JP4390502B2 - 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 cylindrical protruding portion that protrudes forward from the entire outer edge of the distal end surface of the tip body, and the high-frequency incision electrode protrudes forward from the most distal surface of the cylindrical protruding portion. And attached to the cylindrical projecting portion so as to cross the most distal end portion of the cylindrical projecting portion.

In addition, handling is easy if the hood is detachable from the distal end main body of the endoscope.
In addition, if the cylindrical protrusion is formed into a flat shape at the tip, and the high-frequency incision electrode is arranged in the long axis direction, the mucosal piece incised by the high-frequency incision electrode can be easily pushed away, and the cylindrical shape If a slope portion with the high-frequency incision electrode at the top is formed on the most distal surface of the protrusion, the mucosal piece incised by the high-frequency incision electrode can be further pushed away.

  The high-frequency incision electrode is suitable for incision when it is formed in a line connecting two points spaced apart from the foremost position of the cylindrical protrusion, and the high-frequency incision electrode is conductive. It may be a wire. In that case, the conductive wire may be drawn backward through the inner space of the cylindrical protrusion.

  In addition, it is advantageous in terms of heat resistance of the hood if the high-frequency cutting electrode is attached to the most distal end portion of the cylindrical protrusion via a ceramic pipe.

  According to the present invention, the high-frequency incision in the vicinity of and around the high-frequency incision electrode attached in a state of crossing the most advanced portion of the cylindrical protrusion at a position protruding forward from the front-most surface of the transparent cylindrical protrusion Since the incision surface under the mucous membrane that is actually being incised by the electrode can be observed in real time, the desired medically optimal range can be safely incised, and the high-frequency incision unit alone can be guided. It is not necessary, and it can be performed with an extremely simple and easy operation only by the guidance operation of the endoscope.

  A transparent cylindrical protrusion that protrudes forward from the entire outer edge of the distal end surface of the distal end body on the hood that is attached to surround the distal end surface of the distal end body of the endoscope in which the observation window is disposed. The formed conductive wire-shaped high-frequency incision electrode is attached to the cylindrical projecting portion so as to cross the most distal portion of the cylindrical projecting portion at a position projecting forward from the most distal surface of the cylindrical projecting 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 rear half of the transparent hood 10 is a detachable portion 12 formed in a cylindrical shape that is detachable with respect to the outer periphery of the tip portion main body 51, and the tip portion is formed on the step portion 13 formed on the inner surface thereof. The transparent hood 10 is positioned with respect to the distal end main body 51 when the distal end surface 52 of the main body 51 abuts.

  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 front half of the transparent hood 10 is a cylindrical protrusion 11 that protrudes forward from the entire outer edge of the distal end surface 52 of the distal end body 51, and at least the cylindrical protrusion 11 only needs to be transparent. . The tip portion of the cylindrical projection 11 is formed in a flattened shape, and the most distal surface 15 of the cylindrical projection 11 is a horizontally long oval shape as shown in FIG. ing. However, it may be oval.

  The high-frequency cutting electrode 16 is provided in the cylindrical protruding portion 11 so as to cross the longest portion of the cylindrical protruding portion 11 in the major axis direction at a position protruding forward from the most distal surface 15 of the cylindrical protruding portion 11. It is attached. Therefore, the vicinity of the high-frequency incision electrode 16 and the surrounding state can be observed from the observation window 53 through the transparent cylindrical protrusion 11. 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 the vicinity of the left and right ends of the most distal surface 15 of the cylindrical protrusion 11, so that there is a gap therebetween. Are fixedly stretched between the outer end surfaces of the two heat-resistant pipes 17 arranged. The high-frequency incision electrode 16 is arranged in a state of swelling slightly forward as shown in FIG. However, it may be arranged in a straight line.

  The conductive wire 18 connected to the high-frequency incision electrode 16 is drawn backward from the inner end portion of the heat-resistant pipe 17 through the space inside the transparent hood 10, and is used in the treatment instrument insertion channel 56 of the endoscope 50 when used. Arranged to pass.

  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 wire 18 passes through the treatment instrument insertion channel 56 of the endoscope 50 and is 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 58 denotes an endoscope insertion portion, and 59 denotes an operation portion.

  FIG. 6 shows a state in which endoscopic mucosal dissection (EMR) is performed using the endoscopic high-frequency incision instrument of this embodiment, and the high-frequency incision electrode 16 is placed on the mucosal surface of the living tissue 100. It is possible to make an incision under the mucous membrane by applying a high-frequency current while being pressed against.

  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 state of the incision surface of the mucous membrane to be incised can be expanded by pushing the front end surface 15 of the cylindrical projection 11 and observed through the transparent cylindrical projection 11 in real time.

  Then, by operating the bending portion 57 of the endoscope 50 to change the direction of the distal end of the insertion portion of the endoscope 50, the incision depth by the high-frequency incision electrode 16 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.

  Note that, by appropriately setting the distance D between the lower end position 15 ′ of the foremost surface 15 of the cylindrical protrusion 11 and the high-frequency incision electrode 16, it is possible to prevent incision deeply under the mucous membrane. .

  FIG. 7 shows a high-frequency incision instrument for an endoscope according to a second embodiment of the present invention, in which a slope portion with the high-frequency incision electrode 16 as the top is formed on the most distal surface 15 of the cylindrical projection 11. It is. By doing in this way, it becomes easy to push away the mucosa piece incised by the high-frequency incision electrode 16 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 state in which the high frequency incision tool for endoscopes of the 2nd Example of this invention was attached to the front-end | tip part of an endoscope.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 Transparent hood 11 Cylindrical protrusion 12 Detachable / detachable part 15 State-of-the-art surface 16 High frequency incision electrode 17 Heat-resistant pipe 18 Conductive wire 50 Endoscope 51 End part main body 52 End face 53 Observation window 56 Treatment instrument insertion channel

Claims (5)

The hood has a hood attached to surround the distal end surface of the distal end body of the endoscope in which the observation window is arranged, and the hood faces forward from the entire outer edge of the distal end surface of the distal end body. A transparent cylindrical projecting portion projecting from the tube, and the high-frequency incision electrode traverses the most distal portion of the tubular projecting portion at a position projecting forward from the most distal surface of the tubular projecting portion. An endoscopic high-frequency incision tool attached to the protruding portion ,
The high-frequency incision electrode is formed of a conductive wire, and is arranged by connecting two positions that are spaced apart from the most distal position of the cylindrical protruding portion, and the cylindrical protruding from each of the two positions. Two conductive wires drawn into the part are twisted into one, and the two twisted conductive wires are directly inserted into the treatment instrument insertion channel that opens at the distal end surface of the distal end body. A high-frequency incision tool for an endoscope, characterized by being configured as described above .   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 endoscope for an endoscope according to claim 1 or 2, wherein the cylindrical projecting portion is formed in a flattened shape at a tip portion, and the high-frequency incision electrode is disposed in a major axis direction thereof. High frequency incision tool.   The high-frequency incision tool for endoscopes according to claim 1, 2 or 3, wherein the most distal surface of the cylindrical projecting portion has a slope portion with the high-frequency incision electrode as a top. The high-frequency incision tool for endoscopes according to any one of claims 1 to 4 , wherein the high-frequency incision electrode is attached to a foremost portion of the cylindrical protrusion through a ceramic pipe.

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