JP2021186447A - Electric cauterization incision instrument for endoscope - Google Patents

Abstract

To provide an electric cauterization incision instrument for endoscope, comprising a marking function by electric cauterization, a perforation function, an incision function, a peeling function, and closing hemostatic function, as functions capable of being applied for a manipulation of ESD to a biological tissue in a lumen, and comprising excellent operation ability.SOLUTION: An electric cauterization incision instrument for endoscope is configured so that an operation wire 12 arranged in a coil sheath 11a so as to be advanced and retreat, is operated to advance and retreat, and a pair of tip incision pieces 15, 16 which is supported to tip incision tool support means 14 provided on the coil sheath 11a and to which a required voltage is applied, incises an affected part of a biological tissue. A tip side part 15c and a tip side part 16c of the respective tip incision pieces 15, 16 are formed into a rod-shape having a facing surface part 15d, 16d, and the respective tip side parts have an outside protrusion 15e, 16e for marking and for scratching prevention, on an outside face tip part opposite to the facing surface part.SELECTED DRAWING: Figure 3

Description

The present invention is an electrocautery for an endoscope having an advanced treatment portion that is inserted into and removed from the channel of the endoscope and is inserted into the body cavity together with the insertion portion of the endoscope to perform treatment such as incision of a lesion portion of a living tissue. Regarding incisions.

The endoscopic electrocautery incision has a tip treatment part at the tip of the sheath, and the sheath is retractably housed in the channel of the endoscope and inserted into the body cavity together with the insertion part of the endoscope. The treatment of lesions in the body cavity (removal of affected parts of living tissue, sampling, excision, hemostasis, etc.) is reduced by the tip treatment part that extends from the tip of the insertion part of the endoscope in the field of view of the endoscope. Used to do in an invasion.

Endoscopic Submucosal Dissection (hereinafter referred to as Endoscopic Submucosal Dissection) is a method that can reliably remove a wide range of lesions such as early esophageal cancer, early gastric cancer, and early colon cancer using an endoscope. , "ESD")) is known.

ESD is a treatment method for collectively excising a wide range of lesions, and the technique of ESD is (1) marking the excision area of the lesion (marking), and (2) locally injecting a drug solution into the submucosal layer to mucosa. The lesion was raised (local note), (3) the area around the mucosal lesion was incised according to the marking, and then the submucosal layer was peeled off (incision / peeling). It consists of treatments (steps) such as stopping bleeding (stopping bleeding).

In each step of ESD, a dedicated disposable endoscopic treatment tool is used. For example, in the process of incision / peeling, an endoscopic treatment tool equipped with a needle knife or the like that energizes a high-frequency current to excise a mucous membrane or the like is used. In the ESD procedure, bleeding is often accompanied when excising the mucous membrane or the like. When bleeding occurs during the procedure, the surgeon removes the endoscopic treatment tool for incision / detachment from the endoscope and replaces it with an endoscopic treatment tool for hemostasis, and performs endoscopic hemostasis. Need to be done.

Japanese Unexamined Patent Publication No. 2008-272393

The high-frequency treatment tool for an endoscope described in Patent Document 1 includes a pair of high-frequency electrodes that open and close in a fan shape. Each high-frequency electrode has a convex electrode exposed surface elongated in the front-rear direction and in the central portion in the width direction so that the pair of high-frequency electrodes are closed toward each other when the pair of high-frequency electrodes are closed. Further, stepped portions forming a step with respect to the exposed electrode surface are formed on both sides of the exposed electrode surface, and the portion outside the outer edge of the stepped portion is formed in a slope shape gradually spreading outward (paragraph number). 0012,0013, FIGS. 1 and 2).

The pair of exposed electrode surfaces facing each other in the closed state sandwich the living tissue, and the Joule heat generated at the highest high-frequency current density is the highest to cut the living tissue, and both sides of the exposed electrode surface. In the stepped portion, the biological tissue in which the current density becomes sparse is burnt to obtain a bleeding-stopping effect, and a stable bleeding-stopping state is maintained in the slopes on both sides of the stepped portion (paragraph number 0015).

However, according to the high-frequency treatment tool for endoscopes described in Patent Document 1, when the pair of facing electrode exposed surfaces are closed, the space between the pair of electrode exposed surfaces is not maintained at a predetermined interval where bubbles can be generated. Since the structure is such that the electrodes are closed continuously until they come into close contact with each other, there is a risk that the blood vessels will be cut when the pair of facing electrode exposed surfaces sandwich the biological tissue including the blood vessels and make an incision while stopping bleeding. In addition, since it is not possible to take time for bubbles to be generated between the exposed electrode surfaces and between the stepped portions, the high heat generated between the exposed electrode surfaces is positively heated to the stepped portions on both sides of the exposed electrode surface, and the stepped portion is further heated. It is not possible to actively heat the slopes on both sides of the electrode, it is difficult to properly suppress the temperature rise of normal living tissue after excision of the lesion, and it does not have excellent operability when making an incision. There is a problem. In addition, when performing other treatments, it is necessary to take out the high-frequency treatment tool for the endoscope from the endoscope and replace it with another treatment tool, which may take time. ..

The present invention has been made to solve the above-mentioned problems, and has a marking function, an incision function, an incision function, a closed hemostatic function, and a hemostatic function by electric cauterization as functions applicable to the ESD procedure for living tissues in the body cavity. It is an object of the present invention to provide an electric cautery incision tool for an endoscope having excellent operability.

In order to achieve the above object, the electric ablation incision tool for an endoscope according to the present invention has a flexible coil sheath that is inserted into and removed from the channel of the endoscope, and a conductive structure that is movably arranged in the coil sheath. An operation wire having a property, an operation unit connected to each rear end side of the coil sheath and the operation wire to advance and retreat the operation wire, and a cylinder portion provided at the tip end portion of the coil sheath and the tip end side of the cylinder portion. It has a tip treatment portion support means having a pair of opposed arms extending in the region, and a pair of tip incisions formed from a conductive material, and the pair of the tip incisions is a pair of the treatment section support means. The tip treatment section is provided with a tip treatment section that is pivotally supported between the arms and opens and closes in conjunction with the advance / retreat of the operation wire to incise the affected portion of the living tissue by applying a required voltage, and the tip treatment section is each of the tip incisions. The tip end side portion of the piece is formed in a rod shape having a facing surface portion, and in each of the tip end side portions, an outer protrusion for scratch locking and marking is formed on the outer surface tip portion on the opposite side of the facing surface portion. It is characterized by being done.

In the electric ablation incision tool for an endoscope according to the second aspect of the present invention, in addition to the configuration of the first aspect, the pair of tip incisions have medial protrusions on the tip of at least one of the facing surfaces. In the closed state, the facing surfaces are configured to have a gap and are close to each other by the inner protrusion.

In addition to the configuration of the first aspect, the electrocautery incision tool for an endoscope according to the third aspect of the present invention is configured such that the pair of tip incision pieces are in close contact with each other in a closed state. It is characterized by being done.

According to the present invention, as a function that can be applied to the biological tissue in the body cavity in the ESD procedure, it has a marking function by electric cauterization, a perforation function, an incision function, a peeling function, and a closed hemostatic function, and has excellent operability. An electrocautery incision tool for an endoscope can be provided.

It is a figure for demonstrating the endoscopic system including the electric cautery incision tool for an endoscope which concerns on Embodiment 1 of this invention. It is an overall view of the electric cautery incision tool for an endoscope which concerns on Embodiment 1 of this invention. Regarding the electrocautery incision tool for an endoscope according to the first embodiment of the present invention, FIG. 3 (A) is a front view showing the tip of the treatment portion in a state where the tip treatment portion is closed, and FIG. 3 (B) is the tip treatment portion. 3 (C) is a vertical sectional front view showing the tip of the treatment portion in the closed state, FIG. 3 (C) is a vertical sectional front view showing the tip of the treatment portion in the open state of the tip treatment portion, and FIG. 3 (D) is FIG. 3 (A). It is a longitudinal view of the IIId-IIId arrow in. It is a front view which shows the tip part in the state which the tip treatment part of the electric cautery incision for an endoscope which concerns on Embodiment 2 of this invention is closed. 5 (A)-(F) is a process diagram of a series of ESD procedures performed using the electrocautery incision tool for an endoscope according to the first embodiment of the present invention.

Hereinafter, embodiments relating to the electric cautery incision tool for an endoscope according to the present invention will be described with reference to the drawings. In the following description, the side where the tip treatment portion is located is referred to as the tip side, and the side where the operation portion is located is referred to as the base end side.

[Embodiment 1]
[Endoscope system]
FIG. 1 shows an endoscope system 1 to which the electric cautery incision tool for an endoscope according to the first embodiment is applied. The endoscope system 1 has an insertion unit 2 for inserting into the body cavity of a living body, and an endoscope operation unit provided at the base end and having a dial for bending the tip of the insertion unit 2 in the vertical and horizontal directions. 3 and a treatment tool introduction unit 4 arranged so as to connect between the insertion unit 2 and the endoscope operation unit 3 are provided, and the treatment tool introduction unit 4 is provided in the longitudinal direction toward the tip of the insertion unit 2. The formed endoscope channel 5 is formed, and a pair of tip incision pieces 15 as a tip treatment portion for treating a biologically affected portion of the endoscopic electrocautery incision tool 10 described later in the endoscope channel 5. The 16 and the sheath 11 are configured to be operated by the insertion operation unit 13.

[Basic configuration of electric cautery incision tool for endoscopes]
FIG. 2 shows an electrocautery incision tool 10 for an endoscope according to the first embodiment. The electric ablation incision tool 10 for an endoscope is an incision device in which a pair of tip incision pieces 15 and 16 sandwich a biological tissue in a body cavity and a required electric current is applied to electrically cauterize the biological tissue to stop bleeding.

The endoscopic electrocautery incision tool 10 includes a flexible elongated sheath 11 that is inserted into and removed from the endoscope channel 5, an operation wire 12 that is movably arranged in the sheath 11, and an operation wire 12. The operation unit 13 for advancing and retreating operation, the tip treatment unit support member 14 which is a treatment unit support means fixedly connected to the tip of the sheath 11, and the tip rotatably supported by the tip treatment unit support member 14 by the support shaft 18. It is provided with a pair of tip incisions 15, 16 as a treatment section.

The sheath 11 is an elongated tubular body having a length of 1500 to 2000 mm, having flexibility and having appropriate waist strength (flexion resistance). The sheath 11 of the present embodiment is composed of a coil sheath 11a and a resin outer cover 11b that covers the outer surface of the coil sheath 11a. The resin outer cover 11b is made of PTFE, PEEK, PPS, polyethylene, polyimide, etc., and has flexibility and electrical insulation. As the coil sheath 11a, for example, it is preferable to use a coil sheath formed by tightly winding a metal material such as a stainless wire having a rectangular cross-sectional shape.

In the electrocautery incision tool 10 for an endoscope, an electric insulating film is formed on the inner surface of the coil sheath 11a and the outer surface of the tip treatment portion support member 14. In the configuration in which the resin outer cover 11b is not provided, an electric insulating film may be formed on the inner and outer surfaces of the coil sheath 11a.

The operation wire 12 is loosely arranged in the sheath 11 so as to be able to move forward and backward, and is made of a torque wire that is conductive and has a large rotational followability. The operation wire 12 may have, for example, a total length made of stainless steel, or may be formed by connecting a base end side portion made of stainless steel and a tip end side portion made of nitinol (nickel titanium alloy) with a stainless steel pipe. ..

The operation unit 13 has an operation unit main body 13a and a slider 13b. The tip of the operation unit body 13a is connected to the base end of the coil sheath 11a. The slider 13b is provided so as to be fitted to the operation unit main body 13a and slide in a range corresponding to the slit provided on the side surface portion of the operation unit main body 13a, and is introduced into the inside from the tip surface of the operation unit main body 13a. It is connected to the base end of the operation wire 12.

The operation unit 13 can move the operation wire 12 relative to the coil sheath 11a by relatively sliding the operation unit main body 13a and the slider 13b (advancing / retreating operation), and the slider 13b is moved to the left in the drawing (advance / retreat operation). By moving the operation wire 12 to the tip side), the operation wire 12 can be moved relative to the coil sheath 11a to open the pair of tip incision pieces 15 and 16, and the slider 13b can be moved to the right (base end side) in the drawing. The operation wire 12 is relatively moved to the coil sheath 11a toward the base end side, and the pair of tip incision pieces 15 and 16 can be closed. Therefore, the operation unit 13 can move the operation wire 12 relative to the coil sheath 11a, and can open and close the pair of tip incision pieces 15 and 16 through the advance / retreat operation of the operation wire 12. It is configured.

As shown in FIG. 3A, the tip treatment portion support member 14 includes a tubular portion 14a fitted and connected to the distal end portion of the coil sheath 11a and a pair of opposed arm portions extending toward the distal end side from the tubular portion 14a. It has 14b and. The pair of tip incision pieces 15 and 16 are supported by the tip treatment portion support member 14 so as to be openable and closable. The pair of tip incision pieces 15 and 16 have a shape divided into a middle portion (intersection portion) 15a and 16a, a proximal end side portion 15b and 16b, and a tip end side portion 15c and 16c. The tip side portions 15c and 16c have a shape having a square protruding portion on the outside of the tip. It can be used as a needle-shaped knife or marker with the tip side portions 15c and 16c closed, and can be used as scissors when opened and closed.

As shown in FIGS. 3 (B), (C), and (D), the pair of tip incision pieces 15 and 16 functionally have a tip side portion 15c, 16c, a middle portion 15a, 16a, and a base end side portion 15b. , 16b.

A shaft hole is provided in each of the middle portions (intersection portions) 15a and 16a of the pair of tip incision pieces 15 and 16, and the two shaft holes are combined to form a pair of arm portions 14b and 14b of the tip treatment portion support member 14. The support shaft 18 is uniaxially aligned with a pair of bearing holes located between the tip portions and provided at the tip portions of the pair of arm portions 14b and 14b, and the support shaft 18 passes from one bearing hole to the other bearing hole. Has been done.

The support shaft 18 is either forcibly fitted into the bearing holes of the pair of arm portions 14b, 14b, or is fixed by laser welding after fitting, and the middle portion (crossing) of the pair of tip incision pieces 15 and 16. Part) It is loosely fitted to the shaft holes of 15a and 16a. Therefore, in the pair of tip incision pieces 15 and 16, the middle portion (intersection portion) 15a and 16a are pivotally supported between the pair of arm portions 14b and 14b of the tip treatment portion support member 14, and the tip side portions 15c and 16c are provided. It can be opened and closed.

Each base end portion of the pair of tip incision pieces 15 and 16 is connected to each tip portion of the pair of opening / closing actuating links 19 and 20 by pin shafts 22 and 23, and further each of the pair of opening / closing actuating links 19 and 20. The base end portion is connected to the tip end portion of the advance / retreat transmission link 21 by a pin shaft 24, and the advance / retreat transmission link 21 is connected to the operation wire 12.

Specifically, the pin shaft 22 is passed through the pin shaft hole provided in the proximal end side portion 15b of the one tip incision piece 15 and the pin shaft hole provided in the tip portion of the one opening / closing operation link 19 to stop the pin shaft 22. By being worn, one tip incision piece 15 and one opening / closing operation link 19 are connected. The pin shaft hole provided in the proximal end side portion 16b of the other tip incision piece 16 and the pin shaft hole provided in the tip portion of the other opening / closing operation link 20 are superposed, and the pin shaft is formed in these pin shaft holes. 23 is passed through and stopped. As a result, the other tip incision piece 16 and the other opening / closing operation link 20 are connected. Therefore, the base end side portions 15b and 16b of the tip incision pieces 15 and 16 and the opening / closing operation links 19 and 20 are linked in a diamond shape.

Further, the pin shaft holes provided at the base ends of the pair of opening / closing actuating links 19 and 20 are overlapped on both sides of the pin shaft holes provided at the tip ends of the advancing / retreating transmission link 21, and the pins are formed in these shaft holes. The shaft 24 is passed through and fastened, and the pair of opening / closing operating links 19 and 20 and the opening / closing operating link 19 are connected to each other.

The advancing / retreating transmission link 21 has a rod-like outer shape, has a wire receiving hole inward in the axial direction from the base end surface, and the tip of the operation wire 12 is fitted into the wire receiving hole and tightened from the side surface of the advancing / retreating transmission link 21. The screw is screwed in, or it is connected and fixed by silver brazing, soldering, caulking, etc., so that the advancing / retreating transmission link 21 and the operation wire 12 are connected.

Therefore, when the operation wire 12 is relatively moved toward the proximal end with respect to the sheath 11, when the crossing angle of the opening / closing actuating links 19 and 20 becomes smaller, the proximal end side portion 15b of the pair of tip incision pieces 15 and 16. The crossing angle of 16b is also reduced, whereby the tip side portions 15c and 16c of the pair of tip incision pieces 15 and 16 are closed (FIG. 3B), and the crossing angle of the opening / closing actuating links 19 and 20 is also reduced. As the value increases, the crossing angles of the base end side portions 15b and 16b of the pair of tip incision pieces 15 and 16 also increase, whereby the tip end side portions 15c and 16c of the pair of tip incision pieces 15 and 16 open in a fan shape. Go (Fig. 3 (A)). Therefore, when the operation wire 12 is relatively moved with respect to the sheath 11, the tip side portions 15c and 16c of the pair of tip incision pieces 15 and 16 open and close in a fan shape.

A pair of annular projecting seats 14c, 14c provided around the support shaft 18 at the tip of the facing surface of each arm 14b are in contact with the middle portions 15a, 16a of the pair of tip incisions 15, 16. .. This guarantees that the pair of tip incision pieces 15 and 16 rotate smoothly without lateral vibration or lateral displacement.

Other basic configurations will be described. The tip treatment portion support member 14 and the pair of tip incision pieces 15 and 16 are made of stainless steel or nitinol (nickel titanium alloy), and are hydrophilic to the tip treatment portion support member 14 and the resin outer cover 11b of the sheath 11. A coating is formed so that the pair of tip incisions 15, 16 to the sheath 11 can be smoothly introduced into the body cavity without twitching.

The tubular portion 14a of the tip treatment portion supporting means 14 and the tip portion of the coil sheath 11a are connected by welding, brazing, or soldering. The outer shape of the tip of the coil sheath 11a may be ground to provide a small diameter portion, and the tubular portion 14a may be fitted and fixedly connected to the small diameter portion.

Therefore, by advancing and retreating the operation wire 12, the tip side portions 15c and 16c of the pair of tip incision pieces 15 and 16 can be opened and closed in a fan shape, and when the operation wire 12 is closed, a high frequency current is applied to the inside of the body cavity. It is possible to perform treatment such as incising the living tissue while electrocauterizing and stopping bleeding.

[Characteristic configuration of electric cautery incision tool for endoscopes]

The pair of tip incisions 15, 16 are formed from a conductive material. The tip side portions 15c and 16c are formed in a rod shape having a facing surface portions 15d and 16d and having a rectangular cross section perpendicular to the length direction. The pair of tip incision pieces 15 and 16 are fed via the operation wire 12 to become electrode surfaces, and are applied to the living tissue not only on the facing surface portions 15d and 16d but also on the total length and the entire peripheral surface of the tip side portions 15c and 16c. Electric cauterization is performed.

In each of the tip side portions 15c and 16c, outer protrusions 15e and 16e for scratch locking and marking are formed on the outer surface tip portions on the opposite side to the facing surface portions 15d and 16d. The outer protrusions 15e and 16e have a function of being caught on the mucous membrane without slipping when the tip incision pieces 15 and 16 are moved laterally in a closed state to perform an incision procedure as a scalpel.

Further, each of the tip side portions 15c and 16c has inner protrusions 15f and 16f for maintaining a gap at the tip portions of the facing surface portions 15d and 16d. The base end side portions 15b and 16b are connected to the operation wire 12 via the opening / closing operation links 19 and 20 and the advance / retreat transmission link 21.

The tip side portions 15c and 16c are opened and closed by receiving the advancing and retreating motion force of the operating wire 12, and are closed when the operating wire 12 is in the retired state, and the facing surface portions 15d and 16d are in a parallel state. And it is kept in close proximity.

When the tip side portions 15c and 16c are closed, the inner protrusions 15f and 16f are in contact with each other so that the gap c between the facing surface portions 15d and 16d holds a minute dimension of, for example, 0.2-1.0 mm. Close to each other.

The inner protrusions 15f and 16f may be provided at the base end portion or the middle portion instead of the tip end portions of the facing surface portions 15d and 16d. Further, either one of the outer protrusions 15e and 16e may be provided. Further, either one of the inner protrusions 15f and 16f may be provided.

When the inner protrusions 15f and 16f are provided at the tips of the facing surface portions 15d and 16d, in addition to the function of maintaining the gap spacing, when the pair of tip incision pieces 15 and 16 are closed from the fan-shaped open state. In addition, it has a mucosal retention function. The mucosal retaining function is that when a pair of tip incisions 15 and 16 are closed from a fan-shaped open state, a lesion portion located between the facing surface portions 15d and 16d is located from the facing surface portions 15d and 16d. It is a function of catching and holding on the mucous membrane of the lesion so as not to escape in the direction of the tip between the facing surfaces 15d and 16d under pressure.

When the operation wire 12 is pulled toward the base end side of the inner protrusions 15f and 16f in the mucosal peeling process, the operation wire 12 is in the most retired state, and the tip side portions 15c and 16c are closed and the inner protrusions 15f and 16f are closed. When the 16fs come into contact with each other, the facing surface portions 15d and 16d are held in a state of being close to each other substantially in parallel.

[Function of tip treatment section consisting of tip incision pieces 15 and 16]
Since the tip treatment portion composed of a pair of tip incision pieces 15 and 16 is configured as described above in the electrocautery incision tool 10 for an endoscope, the marking function by electrocauterization is performed in the ESD procedure described in detail below. It has an incision function, a closed hemostasis function, and a blood vessel cutting avoidance function, and is excellent in operability.

[Marking function]
As shown in FIG. 5A, the first treatment in the ESD procedure is to place an appropriate number of dot-shaped marks (marking marks) m around the lesion A to determine the incision range (for example, 6 to 6 to 6). 12). Therefore, the insertion portion 2 of the endoscopic system 1 is inserted into the body cavity of the patient, the position of the lesion portion A is confirmed by the endoscopic image, and the tip portion of the sheath 11 inserted into the endoscopic channel 5 is inserted. The tip treatment part (a pair of tip incisions 15, 16) is projected from the tip of the endoscope, and for example, the lateral protrusion 15e or 16e protruding 0.5 mm is pressed against the mucous membrane around the lesion A to the tip treatment part. Energize high frequency current. As a result, the pressing position of the mucous membrane around the lesion A is slightly inserted by the outer protrusion 15e or 16e, and the outer protrusion 15e or 16e does not slip on the mucosal surface, so that the marking mark m is electrocauterized at the target position. It is formed. After that, the high-frequency current is shielded to separate the outer protrusion 15e or 16e from the mucous membrane, and the outer protrusion 15e or 16e is moved to the next pressing position of the mucous membrane around the lesion A to form a pressing marking mark m. This is repeated to form an appropriate number of dot-shaped marking marks m in a circumferential arrangement, and the marking procedure is completed. After completing the marking procedure, a liquid such as hyaluronic acid is subsequently locally injected into the submucosal layer of the lesion, as shown in FIG. 5 (B). Replace the endoscopic electrocautery incision tool 10 with an endoscopic injection tool G that can feed a liquid such as hyaluronic acid, and insert it at the outer position of the marking mark m toward the submucosal layer of the lesion A. , The mucous membrane of the lesion can be lifted by injecting the drug solution.

[Incision function]
After the mucous membrane of the lesion A is raised, an annular recess R is incised in the mucous membrane at the outer peripheral position of the marking mark m as shown in FIG. 5 (C). Therefore, the endoscopic electric ablation incision tool 10 is replaced again, the lateral protrusions 15e and / or 16e are pressed against the mucous membrane around the lesion A, a high-frequency current is applied to the tip treatment portion, and the marking mark m. Make a round of the outer circumference of. As a result, the pressing position of the mucous membrane around the lesion A is slightly inserted by the outer protrusions 15e and / or 16e, and the outer protrusions 15e or 16e are electrocauterized to the target position because they do not slip on the mucosal surface. R can be incised.

[Peeling function]
After incising the annular recess R, the lesion A is subsequently stripped off little by little, as shown in FIG. 5 (D). Therefore, the pair of tip incision pieces 15 and 16 of the electric ablation incision tool 10 for endoscopy are closed, both of the outer protrusions 15e and 16e are aligned with the annular recess R, and a high-frequency current is applied toward the submucosal layer of the lesion A. Each time the energization is applied and the size is slightly inserted by electrocautery, the pair of tip incisions 15 and 16 are opened at a small angle, the incision width is widened, and the incision is repeatedly closed. By adjusting the opening angle of the pair of tip incisions 15 and 16 to the diameter and reaching the other end of the annular recess R, the incision is peeled off from the submucosal layer including the lesion A. When the pair of tip incisions 15 and 16 are opened at a small angle, the lateral projections 15e and 16e catch the submucosal tissue, so that the incision can be made well.

As the peeling function, a method of giving another operation to the pair of tip incision pieces 15 and 16 may be used. After closing the pair of tip incisions 15 and 16 and piercing the submucosal layer of the lesion A from one end of the annular recess R to the other end in the radial direction by electrocautery, the pair of tip incisions 15 and 16 are opened and remain open. When the operation is to pull to the insertion position, or when the pair of tip incisions 15 and 16 are closed, the middle of one tip incision is aligned with one end of the annular recess R, and the other end in the radial direction is cut open by electrocautery. It may be the case.

[Closed hemostatic function]
After removing the lesion A, hemostasis is subsequently performed on the surface of the living body from which the lesion A has been removed, as shown in FIGS. 5 (E) and 5 (F). Therefore, the pair of tip incisions 15 and 16 are opened in an appropriate fan shape and pressed against the surface of the living body so as to sandwich the lesion A, and a high-frequency current is supplied to perform electrocautery while the operation wire 12 is the base end. When pulled slightly to the side, the operation wire 12 is in the fully retracted state, and the pair of tip incision pieces 15 and 16 are closed at a slow speed to sandwich the surface from which the lesion A has been removed, and the electric ablation is maintained for a predetermined number of seconds to stop bleeding. ..

When the distance c between the facing surface portions 15d and 16d is 0.2-1.0 mm, Joule heat is generated at high density between the facing surface portions 15d and 16d, and the lesion tissue sandwiched between the facing surface portions 15d and 16d The mucous membrane is transformed into a large amount of bubbles by Joule heat, and these bubbles flow in the excision direction so as to take away the heat between the facing surface portions 15d and 16d, so that the facing surface portions 15d and 16d are satisfactorily dissipated. As a result, Joule heat is generated between the facing surface portions 15d and 16d to be fed, and the mucous membrane swinging on the facing surface portions 15d and 16d generates a large amount of bubbles and decomposes, and a large amount of bubbles flow in the cutting direction together with the heat. Therefore, when making an incision by sandwiching it, the lesion can be incised so as to be safely separated from a healthy living tissue.

[Vascular cutting avoidance function]
In the above-mentioned closed hemostasis function, even if the pair of tip incision pieces 15 and 16 are in the closed state, the facing surface portions 15d and 16d do not come into close contact with each other, and the gap c has a minute size of, for example, 0.2-1.0 mm. Is retained. Therefore, even if the blood vessel is pinched at the time of incision, there is no risk of crushing and occluding or cutting the blood vessel, and the bubbles move in the excision direction with heat, and the temperature rise of normal living tissue after excision of the lesion increases. It is suppressed from passing, the risk of delayed-acting perforation at the incision site is eliminated, and the operability at the time of incision is excellent.

[Embodiment 2]
As shown in FIG. 2, the electrocautery incision tool for an endoscope of the present embodiment includes a sheath 11, an operation wire 12, an operation portion 13, a tip treatment portion support member 14, and a pair shown in FIG. Instead of the tip incision pieces 15 and 16, a tip treatment portion composed of a pair of tip incision pieces 15A and 16A shown in FIG. 4 is provided.

The tip treatment portion composed of the pair of tip incision pieces 15A and 16A is formed in a rod shape in which the tip side portions 15c and 16c have facing surface portions 15d and 16d, and the tip side portions 15c and 16c are formed with the facing surface portions. The outer protrusions 15e and 16e for scratch locking and marking are formed on the tip of the outer surface on the opposite side, and in the closed state, the facing surfaces 15d and 16d are in close contact with each other.

According to the tip treatment section of this embodiment, the tip treatment section composed of the pair of tip incision pieces 15 and 16 is configured as described above. Similarly, as a function that can perform multiple treatments on living tissues in the body cavity, it has a marking function by electrocautery, an incision function, and a closed hemostasis function. It is possible to provide an electric cautery incision tool for an endoscope, which can save time and effort for insertion / removal and replacement, and has excellent operability.

On the other hand, according to the advanced treatment portion of this embodiment, in the closed state, the facing surface portions 15d and 16d are not in close proximity to each other but in close contact with each other. Not prepared.

According to the present invention, a tip incision tool composed of a pair of tip incisions can be applied to a biological tissue in a body cavity in an ESD procedure, such as a marking function by electrocautery, an incision function, a closed hemostasis function, and a blood vessel cut. It is possible to provide an electric cautery incision tool for an endoscope which has an effect of having an avoidance function and is excellent in operability.

1 ... Endoscope system,
2 ... Insertion part,
3 ... Endoscope operation unit,
4 ... Treatment tool introduction part,
5 ... Endoscopic channel,
10 ... Electric cautery incision tool for endoscopes,
11 ... Sheath,
11a ... Coil sheath,
11b ... Resin jacket,
12 ... Operation wire,
13 ... Operation unit,
13a ... Operation unit body,
13b ... Slider,
14 ... Tip treatment part support member,
14a ... Cylinder,
14b ... arm,
14c ... Circular protrusion,
15, 16 ... Tip incision piece,
15a, 16a ... Middle part,
15b, 16b ... Base end side part,
15c, 16c ... Tip side part,
15d, 16d ... Facing surface,
15e, 16e ... outer protrusion,
15f, 16f ... Inner protrusion,
18 ... Support shaft,
19, 20 ... Link for opening / closing operation,
21 ... Advance / retreat transmission link,
22, 23, 24 ... Pin shaft c ... Gap.

Claims (3)

A flexible coil sheath that can be inserted into and removed from the endoscope channel,
A conductive operation wire arranged in the coil sheath so as to be able to move forward and backward,
An operation unit connected to each rear end side of the coil sheath and the operation wire to advance / retreat the operation wire, and an operation unit.
A tip treatment portion support means having a cylinder portion provided at the tip portion of the coil sheath and a pair of opposed arm portions extending toward the tip end side of the cylinder portion.
It has a pair of tip incisions molded from a conductive material, and the pair of tip incisions are pivotally supported between the pair of arms of the treatment portion support means and opened and closed in conjunction with the advance and retreat of the operation wire. It is equipped with a tip treatment part that incises the affected part of the living tissue by applying the required voltage.
The tip treatment part is
The tip end side portion of each of the tip incision pieces is formed in a rod shape having a facing surface portion.
An electrocautery incision tool for an endoscope, wherein each of the tip side portions is formed with an outer protrusion for scratch locking and marking on the tip portion of the outer surface opposite to the facing surface portion. The pair of tip incisions are provided with an inner protrusion at the tip of at least one of the facing surfaces, and in the closed state, the facing surfaces are configured to be close to each other with a gap by the inner protrusion. An electric cautery incision tool for endoscopes, which is characterized by being present. An electrocautery incision tool for an endoscope, wherein the pair of tip incisions are configured such that the facing surfaces are in close contact with each other in a closed state.

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