JP4324755B2 - Bipolar electrical treatment instrument - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a medical bipolar electric treatment instrument, and more particularly to a bipolar electric treatment instrument that is inserted into a body using, for example, an endoscope, and incises a living tissue such as a mucous membrane by a high-frequency current.
[0002]
[Prior art]
As a medical electrical treatment instrument, a treatment instrument using high-frequency electrical energy is known, and a living tissue can be electrically incised without damaging the living body, thereby reducing bleeding during surgery. Therefore, it has come to be widely used in recent years. The electrical treatment instrument utilizes the action of high-frequency electrical energy between the electrode provided at the distal end of the treatment instrument and the living tissue.
[0003]
As a medical electrical treatment instrument, a high-frequency snare device shown in, for example, US Pat. No. 4,503,855 is conventionally known. In a high-frequency snare device, a snare loop serving as an electrode is hooked on a raised portion such as a mucous membrane, a high-frequency current is passed through the raised portion, and the raised portion is excised.
[0004]
However, in such a high-frequency snare device, the size of the mucous membrane that can be excised is limited by the size of the snare loop. In addition, the snare loop slides against the mucous membrane, and the raised portion cannot be hooked well, so that there is a possibility that it cannot be excised.
[0005]
Therefore, a high-frequency knife disclosed in Japanese Patent Application Laid-Open No. 8-299355 is known for the purpose of excising a wider range of mucosa.
[0006]
[Problems to be solved by the invention]
The high-frequency knife shown in the above publication is a monopolar electrical treatment instrument, and thus has excellent cutting power for living tissue, but requires high power and is cut because the counter electrode is placed outside the patient's body. The range of living tissue is wide, and perforation due to extensive heat denaturation is a problem.
[0007]
The present invention has been made in view of such a situation, and it is possible to make an incision within a necessary minimum range under a low output, to reduce perforation, to be less invasive, and to have excellent operability. An object is to provide a type electric treatment instrument.
[0008]
[Means for Solving the Problems]
In order to achieve the above object, a bipolar electric treatment instrument according to the present invention comprises:
A catheter tube that can be inserted into the body;
A first electrode attached to the distal end of the catheter tube;
A drive wire disposed inside the catheter tube so as to be movable in the axial direction;
A needle-like or spatula-like second electrode that is attached to the distal end of the drive wire, and that can be freely projected and retracted from the distal end of the catheter tube in accordance with the axial movement of the drive wire; Have.
[0009]
In the bipolar electrical treatment instrument according to the present invention, a high-frequency current is passed between the first electrode attached to the distal end of the catheter tube and the second electrode protruding from the distal end of the catheter tube. The living tissue is excised by moving the second electrode serving as an electric knife. As described above, the bipolar electric treatment instrument of the present invention does not need to provide a counter electrode outside the patient's body, and can flow a high-frequency current only to a necessary lesion part, so that it can be compared with a monopolar type device. Low output and less perforation due to heat denaturation. Therefore, the bipolar electric treatment instrument of the present invention is a device that realizes a less invasive treatment for a patient.
[0010]
Preferably, the first electrode has a ring shape, and an insulating tube is attached to an inner periphery of the first electrode so as to protrude from a distal end portion of the first electrode.
[0011]
By setting it as such a structure, insulation with a 1st electrode and a 2nd electrode can be aimed at favorably.
[0012]
Preferably, the insulating tube extends along the inner circumference of the catheter tube along the axial direction, and a conductive wire is disposed between the outer tube of the catheter tube and the insulating tube. The distal end of the conductive wire is connected to the first electrode.
Preferably, the conductive wire is a reinforcing coil.
[0013]
By adopting such a configuration, it is possible to satisfactorily insulate the conductive wire for energizing the first electrode and the drive wire for energizing the second electrode. In particular, by using this conductive wire as a reinforcing wire, the catheter tube can also be reinforced.
[0014]
Preferably, the base end portion of the second electrode includes a stopper convex portion having an outer diameter larger than the outer diameter of the second electrode,
A stopper tube that passes through the second electrode but does not pass through the stopper convex portion is attached to the inner periphery of the distal end portion of the insulating tube.
[0015]
By setting it as such a structure, it can prevent effectively that a 2nd electrode protrudes too much from the distal end part of a catheter tube. In addition, when the 2nd electrode used as an electric knife protrudes too much from the distal end of a catheter tube, there exists a possibility that not only a lesion part but the normal musculature below may be cauterized.
[0016]
Preferably, the proximal end of the catheter tube is provided with an operating body,
The operation main body is provided with an operation handle for connecting the proximal end portion of the drive wire to move the drive wire in the axial direction inside the catheter tube.
The operation main body is for movement restriction for restricting movement of the operation handle with respect to the operation main body and preventing the needle-like or spatula-like second electrode from being drawn too much into the catheter tube. A stopper is provided.
[0017]
By setting it as such a structure, it can prevent effectively that a 2nd electrode pulls in too much inside from the distal end of a catheter tube. If the second electrode is pulled too much, the second electrode will come off the stopper tube, making it difficult to insert the second electrode into the narrow hole of the stopper tube again. Can no longer jump out of the distal end.
[0018]
In the present invention, although not particularly limited, an insulating coating may be applied to a predetermined range from the tip of the second electrode. Examples of the insulating coating include a fluororesin coating. By applying an insulating coating to a predetermined range from the tip of the second electrode and adjusting the range of the coating, heat generation at the tip of the second electrode can be suppressed and contribution to prevention of perforation can be achieved.
[0019]
The insulating coating may be applied over the entire outer periphery of the second electrode. In that case, the entire surface of the second electrode can be made smooth, the movement of the second electrode as an electric knife can be made smooth, and tissue adhesion can be effectively prevented.
[0020]
DETAILED DESCRIPTION OF THE INVENTION
Hereinafter, the present invention will be described based on embodiments shown in the drawings.
FIG. 1 is an overall configuration diagram of a bipolar electric treatment instrument according to an embodiment of the present invention, FIG. 2 is a cross-sectional view of a main portion of a distal end portion of a catheter tube shown in FIG. 1, and FIG. It is the schematic which shows the use condition of an instrument.
[0021]
As shown in FIGS. 1 and 2, a bipolar electric treatment instrument 2 according to this embodiment is an instrument called a so-called high-frequency knife, and has a catheter tube 4 in which a lumen 3 is formed. A drive wire 8 is mounted in the lumen 3 of the catheter tube 4 so as to be movable forward and backward along its axial direction.
[0022]
A ring-shaped first electrode 6 is fixed to the distal end of the catheter tube 4. The material of the first electrode 6 is not particularly limited as long as it is a conductive material. Examples of such a conductive material include gold, silver, platinum, nickel, iron, aluminum, tin, and zinc. Examples include simple metals such as stainless steel and nichrome alloys.
[0023]
The catheter tube 4 includes an outer tube 16, an insulating tube 14 disposed inside the outer tube 16, and a reinforcing coil 18 disposed between the tubes 14 and 16. The distal end of the insulating tube 14 protrudes from the distal end of the electrode 6 in the axial direction with a predetermined length L1 through the internal through hole of the first electrode 6. The predetermined length L1 is not particularly limited, but is usually 0.1 to 1 mm, preferably 0.3 to 0.7 mm. The first electrode 6 and the distal end of the insulating tube 14 are fixed by an adhesive or the like. Also, the first electrode 6 and the distal end of the outer tube 16 are fixed together with an adhesive or the like.
[0024]
The reinforcing coil 18 has conductivity, and the distal end thereof is inserted into the rear end side ring-shaped recess of the first electrode 6, and is connected to the first electrode 6 there. The connection is performed by brazing, for example. The material of the reinforcing coil is not particularly limited, and is made of the same metal or alloy as that of the first electrode 6.
[0025]
A stopper tube 20 is fixed to the inner peripheral portion of the distal end portion of the insulating tube 14 by means such as heat fusion or adhesion. A second electrode insertion hole 21 is formed in the stopper tube 20 along the axial direction. The axial length L2 of the stopper tube 20 is not particularly limited, but is usually 5 to 15 mm, preferably 7 to 12 mm.
[0026]
A needle-like or spatula-like second electrode 10 is connected to the distal end of the drive wire 8. A stopper ring 12 serving as a stopper convex portion having an outer diameter larger than the outer diameter of the second electrode 10 is fixed to a connection portion between the drive wire 8 and the second electrode 10.
[0027]
The material of the drive wire 8, the stopper ring 12, and the second electrode 10 is not particularly limited as long as it is a conductive material. The drive wire 8 may be either a single wire or a stranded wire, and the stranded wire includes a core wire made of a single wire and a coil surrounding the core wire.
[0028]
Although the outer diameter of the 2nd electrode 10 is not specifically limited, Preferably it is 0.2-0.6 mm, More preferably, it is 0.3-0.5 mm. In the case of such an outer diameter, the sharpness is particularly improved. The outer diameter of the stopper ring 12 is not particularly limited, but is preferably 0.9 to 1.0 mm. The outer diameter of the drive wire 8 is not particularly limited, but is preferably 0.7 to 0.85 mm.
[0029]
The material of the outer tube 16, the insulating tube 14, and the stopper tube 20 is not particularly limited as long as it is an electrically insulating material, such as polyethylene, polypropylene, polyvinyl chloride, polyurethane, polyamide, polyester, polycarbonate, polyethersulfone, and fluororesin. Plastics can be used, and a material having an appropriate elastic modulus can be selected according to the purpose.
[0030]
The outer diameter of the outer tube 16 is not particularly limited, but is preferably 1.5 to 3.0 mm, for example. The thickness of the outer tube 16 is not particularly limited, but is about 0.1 to 0.5 mm. Although the outer diameter of the insulating tube 14 is not specifically limited, For example, 1.0-2.0 mm is preferable. The thickness of the insulating tube 14 is not particularly limited, but is about 0.1 to 0.5 mm. The inner diameter of the stopper tube 20 is determined so that the second electrode 10 can be inserted and the stopper ring 12 cannot be inserted. For example, the stopper ring 12 of about 0.7 to 0.9 mm is formed on the stopper tube 20. Since it cannot be inserted into the insertion hole 21, the distal end of the second electrode 10 can not protrude from the distal end of the insulating tube 14 beyond a predetermined maximum protruding length L 3. Although the maximum protrusion length L3 is determined according to the use etc., Preferably it is 5-10 mm.
[0031]
As shown in FIG. 1, an operation main body 30 is attached to the proximal end portion of the catheter tube 4. An operation handle 32 is attached to the operation main body 30 so as to be movable in the axial direction. A movement limiting stopper 36 is mounted on the proximal end side of the operation handle 32 so as to be movable along the longitudinal direction of the operation main body 30 and to be fixed at a predetermined position. The movement restricting stopper 36 restricts the axial movement stroke of the operation handle 32.
[0032]
The proximal end of the drive wire 8 shown in FIGS. 1 and 2 is connected to the operating handle 32. The second electrode 10 connected to the distal end portion of the drive wire 8 is moved in and out of the distal end portion of the catheter tube 4 by moving the operation handle 32 in the axial direction with respect to the operation main body 30. It is possible.
[0033]
A fixing screw 34 is attached to the operation handle 32. The fixing screw 34 is for limiting the axial movement of the operation handle 32 relative to the operation main body 30. By fixing the operation handle 32 at a predetermined axial position of the operation main body 30, it is possible to maintain the state in which the second electrode 10 protrudes from the distal end portion of the catheter tube 4 at a predetermined length. it can. Alternatively, the state in which the second electrode 10 is drawn from the distal end portion of the catheter tube 4 can be maintained.
[0034]
When the distal end portion of the catheter tube 4 in the bipolar electric treatment instrument 2 is guided into the patient's body using an endoscope, the second electrode 10 is retracted from the distal end portion of the catheter tube 4. Maintain the state. Thereafter, when the distal end of the catheter tube 4 is inserted near the lesion in the patient's body, the second electrode 10 is projected from the distal end portion of the catheter tube 4 at a predetermined length. Maintain and perform operations such as excision of the lesion.
[0035]
As shown in FIG. 1, the wiring cord 42 is connected to the operation handle 32. The wiring cord 42 is electrically connected to the proximal end portion of the drive wire 8 connected to the operation handle 32, and supplies a high-frequency current to the second electrode 10 through the drive wire 8. Further, a wiring cord 40 is connected to the proximal end portion of the catheter tube 4. The wiring cord 40 is electrically connected to the proximal end of the reinforcing coil 18 shown in FIG. 2 and supplies a high-frequency current to the first electrode 6 through the reinforcing coil 18. These wiring cords 40 and 42 are connected to the connection connector 44. The connection connector 44 is connected to a high-frequency current generator not shown.
[0036]
During the treatment using the bipolar electric treatment instrument 2 of the present embodiment, the distal end of the catheter tube 4 is moved close to the lesion 50 in the mucosa layer 52 located on the inner surface of the muscle tissue layer 54 shown in FIG. Let For this purpose, first, the operation handle 32 shown in FIG. 1 is operated, and the second electrode 10 is drawn into the second electrode insertion hole 21 from the distal end of the catheter tube 4 to maintain the state. In this state, for example, the distal end of the catheter tube 4 is introduced into the body cavity through the channel of the endoscope.
[0037]
When the distal end of the catheter tube 4 is positioned near the lesioned part 50, the operation handle 32 located outside the body is operated, and the distal end of the second electrode 10 is fed out from the distal end of the catheter tube 4 to obtain a predetermined value. Stop at the protruding position.
[0038]
Next, as shown in FIG. 3, the distal end of the needle-like second electrode 10 is inserted into the mucosal layer 52 located below the lesioned part 50, and the first electrode 6 and the second electrode 10 are connected. By moving the second electrode 10 while flowing a high-frequency current therebetween, the lesion 50 is excised with electrical energy.
[0039]
In the bipolar electric treatment instrument 2 according to the present embodiment, the gap between the first electrode 6 attached to the distal end portion of the catheter tube 4 and the second electrode 10 protruding from the distal end portion of the catheter tube 4. Then, the living tissue is excised by flowing a high-frequency current and moving the second electrode 10 serving as an electric knife. As described above, the bipolar electric treatment instrument 2 according to the present embodiment does not need to provide a counter electrode outside the patient's body, and can flow a high-frequency current only to a necessary lesion portion, so that it is compared with a monopolar type device. Thus, the output is low, and there are few perforations that reach the muscle tissue layer 54 due to thermal denaturation. Therefore, the bipolar electric treatment instrument 2 of the present embodiment is a device that realizes a less invasive treatment for a patient.
[0040]
The present invention is not limited to the above-described embodiment, and can be variously modified within the scope of the present invention.
[0041]
For example, in the above-described embodiment, the insulating coating is not formed on the surface of the second electrode 10, but as shown in FIG. 2, the insulating coating is applied in a region having a predetermined range length L 4 from the tip of the second electrode 10. A film may be coated. The range of the predetermined range length L4 is not particularly limited, and is a range larger than 0 and shorter than the length L2 + L3. By adjusting the length, the heat generation range in the second electrode 10 can be adjusted. it can.
[0042]
The material of the insulating coating film is not particularly limited, and for example, a fluororesin, a polyimide resin, a ceramic, or the like is used. Examples of ceramics include metal oxides, metal nitrides, and metal carbides. The insulating coating film is preferably a film to which the tissue after energization is difficult to adhere or from which the deposit is easily peeled off. From such a viewpoint, a slippery film is preferable.
[0043]
Although the film thickness of an insulating coating film is not specifically limited, About 5-50 micrometers is preferable. The method for forming the insulating coating film is not particularly limited, and examples thereof include a baking method, a spray spraying method, and an immersion method.
[0044]
By applying an insulating coating film to a portion within a predetermined range from the tip of the second electrode 10 and adjusting the coating range, heat generation at the tip of the second electrode 10 can be suppressed, thereby contributing to prevention of perforation. When the insulating coating is applied over the entire area of the second electrode 10, the entire surface of the second electrode 10 can be made smooth, and the movement of the second electrode 10 as an electric knife can be made smooth. At the same time, the adhesion of the tissue can be effectively prevented.
[0045]
Moreover, the risk of perforating the muscle tissue layer can be further reduced by providing an electrically insulating tip having a diameter larger than the outer diameter of the second electrode 10 at the tip of the second electrode 10. Examples of the shape of the electrically insulating chip include a spherical shape and a disk shape.
[0046]
【The invention's effect】
As described above, according to the present invention, it is not necessary to provide a counter electrode outside the patient's body, and a high-frequency current can be supplied only to a necessary lesion part, so that it is compared with a monopolar type device. Low output and less perforation due to heat denaturation. Therefore, the bipolar electric treatment instrument of the present invention is a device that realizes a less invasive treatment for a patient.
[Brief description of the drawings]
FIG. 1 is an overall configuration diagram of a bipolar electric treatment instrument according to an embodiment of the present invention.
2 is a cross-sectional view of a principal part of a distal end portion of the catheter tube shown in FIG.
FIG. 3 is a schematic view showing a use state of the electric treatment instrument shown in FIG. 1;
[Explanation of symbols]
2 ... Bipolar electric treatment instrument 4 ... Catheter tube 6 ... First electrode 8 ... Drive wire 10 ... Second electrode 12 ... Stopper ring 14 ... Insulating tube 16 ... Outer tube 18 ... Reinforcing coil 20 ... Stopper tube 30 ... Operation Main body 32 ... handle for operation

Claims (4)

A catheter tube that can be inserted into the body;
A first electrode secured to the distal end of the catheter tube;
A drive wire disposed inside the catheter tube so as to be movable in the axial direction;
A needle-like or spatula-like second electrode that is attached to the distal end of the drive wire, and that can be freely projected and retracted from the distal end of the catheter tube in accordance with the axial movement of the drive wire; Have
The first electrode has a ring shape, and an insulating tube is fixed to an inner periphery of the first electrode so as to protrude from a distal end portion of the first electrode,
The insulating tube extends along the axial direction on the inner periphery of the catheter tube, and a conductive wire is disposed between the outer tube of the catheter tube and the insulating tube. A distal end of the conductive wire is connected to the first electrode;
A bipolar electric treatment instrument in which the conductive wire is a reinforcing coil. The base end portion of the second electrode includes a stopper convex portion having an outer diameter larger than the outer diameter of the second electrode,
2. The bipolar electric treatment instrument according to claim 1 , wherein a stopper tube that passes through the second electrode but does not pass through the stopper convex portion is attached to an inner periphery of a distal end portion of the insulating tube. The proximal end of the catheter tube comprises an operating body,
The operation main body is provided with an operation handle for connecting the proximal end portion of the drive wire to move the drive wire in the axial direction inside the catheter tube.
The operation main body is for movement restriction for restricting movement of the operation handle with respect to the operation main body and preventing the needle-like or spatula-like second electrode from being drawn too much into the catheter tube. The bipolar electric treatment instrument according to claim 1 or 2, further comprising a stopper. The bipolar electric treatment instrument according to any one of claims 1 to 3 , wherein an insulating coating is applied to a predetermined range from the tip of the second electrode.

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