JP3162084B2 - High frequency knife for endoscope - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a high-frequency knife for an endoscope which is inserted endoscopically into a body cavity and incises, for example, a duodenal papilla.

[0002]

2. Description of the Related Art A high-frequency knife for incising an affected part in a body cavity using a high-frequency current has been known. This is described in, for example, Japanese Utility Model Laid-Open No. 61-67710 and
23.7 and JP-A-63-255050, a conductive wire is inserted into a flexible sheath having electrical insulation, and the distal end of the wire is connected to the sheath. The sheath is exposed at the outer wall surface of the distal end of the sheath, and the distal end of the sheath is bent by pulling the wire, and the exposed wire portion is stretched to form an incision. , And a high-frequency current is applied to the conductive wire to cut the affected part.

[0003]

When incising an affected part in a body cavity with a high-frequency knife, various problems may occur depending on the situation near the affected part.

For example, in the duodenum, when the outlet of the bile duct that carries bile into the duodenum is narrowed by a tumor, a calculus, or the like, a papillary sphincterotomy (hereinafter, referred to as EST) for incising the sphincter at the end of the bile duct is known. However, when performing an incision by this EST, if the pancreas side located near the right of the incision site is inadvertently incised, bleeding may occur due to blood vessels passing through the pancreas side, or this may occur. May cause acute pancreatitis as a cause.

Conventionally, when such incision is performed using the high-frequency knife, in order to avoid a situation in which the pancreas is inadvertently incised, the incision of the conductive wire of the high-frequency knife must be made when incising an affected part in a body cavity. However, when the sheath distal end side is viewed from the sheath proximal end side, the second quadrant (FIG. 2)
It is desirable that the position be within the hatched area on the coordinate plane shown in FIG.

[0006] However, despite these circumstances,
In the conventional high-frequency knife, incorrect use thereof is expected to cause an undesirable situation as described below.

That is, the high-frequency knife disclosed in Japanese Utility Model Application Laid-Open No. 61-67710, which is the conventional example, is configured such that the incision portion of the conductive wire can incise the affected part 13 in the body cavity in the positive y-axis direction shown in FIG. Have been.

[0008] The high frequency knife of G8709823.7 also has a stabilizing plate which is easily bent toward the incision portion in the sheath, and the bending of the entire knife has directionality and stability. The incision is intended to be reliably performed in the positive y-axis direction shown in FIG.

However, in the high-frequency knives shown in these conventional examples, the incised portion, which is the exposed portion of the conductive wire, is incurred when incising the affected part 13 in the body cavity or the like due to manufacturing errors or the like.
When the distal end side of the sheath is viewed from the proximal end side of the sheath, it may be shifted to the right from the positive y-axis direction shown in FIG. 24, and if the incision is located in the first quadrant in FIG. Inadvertently, the pancreas located in that direction may be incised, resulting in bleeding.

A high-frequency knife disclosed in Japanese Patent Application Laid-Open No. 63-255050 is provided with a coil-shaped shape memory alloy which is shape-memory-processed so as to be twisted in a circumferential direction by heating, in a distal end portion of a sheath. If the direction of the incision does not match the direction in which the affected part is to be incised, the coil is energized and heated to twist and rotate the coil in the circumferential direction, thereby fixing the sheath and the sheath. The incision is rotated so that the direction of the incision matches the direction in which the incision is to be made.

However, in this case, it is difficult to control the amount of rotation of the coil. Therefore, if the coil is rotated too much, the knife must be removed from the endoscope and reinserted, resulting in a loss of time. In addition, it was expensive due to its complicated structure.

The present invention has been made in view of the above circumstances, and an object thereof is to make an incision in the first quadrant region of an affected part when the affected part is captured on a coordinate plane by simple means. It is an object of the present invention to provide a high-frequency knife for an endoscope which can be prevented as much as possible, secures a safe incision in a second quadrant region, and is excellent in the stability of the incision action.

[0013]

In order to achieve the above-mentioned object, the present invention comprises inserting a conductive wire into a flexible sheath.
And inserted into two through holes provided at the distal end of the sheath.
To expose the distal end of the wire to the outer wall surface of the sheath.
Out of the sheath by pulling out and pulling the wire.
Curve the end and stretch the exposed wire
To a high-frequency knife for endoscopes with an incision
To regulate the bending direction of the distal end of the sheath.
Direction control means, and the distal end side of the sheath
The direction in which the direction control means curves when viewed from the base end side
0 to 90 ° counterclockwise from the center line of the sheath parallel to
The two through-holes are provided in the range.

[0014]

When the incision of an affected part or the like is made, when the distal end side of the sheath is viewed from the proximal end side of the sheath, the incision part is rotated counterclockwise from the bending direction of the sheath distal end by 0 ° to 90 °. °
In order to regulate the bending direction of the sheath distal end so that it is located within the range of, the incision, when capturing the affected part in the coordinate plane,
The affected part is incised in the area of the second quadrant, avoiding the area of the first quadrant.

[0015]

1 to 6 show a first embodiment of the present invention.

A high-frequency knife 1 for an endoscope shown in FIG. 1 has a sheath 2 made of a flexible tube having electrical insulation, and a conductive wire 3 is inserted through the sheath 2. Also,
A flat direction control member 6 as a direction control means for controlling the bending direction of the distal end portion of the sheath 2 is inserted from the distal end of the sheath 2 to the middle of the sheath 2 (of course, the sheath 2 is substantially omitted). It may be inserted over the entire length). The tip of the direction control member 6 is bent in the direction of an incision 5 described later. Since the width of the direction control member 6 is slightly larger than the inner diameter of the sheath 2, the direction control member
Is held in the sheath 2 by being held by the elastic force. Of course, the direction control member 6 for the sheath 2
Is not limited to this, and various methods can be considered. For example, a part of both ends of the direction control member 6 is embedded in the inner wall of the sheath 2 or fixed by bonding.

The base end of the wire 3 is connected to an operating body (not shown) for pushing and pulling the wire 3, and is connected to a high-frequency power source (not shown) via the operating body. ing. The tip of the wire 3 is
Of the pair of through holes 4, 4 pierced at predetermined intervals along the axial direction at the distal end of the sheath 2, the pair of through holes 4, 4 is led out to the outside from one of the proximal ends and is introduced again from the other side. As shown in FIG. 3, the foremost end is inserted through a through hole 7 formed in the direction control member 6 and is fixed on the back surface of the direction control member 6. Then, a portion of the wire 3 exposed to the outside of the sheath 2 along the axial direction forms an incision 5. When the distal end side of the sheath 2 is viewed from the proximal end side of the sheath 2, the incision 5 has a clockwise angle θ from the width direction (horizontal direction) of the direction control member 6 as shown in FIG. 30 ° -6
It is provided to be 0 °.

A high-frequency knife 1 for an endoscope having such a configuration.
When performing EST or the like by using a, the sheath 2 of the high-frequency knife 1 for an endoscope is inserted into a body cavity transendoscopically. Then, when a treatment target site is found under observation of the endoscope, as shown in FIG. 4, the distal end portion of the sheath 2 is protruded from the distal end opening 11 of the channel 12 of the endoscope 8 through the elevator 9. The raising table 9 is provided in the distal end portion of the channel 12 corresponding to the opening 11 and has a guide surface 10 for guiding the sheath 2 led out of the channel 12 to the side, so that the endoscope 9 can be viewed from the inside. Channel 12 of mirror 8
The distal end of the sheath 2 sent out from the inside is curved. At this time, the direction control member 6 inserted into the sheath 2
Is curved in the most bendable surface direction to regulate the bending direction of the distal end portion of the sheath 2. In other words, since the distal end of the sheath 2 passes through the raising table 9 and rises up reliably along the guide surface 10, the distal end of the sheath 2 is led out from the opening 11 of the endoscope 8 to the outside of the endoscope 8 in a stable state. Is done. At this time, since the distal end of the direction control member 6 is bent in the direction of the incision 5 as described above, the incision 5 connects the distal end of the sheath 2 to the proximal end of the sheath 2 as shown in FIG. When viewed from the sheath 2
It is located in the range of 0 ° to 90 ° counterclockwise from the direction in which the tip portion curves. Then, in this state, the incision 5 of the high-frequency knife 1 is brought close to the affected part 13, and an operating body (not shown) connected to the base end of the wire 3 is operated to pull the wire 3, thereby causing the distal end of the sheath 2 to be pulled. Affected part 1
When the incision 5 is bent in the direction of 3 and the incision 5 is brought into contact with the affected part 13, the incision 5 avoids the area of the affected part 13 in the first quadrant of the coordinate plane shown in FIG. An incision is made in the area of the second quadrant.

Therefore, according to the high-frequency knife 1 for an endoscope having the above-described structure, for example, incision in a dangerous region of the first quadrant can be prevented, and surely in a safe region of the second quadrant. An incision can be made and a stable incision can be made. In addition, since the direction control member according to the present embodiment is obtained by simply deforming a flat member,
The structure is simple and therefore inexpensive. Note that the incision 5 is not limited to the one in parallel with the axis of the sheath 2 as shown in FIG. 1, and may be provided so as to be twisted with respect to the axis of the sheath 2 as shown in FIG. This allows the incision
Twist toward the second quadrant as 14 goes to the tip
When making an incision by flowing high frequency, the incision 1
4 moves away from the first quadrant. Therefore, more secure
An incision can be made. The incision 5 is made of the sheath 2
As long as it is electrically conductive with the wire 3 inserted therein,
A member different from the portion of the wire 3 in the sheath 2 may be used in one direction.

FIGS. 8 to 12 show a second embodiment of the present invention. In the following, in each embodiment, portions common to the first embodiment will be denoted by the same reference numerals in the drawings, and detailed description thereof will be omitted.

The high-frequency knife 18 for an endoscope shown in FIG.
A direction control means for inserting a conductive wire 3 whose base end is connected to a high-frequency power supply into a flexible sheath 2 and for regulating a bending direction of a distal end of the sheath 2 as shown in FIG. The direction control member 15 in the form of a twisted plate is inserted from the distal end of the sheath 2 to the middle thereof.

The wire 3 has its distal end exposed along the axial direction to the outside of the sheath 2 through a pair of through holes 4 and 4 formed in the sheath 2 to form an incision 5. 3 is fixed at the tip of the direction control member 15.

Further, as shown in FIG.
5 is such that the distal end portion 16 is rotated counterclockwise by 30 ° to 60 ° with respect to the horizontal portion 17 of the proximal end portion when viewed from the sheath proximal end side.
° twisted, and this twisted tip 16 is
As shown in the figure, the sheath is disposed in the sheath 2 extending from the area of the incision 5 to the distal end thereof. Then, as shown in FIG. 10, the incision 5 is the distal end 1 of the direction control member 6.
6 is provided at a position where the angle from the width direction is 90 °. Therefore, the incision 5 is formed in the same manner as in the first embodiment.
When the distal end side of the sheath 2 is viewed from the proximal end side of the sheath 2, the position is 30 ° to 60 ° clockwise from the horizontal direction.

As shown in FIG. 10, the width of the distal end 16 of the direction control member 15 is formed slightly larger than the inner diameter of the sheath 2, and as shown in FIG.
Is formed to be slightly smaller than the inner diameter of the sheath 2, the direction control member 15 is held in the sheath 2 by sandwiching both ends of the twisted distal end portion 16 by the elastic force of the sheath 2. I have.

The high-frequency knife 1 for an endoscope having such a configuration.
8 is the channel 1 of the endoscope 8 as shown in FIG.
2, when the twisted tip 16 of the direction control member 15 passes through the guide surface 10 of the elevator 9 by sliding, the width direction of the twisted tip 16 follows the guide surface 10. The incision 5 is positioned vertically as viewed from the sheath base end side, but when the horizontal portion 17 next passes through the elevator 9 as shown in FIG. The sheath 2 is twisted counterclockwise due to the twist of the direction control member 15, and the incision 5 is located at the left from the bending direction of the distal end of the sheath 2 when the distal end of the sheath 2 is viewed from the proximal end side of the sheath 2. It is located in the range of 0 ° to 90 ° and protrudes as it is.

Therefore, the high-frequency knife 18 for an endoscope having the above configuration cuts out the area of the affected area 13 in the second quadrant, avoiding the area of the first quadrant on the coordinate plane shown in FIG. In other words, the high-frequency knife 18 can be prevented from being incised, for example, in the dangerous first quadrant region by the bending rigidity of the direction control member 15, and can be reliably incised in the safe second quadrant region, Moreover, a stable incision can be made.

FIGS. 13 to 15 show a third embodiment of the present invention. Similarly to the above embodiments, the high-frequency knife 21 for an endoscope according to the present embodiment also has a conductive sheath 3 (not shown) inserted through the flexible sheath 2 and, as shown in FIG. Twisted plate-shaped direction control member 19 as direction control means for restricting the bending direction of the distal end portion
Is inserted from the distal end of the sheath 2 to the middle thereof. In the direction control member 19, the rigidity of the left portion when viewed from the proximal end side of the sheath 2 is greater than the rigidity of the right portion. That is, as shown in FIG. 14, the left side is made thicker and the right side is made thinner so that the cross section is tapered. Moreover, as shown in FIG. 15, the left side may be bent so that its rigidity is stronger than that of the right side.

When the high-frequency knife 21 for an endoscope having the above structure is sent out from the channel 12 of the endoscope 8 as shown in FIG. 12 (a), when the distal end portion of the sheath 2 passes through the raising table 9, Since the right side of the directional control member 19, which is weak in rigidity, is greatly bent and rises due to the reaction force received from the guide surface 10, the incision 5 is formed by cutting the distal end of the sheath 2 by two sheaths, as shown in FIG. When viewed from the end, the sheath 2 is positioned counterclockwise from the curved direction of the distal end of the sheath 2 within a range of 0 ° to 90 °. 16 to 19 show a fourth embodiment of the present invention.

The high-frequency knife 24 for an endoscope of this embodiment is also
As shown in FIG. 16, a conductive wire 3 is inserted through a sheath 2 made of a flexible tube having electrical insulation. The proximal end of the sheath 2 is connected to the main body 27 of the operating body 25. The proximal end of the conductive wire 3 is connected to a slider 26 mounted on the main body 27 and slidable along the axial direction of the main body 27. That is, slider 2
The wire 3 can be pushed and pulled by sliding the wire 6 along the axial direction of the main body 27. Further, the slider 26 is connected to a high-frequency power source (not shown) via a cord. Therefore, the wire 3 is energized to the high frequency power supply via the cord and the slider 26.

As shown in an enlarged view in FIG. 19, the distal end of the wire 3 is provided at the distal end of the sheath 2 with a pair of through holes 28 formed at predetermined intervals along the axial direction. , 2
9, out of the first through hole 29 on the base end side,
It is again introduced into the inside from the second through hole 28 on the distal end side, and is fixed to, for example, the inner wall of the sheath 2. And wire 3
Of these, the portion exposed to the outside along the axial direction is the incision 5
Is formed. Further, as a direction control means for regulating the bending direction of the distal end portion of the sheath 2, the second through hole 28 is provided as shown in FIG.
As shown in FIG. 7, when viewed from the base end side of the sheath 2, the sheath 2 is formed obliquely from the upper left to the lower right with respect to the center axis direction. On the other hand, as shown in FIG. 18, the first through hole 29 is formed in the center axis direction.

Accordingly, if the high-frequency knife 24 for an endoscope having the above-described configuration is inserted into a body cavity endoscopically and a lesion to be treated is found under observation of the endoscope, the slider 26
Is slightly pulled toward the hand side to pull the wire 3 and curve the distal end of the sheath 2. At this time, the second through hole 28
When viewed from the proximal end side of the sheath 2, it is pierced obliquely from the upper left to the lower right with respect to the central axis direction.
When the incision 5 is biased to the left and the distal end of the sheath 2 is curved in the direction of the affected part 13, the distal end of the sheath 2 is inclined to the left, so the incision 5 also faces left.
Therefore, the incision section 5 makes an incision in the affected area 13 in the area of the second quadrant, avoiding the area of the first quadrant on the coordinate plane shown in FIG.

FIGS. 21 to 23 show a fifth embodiment of the present invention. The high-frequency knife 32 for an endoscope according to the present embodiment has both the through holes 30 and 31 through which the wires are inserted, as in the through hole 28 according to the fourth embodiment. Other configurations are the same as those of the fourth embodiment. Thereby, the leftward direction of the incision 5 can be further improved. It is needless to say that the present invention is not limited to the above-described embodiment, and various modifications can be made without departing from the scope of the present invention.

[0033]

As described above, according to the present invention, when incising an affected part or the like, when the distal end side of the sheath is viewed from the proximal end side of the sheath, the incision portion turns counterclockwise from the bending direction of the sheath distal end. Since the direction control means for regulating the bending direction of the sheath distal end portion is provided so as to be located within the range of 0 ° to 90 °, when the affected part is captured on the coordinate plane, the incision in the area of the first quadrant of the affected part is performed. In addition to this, the incision can be reliably made in the safe area of the second quadrant, and moreover, a stable incision can be made.

[Brief description of the drawings]

FIG. 1 is a plan view showing the vicinity of the distal end of a high-frequency knife for an endoscope according to a first embodiment of the present invention.

FIG. 2 is a longitudinal sectional view taken along line AA of FIG.

FIG. 3 is a longitudinal sectional view taken along the line BB of FIG. 1;

FIG. 4 is a longitudinal sectional view of a distal end portion of the endoscope into which the high-frequency knife of FIG. 1 is inserted.

FIG. 5 is a plan view of a distal end portion of the endoscope into which the high-frequency knife of FIG. 1 is inserted.

FIG. 6 is a schematic view showing a state where an affected part in a body cavity is incised by the high-frequency knife of FIG. 1;

FIG. 7 is a plan view of the high-frequency knife for an endoscope in which an exposure direction of an incision in FIG. 1 is changed.

FIG. 8 is a perspective view showing a state in which a direction control member of a high-frequency knife for an endoscope according to a second embodiment of the present invention is inserted into a sheath.

FIG. 9 is a longitudinal sectional view showing the vicinity of the tip of a high-frequency knife for an endoscope according to a second embodiment of the present invention.

FIG. 10 is a longitudinal sectional view taken along the line CC in FIG. 9;

FIG. 11 is a longitudinal sectional view taken along the line DD in FIG. 9;

FIG. 12 is a plan view of the distal end portion of the endoscope into which the high-frequency knife of FIG. 9 is inserted.

FIG. 13 is a cross-sectional view of a distal end portion of a high-frequency knife for an endoscope according to a third embodiment of the present invention.

14 is a longitudinal sectional view taken along the line EE in FIG.

FIG. 15 is a longitudinal sectional view showing a modification of the distal end portion of the high-frequency knife for an endoscope in FIGS. 13 and 14;

FIG. 16 is a plan view showing a schematic configuration of a high-frequency knife for an endoscope according to a fourth embodiment of the present invention.

FIG. 17 is a longitudinal sectional view taken along the line AA of FIG. 16;

18 is a longitudinal sectional view taken along the line BB of FIG.

19 is an enlarged view of a distal end portion of the high-frequency knife for an endoscope in FIG. 16;

20 is a schematic view showing a state in which a tip of the high-frequency knife for an endoscope in FIG. 16 is bent.

FIG. 21 is a plan view showing the vicinity of the distal end of a high-frequency knife for an endoscope according to a fifth embodiment of the present invention.

22 is a vertical sectional view taken along the line CC of FIG. 21.

FIG. 23 is a longitudinal sectional view taken along line DD in FIG. 21.

FIG. 24 is a schematic view of an affected part captured on a coordinate plane.

[Explanation of symbols]

 1, 18, 21 ... High-frequency knife for endoscope 2 ... Sheath 3 ... Wire 5 ... Incision part 6, 15, 20 ... Direction control member

──────────────────────────────────────────────────の Continuing from the front page (72) Inventor Toshitaka Hanzawa 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside O-Limpus Optical Industry Co., Ltd. (72) Inventor Kenichiro Maki 2-43-2 Hatagaya, Shibuya-ku, Tokyo (56) References JP-A-64-27555 (JP, A) (58) Fields investigated (Int. Cl. ⁷ , DB name) A61B 18/00-18/28 A61B 1 / 00

Claims (1)

(57) [Claims] 1. A conductive wire is inserted into a flexible sheath and inserted into two through holes provided at the distal end of the sheath.
The distal end portion of the wire exposed to the outside wall of the sheath through, with bending the distal portion of the sheath by pulling the wire, Put the exposed wire portion within which is adapted to form an incision in the high frequency knife for viewing mirror, the direction control means for regulating the bending direction of the distal end portion of the sheath is provided, the curved countercurrent of said direction control means when the front end portion of the sheath seen from the sheath proximal end
0 to 90 ° counterclockwise from the center line of the sheath parallel to
A high-frequency knife for an endoscope, wherein the two through holes are provided in the range of (1).