JP5535862B2 - High frequency peeling knife device for endoscope - Google Patents

Description

  The present invention is a high-frequency endoscopic debonding device that is inserted into a treatment instrument guide pipe of an endoscope so as to freely advance and retreat and delaminates or excises a living tissue such as an adhesion site or a mucosal tissue in a body cavity. The present invention relates to a knife device, and more particularly, to an endoscopic high-frequency peeling knife device in which an operator can easily visually observe the treatment state of a living tissue, and can be peeled and incised in parallel along the mucosal surface to reduce the risk of perforation.

  In general, under the endoscope, a surgical operation to remove a living tissue in a body cavity, such as peeling of a mucous membrane, is performed by inserting a needle knife or the like into the guide channel of the endoscope in advance and projecting it from the tip. After marking the surrounding area, inject saline or hyaluronic acid into the submucosal layer of the affected area to raise the affected area, and then insert a new high frequency fistula etc. into the guide channel of the endoscope Then, move it while applying high-frequency current, make an initial incision around the entire surface of the mucous membrane along the marking, and mark the streaks that have been pulled by hyaluronic acid injected between the submucosa and muscle layers. Expose along. And let the hood attached to the tip of the endoscope between the submucosa and the muscle layer that performed this initial incision, while applying tension to the muscle fibers etc. between the submucosa and the muscle layer, The streak fibers are peeled and incised by applying a high-frequency current to a high-frequency peeling knife device or the like that is inserted into the guide duct of the endoscope and protrudes from the distal end.

  The endoscopic high-frequency exfoliating knife device that is the subject of the present invention is for exfoliating and incising muscle fibers and the like as described above. In such a procedure, as intended for biological tissues such as mucous membranes. Since it is necessary to make an incision only in the target range at the depth as aimed in the direction, and it is often necessary to perform very delicate operation control, it is necessary to make it easy to see through the endoscope, and the endoscope Therefore, it is necessary to adjust the direction and angle of the high-frequency electrode of the high-frequency peeling knife device for use according to the desired incision state.

  Since the endoscope observes the affected area from above with an angle with respect to the mucosal surface, the high-frequency peeling knife device protruding from the tip of the endoscope guide pipe also performs the peeling operation from the direction of looking down on the mucosal surface that is the affected area. I have to do it. That is, since the high-frequency peeling knife device to be inserted between the affected submucosa and muscle layers cannot be inserted from an angle parallel to the mucosal surface, the mucosal surface is pierced, deeply cut deeply, There was a high risk of bleeding. Therefore, skill is required for the operation, and it is necessary to make an exfoliation and incision carefully. It takes time, and the patient suffers a lot of pain, and the operator's fatigue is severe.

  In addition, the following patent document 1 is mentioned as a document in which the technique regarding the said high frequency peeling knife apparatus for endoscopes and a treatment was described, and this patent document 1 includes a pair of saddle structures that are opened and closed by a link mechanism. It has a knife tool and is provided with a blade part with a protrusion formed at one end of the knife tool and a straight blade part, and the insulation coating is removed so that a high-frequency current is applied only to the opposite part of the knife tool. A technique for forming a high-frequency electrode portion is described. Further, as another document describing a linear endoscope high-frequency peeling knife device, the following Patent Document 2 can be cited. This Patent Document 2 includes a thin rod-shaped high-frequency wave in which a metal portion is exposed from a sheath. A technique for bending an electrode knife tool by operating an operation wire is described.

JP 2007-330723 A JP 2007-202874 A

  In the technique described in Patent Document 1, the high-frequency electrode portion is disposed inside the pair of knife tools that open and close when peeling and incising the streak fibers. There is a problem that it is difficult to see the treatment target part by blocking the field of view that can be seen through the objective lens of the endoscope, and because the electrode at the tip of the treatment tool is oriented in the axial direction of the endoscope, In the case of a peeling incision, the incision must be made from the direction of insertion at an acute angle with respect to the mucosal surface, and there is a risk of breaking through the muscle layer.

In the technique described in Patent Document 2, since the high-frequency electrode knife tool exposes the conductive metal portion over the entire circumference, there is a risk of perforation due to cauterization due to contact with a site other than the target affected area. In addition, because it is formed in the shape of a thin rod, the tip of the heart is incised while cauterizing deeply into the mucous membrane without resistance due to contact with the heartbeat or peristalsis during treatment, and unnecessary incision and blood vessels There was a danger of cutting and drilling, and there was a problem that the treatment was difficult.
Further, since the support shaft of the high-frequency electrode is in the sheath, the bending angle of the electrode is limited at the mouth of the distal end portion of the sheath and cannot be bent strongly. From this, it is necessary to make a peeling incision from the direction of piercing the mucous membrane, so that not only the peeling operation is difficult, but also there is a problem that the risk of perforation increases by breaking through the muscle layer.

  Note that it is possible to remove one of the knives having the scissors structure described in Patent Document 1 described above and configure a high-frequency peeling knife device including one knife having a protrusion. In addition, the projecting portion faces the muscle layer direction, so that there is a problem that the muscle layer is broken and the risk of perforation increases.

  An object of the present invention is to solve the above-described problems caused by the prior art, and while observing the affected part from above, the electrode of the high-frequency peeling knife for endoscopes is directed in a direction parallel to the mucosal surface, and the muscle layer By providing an endoscopic high-frequency peeling knife device that can perform mucosal detachment without breaking through, prevent the operator from seeing through the endoscope, and can observe the affected area well. is there.

  The present invention includes a long tubular flexible sheath, a conductive operation wire penetrating through the sheath and having one end fixed to a connecting rod, a tip support frame connected to one end of the sheath, It is attached to the tip support frame and the connecting rod through a mechanism, and is a conductive and long high-frequency peeling knife tool that can be bent within a predetermined bending angle, and for advancing and retracting the operation wire along the axis. An endoscopic high-frequency peeling knife device for performing a peeling incision of a living tissue by applying a high-frequency current to a high-frequency peeling knife tool in a field of view from an operator through an objective lens of an endoscope. The high-frequency peeling knife tool is a rectangular parallelepiped knife having a predetermined height projecting in a direction perpendicular to the tip direction on a straight part extending in the tip direction extending along the axis of the operation wire. And the tip of the straight section Luo and a vertically projecting the protrusions, the high-frequency current only to the upper surface portion of the linear knife portion is a first feature in that the formation of the electrode forming portions to be energized.

  According to the second aspect of the present invention, in the high-frequency knife device according to the first feature, an electrode forming portion through which a high-frequency current flows is formed on an inner surface portion of the protruding portion that faces the straight knife portion.

  Further, the present invention is the endoscope high-frequency peeling knife device according to the first or second feature, wherein an electrode forming portion through which a high-frequency current flows is formed between the protrusion and the linear knife portion. The third feature.

  According to the fourth aspect of the present invention, in the endoscope high-frequency peeling knife device according to any one of the first to third features, the predetermined bending angle of the high-frequency peeling knife tool is 30 to 60 degrees. Features.

  The fifth aspect of the present invention is that in the endoscope high-frequency peeling knife device according to any one of the first to third features, the predetermined bending angle of the high-frequency peeling knife tool is 45 degrees. .

  Further, according to the present invention, in the endoscope high-frequency peeling knife device having any one of the first to fifth features, when the linear knife tool is extended toward the distal direction, the distal end position of the protruding portion is the position of the operation wire. A sixth feature is that the configuration is such that it is positioned on the axis.

  Further, according to the present invention, in the endoscope high-frequency peeling knife device having any one of the first to sixth features, the bending mechanism includes the tip support frame, the connecting rod, and the vicinity of the center via the first shaft. A high-frequency peeling knife tool that is pivotally attached to the tip support frame, and one end that is pivotally attached to the end of the high-frequency peeling knife tool in the direction toward the operation wire via the second shaft. It is comprised from the edge part of the front-end | tip direction of a connecting rod via the 3rd axis | shaft, and the plate-shaped link plate attached so that rotation is possible, When a connecting rod is moved to a front-end | tip direction, a high frequency peeling knife tool is A seventh feature is that the first shaft is bent by rotating about one axis.

  The present invention also provides a high-frequency peeling knife device for an endoscope having any one of the first to seventh features, wherein a portion that obstructs the visual field of the operator who sees the straight knife portion and the projection portion through the objective lens of the endoscope is removed. The eighth characteristic is that the inclined portion is provided.

  A high-frequency peeling knife device for an endoscope according to the present invention is a rectangular parallelepiped knife projecting in a direction perpendicular to the tip direction on a straight portion extending in a direction extending toward the tip direction of the operation wire axis. And a high-frequency peeling knife tool in which an electrode forming part is formed on the upper surface portion of the straight knife part, and the high-frequency peeling knife tool is bent by advancing and retreating the operation wire. By providing the folding mechanism, the high-frequency peeling knife tool can be bent, and the surgeon can be prevented from being perforated by uncaused cauterization without blocking the view of the operator.

  The endoscope high-frequency peeling knife device according to the present invention, when inserted through the endoscope channel, does not bend the high-frequency peeling knife tool so as to be straight with the sheath axis, so that the endoscope channel When the exfoliating and incising operation is performed by projecting from the tape, the exfoliating operation can be easily performed and the perforation can be prevented because the high-frequency exfoliating knife tool is bent by the bending mechanism so as to be parallel to the mucosal surface.

The partial cross section figure of the high frequency peeling knife apparatus for endoscopes by embodiment of this invention. The partial cross section figure of the high frequency peeling knife apparatus for endoscopes by embodiment of this invention. The top view of the high frequency peeling knife apparatus for endoscopes by embodiment of this invention. 1 is an external perspective view of an endoscope high-frequency peeling knife device according to an embodiment of the present invention. The figure for demonstrating the treatment state of the high frequency peeling knife apparatus for endoscopes by embodiment of this invention. The figure for demonstrating the visual field of the high frequency peeling knife apparatus for endoscopes by embodiment of this invention.

  Hereinafter, an embodiment of a high-frequency peeling knife device for an endoscope according to the present invention will be described in detail with reference to the drawings. The endoscope high-frequency peeling knife device according to the present embodiment is inserted into a treatment instrument guide conduit of an endoscope so as to be freely advanced and retracted, and performs incision and the like of a muscular fiber in an affected area. As shown in 1 to 4, a flexible sheath 1 comprising a coil pipe 1a in which a stainless steel wire is tightly wound and a sheath outer skin 1b which is an electrically insulating flexible tube covering the outer periphery of the coil pipe 1a; A conductive operation wire 2 made of a single wire or a stranded wire is inserted into the sheath 1 in the axial direction, and one end is fixed to one end of the operation wire 2 and a link plate 6 described later is connected to the other end. It has a connecting rod 10 having a connecting tip 10a, a tip cap 3 fixedly attached to the tip of the coil pipe 1a and the tip of the sheath 1b, and a bifurcated support frame extending arm 5a. Insulation A tip support frame 5 formed of a coated stainless steel, a plastic material having high heat resistance (PEEK, PPS, etc.), ceramic, etc., and attached to the tip cap 3, and a support frame extending arm portion 5 a in the vicinity of the center. A long high-frequency peeling knife tool 20 that is pivotably attached by a first shaft 8 that crosses the vicinity of the tips of the two, and an end in a direction in which one end faces the operation wire of the high-frequency peeling knife tool 20 by a second shaft 9. A plate-like link plate 6 that is rotatably attached to the connecting portion and has the other end rotatably attached to the connecting tip portion 10a of the connecting rod 10 by the third shaft 7, and the other end of the operation wire 2 and the sheath 1. The operation wire 2 is advanced and retracted by being connected to the other end of the wire, and the high-frequency peeling knife tool 20 is bent by turning about the first shaft 8. And an operation unit (not shown) for performing a rotation operation. The “bending” described in the present invention means that the high-frequency peeling knife tool 20 changes from the state shown in FIG. 1 to the state shown in FIG. 2, that is, the high-frequency knife tool 20 is in the axial direction of the operation wire 2. Mean to bend. Further, the sheath 1 may be configured only by a flexible tube such as PTFE, PEEK, PPS, polyethylene, polyimide resin, etc. instead of the coil pipe 1a and the sheath 1b instead of the present embodiment. good.

  The bending mechanism for bending the high-frequency peeling knife tool 20 in the present embodiment is the above-described tip support frame 5 and the portion of the high-frequency peeling knife tool 20 closer to the second shaft 9 than the first shaft 8. The link plate 6, the connecting tip 10 a extending from the connecting rod 10, and the shafts 7, 8, 9. In the bending mechanism, when the operation wire 2 is moved in the arrow X direction from the state shown in FIG. 1, the connecting tip portion 10a of the connecting rod 10 is linearly moved in the arrow X direction by this pressing force. The link plate 6 converts the force to the rotational force of the high-frequency peeling knife tool 20, and the high-frequency peeling knife tool 20 can be rotated about the first shaft 8 to be in the bent state shown in FIG. . On the other hand, when the operation wire 2 is moved in the arrow Y direction from the state shown in FIG. 2, the connecting tip 10a is linearly moved in the arrow Y direction by this pulling force, and the link plate 6 is subjected to high-frequency peeling by this linear moving force. 1 is converted into the rotational force of the knife tool 20 and rotated by turning the high-frequency peeling knife tool 20 around the first shaft 8, that is, in a straight state, to the state shown in FIG. 1. Can do. The bending angle of the high-frequency peeling knife tool 20 is 30 to 60 degrees, preferably 45 degrees. This bending angle can be easily set by providing a stopper or the like for restricting the rotation amount (angle) at an arbitrary part of the bending mechanism. In this embodiment, this stopper is shown in FIG. In the state where the high-frequency peeling knife tool 20 is extended, the connecting tip portion 10a functions by contacting the opening 5c of the tip support frame 5, and when the high-frequency peeling knife tool 20 shown in FIG. The step portion 20a provided in the high-frequency peeling knife tool 20 and the link plate 6 function by contacting each other.

  Moreover, the high frequency current supplied from the operation part which is not illustrated is comprised so that it may be supplied to the high frequency peeling knife tool 20 via the electroconductive operation wire 2 and the bending mechanism mentioned above. Further, as shown in FIGS. 1, 2, and 4, the support frame extending arm portion 5 a does not obstruct the visual field of the operator who views the straight knife portion 23 and the projection portion 22, which will be described later, in the distal direction. An inclined portion 5b that is partially cut and provided is provided. In the present invention, the direction (X direction) extending along the axis of the operation wire 4 from the rotation center C of the third shaft 7 shown in FIG. Call it.

  The high-frequency peeling knife tool 20 is formed in a long shape and extends in a direction extending toward the distal end direction, and extends on the linear portion 24 toward the distal end direction and protrudes at a predetermined height in the vertical direction. A rectangular knife 23 having a rectangular parallelepiped shape, and a protrusion 22 which is disposed at the tip of the straight portion 24 with a space from the straight knife 23 and protrudes in a vertical direction higher than a predetermined height of the straight knife 23. Is provided. A metal to which a high-frequency current is passed between the upper surface of the straight knife portion 23, the inner surface portion of the protrusion 22 facing the straight knife portion 23, and the straight knife portion 23 and the protrusion 22 on the straight portion 24. An electrode forming portion 29 is formed with an exposed portion. The protruding portion 22 and the straight knife portion 23 are configured to protrude toward the inclined portion 5b side of the tip support frame 5 and fit within the outer diameter of the sheath 1 in a state where the high-frequency peeling knife tool 20 is extended. . Further, the electrode forming portion 29 formed between the inner side surface portion of the protruding portion 22 and the straight knife portion 23 and the protruding portion 22 of the linear portion 24 is formed in a spot shape as shown in FIG. ing.

  The electrode forming portion 29 is formed by applying an insulating coating to the entire outer periphery of the connecting rod 10, the link plate 6, and the high-frequency peeling knife tool 20, and then the upper surface of the straight knife portion 23 and the inner side surface portion of the protruding portion 22. The insulating coating in the portion between the straight knife portion 23 and the projection 22 on the straight portion 24 can be formed by evaporation by laser light irradiation, but is not limited to this manufacturing method.

  The endoscope high-frequency peeling knife device according to the present embodiment can be used in a desired direction by rotating and bending the endoscope and rotating the endoscope high-frequency peeling knife device. When the portion 22 is pressed against the affected part or the like and used, as shown in FIG. 1, Z connecting the top A of the projection 22, the rotation center B of the first shaft 8, and the rotation center C of the third shaft 7. The −Z line segment coincides with the center line of the operation wire 2, and the rotation center D of the second shaft 9 is positioned on the opposite side of the top portion A of the protrusion 22 with the Z-Z line segment as line symmetry. With this configuration, the position of the point of action where the force acts on the living tissue (the top A of the protrusion 22) and the position of the pressurization point (the position of the rotation center C) provided from the operation wire 2 are coaxial. Therefore, when the apex A of the protrusion 22 is pressed against the affected area by endoscopic operation, Is applied to the apex A of the projection 22 via a straight line ZZ line, and thus the rotation of the endoscope high-frequency peeling knife device can be prevented. In this embodiment, the example in which the action point position (the position of the vertex A) and the pressurization point position (the position of the rotation center C) are arranged on the same axis has been described, but the present invention is limited to this. Instead, the high-frequency peeling knife device can be prevented from rotating by disposing the action point (the position of the vertex A) at a lower position away from the pressurization point (the position of the rotation center C) by a predetermined dimension in FIG. The same applies to a state in which the high-frequency peeling knife tool 20 is bent as shown in FIG.

  As shown in FIG. 5, the high-frequency peeling knife device according to the present embodiment allows the transparent hood 102 of the endoscope 100 to enter between the mucosal layer 200 and the muscle layer 201 after the initial incision is performed, After the high-frequency peeling knife tool 20 is protruded from the distal end of the endoscope 100 in the state shown in FIG. 1, the operation wire is pulled by the operation of the operation unit to maximize the high-frequency peeling knife tool 20 as shown in FIG. The endoscope 100 is moved back and forth with respect to the distal direction in a state where a high-frequency current is applied to the electrode forming portion 29 with the back surface of the straight portion 24 being parallel to the muscle layer 201 (mucosal surface). By moving in the left-right and vertical directions, the muscle fibers 202 between the mucosa layer 200 and the muscle layer 201 can be peeled and incised. In this case, the back surface of the straight portion 24 (the straight knife portion 23) is formed on the muscle layer 201. And the surface where To become the surface of the pair) are in contact, it does not scratch without the tip of the linear portion 24 that is insulated coating muscle layer 201 are in contact. Furthermore, since the high-frequency peeling knife tool 20 is in contact with the muscle layer 201 in parallel, there is no risk of breaking through the muscle layer 201, and the peeling and incision can be performed safely.

  In addition, the high-frequency peeling knife device according to the present embodiment uses one long high-frequency peeling knife tool 20 that can be bent as described above as a means for performing incision, and a support frame extending arm on the tip support frame 5. By forming the inclined part 5b in the part 5a, as shown in FIG. 6, the high-frequency peeling knife tool 20 can be protruded from the objective lens 101 of the endoscope 100 by a relatively long dimension L, and The high frequency peeling knife tool 20 does not enter the blind spot range W2 that is the blind spot of the surgeon in the visual field range W1 of the objective lens 101 during the surgery, and the high frequency peeling knife tool 20 and the treatment location are within the surgeon's visual field range W3. Can be paid. And since the electrode formation part 29 has faced the observation visual field direction, it can peel and incise under observation.

  As described above, the endoscope high-frequency peeling knife device according to each embodiment of the present invention has a one-blade knife structure in which the straight knife portion 23 and the protruding portion 22 projecting in the vertical direction are provided at one end portion in the distal direction. Therefore, it is possible to prevent the living tissue from being accidentally pierced, and only on the inner surface of the protruding portion 22 and the upper surface of the linear knife portion 23, and on the portion between the protruding portion 22 and the linear knife portion 23 on the linear portion 24. Since the electrode forming portion 29 for supplying a high-frequency current is provided and other portions are coated with an insulating material, it is possible to prevent perforation due to cauterization to an unintended portion, and the action point and protrusion of the force of the operation wire 2 Since the point of action of the part 22 on the affected part and the like and the center point of the first axis 8 of the bending mechanism are arranged on the same line, the axis of the high-frequency peeling knife device for endoscope even when the protruding part 22 is pressed against the affected part or the like Around times The can be prevented, by forming the inclined portion 5b on the side of the supporting frame extension arm portion 5a extending further in the distal direction, it is possible to secure the field of view of the operator of the treatment target. Further, by providing the projection 22 with the insulating coating other than the electrode formation portion 24, the orientation of the electrode formation portion 24 can be easily understood, and even if the projection 22 contacts an unintended portion, It is safe without being cut while cauterizing to the deep part. Furthermore, the high-frequency peeling knife tool 20 can be bent to be parallel to the muscle layer 201 (mucosal surface), thereby preventing the risk of perforation.

DESCRIPTION OF SYMBOLS 1 Sheath 1a Coil pipe 1b Sheath outer skin 2 Operation wire 5 Tip support frame 5a Support frame extension arm part 5b Inclination part 6 Link plate 7 3rd axis | shaft 8 1st axis | shaft 9 2nd axis | shaft 10 Connecting rod 20 High frequency peeling knife Tool 22 Protruding part 23 Straight knife part 24 Linear part 29 Electrode forming part 100 Endoscope 101 Objective lens

Claims (8)

A flexible sheath having a long cylindrical shape, a conductive operation wire penetrating the inside of the sheath and having one end fixed to a connecting rod, a tip support frame connected to one end of the sheath, and a bending mechanism A conductive and long high-frequency peeling knife tool that is attached to the distal end support frame and the connecting rod and can be bent within a predetermined bending angle, and the operation wire to advance and retract along the axis. A high-frequency peeling knife for an endoscope which performs a peeling incision of a living tissue by applying a high-frequency current to the high-frequency peeling knife tool in a field of view from an operator through an objective lens of the endoscope A device,
The high-frequency stripping knife tool is a rectangular parallelepiped-shaped straight knife portion projecting a predetermined height in a direction perpendicular to the tip direction on a straight portion extending in the tip direction extending along the axis of the operation wire. And a protrusion protruding in the vertical direction from the tip of the linear portion, and an electrode forming portion through which a high-frequency current is passed is formed only on the upper surface portion of the linear knife portion.   The high-frequency knife device according to claim 1, wherein an electrode forming portion through which a high-frequency current is passed is formed on an inner surface portion of the protruding portion toward the linear knife portion.   The high-frequency peeling knife device for an endoscope according to claim 1 or 2, wherein an electrode forming portion through which a high-frequency current is passed is formed between the protrusion and the linear knife portion.   The high-frequency peeling knife device for an endoscope according to any one of claims 1 to 3, wherein the predetermined bending angle of the high-frequency peeling knife tool is 30 to 60 degrees.   The high-frequency peeling knife device for an endoscope according to any one of claims 1 to 3, wherein the predetermined bending angle of the high-frequency peeling knife tool is 45 degrees.   6. The device according to claim 1, wherein when the linear knife tool is extended toward the distal end, the distal end position of the protrusion is positioned on the axis of the operation wire. An endoscopic high-frequency peeling knife device according to claim 1.   The bending mechanism includes the tip support frame, the connecting rod, the high-frequency peeling knife tool that is pivotally attached to the tip support frame via the first shaft at the center, and one end of the bending mechanism. Is attached to the end of the high-frequency peeling knife tool in the direction toward the operation wire via a shaft, and the other end rotates with the end of the connecting rod in the tip direction via a third shaft. It is composed of a plate-like link plate that is movably attached, and when the connecting rod is moved in the distal direction, the high-frequency peeling knife tool is folded by rotating around the first axis. The endoscope high-frequency peeling knife device according to any one of claims 1 to 6, wherein the device is configured to bend.   The said front-end | tip support frame has an inclination part which remove | eliminated the part which obstruct | occluded the visual field of the operator who sees the said linear knife part and the said projection part through the objective lens of an endoscope. The high frequency peeling knife apparatus for endoscopes as described.

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