JP4495442B2 - Endoscopic high-frequency treatment instrument - Google Patents

Description

  The present invention relates to an endoscopic high-frequency treatment instrument that is used through a treatment instrument insertion channel of an endoscope and is used for incision or excision of a mucous membrane of a living tissue by energizing a high-frequency current.

  Endoscopic high-frequency treatment instruments generally have a configuration in which a tip electrode capable of supplying a high-frequency current protrudes forward from the tip of an electrically insulating sheath, and a high-frequency current is applied to the tip electrode pressed against the mucosal surface or the like. As a result, the mucous membrane or the like in contact with the tip electrode is torn by Joule heat.

  However, during such high-frequency treatment, the operator touches the bending operation knob of the endoscope and the distal end portion of the endoscope is greatly displaced, or the patient coughs off the human body. If the tissue side suddenly moves, an unscheduled part of the human tissue may be incised.

Conventionally, as a countermeasure, the tip electrode is formed of a flexible metal strand or the like so that the tip electrode does not suddenly move relative to the affected area even if the positional relationship between the endoscope tip and human tissue changes unexpectedly. (For example, Patent Document 1).
JP 2002-153484 A

  When the tip electrode is formed of a stranded metal wire, if the positional relationship between the endoscope tip and the human tissue is within a certain range, the tip electrode will not move away from the incision due to the deflection of the tip electrode, and the human tissue is scheduled. The phenomenon that the outside part is incised is prevented in advance.

  However, if the positional relationship between the distal end of the endoscope and the human tissue unexpectedly fluctuates several centimeters or more, the fluctuation cannot be absorbed by the degree of bending of the tip electrode, and an unplanned part of the human tissue is incised. There is a risk that.

  Therefore, the present invention provides a technique for safely performing high-frequency treatment even when the positional relationship between the distal end of the endoscope and human tissue changes unexpectedly during the high-frequency ablation procedure and the tip electrode does not leave the affected area. An object is to provide a high-frequency treatment instrument for endoscope.

  In order to achieve the above object, an endoscopic high-frequency treatment instrument according to the present invention is an endoscopic high-frequency treatment configured such that a high-frequency current can be applied to a tip electrode protruding forward from the tip of an electrically insulating sheath. In the device, a wire loop electrically insulated from the distal electrode is disposed so as to surround the distal electrode and can be expanded and contracted by an operation from the proximal end side of the sheath.

  A pair of through holes are formed in the side wall in the vicinity of the distal end of the sheath so that the wire constituting the wire loop enters and exits from the through hole into the sheath, and the wire loop expands and contracts. A portion protruding from the sheath tip may be formed in a flat plate shape, and the plate surface and the wire loop may be arranged on substantially the same plane.

  In addition, a conductive wire electrically connected to the distal electrode is inserted and disposed in the sheath, and an operation wire for expanding and contracting the wire loop operated from the proximal end side of the sheath advances and retreats in the axial direction in the sheath. It may be freely inserted alongside the conductive wire.

  Further, the protruding amount of the distal electrode protruding forward from the distal end of the sheath may be adjustable by an operation from the proximal end side of the sheath, and the distal electrode may be protruded and retracted from the distal end of the sheath.

  According to the present invention, the wire loop electrically insulated from the distal electrode is disposed so as to surround the distal electrode and can be expanded and contracted by an operation from the proximal end side of the sheath. Since the ablation can be performed with the tip electrode while surrounding the affected area with a wire loop and tightened lightly, the positional relationship between the distal end of the endoscope and the human tissue is unexpectedly large during the radiofrequency ablation. Even if it fluctuates, the tip electrode does not move away from the affected area, and high-frequency treatment can be performed safely.

  In an endoscopic high-frequency treatment instrument configured such that a high-frequency current can be applied to a tip electrode protruding forward from the tip of an electrically insulating sheath, a pair of through holes are formed in a side wall near the tip of the sheath, A wire loop that is electrically insulated from the electrode is disposed so as to surround the tip electrode, and the wire constituting the wire loop is swollen by entering and exiting the sheath from the through hole by an operation from the proximal end side of the sheath. I was able to shrink.

Embodiments of the present invention will be described with reference to the drawings.
FIG. 1 is a plan sectional view of the distal end portion of the endoscope high-frequency treatment instrument according to the first embodiment of the present invention, and FIG. 2 is a perspective view thereof. The endoscope can be inserted into and removed from the treatment instrument insertion channel. The flexible sheath 1 is formed of an electrically insulating tube such as a tetrafluoroethylene resin tube.

  A tip electrode 2 made of a conductive metal is provided at the tip of the flexible sheath 1 so as to protrude forward. In this embodiment, the portion of the tip electrode 2 that protrudes from the flexible sheath 1 is formed in a flat plate shape, and a columnar base portion 2a that is provided integrally therewith is provided inside the tip of the flexible sheath 1. It is fixed by fitting.

  A protrusion that bites into the inner peripheral surface of the flexible sheath 1 protrudes from the side surface of the base 2 a of the tip electrode 2. However, the fixing structure of the tip electrode 2 to the flexible sheath 1 may be any means such as a screw, adhesion or the like.

  Reference numeral 3 denotes a conductive wire for supplying a high-frequency current to the tip electrode 2, which is inserted and disposed over the entire length in the flexible sheath 1, and its tip portion is joined to the base portion 2 a of the tip electrode 2 by soldering or the like. ing. The conductive wire 3 may be either a bare wire or a covered wire.

  A pair of through holes 4 are formed in the side wall portion of the flexible sheath 1 in the vicinity of the distal end at positions approximately symmetrical by 180 ° from the diagonally forward direction, and are arranged so as to surround the distal electrode 2. A wire forming the loop 5 is drawn into the flexible sheath 1 from the pair of through holes 4.

  The wire loop 5 is formed of, for example, polyester fiber or fluororesin having both heat resistance and electrical insulation, and the tip electrode 2 and the tip electrode 2 are positioned on substantially the same plane as the tip electrode 2 surface (plate surface). The positional relationship is set.

  Note that the wire constituting the wire loop 5 only needs to be electrically insulated from the tip electrode 2, and for example, a stainless steel thin wire covered with a fluororesin tube may be used.

  An operation wire 7 inserted and arranged alongside the conductive wire 3 so as to be movable forward and backward in the axial direction in the flexible sheath 1 is connected to the proximal end portion of the wire loop 5 positioned in the flexible sheath 1. 6 are connected.

  Accordingly, when the operation wire 7 is advanced and retracted from the proximal end side as indicated by the arrow A, the wire loop 5 disposed so as to surround the distal electrode 2 in front of the flexible sheath 1 is shown in FIG. It expands and contracts as shown by the two-dot chain line.

  FIG. 3 shows the overall configuration of the endoscope high-frequency treatment instrument of the above-described embodiment, which is illustrated on the side surface of the operation unit main body 21 of the operation unit 20 connected to the proximal end of the flexible sheath 1. A connection terminal 23 to which a high-frequency power cord that is not connected is connected to project, and the base end of the conductive wire 3 is connected to the base. Therefore, by connecting a high-frequency power cord to the connection terminal 23, a high-frequency current can be passed through the tip electrode 2 through the conductive wire 3.

  The operation piece 22 slidably disposed on the operation unit main body 21 is connected to the proximal end of the operation wire 7, and the movement of the operation piece 22 is performed by sliding the operation piece 22 as indicated by an arrow A. The wire loop 5 is expanded and contracted by being transmitted to the distal end side by the operation wire 7.

  When performing mucosal resection treatment endoscopically with the endoscope high-frequency treatment tool configured as described above, as shown in FIG. 4, the endoscope is protruded from the treatment tool insertion channel 51 of the endoscope 50. While observing the distal end portion of the endoscopic high-frequency treatment tool through the observation window 52, the distal electrode 2 is pressed against the affected portion 100 while the affected portion 100 to be excised is surrounded by the wire loop 5 and lightly tightened to generate a high-frequency current. Energize.

  As a result, the tissue mucous membrane in contact with the tip electrode 2 is cut, and at that time, the operator touches the bending operation knob of the endoscope or the patient coughs off the tip of the endoscope 50 and the affected part. Even if the positional relationship with 100 is greatly changed (or is going to change), the position of the tip electrode 2 with respect to the affected part 100 does not change because the wire loop 5 is tightening the affected part 100, and the high-frequency ablation is safely performed. It can be carried out.

  FIG. 5 shows the distal end portion of the endoscope high-frequency treatment instrument according to the second embodiment of the present invention. The distal end electrode 2 is movably disposed in the axial direction, and protrudes from the distal end of the flexible sheath 1. It is designed so that it can be immersed.

  In this embodiment, the tip electrode 2 is formed in a rod shape, and the conductive wire 3 is inserted and arranged in the flexible sheath 1 so as to be movable back and forth in the axial direction. The distal electrode 2 is disposed so as to pass through the central hole of the lid 1a attached to the distal end of the flexible sheath 1, and a stopper 2a formed at the proximal end of the distal electrode 2 is formed on the back surface portion of the lid 1a. It comes to contact.

  Therefore, by moving the conductive wire 3 forward and backward from the proximal end side as indicated by the arrow B, the distal electrode 2 protrudes from the distal end of the flexible sheath 1 as indicated by the arrow C, and the amount of protrusion is determined. It can be adjusted arbitrarily. At that time, the stopper 2 a comes into contact with the back surface portion of the lid 1 a, so that the tip electrode 2 does not protrude from the tip of the flexible sheath 1 by a certain amount or more.

  FIG. 6 shows an operation section 20 for the endoscope high-frequency treatment instrument of the second embodiment, and a second operation piece 24 for moving the conductive wire 3 forward and backward as indicated by an arrow B. Is slidably attached to the operation portion main body 21, and the connection terminal 23 is provided on the second operation piece 24.

It is a plane sectional view of the tip part of the high frequency treatment instrument for endoscopes of the 1st example of the present invention. It is a perspective view which cuts off and shows a part of front-end | tip part of the high frequency treatment tool for endoscopes of 1st Example of this invention. BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is an overall configuration diagram of an endoscope high-frequency treatment tool according to a first embodiment of the present invention. It is a perspective view which shows the state of the mucous membrane excision treatment by the high frequency treatment tool for endoscopes of the 1st Example of this invention. It is a perspective view which cuts off and shows a part of front-end | tip part of the high frequency treatment tool for endoscopes of 2nd Example of this invention. It is a top view of the operation part of the high frequency treatment tool for endoscopes of the 2nd Example of the present invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Flexible sheath 2 Tip electrode 3 Conductive wire 4 Through-hole 5 Wire loop 7 Operation wire 20 Operation part

Claims (5)

The endoscopic high-frequency treatment instrument high frequency current is configured to be energized to the tip electrode protruding forward from the front end of the electrically insulating sheath,
Electrically insulated wire loop relative to the tip electrode, in which is provided so as to be able to expand and contract by being arranged so as to surround the tip electrode operation from the base end side of the sheath,
A pair of through holes are respectively drilled from the outer side to the inner side in an obliquely forward direction at approximately 180 ° symmetrical positions on the side wall near the distal end of the sheath. the endoscopic high-frequency treatment instrument, characterized in that the wire loop is expanded and contracted in and out within. It said forward end the sheath tip protruding portion from the electrode is formed in a plate shape, the plate surface and the endoscopic high-frequency treatment instrument according to claim 1, wherein the said wire loop is arranged on substantially the same plane. A conductive wire electrically connected to the distal electrode is inserted and disposed in the sheath, and an operation wire that is operated from the proximal end side of the sheath and expands and contracts the wire loop is disposed in the sheath. The high-frequency treatment instrument for endoscope according to claim 1 or 2, which is inserted and arranged side by side with the conductive wire so as to be movable forward and backward in a direction. The high-frequency treatment instrument for endoscope according to claim 1 or 3 , wherein a protruding amount of the distal electrode protruding forward from a distal end of the sheath can be adjusted by an operation from a proximal end side of the sheath. The high-frequency treatment instrument for endoscope according to claim 4 , wherein the tip electrode can protrude and retract from the tip of the sheath.

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