JP4996440B2 - Endoscopic high-frequency treatment instrument - Google Patents

Description

  The present invention relates to an endoscopic high-frequency treatment instrument.

  Conventionally, a linear or curved rod-shaped high-frequency electrode has been used as a high-frequency treatment instrument for endoscopes for high-frequency cauterization and incision and separation of a raised portion (including a raised portion) of a surface mucosa in a body cavity. In which the wire is projected forward from the distal end of the flexible sheath, or the conductive wire that becomes a high-frequency electrode is disposed transversely at the most distal end portion of the distal end hood of the endoscope (for example, patents) References 1, 2).

  However, the one described in Patent Document 1 in which a rod-shaped high-frequency electrode is protruded is insufficient in width because the high-frequency electrode has almost no width, and a high-frequency electrode that crosses the distal end hood of the endoscope is provided. The thing of patent document 2 has the problem that a small turn with respect to an endoscope does not work and it is difficult to use.

Therefore, the inventors of the present application, as shown in FIG. 11, relatively move the two sheaths of the distal sheath 91 disposed near the distal end and the proximal sheath 92 disposed behind the distal sheath 91 in the direction around the axis. An electrically insulating flexible sheath is formed by being rotatably connected, the distal end surface of the distal end sheath 91 is formed in a slope shape, and a high-frequency electrode 93 made of a conductive wire is disposed across the distal end surface. An endoscopic high-frequency treatment instrument has been created and a patent application has been filed previously (Japanese Patent Application No. 2006-258317, FIG. 13 and the like).
JP 2002-153485 A JP-A-2005-66140

  The endoscopic high-frequency treatment tool shown in FIG. 11 is transected endoscopically (that is, through the treatment tool insertion channel of the endoscope) by high-frequency cauterization of the raised portion of the surface mucosa in the body cavity. However, since the distal sheath 91 can be arbitrarily rotated with respect to the proximal sheath 92, it is easy to use with a small turn when changing the direction of the high-frequency electrode 93.

  However, since the high-frequency treatment instrument for an endoscope shown in FIG. 11 has a small high-frequency electrode, it is not possible to perform a treatment such as removing a raised portion of a surface mucosa in a body cavity at a stretch. When it is necessary to perform the resection, it is inconvenient because it is necessary to perform the resection treatment several times or else to use it separately from other high-frequency treatment tools for resection.

  The present invention is for an endoscope capable of easily performing both a treatment for performing a peeling treatment while performing incision by high-frequency cauterization of a raised portion of a surface mucosa and a treatment for excision at a stroke. An object is to provide a high-frequency treatment instrument.

  In order to achieve the above object, in the endoscope high-frequency treatment instrument of the present invention, an electrically insulating flexible sheath that is inserted into and removed from the treatment instrument insertion channel of the endoscope is disposed near the distal end thereof. Two sheaths, a distal sheath and a proximal sheath disposed behind it, are connected so as to be relatively rotatable in the direction around the axis but not to move forward and backward in the axial direction. A pair of through-holes are formed on the left and right side walls in the vicinity of the distal end of the distal end sheath when the distal end surface is formed in a slope shape and the inclined surface faces obliquely upward in the forward direction. The high-frequency electrode is placed out of the distal sheath between the pair of through holes and disposed along the most distal surface of the distal sheath, and the conductive wire is bent backward at both ends of the region along the most distal surface of the distal sheath. Through the pair of through holes The high-frequency electrode can be protruded forward from the distal end of the distal sheath by moving the conductive wire forward and backward in the axial direction from the proximal end side while being pulled loosely from the sheath into the proximal sheath. By rotating the proximal sheath around the axis, the distal sheath can be rotated about the axial relative to the proximal sheath to change the direction of the most distal surface of the distal sheath.

  Note that a stopper for restricting the maximum protrusion amount of the high-frequency electrode forward from the most distal surface of the distal sheath may be provided in the flexible sheath.

  According to the present invention, the conductive wire is bent backward at both ends of the region along the most distal surface of the distal sheath, and passes through the pair of through holes formed in the side wall near the distal end of the distal sheath. The high-frequency electrode can be projected forward from the distal end of the distal sheath by being retracted from the proximal end to the proximal sheath so as to be able to advance and retract in the axial direction and by operating the conductive wire in the axial direction from the proximal end side. By rotating the conductive wire around the axis from the proximal end side, the distal sheath can be rotated in the axial direction relative to the proximal sheath to change the direction of the most distal surface of the distal sheath. It is possible to easily perform both a treatment for performing a peeling treatment while performing incision by high-frequency cauterization of a raised portion and the like and a treatment for excision at a stroke.

  An electrically insulating flexible sheath that is inserted into and removed from the treatment instrument insertion channel of the endoscope has two axes: a distal sheath disposed near the distal end and a proximal sheath disposed behind the distal sheath. The tip sheath surface is formed in a slanted shape, and the slant surface is inclined obliquely upward in the forward direction. A pair of through-holes are formed in the left and right side walls in the vicinity of the distal end of the distal sheath when facing, and the high-frequency electrode made of a conductive wire is brought out of the distal sheath between the pair of through-holes, and the distal sheath The conductive wire is bent rearward at both ends of the region along the distal end surface of the distal sheath and loosened from the distal sheath into the proximal sheath through a pair of through holes. Passed through and the conductive wire is on the proximal side The high-frequency electrode can be projected forward from the distal end of the distal sheath by moving forward and backward in the axial direction, and the distal sheath can be turned into the proximal sheath by rotating the conductive wire around the axial line from the proximal end side. On the other hand, it is possible to change the direction of the most distal surface of the distal sheath by rotating around the axis.

Embodiments of the present invention will be described below with reference to the drawings.
2, 3, and 4 are a perspective view, a plan sectional view, and a side partial sectional view of the vicinity of the distal end of the endoscope high-frequency treatment device according to the first embodiment of the present invention.

  Reference numerals 1 and 2 shown in each figure indicate an electrically insulative material having a diameter of about 2 mm made of, for example, an ethylene tetrafluoride resin tube that is inserted into and removed from a treatment instrument insertion channel of an endoscope (not shown). It is a flexible sheath.

  Among them, the proximal sheath 1 disposed on the rear side has a long length of about 1 to 2 m, for example, and the distal sheath 2 disposed on the distal side thereof has a short length of about several centimeters. Is formed thinner than the proximal sheath 1. In addition, as the base-side sheath 1, a structure in which an outer surface of a coil pipe formed by tightly winding a thin metal wire with a certain diameter is covered with an electrically insulating tube can be used.

  The proximal sheath 1 and the distal sheath 2 are connected so as to be relatively rotatable in the direction around the axis, but relatively incapable of moving back and forth in the axial direction. Reference numeral 3 denotes a connecting pipe made of electrically insulating hard plastic or the like for connecting the proximal sheath 1 and the distal sheath 2, and the small diameter portion 3 a constituting the latter half of the connecting pipe 3 is formed on the proximal sheath 1. It is inserted into the tip and fixed there.

  The proximal end portion of the distal sheath 2 is loosely inserted and connected in the front half of the connecting tube 3 so as to be rotatable in the direction around the axis but not in the axial direction. Specifically, the annular projection 4 formed on the outer peripheral surface on the distal end sheath 2 side is engaged with a circumferential groove 5 formed on the entire circumference of the inner peripheral surface on the connecting tube 3 side, so that its function is achieved. Has been demonstrated. In this embodiment, the cross-sectional shapes of the annular protrusion 4 and the circumferential groove 5 are triangular, but they may be arcuate or rectangular.

  The most distal surface 2a of the distal sheath 2 is formed in a slope shape, and a roundness is formed in the vicinity of the front end portion 2b located at the foremost side. Then, as shown in FIG. 4, a pair of through holes are formed in the side walls located on the left and right in the vicinity of the distal end of the distal sheath 2 when the foremost surface 2 a formed in a slope shape is directed obliquely upward in the forward direction. 6 is formed. FIG. 5 is a cross-sectional view (cross-sectional view taken along line VV in FIG. 4) of the portion.

  Then, the high-frequency electrode 7 made of a conductive wire is brought out of the distal sheath 2 between the pair of through holes 6, and as shown in FIGS. 2 to 4, the highest frequency electrode 7 is formed along the most distal surface 2 a of the distal sheath 2. It arrange | positions in the state which crosses the front end surface 2a.

  The conductive wire constituting the high-frequency electrode 7 is bent backward at a substantially right angle at both ends of the region along the distal end surface 2a of the distal sheath 2 and passes through the pair of through holes 6 from the distal sheath 2 to the proximal sheath 1. Has been pulled through loosely. Reference numeral 8 denotes a conductive wire located in the flexible sheaths 1 and 2.

  Note that the through-hole 6 is formed so as to be obliquely rearward from the distal sheath 2 into the distal sheath 2 as shown only in an enlarged view in FIG. 6, and the higher the tilt angle θ, the higher the frequency electrode. 7 (conductive wire 8) can pass through the through hole 6 smoothly.

  However, if the inclination angle θ is formed too small, a thin so-called flared portion is formed on the distal sheath 2, so the inclination angle θ is preferably in the range of about 15 to 45 °, and is preferably in the range of about 20 to 35 °. Is more preferable. As a result, when the outlet opening of the through hole 6 is viewed from the outside as shown in FIG. 4, it has an elliptical shape or an oval shape.

  Further, as shown in FIG. 6, at least the portions 6a and 6b to which the high-frequency electrode 7 (conductive wire 8) is pressed are formed in a smooth round shape in the opening edge of the through-hole 6, and accordingly, the high-frequency electrode 7 (conductive wire 8) can pass through the through hole 6 smoothly.

  FIG. 7 shows the overall configuration of the endoscope high-frequency treatment instrument, and the proximal end of the proximal sheath 1 is connected to the operation unit 10. A fixed finger hook 12 is attached to the proximal end of the operation section main body 11 connected to the proximal end of the base sheath 1, and the movable finger hook 13 can be moved forward and backward in the direction around the axis with respect to the operation section main body 11. It is attached to the head so that it can be moved forward and backward.

  A connection terminal 14 to which a base end of the conductive wire 8 is connected and fixed and a high-frequency power cord (not shown) is connected is arranged on the movable finger hook 13, and the high-frequency power cord is connected to the connection terminal 14. Thus, a high-frequency current can be applied to the high-frequency electrode 7 via the conductive wire 8.

  With such a configuration, when the operation of moving the movable finger hook 13 in the distal direction is performed as indicated by an arrow A in FIG. 7, the conductive wire 8 is thereby moved toward the distal end, and the arrow Y in FIG. As shown, the high-frequency electrode 7 projects forward from the distal end of the distal sheath 2.

Therefore, in this state, the high-frequency electrode 7 is in a state of being elongated in the front-rear direction, so that it is possible to easily perform a treatment such as removing the raised portion of the surface mucosa in the body cavity at once.
Further, when an operation for moving the movable finger hook 13 in the direction to draw the fixed finger hook 12 is performed, the high-frequency electrode 7 returns to the state along the most distal surface 2a of the distal sheath 2 as shown in FIG. It is possible to easily perform a treatment such as peeling while performing incision by high-frequency cauterization of a part or the like.

  Further, when the operation of rotating the movable finger hook 13 around the axis as shown by the arrow B in FIG. 7 is performed, the conductive wire 8 rotates around the axis, and as shown by the arrow Z in FIG. The distal sheath 2 rotates in the direction around the axis with respect to the proximal sheath 1. Therefore, the direction of the high-frequency electrode 7 can be arbitrarily controlled in a state where the high-frequency electrode 7 is slightly turned, and each treatment such as incision and peeling can be accurately and easily performed.

  FIG. 8 shows an endoscopic high-frequency treatment instrument according to a second embodiment of the present invention, in which a stopper 9 for restricting the maximum protruding amount of the high-frequency electrode 7 from the distal sheath 2 to the front thereof is a base side. It is provided in the sheath 1. Other configurations are the same as those in the first embodiment.

  The stopper 9 is a hard member fixed to the conductive wire 8, and when the conductive wire 8 moves forward, the stopper 9 abuts against the rear end surface of the connecting pipe 3 as shown in FIG. Movement to is regulated. By doing in this way, the excessive protrusion of the high frequency electrode 7 from the front-end | tip surface 2a of the front-end | tip sheath 2 to the front is controlled, and safety | security is ensured. Note that the stopper 9 may be disposed in the distal sheath 2.

  FIG. 10 shows a high-frequency treatment instrument for an endoscope according to a third embodiment of the present invention, in which a region 3b in the vicinity of the distal end of the outer peripheral surface of the connecting tube 3 is formed in a tapered and tapered shape. is there. Other configurations are the same as those of the first embodiment. With this configuration, the high-frequency electrode 7 is not easily blocked by the connecting pipe 3 on the endoscope observation screen, and is easy to use.

It is a perspective view near the front-end | tip of the high frequency treatment tool for endoscopes of 1st Example of this invention. It is a perspective view near the front-end | tip of the high frequency treatment tool for endoscopes of 1st Example of this invention. It is a plane sectional view near the front-end | tip of the high frequency treatment tool for endoscopes of 1st Example of this invention. It is side surface partial sectional drawing of the front-end | tip part of the high frequency treatment tool for endoscopes of 1st Example of this invention. FIG. 5 is a cross-sectional view of the endoscope high-frequency treatment tool according to the first embodiment of the present invention taken along line VV in FIG. It is a partial expanded plane sectional view of the high frequency treatment tool for endoscopes of the 1st example of the present invention. It is a side view of the whole structure of the high frequency treatment tool for endoscopes of the 1st example of the present invention. It is a plane fragmentary sectional view near the front-end | tip of the high frequency treatment tool for endoscopes of the 2nd Example of this invention. It is a plane fragmentary sectional view near the front-end | tip of the high frequency treatment tool for endoscopes of the 2nd Example of this invention. It is plane sectional drawing of the front-end | tip vicinity of the high frequency treatment tool for endoscopes of the 3rd Example of this invention. It is a perspective view near the front-end | tip of the conventional high frequency treatment tool for endoscopes.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1, 2 Flexible sheath 1 Proximal sheath 2 Tip sheath 2a Most advanced surface 3 Connection pipe 6 Through-hole 7 High frequency electrode 8 Conductive wire 9 Stopper 10 Operation part

Claims (2)

An electrically insulating flexible sheath that is inserted into and removed from the treatment instrument insertion channel of the endoscope has two axes: a distal sheath disposed near the distal end and a proximal sheath disposed behind the distal sheath. It is configured to be connected so as to be relatively rotatable in the direction but not to be relatively advanced and retracted in the axial direction.
The distal end surface of the tip sheath is formed in a slope shape, and a pair of through holes are formed in the side walls located on the left and right in the vicinity of the tip end of the tip sheath when the slope surface is inclined forward and upward. And
A high-frequency electrode made of a conductive wire is placed outside the tip sheath between the pair of through holes and disposed along the most distal surface of the tip sheath,
The conductive wire is bent backward at both ends of the region along the most distal surface of the distal sheath, and is loosely drawn from the distal sheath through the pair of through holes into the proximal sheath,
The high-frequency electrode can be protruded forward from the distal end of the distal sheath by moving the conductive wire in the axial direction from the proximal end side, and the conductive wire is rotated around the axial line from the proximal end side. In this way, the distal sheath can be rotated in the direction around the axis with respect to the proximal sheath so that the direction of the most distal surface of the distal sheath can be changed. .   The high-frequency treatment instrument for an endoscope according to claim 1, wherein a stopper for restricting the maximum protrusion amount of the high-frequency electrode forward from the most distal surface of the distal sheath is provided in the flexible sheath.

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