface Hc of the energy treatment device 2 of the first embodiment (see FIGS. 1 to 8). In this modification, a substantially chevron-shaped cutting blade 42 is provided on each of the upper cutter and the lower cutter of the cutter portion 41 as shown in FIG.

また、生体組織Ｈには２つの押え棒４３が血管、もしくは脈管組織の側部から挿入されるようになっている。そして、２つの押え棒４３間に上カッターの切り刃４２と下カッターの切り刃４２を挿入する状態で、上カッターと、下カッターとを生体組織Ｈに押し込む。これにより、生体組織Ｈの切断面Ｈｃの両側に配置した押え棒４３を中心に上カッターの切り刃４２と下カッターの切り刃４２がスライドすることで、生体組織Ｈの切断面Ｈｃ同士が密着する。
なお、カッター４２が高周波電極を兼ねること、または、押え棒４３が高周波電極を兼ねることも可能である。 In addition, two presser bars 43 are inserted into the living tissue H from the side of the blood vessel or vascular tissue. Then, the upper cutter and the lower cutter are pushed into the living tissue H with the upper cutter cutting blade 42 and the lower cutter cutting blade 42 inserted between the two presser bars 43. Thereby, the cutting blade 42 of the upper cutter and the cutting blade 42 of the lower cutter slide around the presser bar 43 arranged on both sides of the cutting surface Hc of the living tissue H, so that the cutting surfaces Hc of the living tissue H adhere to each other. To do.
The cutter 42 can also serve as a high-frequency electrode, or the presser bar 43 can also serve as a high-frequency electrode.

さらに、本発明は上記実施の形態に限定されるものではなく、本発明の要旨を逸脱しない範囲で種々変形実施できることは勿論である。   Furthermore, the present invention is not limited to the above-described embodiment, and various modifications can be made without departing from the scope of the present invention.

Ｈ…生体組織、７…カッター部、１６ａ、１６ｂ…高周波電極（エネルギー印加部）、Ｈｃ…切断面、２４…封鎖手段。     H ... living tissue, 7 ... cutter part, 16a, 16b ... high frequency electrode (energy applying part), Hc ... cut surface, 24 ... sealing means.

Claims (7)

生体組織を切断するカッター部と、
生体組織に電気的および／または物理的エネルギーを印加させるエネルギー印加部と、
少なくとも前記カッター部で生体組織を切断して生体組織の切断面に前記生体組織の細胞外基質を抽出させた状態で、前記エネルギー印加部を動作させて前記生体組織の切断面に前記電気的および／または物理的エネルギーを印加して前記切断面同士を吻合させ、前記生体組織の切断面の封鎖を行う封鎖手段と、
を具備することを特徴とするエネルギー処置装置。 A cutter unit for cutting a living tissue;
An energy application unit that applies electrical and / or physical energy to a living tissue;
At least in a state where the biological tissue is cut by the cutter unit and the extracellular matrix of the biological tissue is extracted from the cut surface of the biological tissue, the energy application unit is operated to A sealing means for applying physical energy to anastomosing the cut surfaces and sealing the cut surfaces of the biological tissue;
An energy treatment device comprising: 前記封鎖手段は、前記カッター部で切断した生体組織の切断面同士を動かして接触させる切断面移動部を有し、
前記エネルギー印加部は、前記切断面移動部で動かして接触させた生体組織の切断面に対してエネルギーを印加することを特徴とする請求項１に記載のエネルギー処置装置。 The blocking means has a cut surface moving unit that moves and contacts the cut surfaces of the biological tissue cut by the cutter unit,
The energy treatment device according to claim 1, wherein the energy application unit applies energy to a cut surface of a living tissue moved and brought into contact with the cut surface moving unit. 前記切断面移動部は、前記カッターに沿って移動可能なスリーブを有することを特徴とする請求項２に記載のエネルギー処置装置。   The energy treatment device according to claim 2, wherein the cutting surface moving unit includes a sleeve that is movable along the cutter. 前記切断面移動部は、前記カッター部で切断した生体組織の切断面同士を密着させる稼動部を有することを特徴とする請求項２に記載のエネルギー処置装置。   The energy treatment device according to claim 2, wherein the cutting surface moving unit includes an operation unit that closely contacts the cutting surfaces of the biological tissue cut by the cutter unit. 前記スリーブは、前記カッター部で切断した生体組織の切断面同士を内側に折り返すためのバルーンを有することを特徴とする請求項１に記載のエネルギー処置装置。   The energy treatment device according to claim 1, wherein the sleeve includes a balloon for folding inward the cut surfaces of the biological tissue cut by the cutter unit. 生体組織を切断して生体組織の切断面に前記生体組織の細胞外基質を抽出させた後、
生体組織に電気的および／または物理的エネルギーを印加させるエネルギー印加部を動作させて前記生体組織の切断面に前記電気的および／または物理的エネルギーを印加して吻合させ、前記生体組織の切断面同士の封鎖を行う封鎖工程を設けたことを特徴とするエネルギー処置方法。 After extracting the extracellular matrix of the living tissue on the cut surface of the living tissue by cutting the living tissue,
Operating an energy application unit that applies electrical and / or physical energy to the living tissue to apply the electrical and / or physical energy to the cut surface of the living tissue and anastomosing the cut surface of the living tissue An energy treatment method comprising a sealing step for sealing each other. 把持部によって生体組織を把持して前記生体組織を押し潰して生体壁部を密着させる工程と、
前記生体組織の密着部をカッターで切断して前記生体組織の切断面に前記生体組織の細胞外基質を抽出させる工程と、
前記生体組織の切断面に前記生体組織の細胞外基質を抽出させた状態で、生体組織に電気的および／または物理的エネルギーを印加させるエネルギー印加部を動作させて前記生体組織の切断面に前記電気的および／または物理的エネルギーを印加して吻合させ、前記生体組織の切断面同士の封鎖を行う封鎖工程と、
を具備することを特徴とする生体組織の吻合方法。 Gripping the living tissue with the gripping portion and crushing the living tissue to closely contact the living body wall; and
Cutting the adherent portion of the living tissue with a cutter to extract the extracellular matrix of the living tissue on the cut surface of the living tissue; and
In a state where the extracellular matrix of the biological tissue is extracted from the cut surface of the biological tissue, an energy application unit that applies electrical and / or physical energy to the biological tissue is operated to operate the cut surface of the biological tissue. A sealing step in which electrical and / or physical energy is applied and anastomosed to seal the cut surfaces of the living tissue;
A method for anastomosis of biological tissue, comprising:
JP2014021671A 2014-02-06 2014-02-06 Energy treatment device, energy treatment method, and method for anastomosis of biological tissue Pending JP2015146911A (en)

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Publication number Priority date Publication date Assignee Title
JPH01171534A (en) * 1987-12-28 1989-07-06 Matsushita Electric Ind Co Ltd Blood vessel suturing auxiliary utensil
JPH10314178A (en) * 1997-05-22 1998-12-02 Olympus Optical Co Ltd Forceps for medical operation
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