JP4431892B2 - High frequency treatment tool - Google Patents

Description

The present invention is inserted through the endoscope treatment instrument insertion channel, in which a high-frequency treatment again and again relates used to perform treatment such incision diseased mucous membrane.

  When a lesion, such as a tumor, is found in the mucosa in the inner wall of a body cavity such as the esophagus, stomach, duodenum, and large intestine by endoscopy, a treatment is performed to remove the lesion mucosa using a high-frequency treatment tool. In this case, in order to ensure the safety of the treatment, the treatment is performed under observation by an endoscope, and the high-frequency treatment tool used for this purpose is inserted into the treatment tool insertion channel of the endoscope to be treated. To lead to. Here, on the inner wall of the body cavity, a submucosal layer exists below the mucosal layer, and the muscle layer is covered with the submucosal layer. Thus, in the treatment of incising and removing the lesioned mucosa layer using a high-frequency treatment instrument, the lesioned part must be left untouched, and the muscle layer should not be damaged in any way. I must.

  The high-frequency treatment instrument used for incision of the mucosal layer is configured by mounting a high-frequency knife made of an electrode member having a rod-shaped portion in a flexible sheath, and an operating means is provided at the proximal end portion of the flexible sheath. The high-frequency knife can be controlled so as to appear and disappear from the distal end of the flexible sheath by remote operation by the operation means. By energizing the high-frequency knife protruding from the flexible sheath, the mucous membrane can be cauterized and incised.

  The structure of the electrode member constituting the high-frequency knife includes a needle-like knife in which a rod-like electrode member extends straightly, and a large-diameter electrode portion connected to the tip of the rod-like electrode member, or the tip is roughly L-shaped. There is a hook knife in which a hook portion is formed by bending it. The needle knife is operated to pierce the mucous membrane, and the mucous membrane or the like can be incised by horizontally moving the electrode member or swinging the electrode member. On the other hand, the hook knife is incised by hooking a tissue such as a mucous membrane with a hook portion at the tip and pulling it to the insertion portion side of the endoscope.

  As already described, when the high-frequency knife is energized, it must be ensured that the high-frequency knife is not in contact with the muscle layer. By operating the endoscope so that the distal end portion of the high-frequency knife is always captured in the observation field of the endoscope, the safety of the treatment can be expected. Since the needle knife is located in front of the flexible sheath and is inserted into the mucous membrane, the tip of the electrode may not enter the observation field of the endoscope. On the other hand, the hook knife is operated so as to be pulled into the treatment instrument insertion channel by hooking the hook knife on the mucous membrane or the like while observing with an endoscope, and then applying a high-frequency current to the hook knife. An incision will be made by cauterizing. Therefore, while operating the hook knife, the tip of the hook knife can always be performed under observation by an endoscope, so that it can be operated so as not to contact the muscle layer when energized. From the viewpoint of treatment safety, a method using a hook knife is excellent.

In the case of using a hook knife, the tip portion of the hook knife must be stabilized in order to improve the operability of the operation of hooking a tissue such as a mucous membrane. Therefore, Patent Document 1 proposes a configuration including a mechanism for stabilizing the hook knife during operation. In the high-frequency treatment instrument of Patent Document 1, an electrical insulating member is attached to the distal end of a flexible sheath, and a through hole is provided in the electrical insulating member. The hook portion at the tip can be brought into contact with and separated from the outer surface of the tip of the electrical insulating member. When energized, the electrode member is projected from the flexible sheath by a predetermined length, but the difference in diameter between the hole diameter of the through hole and the outer diameter of the electrode member is minimized, and the protruding length of the electrode member is restricted. Thus, the electrode member is stably held.
JP 2004-313537 A

  By the way, the mucous membrane and the submucosa are hooked by the hook knife that constitutes the electrode member, and the tissue is cut by energizing the hook knife and operating it so as to draw it into the treatment instrument insertion channel, and then again the treatment instrument insertion channel. Since the operation of deriving the hook knife from is repeatedly performed, the efficiency and speed of the operation cannot be obtained. Therefore, it takes a long time for the treatment to remove the lesioned mucous membrane, and there is a risk that the pain of the subject and the burden on the operator will increase accordingly. In addition, the hook portion is always exposed to the outside. For example, if the electrode member is accidentally energized while performing an operation of inserting into the treatment instrument insertion channel, the inner wall of the channel may be damaged. There is also a point.

The present invention has been made in view of the above points, and an object of the present invention is to provide a high-frequency treatment instrument capable of performing a treatment such as incision of a mucous membrane safely, quickly and efficiently. is there.

In order to achieve the above-described object, the present invention provides a flexible sheath having a distal end, a proximal end, and a longitudinal axis, and a flexible sheath disposed so as to be movable forward and backward inside the flexible sheath. A treatment instrument main body comprising a cord, and a linear electrode portion provided at a distal end of the flexible cord to which a high-frequency current can be applied, and intersecting the longitudinal axis on the distal end side of the flexible sheath A partition member having an insertion hole through which the electrode portion can be inserted, a distal side surface of the partition member, an inner wall of the flexible sheath on the distal side of the partition member, and the flexible sheath A negative pressure acting portion defined by an opening surface opened at a distal end; and an opening on the negative pressure acting portion side surface of the partition wall member, and a negative pressure suction force acts on the negative pressure acting portion. A suction flow path, and the electrode mounted on the treatment instrument body and contacting the partition member. And a stopper member that regulates the maximum projecting length from the insertion hole, and the electrode portion advances and retreats in the negative pressure acting portion toward the opening surface that opens at the distal end of the flexible sheath. It is characterized by being freely movable.

  The electrode member is a high-frequency knife having a linear or bar-like shape extending from the tip of the flexible cord, the flexible cord is flexible in the bending direction, and the conductive member is provided with an insulating coating Composed of things. In order to give flexibility, the conductive member can be made of a thin metal wire, or it can be made of a spring-like metal wire. The insulation coating can be composed of a tube or a braid, and can also be composed of an electrically insulating coating on the surface of the conductive member, for example, a member that is electrically insulating and slippery, such as a fluororesin. . Since the electrode member is inserted into the mucous membrane or the like, it has rigidity in the bending direction. The electrode member is treated by protruding a predetermined length from the insertion hole of the partition wall member. Therefore, if the protrusion length from the insertion hole is short, even a metal wire has high rigidity. For this reason, when the conductive member of the flexible cord is formed of a metal wire, the metal wire as the electrode member can be extended as it is. In the case where the conductive member is composed of a thin metal wire, the electrode member is formed as a separate member from the conductive member and connected by soldering or the like.

  The partition member is electrically insulating and can be formed of a synthetic resin, but is more preferably formed of ceramic from the viewpoint of shape stability and heat resistance. The partition member is provided with an insertion hole through which the electrode member is inserted. If the overall length of the insertion hole is increased to some extent, and the difference between the inner diameter of the insertion hole and the outer diameter of the electrode member is reduced, the electrode member The straightness of the vehicle is ensured and the stability is ensured. When the electrode member is drawn into the flexible sheath, the electrode member is retracted from the end of the partition member to the base end side so as not to protrude from the insertion hole. Then, when the electrode member is protruded from this state, a calling taper portion is provided on the base end side surface of the partition wall member for guiding the electrode member toward the insertion hole so that the electrode member is reliably guided to the insertion hole. Like that.

  The negative pressure acting part is a part that sucks a tissue such as a mucous membrane by applying a negative pressure suction force to the suction passage. Therefore, the negative pressure acting portion is a space having a predetermined volume defined by the inner periphery of the distal end portion of the flexible sheath and the distal end surface of the partition wall member. The volume of this space depends on the tissue to be incised. For example, when incising a mucosal layer, when a negative pressure suction force is applied to the negative pressure acting part, the mucous membrane and the submucosal layer are accommodated, but the muscle layer may be drawn into the negative pressure acting part. The inner diameter of the flexible sheath and the depth position of the partition member are set so as not to be present.

  The tissue accommodated in the negative pressure acting portion as described above is cauterized by causing the electrode member to protrude from the insertion hole of the partition wall member and energizing the electrode member. Therefore, the protruding length of the electrode member from the partition member is a length that penetrates the mucous membrane and does not reach the muscle layer, that is, a length that penetrates to the submucosal layer. The treatment tool main body is provided with a stopper member, and the stopper member can be brought into contact with and separated from the base end surface of the partition wall member, thereby restricting the protruding length of the electrode member from the partition wall member. The protruding length of the electrode member is preferably set to the position of the distal end surface of the flexible sheath or the vicinity thereof.

In addition, as a second invention, a flexible sheath having a distal end, a proximal end, and a longitudinal axis, a flexible cord disposed inside the flexible sheath so as to be movable forward and backward, A treatment instrument body provided with a linear electrode portion provided at the distal end of the flexible cord and capable of applying a high-frequency current; and provided on the distal end side of the flexible sheath so as to intersect the longitudinal axis; A partition member having an insertion hole through which the electrode portion can be inserted; a distal side surface of the partition member; an inner wall of the flexible sheath on a distal side of the partition member; and a distal end of the flexible sheath A negative pressure acting section defined by a certain opening surface; and a suction flow path having an opening on a surface of the partition wall member on the negative pressure acting portion side and causing a negative pressure suction force to act on the negative pressure acting portion; From the insertion hole of the electrode part by being attached to the treatment instrument body and contacting the partition member The negative pressure acting part accommodates the incision object, and the suction object is previously sucked into the negative pressure action part to specify the range in the depth direction of the incision. The high-frequency treatment instrument is inserted into the body cavity through the treatment instrument insertion channel of the endoscope which is energized and incised by the electrode section.

  By adopting the above configuration, treatment such as incision of the mucous membrane can be safely performed using a needle knife, and the treatment can be performed smoothly, reliably and efficiently.

Hereinafter, embodiments of the present invention will be described with reference to the drawings. First, FIG. 1 shows the overall configuration of the high-frequency treatment instrument, and FIG. In the figure, reference numeral 1 denotes a high-frequency treatment instrument, and the high-frequency treatment instrument 1 includes a long flexible sheath 2 having a distal end, a proximal end, and a longitudinal axis . A connecting pipe 3 is connected to the proximal end, that is, the base end portion of the flexible sheath 2, and an operating means 4 is connected to the other end of the connecting pipe 3. The operating means 4 includes a main body shaft 4a connected to the connection pipe 3, and a slider 4b fitted to the main body shaft 4a and provided to be slidable in the axial direction of the main body shaft 4a. A base end portion of a flexible cord 11 constituting the treatment instrument main body 10 is connected to the slider 4b. The flexible cord 11 is formed by covering a conductive wire with an electrically insulating member. A base end portion of the flexible cord 11 protrudes a predetermined length from a connecting portion to the slider 4b, and a contact portion 12 is provided. Therefore, the contact portion 12 is detachably connected to a high frequency power supply device (not shown).

As is apparent from FIG. 2, the flexible cord 11 constituting the treatment instrument main body 10 extends from the connecting portion to the slider 4b, through the inside of the connecting pipe 3, and into the flexible sheath 2 having the longitudinal axis. Has been. A conductive wire extends in a straight line from the distal end, that is, the tip of the flexible cord 11, and a lead-out portion of the conductive wire serves as an electrode member 13 constituting a needle knife. Further, a partition wall member 14 is inserted into the distal end portion of the flexible sheath 2 and fixed by means such as adhesion. The partition member 14 is made of ceramic, and as is apparent from FIGS. 3 and 4, the partition member 14 is fixed at a position that enters a predetermined distance from the distal end surface of the flexible sheath 2. The partition member 14 is provided with an insertion hole 15 that penetrates in the axial direction at the position of the central axis. The diameter of the insertion hole 15 is slightly smaller than the outer diameter of the electrode member 13. The dimensions are large. A calling taper portion 14 a that guides the electrode member 13 toward the insertion hole 15 is formed at the base end portion of the partition wall member 14.

  Furthermore, a stopper member 16 is attached to a transition portion from the flexible cord 11 to the electrode member 13 or a portion of the electrode member 13 in the treatment instrument body 10. The stopper member 16 is a member having a diameter larger than at least the insertion hole 15. Therefore, the treatment tool body 10 is advanced in the flexible sheath 2, and the electrode member 13 protrudes from the distal end surface of the partition wall member 14 by a predetermined length. In this state, the stopper member 16 comes into contact with the partition wall member 14, and the electrode member 13 is regulated so as not to protrude further. Thereby, the most protruding position of the electrode member 13 from the partition member 14 is defined.

As described above, by fixing the partition member 14 at a position recessed from the distal end of the flexible sheath 2, the distal end surface of the partition member 14 and the inner peripheral surface of the flexible sheath 2 having the distal end opened. It has a predetermined volume from the tip is an open space is made form compartments. This space is the negative pressure acting portion 17. The negative pressure acting part 17 forms a closed space having a predetermined volume formed in the distal end portion of the flexible sheath 2 by bringing the distal end of the flexible sheath 2 into contact with the mucous membrane or the like. And it is set as the structure which can make a negative pressure suction force act on the negative pressure action part 17 which consists of this obstruction | occlusion space. For this purpose, the connection pipe 3 has a connection port 3a, and a suction pipe 6 from the suction source 5 is detachably connected to the connection port 3a. In the middle of the suction pipe 6, a switching means 7 for opening and closing the flow path, such as a foot switch, is provided to control whether or not to apply a negative pressure suction force to the negative pressure acting portion 17. To be done. Therefore, the inside of the connection pipe 3 passes through the connection port 3a and the inside of the flexible sheath 2 connected to the connection pipe 3 forms a suction passage for applying a negative pressure suction force. Further, as shown in FIG. 5, a plurality of (21 in the drawing) grooves 21 are formed on the outer peripheral surface of the partition wall member 14 at equal intervals in the circumferential direction. These grooves 21 have a length that extends over the entire length of the partition wall member 14 in the axial direction. By this groove 21, a negative pressure suction force is applied to the inside of the negative pressure acting portion 17.

  Here, when the electrode member 13 is projected to the maximum projecting position, the stopper member 16 comes into contact with the partition wall member 14. At this time, the negative pressure acting portion 17 can be made to act on the negative pressure. Yes. For this purpose, the outer diameter of the stopper member 16 is made smaller than the outer diameter of the partition wall member 14, and is preferably set so as to have substantially the same diameter as the circle connecting the groove bottoms of the grooves 21. As a result, even if the stopper member 16 abuts against the partition member 14, a suction passage for applying a negative pressure suction force by the groove 21 is secured.

  FIG. 3 shows a state in which the electrode member 13 is most retracted into the flexible sheath 2, and FIG. 4 shows a state in which the electrode member 13 protrudes most from the partition member 14. As is clear from these drawings, when the electrode member 13 is drawn into the flexible sheath 2, the distal end of the electrode member 13 is disposed on the proximal end side with respect to the proximal end surface of the partition wall member 14. On the other hand, in the most projecting state of the electrode member 13, the electrode member 13 is inserted into the insertion hole 15 of the partition wall member 14, and the distal end thereof is projected to substantially the same position as the distal end of the flexible sheath 2. The push / pull operation of the electrode member 13 is performed by a remote operation by the operation means 4.

  As shown in FIG. 6, the high-frequency treatment instrument 1 having the above configuration is inserted into a body cavity via a treatment instrument insertion channel C provided in an endoscope insertion part S having an observation part W, for example, the esophagus When the mucous membrane is present on the inner wall of a body cavity such as the stomach, duodenum, large intestine, etc., it is used for performing a treatment for peeling and removing the mucous membrane part. Therefore, in the following, a procedure for excising the lesioned mucosa will be described. This treatment is performed when it is confirmed as a result of endoscopy that a lesion is present in the mucous membrane.

  Therefore, first, as shown in FIG. 7, the mucous membrane in which the lesioned part D to be excised is marked so as to surround the lesioned mucosal region A. The reason for setting the marking area is to remove the lesion D completely and to prevent damage to the healthy mucous membrane as much as possible. The marking can be performed, for example, by applying an ablation spot B to a required portion of the boundary portion of the lesion mucosa region A.

  Next, as shown in FIG. 8, topical injection of physiological saline or the like is performed inside the lesioned mucosa region A. For this purpose, a local injection means having an injection needle N provided at the distal end of the flexible tube is inserted into the treatment instrument insertion channel C. Here, the submucosa LM exists between the muscle layer LB and the mucosa layer LU, and the injection needle N penetrates the mucosa layer LU and penetrates into the submucosa LM to inject physiological saline or the like. To do. As a result, the submucosa LM bulges and rises. The reason why the submucosal layer LM is thus bulged is to separate the mucosal layer LU from the muscle layer LB and perform a smooth and safe treatment.

  After sufficiently expanding the submucosa LM, the local injection means is extracted from the treatment instrument insertion channel C, and the high-frequency treatment instrument 1 is inserted. And the front-end | tip of the flexible sheath 2 in the high frequency treatment tool 1 is made to contact | abut to any position in the outer edge part of the marked lesioned mucosa area | region A. FIG. Preferably, the distal end surface of the flexible sheath 2 is directly opposed to the mucosal layer LU and lightly pressed against the mucosal surface so that the distal end surface of the flexible sheath 2 is sealed and the pressing force is not applied as much as possible. To.

  The suction pipe 6 is connected to the connection port 3a of the connection pipe 3, and as described above, the suction means 6 is operated by operating the switching means 7 with the distal end surface of the flexible sheath 2 pressed against the mucous membrane layer LU. A negative pressure suction force is applied to the pipe 6. As a result, as shown in FIG. 9, the mucosal layer LU inside the portion surrounded by the distal end surface of the flexible sheath 2 is formed between the inner peripheral surface of the flexible sheath 2 and the distal end surface of the partition wall member 14. As a result, the suction is performed by the negative pressure acting portion 17 formed by the division. Here, as to how much the tissue in the body including the mucosal layer LU is sucked, as shown in FIG. 9, when the surface of the mucosal layer LU comes into contact with the partition wall member 14, the entire mucosal layer LU is completely removed. Into the negative pressure acting part 17, the submucosa LM partially enters the negative pressure acting part 17. At this time, as described above, since the mucosal layer LU is bulged by local injection, the muscle layer LB is not drawn into the negative pressure acting portion 17. In short, the dimensions of the cross-sectional area of the negative pressure acting part 17 due to the inner diameter of the flexible sheath 2 and the depth of the negative pressure acting part 17 due to the position of the flexible sheath 2 of the partition wall member 14 are set as appropriate. It is ensured that the entire mucosal layer LU of the tissue enters the negative pressure acting part 17.

  And, after the negative pressure suction force to the negative pressure acting part 17 does not exceed a predetermined level, that is, after the entire mucosal layer LU and a part of the submucosal layer LM have entered the negative pressure acting part 17, the further By setting so that suction of the body tissue cannot be performed, excessive body tissue is not drawn into the negative pressure acting portion 17. Therefore, by operating the operating means 4, as shown in FIG. 10, the electrode member 13 protrudes from the insertion hole 15 and is inserted into the mucosal layer LU, and a high-frequency current is passed through the electrode member 13. As a result, the electrode member 13 cauterizes from the mucosa layer LU to the submucosa LM. Then, by operating the endoscope insertion portion S to move the high-frequency treatment tool 1 along the outer periphery of the lesion mucosa region A, the entire periphery of the lesion mucosa region A can be incised. When the incision of the lesioned mucosa region A is completed in this manner, the lesioned mucosa is excised using, for example, a treatment tool such as a high-frequency snare, and the excised mucosa is collected using grasping forceps or the like.

  Since the above operation, that is, the operation of moving the marked range of the high-frequency treatment instrument 1 is performed under observation by the observation unit W provided in the endoscope insertion portion S, it is completely possible without leaving the lesion mucosa region A. Can be excised. In addition, when cauterizing tissue in the body with the electrode member 13, the mucosal layer LU can be completely removed without confirming the position or movement of the tip of the electrode member 13, and any damage is caused to the muscle layer LB. Therefore, a safe treatment can be performed, the lesioned mucosa can be removed quickly and efficiently, and the burden on the subject can be minimized.

1 is an overall configuration diagram of a high-frequency treatment tool showing an embodiment of the present invention. It is a principal part expanded sectional view of FIG. It is an expanded sectional view of the front-end | tip part of a treatment tool main body. FIG. 4 is a cross-sectional view similar to FIG. 3, showing an electrode member protruding. FIG. 5 is a cross section taken along line XX in FIG. 4. 1 is an external view showing a state in which a high-frequency treatment instrument showing an embodiment of the present invention is derived from a treatment instrument insertion channel of an endoscope. It is a top view which shows the state which marked the lesioned-mucosa area | region. It is sectional drawing of the structure | tissue which shows the state which is performing local injection with respect to a lesioned mucosa area | region. It is sectional drawing which shows the state which is attracting | sucking a mucous membrane with a high frequency treatment tool. It is sectional drawing which shows the state which is incising with a high frequency treatment tool.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 High frequency treatment tool 2 Flexible sheath 3 Connection pipe 4 Operation means 10 Treatment tool main body 11 Flexible cord 13 Electrode member 14 Partition member 15 Insertion hole 16 Stopper member 17 Negative pressure action part 21 Groove

Claims (3)

A flexible sheath having a distal end, a proximal end, and a longitudinal axis;
A treatment instrument body comprising: a flexible cord disposed inside the flexible sheath so as to freely advance and retract; and a linear electrode portion provided at a distal end of the flexible cord to which a high-frequency current can be applied; A partition member provided on the distal end side of the flexible sheath so as to intersect the longitudinal axis and having an insertion hole through which the electrode portion can be inserted;
A negative pressure acting portion defined by a distal side surface of the partition member, an inner wall of the flexible sheath on the distal side of the partition member, and an opening surface opened at a distal end of the flexible sheath; ,
A suction channel that has an opening on the surface of the partition member on the negative pressure acting portion side, and that exerts a negative pressure suction force on the negative pressure acting portion;
A stopper member that is attached to the treatment instrument body and regulates the most protruding length of the electrode portion from the insertion hole by contacting the partition member,
Consist of
The electrode part is movable in the negative pressure acting part so as to be movable forward and backward toward the opening surface opened at the distal end of the flexible sheath.
A high-frequency treatment instrument that is inserted into a body cavity via a treatment instrument insertion channel of an endoscope .   When the electrode portion is projected most from the distal end surface of the partition wall member through the insertion hole, the distal end portion of the electrode portion is set to be substantially the same position as the distal end portion of the flexible sheath. The high-frequency treatment device according to claim 1. A flexible sheath having a distal end, a proximal end, and a longitudinal axis;
A treatment instrument body comprising: a flexible cord disposed inside the flexible sheath so as to freely advance and retract; and a linear electrode portion provided at a distal end of the flexible cord to which a high-frequency current can be applied;
A partition member provided on the distal end side of the flexible sheath so as to intersect the longitudinal axis and having an insertion hole through which the electrode portion can be inserted;
A negative pressure acting portion defined by a distal side surface of the partition member, an inner wall of the flexible sheath on the distal side of the partition member, and an opening surface at a distal end of the flexible sheath;
A suction channel that has an opening on the surface of the partition member on the negative pressure acting portion side, and that exerts a negative pressure suction force on the negative pressure acting portion;
A stopper member that is attached to the treatment instrument body and regulates the most protruding length of the electrode portion from the insertion hole by contacting the partition member,
Consists of
The negative pressure acting part accommodates an incision target. The endoscope is configured such that the incision target is sucked into the negative pressure acting part in advance, the range in the depth direction of the incision is specified, and the electrode part is energized and incised A high-frequency treatment instrument that is inserted into a body cavity via a treatment instrument insertion channel .

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