JP5186346B2 - Endoscopic high-frequency snare - Google Patents

Description

  The present invention relates to an endoscopic high-frequency snare that is passed through a treatment instrument insertion channel of an endoscope and used for performing an incision and excision treatment of a mucous membrane.

  In general, a high-frequency snare for an endoscope has a conductive operation wire inserted and disposed in an electrically insulating flexible sheath so as to be movable back and forth in the axial direction, and a snare composed of a conductive elastic wire at the tip of the operation wire. The loop is connected, and the snare loop moves in and out of the distal end of the flexible sheath by operating the operation wire forward and backward in the axial direction. The snare loop expands by its own elasticity outside the flexible sheath and enters the flexible sheath. By being pulled in, it is elastically deformed and becomes narrowed (for example, Patent Document 1).

However, such a high-frequency snare can only perform excision such as a polyp. Therefore, in a high-frequency snare for performing mucosal resection or the like, a snare loop is used so that the incision treatment of the mucosal surface, the marking on the mucosal surface preceding it, and the mucosal resection treatment after the incision can be continuously performed. The formed elastic wire is provided with a rod-shaped tip electrode protruding forward from the tip of the snare loop (for example, Patent Document 2).
JP 2000-83963 A JP-A-2005-124697

  In the invention described in Patent Document 2 and the like, the tissue is high-frequency cauterized by applying a high-frequency current by bringing a rod-shaped tip electrode protruding forward from the tip of the snare loop into contact with human tissue, and marking, incision and Each treatment of excision can be performed continuously.

  However, since such a conventional high-frequency snare for an endoscope has a configuration in which a rod-shaped tip electrode simply protrudes from the tip of the snare loop, when performing marking or incision treatment by bringing the rod-shaped tip electrode into contact with human tissue, Even if the surgeon pays close attention, the snare loop may come into contact with the human tissue, and the tissue may be ablated at an unexpected range or depth.

  The present invention is a highly safe endoscope that can continuously perform marking, incision, and detachment treatments on the mucous membrane and that does not cause high-frequency cauterization of the tissue to an unexpected range or depth. The object is to provide a high-frequency snare.

  In order to achieve the above object, an endoscope high-frequency snare according to the present invention has a conductive operation wire inserted and disposed in an electrically insulating flexible sheath so as to be movable back and forth in the axial direction. A snare loop made of a conductive elastic wire is connected to the tip, and the snare loop moves in and out of the tip of the flexible sheath by moving the operation wire forward and backward in the axial direction. In a high-frequency endoscope snare configured to swell due to its own elasticity and to be elastically deformed and retracted by being pulled into a flexible sheath, a snare loop is formed at the tip of the snare loop. An electrically insulating tip is fixedly attached so that the tip of the elastic wire penetrates, and the elastic wire protrudes forward from the tip. It is obtained by the.

  The tip may be formed in a size that does not lead into the tip of the flexible sheath, and the elastic wire may be bound with the tip at the tip position of the snare loop.

  Further, the tip may be formed in a substantially spherical shape, a through hole may be formed in the tip, and the elastic wire may be fixed to the tip in a state of protruding forward through the through hole. .

  According to the present invention, the electrically insulating tip is fixedly attached to the tip portion of the snare loop so that the tip portion of the elastic wire forming the snare loop penetrates, and the elastic wire is moved forward from the tip tip. By projecting into a rod-shaped tip electrode, the treatment such as marking, incision and excision on the mucous membrane can be performed continuously, and an electrically insulating tip is provided. Therefore, the tissue is not subjected to high-frequency cauterization to an unexpected range or deep part, and high safety can be obtained.

  A conductive operation wire is inserted and disposed in an electrically insulating flexible sheath so as to be movable back and forth in the axial direction, and a snare loop made of a conductive elastic wire is connected to the tip of the operation wire. By moving forward and backward in the direction, the snare loop enters and exits the distal end of the flexible sheath, and the snare loop expands by its own elasticity outside the flexible sheath and is elastically deformed by being pulled into the flexible sheath. In an endoscopic high-frequency snare that is configured to be constricted, an electrically insulating tip is fixed so that the tip of the snare loop penetrates the tip of the elastic wire forming the snare loop. The elastic wire is protruded forward from the tip, and the protruding portion is used as a rod-shaped tip electrode.

Embodiments of the present invention will be described below with reference to the drawings.
1 and 2 show the distal end portion of the endoscope high-frequency snare according to the first embodiment. FIG. 1 shows a state in which the snare loop 10 is expanded, and FIG. 2 shows a state in which the snare loop 10 is narrowed. Is shown.

  In the high-frequency snare for an endoscope of this embodiment, a conductive sheath made of, for example, stainless steel is provided in a flexible sheath 1 made of an electrically insulating flexible tube such as a tetrafluoroethylene resin tube. A flexible operation wire 2 formed by twisting a plurality of strands is inserted and disposed so as to be movable forward and backward in the axial direction.

  The conductive metal connecting tube 3 fixed to the distal end of the operation wire 2 is inserted into the proximal end portions of the two elastic wires 4 and 4 forming the snare loop 10 and fixed integrally by silver brazing or the like. The elastic wires 4 and 4 constituting the snare loop 10 are moved by moving the operation wire 2 back and forth in the axial direction with an operation portion (not shown) connected to the proximal end of the flexible sheath 1. The flexible sheath 1 enters and exits the tip.

  As shown in FIG. 1, the snare loop 10 swells in a loop shape by its own elasticity when no external force is applied outside the flexible sheath 1, and is drawn into the flexible sheath 1 as shown in FIG. It will be elastically deformed and narrowed.

  Each of the elastic wires 4 and 4 forming the snare loop 10 is formed of a conductive stranded wire or a single wire made of, for example, stainless steel wire, and the elastic wires 4 and 4 and their wires are connected via the operation wire 2 from the operation unit side. A high-frequency current can be applied to the rod-shaped tip electrode 4A at the tip.

  On the proximal end side of the snare loop 10, the proximal end portions of the two elastic wires 4, 4 are arranged and fixed in parallel in the connection pipe 3, and the two elastic wires are also disposed on the distal end side of the snare loop 10. 4, 4 end portions are arranged in parallel, and are bound by an electrically insulating tip end 5.

  FIG. 3 is an enlarged cross-sectional view showing such a tip portion 5 portion. The tip chip 5 is formed in a substantially spherical shape from an electrically insulating hard plastic or ceramic. Then, the tip portions of the two elastic wires 4 are arranged side by side through the through-hole 5a formed at the axial position of the tip tip 5, and they are integrally fixed with a heat-resistant adhesive or the like. Two snare loops 10 are formed.

  The tip portions of the two elastic wires 4 passed through the through-holes 5a formed in the tip chip 5 pass straight through the through-holes 5a in a state of being arranged in parallel, and from the tip chip 5 For example, it protrudes about several mm to 1 cm forward, and the protruding portion is a rod-shaped tip electrode 4A for performing mucosal dissection treatment or the like. Note that the portion that becomes the rod-shaped tip electrode 4A may be integrally hardened by brazing or welding before passing through the tip tip 5.

  The distal tip 5 is fixedly attached to the elastic wire 4 so that the distal ends of the two elastic wires 4 penetrate, and has an outer diameter dimension larger than an inner diameter dimension of the distal end portion of the flexible sheath 1. ing. Therefore, the distal tip 5 is not drawn into the distal end of the flexible sheath 1.

  4 to 6 show the use state of the endoscope high-frequency snare of the embodiment configured as described above, and the flexible sheath 1 passed through the treatment instrument insertion channel 21 of the endoscope 20. The tip portion of the projection protrudes toward the affected area 100 in the body.

  FIG. 4 shows a state in which the marking 101 is formed by cauterizing the tip of the rod-like tip electrode 4A against the mucosal surface around the affected area 100 in order to clarify the incision range of the mucosa. .

  At that time, the snare loop 10 is pulled into the flexible sheath 1, and the rod-shaped tip electrode 4 </ b> A protruding from the tip of the flexible sheath 1 is brought into contact with the mucosal surface, and a high-frequency current is applied to the mucosal surface. The dot-shaped marking 101 can be attached to the.

  At this time, the tip 5 is not drawn into the flexible sheath 1 and the position of the rod-like tip electrode 4A at the tip of the flexible sheath 1 is stable, so that the marking process can be performed smoothly. .

  Even if the elastic wire 4 comes out of the distal end of the flexible sheath 1 against the operator's will, the elastic wire 4 comes into contact with the surrounding mucosal surface due to the presence of the rod-shaped distal electrode 4A. High safety is ensured because it is difficult.

  FIG. 5 shows a state in which an incision treatment is being performed with the rod-shaped tip electrode 4A, and the rod-shaped tip electrode 4A to which the high-frequency current is applied is moved and operated while being slightly submerged on the mucosal surface. The living tissue that comes into contact with the electrode 4A is cauterized, and the mucous membrane can be incised so as to surround the affected area 100.

  At this time, the electrically insulating tip 5 moves along the surface of the mucous membrane, and even if the tip 5 swings, the elastic wire 4 portion behind it is difficult to touch the mucous membrane. In addition, it is possible to safely perform an incision treatment without being cauterized to an unexpected deep tissue depth under the mucous membrane.

  FIG. 6 shows a state in which a mucous membrane excision treatment is performed by the snare loop 10. The snare loop 10 is surrounded by the snare loop 10 along the incised portion of the mucosa, and a high-frequency current is applied to the affected area 100 while snare loop is applied. By constricting 10, the affected part 100 can be excised.

  At this time, the rod-shaped tip electrode 4A comes close to the mucosal surface outside the excision range, but the tip tip 5 having a diameter larger than the rod-shaped tip electrode 4A comes into contact with the mucosal surface and the rod-shaped tip electrode 4A floats from the mucosal surface. As a result, the surrounding normal mucous membrane is not cauterized and safety is ensured.

  Although not shown, when the rod-shaped tip electrode 4A is inserted under the mucous membrane after the incision to perform mucosal detachment treatment, or when the rod-shaped tip electrode 4A is pressed against the bleeding site on the mucosal surface, hemostasis treatment is performed, etc. In addition, since the tip tip 5 is provided, the elastic wire 4 on the snare loop 10 side does not contact the mucous membrane, and high safety is ensured.

  The present invention is not limited to the above embodiment. For example, as in the second and third embodiments shown in FIG. 7 and FIG. It may be formed into a curved shape that is bent in a straight line or a smoothly curved shape.

It is a plane sectional view in the state where the snare loop of the tip part of the high frequency snare for endoscopes of the 1st example of the present invention spreads. It is a plane sectional view in the state where the snare loop of the tip part of the high frequency snare for endoscopes of the 1st example of the present invention was narrowed. It is an expanded plane sectional view of the most advanced part of the high frequency snare for endoscopes of the 1st example of the present invention. It is a perspective view which shows the state of the marking process to the surface mucous membrane by the high frequency snare for endoscopes of the 1st Example of this invention. It is a perspective view which shows the state of the incision treatment of the surface mucous membrane by the high frequency snare for endoscopes of the 1st Example of this invention. It is a perspective view which shows the state of the mucous membrane excision treatment by the high frequency snare for endoscopes of the 1st Example of this invention. It is a perspective view of the most advanced part of the high frequency snare for endoscopes of the 2nd example of the present invention. It is a perspective view of the most advanced part of the high frequency snare for endoscopes of the 3rd example of the present invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Flexible sheath 2 Operation wire 4 Elastic wire 4A Rod-shaped tip electrode 5 Tip tip 5a Through-hole 10 Snare loop

Claims (5)

A conductive operation wire is inserted and disposed in an electrically insulating flexible sheath so as to be movable back and forth in the axial direction, and a snare loop made of a conductive elastic wire is connected to the tip of the operation wire. By moving back and forth in the axial direction, the snare loop enters and exits into the distal end of the flexible sheath, and the snare loop expands by its own elasticity outside the flexible sheath, and enters the flexible sheath. In a high-frequency endoscope snare configured to be elastically deformed and narrowed by being pulled,
An electrically insulating tip is fixedly attached to the tip of the snare loop so that the tip of the elastic wire forming the snare loop penetrates, and the elastic wire is moved forward from the tip. A high-frequency snare for an endoscope characterized in that the protruding portion is a rod-shaped tip electrode.   The high-frequency snare for endoscope according to claim 1, wherein the tip is formed in a size that does not retract into the tip of the flexible sheath.   The high-frequency endoscope snare according to claim 1, wherein the elastic wire is in a state of being bound by the tip at a tip position of the snare loop.   The high-frequency snare for an endoscope according to any one of claims 1 to 3, wherein the tip is formed in a substantially spherical shape.   The through-hole is formed in the said front-end | tip tip, The said elastic wire passes through the said through-hole, and is adhering with the said front-end | tip tip in the state protruded ahead. High-frequency snare for endoscope.

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