JP4495442B2 - Endoscopic high-frequency treatment instrument - Google Patents

Endoscopic high-frequency treatment instrument Download PDF

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JP4495442B2
JP4495442B2 JP2003368188A JP2003368188A JP4495442B2 JP 4495442 B2 JP4495442 B2 JP 4495442B2 JP 2003368188 A JP2003368188 A JP 2003368188A JP 2003368188 A JP2003368188 A JP 2003368188A JP 4495442 B2 JP4495442 B2 JP 4495442B2
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sheath
frequency treatment
treatment instrument
tip
electrode
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JP2005130957A (en
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輝雄 大内
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Hoya Corp
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Hoya Corp
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Priority to US10/974,827 priority patent/US7276066B2/en
Priority to EP04025819A priority patent/EP1527744B1/en
Priority to DE602004019614T priority patent/DE602004019614D1/en
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Description

この発明は、内視鏡の処置具挿通チャンネルに通して使用され、高周波電流を通電して生体組織の粘膜の切開や切除等に用いられる内視鏡用高周波処置具に関する。   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.

内視鏡用高周波処置具は一般に、高周波電流を通電可能な先端電極が電気絶縁性のシースの先端から前方に突出した構成になっており、粘膜面等に押し付けた先端電極に高周波電流を通電することにより、先端電極と接触している粘膜等がジュール熱によって切り裂かれる。   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.

しかし、そのような高周波処置を行っている最中に、術者が内視鏡の湾曲操作ノブに触れて内視鏡の先端部分が大きく変位してしまったり、患者が咳払い等をして人体組織側が急に動いたりすると、人体組織の予定外の部位が切開されてしまう場合がある。   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.

その対策として従来は、柔軟な金属撚り線等で先端電極を形成して、内視鏡先端と人体組織との位置関係が不意に変動しても患部に対する先端電極の動きが急にならないようにしたものがある(例えば、特許文献1)。
特開2002−153484
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

先端電極を金属撚り線で形成すると、内視鏡先端と人体組織との位置関係の変動がある程度の範囲内の場合には先端電極の撓みによって先端電極が切開部から離れず、人体組織の予定外の部位が切開される現象が未然に防止される。   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.

しかし、内視鏡の先端と人体組織との位置関係が不意に数センチメートル以上変動すると、先端電極の撓み程度ではその変動を吸収しきれなくなって、人体組織の予定外の部位が切開されてしまうおそれがある。   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.

そこで本発明は、高周波切除処置の最中に内視鏡の先端と人体組織との位置関係が不意に大きく変動した場合でも先端電極が患部から離れず、安全に高周波処置を行うことができる内視鏡用高周波処置具を提供することを目的とする。   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.

上記の目的を達成するため、本発明の内視鏡用高周波処置具は、電気絶縁性のシースの先端から前方に突出する先端電極に高周波電流が通電可能に構成された内視鏡用高周波処置具において、先端電極に対して電気絶縁されたワイヤループを、先端電極を囲むように配置してシースの基端側からの操作によって膨縮させることができるようにしたものである。   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.

なお、シースの先端近傍の側壁に一対の通孔が穿設されていて、ワイヤループを構成するワイヤが通孔からシース内に出入りしてワイヤループが膨縮するようにしてもよく、先端電極のシース先端から突出した部分が平板状に形成されて、その板面とワイヤループとが略同一平面上に配置されていてもよい。   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.

また、先端電極に電気的に接続された導電線がシース内に挿通配置されると共に、シースの基端側から操作されてワイヤループを膨縮させるための操作ワイヤがシース内に軸線方向に進退自在に導電線と並んで挿通配置されていてもよい。   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.

また、シースの先端から前方に突出する先端電極の突出量が、シースの基端側からの操作によって調整可能であってもよく、先端電極がシースの先端から突没自在であってもよい。   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.

本発明によれば、先端電極に対して電気絶縁されたワイヤループを、先端電極を囲むように配置してシースの基端側からの操作によって膨縮させることができるようにしたことにより、切除対象となる患部の周囲をワイヤループで囲んで軽く締め付けながら先端電極による切除処置を行うことができるので、高周波切除処置の最中に内視鏡の先端と人体組織との位置関係が不意に大きく変動した場合でも先端電極が患部から離れず、安全に高周波処置を行うことができる。   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.

電気絶縁性のシースの先端から前方に突出する先端電極に高周波電流が通電可能に構成された内視鏡用高周波処置具において、シースの先端近傍の側壁に一対の通孔を穿設し、先端電極に対して電気絶縁されたワイヤループを、先端電極を囲むように配置して、そのワイヤループを構成するワイヤを、シースの基端側からの操作により通孔からシース内に出入りさせて膨縮させることができるようにした。   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.

図面を参照して本発明の実施例を説明する。
図1は本発明の第1の実施例の内視鏡用高周波処置具の先端部分の平面断面図、図2はその斜視図であり、内視鏡の処置具挿通チャンネルに挿脱される可撓性シース1は、例えば四フッ化エチレン樹脂チューブ等のような電気絶縁性のチューブによって形成されている。
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.

可撓性シース1の先端部分には、導電性の金属からなる先端電極2が前方に向けて突設されている。この実施例においては、先端電極2の可撓性シース1から突出する部分は平板状に形成されていて、それと一体に連設されている円柱状の基部2aが可撓性シース1の先端内に嵌め込み固定されている。   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.

なお、先端電極2の基部2aの側面には、可撓性シース1の内周面に食い込む突起が突設されている。ただし、可撓性シース1に対する先端電極2の固定構造はネジ、接着その他どのような手段を用いてもよい。   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.

3は、先端電極2に高周波電流を供給するための導電線であり、可撓性シース1内に全長にわたって挿通配置されて、その先端部分が先端電極2の基部2aに半田付け等によって接合されている。なお、導電線3は裸線又は被覆線のどちらを用いても差し支えない。   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.

可撓性シース1の先端近傍部の側壁部には、略180°対称の位置に一対の通孔4が各々斜め前方の向きから穿設されていて、先端電極2を囲んで配置されたワイヤループ5を形成するワイヤが、一対の通孔4から可撓性シース1内に引き込まれている。   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.

ワイヤループ5は、耐熱性と電気絶縁性とを併有する例えばポリエステル繊維やフッ素樹脂等により形成されて、先端電極2の面(板面)と略同一平面上に位置するように先端電極2との位置関係が設定されている。   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.

なお、ワイヤループ5を構成するワイヤは、先端電極2に対して電気絶縁されていればよく、例えばステンレス鋼細線にフッ素樹脂チューブを被覆したもの等を用いても差し支えない。   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.

そして、可撓性シース1内に位置するワイヤループ5の基端部には、可撓性シース1内に軸線方向に進退自在に導電線3と並んで挿通配置された操作ワイヤ7が接続パイプ6を介して連結されている。   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.

したがって、操作ワイヤ7を矢印Aで示されるように基端側から進退操作することにより、可撓性シース1の前方において先端電極2を囲む状態に配置されているワイヤループ5が、図1に二点鎖線で示されるように膨縮する。   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.

図3は、上記実施例の内視鏡用高周波処置具の全体構成を示しており、可撓性シース1の基端に連結された操作部20の操作部本体21の側面には、図示されていない高周波電源コードが接続される接続端子23が突設されていて、その基部に導電線3の基端が接続されている。したがって、接続端子23に高周波電源コードを接続することにより、導電線3を介して先端電極2に高周波電流を通電することができる。   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.

また、操作部本体21にスライド自在に配置された操作片22には操作ワイヤ7の基端が連結されており、矢印Aで示されるように操作片22をスライド操作することにより、その運動が操作ワイヤ7により先端側に伝えられてワイヤループ5が膨縮する。   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.

このように構成された内視鏡用高周波処置具で経内視鏡的に粘膜切除処置を行う際には、図4に示されるように、内視鏡50の処置具挿通チャンネル51から突出させた内視鏡用高周波処置具の先端部分を観察窓52を通して観察しながら、切除対象の患部100をワイヤループ5で囲んで軽く締め付けた状態で、先端電極2を患部100に押し付けて高周波電流を通電する。   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.

それによって、先端電極2が接触している組織粘膜が切り裂かれ、その際に、術者が内視鏡の湾曲操作ノブに触れたり、患者が咳払い等をして内視鏡50の先端と患部100との位置関係が大きく変動しても(或いは、変動しようとしても)、ワイヤループ5が患部100を締め付けているので患部100に対する先端電極2の位置が変動せず、安全に高周波切除処置を行うことができる。   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.

図5は、本発明の第2の実施例の内視鏡用高周波処置具の先端部分を示しており、先端電極2を軸線方向に可動に配置して、可撓性シース1の先端から突没させることができるようにしたものである。   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.

この実施例では先端電極2が棒状に形成されていて、導電線3は軸線方向に進退自在に可撓性シース1内に挿通配置されている。先端電極2は、可撓性シース1の先端に装着された蓋体1aの中心孔を通過する状態に配置され、先端電極2の基端に形成されたストッパ2aが蓋体1aの裏面部分に当接するようになっている。   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.

したがって、導電線3を矢印Bで示されるように基端側から進退操作することにより、可撓性シース1の先端から先端電極2が矢印Cで示されるように突設し、その突出量を任意に調整することができる。その際に、ストッパ2aが蓋体1aの裏面部分に当接することにより、先端電極2は可撓性シース1の先端から一定量以上突出しない。   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.

図6は、第2の実施例の内視鏡用高周波処置具のための操作部20を示しており、矢印Bで示されるように導電線3を進退操作するための第2の操作片24が操作部本体21にスライド自在に取り付けられていて、接続端子23がその第2の操作片24に設けられている。   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.

本発明の第1の実施例の内視鏡用高周波処置具の先端部分の平面断面図である。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. 本発明の第1の実施例の内視鏡用高周波処置具の先端部分の一部を切除して示す斜視図である。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. 本発明の第1の実施例の内視鏡用高周波処置具の全体構成図である。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. 本発明の第1の実施例の内視鏡用高周波処置具による粘膜切除処置の状態を示す斜視図である。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. 本発明の第2の実施例の内視鏡用高周波処置具の先端部分の一部を切除して示す斜視図である。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. 本発明の第2の実施例の内視鏡用高周波処置具の操作部の平面図である。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.

符号の説明Explanation of symbols

1 可撓性シース
2 先端電極
3 導電線
4 通孔
5 ワイヤループ
7 操作ワイヤ
20 操作部
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)

電気絶縁性のシースの先端から前方に突出する先端電極に高周波電流が通電可能に構成された内視鏡用高周波処置具であって
上記先端電極に対して電気絶縁されたワイヤループ、上記先端電極を囲むように配置されて上記シースの基端側からの操作によって膨縮させることができるように設けられたものにおいて、
上記シースの先端近傍の側壁の略180°対称位置に、一対の通孔が各々外側から内側に斜め前方の向きから穿設されていて、上記ワイヤループを構成するワイヤが上記通孔から上記シース内に出入りして上記ワイヤループが膨縮することを特徴とする内視鏡用高周波処置具。
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.
上記先端電極の上記シース先端から突出した部分が平板状に形成されて、その板面と上記ワイヤループとが略同一平面上に配置されている請求項記載の内視鏡用高周波処置具。 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. 上記先端電極に電気的に接続された導電線が上記シース内に挿通配置されると共に、上記シースの基端側から操作されて上記ワイヤループを膨縮させるための操作ワイヤが上記シース内に軸線方向に進退自在に上記導電線と並んで挿通配置されている請求項1又は2記載の内視鏡用高周波処置具。 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. 上記シースの先端から前方に突出する上記先端電極の突出量が、上記シースの基端側からの操作によって調整可能である請求項1又は3記載の内視鏡用高周波処置具。 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. 上記先端電極が上記シースの先端から突没自在である請求項記載の内視鏡用高周波処置具。 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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EP04025819A EP1527744B1 (en) 2003-10-29 2004-10-29 Medical instrument for endoscope
DE602004019614T DE602004019614D1 (en) 2003-10-29 2004-10-29 Medical device for endoscopes

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