JP5342980B2 - High frequency knife for endoscope - Google Patents

Description

  The present invention relates to an endoscope high-frequency knife.

  As a basic configuration of an endoscopic high-frequency knife that is passed through a treatment instrument insertion channel of an endoscope and used for performing mucosal resection or the like, a rod-shaped incision electrode made of a conductive material is made of an electrically insulating material. One that protrudes forward from the distal end of a flexible sheath is known (for example, Patent Document 1).

  However, simply providing a bar-shaped incision electrode at the distal end of the flexible sheath may cauterize the underlying tissue that should not be damaged and cause perforation. In view of this, an incision electrode or the like is provided at the tip of the incision electrode so that the incision treatment can be performed more safely (for example, Patent Document 2).

JP-A-2005-270240 JP-A-8-299355

  In the invention described in Patent Document 2 and the like, the mucous membrane is not cauterized at the distal end portion of the incision electrode, so that the mucosal incision treatment can be performed safely without fear of perforation. However, since a small cut cannot be made in the mucosa prior to incision of the mucous membrane (precutting), it is necessary to make a cut (ie precut) in the mucosal surface in advance with another treatment tool for precutting. This requires complicated operations for the surgeon.

  Accordingly, the inventors of the present invention are fixedly provided at the distal end of a flexible sheath made of an electrical insulating material so that the cutting electrode made of a conductive material protrudes forward, and is larger than the outer diameter of the cutting electrode. Invented an endoscopic high-frequency knife provided so that an electrically insulating tip having an outer diameter can be moved back and forth along the incision electrode by an operation from the proximal end side of the flexible sheath. (Patent application No. 2009-138927).

  In such a high-frequency endoscope knife, the electrical insulation tip is pulled toward the proximal end of the incision electrode, precut by the incision electrode protruding forward from the electrical insulation tip, and then the electrical insulation tip is attached. By moving to the distal end side of the incision electrode, the mucosal incision treatment can be performed without fear of perforation.

  However, such a high-frequency knife for an endoscope only changes the position of the electrical insulating tip with respect to the incision electrode between the precut and the mucosal dissection procedure, and there is no difference in the length of the incision electrode. The electrode length at the time of pre-cut without an electrical insulating tip at the tip of the wire is too long, and there is a risk of cauterizing to the underlying tissue that should not be damaged and causing perforation. However, if the length of the incision electrode is shortened, mucosal incision, which is the original purpose, cannot be performed satisfactorily.

  The present invention can perform precutting and mucosal dissection treatment of the mucosal surface by high-frequency cauterization with a single treatment tool, and can smoothly and perforate with a necessary and sufficient incision depth that differs between the precut and the mucosal dissection treatment. An object of the present invention is to provide a high-frequency knife for an endoscope that can be safely performed without fear of the above.

  In order to achieve the above object, an endoscope high-frequency knife according to the present invention has a cutting electrode made of an elongated conductive material protruding forward at a distal end portion of a flexible sheath made of an electrically insulating material, and is moved back and forth within a certain range. The electrical insulating chip, which is arranged so as to be able to advance and retract in the direction and has an outer diameter larger than the outer diameter of the incising electrode and which surrounds the outer periphery of the incising electrode, is in the region of the front half of the incising electrode A conductive operation wire that is provided so as to be movable back and forth in the longitudinal direction and is mechanically connected to the electrical insulating tip and electrically connected to the incision electrode can be operated from the proximal end side of the flexible sheath. When inserted in the flexible sheath so that it can advance and retreat in the axial direction, and the operation wire is pushed in from the proximal end side, the electrical insulating tip moves to the distal end side of the incision electrode and the incision electrode moves The most advanced position possible When the operation wire is pulled from the proximal end side, the electrical insulation tip moves to the middle position of the incision electrode and the incision electrode moves to the end position of the movable range. It will be a state.

  The incision electrode may be formed of a conductive cylindrical member, and a guide slit for guiding the forward / backward movement of the electrical insulating chip may be formed in the area of the front half of the incision electrode. In addition, a conductive insertion slide member may be disposed so as to be movable back and forth in the axial direction, and a connecting member that connects the distal end of the insertion slide member and the electrical insulating chip may be disposed so as to pass through the guide slit. .

  Then, a high-frequency current may be applied to the incision electrode via the operation wire and the insertion slide member, and the operation wire is formed of a stranded wire, and the core wire of the stranded wire is forward from the distal end of the operation wire. It may be pulled out to form an insertion slide member.

  Further, when the electrical insulating chip is at the most advanced position in the advanceable / retractable range, the cutting electrode may not protrude forward from the electrical insulating chip.

  According to the present invention, when the operation wire is pushed from the proximal end side, the electrically insulating tip is moved to the distal end side of the incision electrode, and the incision electrode is moved to the most advanced position in the movable range. When the operation wire is pulled from the proximal end side, the electrical insulating tip is moved to the middle position of the incision electrode, and the incision electrode is moved to the last end position of the movable range. Therefore, the precutting of the mucosal surface by high-frequency cauterization, the mucosal dissection treatment, and the like can be performed smoothly with a necessary and sufficient dissection depth that is different in both cases, and can be safely performed without fear of perforation.

1 is an overall configuration diagram of a high-frequency endoscope knife according to a first embodiment of the present invention. In the endoscope high frequency knife according to the first embodiment of the present invention, the electrical insulating tip is a side cross-sectional view of the distal end portion of the cutting electrode in the most protruding state at the foremost position. FIG. 3 is a perspective view of the distal end portion of the endoscope high-frequency knife according to the first embodiment of the present invention in a state where the electrical insulating tip is at the most distal position of the incision electrode in the most protruding state. It is IV-IV sectional drawing in FIG. 2 of 1st Example of this invention. In the high frequency knife for endoscopes concerning the 1st example of the present invention, it is a side sectional view of the tip part in the state where an electric insulation tip is in the last end position of an incision electrode in the most retracted state. FIG. 3 is a perspective view of the distal end portion of the endoscope high-frequency knife according to the first embodiment of the present invention in a state where the electrically insulating tip is at the rearmost end position of the incision electrode in the most retracted state. It is side surface sectional drawing of the front-end | tip part which shows the state in the middle of the protrusion and subtraction operation | movement of the high frequency knife for endoscopes which concerns on 1st Example of this invention. It is side surface sectional drawing of the front-end | tip part which shows the state in the middle of the protrusion and subtraction operation | movement of the high frequency knife for endoscopes which concerns on 1st Example of this invention. FIG. 10 is a side cross-sectional view of the distal end portion of the endoscope high-frequency knife according to the second embodiment of the present invention in a state where the electrically insulating tip is at the foremost position of the incision electrode in the most protruding state.

Embodiments of the present invention will be described below with reference to the drawings.
FIG. 1 shows the overall configuration of the endoscope high-frequency knife according to the first embodiment of the present invention. The distal end of the flexible sheath 1 has an incision electrode 3 and an electrical insulating tip 4 in the front-rear direction. Two different states moved are shown side by side.

  A flexible sheath 1 inserted into and removed from a treatment instrument insertion channel of an endoscope (not shown) is formed of an electrically insulating flexible tube such as a tetrafluoroethylene resin tube. Reference numeral 2 denotes an electrically insulating sheath tip cap fixedly attached to the tip of the flexible sheath 1.

  At the axial position of the distal end portion of the flexible sheath 1, the cutting electrode 3 made of a straight and long conductive material can be moved forward and backward within a certain range so that the sheath distal end base 2 and the axial position are aligned with each other. 2 in a state of protruding forward.

  In addition, the electrical insulating chip 4 having an outer diameter larger than the outer diameter of the incising electrode 3 and arranged so as to surround the outer periphery of the incising electrode 3 is connected to the incising electrode 3 in the region of the front half of the incising electrode 3 It can be moved forward and backward along the direction.

  In the flexible sheath 1, a conductive operation wire 6 is inserted and arranged over the entire length so as to be movable back and forth in the axial direction. When the operation wire 6 is operated to advance and retract in the axial direction, the electrically insulating chip 4 is thereby moved. Advancing and retreating in the axial direction (that is, the front-rear direction) within a certain range along the incision electrode 3.

  Further, following the forward / backward movement of the electrical insulating chip 4, the incision electrode 3 moves forward / backward in the axial direction (that is, the front / rear direction) within a movement range smaller than that of the electrical insulating chip 4. A configuration for performing such an operation will be described later in detail.

  A known operation portion 20 for advancing and retracting the operation wire 6 is connected to the proximal end side 1 e of the flexible sheath 1. In addition, the operation unit 20 side is illustrated as being reduced compared to the distal end side of the flexible sheath 1.

  The base end 6 e of the operation wire 6 is connected and fixed to a slide operation member 22 that is slidably attached to the operation unit main body 21. Accordingly, by sliding the slide operation member 22 along the operation portion main body 21 as indicated by an arrow, the operation wire 6 advances and retreats in the axial direction within the flexible sheath 1, so that the flexible sheath 1 At the tip, the electrically insulating tip 4 and the cutting electrode 3 advance and retract in the axial direction.

  The connection terminal 23 provided on the slide operation member 22 is electrically connected to the proximal end 6e of the operation wire 6. By connecting a high-frequency power cord (not shown) to the connection terminal 23, the connection terminal 23 passes through the operation wire 6. Thus, a high frequency current can be applied to the incision electrode 3.

  Therefore, on the distal end side of the flexible sheath 1, if the electrical insulating chip 4 is pulled toward the base of the incising electrode 3 and a high frequency current is passed through the incising electrode 3 with the incising electrode 3 protruding forward from the distal end, A precut process for making a cut in the surface part of the mucous membrane, a marking process for forming spot-like marks on the mucosal surface, and the like can be performed at the distal end part of the incision electrode 3.

  Then, if the electric insulating chip 4 is moved to the forefront portion of the incision electrode 3 and a high-frequency current is passed through the incision electrode 3, mucosal incision treatment or exfoliation treatment can be performed. At this time, since the electrically insulating tip 4 is located at the tip of the incision electrode 3, there is no risk of cauterizing and perforating the tissue of the submucosa that should not be incised.

  2 and 3 show a high-frequency knife for an endoscope in which the incision electrode 3 protrudes to the maximum from the distal end of the flexible sheath 1 and the electrical insulating chip 4 is located at the most distal end of the incision electrode 3. It is side surface sectional drawing and a perspective view of a front-end | tip part.

  A sheath distal end cap 2 formed of an electrical insulating material such as a plastic material or a ceramic material has a portion in the vicinity of the distal end formed to have an outer diameter that is substantially the same as the outer diameter of the flexible sheath 1. 1 is exposed at the tip.

  The rear end portion of the sheath distal end cap 2 has an outer diameter that is substantially the same as the inner diameter of the flexible sheath 1 and is press-fitted into the distal end of the flexible sheath 1, and is formed on the outer periphery of the portion. The stop projections bite into the inner peripheral surface of the flexible sheath 1, so that the stopper projections are fixed so as not to be detached from the flexible sheath 1.

  The incision electrode 3 formed of a conductive metal material such as a straight cylindrical stainless steel pipe material having a constant inner and outer diameter is sheathed in a state of penetrating back and forth through the hole formed at the axial position of the sheath tip 2. The distal end cap 2 is inserted and arranged, and protrudes straight forward from the center axis position of the sheath distal end cap 2.

  The electrical insulating chip 4 formed of a plastic material or a ceramic material is formed in a circular shape having an outer diameter larger than the outer diameter of the cutting electrode 3 and surrounding the outer periphery of the cutting electrode 3. A through-hole through which the cutting electrode 3 passes loosely to the extent that there is no backlash is formed at the position.

  The incision electrode 3 can advance and retreat the axial position of the sheath tip cap 2 in the axial direction. However, the backward stopper 2a and the forward stopper 2b are provided to protrude inward at the rear end and the distal end of the inner peripheral portion of the sheath distal end cap 2, respectively.

  As a result, the short cylindrical movement stopper 3a fitted and fixed to the rear end of the incision electrode 3 comes into contact with the backward stopper 2a in the rear and comes into contact with the forward stopper 2b in the front, whereby the advance / retreat range of the incision electrode 3 Is regulated.

  As shown in FIG. 2, in a state where the incision electrode 3 protrudes most forward, the movement stopper 3 a of the incision electrode 3 is in contact with the advance stopper 2 b of the sheath tip cap 2. The advance stopper 2b is formed as a separate member from the sheath tip cap 2 for the convenience of assembly and is fixed to the sheath tip cap 2. However, if there is no problem in assembly, the advance stopper 2b is formed as one component with the sheath tip cap 2. May be.

  In the incision electrode 3, a guide slit 5 for guiding the forward / backward movement of the electrical insulating chip 4 is formed straight in a direction parallel to the axis. However, the guide slit 5 is not formed over the entire length of the incision electrode 3 but is formed in the region of the front half of the incision electrode 3.

  The “front half” is not just half of the front side, but about half of the front side. Specifically, for example, in the range of about 1/3 to 2/3. is there. In this embodiment, two guide slits 5 are formed at 180 ° symmetrical positions of the incision electrode 3, but it is sufficient that at least one guide slit 5 is formed.

  A rod-shaped insertion slide member 7 attached to the distal end of the operation wire 6 is inserted into the incision electrode 3 so as to be movable forward and backward in the axial direction. The insertion slide member 7 is formed of a conductive material, and is mechanically and electrically connected to the operation wire 6.

  As shown in FIG. 4 illustrating the IV-IV cross section in FIG. 2, the connecting member 8 fixed in the vicinity of the distal end of the insertion slide member 7 loosely passes through the guide slit 5 and protrudes to the side. The electric insulating chip 4 is connected and fixed. As a result, the electrically insulating chip 4 is substantially integrated with the insertion slide member 7.

  The operation wire 6 is formed of, for example, a stranded wire obtained by twisting a plurality of strands made of stainless steel fine wire, and the core wire of the stranded wire is drawn forward from the tip of the operation wire 6 to be inserted into the insertion slide member 7. Is forming.

  A conductive guide pipe 9 made of a conductive metal material is fitted and fixed to the insertion slide member 7 so that the insertion slide member 7 and the incision electrode 3 are electrically connected to each other. The insertion slide member 7 is slidable in the axial direction within the cutting electrode 3, but the outer peripheral surface of the insertion slide member 7 is always in electrical contact with the inner peripheral surface of the cutting electrode 3.

  Therefore, the conductive guide pipe 9 is mechanically and electrically integrated with the insertion slide member 7, and the cutting electrode 3 always contacts the conductive guide pipe 9. The electrode 3 is electrically and reliably connected through the conductive guide pipe 9.

  As a result, the operation wire 6 is mechanically connected to the electrical insulating chip 4 and electrically connected to the incision electrode 3, and the operation wire 6 and the insertion slide member 7 are A high frequency current can be applied to the incision electrode 3 from the operation unit 20 side.

  With such a configuration, the insertion slide member 7 can advance and retreat in the axial direction at the axial position of the incision electrode 3, and the electrically insulating chip 4 connected to the insertion slide member 7 is also moved together with the insertion slide member 7. It can advance and retreat in the axial direction with respect to the incision electrode 3.

  However, the advance / retreat range of the insertion slide member 7 and the electrical insulating chip 4 is limited to the range in which the connecting member 8 can move within the guide slit 5, and the electrical insulating chip 4 is incised in the region of the front half of the incision electrode 3. It can move forward and backward along the electrode 3.

  With such a configuration, when the operation wire 6 is pushed in from the operation unit 20 side, the electrical insulating chip 4 is moved to the most distal side of the incision electrode 3 as shown in FIGS. At the same time, the incision electrode 3 moves to the most advanced position of the movable range with respect to the flexible sheath 1 (that is, the position where the movement stopper 3a contacts the advance stopper 2b).

  In this state, since the incision electrode 3 does not protrude forward from the electrical insulating chip 4, the incision treatment or exfoliation treatment of the mucosa is necessary and sufficient depth without cauterizing the tissue below the mucosa that should not be incised. Now it can be done safely and reliably.

  When the operation wire 6 is pulled from the operation unit 20 side, as shown in FIGS. 5 and 6, the insulative electrode 3 is the rearward movement limit position where the electrical insulating chip 4 guides the guide slit 5. It moves to an intermediate position, and in that state, the incision electrode 3 moves to the last end position of the movable range (that is, the position where the movement stopper 3a contacts the retraction stopper 2a).

  Then, the electrical insulating tip 4 is retracted to a position where it comes into contact with the distal end surface of the sheath tip 2, and the cutting electrode 3 protrudes forward from the tip of the electrical insulating tip 4. Precutting can be performed at the tip of 3.

  However, the protruding length of the incision electrode 3 at that time is shorter than the state shown in FIGS. 1 and 2 (specifically, it is shorter by the length of the incision electrode 3 drawn into the sheath tip 2). Precutting can be performed very safely without the risk of cauterizing to the underlying tissue that should not be damaged and causing perforation.

  In the middle of the operation wire 6 being pulled toward the operation unit 20 from the electrode protruding state shown in FIG. 1, only the electric insulating chip 4 moves backward as shown in FIG. 3 is not moving, and conversely, in the middle of the operation wire 6 being pushed into the distal end side from the precut state shown in FIG. 3, only the electric insulating chip 4 is shown in FIG. There is a state in which the incision electrode 3 is not moved by moving forward.

  However, this is the case when the frictional resistance of the operation of sliding the electrical insulating tip 4 relative to the cutting electrode 3 is smaller than the frictional resistance of the operation of sliding the cutting electrode 3 relative to the sheath tip 2. When the magnitude of the frictional resistance is opposite to that, the operation follows the reverse of the above.

  FIG. 9 shows a distal end portion of a high-frequency knife for an endoscope according to a second embodiment of the present invention. In this embodiment, the following configuration is different from that of the first embodiment, and the operation is the same as that of the first embodiment.

  That is, in this embodiment, the insertion slide member 7 is formed as a member different from the operation wire 6 and is connected to each other by the conductive connection member 11. The sheath tip cap 2 is formed in a shape having no step portion on the inner periphery, and a receding stopper 2 a formed as a separate member from the sheath tip cap 2 is fixed to the sheath tip cap 2.

  In addition, since the electrical insulating chip 4 is formed of a material that is difficult to wear such as ceramics, the electrical insulating chip 4 is sandwiched between the two connecting members 8 and connected and fixed to the distal end portion of the conductive guide pipe 9. A pressure fixing ring 12 that presses the inner slide member 7 so as not to come out of the inner slide member 7 is fixed to the distal end of the inner slide member 7.

  The present invention is not limited to the above-described embodiment. For example, if the electrical insulating chip 4 can move forward and backward in the region of the front half of the cutting electrode 3, the guide slit 5 is not necessarily provided in the cutting electrode. 3 may not be formed.

DESCRIPTION OF SYMBOLS 1 Flexible sheath 2 Sheath tip cap 2a Retraction stopper 2b Advance stopper 3 Cutting electrode 3a Movement stopper 4 Electrical insulation tip 5 Guide slit 4 Electrical insulation tip 6 Operation wire 7 Insertion slide member 8 Connection member 9 Conductive guide pipe 20 Operation part

Claims (6)

At the distal end portion of the flexible sheath made of an electrically insulating material, an incision electrode made of an elongated conductive material protrudes forward and is disposed so as to be movable forward and backward in a certain range.
An electrical insulating chip having an outer diameter larger than the outer diameter of the incising electrode and arranged so as to surround the outer periphery of the incising electrode is moved back and forth along the incising electrode in the region of the front half of the incising electrode. It can be moved forward and backward in the direction,
A conductive operation wire mechanically connected to the electrical insulating chip and electrically connected to the incision electrode is capable of moving forward and backward in the axial direction by operation from the proximal end side of the flexible sheath. Inserted into the sheath,
When the operation wire is pushed in from the proximal end side, the electrical insulating chip is moved to the distal end side of the incision electrode, and the incision electrode is moved to the most advanced position in the movable range. When the operation wire is pulled from the proximal end side, the electrical insulating tip is moved to the intermediate position of the incision electrode, and the incision electrode is moved to the end position of the movable range. An endoscopic high-frequency knife characterized by comprising:   2. The cutting electrode according to claim 1, wherein the cutting electrode is formed of a conductive cylindrical member, and a guide slit for guiding the advancing / retreating operation of the electrical insulating chip is formed in a region of the front half of the cutting electrode. High-frequency knife for endoscope.   A conductive insertion slide member is disposed in the incision electrode so as to be movable back and forth in the axial direction, and a connecting member that connects the tip of the insertion slide member and the electrical insulating chip passes through the guide slit. The high-frequency knife for an endoscope according to claim 2, which is disposed on the endoscope.   The high-frequency knife for endoscope according to claim 3, wherein a high-frequency current is applied to the incision electrode through the operation wire and the insertion slide member.   5. The endoscope high-frequency knife according to claim 4, wherein the operation wire is formed of a stranded wire, and a core wire of the stranded wire is drawn forward from a tip of the operation wire to form the insertion slide member. .   The inner electrode according to any one of claims 1 to 5, wherein the incision electrode does not protrude forward from the electrical insulation tip when the electrical insulation tip is at the most advanced position of the advanceable / retreatable range. High-frequency knife for endoscope.

Images