JP3922912B2

JP3922912B2 - Ultrasonic treatment device

Info

Publication number: JP3922912B2
Application number: JP2001350430A
Authority: JP
Inventors: 健一木村
Original assignee: Olympus Corp
Current assignee: Olympus Corp
Priority date: 2001-11-15
Filing date: 2001-11-15
Publication date: 2007-05-30
Anticipated expiration: 2021-11-15
Also published as: JP2003144450A

Description

【０００１】
【発明の属する技術分野】
本発明は、超音波振動で組織等を処置する超音波処置装置に関する。
【０００２】
【従来の技術】
この種、超音波処置装置の従来技術として、特開２０００−２９６１３５号公報や特開２００１−１７４４２号公報に開示されたものがある。
【０００３】
【発明が解決しようとする課題】
特開２００１−１７４４２号公報の超音波処置装置では主チャンネル管若しくは主チャンネル孔内に挿通した振動伝達部材を通じて伝達される超音波振動の最も先端側の節に位置して支持部材を配置し、この支持部材により振動伝達部材を緩く支持するようにしている。
【０００４】
ここで、支持部材の内径は振動伝達部材の外径よりも大きい。このため、振動伝達部材が主チャンネル管もしくは主チャンネル孔に対してしっかりと固定されることがなかった。超音波振動の最も先端に位置する節の位置でも主チャンネル孔に対してしっかりと固定されない。このため、超音波振動伝達時、振動伝達部材に横振動などの好ましくない超音波振動が発生し、振動エネルギーを先端処置部まで効率的に伝達できないことがあった。
【０００５】
また、特開２０００−２９６１３５号公報の超音波処置装置では外套管に挿通した超音波振動の最先端の節および先端から２番目の節の位置にスペーサを配置し、各スペーサにより振動伝達部材の先端部が下方へ向く力を受けるときの撓みが抑制されるようにしている。
【０００６】
しかし、ある一定以上の下方へ向く力が加わった状態で超音波振動を加えると、外套管の先端部に取り付けられた把持部材を保持する部材などの金属部品の内面と振動伝達部材が接触し、振動伝達部材がダメージを受ける可能性があった。
また、振動伝達部材の先端部に対する上方向および横方向への力を受けた際の撓みに関して所要の積極的な抑制がなされないため、上方向および横方向へ過剰な力が加わった状態で超音波振動を伝達すると、振動伝達部材が保持部材や開閉部材や操作ロッドなどの金属部品と接触し、振動伝達部材がダメージを受ける可能性があった。
【０００７】
本発明は上記事情に着目してなされたもので、その目的とするところは、振動伝達部材の先端部が上方向または横方向に過剰な力で押し付けられても振動伝達部材の大きな撓み変形を防止し、振動伝達部材のダメージを抑制することにある。
【０００８】
【課題を解決するための手段】
本発明は、生体組織を処置するための超音波振動を発生可能な超音波振動子を有する振動子ユニット（4）と、上記超音波振動子に接続され、上記超音波振動子で発生された上記超音波振動を伝達可能な振動伝達部材（10）と、上記振動伝達部材（10）が挿通されるシース（17）と、上記シース（17）の先端部に取り付けられ、上記振動伝達部材（10）の先端部との間で上記生体組織を把持可能に開閉自在な把持部材（35）と、上記振動伝達部材（10）で伝達される上記超音波振動の最も先端側の節が形成される位置よりも前方に位置して上記振動伝達部材（10）の周りに配置された押さえ部（45）を有し、上記押さえ部（45）と上記振動伝達部材（10）との間に隙間を形成し、上記隙間は、上記振動伝達部材（ 10 ）に対して上記把持部材（35）が位置する向き側を上側と見たときの上側に位置する隙間（ｙ）と、上記振動伝達部材（10）の横方向に位置する両方の隙間（ｘ，ｘ）と、上記振動伝達部材（10）の下側に位置する隙間（ｚ）とを含み、上記押さえ部（ 45 ）により上記振動伝達部材（ 10 ）の撓み変形を規制可能な支持部材（43）と、を具備し、上側に位置する隙間（ｙ）および横方向に位置する両方の隙間（ｘ，ｘ）を、下側に位置する隙間（ｚ）よりも小さくしたことを特徴とする超音波処置装置である。
【０００９】
【発明の実施の形態】
＜第１実施形態＞
図１〜図５を参照して本発明の第１実施形態に係る超音波処置装置について説明する。
【００１０】
（構成）
本実施形態の超音波処置装置１は図１に示すハンドルユニット２と、図２に示すプローブユニット３と、同じく図２に示す振動子ユニット４とから構成されている。
【００１１】
振動子ユニット４は円筒状のカバー５を有し、このカバー５内には図示しない超音波振動子と図５に示すホーン６とが設けられている。振動子ユニット４の基端にはハンドピースコード７が接続されている。ハンドピースコード７は図示しない電源装置に電気的に接続される。ハンドピースコード７を通じて電源装置から駆動用電力を超音波振動子に供給することによって超音波振動子が駆動される。超音波振動子にはホーン６が接続され、超音波振動子で発生した超音波振動をホーン６により増幅し、その振動の振幅を第１の段階まで拡大する。図５に示すように、ホーン６の先端にはプローブユニット３を取り付ける雌ネジ８が形成されている。また、振動子ユニット４の前端にはハンドルユニット２に連結する為の連結部９が設けられている。
【００１２】
図２に示すように、プローブユニット３は振動子ユニット４の超音波振動子で発生した超音波振動を伝達する棒状の振動伝達部材１０として形成されている。振動伝達部材１０の基端にはホーン６の雌ネジ８にねじ込まれる雄ネジ１１が形成されている。振動伝達部材１０はホーン６によって増幅された超音波振動の振幅をさらに第２の段階まで拡大する基端側ホーン１２と、この基端側ホーン１２の先端側に位置した中間部１３と、この中間部１３の先端側に位置し、且つ基端側ホーン１２によって増幅された超音波振動の振幅を最終段階まで拡大する先端側ホーン１４と、この先端側ホーン１４の先端側に位置した円柱状の先端部１５とから成る。そして、超音波振動子で発生した超音波振動はホーン６、基端側ホーン１２、及び先端側ホーン１４によって、次第に増幅され、振動伝達部材１０の先端部１５に伝達され、これにより先端部１５が最も強く振動する。
【００１３】
振動伝達部材１０の中間部１３には伝達される超音波振動の先端側から２番目以降の節に位置してフランジ状の支持体１６が複数個設けられている。各支持体１６は弾性材によって形成されている。各支持体１６は振動伝達部材１０がハンドルユニット２の挿入シース部１７の主チャンネル管１８内に挿通された状態で主チャンネル管１８の内面と弾性的に押圧接触しており、これにより振動伝達部材１０を主チャンネル管１８の中心部位に保持するとともに、振動伝達部材１０と主チャンネル管１８との接触を防止する。支持体１６の外径は主チャンネル管１８の内径よりもわずかに大きい。
【００１４】
図１に示すように、ハンドルユニット２は操作部１９と、この操作部１９に回転可能に取り付けられた長尺な外套管２０からなる挿入シース部１７と、この挿入シース部１７の先端に設けられた先端作用部２１とを備える。
【００１５】
ハンドルユニット２の操作部１９は操作部本体２２と、この操作部本体２２と一体に形成された固定ハンドル２３と、ハンドル枢支軸２４を介して操作部本体２２（または固定ハンドル２３）に回動可能に取り付けられた可動ハンドル２５とを有している。操作部本体２２の基端には振動子ユニット４を着脱自在に接続する振動子接続部２６が設けられている。
【００１６】
また、図５に示すように、可動ハンドル２５は操作部本体２２内のスライダ２７と係合する係合ピン２８を有している。操作部本体２２内には筒状のスライド部材２９が軸方向にスライド可能に設けられている。スライド部材２９の内周面には筒状の押さえ部材３０が取付けられ、この押さえ部材３０の内周面には振動伝達部材１０の基端側外周部分と圧接するゴムパッキン３１が取り付けられている。押さえ部材３０の外周部には圧縮コイルバネ３２と、押さえ部材３０に対してスライド自在な環状のスライダ２７とが設けられ、スライダ２７は上記係合ピン２８と係合している。
【００１７】
従って、可動ハンドル２５がハンドル枢支軸２４を中心に回動されると、係合ピン２８を介してスライダ２７に操作力が作用する。圧縮コイルバネ３２は常時圧縮付勢された状態で装着されているため、可動ハンドル２５に加えられたある一定以上の閉方向の操作力を吸収する。この構成によりスライド部材２９の最大操作力量を規定する過負荷防止機構を構成している。
【００１８】
図４に示すように、ハンドルユニット２の先端作用部２１は外套管２０の先端部に取り付けられた例えば金属製の保持部材３３と、この保持部材３３に枢支軸３４を介して回動可能に取り付けられた片開き型の把持部材３５を備えて成り、この先端作用部２１はプローブユニット３の先端部１５と共に超音波処置装置１の処置部３６を構成している。この片開き型の把持部材３５は先端部１５との間で生体組織を把持することによって生体組織を超音波振動する先端部１５に押し付け、プローブユニット３の先端部１５から生体組織への振動エネルギーの伝達を可能にする。把持部材３５の下面は先端部１５との間で組織を把持する把持面３７となっている。この把持面３７の横断面形状は図６（ａ）に示すように、振動伝達部材１０の先端部１５の横断面形状に合わせて円弧状に形成されている。
【００１９】
この把持面３７の両側にはその把持面３７の長手方向に沿って列をなす複数の歯３８が形成されている。これらの歯３８の列を配設した把持部材３５の基端部分には下方に突出した押さえ部３９が歯状に形成されている（図４および図６（ｇ）を参照）。これらの押さえ部３９は把持面３７の両側に位置して下方に突き出しており、この押さえ部３９によって上記振動伝達部材１０の横方向への移動を規制（抑制）するようになっている。
【００２０】
上記保持部材３３には把持部材３５の基部の移動を許容するために上下の向きに開放した切り欠き３３ａが形成されている。保持部材３３にはプローブユニット３の振動伝達部材１０が挿通される主チャンネル孔４０と、上記把持部材３５を回動操作する操作ロッド４１が挿通される副チャンネル孔４２とが形成されている。主チャンネル孔４０には例えばＰＴＦＥ等のフッ素樹脂等の摩擦係数の小さい材料によって形成された筒状の支持部材４３が密に嵌め込まれている。
【００２１】
支持部材４３は振動伝達部材１０を通じて伝達される超音波振動の最も先端の節のやや先端側に位置して配置されている。後述する支持ゴム４７は超音波振動の最も先端の節に位置して設けられるが、上記支持部材４３はその支持ゴム４７よりも先端側に離れて振動伝達部材１０の先端近傍となる位置に設置されている。
【００２２】
そして、上記支持部材４３は通常時、振動伝達部材１０に接触しない内周形状である。すなわち、支持部材４３の基端側部分は図６（ｄ）に示すように、振動伝達部材１０の長手方向の中心軸と同軸で真円の内周形状を有する基端部４４を形成している。また、支持部材４３の先端側部分は図６（ｃ）に示すように、略楕円の内周形状を有する押さえ部４５を形成している。
【００２３】
ここで、支持部材４３の押さえ部４５と振動伝達部材１０との隙間は次のように設定されている。
すなわち、図６（ｃ）に示すように、振動伝達部材１０の左右横方向の隙間をいずれもｘとし、振動伝達部材１０の上側の隙間をｙとし、振動伝達部材１０の下側の隙間をｚとするとき、各隙間ｘ、ｙ、ｚの寸法関係は、ｘ＝ｙ＜ｚとなるように設定されている。これにより、処置部３６で組織を把持した際に振動伝達部材１０の先端側部分が把持部材３５から受ける力によって撓む、下方への撓み量に比べ、振動伝達部材１０が横方向及び上方向への力を受けたときの撓み量が少なくなるように規制・抑制される。
【００２４】
尚、支持部材４３の基端側部分と振動伝達部材１０の周辺の隙間は図６（ｄ）で示すように全周にわたり同じであるが、この全周の隙間寸法は図６（ｃ）に示される押さえ部４５における振動伝達部材１０の下方向の隙間ｚと同じである。しかし、振動伝達部材１０は先端側程撓み量が大きいので、振動伝達部材１０は先に押さえ部４５に当る。
【００２５】
上記挿入シース部１７の外套管２０内にはプローブユニット３の振動伝達部材１０が挿通される主チャンネル管１８と、操作ロッド４１が挿通される副チャンネル管４６とが設けられている。図６（ｅ）（ｆ）に示すように、主チャンネル管１８はその断面形状が円形であり、副チャンネル管４６はその断面形状が左右に長い扁平な形状のものである。主チャンネル管１８の先端側内周には弾性体、例えばシリコンゴム等から成る支持ゴム４７がその主チャンネル管１８と一体的に設けられている。この支持ゴム４７は振動伝達部材１０を通じて伝達される超音波振動の最も先端に位置する節に配置されており、その支持ゴム４７の内径は振動伝達部材１０の中間部１３の外径よりもわずかに小さい。従って、支持ゴム４７は振動伝達部材１０の外周に密着して弾性力で押さえる状態で振動伝達部材１０を支持する。
【００２６】
また、図６（ｅ）（ｆ）に示すように、各チャンネル管１８および副チャンネル管４６と外套管２０との間の隙間には樹脂４８が充填されている。
【００２７】
図５および図６（ｂ）に示すように、操作ロッド４１の先端は枢支ピン４９を介して把持部材３５の基端部に連結されている。操作ロッド４１の基端側は図５に示すように、ハンドルユニット２のスライド部材２９に連結されている。従って、可動ハンドル２５を回動する操作を行なうことにより、先端作用部２１の把持部材３５の開閉が行われる。
【００２８】
（作用）
次に、上記超音波処置装置１を用いて組織を処置する場合について説明する。まず、ハンドルユニット２の把持部材３５と振動伝達部材１０の先端部１５との間に組織を位置させ、この状態で、可動ハンドル２５を閉方向に回動操作し、把持部材３５と先端部１５との間の組織を把持する。このとき、振動伝達部材１０は把持部材３５から受ける力によって下方に撓むが、保持部材３３には下方に開放した切り欠き３３ａが形成されているので、振動伝達部材１０が保持部材３３に接触することがなく、このため、保持部材３３に接触して振動伝達部材１０が破損することを防止できる。
【００２９】
このように組織を把持した状態で、電源装置から電力を超音波振動子に供給し、超音波振動子を振動させる。この超音波振動はホーン６、基端側ホーン１２、先端側ホーン１４によって増幅され、振動伝達部材１０の先端部１５まで伝達される。
【００３０】
この場合、振動伝達部材１０が複数の支持体１６及び支持ゴム４７により、主チャンネル管１８の中心部に保持されるため、振動伝達部材１０が主チャンネル管１８と接触することが防止される。また、支持体１６及び支持ゴム４７は超音波振動の節にそれぞれ位置し、振動伝達部材１０を主チャンネル管１８に対してしっかりと固定しているため、横振動などの好ましくない振動を抑止することができ、振動エネルギーを効率良く振動伝達部材１０の先端部１５に伝達できる。
【００３１】
以上のようにして超音波振動は振動伝達部材１０の先端部１５まで略損失なく伝達される。そして、先端部１５と接触する把持組織を超音波振動により切開すると共に摩擦熱によって凝固する。
【００３２】
ところで、上記の操作以外にも次のような操作が行なわれることがある。すなわち、組織を把持しないで（つまり、把持部材３５を開いた状態）、振動伝達部材１０の先端部１５を組織に強く押し付けた状態で、振動伝達部材１０に超音波振動を与える普通でない使用法が行なわれることである。この場合、振動伝達部材１０の先端部１５が下方へ向く力を受けたとき、振動伝達部材１０は前述した保持部材３３の切り欠き３３ａにより逃げながら撓み変形し、ある程度、大きく撓むと、支持部材４３に設けた押さえ部４５の下面に接触する。このように振動伝達部材１０が撓み変形したときに、押さえ部４５の下面に接触するため、振動伝達部材１０は保持部材３３に直接に接触することはない。このため、振動伝達部材１０はダメージを受けない。
【００３３】
また、振動伝達部材１０の先端部１５が上方へ向く力を受けたときは振動伝達部材１０は支持部材４３の押さえ部４５の上側面と接触することにより上方向への撓み変形が規制されるため、把持部材３５や操作ロッド４１などの金属部品に振動伝達部材１０が直接に接触することが阻止される。また、振動伝達部材１０の先端部１５が横方向へ向く力を受けたときには振動伝達部材１０が支持部材４３の押さえ部４５の横側面と接触することにより振動伝達部材１０の横方向への撓み変形が規制されるため、この場合にも把持部材３５や保持部材３３などの金属部品に振動伝達部材１０が直接に接触することがなく、振動伝達部材１０のダメージを回避できる。
【００３４】
さらに、振動伝達部材１０の横方向への撓み変形に関しては図６（ｇ）に示すように、把持部材３５の基端付近に設けた押さえ部３９によっても、その横方向への撓み変形が規制されるため、振動伝達部材１０の金属部品との接触がより効果的に防止される。すなわち、振動伝達部材１０の先端部１５が上下または横方向へ向く過剰な力で押し付けられた状態で、超音波振動が振動伝達部材１０の先端部１５に伝達されるような場合であっても、振動伝達部材１０はＰＴＦＥ等の摩擦係数が小さく柔軟な材料からなる支持部材４３と接触して、その撓み変形が規制・抑制され、他の金属部品との直接的な接触が防止されるため、振動伝達部材１０の破損を防止出来る。
【００３５】
また、上記支持部材４３は超音波振動の節のやや近くに設けられるため、振動伝達部材１０と支持部材４３との接触により超音波振動を阻害しない。すなわち、支持部材４３と振動伝達部材１０とが接触したとしても、超音波振動による摩擦熱の発生を抑止することができる。
【００３６】
勿論、上記支持部材４３は組織を把持しない、把持部材３５を開いた状態で振動伝達部材１０が上方または左右横方向への力を受けた場合の撓み変形を防止する場合に限らず、把持部材３５を閉じた状態でも撓み変形の防止作用が得られる。
【００３７】
（効果）
以上の如く、振動伝達部材１０は超音波振動の節に設けられた支持体１６及び支持ゴム４７により、主チャンネル管１８に対してしっかりと固定されているため、横振動などの好ましくない振動を抑止することができ、かつ、振動エネルギーを略損失なく効率的に振動伝達部材１０の先端部１５まで伝達することができる。また、支持部材４３を先端付近に設けたことにより、超音波振動が振動伝達部材１０に伝達されているとき、振動伝達部材１０の先端部１５が上下および横方向に過剰な力で押し付けられたとしても、その振動伝達部材１０の破損を防止することができる。
【００３８】
＜第２実施形態＞
図７を参照して本発明の第２実施形態に係る超音波処置装置について説明する。本実施形態は上述した第１実施形態の変形例であり、この第１実施形態と異なる部分を中心に説明する。
【００３９】
（構成）
本実施形態の超音波処置装置１では把持部材３５の後端側部分で振動伝達部材１０と対向する部位の面にはＰＴＦＥ等のフッ素樹脂からなる保護層５１を形成した。また、操作ロッド４１の先端側部分で振動伝達部材１０と対向する面にもＰＴＦＥ等のフッ素樹脂からなる保護層５２を形成した。各保護層５１，５２はいずれもコーティングや接着等により把持部材３５および操作ロッド４１に一体的に取り付けられている。
【００４０】
（作用・効果）
このような構成によれば、上述した第１実施形態と同様に使用できると共に、振動伝達部材１０の先端部１５が、仮に上方向および横方向に過剰な力で押し付けられた場合、振動伝達部材１０が把持部材３５や操作ロッド４１などの金属部品と接触することがより効果的に防止される。
【００４１】
尚、本発明は前述した各実施形態に限定されるものではなく、他の形態にも適用が可能である。
また、前述した説明によれば、以下に列挙する事項および以下に列挙した事項を任意に組み合わせた事項が得られる。
【００４２】
（付記）
１．超音波振動を発生する超音波振動子を有する振動子ユニットと、超音波振動子に接続され超音波振動子で発生した超音波振動を先端の処置部に伝達する振動伝達部材と、振動伝達部材が挿通されるシースと、シース先端に取付けられた把持部材とを具備し、上記振動伝達部材の先端近傍に、上記振動伝達部材の上方向および横方向の撓みを規制する支持部材を上記シース側の部材に設けたことを特徴とする超音波処置装置。
【００４３】
２．第１項において、支持部材は、振動伝達部材を通じて伝達される超音波振動の最も先端側の節の近傍に設けたもの。
３．第１項において、支持部材は、略楕円の内周形状を形成したもの。
４．第１項において、支持部材は、ＰＴＦＥ等のフッ素樹脂からなり、シースの先端に嵌め込まれているもの。
【００４４】
５．超音波振動を発生する超音波振動子を有する振動子ユニットと、超音波振動子に接続され超音波振動子で発生した超音波振動を先端の処置部に伝達する振動伝達部材と、振動伝達部材が挿通されるシースと、シース先端に取付けられた把持部材とを有する超音波処置装置において、把持部材は、ＰＴＦＥ等のフッ素樹脂からなり、把持部材の後端側には振動伝達部材の横方向の撓みを規制する押さえ部が形成されているもの。
【００４５】
６．超音波振動を発生する超音波振動子を有する振動子ユニットと、超音波振動子に接続され超音波振動子で発生した超音波振動を先端の処置部に伝達する振動伝達部材と、振動伝達部材が挿通されるシースと、シース先端に取付けられた把持部材とを有する超音波処置装置において、振動伝達部材を通じて伝達される超音波振動の最も先端側の節の位置に拘束部材（支持ゴム）を設けたもの。
【００４６】
７．第６項において、振動伝達部材を通じて伝達される超音波振動の先端側から２番目以降の節の位置には、支持体が振動伝達部材に一体的に設けられている。
８．第６項において、拘束部材（支持ゴム）は、シース先端の内腔に一体的に取付けたシリコンゴムであるもの。
【００４７】
【発明の効果】
以上説明したように本発明によれば、振動伝達部材の先端部が上方向または横方向に過剰な力で押し付けられても振動伝達部材の大きな撓み変形を防止し、振動伝達部材のダメージを抑制することができる。
【図面の簡単な説明】
【図１】第１実施形態に係る超音波処置装置のハンドルユニットの側面図。
【図２】同じく第１実施形態に係る超音波処置装置の分離した状態でのプローブユニットと振動子ユニットの側面図。
【図３】同じく第１実施形態に係る超音波処置装置の組立状態での側面図。
【図４】同じく第１実施形態に係る超音波処置装置の挿入シース部先端及び先端作用部の縦断面図。
【図５】同じく第１実施形態に係る超音波処置装置のハンドルユニットと振動子ユニットとの接続部の縦断面図。
【図６】（ａ）は図４のＡ−Ａ線に沿う部分の横断面図、（ｂ）は図４のＢ−Ｂ線に沿う部分の横断面図、（ｃ）は図４のＣ−Ｃ線に沿う部分の横断面図、（ｄ）は図４のＤ−Ｄ線に沿う部分の横断面図、（ｅ）は図３のＥ−Ｅ線に沿う部分の横断面図、（ｆ）は図３のＦ−Ｆ線に沿う部分の横断面図、（ｇ）は図４のＧ矢視図。
【図７】第１実施形態の変形例である第２実施形態を示し、図３のＢ−Ｂ線に沿う部分に対応した部分の横断面図。
【符号の説明】
１超音波処置装置
２ハンドルユニット
３プローブユニット
４振動子ユニット
１０振動伝達部材
１５先端部
１６支持体
１７挿入シース部
１９操作部
２０外套管
２１先端作用部
２２操作部本体
２３固定ハンドル
２５可動ハンドル
３１ゴムパッキン
３３保持部材
３５把持部材
３６処置部
３７把持面
３８歯
３９押さえ部
４１操作ロッド
４３支持部材
４５押さえ部
４７支持ゴム[0001]
BACKGROUND OF THE INVENTION
The present invention relates to an ultrasonic treatment apparatus for treating a tissue or the like with ultrasonic vibration.
[0002]
[Prior art]
As this type of conventional ultrasonic treatment apparatus, there are those disclosed in Japanese Patent Application Laid-Open Nos. 2000-296135 and 2001-17442.
[0003]
[Problems to be solved by the invention]
In the ultrasonic treatment apparatus disclosed in Japanese Patent Laid-Open No. 2001-17442, a support member is disposed at the most distal node of ultrasonic vibration transmitted through a main channel tube or a vibration transmission member inserted into the main channel hole, The vibration transmitting member is loosely supported by this supporting member.
[0004]
Here, the inner diameter of the support member is larger than the outer diameter of the vibration transmitting member. For this reason, the vibration transmitting member is not firmly fixed to the main channel tube or the main channel hole. Even the position of the node located at the extreme end of the ultrasonic vibration is not firmly fixed to the main channel hole. For this reason, at the time of ultrasonic vibration transmission, undesirable ultrasonic vibration such as lateral vibration occurs in the vibration transmission member, and vibration energy may not be efficiently transmitted to the distal treatment section.
[0005]
Further, in the ultrasonic treatment apparatus disclosed in Japanese Patent Laid-Open No. 2000-296135, spacers are disposed at the positions of the most distal node and the second node from the tip of the ultrasonic vibration inserted through the mantle tube, and the vibration transmitting member is arranged by each spacer. The bending when the tip portion receives a downward force is suppressed.
[0006]
However, if ultrasonic vibration is applied in a state where a certain downward force is applied, the vibration transmission member comes into contact with the inner surface of a metal part such as a member that holds the gripping member attached to the distal end of the outer tube. The vibration transmission member may be damaged.
In addition, since the required positive restraint is not restrained with respect to the bending when receiving the force in the upward and lateral directions with respect to the tip of the vibration transmitting member, it is necessary to apply excessive force in the upward and lateral directions. When the sonic vibration is transmitted, the vibration transmitting member may come into contact with a metal part such as a holding member, an opening / closing member, or an operating rod, and the vibration transmitting member may be damaged.
[0007]
The present invention has been made paying attention to the above circumstances, and the purpose of the present invention is to cause a large deformation of the vibration transmitting member even when the tip of the vibration transmitting member is pressed upward or laterally with an excessive force. This is to prevent and suppress damage to the vibration transmitting member.
[0008]
[Means for Solving the Problems]
The present invention relates to a vibrator unit (4) having an ultrasonic vibrator capable of generating ultrasonic vibration for treating a living tissue, and connected to the ultrasonic vibrator and generated by the ultrasonic vibrator. A vibration transmission member (10) capable of transmitting the ultrasonic vibration, a sheath (17) through which the vibration transmission member (10) is inserted, and attached to a distal end portion of the sheath (17), the vibration transmission member ( 10) a gripping member (35) that is openable and closable so as to grip the living tissue and a node on the most distal side of the ultrasonic vibration transmitted by the vibration transmitting member (10). A holding portion (45) disposed around the vibration transmission member (10) and positioned in front of the position where the gap is between the holding portion (45) and the vibration transmission member (10). is formed and the gap, the gripping member (35) position with respect to the vibration transmission member (10) Gap located above when the orientation side viewed the upper to (y) and both the gap (x, x) which is located laterally of the vibration transmission member (10) and said vibration transmission member (10) A support member (43) including a gap (z) positioned on the lower side and capable of restricting flexural deformation of the vibration transmitting member ( 10 ) by the pressing portion ( 45 ) , and positioned on the upper side The ultrasonic treatment apparatus is characterized in that both the gap (y) and the gap (x, x) positioned in the lateral direction are smaller than the gap (z) positioned on the lower side .
[0009]
DETAILED DESCRIPTION OF THE INVENTION
<First Embodiment>
The ultrasonic treatment apparatus according to the first embodiment of the present invention will be described with reference to FIGS.
[0010]
(Constitution)
The ultrasonic treatment apparatus 1 according to this embodiment includes a handle unit 2 shown in FIG. 1, a probe unit 3 shown in FIG. 2, and a transducer unit 4 also shown in FIG.
[0011]
The transducer unit 4 has a cylindrical cover 5, and an ultrasonic transducer (not shown) and a horn 6 shown in FIG. 5 are provided in the cover 5. A handpiece cord 7 is connected to the proximal end of the vibrator unit 4. The handpiece cord 7 is electrically connected to a power supply device (not shown). The ultrasonic vibrator is driven by supplying driving power from the power supply device to the ultrasonic vibrator through the handpiece cord 7. A horn 6 is connected to the ultrasonic vibrator, and the ultrasonic vibration generated by the ultrasonic vibrator is amplified by the horn 6 and the amplitude of the vibration is expanded to the first stage. As shown in FIG. 5, a female screw 8 for attaching the probe unit 3 is formed at the tip of the horn 6. A connecting portion 9 for connecting to the handle unit 2 is provided at the front end of the vibrator unit 4.
[0012]
As shown in FIG. 2, the probe unit 3 is formed as a rod-shaped vibration transmission member 10 that transmits ultrasonic vibration generated by the ultrasonic vibrator of the vibrator unit 4. A male screw 11 to be screwed into the female screw 8 of the horn 6 is formed at the base end of the vibration transmitting member 10. The vibration transmitting member 10 includes a proximal end horn 12 that further expands the amplitude of the ultrasonic vibration amplified by the horn 6 to the second stage, an intermediate portion 13 that is located on the distal end side of the proximal end horn 12, A distal horn 14 that is located on the distal end side of the intermediate portion 13 and that expands the amplitude of the ultrasonic vibration amplified by the proximal horn 12 to the final stage, and a columnar shape that is located on the distal end side of the distal horn 14. And a tip portion 15. Then, the ultrasonic vibration generated by the ultrasonic transducer is gradually amplified by the horn 6, the proximal end horn 12, and the distal end horn 14 and transmitted to the distal end portion 15 of the vibration transmitting member 10, thereby the distal end portion 15. Vibrates most strongly.
[0013]
The intermediate portion 13 of the vibration transmitting member 10 is provided with a plurality of flange-like supports 16 positioned at the second and subsequent nodes from the distal end side of the transmitted ultrasonic vibration. Each support 16 is formed of an elastic material. Each support 16 is elastically pressed into contact with the inner surface of the main channel tube 18 in a state where the vibration transmitting member 10 is inserted into the main channel tube 18 of the insertion sheath portion 17 of the handle unit 2. The member 10 is held at the central portion of the main channel tube 18 and the contact between the vibration transmitting member 10 and the main channel tube 18 is prevented. The outer diameter of the support 16 is slightly larger than the inner diameter of the main channel tube 18.
[0014]
As shown in FIG. 1, the handle unit 2 is provided at the distal end of the operating portion 19, an insertion sheath portion 17 including a long outer tube 20 that is rotatably attached to the operating portion 19, and the distal end of the insertion sheath portion 17. The tip action part 21 is provided.
[0015]
The operation unit 19 of the handle unit 2 is rotated to the operation unit main body 22 (or the fixed handle 23) via the operation unit main body 22, a fixed handle 23 formed integrally with the operation unit main body 22, and a handle pivot shaft 24. And a movable handle 25 movably attached thereto. A transducer connecting portion 26 for detachably connecting the transducer unit 4 is provided at the base end of the operation unit main body 22.
[0016]
As shown in FIG. 5, the movable handle 25 has an engagement pin 28 that engages with a slider 27 in the operation section main body 22. A cylindrical slide member 29 is provided in the operation unit main body 22 so as to be slidable in the axial direction. A cylindrical pressing member 30 is attached to the inner peripheral surface of the slide member 29, and a rubber packing 31 that is in pressure contact with the outer peripheral portion of the proximal end side of the vibration transmitting member 10 is attached to the inner peripheral surface of the pressing member 30. . A compression coil spring 32 and an annular slider 27 slidable with respect to the pressing member 30 are provided on the outer peripheral portion of the pressing member 30, and the slider 27 is engaged with the engagement pin 28.
[0017]
Accordingly, when the movable handle 25 is rotated about the handle pivot shaft 24, an operating force is applied to the slider 27 via the engagement pin 28. Since the compression coil spring 32 is mounted in a state of being constantly compressed and biased, the compression coil spring 32 absorbs an operating force in a closing direction that is applied to the movable handle 25 beyond a certain level. With this configuration, an overload prevention mechanism that defines the maximum operating force amount of the slide member 29 is configured.
[0018]
As shown in FIG. 4, the distal end working portion 21 of the handle unit 2 is rotatable, for example, by a metal holding member 33 attached to the distal end portion of the outer tube 20, and the holding member 33 via a pivot shaft 34. The distal end working part 21 constitutes a treatment part 36 of the ultrasonic treatment apparatus 1 together with the distal end part 15 of the probe unit 3. This single-opening type gripping member 35 presses the biological tissue against the distal end portion 15 that ultrasonically vibrates by grasping the biological tissue with the distal end portion 15, and vibration energy from the distal end portion 15 of the probe unit 3 to the biological tissue. Enables the transmission of The lower surface of the gripping member 35 is a gripping surface 37 that grips tissue with the distal end portion 15. The cross-sectional shape of the gripping surface 37 is formed in an arc shape in accordance with the cross-sectional shape of the distal end portion 15 of the vibration transmitting member 10 as shown in FIG.
[0019]
A plurality of teeth 38 are formed on both sides of the gripping surface 37 in a row along the longitudinal direction of the gripping surface 37. A pressing portion 39 protruding downward is formed in a tooth shape at the proximal end portion of the gripping member 35 in which the rows of teeth 38 are arranged (see FIGS. 4 and 6G). These pressing portions 39 are located on both sides of the gripping surface 37 and protrude downward. The pressing portions 39 restrict (suppress) the movement of the vibration transmitting member 10 in the lateral direction.
[0020]
The holding member 33 is formed with a notch 33a that is open in the vertical direction in order to allow movement of the base of the gripping member 35. The holding member 33 is formed with a main channel hole 40 through which the vibration transmitting member 10 of the probe unit 3 is inserted, and a sub channel hole 42 through which the operation rod 41 for rotating the gripping member 35 is inserted. A cylindrical support member 43 formed of a material having a small friction coefficient such as a fluororesin such as PTFE is closely fitted in the main channel hole 40.
[0021]
The support member 43 is disposed so as to be located slightly on the distal end side of the most distal node of the ultrasonic vibration transmitted through the vibration transmitting member 10. A support rubber 47, which will be described later, is provided at the most distal end of the ultrasonic vibration, but the support member 43 is located at a position closer to the front end side than the support rubber 47 and near the front end of the vibration transmitting member 10. Has been.
[0022]
The support member 43 normally has an inner peripheral shape that does not contact the vibration transmitting member 10. That is, as shown in FIG. 6D, the base end side portion of the support member 43 forms a base end portion 44 that is coaxial with the longitudinal center axis of the vibration transmitting member 10 and has a perfect inner circumference. Yes. Further, as shown in FIG. 6C, the tip side portion of the support member 43 forms a pressing portion 45 having a substantially elliptical inner peripheral shape.
[0023]
Here, the gap between the pressing portion 45 of the support member 43 and the vibration transmitting member 10 is set as follows.
That is, as shown in FIG. 6C, the left and right lateral gaps of the vibration transmission member 10 are both x, the upper gap of the vibration transmission member 10 is y, and the lower gap of the vibration transmission member 10 is the lower gap. When z is set, the dimensional relationship between the gaps x, y, and z is set so that x = y <z. Thereby, when the tissue is grasped by the treatment portion 36, the vibration transmitting member 10 is bent in the lateral direction and the upward direction compared to the downward bending amount in which the distal end portion of the vibration transmitting member 10 is bent by the force received from the holding member 35. It is regulated and restrained so that the amount of bending when receiving the force to is reduced.
[0024]
The gap between the base end portion of the support member 43 and the periphery of the vibration transmitting member 10 is the same over the entire circumference as shown in FIG. 6 (d). This is the same as the downward gap z of the vibration transmitting member 10 in the pressing portion 45 shown. However, since the vibration transmitting member 10 has a larger amount of bending toward the distal end side, the vibration transmitting member 10 first hits the pressing portion 45.
[0025]
A main channel tube 18 through which the vibration transmitting member 10 of the probe unit 3 is inserted and a sub channel tube 46 through which the operation rod 41 is inserted are provided in the outer tube 20 of the insertion sheath portion 17. As shown in FIGS. 6E and 6F, the main channel tube 18 has a circular cross-sectional shape, and the sub-channel tube 46 has a flat shape whose cross-sectional shape is long to the left and right. A support rubber 47 made of an elastic body, such as silicon rubber, is provided integrally with the main channel tube 18 on the inner periphery on the front end side of the main channel tube 18. The support rubber 47 is disposed at a node positioned at the extreme end of the ultrasonic vibration transmitted through the vibration transmission member 10, and the inner diameter of the support rubber 47 is slightly smaller than the outer diameter of the intermediate portion 13 of the vibration transmission member 10. Small. Accordingly, the support rubber 47 supports the vibration transmission member 10 in a state in which it is in close contact with the outer periphery of the vibration transmission member 10 and pressed by an elastic force.
[0026]
Also, as shown in FIGS. 6 (e) and 6 (f), a resin 48 is filled in the gaps between the channel tubes 18 and the sub-channel tubes 46 and the outer tube 20.
[0027]
As shown in FIGS. 5 and 6B, the distal end of the operation rod 41 is connected to the proximal end portion of the gripping member 35 via a pivot pin 49. The proximal end side of the operation rod 41 is connected to the slide member 29 of the handle unit 2 as shown in FIG. Accordingly, by performing an operation of rotating the movable handle 25, the holding member 35 of the distal end working portion 21 is opened and closed.
[0028]
(Function)
Next, a case where a tissue is treated using the ultrasonic treatment apparatus 1 will be described. First, the tissue is positioned between the gripping member 35 of the handle unit 2 and the distal end portion 15 of the vibration transmitting member 10, and in this state, the movable handle 25 is rotated in the closing direction, so that the gripping member 35 and the distal end portion 15 are moved. Grab the tissue between. At this time, the vibration transmitting member 10 bends downward due to the force received from the gripping member 35, but the holding member 33 is formed with a notch 33 a that opens downward, so that the vibration transmitting member 10 contacts the holding member 33. Therefore, it is possible to prevent the vibration transmitting member 10 from being damaged due to contact with the holding member 33.
[0029]
In this state where the tissue is gripped, power is supplied from the power supply device to the ultrasonic transducer to vibrate the ultrasonic transducer. This ultrasonic vibration is amplified by the horn 6, the proximal horn 12, and the distal horn 14 and transmitted to the distal end 15 of the vibration transmitting member 10.
[0030]
In this case, since the vibration transmission member 10 is held at the central portion of the main channel tube 18 by the plurality of supports 16 and the support rubber 47, the vibration transmission member 10 is prevented from contacting the main channel tube 18. Further, since the support 16 and the support rubber 47 are respectively located at the nodes of ultrasonic vibration and the vibration transmitting member 10 is firmly fixed to the main channel tube 18, undesirable vibration such as lateral vibration is suppressed. Therefore, vibration energy can be efficiently transmitted to the distal end portion 15 of the vibration transmitting member 10.
[0031]
As described above, the ultrasonic vibration is transmitted to the distal end portion 15 of the vibration transmitting member 10 with almost no loss. Then, the grasped tissue in contact with the distal end portion 15 is incised by ultrasonic vibration and solidified by frictional heat.
[0032]
Incidentally, in addition to the above operations, the following operations may be performed. That is, an unusual usage in which ultrasonic vibration is applied to the vibration transmitting member 10 without gripping the tissue (that is, with the gripping member 35 opened) and the distal end portion 15 of the vibration transmitting member 10 being strongly pressed against the tissue. Is to be done. In this case, when the distal end portion 15 of the vibration transmitting member 10 receives a downward force, the vibration transmitting member 10 is bent and deformed while escaping by the notch 33a of the holding member 33 described above. It contacts the lower surface of the holding part 45 provided in 43. Thus, when the vibration transmission member 10 is bent and deformed, the vibration transmission member 10 does not directly contact the holding member 33 because it contacts the lower surface of the pressing portion 45. For this reason, the vibration transmission member 10 is not damaged.
[0033]
Further, when the tip 15 of the vibration transmission member 10 receives an upward force, the vibration transmission member 10 comes into contact with the upper side surface of the pressing portion 45 of the support member 43, so that upward bending deformation is restricted. Therefore, the vibration transmitting member 10 is prevented from coming into direct contact with metal parts such as the gripping member 35 and the operation rod 41. Further, when the distal end portion 15 of the vibration transmission member 10 receives a force directed in the lateral direction, the vibration transmission member 10 comes into contact with the lateral side surface of the pressing portion 45 of the support member 43, whereby the vibration transmission member 10 is bent in the lateral direction. Since deformation is restricted, the vibration transmission member 10 does not directly contact metal parts such as the gripping member 35 and the holding member 33 in this case, and damage to the vibration transmission member 10 can be avoided.
[0034]
Further, as shown in FIG. 6G, the lateral deformation of the vibration transmitting member 10 is restricted by the pressing portion 39 provided near the proximal end of the gripping member 35 as shown in FIG. Therefore, the contact of the vibration transmitting member 10 with the metal part is more effectively prevented. That is, even when the ultrasonic vibration is transmitted to the distal end portion 15 of the vibration transmitting member 10 in a state where the distal end portion 15 of the vibration transmitting member 10 is pressed with an excessive force directed vertically or laterally. The vibration transmitting member 10 comes into contact with the support member 43 made of a flexible material having a small friction coefficient such as PTFE, and its bending deformation is restricted and suppressed, and direct contact with other metal parts is prevented. The damage of the vibration transmitting member 10 can be prevented.
[0035]
Further, since the support member 43 is provided slightly near the node of the ultrasonic vibration, the ultrasonic vibration is not inhibited by the contact between the vibration transmitting member 10 and the support member 43. That is, even if the support member 43 and the vibration transmission member 10 come into contact with each other, generation of frictional heat due to ultrasonic vibration can be suppressed.
[0036]
Of course, the support member 43 does not grip tissue, and is not limited to the case where the vibration transmitting member 10 receives a force in an upward direction or a lateral direction with the gripping member 35 open. Even in a state in which 35 is closed, the effect of preventing the bending deformation can be obtained.
[0037]
(effect)
As described above, since the vibration transmitting member 10 is firmly fixed to the main channel tube 18 by the support 16 and the support rubber 47 provided at the ultrasonic vibration node, undesirable vibration such as lateral vibration is generated. In addition, vibration energy can be efficiently transmitted to the distal end portion 15 of the vibration transmitting member 10 without substantial loss. Further, by providing the support member 43 near the tip, when the ultrasonic vibration is transmitted to the vibration transmitting member 10, the tip 15 of the vibration transmitting member 10 is pressed with excessive force in the vertical and lateral directions. However, it is possible to prevent the vibration transmitting member 10 from being damaged.
[0038]
Second Embodiment
An ultrasonic treatment apparatus according to the second embodiment of the present invention will be described with reference to FIG. The present embodiment is a modification of the above-described first embodiment, and a description will be given centering on differences from the first embodiment.
[0039]
(Constitution)
In the ultrasonic treatment apparatus 1 of the present embodiment, a protective layer 51 made of a fluororesin such as PTFE is formed on the surface of the portion facing the vibration transmitting member 10 at the rear end portion of the gripping member 35. A protective layer 52 made of a fluororesin such as PTFE was also formed on the surface of the operation rod 41 facing the vibration transmitting member 10 at the tip side portion. Each of the protective layers 51 and 52 is integrally attached to the gripping member 35 and the operation rod 41 by coating or adhesion.
[0040]
(Action / Effect)
According to such a configuration, the vibration transmitting member can be used in the same manner as in the first embodiment described above, and if the tip 15 of the vibration transmitting member 10 is pressed with excessive force in the upward and lateral directions. 10 is more effectively prevented from coming into contact with metal parts such as the gripping member 35 and the operation rod 41.
[0041]
The present invention is not limited to the above-described embodiments, and can be applied to other forms.
Further, according to the above description, items listed below and items obtained by arbitrarily combining the items listed below can be obtained.
[0042]
(Appendix)
1. A vibrator unit having an ultrasonic vibrator that generates ultrasonic vibrations, a vibration transmission member that is connected to the ultrasonic vibrator and transmits ultrasonic vibrations generated by the ultrasonic vibrator to a treatment portion at the tip, and a vibration transmission member A support member that regulates the upward and lateral deflection of the vibration transmitting member in the vicinity of the distal end of the vibration transmitting member. An ultrasonic treatment apparatus provided on a member of the above.
[0043]
2. In the first item, the support member is provided in the vicinity of the most distal node of the ultrasonic vibration transmitted through the vibration transmitting member.
3. In the first item, the support member has a substantially elliptical inner peripheral shape.
4). In the first item, the support member is made of a fluororesin such as PTFE and is fitted into the distal end of the sheath.
[0044]
5. A vibrator unit having an ultrasonic vibrator that generates ultrasonic vibration, a vibration transmission member that is connected to the ultrasonic vibrator and transmits ultrasonic vibration generated by the ultrasonic vibrator to a treatment portion at the tip, and a vibration transmission member In the ultrasonic treatment apparatus having a sheath through which the needle is inserted and a gripping member attached to the distal end of the sheath, the gripping member is made of a fluororesin such as PTFE, and the rear end side of the gripping member has a lateral direction of the vibration transmitting member. A presser part that restricts the bending of the sheet is formed.
[0045]
6). A vibrator unit having an ultrasonic vibrator that generates ultrasonic vibration, a vibration transmission member that is connected to the ultrasonic vibrator and transmits ultrasonic vibration generated by the ultrasonic vibrator to a treatment portion at the tip, and a vibration transmission member A restraining member (support rubber) at a position of the most distal node of the ultrasonic vibration transmitted through the vibration transmitting member in the ultrasonic treatment apparatus having a sheath through which the needle is inserted and a gripping member attached to the distal end of the sheath What was provided.
[0046]
7). In the sixth aspect, a support body is integrally provided on the vibration transmission member at the position of the second and subsequent nodes from the distal end side of the ultrasonic vibration transmitted through the vibration transmission member.
8). In the sixth aspect, the restraining member (support rubber) is silicon rubber that is integrally attached to the lumen at the distal end of the sheath.
[0047]
【The invention's effect】
As described above, according to the present invention, even if the tip of the vibration transmission member is pressed upward or laterally with an excessive force, the vibration transmission member is prevented from being greatly deformed and the damage of the vibration transmission member is suppressed. can do.
[Brief description of the drawings]
FIG. 1 is a side view of a handle unit of an ultrasonic treatment apparatus according to a first embodiment.
FIG. 2 is a side view of the probe unit and the transducer unit in a state where the ultrasonic treatment apparatus according to the first embodiment is separated.
FIG. 3 is a side view of the ultrasonic treatment apparatus according to the first embodiment in an assembled state.
FIG. 4 is a longitudinal sectional view of the distal end of the insertion sheath portion and the distal end working portion of the ultrasonic treatment apparatus according to the first embodiment.
FIG. 5 is a longitudinal sectional view of a connecting portion between the handle unit and the transducer unit of the ultrasonic treatment apparatus according to the first embodiment.
6A is a cross-sectional view of a portion along the line AA in FIG. 4, FIG. 6B is a cross-sectional view of a portion along the line BB in FIG. 4, and FIG. FIG. 4D is a cross-sectional view of the portion along the line C, FIG. 4D is a cross-sectional view of the portion along the line DD in FIG. 4, FIG. f) is a cross-sectional view of the portion along the line F-F in FIG. 3, and (g) is a view taken in the direction of arrow G in FIG. 4.
7 shows a second embodiment which is a modification of the first embodiment, and is a cross-sectional view of a portion corresponding to a portion along the line BB in FIG. 3. FIG.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 Ultrasonic treatment apparatus 2 Handle unit 3 Probe unit 4 Vibrator unit 10 Vibration transmission member 15 Tip part 16 Support body 17 Inserting sheath part 19 Operation part 20 Outer tube 21 Tip action part 22 Operation part main body 23 Fixed handle 25 Movable handle 31 Rubber packing 33 Holding member 35 Holding member 36 Treatment portion 37 Holding surface 38 Teeth 39 Pressing portion 41 Operation rod 43 Support member 45 Pressing portion 47 Support rubber

Claims

A vibrator unit (4) having an ultrasonic vibrator capable of generating ultrasonic vibration for treating a biological tissue;
A vibration transmission member (10) connected to the ultrasonic transducer and capable of transmitting the ultrasonic vibration generated by the ultrasonic transducer;
A sheath (17) through which the vibration transmitting member (10) is inserted;
A gripping member (35) attached to the distal end portion of the sheath (17) and capable of gripping the living tissue with the distal end portion of the vibration transmitting member (10);
A pressing portion (45) disposed around the vibration transmitting member (10) and positioned in front of a position where the most distal node of the ultrasonic vibration transmitted by the vibration transmitting member (10) is formed. ) , And a gap is formed between the pressing portion (45) and the vibration transmission member (10), and the gap member is positioned with respect to the vibration transmission member ( 10 ). The gap (y) located on the upper side when the orientation side to be viewed as the upper side, both the gaps (x, x) located in the lateral direction of the vibration transmission member (10) , and the vibration transmission member (10) A support member (43) including a gap (z) located on the lower side of the vibration transmitting member ( 45 ) and capable of restricting the bending deformation of the vibration transmitting member ( 10 ) by the pressing portion ( 45 ) ,
Comprising
An ultrasonic treatment apparatus, wherein the gap (y) located on the upper side and both the gaps (x, x) located in the lateral direction are made smaller than the gap (z) located on the lower side .

The ultrasonic treatment apparatus according to claim 1, wherein the support member (43) is made of a resin material fitted into a distal end portion of the sheath (17).

The ultrasonic treatment apparatus according to claim 1 or 2, wherein the pressing portion (45) has a substantially elliptical inner peripheral shape that is long in the vertical direction.

The restraint member (47) for restraining the vibration transmission member (10) is provided at the position of the most distal node of the ultrasonic vibration in the vibration transmission member (10). The ultrasonic treatment apparatus according to claim 2 or claim 3.