JP4556000B2 - Endoscopic monopolar high-frequency cage - Google Patents

Description

  The present invention relates to an endoscope monopolar type high-frequency fold used through an endoscope treatment instrument guide pipe.

There are various types of endoscopic high-frequency incisions depending on the purpose of use, but in order to perform mucosal dissection, there is an electrical connection at the distal end of the sheath that is inserted into and removed from the treatment instrument guide tube of the endoscope. A monopolar type high-frequency reed for an endoscope provided with a pair of electrically conductive high-frequency electrodes opened and closed toward the front is used (for example, Patent Document 1).
JP 2006-346417 A

When performing mucosal dissection using a monopolar high-frequency scissors for endoscopes, a high-frequency scissors are inserted into the incision surface of the mucous membrane whose surface has been incised with an endoscopic high-frequency knife in advance, and then high-frequency power is applied to the electrodes. A treatment is performed in which a current is applied to incise the muscle between the surface mucous membrane and the muscle layer.
However, with the conventional monopolar type high-frequency scalpel for endoscopes as described above, when a sharp incision is made, strong cauterization by high-frequency current is performed to the periphery of the incised portion, and the surrounding living tissue is damaged more than necessary. May end up. Therefore, if the current value is lowered to lighten the damage to the surrounding biological tissue, not only the sharpness of the incision will be reduced, but also the coagulation of the part adjacent to the incision site will be insufficient and a sufficient hemostatic effect will not be obtained. May bleed. As described above, in the conventional monopolar type high-frequency fold for an endoscope, there has been a problem that the degree of cauterization on the incised portion and the surrounding tissue becomes unstable.

  The present invention has been made in order to solve such a problem, and can perform a sharp high-frequency incision, and has a moderate hemostatic effect without damaging the tissue adjacent to the incision more than necessary. An object of the present invention is to provide a monopolar type high-frequency hemorrhoid for an endoscope that can be solidified as reliably as possible.

  The monopolar type high-frequency scissors for endoscope according to the present invention is provided at the distal end of a sheath that is inserted into and removed from the treatment instrument guide tube of the endoscope so that a pair of electrically conductive high-frequency electrodes open and close forward. In addition, when the pair of high-frequency electrodes are in a closed state, the electrode exposed surfaces are formed elongated in the front-rear direction at opposite positions of the high-frequency electrodes facing each other, and the surfaces of the other portions of the high-frequency electrodes are electrically insulated. In a monopolar high-frequency cage for an endoscope, the cross-sectional shape of the high-frequency electrode in a cross-section perpendicular to the longitudinal direction of the high-frequency electrode is such that the electrode exposed surface protrudes in the center and protrudes on both sides of the electrode exposed surface. Thus, a stepped portion forming a step is formed, and a portion outside the outer edge of the stepped portion is formed in a slope shape gradually spreading outward.

  The surface of the portion other than the electrode exposed surface of the high-frequency electrode may be covered with an electrically insulating coating film made of an inert material in a continuous manner. Then, W / 4 ≦ h ≦ W, where W is the width of the electrode exposed surface in the cross section perpendicular to the longitudinal direction of each high-frequency electrode, h is the height of the stepped portion, and w is the width of the stepped surface. W / 4 ≦ w ≦ W, and more preferably h = W / 2 and w = W / 2. Further, when the angle formed by the inclined surface with respect to the opening / closing direction of the high-frequency electrode is θ, 15 ° ≦ θ ≦ 60 ° may be satisfied, and 30 ° ≦ θ ≦ 45 ° is more preferable.

  According to the monopolar type high-frequency cage for an endoscope of the present invention, the cross-sectional shape of the high-frequency electrode is such that the electrode exposed surface protrudes in a convex shape at the center portion, and the step portions that form steps on the electrode exposed surface are formed on both sides thereof. It is formed, and the portion outside the outer edge of the stepped portion is formed in a slope shape that gradually spreads outward, so that a sharp high-frequency incision can be performed, and the tissue adjacent to the incised portion is more than necessary. It can be solidified to such an extent that a hemostatic effect can be appropriately obtained without damage.

Embodiments of the present invention will be specifically described below with reference to the drawings.
FIG. 2 is a side cross-sectional view of the tip portion of the monopolar high-frequency fold for endoscopes according to the first embodiment of the present invention, and FIG. 3 is a plan view thereof.
Reference numeral 1 denotes a flexible sheath that can be inserted into and removed from a treatment instrument guide tube of an endoscope, and is formed of a coil pipe in which a stainless wire is tightly wound. The outer peripheral surface of the flexible sheath 1 is covered with the entire length of a sheath outer skin 2 made of an electrically insulating flexible tube, and is attached to the outer periphery of the distal end cap 3 fixedly attached to the distal end of the flexible sheath 1. The distal end of the sheath outer skin 2 is fixed and fixed. 4 is a conductive operation wire that is loosely inserted into the flexible sheath 1, and can be advanced and retracted in the axial direction by an operation from the operation unit connected to the base end of the flexible sheath 1. It can also be rotated around the axis.

  Reference numeral 5 denotes a tip support frame which cannot be moved in the axial direction with respect to the tip cap 3 but is connected to the tip cap 3 so as to be rotatable in the direction around the axis, and the slit 7 formed in the tip support frame 5 A pair of high-frequency electrodes 6 are supported at the front end portion so as to be pivotable about a support shaft 8 so as to be openable and closable forward. The pair of high-frequency electrodes 6 are provided in a state where they are electrically connected to each other, and the high-frequency current flows in the living tissue where both the high-frequency electrodes 6 and a counter electrode plate (not shown) are in contact with each other.

  9 is a known link mechanism for opening and closing the high-frequency electrode 6, and the tip of the operation wire 4 is connected to the link mechanism. As a result, when the operation wire 4 is moved back and forth in the operation section, the high frequency electrode 6 opens and closes around the support shaft 8, and when the operation wire 4 is rotated around the axis, the tip support frame 5, the high frequency electrode 6, etc. Integrally rotate around the axis of the tip cap 3. Further, by connecting the operation wire 4 to a high-frequency power source on the operation unit side, a high-frequency current can be supplied to the pair of high-frequency electrodes 6 via the operation wire 4. FIG. 2 shows a state in which the pair of high-frequency electrodes 6 are open, but the closed state is also indicated by a two-dot chain line. The pair of high frequency electrodes 6 may be opened and closed by a mechanism other than the link mechanism.

  4 is a front view of the pair of high-frequency electrodes 6 in a closed state (viewed from the left in FIG. 2), and FIG. 1 is a cross-sectional view perpendicular to the longitudinal direction of the high-frequency electrodes 6 (FIG. 2). It is sectional drawing in the AA shown. FIG. 5 is a perspective view of the pair of high-frequency electrodes 6 in a half-open state. At the foremost portion of each high-frequency electrode 6, a tip hook portion 6 a protruding toward the other high-frequency electrode 6 is positioned so as to pass side by side as shown in FIG. 4 when the pair of high-frequency electrodes 6 are closed. Established in relationship.

  Each high-frequency electrode 6 has an electrode exposed surface 6b elongated in the front-rear direction at opposite positions facing each other when the pair of high-frequency electrodes 6 are closed, and an auxiliary electrode surface formed on the back surface of the tip hook portion 6a. The metal surface is exposed only on 6e and its electrode exposed surface 6b, and the other surface of the high-frequency electrode 6 is made of a so-called inert synthetic resin material having high chemical and thermal stability such as a fluororesin. An electrically insulating coating film 10 is coated. As a result, it is possible to safely perform a high-frequency incision only on a living tissue that requires an incision during the mucosal detachment treatment. In addition, the electrically insulating coating film 10 portion is displayed in a grained shape in all drawings.

  As shown in FIG. 1, the portions other than the tip hook portion 6a of each high-frequency electrode 6 are steps in which the electrode exposed surface 6b protrudes in a central portion and has steps on both sides of the electrode exposed surface 6b. A portion 6c is formed, and a portion outside the outer edge of the stepped portion 6c is formed into a slope shape gradually spreading outward (slope portion 6d). The electrically insulative coating film 10 is continuously connected to the entire surface other than the electrode exposed surface 6 b, and encloses the high-frequency electrode 6.

In the cross section perpendicular to the longitudinal direction of the high-frequency electrode 6, the width of the electrode exposed surface 6 b is W, the height of the stepped portion 6 c is h, the width of the stepped surface is w, and the opening and closing direction of the high-frequency electrode 6 is Assuming that the angle formed by the inclined surface portion 6d is θ, in this embodiment, h = W / 2, w = W / 2, and 30 ° ≦ θ ≦ 45 °.
FIG. 6 shows the state of use of the monopolar high-frequency scissors for endoscope according to this embodiment, where a high-frequency current is passed through a pair of high-frequency electrodes 6 sandwiching the living tissue so that the living tissue is indicated by a broken line. Fig. 6 schematically shows a state in which a high-frequency current flows. The distance between the pair of high-frequency electrodes 6 sandwiching the living tissue is the narrowest at the electrode exposed surface 6b portion, and at the stepped portion 6c portion, the distance between the pair of high-frequency electrodes 6 is abruptly widened at a constant interval compared to the electrode exposed surface 6b portion. In the 6d portion, it gradually spreads away from the electrode exposed surface 6b.

  As a result, the Joule heat generated in the electrode exposed surface 6b portion having the highest high-frequency current density (that is, the region sandwiched between the pair of electrode exposed surfaces 6b) is highest, and the living tissue is cut there, and the current density is reduced. In the stepped portion 6c portion (region sandwiched between the stepped portions 6c), the living tissue becomes burnt and a hemostatic effect is obtained. The current density suddenly decreases at the transition portion from the region of the electrode exposed surface 6b to the region of the stepped portion 6c, so that the boundary between the cut portion and the hemostatic portion is clear and a sharp cutting state is obtained. It is done. Further, the current density is constant in the region of the stepped portion 6c where the distance between the pair of high-frequency electrodes 6 is constant, and the hemostatic effect can be reliably obtained in the entire region. In the region of the slope portion 6d, the current density flowing through the living tissue gradually decreases and the cautery state of the living tissue does not change abruptly from the region of the stepped portion 6c, so that a phenomenon that the scab is peeled off is suppressed. Thus, a stable hemostatic state is maintained.

In addition, the magnitudes of h, w, and θ at which such an effect is obtained have a certain range, and W / 4 ≦ h ≦ W, W / 4 ≦ w ≦ W, 15 ° ≦ θ ≦ 60. If it is in the range of °, a certain excellent sharpness and hemostatic effect can be obtained.
FIG. 7 shows a monopolar type high-frequency fold for an endoscope according to a second embodiment of the present invention, in which a tip hook portion 6a is formed so as to protrude at the center position of only one tip portion of a pair of high-frequency electrodes 6. It is. Thus, in the present invention, any shape or the like of the foremost portion of the high-frequency electrode 6 can be used. Further, the high-frequency electrode 6 may have a curved shape or the like.

Sectional drawing in the AA in FIG. 2 of the monopolar type | mold high frequency cage for endoscopes of the 1st Embodiment of this invention. BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a side sectional view of a distal end portion of an endoscope monopolar type high-frequency fold according to a first embodiment of the present invention. The top view of the front-end | tip part of the monopolar type | mold high frequency cage for endoscopes of the 1st Embodiment of this invention. The front view of the state which closed the pair of high frequency electrode of the monopolar type | mold high frequency cage for endoscopes of the 1st Embodiment of this invention. The perspective view of the high frequency electrode of the monopolar type | mold high frequency cage for endoscopes of the 1st Embodiment of this invention. The schematic diagram which shows the state through which the high frequency current flows in the use condition of the monopolar type | mold high frequency cage for endoscopes of the 1st Embodiment of this invention. The perspective view of the high frequency electrode of the monopolar type | mold high frequency cage for endoscopes of the 2nd Embodiment of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 ... Flexible sheath 6 ... High frequency electrode 6a ... Tip hook part 6b ... Electrode exposed surface 6c ... Step part 6d ... Slope part 10 ... Electrical insulating coating film

Claims (6)

When a pair of electrically conductive high-frequency electrodes are provided at the distal end of the sheath inserted into and removed from the endoscope treatment instrument guide tube so as to open and close forward, and the pair of high-frequency electrodes are in a closed state In the monopolar type high-frequency endoscope for an endoscope, the electrode exposed surface is formed to be elongated in the front-rear direction at opposite positions of the high-frequency electrodes facing each other, and the surface of the other part of the high-frequency electrode is electrically insulated.
The cross-sectional shape of the high-frequency electrode in a cross-section perpendicular to the longitudinal direction of the high-frequency electrode has a stepped portion in which the electrode exposed surface protrudes in a central portion and a step is formed on both sides of the electrode exposed surface A monopolar type high-frequency fold for an endoscope, characterized in that the portion outside the outer edge of the stepped portion is formed in a slope shape gradually spreading outward.   The monopolar type high-frequency reed for endoscope according to claim 1, wherein the surface of the portion other than the electrode exposed surface of the high-frequency electrode is coated with an electrically insulating coating film made of an inert material in a continuous manner. Monopolar type high-frequency cage for endoscopes.   The monopolar type high-frequency endoscope for an endoscope according to claim 1 or 2, wherein the width of the electrode exposure surface in a cross section perpendicular to the longitudinal direction of each high-frequency electrode is W, and the height of the step of the step portion. Where h is the width of the stepped surface and w / 4 ≦ h ≦ W and W / 4 ≦ w ≦ W.   The monopolar high-frequency cage for endoscopes according to claim 3, wherein h = W / 2 and w = W / 2.   5. The endoscope monopolar type high-frequency fold according to claim 3, wherein the angle formed by the inclined surface with respect to the opening and closing direction of the high-frequency electrode is θ, where 15 ° ≦ θ ≦ 60 °. Monopolar type high frequency mirror for mirrors.   The monopolar high-frequency cage for endoscopes according to claim 5, wherein 30 ° ≦ θ ≦ 45 °.

Images