JP2016087449A - Scissors for endoscope - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide scissors for an endoscope, the scissors being capable of accurately cutting a targeted biological tissue without slippage of a scissor piece and allowing a low invasive procedure that does not cut the biological tissue to an excessive depth extending to, for example, a muscular coat.SOLUTION: Scissors 100 for an endoscope are configured to be inserted in a forceps hole of the endoscope to cut a biological tissue. The scissors includes one pair of scissor pieces 12, 22 overlapping each other and pivotally supported in an openable manner with a rotation shaft 29 extending in an overlapping direction, and an operation wire 30. The scissor pieces 12, 22 have cutting edges 13, 23 to grip and cut a biological tissue, respectively. At least one of the scissor pieces 12, 22 is provided with a pawl 14 formed at a tip thereof so as to protrude from the cutting edge 13 toward a closing direction for griping the biological tissue. The cutting edges 13, 23 of the scissor pieces 12, 22 is provided with recesses 15, 25 partially formed so as to penetrate in a thickness direction. The cutting edges 13, 23 excluding the pawl 14 and the recesses 15, 25 are formed in a straight linear shape elongating from a distal to a proximal end.SELECTED DRAWING: Figure 3

Description

  The present invention relates to an endoscope cage that is used by being inserted into a forceps hole of an endoscope.

  Since endoscopic surgery is minimally invasive, it is used, for example, in surgery for excising living tissue such as diseased tissue. As this type of endoscope treatment tool, an instrument for ligating and excising a living tissue with an annular snare, a grasping forceps having a cup-like or plate-like forceps piece, and an incision on the living tissue with a scissors piece Endoscope reeds are known.

  Patent Document 1 describes a grasping forceps that opens and closes a pair of plate-shaped forceps pieces in which saw-toothed teeth are formed as a whole. A claw portion that protrudes in the closing direction is formed at the distal end portion of the forceps piece, and a plurality of toothed teeth are provided on substantially the entire forceps piece so as to be connected to the claw portion and aligned in the proximal direction. .

  The grasping forceps is an instrument that strongly grasps a living tissue and excises it by scavenging it. That is, as shown in FIG. 7 of Patent Document 1, the grasping forceps is an instrument that grasps a region having a predetermined area including a part to be excised such as a diseased tissue and scrapes the entire region. On the other hand, an endoscope scissors is an instrument that applies a high-frequency voltage to cauterize a living tissue and applies an incision by applying a shearing force to the living tissue with a pair of overlapped scissors, if necessary. Distinguishable from grasping forceps. An endoscope scissors is an instrument for resecting a resection target site by incising a living tissue around the resection target site such as a diseased tissue in a circular manner. Since the endoscope scissors can accurately excise only the target portion of the living tissue, a less invasive procedure than the grasping forceps is possible.

  Patent Document 2 describes an example of an endoscope cage. A claw portion projecting in the closing direction is formed at the distal end portion of the scissors in the endoscope scissors, and can be accurately incised by the scissors while the living tissue is gripped. FIG. 8 of Patent Document 2 discloses that the blade portion of the hook piece is formed in a sawtooth shape. It is said that relatively hard living tissue can be incised by making the blade portion into a sawtooth shape that bends up and down. More specifically, in the scissors of Patent Document 2, a plurality of saw teeth are formed on substantially the entire tip proximal direction of the blade portion so as to be connected to the tip claw portion, in other words, the recess of the tip saw blade. The nail part protrudes as if standing up.

  Patent Document 3 describes another example of an endoscope cage. A depression is formed in the blade part (blade surface) of the flange (blade) of the endoscope cage. Such a depression is formed with a shallow depth that does not penetrate the heel piece in the thickness direction, and is supposed to function as a slip stopper when incising the living tissue.

JP-A-5-31120 JP 2013-138844 A JP 2012-165812 A

  Unlike a grasping forceps that grips a living tissue in a plane with a pair of cup-shaped or plate-shaped forceps pieces facing each other, the blade portion of the endoscope scissors is formed in a flat and narrow line shape. The gripping force is weak because the position slightly shifted in the thickness direction of the scissors with respect to the tissue is gripped by the shearing force. Therefore, skill is required to accurately incise a desired site with an endoscope scissors. On the other hand, by forming the nail portion at the tip of the heel piece like the endoscope fold of Patent Document 2, the incision can be made while the nail portion is bitten into the living tissue and gripped. Therefore, the target living tissue can be accurately incised without slipping the heel piece. Moreover, the grasping force of the living tissue increases by making the blade portion serrated like the endoscope scissors of Patent Document 2.

  However, the endoscope scissors of Patent Document 2 may incise the living tissue at an excessive depth. For example, when excising mucosal tissue, it may be preferable to avoid incising not only the surface mucosal layer and the lower mucosal layer, but also the lower muscular layer, which is highly invasive. On the other hand, the endoscope scissors of Patent Document 2 have a nail portion and a plurality of saw blades that bite into the mucosal tissue and make an incision with the gripped, so that when the scissors bite too deeply into the mucosal tissue. May be incised up to the muscle layer.

  On the other hand, the endoscope scissors described in Patent Document 3 are supposed to function as an anti-slip when incising because a hollow is formed in the blade portion and the living tissue is locally released into the recess. However, since the living tissue is only released within the depth of the depression, the function of the slip prevention by the depression is extremely limited, except when incising the living tissue that deforms flexibly within such a minute range. Is done.

  The present invention has been made in view of the above-described problems, and it is possible to accurately incise a target living tissue without slipping of a heel piece. For example, an excessive depth reaches a muscle layer. It is an object of the present invention to provide an endoscope scissors that allows a minimally invasive procedure without incision.

  According to the present invention, an endoscopic scissor that is inserted into a forceps hole of an endoscope and used to incise a living tissue, is overlapped with each other and is rotated by a rotating shaft that extends in the overlapping direction. A pair of scissors that are pivotally supported so as to be openable and closable, and each have a blade portion that grips and incises the living tissue, and a distal end portion of the scissors piece by applying a driving force to the proximal end portion of the scissors An operation wire that opens and closes, a claw portion that grips the living tissue is formed in the tip portion of at least one of the pair of collar pieces so as to protrude in the closing direction from the blade portion, A flat line in which a concave portion penetrating in the thickness direction is locally formed in the blade portion of the one or other flange piece, and the blade portion excluding the claw portion and the concave portion extends in the proximal direction. An endoscopic cage characterized by being formed into a shape is provided.

  According to the above invention, the claw portion is formed to protrude in the closing direction at the distal end portion of the heel piece, and the claw portion can be incised by biting the living tissue and gripping it. The target tissue can be accurately incised without slipping on the living tissue. Moreover, since the recessed part formed in the blade part has penetrated in the thickness direction, compared with patent document 3, many biological tissues can escape to a recessed part, and a blade part can be digged in. Here, except for the claw portion and the locally formed concave portion, the blade portion is formed in a flat linear shape extending in the proximal direction, so that the blade portion has a sawtooth shape as in Patent Document 2. Compared with the case where it does, the bite of the blade part with respect to a biological tissue is suppressed moderately. For this reason, for example, even when the sepals are deeply bitten into the mucosal tissue, by pulling the sepals and pulling up the mucosal tissue, the muscle layer falls off between the sepals due to the elastic restoring force, and the mucous membrane is substantially removed. Only the layer and the submucosa are incised by the blade. For this reason, it is possible to cut the mucosal tissue without damaging the muscle layer.

  ADVANTAGE OF THE INVENTION According to this invention, the scissors for endoscopes which can cut | disconnect the target biological tissue correctly and minimally invasively without a spear piece slipping are provided.

It is a mimetic diagram showing the whole endoscope cage structure of a first embodiment of the present invention. It is a longitudinal cross-sectional view of the front-end | tip part in the endoscope cage | basket in a closed state. It is a longitudinal cross-sectional view of the front-end | tip part in the cage | basket for endoscopes of an open state. It is explanatory drawing which shows the state which opened the collar piece. It is explanatory drawing which shows the state which closes a sepal piece and incises a biological tissue. It is a side view of a tip treatment part in an endoscope scissors of a second embodiment of the present invention. It is a side view of the front-end | tip treatment part in the endoscope scissors of 3rd embodiment of this invention. FIG. 8A is a plan view showing a closed state of the distal treatment section in the endoscope scissors according to the fourth embodiment of the present invention, and FIG. 8B is a side view of the distal treatment section. It is a side view which shows the open state of the front-end | tip treatment part in the endoscope scissors of 4th embodiment of this invention.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. In each drawing, corresponding constituent elements are denoted by common reference numerals, and redundant description is omitted as appropriate.

<First embodiment>
FIG. 1 is a schematic diagram showing the overall structure of an endoscope cage 100 according to the first embodiment of the present invention. FIG. 2 is a longitudinal sectional view of the distal end portion of the endoscope cage 100 in the closed state, and FIG. 3 is a longitudinal sectional view of the distal end portion of the endoscope cage 100 in the opened state. FIG. 4 is an explanatory diagram showing a state in which the collar pieces 12 and 22 are opened. FIG. 5 is an explanatory diagram illustrating a state in which the living tissue 200 is incised by closing the collar pieces 12 and 22.

  First, an outline of the endoscope cage 100 of the present embodiment will be described. The endoscope scissor 100 is an instrument that is used by being inserted into a forceps hole (not shown) of an endoscope to incise a living tissue 200 (see FIGS. 4 and 5). Endoscopic reed 100 includes a pair of reed pieces 12 and 22 pivotally supported by a rotation shaft 29 (see FIGS. 2 and 3) that are overlapped with each other and extend in the overlapping direction. And an operation wire 30. The pair of scissors pieces 12 and 22 have blade portions 13 and 23 for grasping and incising the living tissue 200, respectively. The operation wire 30 is a member that applies a driving force to the base end portions of the collar pieces 12 and 22 to open and close the distal end portions of the collar pieces 12 and 22. A claw portion 14 for gripping the living tissue 200 is formed on at least one tip portion of the pair of scissors pieces 12 and 22 so as to protrude from the blade portion 13 in the closing direction. In the endoscope scissors 100 of this embodiment, the blade portions 13 and 23 of the one or other scissors (both scissors 12 and 22 in this embodiment) have recesses 15 and 25 penetrating in the thickness direction. The blade portions 13 and 23 formed locally and excluding the claw portion 14 and the concave portions 15 and 25 are formed in a flat linear shape extending in the distal end direction.

  Next, the endoscope cage 100 of the present embodiment will be described in detail.

  The endoscope scissor 100 has a scissor-shaped tip treatment section 10 that opens and closes thin plate-shaped scissors pieces 12 and 22 that are overlapped with each other to apply a shearing force to the living tissue 200 and grip it. The flanges 12 and 22 open and close each other in the in-plane direction around the rotation shaft 29. The extending direction (axial direction) of the rotation shaft 29 is the overlapping direction of the flange pieces 12 and 22, in other words, the thickness direction of the flange pieces 12 and 22. The distal treatment section 10 is driven to open and close by the operation wire 30. The operation wire 30 is made of a conductive metal material such as stainless steel.

  The endoscope heel 100 includes a flexible sheath 40 and a hand operation unit 50 provided on the proximal side of the sheath 40. The sheath 40 has an insulating tubular shape, and the operation wire 30 is inserted through the sheath 40.

  The hand operating unit 50 includes a shaft portion 58 through which the operation wire 30 is inserted, a finger ring 54 provided at the proximal end portion of the shaft portion 58, and a proximal end of the operation wire 30. And a slider 56 that moves forward and backward. The operation wire 30 is slidably inserted into the shaft portion 58. The user inserts, for example, a thumb into the finger ring 54 and drives the slider 56 forward and backward along the longitudinal direction of the shaft portion 58 with the other two fingers. Thereby, the operation wire 30 moves forward or backward relative to the hand operation unit 50. The operation wire 30 is inserted into the sheath 40 so as to be able to advance and retreat, and the distal end portion of the operation wire 30 moves forward or backward relative to the sheath 40 in conjunction with the movement of the slider 56.

  As shown in FIGS. 2 and 3, an advancing / retreating portion 26 is integrally connected to the distal end side of the operation wire 30. Two link pieces 17 and 27 are rotatably connected to the advancing / retreating portion 26. Further, the first collar 12 is rotatably connected to the link piece 17, and the second collar 22 is rotatably connected to the link piece 27. The 1st collar piece 12, the 2nd collar piece 22, and the link pieces 17 and 27 rotate relatively within the plane shown to FIG. 2 and FIG.

  As shown in FIGS. 1 to 3, the holding frame 20 is attached to the distal end of the sheath 40. The proximal end portion of the holding frame 20 is inserted into the sheath 40 and fixed, and the distal end portion of the holding frame 20 protrudes from the sheath 40 and accommodates the link pieces 17 and 27. A rotation shaft 29 that rotatably connects the first collar piece 12 and the second collar piece 22 is fixed to the holding frame 20.

  As shown in FIG. 2, when the operation wire 30 and the advancing / retreating portion 26 are pulled toward the proximal end side (the right side in FIG. 2), the link pieces 17 and 27 and the collar pieces 12 and 22 become substantially straight, Part 10 is closed. On the contrary, as shown in FIG. 3, when the operation wire 30 and the advancing / retreating portion 26 are pushed out to the distal end side (left side in FIG. 3), the link pieces 17 and 27 approach the rotating shaft 29 inside the holding frame 20. The scissors pieces 12 and 22 are driven, and the distal treatment section 10 is opened.

  The hook pieces 12 and 22 have a substantially L-shape, that is, a sickle shape, which bends shallowly in the direction of the rotation plane in the vicinity of the rotation shaft 29. The shape of the pair of flanges 12 and 22 may be a symmetric shape or an asymmetric shape. The hook pieces 12 and 22 and the link pieces 17 and 27 constitute a four-bar linkage mechanism that opens and closes the distal treatment section 10 with the rotation shaft 29 as a fulcrum. The operation wire 30 applies a driving force to the proximal end portions of the collar pieces 12 and 22 via the advancing / retreating portion 26 and the link pieces 17 and 27, and opens and closes the distal ends of the collar pieces 12 and 22.

  The sheath 40 of the present embodiment is a coil that is formed by closely winding a conductive wire such as a stainless steel wire. An insulating coating 42 is provided in close contact with the outer surface of the sheath 40. The operation wire 30 is frictionally connected to the rotation operation unit 57 (see FIG. 1), and an operation in which the base end is fixed to the slider 56 by rotating the rotation operation unit 57 around the shaft unit 58. The wire 30 rotates inside the sheath 40. Thereby, the distal treatment section 10 can be oriented in a desired direction. The rotation operation unit 57 is rotatably attached to the power supply unit 52 and rotates with a power cable (not shown) connecting the power supply unit 52 and a high-frequency power source (not shown) hanging downward. The operation portion 57 can be rotated around the shaft portion 58. Instead of this embodiment, the slider 56 may be configured to be rotatable about the shaft portion 58, and the function of the rotation operation portion 57 may be imparted to the slider 56. That is, by driving the slider 56 forward and backward along the longitudinal direction of the shaft portion 58, the operation wire 30 is advanced and retracted to open and close the distal treatment section 10, and the slider 56 is rotated about the shaft portion 58. You may comprise so that the front-end | tip treatment part 10 may be rotated and directed in a desired direction.

  Blade portions 13 and 23 are formed along the opposite edges (edges) of the inner surfaces of the flange pieces 12 and 22 that are overlapped with each other. The blade portions 13 and 23 of the present embodiment are formed in a partial area of the collar pieces 12 and 22 on the tip side of the rotation shaft 29. The blade portions 13 and 23 are blade surfaces that are formed relatively sharply in the collar pieces 12 and 22, and are portions that incise the living tissue 200 (see FIGS. 4 and 5). Specifically, the slider 56 (see FIG. 1) of the hand operation unit 50 is pulled to rotate the collar pieces 12 and 22 around the rotation shaft 29 as shown in FIG. Thus, a shearing force is generated between the blade portions 13 and 23.

  The edges of the blades 13 and 23 may be formed so sharp that the living tissue 200 can be incised by the shearing force, or formed at an angle that is so blunt that the living tissue 200 is not incised by the shearing force. Also good. In the endoscope scissor 100 of this embodiment, the edges of the blade portions 13 and 23 are formed at a blunt angle so that the living tissue 200 is not substantially incised only by the shearing force generated by pulling the slider 56. It is configured. Then, in a state where the living tissue 200 is held by the sepals 12 and 22, the living tissue 200 is cauterized and incised by applying a high-frequency voltage described later between the sepals 12 and 22. As a result, the biological tissue 200 is not inadvertently incised while the biological tissue 200 is grasped by the collars 12 and 22 and the biological tissue 200 is stretched and extended with a predetermined tension.

  A claw portion 14 that grips the living tissue 200 is formed on at least one distal end portion of the collar piece 12 or 22 so as to protrude from the blade portion 13 or 23 in the closing direction. The closing direction is a direction from one collar piece 12, 22 toward the other collar piece 22, 12, and the opposite direction is referred to as an opening direction.

  As shown in FIG. 3, in the endoscope scissor 100 according to the present embodiment, the claw portion 14 is formed to protrude in the closing direction at the distal end portion of the first scissor piece 12, and the second scissor piece 22. Such a claw portion is not formed. However, it may replace with this embodiment and may form a claw part (code abbreviation) which protrudes inward to both the 1st collar piece 12 and the 2nd collar piece 22, respectively. When the claw portion is formed on each of the first collar piece 12 and the second collar piece 22, the position, shape, and size of each claw portion are not particularly limited, and the claw portions having the same shape or different shape are the collar pieces 12, Each may protrude inward from 22.

  The nail | claw part 14 is a projection part which bites into the biological tissue 200 as shown in FIG. 5, hold | maintains and hold | maintains the biological tissue 200 hold | gripped with the scissors pieces 12 and 22, and prevents dropping. The claw part 14 is not formed with a blade surface, and the thickness dimension thereof is larger than the thickness dimension of the blade part 13.

  A concave portion 15 penetrating in the thickness direction is locally formed in the blade portion 13 of the first collar piece 12, and the blade portion 13 excluding the claw portion 14 and the concave portion 15 is in the proximal direction (the left-right direction in FIG. 2). It is formed in the shape of a flat line extending. In addition, a concave portion 25 penetrating in the thickness direction is also locally formed in the blade portion 23 of the second flange piece 22, and the blade portion 23 excluding the concave portion 25 is in the distal end direction (left-right direction in FIG. 2). It is formed in the shape of a flat line extending.

  The blades 13 and 23 are flat and linear. The edges of the inner surfaces of the scissors 12 and 22 that are overlapped with each other have a linear shape or a smooth curved shape. Say something. That is, the blade portions 13 and 23 of the present embodiment are not formed with sharp protrusions such as toothed teeth. The blade portion 13 has a linear shape except for the formation region of the claw portion 14 and the recessed portion 15. Similarly, the blade portion 23 has a linear shape except for the formation region of the recess 25. However, instead of this embodiment, one or both of the blade portions 13, 23 may be smoothly curved into a convex arc shape protruding in the closing direction or a concave arc shape recessed in the opening direction.

  Concave portions 15 and 25 penetrating in the thickness direction are locally formed in at least one of the blade portions 13 and 23 (both in the present embodiment). That the recessed parts 15 and 25 are formed in the blade parts 13 and 23 means that the recessed parts 15 and 25 are formed so that it may be depressed in the opening direction from the edge which cut | disconnects the biological tissue 200. FIG. In other words, the recesses 15 and 25 are open at the edge where the living tissue 200 is incised. In addition, in the endoscope collar 100 of this embodiment, although the aspect in which the recessed parts 15 and 25 are formed in both the blade parts 13 and 23 is illustrated, the blade part 13 or 23 like 2nd embodiment mentioned later is mentioned. You may form the recessed part 15 only in one (for example, blade part 13).

  The concave portions 15 and 25 penetrate the blade portions 13 and 23 in the thickness direction. For this reason, unlike the case of forming a bottomed depression in the blade portion as in the endoscope scissors of Patent Document 3, the living tissue 200 is allowed to escape into the recesses 15 and 25 as shown in FIG. 22 is able to bite into the living tissue 200 even better.

  The recesses 15 and 25 of the present embodiment each have a substantially semicircular shape. The substantially semicircular shape means a concave shape composed of smooth curved lines.

  The concave portion 15 is formed so as to be connected to the claw portion 14 formed at the distal end portion of the collar piece 12. That is, the claw portion 14 is formed so as to protrude from the inner peripheral surface of the recess 15 in the closing direction. The blade portion 13 of the collar piece 12 is formed in a linear shape so as to extend to the proximal end side with respect to the concave portion 15.

  The substantially semicircular recesses 15 and 25 are formed so as to face the positions corresponding to each other of the blade portions 13 and 23 of the pair of flange pieces 12 and 22, respectively. Then, by closing the flanges 12 and 22, the recesses 15 and 25 are joined together to form a substantially circular through hole 16 (see FIG. 2).

  By forming the through holes 16 when the collar pieces 12 and 22 are closed, the living tissue 200 can be grasped by the collar pieces 12 and 22 so as to be wrapped in the cylindrical shape by the through holes 16. For this reason, the biological tissue 200 can be gripped at a plurality of locations of the claw portion 14 and the through-hole 16 in combination with the claw portion 14 that has bitten into the biological tissue 200. Thereby, even when a force is applied from the living tissue 200 to the distal treatment section 10 not only in the proximal direction but also in the crossing direction, the biological tissue 200 is preferably prevented from being grasped from the distal treatment section 10.

  As an example of the biological tissue 200, as shown in FIG. 4, a mucosal tissue in which a lower mucosa layer 204 is laminated on the upper surface of a muscle layer 206 and a mucous membrane layer 202 is further laminated on the upper surface thereof is exemplified. Examples of the living tissue 200 include an inner wall of a body cavity of the digestive system such as the inner wall of the stomach. A lesion tissue 203 is locally formed in the mucosa layer 202. A bulging portion 210 into which physiological saline, hyaluronic acid, or the like is injected is formed in advance in a region corresponding to the lower portion of the diseased tissue 203 in the submucosa 204. By forming the bulging portion 210, the diseased tissue 203 is largely released from the muscle layer 206. The endoscope scissors 100 of the present embodiment are incised so as to surround the periphery of the diseased tissue 203, and the mucosa layer 202 and the submucosa 204 including the diseased tissue 203 are excised from the living tissue 200.

  By forming the concave portions 15 and 25 locally with respect to the blade portions 13 and 23, the nail portion 14 and the concave portions 15 and 25 (through holes 16) are bitten into the mucous membrane layer 202 of the living tissue 200. The linear blade portions 13 and 23 come into contact with the mucous membrane layer 202. For this reason, it is suppressed that the mucous membrane layer 202 bites into the collar pieces 12 and 22 excessively. In other words, the blade portions 13 and 23 are pressed flat against the mucous membrane layer 202, so that the depth at which the mucosal layer 202 bites into the claw portion 14 and the through hole 16 is moderately suppressed. Then, when the distal treatment section 10 holding the living tissue 200 is pulled upward, the living tissue 200 is advanced along the flat blade portions 13 and 23 with the mucous membrane layer 202 hooked to the nail portion 14. Can slide down slightly in the direction. As a result, the mucous membrane layer 202 and the submucosal layer 204 are gripped and stretched by the distal treatment section 10 and are stretched with a predetermined tension, while the muscle layer 206 is detached from the distal treatment section 10. In this state, the slider 56 (see FIG. 1) is further pulled to close the flanges 12 and 22, and a high frequency voltage is applied as described later, whereby the mucosa layer 202 (or the mucosa layer 202 and the submucosa 204) is applied. An incision is made. By applying tension to the mucosal layer 202 and the submucosal layer 204, the shearing force by the blades 13 and 23 is transmitted straight to the mucosal layer 202 in the depth direction, and the mucosal layer 202 is accurately transmitted at a desired position. An incision can be made.

  The living tissue 200 may be incised by the endoscope scissors 100 a plurality of times in the depth direction. That is, after incising the mucosal layer 202, the distal treatment section 10 may be inserted deeper into the living tissue 200 to incise the submucosal layer 204. Further, the submucosal layer 204 below the bulging portion 210 may be cut in the horizontal direction along the boundary surface between the submucosal layer 204 and the muscle layer 206.

  In this embodiment, although the recessed parts 15 and 25 were formed facing each other and the flanges 12 and 22 were closed, the substantially circular through-hole 16 was formed, but the recessed parts 15 and 25 are restricted to this. Absent. The concave portions 15 and 25 may be formed at different positions in the front end direction of the flange pieces 12 and 22, respectively. In this case, the recesses 15 and 25 may be formed at positions where some of the recesses 15 and 25 are continuous, or the recesses 15 and 25 may be formed at positions completely separated from each other.

  The distal treatment section 10 of this embodiment makes an incision by applying a shearing force while cauterizing the living tissue 200. Thereby, the living tissue 200 can be incised with a small force, and the incised site can be hemostatic at the same time.

  As shown in FIG. 1, the endoscope cage 100 includes a power feeding unit 52 that applies a high-frequency voltage to the collar pieces 12 and 22 through the operation wire 30. The power feeding unit 52 is a terminal connected to a high frequency power source (not shown).

  The scissors pieces 12 and 22, the link pieces 17 and 27, and the advancing / retreating portion 26 constituting the distal treatment section 10 are all made of a conductive metal material. Further, as described above, the operation wire 30 is also made of a conductive metal material. For this reason, the high frequency voltage applied to the power feeding unit 52 is loaded on the flanges 12 and 22.

  As shown in FIG. 3, insulating coatings 18 and 28 are provided on the surfaces of the pair of flanges 12 and 22, respectively. For the sake of convenience, the insulating coatings 18 and 28 are partially illustrated in FIG. 3, but the insulating coatings 18 and 28 are formed on substantially the entire hook pieces 12 and 22 except for the blade portions 13 and 23 and the concave portions 15 and 25. Has been. That is, the inner peripheral surfaces of the blade portions 13 and 23 and the recesses 15 and 25 are exposed from the insulating coatings 18 and 28.

  The insulating coatings 18 and 28 can be formed, for example, by coating an insulating material such as a fluororesin; diamond-like carbon (DLC); a ceramic material such as titanium oxide or silicon. According to the study of the present inventor, it becomes clear that an insulating coating that is particularly excellent in insulation, durability against electric conduction and adhesion can be obtained by selecting a silicon-based ceramic material as an insulating material. Yes. Insulating properties and durability are achieved by increasing the film thickness of the insulating coating. However, when the film thickness is increased, there is a problem that the adhesiveness with the strip decreases. On the other hand, by selecting a silicon-based ceramic as the insulating material, it is possible to improve the balance of insulation, durability against electric current and adhesion as compared with other ceramic materials, fluororesin, and DLC. it can.

  When silicon-based ceramic is used as the insulating material, the insulating coatings 18 and 28 can be formed by applying a liquid insulating coating agent containing polysiloxane (organopolysiloxane) to the strips 12 and 22. As an insulating coating agent, in addition to polysiloxane, an inorganic filler such as silica, a binder resin, a pigment such as a pigment may be blended in an aqueous or solvent-based solvent, and a curing agent may optionally be blended.

  The insulating coatings 18 and 28 provided respectively on the surfaces of the pair of collar pieces 12 and 22 may be colored in different colors. Specifically, a first pigment blended in the insulating coating 18 applied to the sepal piece 12 and a second pigment blended in the insulating coating 28 applied to the septum 22; It is preferable that the different materials exhibit different colors to such an extent that they can be visually discriminated. Thereby, the direction of the front and back of the lids 12 and 22 can be easily grasped under endoscopic observation.

  The thickness of the insulating coatings 18 and 28 is not particularly limited, but is 20 μm or more and 80 μm or less when a fluororesin is used as the insulating material, 1 μm or more and 5 μm or less when DLC is used, and 5 μm or more when a silicon ceramic material is used. It can be 40 μm or less.

  The blade portions 13 and 23 exposed from the insulating coatings 18 and 28 become linear electrodes. The saddle pieces 12 and 22 are applied with a high-frequency voltage having the same phase from the power supply unit 52 to become monopolar high-frequency electrodes.

  When the blade portions 13 and 23 are used as conductive electrodes and the insulating coatings 18 and 28 are formed in other regions of the flange pieces 12 and 22, the following steps can be performed. That is, an insulating material is coated on the whole of the collar pieces 12 and 22 in advance, and then the coating of the bent linear regions corresponding to the inner peripheral surfaces of the blade portions 13 and 23 and the concave portions 15 and 25 is polished or chemically treated. Can be peeled off.

  In the present embodiment, an example in which the substantially semicircular inner peripheral surfaces of the recesses 15 and 25 are entirely exposed from the insulating coatings 18 and 28 and used as a part of the electrode is illustrated. Not limited. The insulating coatings 18 and 28 may be formed on the inner peripheral surfaces of the recesses 15 and 25.

  By exposing the inner peripheral surfaces of the recesses 15 and 25 without forming the insulating coatings 18 and 28 as in this embodiment, the living tissue 200 can be cauterized in the blade portions 13 and 23 and the recesses 15 and 25. As a result, a quick incision procedure is possible. Conversely, by forming the insulating coatings 18 and 28 on the inner peripheral surfaces of the recesses 15 and 25, it is possible to prevent the solidified tissue from adhering to the inside of the recesses 15 and 25 when the living tissue 200 is cauterized. The For this reason, when the living tissue 200 is incised over a plurality of locations using the endoscope scissors 100, the concave portions 15 and 25 are not filled with the solidified tissue, and the gripping force of the scissors pieces 12 and 22 is high. Decrease is prevented.

  The holding frame 20 is made of an insulating material such as a metal material or a ceramic material or a resin material in which an insulating film is coated on at least the outer surface. That is, the high-frequency voltage applied to the power feeding unit 52 is not unexpectedly applied to the living tissue 200 (see FIGS. 4 and 5) through the holding frame 20. Thereby, the living tissue 200 to be cauterized is prevented from adhering not only to the scissors pieces 12 and 22 excluding the blade portions 13 and 23 but also to the holding frame 20.

<Second embodiment>
FIG. 6 is a side view of the distal treatment section 10 in the endoscope scissor 100 according to the second embodiment of the present invention. The figure shows the distal treatment section 10 in a closed state.

  In the endoscope scissor 100 of the present embodiment, a plurality of recesses 15 (15a to 15c) are provided on the blade part 13 of at least one of the pair of scissors pieces 12 and 22 (for example, the scissor piece 12). They are formed side by side in the end direction. And it differs from 1st embodiment by the point by which the other length area | region except the formation area of the recessed parts 15a-15c in the said hook piece 12 is formed in the continuous linear form.

  Hereinafter, the description which overlaps with 1st embodiment is abbreviate | omitted suitably.

  By forming the plurality of recesses 15a to 15c in the collar piece 12 like the endoscope collar 100 of the second embodiment, a high gripping force for the living tissue 200 (see FIG. 5) can be obtained. A claw portion 14 is formed on the collar piece 12 so as to protrude in the closing direction from the blade portion 13. A plurality of recesses 15a to 15c are formed on the blade portion 13 or 23 on the side where the claw portion 14 is formed (blade portion 13). By forming the nail | claw part 14 and recessed part 15a-15c, it can suppress favorably that the hold | gripped biological tissue 200 falls off from the front-end | tip treatment part 10. FIG.

  The recesses 15a to 15c each have a substantially semicircular shape. The radius of curvature and depth of the recesses 15a to 15c are not particularly limited, but in this embodiment, the radius of curvature and depth of the recesses 15a to 15c are common.

  At this time, the recesses 15a to 15c are formed apart from each other, and the flat linear blade portion 13 is formed between them, thereby suppressing the heel piece 12 from excessively biting into the living tissue 200. . Further, by not forming the recess 25 (see FIG. 2) in the other collar piece 22 and flattening the opposing positions of the recesses 15a to 15c, similarly, the collar piece 12 is prevented from excessively biting into the living tissue 200. Is done. As a result, the muscle layer 206 (see FIG. 5) in the living tissue 200 that is strongly engaged with the heel piece 12 slides down mainly from the heel piece 22 side. For this reason, without incising the muscle layer 206, the mucous membrane layer 202 can be satisfactorily held by the scissors 12, and this can be cauterized and incised.

  In addition to the space between the recess 15a and the recess 15b and between the recess 15b and the recess 15c, the conductive blade portion exposed from the insulating coating 18 (see FIG. 3) also between the claw portion 14 and the recess 15a. 13 is formed. Thereby, in a state where the nail part 14 and the recesses 15a to 15c are bitten into the living tissue 200, the living tissue 200 is cauterized and incised at a portion between them.

  In addition, it may replace with 2nd embodiment and may make the recessed parts 15a-15c differ mutually. Specifically, the concave portion 15a positioned on the distal end side of the flange piece 12 is formed deeper than the central concave portion 15b, and the concave portion 15c positioned on the proximal end side of the flange piece 12 is formed shallower than the concave portion 15b. Good. Since the collar pieces 12 and 22 pivot about the pivot shaft 29 and the distal end side opens larger than the proximal end side, many living tissues 200 are grasped on the distal end side of the collar pieces 12 and 22 (FIG. 5). reference). For this reason, it is possible to obtain an equal engaging force on the living tissue 200 in the recesses 15a to 15c by deepening the recess 15a on the distal end side and shallowing the recess 15c on the proximal end side.

<Third embodiment>
FIG. 7 is a side view of the distal treatment section 10 in the endoscope scissor 100 according to the third embodiment of the present invention. The figure shows the distal treatment section 10 in a closed state.

  The endoscope scissor 100 of this embodiment is different from the first embodiment in that the recesses 15 and 25 are formed on the base end side with respect to the intermediate portion in the front base end direction of the scissors pieces 12 and 22.

  Here, the intermediate portion of the flanges 12 and 22 refers to the center of the length in the distal direction from the distal ends of the flanges 12 and 22 to the rotation shaft 29, and is closer to the proximal side than the rotation shaft 29. Thus, the region driven by the link pieces 17 and 27 is not considered. Moreover, the recessed parts 15 and 25 are formed in the base end side rather than the intermediate part of the tip base end direction of the collar pieces 12 and 22 that the center position of the recessed parts 15 and 25 is the tip proximal end of the collar pieces 12 and 22. This means that it is on the proximal side of the middle part of the direction.

  Hereinafter, the description which overlaps with 1st embodiment or 2nd embodiment is abbreviate | omitted suitably.

  A claw portion 14 is formed on the collar piece 12 so as to protrude in the closing direction from the blade portion 13. Between the nail | claw part 14 and the recessed part 15, the flat and linear blade part 13 is exposed and formed from the insulating coating 18 (refer FIG. 3). Similarly, the blade portion 23 (see FIG. 3) of the flange piece 22 is formed on the distal end side of the recess 25.

  The recesses 15 and 25 have a substantially semicircular shape, and are formed so as to be opposed to positions corresponding to each other of the blade portions 13 and 23 of the pair of collar pieces 12 and 22. By closing the collar pieces 12 and 22, the concave portions 15 and 25 are combined to form a substantially circular through hole 16, which is common to the first embodiment.

  The formation depth of the recess 15 formed in the collar piece 12 is equal to or greater than the protrusion height at which the claw portion 14 protrudes from the blade portion 13 in the closing direction. Thereby, many biological tissues 200 (refer FIG. 5) can escape to the through-hole 16, and the collar pieces 12 and 22 can be made to bite into the biological tissue 200. FIG. For this reason, when the distal treatment section 10 is pulled up while holding the living tissue 200, between the claw 14 at the distal end of the heel piece 12 and the recesses 15 and 25 formed on the proximal end side with respect to the intermediate portion, Tension can be applied to the living tissue 200 (mucosal layer 202). That is, the concave portions 15 and 25 are formed on the proximal end side with respect to the intermediate portion, and the blade portions 13 and 23 are formed exclusively on the distal end side with respect to the concave portions 15 and 25. Tension can be applied to substantially the entire length region to be incised.

<Fourth embodiment>
FIG. 8A is a plan view showing a closed state of the distal treatment section 10 in the endoscope scissors 100 of the fourth embodiment, and FIG. 8B is a side view of the distal treatment section 10. FIG. 9 is a side view showing an open state of the distal treatment section 10 in the endoscope scissor 100 of the fourth embodiment. Description overlapping with any of the first to third embodiments described above will be omitted as appropriate.

The pair of scissors pieces 12 and 22 in the endoscope scissor 100 of the present embodiment are curved toward one end in the overlapping direction (upward in FIG. 8A) toward the distal end side than the formation region of the recesses 15a to 15d. It differs from the first embodiment in that it has a tip bending portion 60.
The distal end bending portion 60 can be created by bending the plate-shaped flanges 12 and 22 in the direction perpendicular to the surface. More specifically, the bent portions 66 are formed by bending the intermediate portions of the flange pieces 12 and 22 in a direction perpendicular to the surface, so that the distal ends 64 of the flange pieces 12 and 22 are extended lines L of the operation wire 30. Will be directed diagonally. The extension line L is an imaginary line in the endoscope cage 100 and is illustrated by a two-dot chain line in FIG.
The bent protrusion 66 is a convex region formed on the opposite side to the bending direction of the distal bending portion 60 (lower side in FIG. 8A) of the collar pieces 12 and 22. The curvature radii of the flanges 12 and 22 in the bending protrusion 66 are not particularly limited, but it is preferable that the distal bending portion 60 and the proximal bending portion 62 are smoothly and continuously formed in the bending protrusion 66. By forming the distal bending portion 60 as in the present embodiment, the bent protrusion 66 is brought into contact with the mucosal layer 202 when the distal treatment section 10 is advanced along the mucosal layer 202 (see FIG. 4). Since the distal end 64 of the distal treatment section 10 faces away from the mucosal layer 202, the distal end 64 is prevented from interfering with the mucosal layer 202.

  In the endoscope scissor 100 of the present embodiment, the pair of scissors pieces 12 and 22 are proximal to the proximal end side with respect to the distal end bending portion 60 and are curved to the other side in the overlapping direction (downward in FIG. 8A). An end curved portion 62 is provided. The tips 64 of the pair of flanges 12 and 22 are located on the extension line L of the operation wire 30. Further, when the endoscope scissors 100 are viewed from the distal end side, the scissors pieces 12 and 22 including the distal end bending portion 60 and the proximal end bending portion 62 are within the envelope region of the holding frame 20. Accordingly, when the endoscope scissors 100 are inserted into the forceps hole of the endoscope and advanced toward the living tissue, the scissors pieces 12 and 22 including the distal end bending portion 60 interfere with the wall surface of the forceps hole. Is prevented.

  As shown in FIG. 8A, the flanges 12, 22 are parallel to the advance / retreat portion 26 at the most proximal end portion 67 accommodated in the holding frame 20, and extend to the extension line L of the operation wire 30. Are arranged along. A part of the most proximal end portion 67 protrudes from the holding frame 20 toward the distal end side. The proximal end bending portion 62 is connected to the distal end side of the most proximal end portion 67.

A plurality of recesses 15 are formed in at least one of the blade portions 13 and 23 of one or the other of the pair of flanges 12 and 22 so as to be spaced apart from each other in the proximal direction. In the present embodiment, four concave portions 15 (15a to 15d) and 25 are formed at positions corresponding to each other with respect to the blade portions 13 and 23 of the pair of scissors pieces 12 and 22, respectively. The recesses 15 and 25 are formed on the base end side with respect to the intermediate portion in the front base end direction of the flange pieces 12 and 22. Specifically, the recessed portion 15 is formed in the proximal curved portion 62 of the blade portion 13, and the recessed portion 25 is formed in the proximal curved portion 62 of the blade portion 23. And the other length area | region except the formation area of the recessed part 15 in the blade part 13 is formed in the continuous linear form. Similarly, the length region other than the formation region of the recess 25 in the blade portion 23 is formed in a continuous linear shape. That is, the blade portions 13 and 23 are formed in a flat line shape at the distal end bending portion 60 (excluding the claw portion 14).
By bending the distal end bending portion 60 in the collar pieces 12 and 22 on the distal end side with respect to the length region where the recesses 15 and 25 are formed, the concave portion 15 and 25 are bitten into the mucosa layer 202 and the living tissue 200 is formed. The mucous membrane layer 202 and the submucosal layer 204 can be incised shallowly by the distal bending portion 60 while being gripped by the distal treatment section 10 (see FIG. 5). Thereby, incision of the muscle layer 206 by the distal treatment section 10 is preferably avoided.

  In the distal treatment section 10 of the present embodiment, the spacer section 19 is disposed between the collar piece 12 and the holding frame 20 and between the collar piece 22 and the holding frame 20. The spacer portion 19 has an annular shape, and the rotation shaft 29 is inserted therethrough. The spacer portion 19 is fixedly provided on the outer surfaces of the flange pieces 12 and 22 or the inner surface of the holding frame 20. By providing the spacer portion 19 in the distal treatment section 10 in this way, it is possible to prevent the outer surfaces of the scissors pieces 12 and 22 from coming into contact with the inner surface of the holding frame 20 during the opening / closing operation of the endoscope scissors 100 or during assembly work. Is done. For this reason, it is prevented that the insulating coatings 18 and 28 formed on the surfaces of the flanges 12 and 22 come into contact with the holding frame 20 and peel off unexpectedly.

The present invention is not limited to the above-described embodiment, and includes various modifications and improvements as long as the object of the present invention is achieved.
For example, in the above-described embodiment, the sheath 40 is formed by a coil of conductive wire. However, the present invention is not limited to this. In the above-described embodiment, the monopolar endoscope cage 100 that applies the high-frequency voltage of the same phase to the collar pieces 12 and 22 is exemplified, but the present invention is not limited thereto. One of the collar pieces 12 and 22 may be an active electrode and the other may be a bipolar endoscope collar 100 having a return electrode.

  Note that the various components of the endoscope cage 100 of the present invention do not have to be individually independent. A plurality of components are formed as one member, a component is formed of a plurality of members, one component is a part of another component, and one component is And a part of other components are allowed to overlap.

The above embodiment includes the following technical idea.
(1) An endoscopic scissor that is inserted into a forceps hole of an endoscope and used to incise a living tissue, and can be opened and closed by a rotating shaft that overlaps each other and extends in the overlapping direction. A pair of scissors that are pivotally supported and each have a blade portion that grips and incises the living tissue, and a driving force is applied to the base end of the scissors to open and close the distal end of the scissors A claw portion for gripping the living tissue is formed to protrude in a closing direction from the blade portion at least at one of the distal ends of the pair of collar pieces. A concave portion penetrating in the thickness direction is locally formed in the blade portion of the other flange piece, and the blade portion excluding the claw portion and the concave portion is formed in a flat linear shape extending in the proximal direction. Endoscope cage characterized by being made.
(2) The endoscope cage according to (1), wherein the concave portion has a substantially semicircular shape.
(3) The substantially semicircular recesses are formed opposite to each other at positions corresponding to each other of the blade portions of the pair of flange pieces, and the recesses are joined together by closing the flange pieces to form a substantially circular penetration. The endoscope scissors according to (2) above, wherein a hole is formed.
(4) The endoscope scissors according to any one of (1) to (3), wherein the concave portion is formed on a proximal end side with respect to an intermediate portion in a distal proximal direction of the flange piece.
(5) A plurality of the concave portions are formed in the blade portion of either the one or the other of the pair of flange pieces so as to be spaced apart from each other in the proximal direction, and the other blade portions are continuous. The endoscope cage according to any one of (1) to (4), wherein the endoscope is formed in a linear shape.
(6) The apparatus further includes a power feeding unit that applies a high-frequency voltage to the flange through the operation wire, an insulating coating is provided on a surface of the flange, and an inner peripheral surface of the blade portion and the recess is insulated. The endoscope scissors according to any one of (1) to (5) above, wherein the endoscope is exposed from an adhesive coating.

Moreover, the said embodiment includes the following technical thoughts.
(7) The endoscope scoop described above, wherein the pair of scissors has a distal end bending portion that is curved toward one side in the overlapping direction on a distal end side with respect to the formation region of the recess.
(8) The pair of collar pieces has a proximal curved portion that curves toward the other side in the overlapping direction on the proximal side with respect to the distal curved portion, and the distal ends of the pair of collar pieces are in the operation. The above-mentioned endoscope cage which is located on the extension line of the wire.
(9) A plurality of the concave portions are formed in the blade portion of at least one of the one or the other of the pair of flange pieces so as to be spaced apart from each other in the proximal direction, and the concave portion in the blade portion The above-mentioned endoscope reed, in which the other length region excluding the formation region is formed in a continuous linear shape.
(10) A power supply unit that applies a high-frequency voltage to the flange piece through the operation wire is further provided, and an insulating coating is provided on each surface of the pair of flange pieces, and the blade portion and the inner peripheral surface of the recess portion The endoscope cage described above, wherein is exposed from the insulating coating.
(11) The above endoscope cage, wherein the insulating coating includes a silicon-based ceramic.
(12) The endoscope scoop described above, wherein the insulating coatings provided on the surfaces of the pair of scissors pieces are colored in different colors.

DESCRIPTION OF SYMBOLS 10 Tip treatment part 12 1st collar piece 22 2nd collar piece 13, 23 Blade part 14 Claw part 15, 15a-15d, 25 Recessed part 16 Through-hole 17, 27 Link piece 18, 28 Insulation coating 19 Spacer part 20 Holding frame 26 Advancing / retracting portion 29 Rotating shaft 30 Operating wire 40 Sheath 42 Insulating coating 50 Hand operating portion 52 Power feeding portion 54 Finger ring 56 Slider 58 Shaft portion 60 Tip bending portion 62 Base end bending portion 64 Tip 66 Bending protrusion 67 Endmost end 100 Endoscope fold 200 Biological tissue 202 Mucosal layer 203 Diseased tissue 204 Submucosal layer 206 Muscle layer 210 Swelling portion L Extension line

Claims (10)

An endoscope scissor that is used by being inserted into a forceps hole of an endoscope and incising a living tissue,
A pair of scissors that overlap each other and are pivotally supported by a pivot shaft extending in the stacking direction so as to be openable and closable, and each having a blade portion for grasping and incising the living tissue;
An operation wire that applies a driving force to the proximal end portion of the flange piece to open and close the distal end portion of the flange piece,
At least one of the tip portions of the pair of collar pieces, a claw portion that grips the living tissue is formed to protrude in the closing direction from the blade portion,
A flat line in which a concave portion penetrating in the thickness direction is locally formed in the blade portion of the one or other flange piece, and the blade portion excluding the claw portion and the concave portion extends in the proximal direction. Endoscope cage characterized by being formed into a shape.   The endoscope scissors according to claim 1, wherein the recess has a substantially semicircular shape.   The substantially semicircular recesses are formed opposite to each other at positions corresponding to each other of the blade portions of the pair of flange pieces, and the recesses are combined to form a substantially circular through hole by closing the flange pieces. The endoscope scissors according to claim 2, wherein   The endoscope scoop according to any one of claims 1 to 3, wherein the concave portion is formed on a base end side with respect to an intermediate portion in a tip base end direction of the collar piece.   5. The endoscope scissors according to claim 4, wherein the pair of scissors pieces have a distal end bending portion that is curved toward one side in the overlapping direction on a distal end side with respect to the formation region of the concave portion. The pair of collar pieces have proximal curved portions that are curved toward the other side in the overlapping direction on the proximal side with respect to the distal curved portion,
The endoscope scissors according to claim 5, wherein tips of the pair of scissors pieces are located on an extension line of the operation wire.   A plurality of the recesses are formed in the blade portion of at least one of the one or the other of the pair of flange pieces so as to be spaced apart from each other in the proximal direction, and the formation region of the recess in the blade portion The endoscope cage according to any one of claims 1 to 6, wherein the other length regions excluding are formed in a continuous linear shape. A power supply unit that applies a high-frequency voltage to the rod through the operation wire;
Insulating coatings are provided on the surfaces of the pair of flanges,
The endoscope scissors according to any one of claims 1 to 7, wherein inner peripheral surfaces of the blade part and the concave part are exposed from the insulating coating.   The endoscope scissors according to claim 8, wherein the insulating coating includes a silicon-based ceramic.   The endoscope scissors according to claim 8 or 9, wherein the insulating coatings provided on the surfaces of the pair of scissors pieces are colored in different colors.

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