JP5952068B2 - Endoscopic high-frequency treatment instrument - Google Patents

Description

  The present invention relates to a high-frequency treatment instrument for an endoscope.

  As a high-frequency endoscopic treatment instrument for incision and peeling of the mucous membrane, a distal sheath attached in a state where the electrode wire is exposed between a pair of electrode passage holes is used as a treatment instrument insertion channel of the endoscope. A base sheath that can be freely inserted and removed is widely connected to the distal side of the base sheath so as to be rotatable in the axial direction and to be movable back and forth in the axial direction.

  The position and orientation of the electrode wire relative to the front sheath are determined by the arrangement of the pair of electrode passage holes, but can be freely set depending on the purpose of use of the treatment instrument. In any case, since the direction and position of the electrode wire relative to the proximal sheath can be freely controlled during use, it is very convenient (for example, Patent Documents 1, 2, and 3).

JP-A-2005-334000 JP 2008-73378 A JP 2010-75578 A

  In the endoscopic high-frequency treatment instrument as described above, the distal sheath has an axis with respect to the proximal sheath against the surgeon's will while the mucosal incision or the like is performed by applying a high-frequency current to the electrode wire. If it rotates in the surrounding direction, the incision direction by the electrode wire will be out of order and it will not be possible to incise in the desired direction.

  Therefore, for example, as shown in FIG. 4, a conductive operation wire is formed on the outer peripheral portion in the middle of the distal sheath 92 to which the electrode wire 90 is attached, and the outer diameter size is larger than the inner diameter of the distal end of the proximal sheath 91. When 93 is pulled from the rear end side, a large diameter portion 94 is formed which is press-fitted into the distal end of the proximal sheath 91 while expanding the diameter of the distal end of the proximal sheath 91.

  With such a configuration, when the conductive operation wire 93 is pulled from the rear end side with a certain level of force during a mucosal incision treatment or the like, as shown in FIG. The distal sheath 92 is in a state in which the distal sheath 92 is restricted from rotating with respect to the proximal sheath 91 due to frictional resistance there.

  As a result, the orientation of the electrode wire 90 is maintained in a constant orientation, and the incision treatment can be performed stably. Then, if the conductive operation wire 93 is pushed in from the rear end side, the rotation restriction is released, and the front sheath 92 returns to a state in which the front sheath 92 can be rotated around the axis.

  However, if the force for pulling the conductive operation wire 93 from the rear end side is too strong when the rotation restricting operation is performed, the large diameter portion 94 bites into the distal end of the proximal sheath 91 tightly. Then, even if the conductive operation wire 93 is next pushed in from the rear end side, the large diameter portion 94 is not pushed out from the inside of the distal end of the base sheath 91, which may hinder subsequent operations. .

  The present invention has been made in view of such circumstances, and a distal sheath attached in a state in which an electrode wire is exposed between a pair of electrode passage holes is arranged in a direction around an axis on the distal side of the proximal sheath. In an endoscopic high-frequency treatment instrument having a configuration that is connected to be freely rotatable and reciprocally movable in an axial direction, the rotation restriction of the distal sheath relative to the proximal sheath can be reliably switched between valid and invalid. With the goal.

  In order to achieve the above object, the high-frequency endoscope treatment instrument of the present invention has an electrically insulative potential at the distal end portion of an electrically insulative flexible proximal sheath into which a conductive operation wire is loosely inserted. A portion near the rear end of the flexible front sheath is inserted and connected so as to be rotatable about the axis and movable back and forth in the axial direction. The front sheath is mechanically and electrically connected to the conductive operation wire. A pair of electrode passage holes through which the electrode wire passes are formed, the electrode wire is exposed to the outside of the front sheath between the pair of electrode passage holes, and the conductive operation wire is rotated around the axis from the rear end side of the base sheath The distal sheath rotates in the axial direction relative to the proximal sheath by rotating in the direction, and the distal sheath moves in the axial direction relative to the proximal sheath by operating the conductive operation wire in the axial direction. Configured to advance and retreat In both cases, when the outer diameter size is larger than the inner diameter of the distal end of the proximal sheath and the conductive operation wire is pulled from the rear end side, the diameter of the distal end of the proximal sheath is reduced in the middle part of the distal sheath. In an endoscopic high-frequency treatment instrument in which a large-diameter portion that is press-fitted into the distal end of the proximal sheath is formed while being expanded, the large-diameter portion expands the distal end of the proximal sheath and widens the distal end of the proximal sheath If the conductive operation wire is pushed in from the rear end side and the large diameter portion is pushed forward from the front end of the proximal sheath, the distal sheath is the proximal sheath. Pull-in restricting stoppers that come into contact with each other so as to restrict further drawing into the inside are provided on the inner peripheral portion of the proximal sheath and the outer peripheral portion of the conductive operation wire.

  The pull-in restricting stopper includes a fixed stopper made of a cylindrical body fixed on the inner peripheral surface of the base sheath by causing sharp protrusions formed on the outer peripheral surface to be fixed, and an outer peripheral portion of the conductive operation wire. And a movable stopper made of a cylindrical body that moves forward and backward together with the conductive wire and comes into contact with the fixed stopper from the front. A connecting tube that connects the wire and the electrode wire may be used.

  In addition, a protrusion restricting stopper that abuts against the fixed stopper of the pull-in restricting stopper from the rear side may be fixedly attached to the conductive operation wire so as to restrict the sheath from protruding too far from the distal end of the base sheath.

  According to the present invention, when the conductive operation wire is pushed in from the rear end side, the front sheath is in the base side when the large diameter portion of the front sheath is pushed forward from the front end of the base sheath. By providing a pull-in restriction stopper that restricts further pulling into the sheath, the rotation of the front sheath relative to the base sheath is reliably switched between valid and invalid, and the direction of the electrode wire is controlled appropriately. Can do.

It is side surface sectional drawing of the rotation control state of the high frequency treatment tool for endoscopes which concerns on the Example of this invention. It is side surface sectional drawing of the state in which the rotation control of the high frequency treatment tool for endoscopes which concerns on the Example of this invention is not applied. It is a perspective view of the front-end | tip part of the high frequency treatment tool for endoscopes which concerns on the Example of this invention. It is side surface sectional drawing of the state in which the rotation control of the conventional high frequency treatment tool for endoscopes is not applied. It is side surface sectional drawing of the rotation control state of the conventional high frequency treatment tool for endoscopes.

Embodiments of the present invention will be described below with reference to the drawings.
FIG. 2 is a side cross-sectional view of a high-frequency treatment instrument for endoscope, and FIG. 3 is a perspective view of a distal end portion thereof.
Reference numeral 1 denotes a proximal sheath that is inserted into and removed from a treatment instrument insertion channel of an endoscope (not shown). For example, an electric sheath such as a fluororesin tube having a diameter of about 2.5 mm and a length of about 1 to 2 m. It is formed of an insulating flexible tube.

  In the proximal sheath 1, for example, a flexible conductive operation wire 2 made of a stranded wire formed by twisting a plurality of (for example, seven) stainless steel fine wires or the like is rotatable in the axial direction and in the axial direction. It is placed loosely so that it can move forward and backward.

  A distal sheath 3 is connected to the distal end of the proximal sheath 1 on a coaxial line with respect to the proximal sheath 1 so that the distal sheath 3 can rotate around the axis with respect to the distal end of the proximal sheath 1 and can advance and retreat in the axial direction. It is arranged in the state.

  The front sheath 3 is formed by integrally connecting and fixing an electrode attachment sheath 3A to which the electrode wire 4 is attached and a guide sheath 3B in which the latter half portion is inserted and connected into the distal end of the base sheath 1. Both the electrode attachment sheath 3A and the guide sheath 3B are formed of a flexible tube having electrical insulation, such as a fluororesin tube.

  In this embodiment, the distal end surface of the electrode mounting sheath 3A is formed in a shape that is cut obliquely, and as shown in FIG. 3, the side surface of the electrode mounting sheath 3A is, for example, 180 ° symmetrical. The electrode wire 4 is exposed between the formed pair of electrode passage holes 5. The arrangement of the electrode passage hole 5 and the electrode wire 4 is not limited thereto, and the electrode wire 4 may be arranged so as to be exposed at the side surface position of the electrode attachment sheath 3A.

  Returning to FIG. 2, the guide sheath 3 </ b> B is loosely inserted into the proximal sheath 1 from the distal end of the proximal sheath 1. However, the rear end portion of the electrode attachment sheath 3A is press-fitted and bonded to the most distal portion of the guide sheath 3B, and the electrode attachment sheath 3A and the guide sheath 3B are integrally connected and fixed. The outer diameter of the expanded guide sheath 3B is sized to be tightly pressed into the distal end of the proximal sheath 1 (large diameter portion 3C).

  Reference numeral 6 denotes a connecting tube that mechanically and electrically connects the conductive operation wire 2 and the electrode wire 4 and is formed of, for example, a stainless steel material. The end of the conductive operation wire 2 is inserted into the rear half of the connecting tube 6 from the rear, and the two ends of the electrode wire 4 are inserted side by side into the front half of the connecting tube 6. They are fixed to each other by attaching or the like.

  As a result, if the conductive manipulation wire 2 is rotated from the rear end side of the proximal sheath 1 in the direction around the axis, the distal sheath 3 is rotated in the direction around the axis at the distal end of the proximal sheath 1 and the electrode wire 4 If the direction is changed and the conductive operation wire 2 is advanced and retracted in the axial direction, the distal sheath 3 is advanced and retracted in the axial direction at the distal end of the proximal sheath 1 to change the position of the electrode wire 4.

  The connecting pipe 6 is inserted into and fixed to the rear end portion of the guide sheath 3B (however, it does not necessarily have to be fixed). The vicinity of the rear end portion of the connecting pipe 6 is in a state of projecting rearward from the rear end of the guide sheath 3 </ b> B in the proximal sheath 1.

  A fixed stopper 7 made of a cylindrical rigid member is fixed to the inner peripheral surface of the proximal sheath 1 at a position slightly behind the connecting pipe 6. A plurality of fine protrusions with sharp tips are formed on the outer peripheral surface of the fixed stopper 7 so as to protrude into the inner peripheral surface of the base sheath 1 and are firmly fixed. The inner diameter d1 of the fixed stopper 7 is set to a diameter that allows the conductive operation wire 2 to advance and retract without resistance.

  At a position slightly further rearward than the fixed stopper 7, a protrusion restricting stopper 8 made of a cylindrical rigid member that comes into contact with the fixed stopper 7 from the rear is disposed so as to be fixedly attached to the conductive operation wire 2. Specifically, the conductive operation wire 2 is passed through the protrusion regulating stopper 8 made of a stainless pipe material or the like, and both members are fixed by silver brazing or the like.

  Here, if the inner diameter of the fixed stopper 7 is d1, and the outer diameter of the protrusion restricting stopper 8 is D2, d1 <D2, and the protrusion restricting stopper 8 cannot enter the fixed stopper 7. When the distal end of the protrusion regulating stopper 8 comes into contact with the rear end of the fixed stopper 7, the conductive operation wire 2 can no longer move forward, and the distal sheath 3 protrudes beyond a predetermined amount from the distal end of the proximal sheath 1. To be regulated.

  Further, as shown in FIG. 1, when the outer diameter of the rear end portion of the connecting pipe 6 is D3, d1 <D3 with respect to the inner diameter d1 of the fixed stopper 7, and the connecting pipe 6 enters the fixed stopper 7. I can't.

  Therefore, the cylindrical connecting tube 6 fixed to the outer peripheral portion of the distal end portion of the conductive operation wire 2 moves forward and backward together with the conductive operation wire 2 and comes into contact with the fixed stopper 7 from the front side. And functions to restrict the leading sheath 3 (guide sheath 3B) from being pulled into the proximal sheath 1 by a predetermined amount or more. In this way, the pull-in restricting stopper that restricts the leading sheath 3 from being pulled into the proximal sheath 1 by a predetermined amount or more is constituted by the connecting pipe 6 and the fixed stopper 7.

  In such an endoscopic high-frequency treatment instrument, when the conductive operation wire 2 is pulled from the rear end side, the large-diameter portion 3C of the distal sheath 3 is formed on the proximal sheath 1 as shown in FIG. As the diameter of the distal end is increased, the distal end of the proximal sheath 1 is press-fitted into the distal end, and as a result, a frictional resistance acts on the proximal sheath 1 in an attempt to rotate the distal sheath 3 in the direction around the axis. .

  The frictional resistance increases as the operating force for pulling the conductive operating wire 2 from the rear end side increases, and the front sheath 3 rotates to change the direction of the electrode wire 4 against the will of the operator. Can not be.

  However, if the force that pulls the conductive operation wire 2 is too great and the large diameter portion 3C of the distal sheath 3 bites into the distal end of the proximal sheath 1 too strongly, the conductive operation wire 2 is pushed from behind. Even if the operation is performed, there is a possibility that the state in which the large diameter portion 3C bites into the distal end of the proximal sheath 1 cannot be released.

  Therefore, the conductive manipulation wire 2 is pushed in from the rear end side in a state where the large diameter portion 3C of the front sheath 3 presses and widens the tip end of the base sheath 1 into the tip end of the base sheath 1. When operated, the connecting tube 6 and the fixed stopper 7 are assembled so that the large diameter portion 3C is pushed forward from the inside of the distal end of the proximal sheath 1.

  For that purpose, it is necessary to set the positional relationship of the attachment between the connecting pipe 6 and the fixed stopper 7 accurately, and it may be adjusted one by one so that there is no great variation depending on the product.

  Thus, according to the present invention, by pulling the conductive operation wire 2 from the rear end side, the rotation of the front sheath 3 is restricted with respect to the base sheath 1 to stabilize the direction of the electrode wire 4. If the conductive operation wire 2 is loosened, it can be switched to a state in which the rotation restriction of the front sheath 3 is invalidated and the direction of the electrode wire 4 can be arbitrarily set. Can be adjusted.

DESCRIPTION OF SYMBOLS 1 Base side sheath 2 Conductive operation wire 3 Lead side sheath 3A Electrode mounting sheath 3B Guide sheath 3C Large diameter part 4 Electrode wire 5 Electrode passage hole 6 Connecting pipe (retraction restriction stopper)
7 Fixed stopper (retraction restriction stopper)
8 Protrusion restriction stopper

Claims (4)

The distal end portion of the electrically insulating flexible proximal sheath into which the conductive operation wire is loosely inserted can be rotated in the direction of the axis around the rear end of the electrically insulating flexible distal sheath. is and capable of advancing and retreating plug connection in the axial direction, on the tip side sheath, a pair of electrodes passing hole through which the conductive operation wire and mechanically and electrically connected to the electrode wire passes is formed, the pair the destination side sheath the base by the electrode wire between the electrodes passing hole is exposed to the outside of the tip side sheath, rotating the said conductive operation wire from the rear end side of the base side sheath around the axial line direction rotate in the axial direction around to the side sheath, together with the tip side sheath by advancing and retracting operation of the conductive operation wire in the axial direction is configured to advance and retreat in the axial direction with respect to the base side sheath, the destination The middle portion of the sheath, and the outer diameter size is larger than the inner diameter of the distal end of the base side sheath and the conductive operation wire is pulled from the rear end side, push the diameter of the tip mouth of the base side sheath in endoscopic high-frequency treatment instrument that large diameter portion to be press-fitted into the distal mouth of the base side sheath is formed while expanding,
By the large diameter portion is pressed into the tip mouth of the press spread the base side sheath tip mouth of the base side sheath, in the axial direction around which acts between the tip side sheath and the base side sheath frictional resistance by the destination side the conductive rotation in a state which is defined in the sheath operating wire within said large-diameter portion when it is pushed from the rear end side tip mouth of the base side sheath with respect to the base side sheath when the state is pushed forward from the abutting pull regulating stopper to each other as the destination side sheath to restrict the drawn more in the base side sheath, the conductive and the inner peripheral portion of the base side sheath Provided on the outer periphery of the operation wire ,
High-frequency treatment tool for endoscope. The retraction restricting stopper, the fixed side stopper comprising a pointed projection formed on the outer peripheral surface from the inner peripheral surface so bite fixed thereto by a tubular body of the base side sheath, the outer periphery of the conductive operation wire is secured to the section is composed of a movable side stopper consisting of contact with the tubular body from the front to the fixed side stopper to advance and retreat together with the conductive wire,
The high-frequency treatment tool for endoscope according to claim 1. The pull-regulating stopper is a connecting pipe for connecting the electrode wire and the conductive operating wire,
The high-frequency treatment tool for endoscope according to claim 2. Protruding restricting stopper which the tip side sheath abuts the rear with respect to the fixed side stopper of the pull regulation stopper to restrict the excessive protruding from the distal end of the base side sheath are features affixed to the conductive operation wire Yes ,
The high-frequency treatment instrument for an endoscope according to any one of claims 1 to 3.

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