JPS6053138A - High frequency incising tool of living body tissue - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

Detailed Description of the Invention (Technical Field) The present invention 8A is a high-frequency resection tool for living tissue, specifically, it is inserted into a body cavity and cauterizes it by applying a high-frequency current to remove affected parts of living tissue such as polyps. This invention relates to a high-frequency cutting tool for biological tissue.

(Prior art) The conventional high-frequency cutting tool for living tissue was developed in U.S. Pat.
It is configured as described in Publication No. 07S.

That is, as shown in FIG. 1, the biological tissue resection tool 1 includes an insertion section 2 made of a flexible tube that is inserted into a forceps channel (not shown) of an endoscope. This insertion part 2
The handle is fixed to the operating section main body 4 via the partition mounting section 3. An operating slider 5 is provided which is movable in the longitudinal direction using the operating section main body 4 as a guide, and one end of the operating pipe B is connected to the operating slider 5.

The other end of the operating vibro is slidably inserted into the attachment section 3, and a loop wire 7, which is inserted into the insertion section 2, is fixed to its tip. As shown in FIG. 2, the distal end of the insertion section 2 houses a slider 8 that can move forward and backward, and the distal end 7a of the loop wire 7 is fixed to the slider 8, and the distal end 7a of the loop wire 7 is connected to the bending section 7b. It is inserted through a through hole 8a formed in the slider 8 via a stopper 7C, passes through the insertion portion 2, and is fixed to the operation slider 5.

Furthermore, a small-diameter locking ring 2a is fixed to the distal end of the insertion portion 2 made of a flexible tube, and a metal ring 2b is further fixed to the inside of the insertion portion 2.

Therefore, when the loop wire 7 fixed to the operating vibro is moved forward by pushing the operating slider 5, the slider 8 is moved between the locking ring 2a and the metal ring 2b.
The bent portion 7b of the loop wire 7 protrudes from the distal end of the insertion portion 2, forming a substantially half-moon-shaped loop. This loop is hung over the root of an affected area such as a polyp in the body cavity, and while the operating slider 5 is being pulled back, the loop is squeezed and the IJ-7' is held in the loop. In this state, the polyp can be burned off by passing a high frequency current through the loop wire 7.

However, when removing an affected area such as a polyp several times, carbonized living tissue may adhere to the loop wire 7 or the loop wire 7 may become deformed, causing the loop wire 7 to become stuck in the through hole of the slider 8. The amount of operating resistance when the slider 8 passes through the metal ring 2b increases compared to when the slider 8 passes over the metal ring 2b. Then, the loop of the loop wire 7 is not completely closed, that is, the slider 8 is retracted without the stopper 7c coming into contact with the end of the through hole 8a of the slider 8, and the loop wire protrudes from the tip of the insertion portion 2. become.

Therefore, there arises a drawback that the bent portion 7b of the loop wire becomes fully extended and cannot be used again.

In addition, instead of the metal ring 2b, an inner convex portion 2c formed by squeezing a flexible chain near the locking ring 2a is provided as shown in FIG. ), the lever 20.2 has the proximal side of the locking ring 2a extended.
Although there is also a structure in which a convex portion 21.21 is provided at 0, the above-mentioned drawbacks occur even in such a structure.

(Objective) The present invention eliminates all of the above-mentioned drawbacks and ensures that the loop wire can be reliably pulled into a flexible tube even when carbide of living tissue is attached to the loop wire and the operating resistance increases when the loop wire is pulled into a flexible tube. The purpose of the present invention is to provide a high-frequency ablation tool for living tissue that can pull in the body tissue.

(Summary) The present invention is capable of moving the slider toward the opening when the operating pipe is pushed into the mouthpiece, and is provided with a lever member that prevents the slider from moving in the drawing direction when the operating pipe is pulled back. It is something that

(Example) Embodiments of the present invention will be described below with reference to the drawings.

First, the first embodiment will be explained using Figures 4 to 7. As shown in FIG. 4, the distal end 1 of the sheath 10 is made of a flexible tube made of a material having flexibility and electrical insulation properties.
0a is cut diagonally.

A locking ring 11 having a hole 11a formed at an acute angle and having a small inner diameter is fixed deep inside the tip 10a. Further, the distal end portion 10b of the sheath 10 has a stepped portion 12b having a hole 12a having approximately the same diameter as the inner diameter of the distal end portion 10b, and is fitted into a base portion 12 made of an electrically insulating material. This mouthpiece 12 is connected to the hole 12a, and
The diameter of this hole is 12d, which is larger than the diameter of the circumference of 12m.
A connecting portion 12a for fitting a protective tube (not shown) is provided at the end in the axial direction. A cylindrical protection member 13 is fitted into the outer periphery of the distal end 10b of the sheath 1o, and the protection member 13 is fitted into the base portion 120 and the stepped portion 12b.
The distal end 10b of the sheath 1o is held between the two.

Further, as shown in detail in FIG. 5, the bottle shaft 14, which is perpendicular to the central axis direction of the metal part 12 and located below the same central axis, is fixed to penetrate through the wall of the metal part 12. There is.

A lever member 15 is attached to this bottle shaft 14'. That is, as shown in detail in FIG. 6, this lever member is formed of a thin medium plate, and the tip end 10a of the sheath 10 is bent at a bent part 15a at the end of one arm that extends out. A check portion 15b is provided, and a receiving portion 15c that fits the bottle shaft 14 is fixed to the lower surface near the end of the narrow arm.

A retaining portion 15d is formed at the end of the thin arm, and a return spring 16 having an elastic spring force is disposed between the lower surface of the retaining portion 15d and the bottom wall of the recess 12c, as shown in FIG. There is. In normal life, the lever member 15 is given a counterclockwise rotational habit by applying the tension spring force of the return spring 16 to the engaging portion 15d, and this rotation is caused by the bending portion 15a being applied to the sheath 10.
This is prevented by contacting the bottom wall of the

Further, a cylindrical slider 17 is disposed inside the sheath 1D, and is movable into the sheath 10 and has a diameter larger than the diameter of the hole 11a of the locking ring 11. The starting end 18a of a metallic loop wire 18 made of, for example, stainless steel is fixed, and the loop wire 1
8 is formed with a bent portion 18bK bent into a U-shape, and the hole 11 is further formed at the extended end of this bent portion 18b.
a through-hole 1 which can be inserted freely and which is bored in the slider 17.
A stop collar 19 through which 7g cannot be inserted is fixed. Furthermore, the extended end of the loop wire 18 passes through the through hole 17a,
After passing through the recess 12c and the hole 12d, it is fixed to the operating pipe 2o which is fitted into the opening of the connecting part 12e so as to be able to move forward and backward. A pressing tip 20a shaped like a truncated cone is formed at the inner end of the operating pipe 20 to which the loop wire is fixed. At the outer end of this operation pipe 20, there is an operation slider 5 similar to that shown in FIG.
A fixed R20b is attached for connection to.

The high-frequency resection tool for living tissue of the first embodiment is constructed in this manner. Next, its operation will be explained.

Sheath 1 through the internal forceps channel (not shown)
0 into the body. When the operating pipe 2° is moved forward, the bent portion 18b of the loop wire 18 protrudes from the tip 10a while the stopper 19 is in contact with the slider 17, the stopper 19 enters the hole 11a, and the tip surface of the slider 17 is locked. It abuts against the rear end surface of the ring 11. When the operating knob 20 is further advanced, the forward movement of the starting end 18a of the loop wire 18 is blocked, and the loop wire 18 to which the stopper 19 is fixed advances further to bring the bent portion 18b to the apex as shown in FIG. A roughly cow-moon-shaped loop is formed. Also, during this operation, the engaging portion 15d of the lever member 15 is returned to the spring 16 by the pressing tip 20a of the operating pipe 2o.
As the lever member 15 is pressed against the spring force of
A slider 17 is located between the end face of the slider 5b.

Next, the loop of the loop wire 18 thus formed is hung around the base of the polyp to be removed, and the operating pipe 20 is retreated through the hole 12d of the mouthpiece 12. Then,
The loop wire 18 passes through the through hole 17a of the slider 17 and is drawn into the rear of the sheath 10, and the loop of the loop wire 18 protruding from the distal end 10a of the sheath 10 is tightened. In this state, one end of the output end of a high frequency current supply device (not shown) is connected to the living body, and the other end is connected to the loop wire 18.
When connected to the wire 18, a high frequency current flows through the wire 18 to cauterize and remove the polyp.

Thereafter, when the operation pipe 20 is further retreated, the loop wire 18 is further retracted, and this retracted state continues until the stopper 19 comes into contact with the slider 17. If carbide generated when living tissue is cauterized by electric current adheres, the resistance to the retracting operation of the loop wire 18 increases, and the loop of the loop wire 18 protruding from the distal end 10a of the sheath 10 closes. A state of not being able to
In other words, even if the stopper 19 does not fully contact the slider 17, it is pulled in as it is in the conventional device, resulting in various inconveniences, but in the present invention, the slider 17 is brought into contact with the ζ member 15. Retraction is prevented by the check portion 15b of the sheath 10, and the operation pipe 20 is pulled out until the stopper 19 comes into contact with the slider 17, in other words, until the loop of the loop wire 18 protruding from the distal end 10a of the sheath 10 is closed. .

The reason why the slider 17 is prevented from retracting in this manner is that the pressing tip 20a of the operating pipe 20 is connected until the pressure contact by the engaging portion 15d of the lever member 15 is released. Then, when the operating pipe 20 is further pulled out, the engaging portion 15d of the lever member 15 returns to its original position and moves back in the counterclockwise direction by the tension spring force of the spring 16. 15b is restored, and when the operation pipe 20 is pulled out to the east, the loop wire 1B is pulled into the sheath 10 while the stopper 19 and the slider 17 are kept in contact with each other, and the initial state as shown in FIG. 4 is restored. The series of cutting operations is completed.

Next, a second embodiment of the present invention will be described using FIGS. 8 to 12.

In FIG. 8, the distal end portion 1ob of the sheath 10 has a base formed with a stepped portion 30b having a hole 30a having approximately the same diameter as the inner diameter of the sheath 10 and having a diameter smaller than the diameter of the slider 17. It is fixed to the section 30 together with the retention member 13. This mouthpiece 30 is connected to the hole 50a,
A hole 30C is provided which is larger than the RF diameter of the opening 30a and into which the slider 17 can be loosely inserted.

Furthermore, a fourth part 30d is formed which is connected to this hole 30c and has a diameter larger than the diameter of the opening 50c. Also, on the proximal side of the mouthpiece part 30, there is a hole 3De through which the operating pipe 20 can freely move forward and backward. A connecting portion 30f for fitting a protective tube (not shown) is provided. An annular plate-shaped fulcrum ring 31 is fixed approximately at the center of the recess 30d. Also, the cap part 3
A cylindrical member 32 is fixed to the inner end of the base of the cylindrical member 32 . In the middle of this cylindrical member 32, two square holes 52a are bored at symmetrical positions.

As shown in detail in FIGS. 9 to 11, a part of the lever member 33 formed of a thin strip plate is inserted into the square hole 32a.
The engaging portion 33a bent into a letter shape is engaged. Non-return portion 5 formed by the engaging portion 53a and the tip of the lever member 33
The fulcrum portion 33c located approximately at the center between the fulcrum portion 33c and the fulcrum portion 33c is in contact with the inner surface of the fulcrum ring 31. Further, the distance between the tips of the two engaging portions 33a of the two lever members 36 is set smaller than the diameter of the operating pipe 20. For this purpose, the lever member 36 uses the contact point (fulcrum part 33C) with the inner circumference of the fulcrum ring 31 as a fulcrum, and when the engaging part 55a is pressed, the check parts 33b move inwardly. I will do it.

Therefore, when the operation pipe 20 is now pushed into the hole 30e of the mouthpiece 30, the loop wire 18 is moved to the slider 17.
moves within the sheath 10 with the stopper 19 in contact with the
A bent portion 18b protrudes from the distal end of the sheath 10. This state continues until the front end surface of the slider 17 comes into contact with the front end step of the hole 50C of the mouthpiece 30 and the slider 17 is prevented from entering.

Further, when the operation pipe 20 is pushed in, the loop wire 18 integrated with the stopper 19 moves to the tip 1 of the 7-seat 10.
It protrudes from 0a, and as shown in FIG. 12, a substantially half-moon-shaped loop is formed. During this operation, the engaging portions 33a of the lever member 33 are pushed outward by the outer circumferential surface of the operation pipe 20, so the contact point with the fulcrum ring 31 (fulcrum portion 63C) is used as a fulcrum, and the non-return portion 55b will move inward from each other. Therefore, the slider 17 is located between the front end step of the hole 50C and the tip of the check portion 35b (inside the hole 50C).

The loop of the loop wire formed in this manner is cut out and hooked onto the base of the polyp. When the operation pipe 20 is retreated from the hole 30f of the base portion 30, the positions of the slider 17 and the lever member 33 remain unchanged. , loop wire 1
8 is passed through the through hole 17a of the slider 17 and drawn in, and the polyp is held between the loop wires 18 in the same manner as described above, and the polyp is excised in the same manner as described above.

After that, when the operation pipe 20 is further retreated, the loop wire 18 is further retracted, and this state is reached by the stopper 19.
However, if the pull-in operation resistance of the loop wire 18 increases due to adhesion of carbide near the bent portion 18b of the loop wire 1B, the slider 17 will move in the direction in which it is pulled in. Although the slider 17 moves, the retraction of the slider 17 is caused by the non-return part 3 of the lever part @33.
3b, and as the operating pipe 20 is pulled out, the stopper 19 comes into contact with the front end surface of the slider 17! In other words, the state in which the engaging portion 35a of the lever member 33 is pressed by the surface of the operating pipe 20 continues until the state is released. Then, when the operating pipe 20 is further pulled out, the engaging portion 33a of the lever member 33 and the operating pipe 20
The lever member 33 comes out of contact with the outer circumferential surface of the fulcrum ring 31.
It rotates using the contact point (fulcrum part! 13c) as a fulcrum,
The same lever member 33 is restored. When the operating pipe 20 is further pulled out, the slider 17 and the stopper 19 are kept in contact with each other and restored to the initial state shown in FIG. 8, completing the series of cutting operations.

Next, a third embodiment of the present invention will be described using FIGS. 13 and 14. This third embodiment uses a short lever member 3 similar to the two lever members 33 in the second embodiment described above.
4, the length of the above-mentioned non-return part 33b is longer than the length of the above-mentioned lever member 34, and the above-mentioned hole 30c is used as a long lever member 35.
Since the other members are the same as those described above, corresponding members are designated by the same reference numerals as described above, and their explanations will be omitted. The diameter of the hole 30'C formed in the base portion 60 is smaller than the inner diameter of the fulcrum ring 31 and larger than the diameter of the hole 30a. The tip of the push-up portion 35b of the long lever member 35 enters the hole 30'C.

Therefore, when the operation pipe 20 is now pushed into the hole 30e of the mouthpiece 30, the loop wire 18 moves within the sheath 10 while the stopper 19 is in contact with the slider 17.
A bent portion 18b protrudes from the distal end of the sheath 10. In this state, the front end surface of the slider 17 is
This continues until the slider 17 comes into contact with the front end step of the slider 17 and is prevented from entering.

Furthermore, when the operation pipe 20 is pushed in, the loop wire 18 integrated with the stopper 19 moves to the distal end 1 of the sheath 10.
It protrudes from 0a, and as shown in FIG. 14, a substantially half-moon-shaped loop is formed. During this operation, the engaging portion 54a of the short lever member 34 is pushed upward by the outer peripheral surface of the operation pipe 20, and the contact point between the inner peripheral surface of the fulcrum ring 31 and the fulcrum portion 34C of the short lever member 64 is used as a fulcrum. As a result, the check portion 34b moves downward. At the same time, the engaging portion 3 of the long lever member 35
5a is pushed down by the outer peripheral surface of the operation pipe 20, and the push-up part 35b moves upward using the contact point between the inner peripheral surface of the fulcrum ring 6115- and the fulcrum part 55c of the long lever member '55 as a fulcrum, Along with this, the slider 17, which has been moved into the hole 30'C, is pushed upward. Therefore, after performing the desired cutting in the same manner as described above, when the operating pipe 20 is further retreated from the hole 30e of the mouthpiece 30, the loop wire 18 is further retracted, and this state continues until the stopper 19 comes into contact with the slider 17. However, when the pull-in operation resistance of the loop wire 18 increases due to adhesion of carbide near the bent portion 18b of the loop wire 18, the slider 17 moves in the direction of being pulled in, but the pull-in of the slider 17 is shortened. The stopper 19 is blocked by the tip of the non-return portion 34b of the lever member 34, and the stopper 19 is moved from the slider 1 by pulling in the operation pipe 20.
In other words, the operation pipe 2
This continues until the engagement portion 34a of the short lever member 34 is released from the pressed state due to the phase 0. Then, when the operation pipe 20 is further pulled out, the engagement portion 3 of the short lever member 34
4a and the outer peripheral surface of the operating pipe 20 are removed, the short lever member 34 rotates about the contact point (fulcrum part 34C) with the fulcrum ring 31 as a fulcrum, and the short lever member 34 is restored. . When the operation pipe 20 is further pulled out, the slider 17 and the stopper 19 remain in contact with each other and the first
As shown in FIG. 3, the initial state is restored and the series of cutting operations is completed.

Next, a fourth embodiment of the present invention will be described using FIG. 15.

This 4th''iA embodiment is a non-return portion 15b formed at the tip of the bent portion 15a of the lever member 15 in the first embodiment described above.
Non-returning part 15'b whose length is extended to just before the locking ring 11
and a sheath 10 between the locking ring 11 and the mouthpiece 12
A non-returning portion 40 is provided on the inner upper side, and the other members are the same as those described above, so the corresponding members have the same reference numerals as those described above, and the explanation thereof will be omitted.

Even if the pull-in movement resistance increases due to adhesion of carbide near the bent portion 18b of the lever member 15, the slider 17 is pushed upward by the tip of the non-return portion 15'b of the lever member 15, and the movement of the slider 17 is reversed. Since the stopper 40 prevents the slider 17 from being pulled in, the stopper 19
The slider 17 does not move until it comes into contact with the slider 17, in other words, until the knife-shaped loop formed by the bent portion 18b is closed. As the stopper 19 comes into contact with the slider 17 in this way, the operation pipe 20
The lever member 15 is tilted back and forth by the outer peripheral surface of the slider 17.
The loop wire 18 with the stopper 19 integrated therein is pulled in.

In each of the above-mentioned embodiments, polyps and the like are removed by passing a high-frequency current through the loop wire, but the same applies when incising the stomach wall etc. by passing a high-frequency current through the loop wire. Of course.

(Effects of the Invention) According to the present invention, since the slider is prevented from being pulled in until the stopper comes into contact with the slider, the pull-in operation resistance increases due to carbide attached to the loop wire or deformation of the loop wire. However, the slider is not retracted until the loop wire is closed, which prevents the loop wire from protruding from the distal end of the sheath or from causing the bent portion of the loop wire to become fully extended, making it impossible to reuse it.

[Brief explanation of drawings]

FIG. 1 is a plan view showing an example of a high-frequency cutting tool for living tissue; FIG. 2 is a cross-sectional view showing the configuration of the tip of a conventional high-frequency cutting tool for living tissue; FIG. 4 i1 is a cross-sectional view showing each side of the non-return part of a conventional high-frequency resection tool for living tissue; FIG. 6 is an enlarged perspective view showing only the lever part shown in FIG. 4, and FIG. 7 is a sectional view taken along line A-A in the figure. 8 is a sectional view of a high-frequency cutting tool showing a second embodiment of the present invention; FIG. 9 is an enlarged perspective view showing only the lever section in FIG. 8; FIG. FIG. 11 is an enlarged cross-sectional view taken along line B-B in FIG. 8, FIG. 12 is an enlarged cross-sectional view taken along line C-C in FIG. 8, and FIG. 12 is an enlarged cross-sectional view taken along line B-B in FIG. 16 is a sectional view of a high-frequency cutting tool according to the third embodiment of the present invention; FIG. 14 is a sectional view showing the operating state of the high-frequency cutting tool of the third embodiment; Fig. 15 is a sectional view of a high-frequency cutting tool showing a fourth embodiment of the present invention. 10...Sheath (flexible tube) 171...
・Slider 20... Operation pipe 18... Loop wire

Claims (1)

[Scope of Claims] (1) A flexible tube having a distal end exposed in the body cavity formed at one end and a mouthpiece formed at the other end, and a flexible tube capable of moving forward and backward into the flexible tube and/or into the mouthpiece. a slider disposed, an operation pipe disposed movably back and forth within the mouthpiece, one end fixed to the slider and the other end folded back at a bent portion located beside the distal end of the flexible tube. , passing through the slider and extending to the base of the flexible cheep,
A high-frequency resection tool for living tissue, comprising: a high-frequency loop wire fixed to the operating pipe; High-frequency ablation characterized by comprising a lever member having an engaging part that is pressed by the engaging part and a check part that prevents the slider from moving toward the mouth part by the operation of the engaging part. Ingredients. (2) The high-frequency cutting tool for living tissue according to claim 1, wherein the fulcrum of the lever member is a shaft disposed inside the mouthpiece. (6) The high-frequency resection tool for living tissue according to claim 1, wherein the fulcrum of the lever member is a protrusion disposed on the inner wall of the mouthpiece.