JPH10146345A - High-frequency excision tool for endoscope - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a high-frequency excision tool for an endoscope capable of simply and surely changing the direction of the loop of an excision wire against the tissue portion of an excision object in spite of a relatively simple structure and having good operability for the excision work. SOLUTION: This high-frequency excision tool for an endoscope is provided with an operation wire 4 slidably in a flexible sheath 2 and a loop-like high-frequency excision wire 6 at the distal end of the operation wire 4, and the high-frequency excision wire 6 is operated by an operation section provided at the proximal end of the flexible sheath 2. Notch sections 25a, 25b insertable with the high-frequency excision wire 6 are formed at the tip of the flexible sheath 2. When the high-frequency excision wire 6 is inserted into the notch sections 25a, 25b and coupled, the loop of the high-frequency excision wire 6 is set to such direction that the tissue portion of an excision object is easily incorporated.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a high-frequency resection tool for an endoscope for resecting an affected part formed in a body cavity with a high-frequency resection wire.

[0002]

2. Description of the Related Art When resecting a polyp or a diseased tissue site generated in a body cavity, a high-frequency resection tool is introduced endoscopically into the body cavity, and the high-frequency resection tool is operated under the observation of the endoscope. More and more resections have been performed. This type of high-frequency endoscope resection tool is usually called a high-frequency snare.

In general, a high-frequency snare is provided with a loop-shaped high-frequency ablation wire at the tip of an operation wire inserted in a flexible sheath so as to be able to advance and retreat, and an operation section provided at a proximal end of the flexible sheath. The excision operation is performed by pushing and pulling the wire so that the loop-shaped high-frequency excision wire protrudes and retracts from the distal end opening of the flexible sheath.

When the high-frequency ablation wire is protruded from the distal end opening of the flexible sheath, the high-frequency ablation wire spreads out in a loop. When performing high-frequency ablation, high-frequency ablation is performed by capturing the polyp or lesion tissue site to be ablated in the loop of the high-frequency ablation wire, and then pulling the high-frequency ablation wire into the distal opening of the flexible sheath. The diameter of the loop of the wire is reduced to bind the polyp or the affected tissue site, and the high-frequency ablation wire is energized with high frequency to perform resection.

[0005]

However, when performing a technique of cutting a polyp or a diseased tissue site with a high-frequency snare, the direction of the loop-shaped high-frequency cutting wire protruding from the distal end opening of the flexible sheath becomes a problem. Only when the mucosal surface with the polyp or lesion tissue site and the loop surface of the resection wire are substantially parallel can the polyp or lesion tissue portion be entrapped and hooked into the resection wire loop.
Therefore, when observed by an endoscope and not in the specific orientation, the operator turns the entire high-frequency snare at the hand side so that the loop of the resection wire has a relationship close to the specific orientation. He was performing a hand operation to rotate the snare as a whole.

However, the flexible sheath and the operation wire are slippery, and the operation wire is a relatively elongated and flexible wire, so that it has low followability with respect to its own torsion. Even if the user tries to turn the cutting wire so as to have a relationship close to a specific direction, the cutting wire remains without following the rotation, and the loop direction of the cutting wire cannot be easily changed. Reorienting the loop of the resection wire has been an extremely difficult and time consuming task.

SUMMARY OF THE INVENTION The present invention has been made in view of the above-mentioned problem. The object of the present invention is to provide a simple and reliable arrangement of a loop of a resection wire with respect to a tissue portion to be resected, while having a relatively simple structure. An object of the present invention is to provide a high-frequency resection tool for an endoscope which can be changed and has good operability in resection operation.

[0008]

SUMMARY OF THE INVENTION The present invention provides a flexible sheath, an operating wire slidably provided within the flexible sheath, and a loop-shaped wire provided at a distal end of the operating wire. A high-frequency resection tool for an endoscope having a high-frequency ablation wire and an operation unit provided at a proximal end of the flexible sheath for pushing and pulling the high-frequency ablation wire, wherein the high-frequency ablation wire is attached to a distal end of the flexible sheath. A cut portion into which a cutting wire can be inserted is provided. By inserting the high-frequency ablation wire into the notch of the flexible sheath and engaging it,
By rotating the flexible sheath, the loop of the high-frequency ablation wire can be positioned so as to easily take in the tissue site to be ablated.

[0009]

BEST MODE FOR CARRYING OUT THE INVENTION

(First Embodiment) A first embodiment of the present invention will be described with reference to FIGS. (Structure) As shown in FIG. 1, a high-frequency resection tool 1 for an endoscope has a flexible sheath 2 as an insertion tube and an operation unit 3 connected to a proximal end of the flexible sheath 2. It is configured. An operation wire 4 is provided in the flexible sheath 2 so as to be slidable in the front-rear direction of the flexible sheath 2. The operation wire 4 is composed of a conductive metal stranded wire member or a wire member coated with a multi-strand coil.
A high-frequency ablation wire 6 is attached to a distal end (distal end) of the operation wire 4 as a high-frequency treatment section 5 having a directional shape in performing a shape treatment. The high-frequency ablation wire 6 is usually pulled into the flexible sheath 2, and is projected from the distal end of the flexible sheath 2 after introducing the flexible sheath 2 into a body cavity.

The operating section 3 is detachably attached and fixed to the proximal end of the flexible sheath 2 by a connection ring 7.
A stopper tube 8 is provided near the proximal end of the flexible sheath 2 so as to cover this portion. And
The operation unit 3 is a slider 1 to which a proximal end of an operation wire 4 is connected.
1 and a base portion 12 which also serves as a guide portion for guiding the slider 11, and finger-hanging ring portions 14 and 15 are formed at left and right ends of the slider 11 and a rear end portion of the base portion 12, respectively. The slider 11 is provided with a connection terminal 16 electrically connected to the operation wire 4, and a connector of a high-frequency power supply cord (not shown) is connected to the connection terminal 16.

The high-frequency ablation wire 6 is made of a conductive twisted wire member that is relatively thin compared to the operation wire 4. This wire member is strongly bent at the middle portion into two, and a plurality of bent portions are provided on both side wire portions. 21 are provided, and the distal ends of both side wire portions are collectively attached to the distal end of the operation wire 4 to form a loop. The high frequency cutting wire 6 has its own elastic restoring force in a free state,
As shown in FIG. 2, the outer diameter of the flexible sheath 2 is larger than the outer diameter of the flexible sheath 2 in a substantially elliptical planar loop shape including a plurality of corners. The wire portions located at the proximal end of the high-frequency ablation wire 6 are inclined wire portions 22a and 22b which spread obliquely to the left and right, respectively. When the cutting wire 6 protrudes, the cutting wire 6 is located at a position facing the distal end edge of the flexible sheath 2. Various shapes such as a circle, an ellipse, a hexagon, and an octagon can be selected as the loop shape of the high-frequency ablation wire 6.

As shown in FIG. 2, the flexible sheath 2 is formed by laminating an inner tube 2a and an outer tube 2b made of a synthetic resin and forming a multi-strip coil between the tubes 2a and 2b. It is formed by inserting a reinforcing member 2c of a metal wire. The reinforcing member 2c increases the rotational force transmission capability of the flexible sheath 2. However, the reinforcing member 2c is not provided near the distal end edge of the flexible sheath 2 and the flexible sheath 2
Is formed only by polymerization of the inner tube 2a and the outer tube 2b.

The distal end of the flexible sheath 2 is provided with a pair of upper and lower cutouts 25a, 25b, and the upper and lower cutouts 25a, 25b are provided with wire portions of the high-frequency ablation wire 6, particularly inclined wires. The parts 22a and 22b are inserted and engaged respectively. Each notch 25
As shown in FIG. 3, a and 25b are formed by slits cut in the axial direction of the flexible sheath 2, and inside the slits, the high-frequency ablation wire 6, which has pulled out the operating wire 4 and protruded, is located at the proximal end. The inclined wire portions 22a and 22b located at the proximal end of the high-frequency ablation wire 6 are individually fitted and locked when pulled into the side.

As shown in FIG. 4, as the shape of the cuts 25a and 25b, a slope 26 where the slit opening is widened may be formed. If the slope 26 is formed, the slope 26 is formed. As a guide, the notch 25a,
25b, the inclined wire portion 22a of the high-frequency ablation wire 6
It becomes easy to pull in 22b.

(Operation) Next, an example of use of the high-frequency resection tool 1 for an endoscope will be described. First, the slider 11 of the operation unit 3
Thus, the high-frequency cutting wire 6 is pulled into the distal end portion of the flexible sheath 2 by pulling the operation wire 4 to prepare the high-frequency cutting tool 1 for an endoscope.

On the other hand, the inside of the body cavity is observed with an endoscope (not shown). Then, when the presence of the diseased tissue portion 32 in the superficial mucosa 31 shown in FIG. 5 is confirmed, physiological saline is injected under the mucosa of the diseased tissue portion 32, and as shown in FIG. A raised portion 33 is formed so that the raised portion 32 is raised.

Next, the flexible sheath 2 of the high-frequency excision tool 1 is introduced into the body cavity through the insertion channel of the endoscope, and the operation wire 4 is pushed by the slider 11 of the operation section 3 so that the distal end of the flexible sheath 2 is moved. The high-frequency ablation wire 6 is protruded from. Then, the high-frequency ablation wire 6 expands into a substantially elliptical planar loop shape including a plurality of corners by its own elastic restoring force (see FIG. 2). At this time, if the spread loop-shaped plane of the high-frequency ablation wire 6 is in a direction orthogonal to the height direction of the raised portion 33 having the diseased tissue portion 32, the raised portion 33 can be easily inserted into the loop of the high-frequency ablation wire 6. Can be captured.

However, if the loop surface of the high-frequency ablation wire 6 has a relationship as shown in FIG. 5A such that the loop surface of the high-frequency ablation wire 6 is orthogonal to the surface of the mucous membrane 31 having the diseased tissue portion 32, the loop of the high-frequency ablation wire 6 The raised part 33 cannot be easily taken in. Therefore, the surgeon uses the high-frequency resection tool 1
By rotating the high-frequency ablation wire 6 together with the flexible sheath 2 by rotating the entirety of the high-frequency ablation wire 6, an attempt is made to bring the loop surface of the high-frequency ablation wire 6 closer to a surface parallel to the surface of the mucous membrane 31 having the ridge 33, Usually, following the rotating operation on the hand side, the high-frequency cutting wire 6 on the distal end side does not rotate and often remains as it is.

In this case, the flexible sheath 2 is rotated until the position of the high-frequency ablation wire 6 and the cut portions 25a and 25b of the flexible sheath 2 are aligned.
As shown in FIG. 5 (a), the high-frequency ablation wire 6 that has been pulled by pulling out the operation wire 4 is slightly pulled into the proximal end side, and the high-frequency ablation wire 6 is inserted into the cut portions 25 a and 25 b of the flexible sheath 2. 6, the inclined wire portion 22a at the proximal end
22b is pulled in to engage both. Flexible sheath 2
Can be engaged by rotating at least 90 degrees. By this engagement, the high-frequency ablation wire 6 is integrated with the flexible sheath 2 around the axis. When the entire high-frequency cutting tool 1 is rotated near the hand, the high-frequency cutting wire 6 also rotates following the rotation of the flexible sheath 2.

Therefore, the high-frequency ablation wire 6 on the distal end side can be reliably rotated by the rotation operation on the proximal side, so that its direction can be easily changed. And FIG.
As shown in (b), the loop plane of the high-frequency ablation wire 6 can be easily and reliably set to the plane of the mucous membrane 31 having the diseased tissue portion 32, that is, the direction perpendicular to the height direction of the raised portion 33. The raised portion 3 having the lesion tissue portion 32
3 can be easily taken into the loop of the high-frequency ablation wire 6.

Then, the high-frequency ablation wire 6 is drawn into the distal end opening of the flexible sheath 2 of the high-frequency ablation wire 6 to reduce the diameter of the loop of the high-frequency ablation wire 6 to reduce the diameter of the raised portion 33 having the diseased tissue portion 32. Tighten the base. Then, the high frequency excision wire 6 is energized with high frequency to excision of the raised portion 33 including the diseased tissue portion 32. By the way, since the cuts 25a and 25b are installed corresponding to the plane direction of the deployment loop surface of the high-frequency ablation wire 6,
Actually, after the high-frequency cutting tool 1 is introduced into the body cavity, when the high-frequency cutting wire 6 is projected from the distal end of the flexible sheath 2, the inclined wire portion 22 of the high-frequency cutting wire 6 is used.
a, 22b often enter the cuts 25a, 25b and protrude therethrough. In this case, when the high-frequency cutting wire 6 is protruded, the inclined wire portions 22a and 22b and the cut portions 25a and 25b are formed.
Has already been engaged. Therefore, in this case, it is not necessary to perform the above-described positioning and engaging operations as long as the operation is performed so as not to release the engagement.

The high-frequency excision tool 1 can of course be used similarly for excision of polyps and the like. (Second Embodiment) A second embodiment of the present invention will be described with reference to FIG. (Configuration) The second embodiment is a modification of the flexible sheath 2 in the first embodiment. The flexible sheath 2 of this embodiment is composed of a multi-layered metal densely wound coil 41 and an outer tube 42 made of a fluororesin that covers the coil 41. Further, the inner surface of the outer tube 42 at the distal end has a cylindrical shape. The metal tip member 43 is attached. The distal end of the close-wound coil 41 is attached and fixed in a state of being fitted into the rear end of the metallic distal member 43. The cut portions 25a and 25b are formed over both the outer tube 42 and the metal tip member 43.

The material of the outer tube 42 may be a thermoplastic resin, which may be thermally contracted so as to be closely adhered to the outer periphery of the close-wound coil 41. Other configurations are the same as those in the first embodiment described above, and description thereof will be omitted.

(Operation) The same operation as in the first embodiment described above can be used. However, since the distal end portion of the flexible sheath 2 is provided with the metal distal end member 43, the distal end portion is reinforced. Further, since the core material of the flexible sheath 2 is composed of the multiple closely-wound coils 41, the rotation transmitting ability of the flexible sheath 2 around the axis is increased, and the rotating operability of the high-frequency ablation wire 6 is improved.

(Third Embodiment) A third embodiment of the present invention will be described with reference to FIG. (Construction) In this embodiment, only one relatively wide cut portion 25 located below the distal end edge of the flexible sheath 2 in the first embodiment described above is formed. The base portion is bent and inclined so that the loop portion 6a of the cutting wire 6 has its tip portion lowered toward the lower side where the cut portion 25 is located. The loop surface of the high-frequency ablation wire 6 is bent with respect to the base end portion 6b, and the inclined wire portions 22a and 22b near the bend are formed by the cut portions 2a.
5 to be engaged. Other configurations are the same as those in the first embodiment described above,
The description is omitted.

(Operation) The same operation as that of the first embodiment is used, but the form of engagement between the high-frequency cutting wire 6 and the cut 25 is different. That is, the inclined wire portions 22a and 22b at the proximal end of the high-frequency ablation wire 6 both enter and engage in one common cut portion 25. When the flexible sheath 2 is rotated by at least 180 degrees, the two are brought into a position where they are engaged with each other.

The loop portion 6a of the high-frequency ablation wire 6
Is inclined in a certain direction of the notch 25, so that when the loop portion 6a approaches a parallel relationship with the surface of the mucous membrane 31 having the diseased tissue portion 32, the axial direction of the flexible sheath 2 is applied to the surface of the mucous membrane 31. Can be set obliquely, so that the raised portion 3 having the lesion tissue portion 32 on the loop portion 6a of the high-frequency ablation wire 6
3 can be easily taken.

In each of the above-described embodiments, the cut portion for engaging the wire portion of the high-frequency ablation wire is one pair or one. However, the present invention is not limited to this, and a plurality of pairs may be provided. A plurality of cut portions of the third embodiment may be provided.

[Supplementary Notes] A flexible sheath, an operation wire slidably provided in the flexible sheath, a loop-shaped high-frequency ablation wire provided at a distal end of the operation wire, and a proximal end of the flexible sheath. An endoscope provided with an operating portion for pushing and pulling the high-frequency ablation wire, the high-frequency resection tool for an endoscope, wherein a notch portion into which the high-frequency ablation wire can be inserted is provided at a distal end of the flexible sheath. High-frequency resection tool for endoscopes. 2. An elongated flexible sheath with good rotation followability, an operation wire slidably provided in the flexible sheath,
A loop-shaped high-frequency ablation wire provided at a distal end of the operation wire, an operation unit provided at a proximal end of the flexible sheath for pushing and pulling the high-frequency ablation wire, A cutting portion provided at a distal end thereof so that the high-frequency cutting wire can be inserted thereinto, and when the high-frequency cutting wire is inserted into the cut portion, the high-frequency cutting wire follows at least the rotation of the flexible sheath. A high-frequency resection tool for an endoscope, wherein the resection wire also rotates.

3. 2. The high-frequency cutting tool for an endoscope according to claim 1, wherein the high-frequency cutting wire is formed in a loop shape by providing a bent portion. 4. 4. The endoscope according to claim 1, wherein a loop surface of the high-frequency ablation wire is bent with respect to a base end portion, and a portion near the bent portion is inserted into and engaged with the cut portion. For high frequency cutting tools. 5. 3. The high-frequency cutting tool for an endoscope according to claim 1, wherein the cut portion is a pair of cuts through which a high-frequency cutting wire can be inserted. 6. The first and second appendixes, wherein the flexible sheath is formed by providing a metal wire reinforcing member on a tube made of synthetic resin.
Item 7. The high-frequency resection tool for endoscope according to Item 1. 7. 7. The high frequency resection tool for an endoscope according to claim 6, wherein the synthetic resin is a thermoplastic resin. 8. 7. The high frequency resection tool for an endoscope according to claim 6, wherein the synthetic resin is a fluorine-based resin. 9. The first and second appendices, wherein the flexible sheath is formed by using a coil sheath made of a plurality of metal wires as a core material.
Item 7. The high-frequency resection tool for endoscope according to Item 1.

[0031]

As described above, according to the present invention, since the cut portion into which the cutting wire can be inserted is provided at the distal end of the flexible tube, the cutting wire can be inserted into the cut portion and engaged. In addition, the direction of the loop of the cutting wire can be positioned so that the tissue portion to be cut can be easily taken in. That is, according to the present invention, the direction of the loop of the resection wire with respect to the tissue site to be resected can be easily and reliably changed with a relatively simple configuration, and the endoscope with good operability of the resection operation is provided. The high frequency cutting tool for use can be provided.

[Brief description of the drawings]

FIG. 1 is an explanatory view schematically showing an overall configuration of a high-frequency resection tool for an endoscope according to a first embodiment.

FIG. 2 is a cross-sectional view showing a high-frequency ablation wire of the high-frequency resection tool for an endoscope according to the first embodiment and a distal end portion of a flexible sheath.

FIG. 3 is a perspective view showing a distal end portion of a flexible sheath of the high-frequency resection tool for an endoscope according to the first embodiment.

FIG. 4 is a perspective view showing a modification of the distal end portion of the flexible sheath of the high-frequency resection tool for an endoscope according to the first embodiment.

FIG. 5 is an explanatory view of a usage state of the high-frequency resection tool for an endoscope according to the first embodiment.

FIG. 6 is a cross-sectional view showing a high-frequency ablation wire of a high-frequency resection tool for an endoscope according to a second embodiment and a distal end portion of a flexible sheath.

FIG. 7 is a cross-sectional view showing a high-frequency ablation wire of a high-frequency resection tool for an endoscope according to a third embodiment and a distal end portion of a flexible sheath.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... High frequency resection tool for endoscopes 2 ... Flexible sheath 3 ... Operation part 4 ... Operation wire 5 ... High frequency treatment part 6 ... High frequency resection wire 22a ... Inclined wire section 22b ... Inclined wire section 25a ... Cut section 25b ... Notch Part 25 ... Notch

Claims (1)

[Claims] 1. A flexible sheath, an operation wire slidably provided in the flexible sheath, and a loop-shaped high-frequency ablation wire provided at a distal end of the operation wire.
A high-frequency resection tool for an endoscope, which is provided at a proximal end of the flexible sheath and has an operation unit for pushing and pulling the high-frequency resection wire, wherein the high-frequency resection wire can be inserted into a distal end of the flexible sheath. A high-frequency resection tool for an endoscope, comprising a notch.