JP4269509B2 - High frequency incision device - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a high-frequency incision device commonly referred to as a high-frequency knife, and more specifically, for example, a high-frequency knife section provided at a distal end portion that is used with an endoscope to incise an affected area in a body cavity. The present invention relates to a high-frequency incision device that can be surely directed to an affected area.
[0002]
[Prior art]
In a high-frequency incision device called a high-frequency knife, a conductive wire inserted inside a flexible sheath is partially exposed outside the sheath at the distal end of the sheath, and this portion is a high-frequency knife. It becomes a knife part. By manipulating the proximal end of the sheath, the affected part is sandwiched between the conductive wire which is the high frequency knife part and the sheath, and a high frequency voltage is applied to the conductive wire, thereby burning the affected part.
In such a high-frequency incision device, it is important to ensure that the direction of the high-frequency knife is directed to the affected area, and a technique for this purpose has been proposed.
[0003]
For example, in the device described in Japanese Patent Laid-Open No. 4-364636, a flat plate is passed through the flexible sheath from the distal end portion to the intermediate portion, and the clockwise angle from the horizontal direction of this flat plate is 30. A conductive wire is attached so that the high-frequency knife portion is located at a position of ˜60 degrees. In this device, when the wire is operated from the proximal side of the sheath, the high-frequency knife portion provided at the distal end portion of the sheath is said to have an effect of reliably bending toward the affected area.
[0004]
However, when the structure of the above publication is adopted, the knife portion at the distal end portion of the sheath can be bent to the affected portion side with certainty, but it is intermediate from the distal end portion of the flexible sheath. It is necessary to insert a flat directional control member up to the portion or over the entire length of the sheath. For this reason, there is a possibility that flexibility and operability that are most required as a medical instrument for an endoscope may be impaired, and improvement by other structures is required.
[0005]
[Problems to be solved by the invention]
An object of the present invention is to provide a high-frequency incision device capable of reliably directing the high-frequency knife provided at the distal end of the sheath to the affected area without losing the flexibility of the sheath when incising the affected area inside the body cavity. Is to provide.
[0006]
[Means for Solving the Problems]
In order to achieve the above object, as a result of intensive studies, the present inventors have previously curved the distal end portion of the flexible sheath, and further shifted the circumferential position before and after the curved portion in the longitudinal direction. We have developed a device that makes a high-frequency knife part by exposing a conductive wire to the outside of the sheath through these conduction holes and found that the direction of the high-frequency knife part can be easily controlled. Based on this, the present invention has been completed.
[0007]
Thus, according to the present invention,
A hollow flexible sheath having a curved portion at the distal end portion of the sheath and formed with a first wire conducting hole and a second wire conducting hole penetrating the sheath tube wall before and after the curved portion in the longitudinal direction;
The high-frequency knife portion located between the first wire conduction hole and the second wire conduction hole is located outside the flexible sheath, and other than the high-frequency knife portion, in the longitudinal direction in the flexible sheath. The wire distal end is fixed to the inside of the flexible sheath, and other than the wire distal end is configured to be movable along the longitudinal direction with respect to the flexible sheath. A high-frequency incision device having a conductive wire,
When the flexible sheath is viewed from the distal end side toward the proximal end side, with respect to a first imaginary line connecting the center of the cross section of the flexible sheath and the center of the first wire conduction hole. In addition, a high-frequency incision device is provided in which an intersection angle of a second imaginary line connecting the center of the cross section of the flexible sheath and the center of the second wire conduction hole is 45 to 180 degrees. .
[0008]
The second wire conduction hole provided on the distal end side of the bending portion is distal to the flexible sheath with respect to the first wire conduction hole provided on the proximal end side of the bending portion. When viewed from the end side toward the proximal end side, it is preferable to form the crossing angle at a circumferential position in the clockwise direction.
[0009]
It is preferable that a tip end is connected and fixed to the distal end portion of the conductive wire, and the tip end is fixed inside the distal end portion of the flexible sheath. Although it does not specifically limit as a front-end | tip tip, For example, it is comprised with a short cylindrical pipe or a short cylinder tip. The material of the tip is not particularly limited, but is preferably a metal. In the case of metal, the tip can also serve as a contrast marker, and the position of the distal end portion of the flexible sheath can be known from outside the body by X-rays or the like. The contrast marker may be provided separately at the distal end of the flexible sheath.
[0010]
It is preferable that a reinforcing coil is inserted into the curved portion of the flexible sheath. Although it does not specifically limit as said coil for reinforcement, For example, it is comprised with metal coils, such as stainless steel.
[0011]
The method for forming the curved portion formed at the distal end portion of the flexible sheath is not particularly limited. For example, the bending portion may be formed in advance by bending the distal end portion of the linear sheath while heating. it can. In addition, the reinforcing coil inserted into the bending portion may be curved in advance in accordance with the curved shape of the bending portion of the sheath, but even if it is not curved in advance, a coil is attached to the bending portion of the sheath. When inserted, the coil bends in accordance with the curved shape of the sheath.
[0012]
Preferably, the reinforcing coil is positioned in the bending portion at a distance longer than a distance between the first wire conduction hole and the second wire conduction hole. More preferably, the reinforcing coil has a rough pitch portion with a relatively long winding pitch and a dense pitch portion with a relatively short winding pitch along the longitudinal direction of the coil, the rough pitch portion being In the bending portion, the flexible wire is positioned at a distance longer than the distance between the first wire conduction hole and the second wire conduction hole, and the dense pitch portion is located closer to the proximal end than the bending portion. Located within the sex sheath.
[0013]
DETAILED DESCRIPTION OF THE INVENTION
Hereinafter, the present invention will be described based on embodiments shown in the drawings.
First embodiment As shown in Fig. 1, a high-frequency incision device 2 according to this embodiment includes a flexible sheath 4 having a lumen 5 continuous from a distal end to a proximal end. A connector hub 7 is fixedly connected to the proximal end of the sheath 4 via a protective tube 8 and a connector tube 6. A conductive wire 10 is inserted into the lumen 5 of the flexible sheath 4.
[0014]
In the connector hub 7, two connection ports 9 and 11 are formed. However, in the present invention, the specific shape of the connector hub 7 is not particularly limited, and a connector having only a single connection port is used. A connector having a connection port may be used. In general, the rigidity (hardness) of the connector hub 7 is higher than the rigidity (hardness) of the flexible sheath 4, and the connector hub 7 is made of heat such as polycarbonate, polyamide, polysulfone, polymethylmethacrylate, polyacetal and the like. It is formed of a metal such as a plastic resin or stainless steel. The connector hub 7 is located on the outside of the patient, and is shaped and shaped to be easily grasped by an operator with one hand.
[0015]
The inner diameter of the flexible sheath 4 is preferably 0.3 mm to 2.5 mm, and the outer diameter of the flexible sheath 4 is preferably 1 to 3 mm. The axial length of the flexible sheath 4 is not particularly limited, but is generally 800 mm to 3500 mm.
[0016]
The flexible sheath 4 is made of, for example, polyethylene, polyethylene terephthalate, polypropylene, ethylene-propylene copolymer, ethylene-vinyl acetate copolymer, polyvinyl chloride (PVC), polyurethane, polyamide, polyamide elastomer, polyimide, polyimide elastomer, fluorine. Resin, silicone rubber and the like can be used, and preferably, a fluororesin such as polytetrafluoroethylene (PTFE) is used. PTFE has excellent properties such as excellent heat resistance, chemical resistance, low friction, non-adhesiveness, and electrical insulation, and is thin and has high rigidity. Although the hardness of the flexible sheath 4 is not specifically limited, it needs to have moderate flexibility, and the bending elastic modulus is preferably 300 to 1000 MPa (JIS-Z-2000).
[0017]
The conductive wire 10 is made of a metal wire having a wire diameter of about 0.1 mm to 1.5 mm, for example. The material of the wire is not particularly limited as long as it has conductivity. For example, nickel titanium alloy, stainless steel, gold, silver, copper, platinum, nickel, iron, titanium, aluminum, tin, zinc, tungsten, or these Examples of the alloy are stainless steel and nickel titanium alloy. The conductive wire 10 may be a single wire or a stranded wire.
[0018]
As shown in FIGS. 1 and 2, in this embodiment, a bending portion 20 is formed in advance at the distal end portion of the flexible sheath 4. Although the curvature radius of the curved part 20 is not specifically limited, For example, it is about 20-50 mm. The bending portion 20 can be formed by heating and deforming the distal end portion of the sheath 4.
[0019]
A reinforcing coil 22 is mounted inside the bending portion 20. The reinforcing coil 22 is formed of, for example, a metal coil, and has an outer diameter that is approximately equal to or less than the inner diameter of the sheath 4 and does not move in the axial direction inside the bending portion 20. In the present embodiment, the length of the reinforcing coil 22 in the axial direction is slightly shorter than the length of the bending portion 20.
[0020]
Before and after the bending portion 20 in the longitudinal direction, first and second wire conduction holes 26 penetrating the sheath tube wall are formed. As shown in FIG. 3A, the formation positions of the wire conduction holes 24 and 26 are assumed when the sheath 4 is assumed to be straight (in FIG. 3A, the bending portion 20 is drawn as a straight line). The second wire conduction hole 26 is formed at a position L1 from the distal end of the sheath 4, and the first wire conduction hole 24 is formed at a position L1 + L2. The distances L1 and L2 are not particularly limited. For example, L1 is 1 to 70 mm, and L2 is 10 to 50 mm.
[0021]
In the present embodiment, the circumferential positions of the conduction holes 24 and 26 are different from each other. As shown in FIGS. 3A and 3B, the flexible sheath 4 is connected to the distal end. When viewed in the direction from the proximal side to the proximal end side, the flexible sheath 4 with respect to the first virtual line V1 that connects the center C of the cross section of the flexible sheath 4 and the center of the first wire conduction hole 24 The crossing angle θ of the second virtual line V2 connecting the center C of the cross section and the center of the second wire conduction hole 26 is 45 to 180 degrees, preferably 60 to 150 degrees. Moreover, when the flexible sheath 4 is viewed from the distal end side toward the proximal end side with respect to the first wire conduction hole 24, the second wire conduction hole 26 is positioned in the circumferential direction in the clockwise direction. Are formed at the position of the intersection angle θ.
[0022]
As shown in FIGS. 1 and 2, the distal end portion of the conductive wire 10 is located outside the sheath 4 through the first wire conduction hole 24 and the second wire conduction hole 26 to form a high-frequency knife portion 30. is doing. The distal end portion of the conductive wire 10 that goes out of the sheath 4 from the first wire conduction hole 24 and returns to the inside of the sheath 4 again from the second wire conduction hole 26 is brazed to the tip tip 32. The connection is fixed.
[0023]
The material of the tip 32 is not particularly limited, but is preferably made of metal, for example. This is because it can also serve as a contrast marker. The distal tip 32 has, for example, a cylindrical shape, and an outer diameter thereof is substantially the same as the inner diameter of the sheath 4. The distal end tip 32 is inserted into the distal end portion of the sheath 4 and fixed so as not to move in the axial direction. That is, the distal end portion of the conductive wire 10 is fixed to the distal end portion of the sheath 4 on the distal end side of the bending portion 20.
[0024]
The conductive wire 10 is inserted along the longitudinal direction into the sheath 4 except for the high-frequency knife portion 30, and is fixed to the inside of the flexible sheath 4 by the tip tip 32 at the distal end portion of the wire. Except for the ends, the flexible sheath 4 is movable along the longitudinal direction.
[0025]
As shown in FIG. 1, the proximal end of the conductive wire 10 is exposed to the outside from the connection port 11 of the connector hub 7. An operation tool (not shown) for operating the longitudinal movement of the wire 10 with respect to the sheath 4 is connected and fixed to the connection port 11. Further, a power source for applying a high frequency voltage to the wire 10 is connected to the operation tool via a cord or the like.
[0026]
The distal end side of the sheath of the high-frequency incision device 2 according to the present embodiment is inserted into the body by being inserted into the endoscope and exposed to the outside from the distal end of the endoscope, as shown in FIG. The affected part 40 to be incised in the body cavity is sandwiched between the bending part 20 of the sheath and the high-frequency knife part 30. In that case, the proximal end of the connector hub 7 and the conductive wire 10 is operated, and the longitudinal movement of the wire 10 with respect to the sheath 4 is operated, whereby the curved portion formed at the distal end portion of the sheath 4. The degree of curvature of 20 changes. Therefore, the direction of the distal end of the sheath 4 can be changed and the gap between the high-frequency knife portion 30 and the bending portion 20 can be adjusted as indicated by an arrow A shown in FIG. As a result, the distal end of the sheath 4 can be conveniently directed toward the affected part 40, and the affected part can be easily sandwiched between the high-frequency knife part 30 and the curved part 20. Thereafter, a high frequency voltage is applied to the conductive wire 10, a high frequency current is allowed to flow from the high frequency knife 30 toward the affected area, and the affected area 40 can be burned out.
[0027]
In the present embodiment, as shown in FIG. 3B, the second wire conducting hole 26 is formed at the position of the intersection angle θ at a circumferential position in the clockwise direction with respect to the first wire conducting hole 24. In addition, a reinforcing coil 22 is built in the bending portion 20. For this reason, by operating the wire 10, the bending portion 20 bends in a three-dimensional direction, and the distal end portion of the sheath 4 can be directed to the affected portion 40 in a particularly convenient manner. The affected part 40 can be sandwiched very easily in the gap between the curved part 30 and the curved part 20.
[0028]
The manufacturing method of the high frequency incision apparatus 2 which concerns on this embodiment is not specifically limited. For example, after the linear flexible sheath 4 is prepared, the first and second wire conduction holes 24 and 26 are formed with a predetermined size at the distal end portion using a needle, a drill or the like. At that time, it is preferable to put a metal pipe inside the sheath so as not to make a hole in an unnecessary portion. Further, it is preferable that the needle for making a hole is previously heated with a lighter, an alcohol lamp or the like.
[0029]
Next, the protective tube 8, the connector tube 6 and the connector hub 7 shown in FIG. Thereafter, the conductive wire 10 is passed through the inside of the sheath 4, taken out from the first wire insertion hole 24 to the outside of the sheath, inserted again into the sheath through the second wire insertion hole 26, and the distal end of the wire is connected to the distal end of the sheath 4. Jump out from the top end opening. Before and after that, the reinforcing coil 22 is inserted into the bending portion 20 from the distal end opening of the sheath 4. Thereafter, the tip tip 32 is connected and fixed to the distal end of the wire 10 by soldering or the like, and the tip tip 32 is inserted into the sheath 4 from the distal end opening of the sheath 4 and fixed. Thereafter, the protective tube 8, the connector tube 6, the connector hub 7, and the like that are preset at the proximal end of the sheath 4 are fixed to the high frequency incision device 2. The bending portion 20 may be formed at any point in the manufacturing process described above, but is preferably formed at any point before the reinforcing coil 22 is inserted into the bending portion 20. preferable.
[0030]
Second embodiment A high-frequency incision device 102 according to the embodiment shown in Fig. 4 is a modification of the high-frequency incision device 102 according to the embodiment shown in Figs. 1 to 3 are different from the configuration of the reinforcing coil 22 of the embodiment shown in FIGS. Therefore, common members are denoted by common reference numerals, and a part of the description is omitted.
[0031]
As shown in FIG. 4, in this embodiment, the reinforcing coil 122 includes a rough pitch portion 122a having a relatively long winding pitch and a dense pitch portion 122b having a relatively short winding pitch along the longitudinal direction of the coil. And have. The rough pitch portion 122a is located in the bending portion 20 at a distance longer than the distance L2 (see FIG. 3A) between the first wire conduction hole 24 and the second wire conduction hole 26, and the dense pitch portion. 122 b is located in the flexible sheath 4 on the proximal end side of the curved portion 20.
[0032]
The reinforcing coil 122 is made of, for example, a metal coil, and the outer diameter thereof is approximately equal to or less than the inner diameter of the sheath 4, and the wire diameter is not particularly limited, but is preferably 0.10 to 0.3 mm. More preferably, it is about 0.15 to 0.2 mm. Further, the winding pitch of the rough pitch portion 122a in the reinforcing coil 122 is longer than the winding pitch of the dense pitch portion 122b, and preferably a gap that allows the conductive wire 30 to be inserted between one coil unit. The winding pitch is such that is formed. Specifically, the winding pitch of the rough pitch portion 122a is preferably about 0.3 to 0.6 mm. The conductive wire 30 enters the inside of the sheath 4 through the conduction holes 24 and 26, and the conductive wire 30 enters the inside of the coil well from the gap between the coil units of the rough pitch portion 122a of the reinforcing wire 122 located there. It is to make it. The axial length of the rough pitch portion 122a is not particularly limited, but is preferably about 10 to 60 mm. The distal end of the rough pitch portion 122 a may be connected to the tip tip 32.
[0033]
The winding pitch of the dense pitch portion 122b of the reinforcing coil 122 may be as short as the gap between the coil units becomes zero. The axial length of the dense pitch portion 122b is not particularly limited, but is preferably about 10 to 40 mm.
[0034]
The high-frequency incision device 102 according to the present embodiment has the same functions and effects as those of the embodiment shown in FIG.
That is, the sheath 4 is sufficiently reinforced by extending the reinforcing coil 122 to the proximal end side with respect to the first wire conduction hole 24, and the sheath 4 is sheathed at a portion other than the bending portion 20 during the operation of the high-frequency incision device 102. 4 can be effectively prevented from being bent.
[0035]
In the present embodiment, since the conductive wire 30 enters the inside of the sheath 4 from the conduction holes 24 and 26 and then enters the inside of the coil 122, the operating force acting on the wire conduction holes 24 and 26 is applied to the coil 122. Therefore, the expansion of the conduction holes 24 and 26 can be effectively prevented. Therefore, when the contrast medium is injected using the high-frequency incision device 102, it is possible to effectively prevent the contrast medium from leaking from the expanded conduction holes 24 and 26. Note that an axial through hole may be formed in the distal tip 32 in order to lead the contrast agent from the distal end opening of the sheath.
[0036]
The present invention is not limited to the above-described embodiment, and can be variously modified within the scope of the present invention.
For example, in the embodiment shown in FIG. 4, the positional relationship between the first wire conduction hole 24 and the second wire conduction hole 26 is not necessarily the positional relationship as shown in FIG. Θ shown in B) may be zero.
[Brief description of the drawings]
FIG. 1 is a schematic cross-sectional view of a high-frequency incision device according to an embodiment of the present invention.
2 is a partial cross-sectional perspective view of a high-frequency knife portion at a distal end portion of the flexible sheath shown in FIG. 1. FIG.
FIG. 3 (A) is a view showing a positional relationship between first and second wire conduction holes formed in the distal end portion of the flexible sheath, and FIG. 3 (B) is shown in FIG. 3 (A). It is principal part sectional drawing which follows the IIIB-IIIB line.
FIG. 4 is a schematic cross-sectional view of a high-frequency incision device according to an embodiment of the present invention.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 2,102 ... High frequency incision apparatus 4 ... Sheath 5 ... Lumen 6 ... Connector tube 7 ... Connector hub 10 ... Conductive wire 20 ... Bending part 22, 122 ... Reinforcing coil 24 ... First wire insertion hole 26 ... Second wire Insertion hole 30 ... High-frequency knife part 32 ... Tip 40 ... Affected part 122a ... Rough pitch part 122b ... Dense pitch part

Claims (5)

A hollow flexible tube having a curved portion formed in advance at the distal end portion of the sheath, and a first wire conducting hole and a second wire conducting hole penetrating the sheath tube wall in the longitudinal direction of the curved portion. Sex sheath,
The high-frequency knife portion located between the first wire conduction hole and the second wire conduction hole is located outside the flexible sheath, and other than the high-frequency knife portion, in the longitudinal direction in the flexible sheath. The wire distal end is fixed to the inside of the flexible sheath, and other than the wire distal end is configured to be movable along the longitudinal direction with respect to the flexible sheath. A high-frequency incision device having a conductive wire,
When the flexible sheath is viewed from the distal end side toward the proximal end side, with respect to a first imaginary line connecting the center of the cross section of the flexible sheath and the center of the first wire conduction hole. The intersection angle of the second imaginary line connecting the center of the cross section of the flexible sheath and the center of the second wire conduction hole is 45 to 180 degrees .
The second wire conduction hole and the first wire conduction hole are previously formed in the flexible sheath,
By manipulating the longitudinal movement of the conductive wire relative to the flexible sheath, the degree of curvature of the bending portion formed in advance at the distal end portion of the sheath changes, and the high-frequency knife portion and the bending portion A high-frequency incision device characterized in that a gap can be adjusted. A hollow flexible tube having a curved portion formed in advance at the distal end portion of the sheath, and a first wire conducting hole and a second wire conducting hole penetrating the sheath tube wall in the longitudinal direction of the curved portion. Sex sheath,
A reinforcing coil inserted into the bending portion of the flexible sheath;
The high-frequency knife portion located between the first wire conduction hole and the second wire conduction hole is located outside the flexible sheath, and other than the high-frequency knife portion, in the longitudinal direction in the flexible sheath. The wire distal end is fixed to the inside of the flexible sheath, and other than the wire distal end is configured to be movable along the longitudinal direction with respect to the flexible sheath. A high-frequency incision device having a conductive wire,
When the flexible sheath is viewed from the distal end side toward the proximal end side, with respect to a first imaginary line connecting the center of the cross section of the flexible sheath and the center of the first wire conduction hole. The intersection angle of the second imaginary line connecting the center of the cross section of the flexible sheath and the center of the second wire conduction hole is 45 to 180 degrees .
The second wire conduction hole and the first wire conduction hole are previously formed in the flexible sheath,
By manipulating the longitudinal movement of the conductive wire relative to the flexible sheath, the degree of curvature of the bending portion formed in advance at the distal end portion of the sheath changes, and the high-frequency knife portion and the bending portion A high-frequency incision device characterized in that a gap can be adjusted. The high frequency incision apparatus according to claim 2, wherein the reinforcing coil is located in the bending portion at a distance longer than a distance between the first wire conduction hole and the second wire conduction hole. The reinforcing coil has a rough pitch portion with a relatively long winding pitch and a dense pitch portion with a relatively short winding pitch along the longitudinal direction of the coil, and the rough pitch portion is in the curved portion. The dense pitch portion is located in the flexible sheath closer to the proximal end side than the curved portion, and is located at a distance longer than the distance between the first wire conduction hole and the second wire conduction hole. position serial mounting of the high-frequency incision apparatus to claim 3, characterized in that. The high-frequency incision device according to any one of claims 1 to 4 , wherein a radius of curvature of the pre-formed curved portion is 20 to 50 mm.

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