JP4390501B2 - Endoscopic high-frequency incision tool - Google Patents

Description

  The present invention relates to a high-frequency incision tool for an endoscope that is used by being attached to an endoscope in order to incise a mucous membrane or the like of a human tissue by energizing a high-frequency current.

  In general, a high-frequency incision instrument for an endoscope is configured such that a high-frequency incision electrode is attached to the tip of an electrically insulating flexible sheath that is inserted into a treatment instrument insertion channel of an endoscope. Since the tip of the high-frequency incision electrode lies in the back of the incision while the incision is being incised, the incision depth is not well understood, and human tissue may be incised to an unplanned depth.

Therefore, it is possible to form a high-frequency incision electrode in a rod shape that is bent so that the tip portion is exposed on the surface of the mucosa during submucosal incision, and incision can be performed while checking the tip of the high-frequency incision electrode on the endoscopic observation screen. There is what can be made (for example, Patent Document 1).
JP 2002-153485 A

  However, even though the tip of the high-frequency incision electrode exposed on the surface of the mucous membrane can be confirmed on the endoscopic observation screen as in the invention described in Patent Document 1, the incision is actually made by the high-frequency incision electrode. Since an incision surface such as a submucosa cannot be observed in real time, there is a case where a desired medically optimal range cannot always be incised.

  In order to perform an incision treatment on an affected area with a conventional endoscopic high-frequency incision tool, first, the distal end portion of the endoscope is guided to a position convenient for treatment on the affected area, and then the high-frequency incision tool is inserted into the endoscope. Therefore, it is necessary to incise the affected part by combining the guidance operation of the endoscope and the guidance operation of the treatment instrument, and the operation is very complicated.

  Therefore, the present invention is capable of easily and safely incising a desired medically optimal range by a simple operation while observing in real time an incision surface such as a submucosa that is actually being incised by a high-frequency incision electrode. An object is to provide a high-frequency incision tool for an endoscope.

  In order to achieve the above object, the endoscope high-frequency incision tool of the present invention has a hood attached so as to surround the distal end surface of the distal end main body of the endoscope in which the observation window is arranged, The hood is formed with a transparent bowl-shaped portion that protrudes forward from the peripheral portion of the distal end surface of the distal end body and covers the front of the distal end surface of the distal end body as it moves away from the distal end surface of the distal end body. The high-frequency incision electrode is attached in the vicinity of the most distal end of the bowl-like portion so as to protrude forward therefrom.

In addition, handling is easy if the hood is detachable from the distal end main body of the endoscope.
In addition, the high-frequency incision electrode is suitable for use in incision if it is formed in a line connecting two locations that are spaced apart at a position that crosses the vicinity of the most distal end of the saddle-shaped part. It may be formed in a shape, or may be formed in an arc shape that bulges forward. In addition, when the high-frequency incision electrode extends to the side surface of the hook-like portion, lateral incision can be performed.

  Such a high-frequency incision electrode may be a conductive wire, and the conductive wire forming the high-frequency incision electrode passes through the inner space of the bowl-shaped portion and is outside the hood in the vicinity of the attachment portion with respect to the front end body of the hood. It may be pulled out. Alternatively, the conductive wire that forms the high-frequency incision electrode may be drawn backward from the rear end of the hood through the inner space of the bowl-shaped portion.

  Note that it is advantageous in terms of durability of the hood that the high-frequency cutting electrode is attached to the vicinity of the most distal end of the bowl-shaped portion via a ceramic pipe. In addition, the hood may have an opening in a shape that is cut off between the vicinity of the front end and the vicinity of the attachment portion with respect to the tip body at the back side position of the hook-shaped portion.

  In that case, the opening may be formed in a shape in which the hood is cut off obliquely, and may be positioned in front of the distal end surface of the distal end main body of the endoscope, or the hook-shaped portion may be positioned at the distal end surface of the distal end main body. The opening part may be located in the side part which remove | deviated from the front position of the front end surface of a front-end | tip part main body.

  According to the present invention, in the vicinity of the high-frequency incision electrode attached in a state of protruding forward from the vicinity of the leading edge of the transparent bowl-like portion, the submucosa and the like that are actually being incised by the high-frequency incision electrode The incision surface of the endoscope can be observed in real time, so that the desired medically optimal range can be safely incised, and the guidance operation of the endoscope is not required without requiring the guidance operation of the high-frequency incision tool alone. You can do it with just a very simple and easy operation.

  The hook-shaped portion of the hood attached to the peripheral portion of the distal end surface of the distal end body so as to protrude forward from the distal end surface of the distal end body of the endoscope in which the observation window is arranged is A high-frequency incision electrode is attached in a state of being curved toward the front of the front end surface of the main body of the front end portion as it moves away from the front end surface, and protruding forward from the vicinity of the most distal end of the hook-shaped portion.

Embodiments of the present invention will be described with reference to the drawings.
FIG. 1 is a side sectional view of a state in which the endoscope high-frequency incision instrument according to the first embodiment of the present invention is attached to the distal end portion of the endoscope 50, and FIG. 3 and 4 are a side view III view (front view) and an arrow view IV view (bottom view) in FIG.

  The endoscope 50 is a so-called front-view endoscope in which an observation window 53 for observing the front is arranged on a distal end surface 52 of a columnar distal end main body 51 that constitutes the distal end of the insertion portion. However, it may be a front perspective type endoscope or the like.

  The optical image of the subject taken in from the observation window 53 is projected onto the imaging surface of the solid-state imaging device 55 (or the end surface of the image guide fiber bundle) by the objective optical system 54. Reference numeral 56 denotes a treatment instrument insertion channel for allowing the treatment instruments to be inserted, and an outlet thereof opens to the distal end surface 52 of the distal end portion main body 51.

  The insertion portion of the endoscope 50 is formed in a flexible tubular shape that is freely bent by an external force, but a portion closer to the most distal end of the insertion portion adjacent to the distal end portion main body 51 is connected to the proximal end of the insertion portion. The bending portion 57 can be arbitrarily bent by a remote operation from the operating portion. Since the structure is well-known, detailed description is abbreviate | omitted.

  The endoscope high-frequency incision tool is provided with a transparent hood 10 that is detachably attached to the distal end body 51 so as to surround the distal end surface 52 of the distal end body 51 of the endoscope 50. As a material of the transparent hood 10, a transparent acrylic resin or polycarbonate resin can be used.

  The main part of the transparent hood 10 protrudes forward from the peripheral portion of the distal end surface 52 of the distal end main body 51, and moves forward of the distal end surface 52 of the distal end main body 51 as it moves away from the distal end surface 52 of the distal end main body 51. It is the hook-shaped part 11 formed in the curved surface shape to cover, and the hook-shaped part 11 should just be transparent.

  The rear portion of the transparent hood 10 from the bowl-shaped portion 11 is a detachable portion 12 formed in a cylindrical shape that is removable with respect to the outer periphery of the tip portion main body 51, and a step portion 13 formed on the inner surface thereof. The transparent hood 10 is positioned with respect to the distal end portion main body 51 by contacting the distal end surface 52 of the distal end portion main body 51 with the distal end portion main body 51.

  In this embodiment, the detachable portion 12 is tightly fitted to the tip portion main body 51 with elastic deformation, so that the transparent hood 10 does not fall off from the tip portion main body 51 naturally. However, it is possible to provide engaging protrusions and grooves, other engaging members, and the like to prevent natural dropout.

  The bowl-shaped portion 11 of the transparent hood 10 is formed in a slightly convex curved shape. As shown in FIG. 4, the foremost portion is formed on a side that is straight to the side, and the high-frequency incision electrode 16 is attached to the portion so as to protrude forward.

  Therefore, it is possible to observe the vicinity of the high-frequency incision electrode 16 and the state around the high-frequency incision electrode 16 through the transparent bowl-shaped portion 11 from the observation window 53. The observation depth of the objective optical system 54 may be set so as to be suitable for it, and the distance from the observation window 53 to the high-frequency incision electrode 16 is, for example, about 10 mm or more, so that it is most easily used.

  The high-frequency incision electrode 16 is formed of a conductive wire, and is inserted into a ceramic heat-resistant pipe 17 embedded in a state penetrating in the front-rear direction near the left and right ends of the foremost portion of the bowl-shaped portion 11. Thus, it is fixedly installed in a state where it is stretched straight between the outer end surfaces of the two heat-resistant pipes 17 arranged with a space therebetween.

  The conductive wire 18 connected to the high-frequency cutting electrode 16 passes from the inner end portion of the heat-resistant pipe 17 through the space inside the bowl-shaped portion 11 in the vicinity of the attachment portion with respect to the distal end body 51 of the transparent hood 10. It is pulled out to the outside and extends from there as a conductive cable 19.

  In addition, since the high frequency incision electrode 16 of the present invention is a monopolar type, there is no necessity of arranging two conductive wires 18, and one end of the high frequency incision electrode 16 may be fixed to the heat resistant pipe 17 or the like. There is no problem.

  The transparent hood 10 is formed with an opening 14 having a shape obtained by obliquely cutting between the vicinity of the front end and the vicinity of the attachment portion with respect to the tip body 51 at the back side position of the bowl-shaped portion 11. Since the opening 14 is opened in front of the treatment instrument insertion channel 56 of the endoscope 50, the treatment instruments inserted through the treatment instrument insertion channel 56 can be projected forward through the opening 14. it can.

  FIG. 5 shows a setting state when the submucosal portion of the human tissue 100 is incised using the endoscope high-frequency incision instrument according to the first embodiment of the present invention, and is pulled out rearward from the transparent hood 10. The conductive cable 19 is fixed along the insertion portion 58 of the endoscope 50 by the fixing band 20 or the like and connected to the positive terminal of the high frequency power supply device 70. The negative electrode terminal of the high frequency power supply device 70 is connected to a counter electrode plate 71 arranged in contact with the outer surface of the living tissue 100 in a wide area. Reference numeral 59 denotes an operation unit of the endoscope.

  6 to 9 show a state in which endoscopic mucosal dissection (EMR) is performed using the endoscopic high-frequency incision instrument according to the present embodiment. First, as shown in FIG. Then, physiological saline or the like is injected into the affected area with an endoscope syringe 81 passed through the treatment instrument insertion channel 56 of the endoscope 50 to raise the mucosal surface of the living tissue 100. Then, by applying a high-frequency current by pressing the high-frequency incision electrode 16 against the mucosal surface, the submucosa can be incised as shown in FIG.

  At this time, it is not necessary to perform the guiding operation of the high-frequency incision tool alone, and the high-frequency incising electrode 16 can be guided to a desired affected area only by performing the guiding operation of the endoscope. The incision treatment can be performed while observing in real time the state of the incision surface of the mucosa to be incised through the transparent hook-shaped portion 11.

  Then, the bending portion 57 of the endoscope 50 is bent to change the direction of the distal end of the insertion portion of the endoscope 50 as indicated by a broken line arrow A in FIG. The height can be easily adjusted remotely. In this way, the mucous membrane can be peeled off by accurately cutting the streaks between the mucosal surface and the muscle layer, which has been considered difficult in the past.

  Further, as shown in FIG. 8, the curved portion 57 of the endoscope 50 is remotely operated as indicated by a broken line arrow B to lift the mucous membrane at the hook-shaped portion 11 and observe the state of the incision surface well. It is possible to easily determine the necessity of additional incision.

  If necessary, the endoscopic high-frequency snare 82 or other endoscopic treatment instrument passed through the treatment instrument insertion channel 56 of the endoscope 50 as shown in FIG. Various treatments can be performed to increase the therapeutic effect.

  10 and 11 are a side sectional view and a bottom view of the endoscope high-frequency incision instrument according to the second embodiment of the present invention, in which the high-frequency incision electrode 16 is formed in an arc shape that swells forward. Yes. Thus, the shape of the high-frequency incision electrode 16 can take various embodiments.

  FIGS. 12, 13, and 14 are a side sectional view, a front view (arrow XIII view), and a bottom view (arrow XIV view) of a high-frequency cutting instrument for an endoscope according to a third embodiment of the present invention. As shown in FIG. 14, the high-frequency incision electrode 16 made of a conductive wire is formed in an arc shape along the distal end surface of the bowl-shaped portion 11.

  Further, the bowl-shaped portion 11 of the transparent hood 10 is formed so as to completely cover the front of the distal end portion main body 51 of the endoscope 50, and the opening portion 14 is located from the front position of the distal end surface 52 of the distal end portion main body 51. An opening is formed in a lateral direction at the detached side surface portion, and the conductive wire 18 is pulled out rearward from the rear end of the transparent hood 10 through the inner space of the bowl-shaped portion 11. It passes through the treatment instrument insertion channel 56.

  FIG. 15 is a bottom view of a high-frequency incision tool for an endoscope according to a fourth embodiment of the present invention, in which the high-frequency incision electrode 16 according to the third embodiment is extended to the side surface of the hook-shaped portion 11. . With this configuration, the transparent hood 10 can be shaken sideways as indicated by the broken line arrow C to perform mucosal incision to the side.

  The present invention is not limited to the above embodiments. For example, the high-frequency incision electrode 16 does not necessarily need to be a wire, and any conductive member may be used.

It is side surface sectional drawing of the state in which the high frequency incision tool for endoscopes of the 1st Example of this invention was attached to the front-end | tip part of an endoscope. It is side surface sectional drawing of the high frequency cutting tool for endoscopes of the 1st Example of this invention. It is a front view (arrow III figure in FIG. 2) of the high frequency incision tool for endoscopes of the 1st Example of this invention. FIG. 3 is a bottom view of the endoscope high-frequency incision tool according to the first embodiment of the present invention (an arrow IV view in FIG. 2). It is a schematic diagram of the setting state at the time of incising the submucosa of a human body tissue using the endoscope high frequency incision instrument of the 1st example of the present invention. It is side surface sectional drawing of the use condition of the high frequency incision tool for endoscopes of the 1st Example of this invention. It is side surface sectional drawing of the use condition of the high frequency incision tool for endoscopes of the 1st Example of this invention. It is side surface sectional drawing of the use condition of the high frequency incision tool for endoscopes of the 1st Example of this invention. It is side surface sectional drawing of the use condition of the high frequency incision tool for endoscopes of the 1st Example of this invention. It is side surface sectional drawing of the high frequency cutting tool for endoscopes of the 2nd Example of this invention. It is a bottom view of the high-frequency incision tool for endoscopes according to the second embodiment of the present invention. It is side surface sectional drawing of the high frequency incision tool for endoscopes of the 3rd Example of this invention. It is a front view (arrow XIII figure in FIG. 12) of the high frequency incision tool for endoscopes of the 3rd Example of this invention. It is a bottom view (arrow XIV figure in FIG. 12) of the high frequency incision tool for endoscopes of the 3rd Example of this invention. It is a bottom view of the high frequency incision tool for endoscopes of the 4th example of the present invention alone.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 Transparent hood 11 Cage-like part 12 Detachable part 14 Opening part 16 High frequency incision electrode 17 Heat resistant pipe 18 Conductive wire 50 Endoscope 51 Tip part main body 52 Tip surface 53 Observation window 56 Treatment instrument insertion channel

Claims (5)

A hood attached to surround the distal end surface of the distal end body of the endoscope in which the observation window is disposed, and the hood is directed forward from a peripheral portion of the distal end surface of the distal end body. A transparent hook-shaped part that covers the front of the tip surface of the tip part body is formed as it protrudes and moves away from the tip surface of the tip part body. A high-frequency incision electrode made of conductive wire is attached to the protruding state ,
The high-frequency incision electrode has an arcuate portion arranged in a semicircular shape along the entire width of the distal end surface of the hook-shaped portion, and continuously on both sides of the hook-shaped portion backward from both ends of the arc-shaped portion. An endoscopic high-frequency incision tool comprising: an extending portion extending along the same .   The high-frequency incision tool for an endoscope according to claim 1, wherein the hood is detachable from a distal end main body of the endoscope. The high-frequency incision tool for endoscopes according to claim 1 or 2, wherein the conductive wire forming the high-frequency incision electrode is drawn backward from the rear end of the hood through the inner space of the bowl-shaped portion. The hood, either the opening of the skived's shape cut between the vicinity of the mounting portion of 3 claims 1 and has on the rear side position of the eaves-shaped portion with respect to the cutting edge and near the said distal end portion main body The high-frequency incision tool for endoscopes as described in the item. The hook-shaped portion is formed in a shape that completely covers the front of the front end surface of the front end portion main body, and the opening is located on a side surface portion that deviates from the front position of the front end surface of the front end portion main body. The high frequency incision tool for endoscopes according to claim 4 .

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