JPH10118095A - High-frequency dissection and abscission tool - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a high-frequency dissection and abscission tool which can easily hang a loop part of a wire for dissection on a lesion part even when there exists an obstruction such as a wrinkle and a curved part on this side of the lesion part and can surely bind the lesion part and can rapidly perform dissection and abscission of the lesion part. SOLUTION: A high-frequency dissection and abscission tool is provided with a insulative flexible tube 2 with an inner layer, an outer layer and a blade embedded between them and formed with a curved part 16 at its apex, an operational wire member 9 being freely forward and backward inserted in the flexible tube 2 and a high-frequency processing part 12 with a high-frequency dissection wire 11 provided at the apex of the operational wire member 9 so as to be freely projected and sunk from the apex of the flexible tube 2 and being formed into a loop shape being opened and closed by an action of projection and sinking. After the curved part 16 of the flexible pipe 2 is projected from the apex of an endoscope, the apex side of the flexible tube 2 is rotated by rotating this side of the flexible tube 2 to position the apex of the curved part 16 of the flexible tube 2 at the inner part over a wrinkle and a curved part being obstructions.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a high-frequency incision and resection tool such as a high-frequency snare which is inserted endoscopically into a body cavity and incises and resects a lesion in the body cavity with high-frequency current.

[0002]

2. Description of the Related Art A conventional high frequency snare is disclosed in
As disclosed in Japanese Patent Publication No. 1744, a conductive wire is inserted into a flexible sheath having electrical insulation, and a loop portion of an incision wire is provided at the distal end of the wire. It is.

[0003]

In this conventional high-frequency snare, as shown in FIG. 7, the distal end of the sheath 41 normally has a straight posture, and the incision wire 42 is used.
The loop portion 43 is also configured to protrude and retract coaxially with the sheath 41. Since the distal end portion of the sheath 41 has a shape in which a straight posture is normal as described above, when the sheath 41 is used when there is a lesion in the back of a fold or a curved portion of the large intestine, the fold or the curved portion becomes an obstacle, There is a problem that it is very difficult to hook the loop 43 on the lesion.

In such a case, it is conceivable to adjust the direction of the loop 43 of the incision wire 42 by changing the direction of the distal end of the insertion section by bending the angle of the insertion section of the endoscope. Is also troublesome. In addition, there is a limit naturally in a narrow body cavity such as the large intestine, and it is very difficult to quickly hook the loop portion 43 on a lesion, and the problem has not been fundamentally solved.

The present invention has been made in view of the above-mentioned problems, and an object of the present invention is to provide an incision wire at a lesion even if there is an obstacle such as a fold or a curve in front of the lesion. An object of the present invention is to provide a high-frequency incision and resection tool that can easily hook a loop portion, can securely bind a lesion, and can incisively resect the lesion.

[0006]

SUMMARY OF THE INVENTION The present invention provides a flexible tube having an inner layer, an outer layer, and a core material buried between the inner and outer layers and having a curved portion formed at the tip, and having an insulating property. An operating wire member which is inserted into and retracted from the operating wire member; and a high-frequency incision wire formed in a loop shape which is provided at the distal end of the operating wire member so as to be able to protrude and retract from the distal end of the flexible tube and opens and closes by the protruding and retracting operation. A high-frequency incision and resection tool characterized by comprising a treatment section having: According to this configuration, after projecting the curved portion of the flexible tube from the distal end of the endoscope, the distal end side of the flexible tube is rotated by rotating the proximal side of the flexible tube, and the curved portion of the flexible tube is rotated. Is located beyond the obstacles, such as folds and curved parts. In this state, since the distal end of the flexible tube is over the obstacle and close to the lesion at the back, the operation of hooking the loop on the lesion can be performed by the same operation as when there is no obstacle such as a fold,
The binding and incision and resection of the lesion can be performed easily and reliably.

[0007]

BEST MODE FOR CARRYING OUT THE INVENTION

<First Embodiment> A first embodiment of the present invention will be described with reference to FIGS.
An embodiment will be described. (Configuration) FIG. 1 shows a high-frequency incision and resection tool 1 according to the first embodiment.
The outline is shown. A high-frequency incision resection tool 1 is a flexible tube 2 as a sheath inserted into a body cavity of a patient through an endoscope.
Is provided. An operation unit 3 is provided at a base end of the flexible tube 2. It is preferable that the flexible tube 2 is rotatably connected to the operation unit 3.

The operating section 3 includes a guide section 4 formed by two parallel rod-shaped members, and a slider 5 slidably mounted on the outer peripheral portion of the guide section 4. Finger guides 6, 7 are provided on both the guide 4 and the slider 5.
Are formed. Then, the thumb of one hand is put on the finger hook 6 of the guide unit 4, and the index finger and the middle finger of the same hand are hooked on the finger hook 6 of the slider 5, so that the slider 5 can be slid back and forth with respect to the guide unit 4. It has become.

A power supply electrode 8 is provided on the slider 5.
The proximal end of an operation wire member 9 inserted into the flexible tube 2 at an advance / retreat position is connected to the electrode 8. The electrode 8 is connected to a high-frequency power source (not shown) through a power cord (not shown).

The operation wire member 9 is formed of a conductive wire member, and also serves as a lead wire for conducting a high-frequency current from the high-frequency power source to a high-frequency incision wire 11 described later. The high-frequency incision wire 1 is provided at the tip of the operation wire member 9.
1 is connected. The high-frequency incision wire 11 is previously bent so as to spread in a loop such as a hexagon or an ellipse, and the high-frequency treatment section 12 is formed by the loop. When the high-frequency incision wire 11 formed in the loop is elastically deformed by pulling the high-frequency incision wire 11 by retreating the slider 5 of the operation unit 3 to the base end side, the high-frequency incision wire 11 thus configured is elastically deformed. Then, the flexible tube 2 is squashed and squeezed into the distal end portion of the flexible tube 2 and stored. The high-frequency incision wire 11 projects from the distal end of the flexible tube 2 and is opened by advancing the slider 5 of the operating section 3 to the distal end side, so as to spread in a loop shape.

On the other hand, as shown in FIG. 2, the flexible tube 2 of the high-frequency incision and resection tool 1 is formed of an inner layer 13 and an outer layer 14, and a core material such as a metal such as stainless steel is provided between the inner layer 13 and the outer layer 14. A blade 15 made of wire is embedded. As a constituent material of the inner layer 13 and the outer layer 14, a material arbitrarily selected from resins such as a fluorine-based resin, a polyamide-based resin, and a polyamide-based elastomer can be used, and at least one of the inner layer 13 and the outer layer 14 is , Fluororesin, for example, tetrafluoroethylene / perfluoroalkylvinyl ether copolymer (PFA)
It is formed from a material having electrical insulation such as In order to improve the rotation followability of the flexible tube 2, the inner layer 13
It is preferable that the outer layer 14 and the outer layer 14 are firmly adhered to each other via the blade 15 and through the gap between the blades 15. It is preferable that the constituent materials of the inner layer 13 and the outer layer 14 be selected from materials that easily adhere to each other. It is more preferable to select a material that easily adheres to the blade 15. The element wire of the blade 15 is not limited to a metal wire, and may have a non-circular element cross section such as a metal ribbon. Further, the blade 15 may be formed of a filament other than a metal having high torsional rigidity, instead of a metal such as stainless steel.

The distal end of the flexible tube 2 has a curved portion 16 formed into a curved shape by thermoforming. Bending section 16
The angle θ of the curved portion 16 is such that if the angle of the curved portion 16 is large, the amount of insertion force at the time of insertion into the channel of the endoscope becomes heavy, and the curved portion 16 gradually becomes straight while being repeatedly inserted into the channel of the endoscope. Considering the deformation, 3
Preferably it is 0 to 60 degrees.

The length of the curved portion 16 is set in accordance with the size of the body cavity to be inserted. For example, the length used for the large intestine is preferably about 15 to 20 mm. A distal tip 17 made of an electrically insulating material such as polysulfone is connected to the distal end of the curved portion 16.

Further, for example, a rotation knob 18 is provided as a rotation operation member in the middle of the flexible tube 2 at the hand side. As shown in FIG. 3, the rotary knob 18 is provided so as to be located near the forceps port 22 in the endoscope 21. By providing the rotary knob 18 so as to be located near the forceps port 22 of the endoscope 21, when the rotary knob 18 is rotated, the flexibility between the forceps port 22 and the rotary knob 18 is increased. Twist accumulates in the tube 2 and the curved portion 1
6 can be prevented from deteriorating the rotation followability up to the tip.

(Operation) With reference to FIG. 4, description will be given of a case where the high-frequency incision and resection tool 1 is used to perform high-frequency incision and resection of a lesion 26, such as a polyp, deep inside the curved portion of the left colonic flexure 25 of the large intestine. . First, the flexible tube 2 is inserted through the forceps port 22 of the endoscope 21 into a channel (not shown) and inserted into the body cavity of the patient. When the flexible tube 2 is inserted into the channel of the endoscope 21, the bending portion 16 of the flexible tube 2 is elastically deformed into a straight shape due to its flexibility.
When the bending portion 16 protrudes from the distal end of the endoscope 21, the bending portion 16 is restored to the initially bent shape by its own restoring force.

Further, the flexible tube 2 is pushed forward, and FIG.
As shown in (2), the bending portion 16 is positioned so as to be located behind the bending portion of the left colonic bend 25. At that time, the tip of the curved portion 16 is not always located in the direction facing the lesioned portion 26. In that case, the flexible tube 2 of the high-frequency incision and resection tool 1 is rotated while holding the rotary knob 18 so that the distal end of the curved portion 16 faces the lesion 26.

The bending portion 16 of the high-frequency incision and resection tool 1
The slider 5 of the operation unit 3 is pushed forward to the distal end side in a state where the distal end of the flexible tube 2 faces the lesion 26, and the high-frequency incision wire 11 protrudes from the distal end of the flexible tube 2. The high-frequency incision wire 11 restores and expands the loop shape by this operation, and forms the high-frequency treatment section 12 in a loop shape.

Next, the high-frequency treatment unit 1 is placed on the lesion 26.
After locating 2, the loop-shaped wire 11 of the high-frequency treatment unit 12 is hooked on the lesion 26 as shown in FIG. 4B by a delicate operation such as an angle of the endoscope 21. From this state, the slider 5 of the operation unit 3 is retracted to the base end side, and the high-frequency incision wire 11 is drawn into the distal end portion of the flexible tube 2, so that the base of the lesioned part 26 is tightened by the high-frequency incision wire 11. . And the high-frequency incision wire 11
A high-frequency current is passed through the high-frequency incision, and the lesioned part 26 sandwiched between the high-frequency incision wires 11 is cut off.

(Effect) Since the bending portion 16 is provided at the distal end of the flexible tube 2 and the bending portion 16 can be rotated by rotating the flexible tube 2 from the near side, the folds and bending portions of the large intestine and the like can be obtained. Even if there is a lesion 26 at the back of the flexible tube 2
Can be made to approach the lesioned part 26 over a fold or a curved part serving as an obstacle. As a result, just performing the same operation as when there are no obstacles such as folds and curved parts,
The treatment section 12 can be quickly hooked and tied to the lesioned part 26, and the incision and resection of the lesioned part 26 can be performed reliably and easily. By configuring the flexible tube 2 with the inner layer 13, the outer layer 14, and the blade 15 between them, the rotation followability of the flexible tube 2 is improved, and the operability of rotating the flexible tube 2 from the hand side can be improved. it can.

<Second Embodiment> A second embodiment of the present invention will be described with reference to FIGS. (Construction) In the present embodiment, as shown in FIG. 5, the outer layer 14 of the flexible tube 2 is separated from the proximal end of the curved portion 16 by the outer soft layer 31 on the proximal side and the outer hard layer 32 on the distal side. Is formed. The outer layer soft part 31 and the outer layer hard part 32 are formed of the same material, and differ only in their hardness. Due to the difference in hardness of these outer layers, the curved portion 16 of the flexible tube 2 is formed so as to have lower flexibility than the hand portion 33. As shown in FIG. 6, the flexibility of the flexible tube 2 is set by an amount of force until the intermediate portion of the two-point support (distance between supports: 45 mm) is bent by 10 mm when pushed at a speed of 50 cm / min.

If the flexible portion 2 is rotated while the endoscope is bent in the body cavity if the proximal portion 33 is too hard, the channel of the endoscope and the flexible tube 2 come into strong contact at the bent portion. The resistance increases, and the ability to follow the rotation to the distal end of the curved portion deteriorates. If the flexible tube 2 is rotated if it is too soft,
Twist accumulates in the flexible tube 2 and the rotation followability deteriorates. Therefore, the hand portion needs to have an appropriate flexibility, and when the outer diameter of the flexible tube 2 is about φ2.6 mm, 150 to 2
It is preferably 00 g.

If the bending portion 16 is too hard, it cannot be inserted into the channel of the endoscope. If it is too soft, the bending shape returns to straight by inserting the bending portion 16 into the channel. When the outer diameter of the flexible tube 2 is approximately φ2.6 mm, the flexibility of the bending portion 16 is 250 to 300
g, and is set to be lower in flexibility than the hand portion 33.

In the above embodiment, the flexibility of the curved portion 16 and the hand portion 33 is adjusted by changing the hardness of the outer layer 14, but only the hardness of the inner layer 13 or the hardness of the inner layer 13 and the outer layer 14 is adjusted. It goes without saying that the hardness may be adjusted by changing both hardnesses.

(Operation) The same can be used in the first embodiment. (Effect) When the bending portion 16 is inserted into the channel of the endoscope, the bending portion 16 is deformed so as to conform to the channel shape of the endoscope and becomes straight, but the bending portion 16 is harder than the hand portion 33 and has an appropriate flexibility. Therefore, when the bending portion 16 protrudes from the end of the endoscope, the bending portion 16 is less likely to be plastically deformed, and even when the bending portion 16 is repeatedly used, the angle of the initially formed curved shape can be maintained. .

[Supplementary Notes] (1) An insulating flexible tube having an inner layer, an outer layer, and a core material such as a blade buried therebetween and having a curved portion formed at the tip end, and a flexible tube inside the flexible tube. An operation wire member inserted so as to be able to advance and retreat, and a high-frequency incision wire formed in a loop shape which is provided at the end of the operation wire member so as to be able to protrude and retract from the distal end of the flexible tube and opens and closes by the protruding and retracting operation. A high-frequency incision and resection tool, comprising: (2) The high-frequency incision and resection tool according to appendix 1, wherein the flexibility of the bending portion is lower than the flexibility of the flexible tube at the proximal side of the bending portion. (3) The outer layer is formed of a different material with the base end of the curved portion as a boundary, and the outer layer on the distal end side is formed of a material having higher hardness than the outer layer on the proximal side of the curved portion. The high-frequency incision and resection tool according to the paragraph. (4) The high-frequency incision and resection tool according to claim 1, wherein at least one of the inner layer and the outer layer is made of a material having an electrical insulating property.

[0026]

The high-frequency incision and resection tool of the present invention has a curved portion at the distal end of its flexible tube. Therefore, even when the lesion to be incised and resected is located behind an obstacle such as a fold or a curved portion of the large intestine. The distal end of the flexible tube can be brought close to the lesion, and as a result, the loop formed by the high-frequency incision wire, which is a high-frequency treatment unit, can be securely and easily hooked on the lesion, thereby quickly binding the lesion.・ Can be incised. Further, since the flexible tube is composed of the inner layer and the outer layer and the core material embedded between them, the rotation followability of the flexible tube is improved, the rotation operability of the flexible tube is enhanced, and the flexible tube is rotated. The rotation operation to bring the tip of the curved portion close to the lesion is ensured.

[Brief description of the drawings]

FIG. 1 is a plan view schematically showing a high-frequency incision and resection tool according to a first embodiment.

FIG. 2 is a cross-sectional view of the vicinity of a distal end of the high-frequency incision and resection tool according to the first embodiment.

FIG. 3 is a perspective view showing a state in which the high-frequency incision and resection tool according to the first embodiment is inserted into an endoscope.

FIG. 4 is an explanatory view of a use state of the high-frequency incision and resection tool according to the first embodiment.

FIG. 5 is a cross-sectional view of the vicinity of a distal end of a high-frequency incision and resection tool according to a second embodiment.

FIG. 6 is an explanatory diagram for measuring the degree of flexibility of a flexible tube of the high-frequency incision and resection tool according to the second embodiment.

FIG. 7 is a sectional view of a tip of a conventional high-frequency snare.

[Explanation of symbols]

DESCRIPTION OF SYMBOLS 1 ... High frequency incision cutting tool, 2 ... Flexible tube, 3 ... Operation part, 4 ...
Guide part, 5 ... slider, 9 ... operation wire member, 11 ...
High-frequency incision wire, 12 high-frequency treatment section, 13 inner layer, 14 outer layer, 15 blade, 16 bending section, 18
... Rotating knob, 21 ... Endoscope, 25 ... Left colon curve of large intestine, 26 ... Lesion.

[Procedure amendment]

[Submission date] January 27, 1997

[Procedure amendment 1]

[Document name to be amended] Statement

[Correction target item name] 0008

[Correction method] Change

[Correction contents]

The operating section 3 includes a guide section 4 formed by two parallel rod-shaped members, and a slider 5 slidably mounted on the outer peripheral portion of the guide section 4. Finger guides 6, 7 are provided on both the guide 4 and the slider 5.
Are formed. Then, the thumb of one hand is hung on the finger hook 7 of the guide 4, and the index and middle finger of the same hand are hooked on the finger hook 6 of the slider 5, so that the slider 5 can be slid back and forth with respect to the guide 4. It has become.

Claims (1)

[Claims] An insulative flexible tube having an inner layer, an outer layer, and a core material embedded therebetween and having a curved portion formed at a tip thereof, and an operation inserted into the flexible tube so as to be able to advance and retreat. A treatment unit having a high-frequency incision wire formed in a loop shape and provided in a distal end of the operation wire member so as to be able to protrude and retract from the distal end of the flexible tube and opened and closed by the protruding and retracting operation. A high-frequency incision and resection tool, characterized in that: