JP2018099401A - Medical high frequency treatment tool - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a medical high frequency treatment tool which can achieve easy incision of living tissues and excellent hemostasis regardless of the kind of non-conductive layer.SOLUTION: A medical high frequency treatment tool includes: a pair of conductive grip pieces 12, 22 openably/closably pivotally supported by a rotary shaft; an operation wire that performs opening/closing operation of the grip pieces by imparting a driving force to base end parts of the grip pieces 12, 22; and a power supply part supplying the grip pieces 12, 22 with high-frequency current. The surfaces of the grip pieces 12, 22 have formation areas 131, 231 and non-formation areas 132, 232 of a non-conductive layer. The non-formation areas 132, 232 are formed along a surface on a closing direction side of at least the grip pieces 12, 22. Wide parts 132b, 232b where the non-formation areas 132, 232 become wide on a distal side are formed.SELECTED DRAWING: Figure 7

Description

  The present invention relates to a medical high-frequency treatment instrument.

  Medical high-frequency treatment tools include an openable / closable scissors-type or forceps-type, and are instruments that incise, excise, cauterize, or stop hemostasis using a high-frequency current.

  A medical high-frequency treatment instrument includes, for example, a set of gripping pieces and a power supply unit that supplies a high-frequency current to the gripping pieces (see Patent Document 1).

  The surface of the gripping piece has a non-conductive layer forming region and a non-forming region, the non-forming region is formed along the surface of the gripping piece in the closing direction, and the other regions are forming regions. .

  When a high-frequency current is supplied to the grasping piece, a current is mainly applied from the non-conductive layer non-formation region to the living tissue, and a treatment such as incision is performed on the living tissue.

  By the way, in the medical high frequency treatment instrument, in addition to the application of current from the non-formation region of the non-conductive layer, the current generated from the formation region plays an important role.

  That is, although the high frequency current concentrates on the non-formation region of the non-conductive layer, it becomes easy to incise the living tissue, but it is difficult to stop hemostasis unless current flows around the incised portion.

  Therefore, when current is generated from the formation region of the non-conductive layer, current can be passed to the peripheral portion of the incised portion, and hemostasis can be performed satisfactorily.

JP 2012-205606 A

  The current from the formation region of the non-conductive layer is difficult to generate when a highly conductive non-conductive layer is formed, so it may be difficult to stop hemostasis depending on the type of the non-conductive layer. It was.

  The present invention has been made in view of the problems as described above, and provides a medical high-frequency treatment instrument that can achieve both easy incision and good hemostasis regardless of the type of the non-conductive layer. It is.

  According to the present invention, there is provided a medical high-frequency treatment instrument for incising, excising, cauterizing or hemostasis of a living tissue, the pair of conductive gripping pieces pivotally supported by a rotating shaft so as to be opened and closed, and the gripping pieces. An operation wire that applies a driving force to the base end of the gripper to open and close the gripping piece, and a power feeding unit that supplies a high-frequency current to the gripping piece, and a surface of the gripping piece includes a non-conductive layer. It has a formation region and a non-formation region, the non-formation region is formed along at least the surface of the gripping piece in the closing direction, and a wide portion is formed on the distal side so that the non-formation region is wide. A medical high-frequency treatment device is provided.

  According to the medical high-frequency treatment instrument of the present invention, it is possible to achieve both ease of incision of the living tissue and ease of hemostasis regardless of the type of the non-conductive layer.

It is a mimetic diagram showing the whole medical high frequency treatment instrument structure concerning an embodiment of the present invention. It is a top view which shows the closed state of the front-end | tip treatment part in a medical high frequency treatment tool. It is a side view which shows the closed state of the front-end | tip treatment part in a medical high frequency treatment tool. It is a longitudinal cross-sectional view of the front-end | tip treatment part in the medical high frequency treatment tool of a closed state. It is a side view which shows the open state of the front-end | tip treatment part in a medical high frequency treatment tool. It is a longitudinal cross-sectional view of the front-end | tip treatment part in the medical high frequency treatment tool of an open state. It is a front view which shows a collar piece. It is a perspective view which shows the collar piece of the medical high frequency treatment tool which concerns on the modification of this invention.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. Note that in all the drawings, the same components are denoted by the same reference numerals, and redundant description will be appropriately omitted.

  FIG. 1 is a schematic diagram showing the overall structure of a medical high-frequency treatment device 100 according to an embodiment of the present invention. FIG. 2 is a plan view showing a closed state of the distal treatment section 10 in the medical high-frequency treatment instrument 100. FIG. 3 is a side view showing a closed state of the distal treatment section 10 in the medical high-frequency treatment instrument 100. FIG. 4 is a longitudinal sectional view of the distal treatment section 10 in the medical high-frequency treatment instrument 100 in the closed state. FIG. 5 is a side view showing an open state of the distal treatment section 10 in the medical high-frequency treatment instrument 100. FIG. 6 is a longitudinal sectional view of the distal treatment section 10 in the medical high-frequency treatment instrument 100 in an open state. FIG. 7 is a front view showing the collar pieces 12 and 22.

First, the outline | summary of the medical high frequency treatment tool 100 of this embodiment is demonstrated. The medical high-frequency treatment instrument 100 is a medical high-frequency treatment instrument that incises, excises, cauterizes, or stops hemostasis of a living tissue.
The medical high-frequency treatment instrument 100 is provided at a base end portion of a pair of conductive grip pieces (saddle pieces 12, 22) that are pivotally supported by a pivot shaft so as to be opened and closed. An operation wire 30 that opens and closes the gripping pieces (hook pieces 12 and 22) by applying a driving force and a power feeding unit 52 that supplies a high-frequency current to the gripping pieces (hook pieces 12 and 22) are provided.
The surface of the gripping piece (saddle piece 12, 22) has non-conductive layer forming regions 131, 231 and non-forming regions 132, 232 (see FIG. 7), and the non-forming regions 132, 232 are at least the gripping piece ( A wide portion is formed along the surface on the closing direction side of the flange pieces 12, 22), and the non-forming regions 132, 232 are wide on the distal side.

  According to the medical high-frequency treatment device 100 having such a configuration, the non-formation regions 132 and 232 serving as electrodes serve for incision of a living tissue, and the current from the non-conductive layer is generated due to the formation of the wide portion. Even if it does not occur or is very small, it is possible to facilitate cauterization and hemostasis of living tissue. Thereby, it is possible to achieve both ease of incision of the living tissue and ease of hemostasis regardless of the type of the non-conductive layer.

  Next, the medical high-frequency treatment tool 100 of this embodiment will be described in detail.

  The high-frequency medical treatment instrument 100 has a hook-shaped distal treatment section 10 that opens and closes the hook pieces 12 and 22 as thin plate-like holding pieces that are overlapped with each other and applies a shearing force to a living tissue to hold it. Yes.

  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 medical high-frequency treatment device 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. In the description of this embodiment, the term “insulation” includes a state where a weak current flows.

  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 retract, 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.

  An advance / retreat portion 26 is integrally connected to the distal end side of the operation wire 30 (see FIGS. 2, 4 and 6). Two link pieces 17 and 27 are rotatably connected to the advancing / retreating portion 26. Further, the first hook piece 12 is rotatably connected to the link piece 17, and the second hook piece 22 is rotatably connected to the link piece 27. The first collar piece 12, the second collar piece 22, and the link pieces 17, 27 rotate relatively within the plane shown in FIGS.

  As shown in FIGS. 2 and 4, the holding frame 20 is attached to the distal end of the sheath 40. The proximal end portion of the holding frame 20 is rotatably fixed to the sheath 40, 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 flange 12 and the second flange 22 is fixed to the holding frame 20.

  As shown in FIG. 4, when the operation wire 30 and the advancing / retreating portion 26 are pulled toward the proximal end side (the right side in FIG. 4), the link pieces 17 and 27 and the collar pieces 12 and 22 become substantially straight, The part 10 is in a closed state. On the contrary, as shown in FIG. 6, when the operation wire 30 and the advancing / retreating portion 26 are pushed out to the distal end side (left side in FIG. 6), 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 according to the present embodiment includes a flexible tube and a coil formed by tightly winding a conductive wire such as a stainless steel wire inside the tube. An insulating outer layer 42 is provided in close contact with the outer surface of the sheath 40. In the present invention, the coil is not an essential configuration, and it can be omitted and only a flexible tube can be used.

  The operation wire 30 is connected to the rotation operation unit 57 (see FIG. 1), and the operation wire 30 whose base end is fixed to the slider 56 is obtained by rotating the rotation operation unit 57 around the shaft unit 58. It 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.

  Alternatively, the rotation operation unit 57 may be provided on the shaft unit 58 so as to be rotatable with respect to the power supply unit 52. In this case, the slider 56 may be configured to be rotatable around the shaft portion 58.

  In the present embodiment, the gripping pieces are the scissors pieces 12 and 22 having a thin blade portion, and the pair of scissors pieces 12 and 22 is at least a part of the side surface parallel to the opening and closing direction of the scissors pieces 12 and 22 in the closed state. Are overlapping in side view.

  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 for incising a living tissue.

  Specifically, by pulling the slider 56 (see FIG. 1) of the hand operation unit 50 and rotating the hook pieces 12 and 22 around the rotation shaft 29 to close the tip, A shearing force is generated between the two members 23.

  The edges of the blade portions 13 and 23 may be formed so sharp that the living tissue can be incised by the shearing force, or may be formed at an angle that is so blunt that the living tissue is not incised by the shearing force. .

  In the medical high-frequency treatment device 100 of the present embodiment, the edges of the blade portions 13 and 23 are formed at a blunt angle, and the living tissue is not substantially incised only by the shearing force generated by pulling the slider 56. Has been. Then, in a state where the living tissue is gripped by the sepals 12 and 22, the living tissue is cauterized and incised by applying a high-frequency current described later between the sepals 12 and 22. Thus, the biological tissue is not inadvertently incised while the biological tissue is gripped by the flanges 12 and 22 and the biological tissue is stretched and extended with a predetermined tension.

  A claw portion 14 for gripping a living tissue 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 medical high-frequency treatment device 100 of the present embodiment, the claw portion 14 is formed to protrude in the closing direction at the distal end portion of the first collar 12, and the second collar 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 in 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 bites into a biological tissue, and is a projection part for hold | maintaining so that it may hold | maintain the biological tissue hold | gripped with the scissors pieces 12 and 22, and preventing dropping. Specifically, the nail portion 14 drops the muscle layer so as to sandwich biological tissues other than the muscle layer (mucosal layer and submucosa) and hold the mucosa layer and submucosa gripped by the scissors 12 and 22. Hold. When the tissue is grasped and pulled, the nail portion 14 has a role in which the tissue of the hard muscle layer part is dropped and the soft mucosa layer and the submucosa are grasped. As the muscle layer tissue falls off in this way, there is no risk of perforating the muscle layer when energized, and treatment can be performed safely. Further, in order to achieve this purpose, the claw portion 14 may not have a blade surface, and the thickness dimension thereof may be larger than the thickness dimension of the blade portion 13.

  The pair of flanges 12 and 22 has a distal end bending portion 60 that is curved toward one side (upward in FIG. 2) in the overlapping direction on the distal end side with respect to the formation region of the recesses 15a to 15d.

  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 medical high-frequency treatment instrument 100, and is illustrated by a one-dot chain line in FIG.

  The bent protrusion 66 is a convex region formed on the opposite side (lower side in FIG. 2) of the collar pieces 12 and 22 to the bending direction of the distal bending portion 60. 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. The distal end bending portion 60 is formed as in the present embodiment, and when the distal treatment section 10 is advanced along the mucosal layer, the bending projection 66 is brought into contact with the mucosal layer, so that the distal end 64 of the distal treatment section 10 is Since it faces away from the mucosal layer, the tip 64 is prevented from interfering with the mucosal layer.

  In the medical high-frequency treatment device 100 according to the present embodiment, the pair of scissors pieces 12 and 22 are proximally curved with respect to the distal end bending portion 60 and are bent toward the other side in the overlapping direction (downward in FIG. 2). 62. 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 medical high-frequency treatment instrument 100 is viewed from the distal end side, the collar pieces 12 and 22 including the distal end bending portion 60 and the proximal end bending portion 62 are contained within the envelope region of the holding frame 20. Accordingly, when the medical high-frequency treatment instrument 100 is inserted into the forceps hole of the endoscope and advanced toward the living tissue, the collar 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. 2, the collar pieces 12, 22 are arranged along the extension line L of the operation wire 30 at the most proximal end portion 67 accommodated in the holding frame 20 and parallel to the advance / retreat portion 26. Has been. 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.

  In at least one of the pair of grip pieces (saddle pieces 12, 22), a concave portion 15 penetrating in the thickness direction is formed on the surface on the closing direction side.

  In the present embodiment, four recesses 15 (15a, 15b, 15c, 15d) and recesses 25 respectively correspond to the cutting edges of both the blade portions 13, 23 of the pair of scissors pieces 12, 22. Formed in position.

  By forming such a recess 15, the living tissue enters the recess 15 when grasping the living tissue, so that the living tissue can be prevented from dropping from the medical high-frequency treatment instrument 100.

  The wide portion is formed on the distal side of the recess 15.

  The wide portion may be formed more distally than at least one of the recesses 15 (15a, 15b, 15c, 15d), or may be formed more distally than all the recesses 15. Since the wide portion is formed on the distal side of the concave portion 15 as described above, it is possible to prevent the current from being excessively applied to the living tissue and damaging the living tissue more than necessary.

  Concave portions 15 and 25 are formed opposite to each other at positions corresponding to each other of the pair of grip pieces (saddle pieces 12 and 22), and the concave portions 15 and 25 are arcuate when viewed in the axial direction of the rotation shaft.

  Since the recesses 15 and 25 are formed at corresponding positions and the recesses are arcuate, it is possible to easily grasp the living tissue and prevent the grasped living tissue from being damaged.

  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 flanges 12 and 22 on the distal end side of the length region where the recesses 15 and 25 are formed, the recesses 15 and 25 are bitten into the mucosal layer and the living tissue is subjected to distal treatment. The mucous membrane layer and the submucosal layer can be incised shallowly by the distal bending portion 60 while being gripped by the portion 10. Thereby, incision of the muscle layer 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 avoided that the outer surfaces of the scissors pieces 12 and 22 come into contact with the inner surface of the holding frame 20 during the opening / closing operation or assembly operation of the medical high-frequency treatment instrument 100. Is done. For this reason, it is prevented that the insulating layer formed in the surface of the collar pieces 12 and 22 contacts with the holding frame 20, and peels.

  A non-conductive layer is formed on the surfaces of the flanges 12 and 22. The non-conductive layer can be formed 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 inventor's study, it is clear that an insulating coating particularly excellent in non-conductivity, durability against electric conduction and adhesion can be obtained by selecting a silicon-based ceramic material as a non-conductive material. It has become.

  Non-conductivity and durability can be achieved by increasing the film thickness of the non-conductive coating. However, when the film thickness is increased, there is a problem that the adhesiveness with the strips 12 and 22 decreases. On the other hand, by selecting silicon-based ceramic as the non-conductive material, the non-conductive, durability against electric current and adhesion are improved in comparison with other ceramic materials, fluororesin, and DLC. be able to.

  When silicon ceramic is used as a non-conductive material, a non-conductive layer can be formed by applying a liquid insulating coating agent containing polysiloxane (organopolysiloxane) to the strips 12 and 22. As the non-conductive 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 nonconductive layers provided on the surfaces of the pair of flanges 12 and 22 may be colored in different colors. Specifically, the first pigment blended in the non-conductive layer coated on the sepal piece 12 and the second pigment blended in the insulating layer coated on the septum 22 are visually observed. Therefore, it is preferable that the different materials exhibit different colors so that they can be distinguished. 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 non-conductive layer is not particularly limited, but when using a fluororesin as an insulating material, it is 20 μm or more and 80 μm or less, when using DLC, it is 1 μm or more and 5 μm or less, and when using a silicon-based ceramic material, it is 5 μm or more and 40 μm or less. It can be.

The nonconductive layer includes a resin having a lower limit value of the volume resistivity of 1.0 × 10 ¹² Ω · cm to 1.0 × 10 ¹⁵ Ω · cm.

  When the lower limit value of the volume resistivity of the nonconductive layer is within this range, good insulating properties can be ensured in the formation regions 131 and 231 of the nonconductive layer.

  In addition, the non-conductive layer includes a resin having a lower limit value of continuous use temperature in accordance with UL746B of 200 degrees or more and 300 degrees or less.

  When the lower limit value of the continuous use temperature based on UL746B is within the above-described range, it is possible to effectively prevent thermal deterioration of the nonconductive layer.

  The non-formation regions 132 and 232 become electrodes. The saddle pieces 12 and 22 become monopolar high-frequency electrodes when a high-frequency current having the same phase is applied from the power supply unit 52.

  The non-conducting layer non-formation regions 132 and 232 are formed along the surface of the flanges 12 and 22 in the closing direction, and a wide portion is formed on the distal side where the non-formation regions 132 and 232 are wide.

  In the present embodiment, the wide portion is formed from the surface on the closing direction side of the gripping pieces (strip pieces 12, 22) to the side surface parallel to the opening / closing direction of the gripping pieces (strip pieces 12, 22). In addition, the front end surface is not included in the side surface parallel to the opening and closing direction of the flanges 12 and 22.

  Since the wide portion is formed from the surface on the closing direction side of the collar pieces 12 and 22 to the side surface parallel to the opening and closing direction of the collar pieces 12 and 22, the wide portion is efficiently formed around the incision portion of the living tissue. They can be brought into contact with each other, and the peripheral portion can be cauterized and hemostatically efficiently.

  In this embodiment, the wide portion is a side portion formed continuously with the blade edge portion non-formation regions 132a and 232a formed at the blade edges of the blade portions 13 and 23 of the scissors pieces 12 and 22, as shown in FIG. Non-formation regions 132b and 232b.

  Since the wide portion is formed on the distal side of the non-formation region of the nonconductive layer, the wide portion is formed even when no current is generated from the formation regions 131 and 231 of the nonconductive layer or the amount is very small. Current can flow from the side non-formation regions 132b and 232b, which are portions, to the peripheral portion of the incision portion, and hemostasis can be performed satisfactorily.

  Moreover, in this embodiment, the non-formation area | region is formed in the surface by the side of a close direction of a pair of collar pieces 12 and 22, and the surface which overlaps in a side view of a pair of collar pieces 12 and 22.

  In addition, the surface which overlaps in side view here means the surface (inner side surface) which opposes and overlaps in a pair of collar pieces 12 and 22. FIG. In addition, the inclined surfaces formed on the outer surfaces of the blade portions 13 and 23 in FIG. 7 are the side surfaces of the blade portions 13 and 23 and are not included in the surfaces on the closing direction side.

  The non-formation region is formed on the surface in the closing direction of the pair of collars 12 and 22 and the surface overlapping in the side view of the pair of collars 12 and 22, so that the medical high-frequency treatment instrument 100 is in the closed state. In this case, the exposed portion of the electrode is only the surface on the closing direction side of the flanges 12 and 22. Therefore, it is possible to prevent the non-forming regions 132 and 232, that is, the electrodes from unnecessarily coming into contact with the surrounding living tissue, and to prevent the current from being damaged by the current.

  Moreover, the non-formation area | regions 132 and 232 are non-formation in the side surface other than the part which overlaps in the side view of a pair of scissors piece side surface, and a pair of scissors piece side view.

  As described above, the non-formation regions 132 and 232 are not formed on the side surface of the pair of flange pieces in the closing direction and on the side surfaces other than the overlapping portions in the side view of the pair of flange pieces, thereby ensuring sufficient insulation. In addition, the living tissue can be prevented from being unnecessarily damaged by the electric current.

  When the blade portions 13 and 23 are made non-conductive electrodes and the non-conductive layer is formed in other regions of the flanges 12 and 22, the following steps can be performed. That is, a non-conductive 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 polished. Can be peeled off by chemicals.

  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 nonconductive layer and used as a part of the electrode is illustrated, but the present invention is not limited thereto. Absent. A non-conductive coating may be formed on the inner peripheral surfaces of the recesses 15 and 25.

  Since the living tissue can be cauterized in the blade portions 13 and 23 and the concave portions 15 and 25 by exposing the inner peripheral surfaces of the concave portions 15 and 25 without forming a nonconductive layer as in the present embodiment, A quick incision procedure is possible. Conversely, by forming a non-conductive layer on the inner peripheral surfaces of the recesses 15 and 25, the solidified tissue is prevented from adhering to the inside of the recesses 15 and 25 when the living tissue is cauterized. For this reason, when the biological tissue is cut through a plurality of locations using the medical high-frequency treatment instrument 100, the recesses 15 and 25 are not filled with the solidified tissue, and the high gripping force of the scissors pieces 12 and 22 is reduced. Is prevented.

  The holding frame 20 is made of a non-conductive material such as a metal material having a non-conductive layer coated on at least an outer surface, or a ceramic material or a resin material. That is, the high-frequency current applied to the power feeding unit 52 is not unexpectedly applied to the living tissue through the holding frame 20. Thereby, the living tissue 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.

  In addition, this invention is not limited to embodiment mentioned above, A various deformation | transformation is employable.

  For example, the gripping pieces may be rod-shaped, and the pair of gripping pieces may be in a state where the surfaces in the closing direction face each other in the closed state.

  That is, the medical high-frequency treatment device 100 according to the modification is not a hook shape as in the above-described embodiment, but a forceps shape. Even with such a medical high-frequency treatment instrument 100, it is possible to incise, excise, cauterize, or stop hemostasis of a living tissue. By forming the wide part that becomes wide, it becomes possible to achieve both ease of incision of the living tissue and ease of hemostasis.

  Moreover, in this invention, the wide part is not restricted to the aspect formed in the side surface parallel to the opening / closing direction of a holding piece (saddle piece 12, 22), You may form in another aspect.

  FIG. 8 is a perspective view showing the scissors pieces 12 and 22 of the medical high-frequency treatment device 100 according to a modification of the present invention. For example, as shown in FIG. 8, the widened portion 132c (232c) is formed by expanding the width of the blade edge portion non-forming regions 132a and 232a at the distal end portions of the blade portions 13 and 23 of the flanges 12 and 22, as shown in FIG. You may form as. Even in such an embodiment, it is possible to achieve both ease of incision of the living tissue and ease of hemostasis regardless of the type of the non-conductive layer.

  The components of the medical high-frequency treatment device 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) A medical high-frequency treatment instrument for incising, excising, cauterizing or hemostasis of a living tissue, and a pair of conductive gripping pieces pivotally supported by a rotating shaft so as to be opened and closed, and a proximal end of the gripping piece An operation wire that applies a driving force to the part to open and close the grip piece, and a power supply unit that supplies a high-frequency current to the grip piece, and a surface of the grip piece has a non-conductive layer formation region and It has a non-formation area, the non-formation area is formed at least along the surface on the closing direction side of the gripping piece, and a wide portion is formed on the distal side where the non-formation area is wide. Medical high-frequency treatment tool.
(2) The high-frequency medical instrument according to (1), wherein the wide portion is formed from a surface on the closing direction side of the gripping piece to a side surface parallel to the opening / closing direction of the gripping piece.
(3) The medical high-frequency treatment instrument according to (1) or (2), wherein a concave portion penetrating in the thickness direction is formed on at least one of the pair of grip pieces on the surface on the closing direction side.
(4) The medical high-frequency treatment device according to (3), wherein the wide portion is formed on a distal side of the concave portion.
(5) The concave portions are formed opposite to each other at positions corresponding to each other of the pair of gripping pieces, and the concave portions are arcuate when viewed in the axial direction of the rotation shaft. Medical high-frequency treatment tool.
(6) The gripping piece is a hook piece having a thin plate-like blade portion, and the pair of hook pieces in the closed state overlap at least a part of side faces parallel to the opening and closing direction of the hook piece in a side view (1). The medical high-frequency treatment tool according to any one of items (5) to (5).
(7) The medical high-frequency treatment instrument according to (6), wherein the non-formation region is formed on a surface on the closing direction side of the pair of collar pieces and a surface overlapping in the side view of the pair of collar pieces. .
(8) The non-formation region is non-formation on a surface of the pair of collar pieces on the side in the closing direction and on a side surface other than a portion overlapping in the side view of the pair of collar pieces. High frequency treatment tool.
(9) The medical high-frequency treatment device according to any one of (1) to (5), wherein the gripping pieces are rod-shaped, and the pair of gripping pieces face each other in the closed direction when the gripping pieces are closed.
(10) The non-conductive layer includes a resin having a volume resistivity lower limit value of 1.0 × 10 ¹² Ω · cm or more and 1.0 × 10 ¹⁵ Ω · cm or less. The medical high-frequency treatment tool according to claim 1.
(11) The high-frequency medical treatment according to any one of (1) to (10), wherein the non-conductive layer includes a resin having a lower limit value of a continuous use temperature in accordance with UL746B of 200 degrees to 300 degrees. Ingredients.

DESCRIPTION OF SYMBOLS 10 Tip treatment part 12, 22 Claw piece 13, 23 Blade part 14 Claw part 15, 25 Concave part 15a-15d Concave part 17, 27 Link piece 19 Spacer part 20 Holding frame 26 Advance / Retreat part 29 Rotating shaft 30 Operation wire 40 Sheath 42 Insulation Outer layer 50 Hand operating section 52 Power feeding section 54 Finger ring 56 Slider 57 Rotating operation section 58 Shaft section 60 Front end bending section 62 Base end bending section 64 Front end 66 Bending projection 67 Most proximal end section 100 High-frequency treatment tools 131 and 231 for medical use Formation region 132, 232 Non-formation region 132a, 232a Cutting edge non-formation region 132b, 232b Side non-formation region 132c, 232c Extended wide portion L Extension line

Claims (11)

A medical high-frequency treatment instrument for incising, excising, cauterizing or hemostasis of living tissue,
A pair of conductive gripping pieces that are pivotally supported by a pivot shaft;
An operation wire for applying a driving force to the proximal end of the gripping piece to open and close the gripping piece;
A power feeding unit for supplying a high-frequency current to the gripping piece;
With
The surface of the grip piece has a non-conductive layer forming region and a non-forming region,
The high frequency treatment tool for medical use, wherein the non-formed region is formed at least along a surface on the closing direction side of the gripping piece, and a wide portion is formed on the distal side where the non-formed region is wide.   The medical high-frequency treatment instrument according to claim 1, wherein the wide portion is formed from a surface on the closing direction side of the gripping piece to a side surface parallel to the opening / closing direction of the gripping piece.   The medical high-frequency treatment instrument according to claim 1 or 2, wherein a concave portion penetrating in the thickness direction is formed in at least one of the pair of grip pieces on the surface on the closing direction side.   The medical high-frequency treatment instrument according to claim 3, wherein the wide portion is formed on a distal side of the concave portion.   The medical high-frequency treatment instrument according to claim 3 or 4, wherein the recesses are formed opposite to each other at positions corresponding to each other of the pair of gripping pieces, and the recesses are arcuate when viewed in the axial direction of the rotation shaft. .   6. The gripping piece according to claim 1, wherein the gripping piece is a flange having a thin blade portion, and at least a part of side surfaces parallel to the opening / closing direction of the flange overlap in a side view when the pair of flanges are closed. The medical high-frequency treatment device according to any one of the above.   The medical high-frequency treatment instrument according to claim 6, wherein the non-formation region is formed on a surface on the closing direction side of the pair of collar pieces and a surface overlapping in a side view of the pair of collar pieces.   The medical high-frequency treatment device according to claim 7, wherein the non-formation region is non-formation on a surface of the pair of scissors in the closing direction and on a side surface other than a portion overlapping in the side view of the pair of scissors. .   The medical high-frequency treatment device according to any one of claims 1 to 5, wherein the gripping pieces are rod-shaped, and the pair of gripping pieces face each other in the closed direction. 10. The non-conductive layer according to claim 1, wherein the non-conductive layer includes a resin having a lower limit of volume resistivity of 1.0 × 10 ¹² Ω · cm to 1.0 × 10 ¹⁵ Ω · cm. Medical high frequency treatment tool.   11. The medical high-frequency treatment device according to claim 1, wherein the non-conductive layer includes a resin having a lower limit value of a continuous use temperature in accordance with UL 746B that is not less than 200 degrees and not more than 300 degrees.

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