JPS61154660A - Cauterization hemostatic apparatus - 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 of the Invention] The present invention relates to a cautery and hemostasis device that is used endoscopically to cauterize and stop bleeding from a bleeding wound.

[Technical background of the invention and its problems] In recent years, by inserting an elongated insertion section into a body cavity,
Is it possible to perform diagnostic or therapeutic procedures inside body cavities without requiring incisions from the body surface? ll mirrors are widely used. In addition to the observation means, this endoscope is generally equipped with a hollow channel through which various treatment instruments are inserted, and the operator visually observes the symptoms with the treatment instrument inserted through this channel. Various therapeutic procedures can be performed underneath.

By the way, there are laser treatment devices that irradiate laser beams to coagulate blood as a means to stop the bleeding of wounds such as those removed from tumors or ulcers in body cavities, but at present, the laser beam irradiation requires skill. However, there are also problems in that the cost is high.

For this reason, a device has been proposed that uses an ablation probe that can be inserted through the channel of an endoscope and energizes a heating coil installed at the tip of the ablation probe to coagulate the bleeding area that is pressed against it. .

However, with this heating coil type device, the responsiveness of the rise in temperature when coagulating blood and the fall of temperature after hemostasis is low, so the time required for coagulation,
Alternatively, there is a problem that the surrounding tissues other than the target site (wound) are necrotized due to heat conduction to the surrounding tissues during the time until the probe cools down after the coagulation is avoided.

Therefore, Japanese Unexamined Patent Publication No. 58-69556 discloses a high-speed heat-generating ablation probe that can be inserted into the channel of an endoscope and uses a heat-generating element with good heating and cooling response. There is. This prior art device is
The probe is equipped with a nozzle and has the function of discharging a cleaning fluid that is pumped through a catheter (sheath) to clean blood from the wound and make it easier to find bleeding sites that require coagulation.

By the way, in the prior art device, the sheath having the probe at the tip guides the probe to the tip of the endoscope through the long and narrow channel of the endoscope.
It is formed to have a uniform hardness to prevent buckling within the channel.

However, if the sheath has uniform hardness from the distal end side with the probe to the base side with the connector connected to the main body of the device, the sheath will be exposed to the outside except for the part inserted into the channel of the endoscope during use. The proximal side of the proximal end may be bent or deformed by erroneous external force or by force applied by the surgeon during treatment.

If the sheath is bent or deformed, there is a problem that since the sheath has a cleaning liquid feeding path, this liquid feeding path is blocked and liquid cannot be fed.

[Object of the Invention] The present invention has been made in view of these circumstances, and is designed to prevent the sheath from being inserted into the channel of the endoscope even if an external force is applied or a bending force is applied by the operator's operation. The object of the present invention is to provide a cautery hemostasis device that prevents the sheath at the site from breaking or deforming.

[Summary of the Invention] In order to achieve the above object, the cautery hemostasis device according to the present invention has the following features:
An elongated sheath that has a connector at its base that is connected to the main body of the device that has a built-in power source, etc., and a cautery probe at its tip that is inserted into the treatment instrument channel of the endoscope. The part of the sheath that is inserted into the channel of the endoscope is formed to have a substantially uniform predetermined hardness and flexibility, while the part of the sheath that is not inserted into the channel of the endoscope and is exposed to the outside is made of a soft material. is formed.

With this configuration, the portion of the endoscope exposed outside the channel is flexible and will not break or deform even if an external force is applied or a force due to an operator's operation is applied, and the portion exposed outside the channel of the endoscope is The portion of the endoscope that is inserted into the channel has a predetermined, substantially uniform hardness, and can be smoothly advanced without buckling during insertion and advancement.

[Embodiments of the invention] Embodiments of the apparatus of the present invention will be described below with reference to the drawings.

1 to 5 relate to an embodiment of the device of the present invention, in which FIG. 1 is a sectional view showing the ablation probe, and FIG.
-I sectional view, Figure 3 is a perspective view showing the entire sheath, Figure 4 is a perspective view showing the entire sheath.
The figure is an internal omitted cross-sectional view showing the connecting portion of the sheath, and FIG. 5 is a perspective view showing the overall configuration of the device.

As shown in FIG. 5, the ablation treatment device 1 includes a power supply box 3 provided with an operation panel 2 on the front, and an ablation probe device 6 detachably connected to the power supply box 3 through an electrical connector 4 and a water supply connector 5. , a watt switch 9 which is detachably attached to the power supply box 3 via a connector 8 provided on the cable 7, and a cleaning water tank 10 which is detachably attached to the side of the power supply box 3.

The ablation probe device 6 includes an elongated and flexible sheath 11, an ablation probe 12 connected to the tip of the sheath 11, and the electrical connector 4 and water supply connector 5 provided on the base side of the sheath 11. The sheath 11 and the ablation probe 12 at its tip can be inserted into a treatment instrument channel of an endoscope (not shown), and the ablation probe 12 is introduced into the body cavity through this channel.

A coaxial cable 13 is inserted into the sheath 11 at the center in the axial direction to energize a heating element 14 installed inside the ablation probe 12 at the tip, and the outer circumferential axis of the coaxial cable 13 inside the sheath 11 In this direction, a water supply channel 16 is formed for pumping cleaning water to a plurality of nozzles 15 formed on the outer periphery of the ablation probe 12. and,
The electrical connector 4 and water supply connector 5 on the base side of this ablation probe device 6 are connected to the power supply box 3, and the foot switch 9 also connects the connector 8 of its cable 7 to the power supply box 3, and the main power supply of the power supply box 3 is connected to the power supply box 3. switch 3
a, and with the heating amount and cleaning water supply amount setting buttons 2a and 2b provided on the operation panel 2 selected and set, press the cleaning water supply side switch 9a of the foot switch 9.
By pressing , the water pump installed in the power supply box 3 is activated, and the cleaning water in the cleaning water tank 10 is passed through the water supply channel 16 in the sheath 11 and from the nozzle 15 on the outer periphery of the ablation probe 12 at the tip. By sending water toward the affected area in the body cavity to wash away blood, etc., or by pressing the heating switch 9b side of the foot switch 9, the heating element 14 in the ablation probe 12 at the tip is transmitted via the coaxial cable 13 in the sheath 11. It can be heated to a predetermined temperature by energizing it.

In addition, the power supply box 3 has a configuration in which an electric system for the cauterization power source and a water supply system for supplying cleaning water are installed in the same box. Safety is ensured by isolating the electrical system and water supply system by separating them using an isolation chassis, and the manufacturing process can be completed by separating and assembling each prefecture and then assembling both. It also makes the process easier.

On the other hand, the elongated sheath 11 has a portion 11a that is inserted into a treatment tool channel of an endoscope (not shown) and a portion 11b that is not inserted into the channel and is exposed to the outside between the endoscope and the power supply box 3. There are different degrees of softness. The former portion 11a is formed of, for example, Teflon or the like to be substantially uniform and have a predetermined hardness and flexibility. Further, the aging portion 11b is formed to be soft so that it will not break or deform even if a large bending force is applied. Both tubes 11a and 11b are connected by a joint 11c, etc., and the joint 11c is arranged closer to the connector 4 than the part 11a inserted into the channel. Therefore, the portion 11a of the elongated sheath 11 that is inserted into the channel of the endoscope can move smoothly forward within the channel without buckling.
In addition, the portion 11b that is not inserted into the channel and is exposed to the outside will not bend or deform even if external force is applied, and the water supply channel 16 will not be crushed and blocked.

The details of the ablation probe 12 on the distal end side of the ablation probe device 6 are constructed as shown in FIGS. 1 and 2. That is, a main body 18 having a solid axial through hole 17 is connected and fixed to the distal end of an elongated flexible sheath 112, for example, a Teflon sheath, and the distal end is pressed against the wound on the outer periphery of the main body 18. A hollow cylindrical cap 19 having a hemispherical surface (arc surface) and having good heat transfer is attached and fixed as a heat transfer surface 19a for cauterizing and coagulating the wound. On the distal end side of the main body 18, there are four parts 17 connected to the through hole 17.
A is formed and the tip of the coaxial cable 13 inserted from the sheath 11 side is located, and a Zener diode, for example, as a heat generating element 14 is attached to the inner wall of the cap 19 opposite to the hemispherical heat transfer surface 19a by soldering 20. are joined,
The tip of the coaxial cable 13 and the heating element 14 are electrically connected through a power transmission coil 21. Moreover, the heating element 1
4 is biased toward the soldering 20 side by a coil spring 23 whose one end is in contact with the inner wall of the recess 17 of the main body 18 via an insulating tube 22 such as a glass tube. this is,
Since the heating element 14 reaches a temperature of about 250° C. when heated, this is to prevent the solder joining the heating element 14 from melting and making the heating element 14 unstable.

Also, in this way, the heating element 14 is connected to the coil spring 23.
As described above, the coaxial cable 13 and the heating element 14 are connected by the power transmitting coil 21 as described above.

a cap 19 having a hemispherical heat transfer surface 19a at the tip;
A non-adhesive coating 24, such as a Teflon coating (Silverstone coating), is applied to the outer periphery of the cap 19 to prevent the cap 19 from sticking to tissue. This is cap 19. The cauterization probe 12 is heated by the heat generated by the inner thigh heating element 14, and cauterizes and coagulates the bleeding part of the wound to stop the bleeding, and because it comes into direct contact with the tissue, it does not stick to the tissue or cause damage due to the cauterization probe 12. This prevents rebleeding. Furthermore, since the non-adhesive coating 24 on the outer peripheral surface of the ablation probe 12 is formed on a cap 19 that is separate from the main body 18, after applying the non-adhesive coating 24 to one cap, the cap 19 is
is assembled to the heating element 14 and the main body 18 side. Therefore, there is no possibility that the heating element 141, for example, the Zener diode, will be destroyed or deteriorated. However, in the past, the structure was such that non-adhesive coating was performed after joining the hemispherical tip and the main body, so the baking temperature of the non-adhesive coating exceeded 400°C, which destroyed the internal diode. There were problems such as deterioration.

A plurality of nozzles 15 on the outer periphery of the ablation probe 12 are formed in straight portions of the main body 18 and the cap 19. This nozzle 15... is formed in a groove shape in the direction of the outer circumferential axis, and the rear end side is linearly connected to the water supply channel 16 formed in the sheath 11, while the output side is directly connected to the water supply channel 16 formed in the sheath 11. It rises in a gentle arc shape, and the output angle θ is 15
It is formed at a temperature of 16 degrees to 16 degrees. Further, the distance from the nozzle output end to the tip of the probe 12 is set to be greater than or equal to the radius of curvature of the hemispherical heat transfer surface 19a of the probe 12. Nozzle 1
5 is formed in this way, the cleaning water emitted from the nozzle 15 is transferred to the cauterization probe 12.
The water can be flowed in a straight line along the outer circumferential axis direction and can be sent straight ahead of the probe 12. This makes it easy to aim at the area to be cleaned, and the water is sent in a hemispherical shape. It is also prevented from going around the heat transfer surface 19a.

Note that a heat radiation groove 188 for cooling is formed in the main body 18.

FIG. 6 shows a modification of the invention. This is an application of the hemostasis device of the present invention to an ultrasound endoscope. In FIG. 6, reference numeral 31 is an ultrasonic probe disposed at the tip of the insertion portion 33 of the endoscope 32, and 34 is a channel, into which the ablation probe device 6 according to the present invention is inserted. When used in this modified example, the area where bleeding has been stopped by the ablation probe 12 can be confirmed by ultrasound image processing. As a result, protein denaturation can be confirmed in real time, and the ablation depth can be confirmed by images.

FIG. 7 shows a modification of the heat generating member of the ablation probe according to the present invention. In this modification, a quartz fiber 41 is axially inserted into the sheath 11 in place of the Zener diode 14 as the heat generating element according to the above embodiment, and its tip is connected to the inner surface of the hemispherical cap 19 as a heat conduction part. A laser is transmitted through the fiber 41, and the laser is emitted to the cap 19, causing the cap 19 to generate heat. With this configuration, the cap 19 is instantaneously heated and bleeding can be stopped quickly, and high frequency electricity is not used, so it is safer, and the fiber 41 is not exposed to the outside, so it has excellent durability. In Figure 7 (
A) shows a basic example, (B) shows a hemispherical cap 19 with a uniform wall thickness so that heat is generated evenly, and (C) shows a hemispherical end surface of the fiber 41. The laser is emitted in a diffused manner, and (D) the tip of the fiber 41 is formed into a concave surface so that the laser is emitted in a diffused manner.

[Effects of the Invention] As explained above, according to the present invention, even if an external force is applied to the sheath in the region that is not inserted into the channel of the endoscope or a bending force due to the operation of the operator is applied, the sheath in that region remains intact. It does not break or deform, and as a result, it has the effect of widening the operator's range of action during use and improving operability.

[Brief explanation of the drawing]

1 to 5 relate to one embodiment, FIG. 1 is a cross-sectional view showing the ablation probe, FIG. 2 is a cross-sectional view taken along the line II in FIG. 1, and FIG. 3 is an overall view showing the sheath. Fig. 4 is a cross-sectional view showing the sheath joint, Fig. 5 is a schematic view showing the entire device, and Fig. 6 is a sectional view showing the joint part of the sheath.
FIG. 7 and FIG. 7 are cross-sectional views showing modified examples. 6... Cauterization probe 11... Sheath 11
a... Sheath at the insertion site

Claims (1)

[Claims] A cautery probe is provided at the tip of an elongated sheath through which a treatment instrument channel of an endoscope can be inserted, and a heat generating member is disposed within the probe to make the tip surface of the probe a heat transfer portion.
In the case where a liquid passage is provided in the sheath from the base side to the probe, the part inserted into the channel of the sheath is formed to have substantially uniform hardness and flexibility, and the part inserted into the channel of the sheath is formed to have substantially uniform hardness and flexibility. A cautery hemostasis device characterized by having a soft part that is exposed to the outside without being inserted through the body.