JPH11155876A - Forceps type electric treatment tool - Google Patents

Abstract

PROBLEM TO BE SOLVED: To form a conductive path for supplying voltage to each electrode of a cup-like forceps pieces without an increase in the number of parts and provide a forceps type electric treatment tool excellent in insulation property of a conductive path. SOLUTION: This treatment tool includes a catheter tube 4 having flexibility, which can be inserted in the body, a support 6 which is installed on the distal end side of the catheter tube 4 to hold a first forceps piece 12 having a first cup-like recessed part and a second forceps piece 12 having a second cup-like recessed part in such a manner as to make the first recessed part and the second recessed part opposite to each other and be freely opened and closed, and formed by a conductive member, a first electrode of the first forceps piece a second electrode of the second forceps piece and a voltage supply means for supplying high frequency voltage between the first electrode and the second electrode. In this case, after a conductive flexible pipe 50 forming the catheter tube and the support 6 are joined to each other, the surfaces of the conductive flexible tube 50 and the support 6 are integrally covered with an insulating coating layer 54.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a forceps-type electric treatment instrument, and more particularly, to grasping a tissue piece such as a lesion in a body cavity using a cup-shaped forceps and flowing a high-frequency current between the forceps. The present invention relates to a bipolar forceps-type electric treatment instrument capable of burning off the base of a tissue piece by means of the device, thereby enabling treatment of a lesion and collection of the tissue piece.

[0002]

2. Description of the Related Art Biopsy forceps are used to histologically diagnose whether a lesion in a body cavity is benign or malignant. Conventional biopsy forceps are disclosed, for example, in Japanese Patent Application Laid-Open No. 59-9055.
As disclosed in Japanese Unexamined Patent Application Publication No. HEI 3 (1995) -1995 and Japanese Unexamined Patent Application Publication No. Hei 5-42159, a type in which a pair of cup-shaped forceps pieces are opened and closed and cut by an edge of the cup is known.

[0003] However, the biopsy forceps of the type that is cut by the edge of the cup has a problem that the sharp edge portion is likely to damage normal tissue other than the lesion. Also, with this type of biopsy forceps, the sharpness of the edge portion is reduced by several samplings, and the engagement of the edge portion is displaced, resulting in a sharp decrease in sharpness, making it impossible to collect well. It has the problem of becoming.

On the other hand, as shown in Japanese Utility Model Laid-Open Publication No. 62-186,708, a monopolar forceps type electric treatment instrument has been proposed. In this monopolar electric treatment instrument, an electrode is provided on a cup-shaped forceps piece inserted into a body cavity, an electrode plate constituting another electrode is arranged in contact with the outside of a patient, and a high voltage is applied between these electrodes. Is applied. By pinching the tissue piece with the cup-shaped forceps piece, current is concentrated at the base of the picked tissue piece, and the affected tissue at that portion can be coagulated and necrotic and burned off. The burned-out tissue piece remains inside the cup-shaped forceps piece and can be collected.

[0005]

However, in the monopolar forceps-type electric treatment instrument disclosed in the above publication, since the electric current completely penetrates the patient's body because of the monopolar type, the forceps piece is used. There is a possibility that an arc may be generated from a target electrode to an unintended part, or an electric current flowing through the body of a patient may become stray and damage tissue that should not be damaged. In addition, since the unipolar type requires a relatively high output, the arc may cause excessive tissue destruction.

Therefore, a bipolar electric treatment instrument in which a pair of cup-shaped forceps pieces are used as separate electrodes and a high-frequency voltage is applied between these electrodes can be considered. It is necessary to supply a voltage from the conductive paths, and securing of the conductive paths in a narrow space and insulation of these conductive paths become problems.

The present invention has been made in view of such circumstances, and in a bipolar forceps-type electric treatment instrument, a conductive path for supplying a voltage to each electrode of cup-shaped forceps pieces is provided without increasing the number of parts. It is an object of the present invention to provide a forceps-type electric treatment instrument which is formed and has excellent insulation between these conductive paths.

[0008]

To achieve the above object, a forceps-type electric treatment instrument according to the present invention comprises a flexible catheter tube insertable into a body, and a distal end side of the catheter tube. A first forceps piece having a cup-shaped first recess formed therein and a second forceps piece having a cup-shaped second recess formed therein, the first forceps piece and the second recess being Are held openably and closably so that they face each other, and a support member made of a conductive member, a first electrode formed on the first forceps piece, and a second electrode formed on the second forceps piece. And a voltage supply means connected to a proximal end side of the catheter tube so as to supply a high-frequency voltage between the first electrode and the second electrode. The conductive flexible tube forming the tube and the support are joined to each other. After the surface of the conductive flexible tube and support they are are integrally insulating coating.

The conductive flexible tube is not particularly limited, but is preferably a metal coil tube.
The means for joining the conductive flexible tube and the support is not particularly limited, but may be silver brazing, laser welding, or the like.
Means such as soldering and heat shrink bonding by a heat shrink tube are exemplified. The means for integrally insulating the surfaces of the conductive flexible tube and the support member is not particularly limited, and examples thereof include means for forming an insulating coating layer by means such as coating.

[0010] On the outer periphery of the conductive flexible tube coated with insulation,
Preferably, an insulating outer tube is arranged. It is preferable that the outer tube and the conductive flexible tube can be relatively moved in the axial direction.

The forceps-type electric treatment instrument according to the present invention is more preferably a flexible catheter tube which can be inserted into the body, and a cup-shaped first recess mounted on the distal end side of the catheter tube. The first forceps piece having a place formed therein, and the second forceps piece having a cup-shaped second recess formed therein,
A support for opening and closing the first recess and the second recess so as to face each other; and a first tool formed on the first forceps piece.
An electrode, a second electrode formed on the second forceps piece, and a voltage connected to a proximal end side of the catheter tube so as to supply a high-frequency voltage between the first electrode and the second electrode. Supply means, a first link piece connected to the first forceps piece and connected to the support so as to drive the first forceps piece, and a second forceps connected to the second forceps piece A forceps-type electric treatment instrument having a second link piece coupled to the support to drive the piece, wherein the first link piece supplies a voltage to the first electrode. And a conductive member so as to be a part of the second member.
The link piece is formed of an insulating member, and a part of the second conductive path that supplies a voltage to the second electrode of the second forceps piece is the support.

Preferably, the thickness of the second link piece is greater than the thickness of the first link piece. Since the second link piece is made of an insulating member, the second link piece has mechanical strength substantially equivalent to that of the first link piece made of a conductive member such as a metal.

It is preferable that the second forceps piece and the support are electrically connected via a conductive spacer. It is preferable that an insulating spacer is mounted on the outer periphery of the conductive spacer.

The first link piece and the second link piece are
The inside of the catheter tube is connected to the distal end of a conductive wire movably disposed along the axial direction, and the conductive wire is electrically connected to the first link piece. Preferably, they are connected. This conductive wire becomes a first conductive path for supplying a voltage from the voltage supply means to the first electrode. The conductive wire is also a member that transmits a driving force from the proximal end side of the catheter tube to the two link pieces.

The conductive flexible tube bonded to the support serves as a second conductive path for supplying a voltage from the voltage supply means to the second electrode. The conductive flexible tube is a part of the catheter tube, holds the support, and also allows the conductive wire to move in the axial direction inside the catheter tube. The conductive flexible tube and the conductive wire need to be insulated so as not to be short-circuited.

The first forceps piece and the second forceps piece are preferably made of a metal having an insulating layer formed on the surface, and only the portion where the electrodes and connecting portions are formed has no insulating layer. Is preferably exposed.

The conductive member constituting the forceps piece is preferably a metal having excellent heat resistance and corrosion resistance, such as stainless steel, carbon steel, gold, silver, platinum, nickel, and aluminum. The insulating film formed on the surface of the forceps piece made of such a conductive member is not particularly limited, but may be alumina, titanium nitride, a ceramic coating film such as titanium carbide, a glass coating film,
Synthetic diamond films, polyimide resins, fluororesins and the like are preferred from the viewpoint of heat resistance. Examples of the coating method include an ion plating method, a plasma or flame spray deposition method, an immersion method, and a coating method.

In the present invention, a predetermined gap is formed between the first electrode and the second electrode in a state where the first forceps piece and the second forceps piece are completely closed. Is preferred. In the present invention, the predetermined gap is a distance that keeps the electrodes insulated and does not generate an arc or the like in a state where no living tissue is interposed between the first electrode and the second electrode. Specifically, preferably 0.3 to 1..
5 mm, more preferably 0.5 to 1.0 mm.
If the gap is too far, it becomes difficult to cut the living tissue, and if it is too close, insulation cannot be maintained.

In the present invention, the frequency of the high-frequency voltage supplied from the voltage supply means is not particularly limited.
The power is preferably about 0 kHz to 800 kHz, and the power is preferably about 5 to 35 watts.

[0020]

In order to collect, for example, coagulated necrosis of a diseased tissue and a living tissue using the forceps-type electric treatment device according to the present invention, first, the distal end of the treatment device is removed by using an endoscope or the like. Guide to near the lesion inside. Next, the operating portion connected to the proximal end of the outside of the catheter tube is operated to rotate the pair of forceps pieces attached to the distal end of the catheter tube in the closing direction. By closing the pair of forceps pieces, the living tissue piece at the lesion is picked up and positioned in the cup-shaped first and second recesses formed in the forceps pieces. The base of the picked-up living tissue piece at the lesion is sandwiched between the first electrode and the second electrode of each forceps piece.

Next, a high-frequency voltage is applied between the first electrode and the second electrode from a voltage supply means connected to the proximal end side of the catheter tube through a conductive path wired in the catheter tube. When a high-frequency voltage is applied between these electrodes, current flows only in the base of the piece of tissue sandwiched between the electrodes and heats it, burning off the base. With this heating,
Hemostasis and coagulation necrosis of the cut part is also performed. The cut biopsy piece remains in the recess of the forceps piece. Therefore, if the treatment instrument is taken out of the body cavity with the forceps pieces closed, the collection of the biopsy tissue piece is completed.

In the forceps-type electric treatment instrument according to the present invention, the current flows only through the living tissue sandwiched between the electrodes formed on the distal end side edge of the forceps piece. Therefore, as compared with the monopolar system, the cauterization range of the living tissue is smaller, and the coagulation necrosis of the lesion and the excision of the tissue piece can be reliably performed with a small power. In addition, electrodes are formed only in portions necessary for energization, and by insulating the inside of the cup-shaped recess of the forceps piece in which the cut living tissue piece is stored, damage to the cut living tissue piece is prevented. Absent.

In particular, in the forceps type electric treatment instrument of the present invention,
The conductive flexible tube joined to the support serves as a second conductive path for supplying a voltage from the voltage supply means to the second electrode. Moreover, the conductive flexible tube is a part of the catheter tube, and the supporter holds the forceps pieces, and these do not add new components. Therefore, a conductive path to the electrode can be formed by effectively using the catheter tube and the support.

Further, since the conductive conduit and the support are insulated and coated, the conductive path formed by the conductive conduit and the support is effectively prevented from being electrically short-circuited with other conductive paths. be able to.

[0025]

DESCRIPTION OF THE PREFERRED EMBODIMENTS The present invention will be described below based on embodiments shown in the drawings.

First Embodiment As shown in FIG. 1, a forceps-type electrosurgical treatment instrument 2 according to this embodiment includes a catheter tube 4 that can be inserted into a body.
Having. The catheter tube 4 has a lumen inside and is made of a flexible material.

In this embodiment, the catheter tube 4
Has a metal coil tube 50 as a conductive flexible tube and an outer tube 52 arranged to cover the outer periphery thereof, as shown in FIG. The coil tube 50 is a flexible tube formed by winding a metal wire such as stainless steel, carbon steel, gold, silver, platinum, and aluminum in a coil shape. The wire diameter of the metal wire forming the coil tube 50 is not particularly limited, but is preferably 0.1 to 1.5 m.
m, more preferably 0.2 to 1.0 mm. Further, the outer diameter of the coil tube 50 is not particularly limited, either.
Preferably, it is 1.0 to 5.0 mm, more preferably 1.
5 to 3.0 mm.

The distal end of the coil tube 50 is inserted into the rear end opening 7 of the support 6 as shown in FIGS. The support 6 is joined to the support 6 by means such as soldering or joining with a heat-shrinkable tube. In this embodiment, as shown in FIG. 4, after the support tool 6 and the distal end of the coil tube 50 are joined by means such as a silver low 9, the inner and outer peripheral surfaces of the support tool 6 and the coil tube 50 are attached. Insulating coating layer 54 integrally
Is formed. The resin coating layer 54 is not particularly limited, but a resin coating layer of a polyimide resin, a fluororesin, or the like is preferable from the viewpoint of heat resistance. Examples of the coating method include a dipping method and a coating method. The thickness of the resin coating layer 54 is not particularly limited as long as the insulating property can be maintained, but is about 5 to 50 μm in each of the inner layer and the outer layer.

The proximal end of the coil tube 50 covered with the resin coating layer 54 is joined to the operating section 20 shown in FIG. Connected.

In the present embodiment, the outer tube 52 is
At its distal end, it is not joined to the support 6 or to the coil tube 50 so that it can move axially relative to the coil tube 50, only its proximal end, It is joined to the operation unit 20 shown in FIG.

As a material for forming the outer tube 52,
There is no particular limitation as long as it is an electrically insulating material having flexibility,
Plastics such as polyethylene, polypropylene, polyvinyl chloride, polyurethane, polyamide, polyester, polycarbonate, polyether sulfone, and fluororesin can be used, and a material having an appropriate elastic modulus can be selected according to the purpose. it can.

The inner diameter of the outer tube 52 is about 0.1 to 0.8 mm larger than the outer diameter of the coil tube 50, and the thickness thereof is not particularly limited, but is preferably 0.05 to 0.5 mm. , More preferably 0.1 to 0.1.
3 mm.

In this embodiment, the support 6 shown in FIGS.
Is formed by integrally surrounding a metal such as stainless steel, carbon steel, gold, silver, platinum and aluminum with an insulating layer 54 of a coil tube 50. As shown in FIGS. And a pair of support pieces 8, 8 protruding therefrom.

At the distal ends of the support pieces 8, 8, a fulcrum shaft 10 is provided.
And both ends thereof are fixed to the support pieces 8, 8 by means such as caulking. In the present embodiment, the fulcrum shaft 10 is made of metal in consideration of mechanical strength, but may be made of plastic. In the case of a plastic fulcrum shaft 10, both ends are heat caulked,
If it is made of metal, it will be simply swaged. In the present embodiment, since the fulcrum shaft 10 is made of metal, an insulating tube 56 made of plastic or the like is arranged on the outer periphery thereof, as shown in FIG. The first and second link rear ends 13, 15 of the first forceps piece 12 and the second forceps piece 14 are rotatably mounted.

The first forceps piece 12 and the second forceps piece 14
A cup-shaped first recess 24 and a second recess 26 are respectively formed. The volume of each of the recesses 24 and 26 is not particularly limited, but is determined according to the volume of a living tissue piece to be collected and the like, and is preferably 0.5 to 33.0 mm ³ , and more preferably 1.0 to 18 mm ³ . .0mm is about ^3. Each recess 2
The link rear ends 13, 15 of the forceps pieces 12, 14 are rotatably mounted on the fulcrum shaft 10 such that the forceps 4, 26 face each other. In addition, as shown in FIGS.
An opening 11 communicating to the outside may be formed at the bottom of each of the recesses 24, 26 of 2, 14. The formation of the opening 11 makes it possible to collect a tissue piece larger than the volume of the recesses 24 and 26.

The first electrode 30 and the second electrode 3 are located on the distal side edges of the recesses 24, 26 of the forceps pieces 12, 14, respectively.
2 are formed. The electrode area of each of the electrodes 31 and 32 is not particularly limited, but is preferably 0.3 to 5.0 mm ² .

In this embodiment, each forceps piece 12, 14
It is made of a metal such as stainless steel, and all parts other than the parts corresponding to the first electrode 30 and the second electrode 32 are covered with an insulating coating layer. In the present embodiment, the insulating coating layer employs a ceramic coating film such as alumina.
This ceramic coating film can be formed by an ion plating method or the like. The thickness of this insulating coating layer is such that the insulating properties of both forceps pieces 12 and 14 are maintained, and is preferably 0.01 to 0.06 mm.

As shown in FIGS. 9A and 9B,
The surfaces of the link rear ends 13 and 15 of the forceps pieces 12 and 14 are also coated with the insulating coating layer 53.
It is preferable that all the corners 55 of the rear ends 13 and 15 have a radius of curvature R so that the film thickness is uniform. The radius of curvature R is preferably at least 0.01 mm. The same applies to all the corners of the forceps pieces 12 and 14 and also to all other members on which the insulating coating layer is formed.

In this embodiment, each forceps piece 1 shown in FIG.
The members constituting the first and second conductive paths, which will be described later, come into contact with the link rear ends 13 and 15, which are electrically connected to the respective electrodes 30 and 32 of the second and second electrodes 14, 32, respectively. Connection is achieved. As a result, the high-frequency power supply 4 shown in FIG.
From 0, a high-frequency voltage is applied between the electrodes 30 and 32. The frequency of the high-frequency voltage supplied from the high-frequency power supply 40 is not particularly limited, but may be 100 kHz.
８００800 kHz is preferable, and the electric power is preferably 5
About 35 watts.

Further, in the present embodiment, as shown in FIG. 2, when the pair of forceps pieces 12, 14 are completely closed, the electrodes 30, 32 of the forceps pieces 12, 14 have a predetermined gap t. Are formed, so that links 17 and 19 described later are adjusted. The predetermined gap t shown in FIG. 2 is such that no living tissue is interposed between the first electrode 30 and the second electrode 32, the electrodes 30 and 32 are kept in an insulated state, and an arc or the like is not generated. Distance, specifically,
0.4 to 1.5 mm.

As shown in FIG. 3, the link rear end portion 13,
15, an intermediate insulating spacer 16 is attached,
These insulations are maintained. In the present embodiment, the intermediate insulating spacer 16 is a disk-shaped washer.

Further, the rear end portion 13 for the first link and the support piece 8
A side insulating spacer 58 is mounted between the two. In the present embodiment, the side insulating spacer 58 is a disk-shaped washer having the same outer diameter as the intermediate insulating spacer 16.

On the other hand, the rear end 15 for the second link and the support piece 8
A metal washer 60 as a conductive spacer is disposed on the outer periphery of the insulating tube 56 located between the support member 6 and the support tube 8 to make electrical contact with the support piece 8. Since the surface of the support 6 is coated with the insulating coating layer 54, the insulating coating layer 54 is peeled off at the connection with the metal washer 60, so that electrical contact is possible.
As a result, the support piece 8 of the support 6 is electrically connected to the link rear end 15 of the second forceps piece 12 via the metal washer 60. As described above, since the forceps pieces 12 and 14 are insulatively coated including the rear ends 13 and 15, the insulative coating is applied to the portion corresponding to the electrode 32 and the contact portion with the metal washer 60. It is peeled off to ensure electrical continuity.

In this manner, current can be supplied to the second electrode 32 of the second forceps piece 14 through the second conductive path including the metal washer 60, the support piece 8 of the support 6 and the coil tube 50. I have. A side insulating spacer 62 is mounted on the outer periphery of the metal washer 60 to prevent the metal washer 60 from contacting another conductive member. In the present embodiment, the outer diameters of the insulating spacers 16, 58, and 62 are all the same, and are large enough to protrude from the support piece 8 of the support 6 by a predetermined length p as shown in FIG. Is preferred. This is because, in both the closed state and the open state of the forceps pieces 12, 14, the forceps pieces 12, 14 and the support piece 8 are effectively prevented from contacting and short-circuiting. The predetermined length p is not particularly limited, but is preferably about 0.5 to 2.0 mm. In the present embodiment, the insulating spacer 1
Although the outer diameters of 6, 58 and 62 are all the same, they may be different.

The insulating tube 56 and the insulating spacer 1
6, 58 and 62 are made of heat-resistant plastic such as polyimide, polyethersulfone, and fluorine-based resin.

In this embodiment, the coil tube 50
The length of the coil tube is not particularly limited, and can be increased arbitrarily depending on the application. For example, when it is desired to lower the bending rigidity of the coil tube 50 on the distal end side, the coil tubes having different bending rigidities are used. Must be connected to each other. In such a case, in this embodiment, FIG.
Connection tube 63a or 63b shown in (A), (B)
Is used.

In the connection tube 63a shown in FIG. 5A, a straight or curved notch 6 is formed along the longitudinal direction.
5a is formed, and after the silver brazing for silver brazing is poured into the tube 63a, the ends of the coil tubes 50a and 50b are inserted into the openings at both ends. Since the notch 65a is formed in the connection tube 63a, the notch 65a serves as air bleeding at the time of connection, and air can be satisfactorily connected to the silver braid without air remaining at the connection portion.

In the connection tube 63b shown in FIG. 5B, an opening 65b is formed in place of the notch, and the opening 65b serves to release air at the time of connection, so that the ends of the coil tubes 50a and 50b are connected. Good connection can be achieved by silver brazing or the like. In the present embodiment, in order to connect the end portions of the long metal members such as the coil tubes 50a and 50b, the metal connection tubes 63a and 63b are connected.
Although 63b is used, in the case of a connection tube for connecting the ends of the resin-made longitudinal members to each other, the connection tube may be made of resin and an adhesive or the like may be poured. That is, the connection method using the connection tube shown in FIG. 5 can be applied to all cases where the metal longitudinal member and the longitudinal member of another material are connected by brazing or an adhesive. In these cases, the connecting tube 6
Preferably, 3a and 63b are transparent. This is because the filling state of the welding agent such as an adhesive or a brazing agent for joining can be visually confirmed.

As shown in FIGS. 1 and 3, each forceps piece 12, 1
The first and second link pieces 1 are respectively connected to the link rear end portions 13 and 15 via pivot pins 64 and 66, respectively.
7, 19 are connected in a pantograph shape.

In this embodiment, one of the first link pieces 17
Are made of a conductive member such as metal, and the second link piece 19 is made of an insulating member such as plastic. The plastic constituting the second link piece is not particularly limited, but preferably has excellent heat resistance, and is made of, for example, a fluorine resin, a polyimide resin, an ABS resin, or the like. The first link piece 17 is made of, for example, a metal such as stainless steel. In the case of the same thickness, it is common that metal has higher mechanical strength than plastic, so in the present embodiment, the thickness of the second link piece 19 made of synthetic resin is reduced. The first link piece 17 made of metal is thicker than the first link piece 17 to balance mechanical strength. As a result, in the cross section shown in FIG. 3, the structure is not symmetrical with respect to the center axis of the support 6.

In the present embodiment, the first link piece 17 constitutes a part of the first conductive path to the first electrode 30 of the first forceps piece 12, and the link rear end of the first forceps piece 12 These portions are electrically connected to each other at a portion that contacts the portion 13 (the position of the rotation pin 64). The first link piece 17 has an insulating coating layer formed thereon to prevent a short circuit with another conductive member. However, the first link piece 17 has a contact portion with the link rear end portion 13 and a driving piece 70 described later. The insulating coating layer is peeled off at the contact portion with the contact to ensure electrical connection. As described above, the first forceps piece 12 is also formed of a conductive member such as a metal, and has an insulating coating layer formed on the surface thereof. The coating layer has been peeled off. Also, the portion corresponding to the first electrode 30 has the insulating coating layer peeled off.

As shown in FIGS. 1 and 3, the front end of a driving piece 70 is connected to the rear ends of the first and second link pieces 17 and 19 via a rotation pin 68. Drive piece 70
As shown in FIGS. 6 (A) and 6 (B),
It has a mounting hole 72, and the mounting hole 72 is shown in FIGS.
The rotation pin 68 shown in FIG. Drive piece 7
At the rear end of the cylindrical portion 75, a cylindrical portion 75 having a shaft hole 74 into which the distal end of the conductive wire 18 is inserted is formed, and the outer periphery of the cylindrical portion 75 is communicated with the shaft hole 74. An opening 76 is formed on the surface. The opening 76 is used for inserting the distal end of the conductive wire 18 into the shaft hole 74 and connecting the conductive wire 18 in a state where electrical conduction is possible by means such as silver brazing. The air is released, and the silver solder spreads over the entire inside of the shaft hole 74, and the connection between the wire 18 and the driving piece 70 is improved.

After the connection between the distal end of the conductive wire 18 and the driving piece 70 is completed, it is preferable to form an insulating coating layer integrally on these surfaces. The material of the insulating coating layer may be the same material as the insulating coating layer 54 described above,
It is formed by a coating method or the like.

The conductive wire 18 is made of a metal wire or the like, and is mounted so as to be movable in the longitudinal direction X along the lumen inside the catheter tube 4 as shown in FIGS. The conductive wire 18 has sufficient flexibility so that an operating force can be transmitted along the longitudinal direction X and can be bent together with the catheter tube 4 in the radial direction of the catheter tube 4. Have.

As shown in FIG. 1, the proximal end of the conductive wire 18 is connected to a handle 22 movably mounted in the longitudinal direction X with respect to the operation unit 20 disposed outside the body. . The proximal end of the conductive wire 18 is electrically connected via an electric cord 42 to a high-frequency power supply 40 as a voltage supply means. The operation unit 20 has an outer diameter that is easy to hold with one hand.

In the present embodiment, the conductive wire 18 is electrically connected to the high-frequency power supply 40 shown in FIG. 1 and forms a part of the first conductive path. Conductive wire 1
8 has a distal end as previously described in the description of FIG.
It is electrically connected to the driving piece 70.

Therefore, the first electrode 3 of the first forceps piece 12
0 can be supplied with current through a first conductive path including a link rear end portion 13, a first link piece 17, a driving piece, and a conductive wire 18.

The conductive wire 18 not only forms a conductive path but also controls opening and closing operations of the forceps pieces 12 and 14. That is, by moving the handle 22 forward and backward in the longitudinal direction X with respect to the operation unit 20 shown in FIG. 1, the conductive wire 18 moves in the lumen of the catheter tube 4 along the arrow X direction, and FIG. A) and (B), the links 17 and 19 are operated to
14 are rotated in the direction of arrow Y to control their opening and closing.

In this embodiment, the rotation pins 64, 66 or 68 shown in FIG.
As shown in FIGS. 7 (A) and 7 (B), 9 is rotatably connected to each other by means such as caulking.
The caulking portion formed at the end of the pivot pin 64, 66 or 68 is preferably formed by being slightly retracted from the surface of the link piece 17 or 19, and the gap is provided in the gap shown in FIG.
As shown in (A), it is preferable to pack a filler 77 such as silicon. The surface of the link piece 17 or 19 is preferably covered with an insulating coating layer 78 including a caulked portion, as shown in FIG. The insulating coating layer 78 can be made of the same material as the insulating coating layer 54 shown in FIG. 4 and can be formed by coating.

In order to use the forceps-type electrosurgical treatment instrument 2 according to the present embodiment to collect, for example, a living tissue at a lesion, the distal end of the treatment instrument 2 is firstly treated with an endoscope or the like.
It is guided to the vicinity of the lesion 82 in the body cavity 80 shown in FIG. Next, the handle 22 is pulled from an operating section 20 connected to the proximal end of the catheter tube 4 shown in FIG. 1 to pull a pair of forceps pieces 12 attached to the distal end of the catheter tube 4. 14 is rotated in the closing direction.
By closing the pair of forceps pieces 12, 14, the lesion 5
The biological tissue piece 2 is picked up and positioned in the cup-shaped first and second recesses 24 and 26 formed in the forceps pieces 12 and 14. The base of the biological tissue piece of the picked up lesion 52 is
Each of the forceps pieces 12 and 14 is sandwiched between the first electrode 30 and the second electrode 32 at the edge of the distal end side. Fig. 1
0 is shown.

Next, from the high-frequency power source 40 shown in FIG. 1 connected to the proximal end side of the catheter tube 4, the conductive wire 18, the driving piece 70, the first link piece 17, the first forceps piece 1
2 and a second conductive path including the coil tube 50, the support 6, the metal washer 60, and the second forceps piece 14, and the first electrode 30 and the second electrode 32.
A high frequency voltage is applied in between. When a high-frequency voltage is applied between the electrodes 30 and 32, current flows only in the base of the piece of tissue sandwiched between the electrodes 30 and 32, and the tissue is heated and burned. This heating also causes coagulation necrosis and hemostasis around the cut. The cut biopsy pieces remain in the recesses 24 and 26 of the forceps pieces. Therefore, if the treatment instrument is taken out of the body cavity with the forceps pieces closed, the collection of the biopsy tissue piece is completed.

In the present embodiment, current flows only through the living tissue sandwiched between the electrodes 30 and 32 formed on the distal end side edges of the forceps pieces 12 and 14. Therefore, compared with the monopolar system, the cauterization of the living tissue is reduced, and the tissue piece can be reliably removed with a small electric power. Electrodes 30 and 32 are formed only in portions necessary for energization, and the insides of the cup-shaped recesses 24 and 26 of the forceps pieces for accommodating the cut biological tissue pieces are insulated. No damage to living tissue pieces.

Further, since a predetermined gap is formed between the first electrode 30 and the second electrode 32 in a state where the forceps pieces 12 and 14 are closed, a short circuit between the electrodes 30 and 32 may occur. It can be effectively prevented. Forceps pieces 12, 14
The insulation between the link rear ends 13 and 15 formed integrally with each other is ensured by the insulating tube 56 and the intermediate insulating spacer 16 made of an insulating member shown in FIG. The insulation between the forceps pieces 12 and 14 and the support piece 8 of the support 6 is achieved by the side insulating spacers 58 and 62.

In this embodiment, in particular, the first link piece 17
Is formed of a conductive member so as to be a part of a first conductive path for supplying a voltage to the first electrode 30.
9 is made of an insulating member, and the second forceps piece 14
A part of the second conductive path for supplying a voltage to the electrode 32 is the support 8. For this reason, as a member for forming a conductive path for supplying a voltage to each electrode, a conductive path is formed by using members necessary for configuring the treatment instrument 2 without adding new parts. I have. Therefore, each electrode 3 of each forceps piece 12, 14 can be increased without increasing the number of parts.
For each of the 0, 32 high frequency voltages can be supplied through separate conductive paths that are insulated from each other. In addition, the conductive paths are well held by the insulating spacers 16, 58, 62 and the like.

Second Embodiment In this embodiment, as shown in FIGS. 11A and 11B,
The shape of the side insulating spacer 58a is changed to the support piece 8 of the support 6.
Is elongated along the longitudinal direction. That is,
The shape of the side insulating spacer 58a is changed to the support piece 8 of the support 6.
It has almost the same shape as. The side insulating spacer 58a of the present embodiment is the same as the side insulating spacer 5 of the first embodiment.
8, a disc-shaped boss 57 having a through hole 61 through which the insulating tube 56 is inserted;
The boss portion 57 has a flat plate portion 59 formed integrally therewith.

In the present embodiment, the thickness of the flat portion 59 is made smaller than the thickness of the boss portion 57. This is because the movement of the first link 17 is not hindered by providing a small gap between the first link piece 17 and the first link piece 17. However, by making the sliding characteristics of the surface of the flat plate portion 59 good, the first link piece 17 can be slidably contacted. In that case, the thickness of the flat plate portion 59 may be substantially the same as the thickness of the boss portion 57.

In this embodiment, the metal washer 60 is used.
The side insulating spacer 62 used in the first embodiment is mounted on the outer periphery of the first embodiment. However, the shape of the side insulating spacer 62 may be as shown in FIG. 11B. In this case, the inner diameter of the through hole 61 needs to be substantially equal to or more than the outer diameter of the metal washer 60. Further, it is necessary to have a structure that does not hinder the movement of the second link piece 19.

The forceps-type electric treatment instrument 2a according to the present embodiment
Other structures are the same as those of the forceps-type electric treatment instrument of the first embodiment, and have the same functions and effects. Moreover, since the forceps-type electric treatment instrument 2a according to the present embodiment has the side insulating spacer 58a of a predetermined shape, it is possible to reliably prevent an electrical short circuit between the first link piece 17 and the support piece 8 of the support tool 6. Can be.

Third Embodiment In this embodiment, as shown in FIG. 12, the distal end of the outer tube 52a constituting a part of the catheter tube 4a is adhered and fused to the outer periphery of the rear end of the support 6a. It is joined by means such as wearing, heat shrinking tube or heat caulking.

In this embodiment, one or more grooves 84 are formed in the outer periphery of the rear end of the support 6a in order to ensure the joining of the support 6a to the outer periphery of the end. The groove 84 may be ring-shaped or spiral-shaped, and may be continuous or intermittent in the circumferential direction.

The support 6a in which such a groove 84 is formed
If the outer end of the outer tube 52a is covered with the distal end of the outer tube 52a and a heating / pressing mold is used, the distal end of the outer tube 52a is easily joined to the outer periphery of the end of the support 6a by thermal caulking. be able to. Unlike the first embodiment, the proximal end of the outer tube 52a is not joined to the operation unit 20 shown in FIG. 1 and is a free end. As described above, at least one end of the outer tube 52 or 52a is a free end because the catheter tube 4 or 4a is inserted into the meandering body cavity, and the outer tubes 52a and 52 and the coil tube 50 are relatively axially connected. This is to absorb the movement since the movement is performed in the direction.

In this embodiment, the outer tube 52a is made of the same material and dimensions as the outer tube 52 of the above embodiment, and the configuration other than that shown in FIG. 12 is exactly the same as that of the above embodiment. is there.

The forceps-type electric treatment instrument according to the present embodiment has the same effects as the electric treatment instrument of the first embodiment, and also has the following effects. That is,
In the present embodiment, instead of fixing the outer tube 52a on the operation unit 20 side, the end of the outer tube 52a is fixed on the support 6a side. Therefore, it is possible to effectively prevent body fluid existing in a body cavity or the like from entering the gap between the outer tube 52a and the coil tube 50 from between the outer tube 52a and the support tool 6a.

Fourth Embodiment In this embodiment, as shown in FIGS.
First forceps pieces 12a to 12c and second forceps pieces 14a to 14
The shape of c is changed.

In the example shown in FIG. 13A, an opening 11a larger than the opening 11 formed in the forceps pieces 12, 14 according to the first embodiment is formed. In the example shown in FIG. 13B, the opening 11b is formed in each of the forceps pieces 1b so that the distal ends of the forceps pieces 12b and 14b have an arrow shape when viewed from the side.
2b and 14b. The example shown in FIG. 13C is a modification of the example shown in FIG.
The shape of c is the same as that shown in FIG.
The shape of the gap when the forceps pieces 12c and 14c are closed is different. That is, the gap between the forceps pieces 12c and 14c is
Each of the forceps pieces 12 should not be parallel along the axial direction.
Alternating protrusions 85c are formed on mutually facing surfaces of c and 14c. Such protrusions 85c, 85c
Is formed on the mutually facing surfaces of the forceps pieces 12c and 14c, thereby making it easier to grasp the tissue piece. Moreover, since the distance between the electrodes (not shown) formed on the forceps pieces 12c and 14c can be maintained, a short circuit can be effectively prevented.
Other functions and effects of this embodiment are the same as those of the first embodiment.

Fifth Embodiment In this embodiment, as shown in FIGS. 14A and 14B,
Sharp cutting edges 31, 33 are formed at the distal end side edges of the recesses 24, 26 of the forceps pieces 12d, 14d. The forceps pieces 12d and 14d are closed with each other, and the edge portion 3
The meshing of the tissue pieces is enabled by the meshing of the pieces 1 and 33.

In this embodiment, each forceps piece 12d,
A first electrode 30d and a second electrode 32d are formed on the outer peripheral surface on the distal end side of each forceps piece that does not include the contact portion 14d. The electrode area of each of the electrodes 30d and 32d is not particularly limited, but is preferably 2.0 to 40.0 mm ² . The first electrode 30d and the second electrode 32d are insulated because no electrodes are formed at these contact portions so as to prevent a short circuit even when the forceps pieces 12d and 14d are closed. In addition, forceps piece 1
No electrodes are formed on the inner surfaces of the recesses 24 and 26 of 2d and 14d, respectively, so that they are insulated.

In this embodiment, each forceps piece 12
d and 14d are made of an insulating member, and each forceps piece 12d, 1
Electrodes 30d and 32d are formed by forming a conductive film only on portions corresponding to 4d electrodes 30d and 32d. As the insulating members constituting the forceps pieces 12d and 14d, ceramics such as alumina, titanium nitride, and titanium carbide; polyimide, polyetherimide, polyethersulfone, and fluororesin are preferable from the viewpoint of heat resistance. Forceps pieces 12d, 1 made of such an insulating member
The conductive film formed on the surface of 4d is not particularly limited, but is preferably silver, copper, gold, platinum or the like. This is because the conductivity is high. Examples of the coating method include a metal plating method, a sputtering method, an evaporation method, and a coating method.

However, in the present embodiment, the first electrode 30d shown in FIG.
It is necessary to secure a conductive path and a second conductive path from the second electrode 32d shown in FIG. 14 to the metal washer 60 shown in FIG.

As a modification of the present embodiment, each of the forceps pieces 12d and 14d is made of stainless steel, and the portions other than the portions corresponding to the first electrode 30d and the second electrode 32d are covered with an insulating coating layer. Is also good.

In order to collect, for example, a living tissue at a lesion using the forceps-type electric treatment instrument 2 according to the present embodiment, first, the distal end of the treatment instrument 2 is attached by using an endoscope or the like as shown in FIG.
It is guided to the vicinity of the lesion 82 in the body cavity 80 shown in FIG. Next, the handle 22 is operated to be pulled from the operating portion 20 connected to the outside proximal end of the catheter tube 4 shown in FIG. 1, so that a pair of forceps pieces 12 d attached to the distal end of the catheter tube 4. 14d is rotated in the closing direction. By closing the pair of forceps pieces 12d and 14d,
A piece of the living tissue at the lesion 82 is picked up, and the forceps pieces 12d, 1
Cup-shaped first and second recesses 24, 26 formed in 4d
Within. The base of the biological tissue piece of the picked up lesion 82 is located at the cutting edge 3 of each of the forceps pieces 12d and 14d.
By the engagement of 1, 33, it is completely cut. Alternatively, even if it is not completely cut, it can be completely cut as shown below.

That is, by operating the operation unit 20 shown in FIG. 1, the distal ends of the closed forceps pieces 12d and 14d are brought into contact with the body cavity 8.
Press against the 0 biological tissue surface. Thereby, the forceps piece 12
The first electrode 30d and the second electrode 32d are pressed against the surfaces of the living tissue located on both sides of the base of the living tissue piece sandwiched between d and 14d, respectively. In this state, from the high frequency power supply 40 connected to the proximal end side of the catheter tube 4,
A high-frequency voltage is applied between the first electrode 30d and the second electrode 32d through the first conductive path and the second conductive path. When a high-frequency voltage is applied between the electrodes 30d and 32d, current flows only in the base of the tissue piece located between the electrodes 30d and 32d, and the tissue is heated and burned. By this heating, the cut part is also stopped. The cut biopsy pieces remain in the recesses 24 and 26 of the forceps pieces. Therefore, if the treatment instrument is taken out of the body cavity with the forceps pieces closed, the collection of the biopsy tissue piece is completed.

When the base of the tissue piece is completely cut by the cutting edges 31 and 33 of the forceps pieces 12d and 14d, the application of the high-frequency voltage does not affect the hemostasis on the surface of the living tissue after cutting. And for coagulation necrosis of surrounding tissue. Such hemostasis can also be performed by applying a high-frequency voltage by pressing the tips of the closed forceps pieces 12d and 14d against a site that has bleeding for some reason other than the portion where the tissue piece is collected. it can.

In the present embodiment, in addition to the functions and effects of the first embodiment, the above-described functions and effects are achieved.

Sixth Embodiment In this embodiment, as shown in FIGS.
First forceps pieces 12e to 12g and second forceps pieces 14e to 14
g are in contact with each other so as to mesh with each other. In the example shown in FIG. 15A, the forceps pieces 12e and 14e
The engaging surface 86e on the tip side of the is parallel to the axis,
The contact is made within a predetermined linear range. FIG. 15B
In the example shown in (1), the engaging surfaces of the forceps pieces 12f and 14f are tapered surfaces 86f, and are contacted only at their tips. Further, in the example shown in FIG.
The engagement surface 86e of the forceps piece 12g is a surface parallel to the axis, and the engagement surface 86f of the other second forceps piece 14g is a tapered surface, and they are brought into contact only at their tips.

In these examples, since the forceps pieces are brought into contact with each other at the engagement surfaces, it is necessary that at least those contact portions have an insulating coating layer formed thereon. As an example of such a structure, for example, as shown in FIG.
Forceps pieces 12h, 1 made of conductive material such as metal
The inner and outer surfaces of 4h are coated with an insulating coating layer 53 so as to be insulated at least on the mating surface. Also,
The first electrode 30h and the second electrode 32h are connected to each forceps piece 12
h, 14h can be formed by peeling off the insulating coating layer on the inner wall surface near the mating surface.

In the example shown in FIG. 16B, the inner and outer surfaces of the forceps pieces 12i and 14i made of a conductive material such as a metal are coated with an insulating coating layer 53, and the first electrode 30h and the second electrode The electrode 32h is connected to each forceps piece 12h, 14
h can be formed by alternately peeling off the insulating coating layer on the mating surface.

The present invention is not limited to the above-described embodiment, but can be variously modified within the scope of the present invention.

[0089]

As described above, according to the present invention, in the bipolar forceps-type electric treatment instrument, the number of parts of the conductive path for supplying a voltage to each electrode of the cup-shaped forceps pieces is increased. Therefore, it is possible to provide a forceps-type electric treatment instrument which is formed without any trouble and is excellent in insulation between these conductive paths.

[Brief description of the drawings]

FIG. 1 is a schematic perspective view of a forceps-type electric treatment instrument according to an embodiment of the present invention.

FIG. 2 is a side view of a component mounted on the distal end of the forceps-type electric treatment instrument shown in FIG.

FIG. 3 is a sectional view of a principal part taken along line III-III shown in FIG. 2;

FIG. 4 is a schematic view showing a connecting portion between a supporter of the forceps-type treatment instrument shown in FIG. 1 and a catheter tube.

FIGS. 5A and 5B are perspective views of a connector used for connecting a conductive flexible tube.

FIGS. 6A and 6B are a perspective view and a sectional view showing a connection portion between a conductive wire and a link driving piece.

FIGS. 7A and 7B are cross-sectional views of a main part showing details of a connection portion between a link and focus.

FIGS. 8A and 8B are schematic diagrams showing opening and closing of a forceps piece by the action of a link.

9 (A) is a plan view of a forceps piece, and FIG. 9 (B) is an enlarged sectional view taken along line BB shown in FIG. 9 (A).

FIG. 10 is a schematic diagram showing a use state of the forceps-type electric treatment instrument.

FIG. 11A is a sectional view of a main part of a forceps-type treatment instrument according to another embodiment of the present invention, and FIG. 11B is a view of FIG.
FIG. 5 is a perspective view of a side insulating spacer used in FIG.

FIG. 12 is a schematic view showing a connecting portion between a supporter of a forceps-type treatment instrument and a catheter tube according to another embodiment of the present invention.

FIGS. 13A to 13C are main part side views showing modified examples of the forceps piece.

FIG. 14 (A) is a side view of a distal end side of a forceps-type treatment instrument according to another embodiment of the present invention, and FIG. 14 (B) is a cross-sectional view of a main part near the forceps piece.

FIGS. 15A to 15C are main part side views showing other modified examples of the forceps piece.

FIGS. 16A and 16B are cross-sectional views of a main part showing a modified example of an electrode of a forceps piece.

[Explanation of symbols]

 2, 2a ... forceps-type electric treatment instrument 4 ... catheter tube 6 ... support tool 8 ... support piece 10 ... fulcrum shaft 12, 12a to 12i ... first forceps piece 13 ... rear end portion for first link 14, 14a to 14i ... Second forceps piece 15 Rear end for second link 16 Intermediate insulating spacer 17 First link 18 Conductive wire 19 Second link 20 Operating part 22 Handle 24 First recess 26 Second Recesses 30, 30d, 30h, 30i First electrode 31 Cutting edge 32, 32d, 32h, 32i Second electrode 33 Cutting edge 40 High frequency power supply 50 Coil tube 56 Insulating tube 58 58a: Side insulating spacer 60: Metal washer 62: Side insulating spacer

Claims (1)

[Claims] 1. A catheter tube having flexibility that can be inserted into a body, a first forceps piece attached to a distal end side of the catheter tube and having a cup-shaped first recess formed therein, and a cup-shaped And a second forceps piece having the second recess formed therein, the support being configured to be openable and closable so that the first recess and the second recess face each other, and comprising a conductive member; A first electrode formed on the first forceps piece, a second electrode formed on the second forceps piece, and the catheter so as to supply a high-frequency voltage between the first electrode and the second electrode. A forceps-type electric treatment instrument having voltage supply means connected to a proximal end side of a tube, wherein the conductive flexible tube constituting the catheter tube and the support are joined to each other, and the conductive member is electrically conductive. A forceps-type electrode in which the surfaces of the flexible tube and the support are integrally insulated. Treatment equipment.