JP3342034B2 - High frequency treatment tool - 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 treatment device for applying a high-frequency current only to a tissue portion requiring treatment such as resection to perform a medical treatment.

[0002]

2. Description of the Related Art A high-frequency treatment device is used for various surgical operations, and recently, it is often used for operations under observation of an endoscope without laparotomy. Conventionally, when performing a procedure such as excision or hemostasis, a portion to be treated is grasped with one treatment tool using two treatment tools so that the treatment is facilitated (by moving to a position where treatment is easy). ) Another treatment tool (mainly a high-frequency treatment tool) was used for treatment.

According to this method, since two treatment tools are used, the operation becomes complicated, and the number of insertion tools for inserting various treatment tools and endoscopes which can be opened in the body skin for a patient. However, there are two drawbacks in that the load increases and the burden increases. In addition, according to the above-described method, the high-frequency treatment instrument often touches normal tissue other than the target site, and thus may cause electrical damage to the normal tissue.

For this reason, for example, Japanese Patent Application Laid-Open No. 61-50106
No. 8 discloses a surgical treatment tool capable of performing treatment by sandwiching a target portion at the distal end of the treatment tool and applying a high-frequency current to a member sandwiched between the target portions.

[0005]

In the above-mentioned conventional treatment device, the member for flowing the high-frequency current is exposed to the outside, and the normal living tissue around the target site is electrically damaged. There is a disadvantage that it will.

[0006] The present invention has been made in view of the above points, and has as its object to provide a high-frequency treatment instrument which can simplify high-frequency treatment and can ensure safety.

[0007]

To the means and act to solve the problem] tip distal clasps
A high-frequency treatment device for performing a medical treatment by inserting a high-frequency current into a living body and performing medical treatment, wherein the distal-end gripping portions face each other.
Openable and closable, with at least one
At least from one end of the gripping surface to the vicinity of the other end.
One line-shaped electrode;
The target tissue is grasped on the opposing gripping surface of the tip gripping part because the parts other than the pin-shaped electrode are electrically insulated.
By sandwiching and grasping, high-frequency treatment such as excision can be easily performed with the electrode provided on the grasping surface , and safety is secured by preventing electrical damage to living tissue other than the area where the electrode contacts. are doing.

[0008]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Embodiments of the present invention will be specifically described below with reference to the drawings. 1 and 2 relate to a first embodiment of the present invention. FIG. 1 shows the entire configuration of the high-frequency treatment device of the first embodiment, and FIG. 2 is an enlarged view of a distal end grip portion formed at the distal end of the high-frequency treatment device. Is shown.

As shown in FIG. 1, a high-frequency treatment instrument 1 according to a first embodiment has a rigid shaft portion 2, a tip grip portion 3 formed at the tip of the shaft portion 2, and a rear end of the shaft portion 2. It is composed of a pair of handles 4a, 4b provided. The pair of handles 4a and 4b are rotatably connected by a pin 5, and a finger hook is formed at a lower end. The rear end of the pipe 2a forming the shaft 2 is inserted into the top of one handle 4a, and is fixed with an adhesive or the like.

The rear end of the shaft rod 2b inserted into the pipe 2a is connected to an insulating member 6, and the hemispherical portion at the rear end of the insulating member 6 is housed in a groove formed on the top of the other handle 4b. ing. A high-frequency pin 7 protrudes from the top of one handle 4a, and two contacts (not shown) at the base end of the high-frequency pin 7 are connected to a pipe 2a forming the shaft portion 2 or a shaft inserted into the pipe 2a. It is electrically connected to two conductors (not shown) of the rod 2b. The pipe 2a and the shaft 2b are electrically connected to the electrodes 8a and 8b (see FIG. 2) provided on the holding members 3a and 3b forming the tip holding portion 3. The pair of handles 4a and 4b are coated with insulation.

As shown in the enlarged view of FIG. 1, the tip of the shaft portion 2 is connected to a pair of gripping members 3a, 3b via a link mechanism 9 to move the shaft 2b forward and backward. Thus, the pair of gripping members 3a, 3b can be opened and closed. An O-ring 11 is interposed at the tip of the shaft 2b and the pipe 2a to form a watertight structure. or,
The outer peripheral surface of the pipe 2a is covered with an insulating tube 12.

FIG. 2 shows the gripping members 3a and 3b in an enlarged manner. Electrodes 8a and 8b are provided on gripping surfaces 13a and 13b of the gripping members 3a and 3b for gripping living tissue.
That is, the line-shaped electrodes 8a and 8b are embedded at opposing positions on the opposing inner gripping surfaces 13a and 13b of the gripping members 3a and 3b, respectively.
When a and 3b are closed, they come into contact with each other.

The electrodes 8a and 8b are electrically connected to conductors of the pipe 2a or the shaft 2b by lead wires (not shown) (for example, one conductor is a pipe 2a and the other conductor is a lead wire insulated from the pipe 2a). ing. The surfaces of the gripping members 3a, 3b other than the electrodes 8a, 8b are coated with insulation.
The areas of the electrodes 8a and 8b are equal, and
a, 13b are provided sufficiently smaller than the entire area.

An example of use of the first embodiment will be described. First, a puncture hole is made in the abdomen or the like of a living body with a trocar (not shown), and a scope or this high-frequency treatment instrument 1 is inserted.
Further, the high frequency pin 7 is connected to a high frequency power supply via a cable, and a switch of the high frequency power supply is turned on.

Opening the gripping members 3a, 3b by gripping the handles 4a, 4b as shown in FIG. 1 and performing an operation of opening the other handle 4b with respect to one handle 4a as shown by a two-dot chain line. Can be. Then, the gripping members 3a, 3b are closed so as to grip the target tissue to be cut by the opened gripping members 3a, 3b. Then, the electrodes 8a, 8
The high-frequency current flows during the period b, and the tissue in contact with the electrodes 8a and 8b can be cut by the high-frequency current. After closing the grip members 3a and 3b, a high-frequency current may be supplied by turning on a foot switch or the like.

According to the first embodiment, the distal end gripping portion 3 is also insulated except for the electrodes 8a and 8b, so that normal tissues other than the target site are not electrically damaged and are safe.

Further, since the area of the electrodes 8a and 8b is sufficiently small, it is possible to reliably perform a treatment such as excision (the electrodes 8a and 8b).
The energy developed in b is proportional to the reciprocal of its surface area). Conventionally, treatment using two treatment tools is performed with one treatment tool, so that the number of insertion holes to be opened in the patient can be reduced, and the burden on the patient can be reduced. further,
The procedure can be completed easily and in a short time from the viewpoint of the surgeon.

FIG. 3 shows a tip grip 21 according to a second embodiment of the present invention. In the second embodiment, a pair of electrodes 22a, 22b and 23a, 23b are provided on both sides in addition to the electrodes 8a, 8b of the gripping members 3a, 3b shown in FIG. In this embodiment, the central electrodes 8a and 8b are electrodes through which a current for ablation flows, and the electrodes 22a, 22b and 23 on both sides thereof.
Reference numerals a and 23b denote electrodes through which a hemostatic current flows. Electrode 2
2a, 22b and 23a, 23b are, for example, electrodes 8a, 8b
Although the shape and area are the same as those described above, the waveform of the flowing current is different.

The electrodes 22a, 22b and 23 facing each other
a and 23b are high-frequency pins 7 via lead wires (not shown).
Is connected to An ablation current is supplied to the electrodes 8a and 8b from the high-frequency power supply via the high-frequency pin 7, and a hemostatic current is supplied to the electrodes 22a and 22b and 23a and 23b. Other configurations are the same as in the first embodiment.

According to this embodiment, when a target site is cut or cut, a cutting current is applied to the electrodes 8a and 8b and a hemostatic current is applied to the electrodes 22a and 22b and 23a and 23b at the same time. At the same time as the target portion is cut into two portions at the portions corresponding to the electrodes 8a and 8b, a hemostatic treatment can be performed. Other functions and effects are the same as those of the first embodiment.

By the way, the sealing valve (auto valve, trumpet valve) attached to the conventional trocar has a biased valve which is always in contact with the scope when the scope is inserted.
Not applicable to flexible scope. Further, since the structure of the valve is complicated, cleaning is troublesome. For this reason, a trocar with a torsion valve as shown in FIG.

One end of a flexible tube 34 provided with a plurality of spiral grooves 33 on the outer periphery is connected to the proximal side of the flange-like base 32 of the outer tube 31 of the trocar. The other end of the flexible tube 34 is connected to an opening of the flange base 35, and this opening communicates with the opening of the flange base 32 via the flexible tube 34, that is, the lumen of the mantle tube 31.

The two bases 32 and 35 are connected by a biasing member 36 such as a spring provided on the outer periphery of the flexible tube 34. The flexible tube 34 is twisted in a normal state by the biasing force of the biasing member 36. And the opening of the trocar is closed. The flexible tube 34 has a spiral groove 33.
Is provided, so that it can be easily twisted. When the urging member 36 is removed, as shown in FIG.
1 is in a normal tubular state in which the tube 34 is connected.

The operation of the mantle tube 31 is as follows. In the state shown in FIG. 4 (a), the opening of the flexible tube 34 is largely opened by applying an external force to return the torsion of the flexible tube 34, and a scope, a treatment tool or the like is inserted therein. Numeral 34 tries to return to the original state by the urging member 36 (the opening is about to be closed). This provides an airtight structure even when the insert is inserted.

Therefore, the airtight structure can be easily maintained. In addition, since the valve structure and the like are not complicated structures and are formed as a single tube, the cleaning performance is improved. Furthermore, it is possible to keep the inserts of any diameter airtight.

Incidentally, when the double lumen tubes are merged into one such as the air / water supply tube, they may be merged as shown below. A pipe 4 having two circular cross sections of a double lumen tube 41 shown in FIG.
The semicircular portions 2 (43) facing each other (adjacent) are cut so as to be removed from the end side, as shown in FIG. 5B.
Then, the opposing cut surfaces 44 and 45 are merged in a tapered shape, and the two opposing cut surfaces 44 and 45 are joined to form an adjacent semicircular portion into a circular shape, as shown in FIG. Tube.

On the other hand, as shown in FIGS. 6A and 6B, in the two tubes 51 and 52, one of the tubes 51 is cut to the center at right angles to the axis, and the outer surface is cut in the radial direction from the cut surface. The tube 52 is cut into a tapered shape, and the other tube 52 is cut out from the center in a tapered shape in the outer diameter direction from the center. The tubes 51 and 52 are joined so that they merge smoothly at the cut surface to form a merged tube as shown in FIG.

According to the tubes shown in FIGS. 5 and 6, since the tubes are joined to each other, the size of the pipe connection can be reduced. Further, since the air / water supply conduit can be easily joined, the flow path is simplified. In addition, since the space for the tube connection can be saved, the diameter of the scope can be reduced. In addition, since the flow path of the fluid is simplified, the cleaning property is improved.

It should be noted that the shaft portion 2 in FIG. 1 may be made flexible so that it can be used by being inserted through the channel of the flexible endoscope. In addition, the structure is not limited to the structure in which the two gripping members open and close the tip gripping portion, and three or more gripping members may be opened and closed, and electrodes may be provided on the opposite gripping surfaces of two or more gripping members.

[0030]

As described above, according to the present invention, since the electrodes are provided on the opposite gripping surfaces of the gripping members forming the tip gripping portions, electrical damage is caused to the tissue other than the target tissue to be cut or the like. Can be prevented and safety can be improved.
In addition, high-frequency treatment such as excision can be easily performed by a gripping operation.

[Brief description of the drawings]

FIG. 1 is an overall configuration diagram of a high-frequency treatment device according to a first embodiment of the present invention.

FIG. 2 is an enlarged perspective view showing a distal end grip portion of the high-frequency treatment device according to the first embodiment.

FIG. 3 is an enlarged perspective view showing a distal end grip portion in a high-frequency treatment device according to a second embodiment of the present invention.

FIG. 4 is a perspective view showing the structure of a trocar mantle tube with a torsion valve.

FIG. 5 is an explanatory view showing one example of a process for forming a double lumen tube.

FIG. 6 is an explanatory view showing another example of the step of forming the double lumen tube.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... High frequency treatment tool 2 ... Shaft part 3 ... Tip holding part 3a, 3b ... Holding member 4a, 4b ... Handle 5 ... Pin 7 ... High frequency pin 8a, 8b ... Electrode 9 ... Link mechanism 12 ... Insulating tube 13a, 13b ... Holding surface

Claims (4)

(57) [Claims] 1. A high-frequency treatment instrument having a distal end grip portion at a distal end thereof, which is inserted into a living body to apply a high-frequency current to carry out a medical treatment, wherein the distal end grip portion has an opposite gripping surface and can be freely opened and closed. Arrangement
From one end of at least one of the gripping surfaces to the other end.
At least one linear electrode is provided alongside
And the parts other than the linear electrodes are electrically
A high-frequency treatment instrument characterized by being insulated . (2) The line-shaped electrodes are the opposite grips
2. The method according to claim 1, wherein each of the surfaces is provided.
The high-frequency treatment device as described in the above. (3) The line-shaped electrodes are the opposite grips
Characterized by being provided from the front end of the surface to the vicinity of the base end
The high-frequency treatment device according to claim 1 or 2, wherein (4) The linear electrodes are provided substantially in parallel.
Consists of three electrodes, and the center electrode is for cutting
It consists of electrodes through which current flows, and the remaining electrodes stop bleeding
The electrode comprises a current-carrying electrode.
4. The high-frequency treatment device according to any one of 1 to 3.