KR100777992B1 - High-frequency treatment tool - Google Patents

Abstract

Treatment instrument that forms a flexible sheath that can be inserted into the treatment instrument insertion channel of an endoscope and a high frequency knife provided inside the flexible sheath to apply a high frequency current to the tip of the flexible cord. In the high frequency treatment instrument configured from the main body, a rigid cylinder having electrical insulation is inserted and fixed in the flexible sheath such that the front end face is substantially coplanar with the front end face of the flexible sheath. The high frequency knife is provided with a plurality of blade portions radially having an engaging portion at a predetermined position in the axial direction. When the high frequency knife protrudes from the hard cylinder, the engaging portion and the hard portion of the blade portion are provided. By contacting the rear end of the cylinder, the high-frequency knives are engaged, and between adjacent blades Group Is obtain high frequency treatment, it characterized in that the configuration is formed of the communicating passage communicating the inside and outside of the property system.

High frequency treatment instrument, flexible sheath, hard cylinder, blade part

Description

High frequency treatment instrument {HIGH-FREQUENCY TREATMENT TOOL}

1 is an overall configuration diagram of a high frequency treatment instrument showing an embodiment of the present invention.

FIG. 2 is an enlarged cross-sectional view of the main portion of FIG. 1. FIG.

3 is an enlarged cross-sectional view of a tip portion of the treatment instrument body.

FIG. 4 is a cross-sectional view similar to FIG. 3 shown with the electrode member protruding.

5 is a front view of the stopper wall.

6 is a cross-sectional view taken along line X-X of FIG. 5.

7 is a front view of FIG. 4.

8 is an enlarged cross-sectional view of the main part of FIG. 1.

9 is an enlarged cross-sectional view of a tip portion of the high frequency treatment instrument.

10 is a front view of the high frequency treatment instrument.

It is sectional drawing similar to FIG. 9 which showed the state where the high frequency knife was drawn in to the base end side by the drawing member.

It is sectional drawing similar to FIG. 9 which shows the state in which the rod-shaped electrode of the high frequency knife was guided to the drawing member.

It is a top view of a high frequency knife.

It is a front view of a high frequency knife.

Fig. 15 is an external view showing a state in which the high frequency treatment instrument showing the embodiment of the present invention is derived from the treatment instrument insertion channel of the endoscope.

Fig. 16 is a plan view showing a state where marking is performed on the lesion mucosa area.

17 is a cross-sectional view of a tissue showing a state in which local injection is performed on the lesion mucosa area.

It is explanatory drawing about the area which occupies an annular end wall.

19 is a cross-sectional view of a tissue showing a state where an incision is being made using a radiofrequency treatment instrument.

20 is a plan view including a lesion mucosa area showing a state where the incision by the radiofrequency treatment instrument is completed.

It is sectional drawing of the structure which shows the state which is performing mucosal peeling.

The present invention relates to a high frequency treatment instrument inserted in a treatment instrument insertion channel of an endoscope and used to perform a procedure such as incision of a lesion mucosa.

When a lesion such as a tumor is found in the mucosal part of the inner wall of the body cavity such as the esophagus, stomach, duodenum, or large intestine by endoscopy, a procedure of excision of the site of the lesion mucosa is performed using a high-frequency treatment instrument. In this case, in order to ensure the safety of the treatment, the treatment is performed under an endoscope observation, but the high frequency treatment instrument used is inserted into the treatment instrument insertion channel of the endoscope so as to be guided to the site to be treated. Here, in the body cavity inner wall, the lower mucosal layer exists below the mucosal layer, and the near layer is covered by this lower mucosal layer. And the treatment which cuts and removes a lesion mucosal layer using a high frequency treatment tool must leave no lesion part, and must also inflict inferior damage to a near layer.

The high frequency treatment tool used for the incision of the mucosa layer is constituted by mounting a high frequency knife made of an electrode member having a rod in the flexible sheath, and an operation means is connected to the proximal end of the flexible sheath, and the high frequency is operated by remote operation by the operation means. The knife can be controlled so that it is raised and dropped from the tip of the flexible sheath. By energizing the high frequency knife which protruded from a flexible sheath, a mucosa can be cauterized and cut | disconnected.

As a structure of the electrode member which comprises a high frequency knife, the needle-shaped knife which extended the rod-shaped electrode member straight, and the large-diameter electrode part was extended to the tip of the rod-shaped electrode member, or the tip was bent to approximately L shape. There is a hook knife that forms a hook portion. The needle knife is operated to pierce the mucosa, and the mucosa and the like can be cut by horizontally moving or swinging the electrode member. On the other hand, the hook knife is incised by operating such that the tissue such as the mucosa is caught at the hook portion at the tip and pulled into the insertion portion side of the endoscope.

As described above, this high frequency knife must be kept in a non-contact state with respect to the near floor at the time of energization of the high frequency knife. In the case of using a needle knife, the needle knife is located in front of the flexible sheath, and since the needle is punctured by the mucosa, the tip of the needle knife may not be captured by the endoscope observation field during the treatment. . Therefore, the safety of the treatment cannot be secured unless the protruding length from the flexible sheath of the needle knife and the direction thereof are accurately controlled.

On the other hand, the hook knife is made to hook the hook knife to the mucosa or the like under the observation of the endoscope, and then the mucosa is cut by operating to be introduced into the treatment instrument insertion channel while flowing a high frequency current through the hook knife. Therefore, while the hook knife is being operated, the tip portion of the hook knife can always be performed under the observation of the endoscope, so that it can be operated so that it does not come into contact with the near floor when it is in the energized state.

However, in the case of using a hook knife, the stability of the tip portion of the hook knife must be obtained in order to smoothly perform the operation of catching the tissue such as the mucous membrane. Therefore, it is proposed by Unexamined-Japanese-Patent No. 2004-313537 with the structure provided with the mechanism which aims at stabilizing the hook knife at the time of operation. The high frequency treatment tool of JP-A-2004-313537 discloses an electrical insulation member attached to the tip of a flexible sheath, forms a hole in the electrical insulation member, and constitutes a hook knife. The rod-shaped portion is inserted into the through hole, and the hook portion at the tip end is able to contact and detach from the tip outer surface of the electrical insulation member. In the case of energization, the electrode member protrudes from the flexible sheath for a predetermined length, but the diameter difference between the hole diameter of the perforation and the outer diameter of the electrode member is minimized, and the electrode member is stably held by regulating the protruding length of the electrode member. I make it a constitution.

In addition, bleeding may occur during the procedure of dissecting the lesion using the electrode member described above, and there is a concern that the lesion may not be identified. Therefore, by forming an opening separate from the hole for inserting the electrode member in the electrical insulation member or making the hole cross-shaped or triangular, the rod-shaped portion of the electrode member cannot enter, i.e., closes in the electrode member. It does not form a liquid outflow. A syringe can be connected to the base end of the flexible sheath to fill the syringe with physiological saline, and the syringe can be rinsed by flushing the physiological saline from the liquid outlet toward the bleeding portion.

However, in the method of Japanese Patent Laid-Open No. 2004-313537, the hook knife constituting the electrode member is applied to the mucosa or the lower layer of the mucosa so as to be drawn into the treatment instrument insertion channel, and then the tissue is cauterized by energizing the hook knife. Since the operation of cutting and cutting the hook knife from the treatment instrument insertion channel is repeated, the operation is complicated and difficult, and the efficiency of the operation is not achieved. Therefore, a long time is required for the procedure for removing the lesion mucosa, and there is a fear that the pain of the subject and the burden on the operator increase. In addition, the hook portion is always exposed to the outside, and there is also a problem such as damaging the inner wall of the channel if the electrode member is inadvertently energized while performing an operation of inserting into the treatment instrument insertion channel, for example.

In addition, the electrically insulating member provided at the tip of the flexible sheath is provided with a plurality of perforations or complicated complex perforations to form a fluid outlet portion which cannot enter the electrode member. Here, the electrical insulation member needs to be formed with good heat resistance, and for this reason, although it is preferable to form with ceramic, there also exists a problem that it is difficult to form the perforation of the shape mentioned above in this ceramic.

This invention is made | formed in view of the above point, The objective is to enable safe and efficient treatment by the high frequency treatment instrument of the simple structure which used the needle knife.

In order to achieve the above object, the present invention provides a flexible sheath insertable into the treatment instrument insertion channel of the endoscope, and a high frequency knife provided inside the flexible sheath for applying a high frequency current to the tip of the flexible cord. A high frequency treatment instrument comprising a treatment instrument body, wherein a rigid cylinder having electrical insulation is inserted and fixed in the flexible sheath so that the front end face is substantially flush with the distal end surface of the flexible sheath. A plurality of blade portions having engaging portions at predetermined positions in the axial direction are provided radially, and when the high frequency knife protrudes from the hard cylinder, the engaging portion of the blade portion and the rear end portion of the hard cylinder come into contact with each other. Bite and said flexible between adjacent blade sections It characterized by a configuration that the communication path is formed to communicate the inside and outside of the switch.

As a 1st Embodiment of this invention, the said hard cylinder has a hole diameter larger than the outer diameter of the said high frequency knife, The rear end part of the said hard cylinder forms the taper surface shape which inclines inward toward the inner peripheral edge from the outer peripheral side, The said blade The shear surface of the portion forms an inclined portion corresponding to the tapered surface of the hard cylinder as the engaging portion, and when the high frequency knife projects from the hard cylinder, the inclined portion of the blade portion and the tapered surface of the hard cylinder contact each other. Is interlocking.

The rigid cylinder fixedly provided to the flexible sheath is a cylindrical member in which a through hole having a hole diameter into which a high frequency knife is inserted is formed, the rear end of which is a tapered surface, and has an extremely simple shape. Here, the taper surface which comprises the rear end surface of a hard cylinder functions as an insertion taper surface for drawing a high frequency knife into a through hole. Therefore, a tapered surface may be formed from the outer peripheral edge of a hard cylinder, and a tapered surface may be formed from the middle. However, the distance from the outer peripheral edge to the tapered surface must be shorter than the radius of the tip end portion of the high-frequency knife, and the tapered surface must be provided to the inner peripheral edge.

The high frequency knife is provided with a stopper projection as a blade portion at a position deviated by a predetermined interval from the tip thereof. Two or more of these stopper protrusions are provided, Preferably, three places are provided at 120 degree intervals, or four places are provided at 90 degree intervals. The stopper projection is in contact with and separated from the tapered surface of the rigid cylinder. When the high frequency knife protrudes from the flexible sheath, the stopper projection and the tapered surface are in surface contact and function as a stopper for regulating the protruding length from the front end surface of the flexible sheath. In addition, the high frequency knife is reliably guided toward the center axis position of the flexible sheath, and has a function to stably hold the center axis line. In addition, even when the stopper projection is in the maximum protruding state in contact with the proximal end of the hard cylinder, the inner diameter of the hard cylinder is pumped or sucked toward the site where the treatment is performed on the sites of the stopper protrusions adjacent to each other. Communication paths are formed. Moreover, although it is preferable that the inclination angle of a stopper front end surface and the taper angle of a hard cylinder correspond substantially, there may be some difference in angle unless the function mentioned above is impaired.

As described above, the rigid cylinder is formed of an electrical insulation member, but heat resistance is also required. Therefore, although this hard cylinder can be formed from synthetic resin, since it is a simple cylindrical member, it is not necessary to make workability into a requirement of a raw material. For this reason, even if it is a ceramic which is difficult to process, a hard cylinder can be formed easily. On the other hand, the stopper protrusion is a hard member, but it is not necessarily formed of an electrically insulating member. Thus, for example, it can be formed of a metal material that is easy to process.

By making the front end face of the flexible sheath and the hard cylindrical shearing plane coplanar, an annular end wall serving as a contact surface to the body cavity inner wall is formed. When the treatment instrument main body is brought into contact with the body cavity inner wall, it is necessary to ensure a large area of the annular end wall in order to make the surface pressure as small as possible. In this respect, it is preferable to make the hole diameter of the hard cylinder as small as possible. Although a communication path is formed between the inner surface of the hard cylinder and the outer surface of the high-frequency knife, the communication path is formed at the site of the stopper protrusion adjacent to each other, but the passage area of the communication path is preferably larger. For this reason, it is advantageous to enlarge the internal diameter of a hard cylinder. In order to satisfy the above conflicting requests, in the circle constituting the outer diameter of the flexible sheath, the annular end wall occupies 65 to 90% of the total area, more preferably about 80%.

As a 2nd embodiment of this invention, the said high frequency knife is provided with the rod-shaped electrode which can be inserted in the form inserted loosely in the said hard cylinder, and the said some blade part provided in the base end side of the said rod-shaped electrode, and each of these said blade parts The outer surface has a size that is almost in contact with the inner circumferential surface of the hard cylinder, and at the base end has a stopper surface projecting to the outer circumferential side than the hole diameter of the hard cylinder, when the high-frequency knife protrudes from the hard cylinder, The stopper surface is in contact with the end face of the hard cylinder to engage the high frequency knife.

As described above, the rigid cylinder is made of a cylindrical shape having an extremely simple shape, and the rigid cylinder can be easily formed of, for example, a ceramic material. In addition, this rigid cylinder does not necessarily need to be formed of a ceramic material, but may be formed of a synthetic resin or the like having good heat resistance. On the other hand, the high frequency knife is composed of a conductive member, and the rod-shaped electrode, the blade portion, and the stopper surface are integrally formed of a metal material which is easy to process.

By indenting the flexible cord in the flexible sheath, the high-frequency knife can be displaced in a state of accommodating the inside of the flexible sheath and protruding from the tip of the flexible sheath. When the high frequency knife protrudes a predetermined amount, the stopper surface comes into contact with the basic end face of the hard cylinder, so this position becomes the maximum protruding position of the high frequency knife, and the treatment such as cutting is performed in this state. Therefore, the protruding length of the rod-shaped electrode of the high frequency knife in this largest protrusion position is set so that it may become optimal according to a treatment site | part. For example, when the mucosal detachment is performed, the protruding length of the rod-shaped electrode is longer than the thickness of the mucosa and shorter than the total thickness of the mucosa and the mucosa underlayer. As a result, safety is ensured when the treatment is performed, and the remaining of the lesion mucosa can be eliminated.

In the high frequency knife, a plurality of blade parts are provided on the proximal end of the rod-shaped electrode, and the outer surface of each of the blade parts substantially contacts the inner surface of the hard cylinder, so that the high frequency knife is aligned with the flexible sheath to generate vibrations or the like. It remains stable without work. Therefore, from this point, it is preferable to increase the number of blade portions and to make the width dimension as wide as possible. However, the spacing between the blade portions adjacent to each other is a communication path for communicating the inside of the flexible sheath to the outside thereof, and the fluid is supplied from the body, such as saline solution, or sucked from the body. In order to enlarge the passage area of the communication path, the number of blade portions must be reduced, and the width thereof must be narrowed. At least two blade portions are provided, but preferably three portions at 120 ° intervals or four at 90 ° intervals. In addition, the width | variety dimension of a blade part shall be made into the minimum width | variety in that stability is not impaired based on the external force acting on a high frequency knife when performing procedures, such as an incision. Moreover, in the stability of a high frequency knife, it is preferable to make the outer surface of each blade part slide contact with the inner wall of a hard cylindrical through-hole. However, in order to be able to insert and remove a high frequency knife to a hard cylinder easily, some clearance may arise between them.

When a high frequency knife is drawn in a flexible sheath, it may be located from the hard cylinder to the base end side. In this case, in order to guide the front-end | tip of a rod-shaped electrode smoothly and reliably to the through-hole of a hard cylinder, an introduction member may be attached to the base end side position of a hard cylinder. This lead-in member is a ring-shaped member whose taper surface is inclined toward the distal end side of its proximal end side. And this pull-out member shall have an internal diameter which can insert a high frequency knife. In addition, since this lead-in member is not exposed to the outside, it is not necessary to necessarily form it as an electrical insulation member, and it can form easily with a plastic material, a metal material, etc.

The distal end face of the flexible sheath and the distal end face of the rigid cylinder are substantially coplanar, whereby an annular end wall serving as a contact surface to the body cavity inner wall is formed. In order to make the surface pressure as small as possible when the treatment instrument main body is brought into contact with the body cavity inner wall, it is necessary to secure a large area of the short wall. From this point of view, the hole diameter of the hard cylinder is preferably as small as possible. On the other hand, the communication path is formed in the part of the blade part adjacent to each other in the through-hole of a hard cylinder, The passage area of this communication path is preferably larger. Therefore, in consideration of these, the inner diameter of the rigid cylinder is appropriately set.

EMBODIMENT OF THE INVENTION Hereinafter, embodiment of this invention is described based on drawing. First, the whole structure of the high frequency treatment tool is shown in FIG. 1, and the high frequency treatment tool main part enlarged cross section of 1st Embodiment is shown in FIG. 8, the main part enlarged cross section of the high frequency treatment tool of 2nd Embodiment is shown.

First, in FIG. 1, FIG. 2, and FIG. 8, 1 is a high frequency treatment tool, This high frequency treatment tool 1 has a long flexible sheath 2, and the The connection pipe 3 is connected to the base end, and the operation means 4 is connected to the other end of this connection pipe 3. The operation means 4 is comprised by the main-body shaft 4a connected to the connection pipe 3, and the slider 4b fitted in this main-body shaft 4a and slidably installed in the axial direction of the main-body shaft 4a. The base end part of the flexible cord 11 which comprises the treatment instrument main body 10 is connected to the slider 4b, and is formed.

[First embodiment]

Hereinafter, 1st Embodiment is described.

3 and 4 each show a cross section of the tip portion of the radiofrequency treatment instrument in different operating states. The flexible cord 11 is made by inserting the outer peripheral part of the electrically conductive wire part 11a into the insulation coating 11b, for example, as is clear from FIG. 3, and has the flexibility in the bent direction at least. The proximal end of the conductive wire portion 11a in the flexible cord 11 protrudes a predetermined length from the connection portion to the slider 4b, and the contact portion 12 is formed. And this contact part 12 is detachably connected to the high frequency power supply device which is not shown in figure.

The flexible cord 11 constituting the treatment instrument body 10 extends into the flexible sheath 2 from inside the connecting pipe 3 from the installation portion to the slider 4b. And the needle-like knife 13 is provided from the front-end | tip part of the flexible sheath 2 so that a piercing is possible. The needle knife 13 is preferably made of a hard needle or rod-shaped conductive member having a predetermined length of which the tip is spherical, that is, it does not have a hook portion, and has a conductive portion 11a of the flexible cord 11. It is electrically connected, and the predetermined length portion is exposed to the outside. At the time of energization, the portion acts on the internal tissues, cauterizes the tissues, and the treatment such as incision is performed.

20 is a hard cylinder, and this hard cylinder 20 consists of a hard member inserted and fixed to the front-end | tip of the flexible sheath 2, and consists of a member which has electrical insulation and heat resistance, Preferably it is a ceramic. Although the outer surface of the hard cylinder 20 is few, three step | step surfaces with a diameter difference are formed, respectively, and a front end side is the smallest diameter, and a rear end part is the largest diameter. And an adhesive agent adheres between the outer surface of this hard cylinder 20 and the inner surface of the flexible sheath 2, and the hard cylinder 20 is the tip of the flexible sheath 2 by the action of this adhesion | attachment and the outer surface. It is fixed so as not to fall toward the side.

The through-hole 21 is formed in the hard cylinder 20, and the front end surface 20a becomes the surface orthogonal to the axis line, and this front end surface 20a is the front end surface of the flexible sheath 2 ( The plane which is substantially the same as 2a) is formed, and the annular end wall P is formed by these end surfaces 2a and 20a. The hole diameter of the through-hole 21 of the hard cylinder 20 is larger than the outer diameter of the needle-knife 13, and therefore the needle-knive 13 is inserted in the state fitted loosely with respect to this through-hole 21. As shown in FIG.

As illustrated in FIG. 3, the needle knife 13 is displaceable in a state in which it is drawn from the hard cylinder 20 to the proximal end side, and as shown in FIG. 4, in a state of protruding a predetermined length from the annular end wall P. FIG. It is. And the rear end surface 20b of the hard cylinder 20 becomes a taper surface so that the front-end | tip part of the needle knife 13 can be reliably drawn in the inside of the hard cylinder 20. As shown in FIG. The tapered surface of the rear end surface 20b is inclined inward from the outer peripheral side toward the inner peripheral edge, and the predetermined width portion of the outer peripheral edge portion is rounded. And the width | variety of the part which has this round is made into the radius of a needle-shaped knife or less. Therefore, when the needle knife 13 is operated to be extruded from the tip of the flexible sheath 2, the tip end of the needle knife 13 is placed on the tapered surface constituting the rear end surface 20b of the hard cylinder 20. It is guided and is oriented in the direction of the center axis of this hard cylinder 20.

The needle knife 13 is provided with a stopper protrusion (blade portion) 22 at a position in which only a predetermined distance from the tip end is biased toward the proximal end. As shown in Figs. 5 and 6, the stopper protrusion 22 protrudes radially in three places with 120 ° phases on the outer circumferential portion of the needle knife 13, and the protruding height thereof is that of the flexible sheath 2. It is lower than an inner peripheral surface and is higher than the inner peripheral edge of the through-hole 21 formed in the hard cylinder 20 at least. Each stopper projection 22 has a predetermined thickness, and the front end surface 22a is an inclined surface that protrudes toward the front end side of the high frequency treatment instrument 1. The inclination angle of the front end face 22a of the stopper protrusion 22 almost corresponds to the inclination angle of the rear end face 20b of the hard cylinder 20. Here, the stopper protrusion 22 is made of a metal member such as stainless steel provided integrally with the cylinder 23 fitted to the needle knife 13, and the cylinder 23 is attached to the needle knife 13 by means of welding or the like. It is fixed and installed.

Therefore, as apparent from Fig. 4, when the needle knife 13 protrudes a predetermined length from the tip of the flexible sheath 2, that is, from the annular end wall P, the front face 22a of the stopper protrusion 22 becomes hard. It comes into substantial surface contact with the rear end face 20b of the cylinder 20, and this position becomes the maximum protruding position of the needle-like knife 13. Here, in the largest protrusion position of the needle knife 13, the space | interval from the annular end wall P to the tip of the needle knife 13 is larger than the thickness of the mucosa in the body cavity inner wall, and the thickness of the sum total of the mucosa and the mucosa lower layer. It is set to be smaller.

Then, when the needle knife 13 is in the maximum protruding position, as shown in FIG. 7, the needle knife 13 is based on the difference in diameter between the outer circumference of the needle knife 13 and the hole diameter of the hard cylinder 20 through hole 21. Three communication paths 24 are formed in a portion between adjacent stopper protrusions 22 and 22. The connection pipe 3 provided at the proximal end side portion of the high frequency treatment instrument 1 has a connection port 3a, and a syringe or suction pipe for supplying a liquid such as physiological saline solution is connected to the connection port 3a. have.

Second Embodiment

Hereinafter, 2nd Embodiment is described.

As shown in FIG. 8, the flexible cord 11 has the electrically conductive wire part 11a which consists of the flexible member by which the outer peripheral part was insulation-coated, The base end of this electrically conductive wire part 11a is predetermined length from the connection part to the slider 4b. It protrudes and is provided, The contact part 12 is provided in the base end part, This contact part 12 is detachably connected to the high frequency power supply device which is not shown in figure. As shown in FIG. 9, the hollow wire 11b is connected to the front-end | tip of the conductive wire part 11a. The hollow wire 11b is made of a conductive member having flexibility in the bent direction, and its outer circumferential surface is covered with an insulating member. Therefore, the electrically conductive wire part 11a and the hollow wire 11b are electrically conductive, and the outer surface is insulated.

The flexible cord 11 which consists of the conductive wire part 11a and the hollow wire 11b passes through the inside of the connection pipe 3 from the installation part to the slider 4b, and is extended in the flexible sheath 2. In addition, a high frequency knife 113 is provided at the distal end of the flexible sheath 2 so that it can be projected. The high frequency knife 113 is preferably made of a hard needle or rod-shaped conductive member having a predetermined length of which the tip is spherical, that is, a rod-shaped electrode 14 having no hook portion, and an outer peripheral portion of the rod-shaped electrode 14. It is composed of a blade unit 15 provided to. The proximal end of the rod-shaped electrode 14 is inserted into the hollow wire 11b of the flexible cord 11, so that the high-frequency knife 113 contacts the hollow wire 11b and the conductive wire portion 11a through the contact portion. It is electrically connected with (12). In this high frequency knife 113, a predetermined length portion is exposed to the outside from the flexible sheath 2, and at the time of energization, the portion acts on the internal tissues to cauterize the tissues, and treatment such as incision is performed.

As shown to FIG. 9 and FIG. 10, the hard cylinder 120 is inserted and fixed to the front-end | tip part of the flexible sheath 2. This rigid cylinder 120 is composed of a member having good electrical insulation and heat resistance, preferably of a ceramic material. The outer surface of the hard cylinder 120 is provided with the spiral protrusion 120a, and this hard cylinder 120 is thus to be screwed into the flexible sheath 2. In addition, an adhesive is interposed between the outer surface of the rigid cylinder 120 and the inner surface of the flexible sheath 2, and the hard cylinder 120 is formed by the action of the protrusion 120a on the outer surface of the flexible sheath 2. It is fixed so as not to fall toward the tip side.

The hard cylinder 120 is perforated so that the through hole 121 for piercing the high frequency knife 113 penetrates in the axial direction. Moreover, the both end surfaces of the hard cylinder 120 are a surface orthogonal to the axis line. This rigid cylinder 120 is inserted to the position where the front end surface becomes substantially the same plane as the front end surface of the flexible sheath 2, and therefore, the front end surface of these flexible sheath 2 and the hard cylinder 120 is thus inserted. As a result, the distal end face of the flexible sheath 2 is configured to have an annular end wall P. FIG. The hole diameter of the through hole 121 of the hard cylinder 120 is larger than the outer diameter of the high frequency knife 113, so that the rod-shaped electrode 14 of the high frequency knife 113 is loosely fitted with respect to the through hole 121. Will be inserted.

At the proximal end of the rigid cylinder 120, an inlet member 122 is mounted to allow the high-frequency knife 113 to be reliably drawn into the through hole 121 from a position at the proximal end side than the through hole 121. The drawing member 122 is a ring-shaped member made of stainless steel or the like, and its basic end face is a tapered surface 122a inclined toward the tip side from the outer circumferential side toward the inner circumferential side. 113 is introduced into the through hole 121. That is, the high frequency knife 113 is drawn in from the hard cylinder 120 to the proximal end side normally, as shown in FIG. 11, From this state, as shown in FIG. 12, the through-hole along the tapered surface 122a ( Guided toward the direction of 121, the tip of the rod-shaped electrode 14 is guided in the through hole 121. The portion having the smallest diameter of the tapered surface 122a is sized to allow the high frequency knife 113 to pass therethrough. Moreover, the recessed part 122b is formed in the front-end | tip side from the minimum neck part of the pulling-in member 122, and the annular cross section which becomes the large diameter formed by this recessed part 122b is formed in the basic cross section of the hard cylinder 120. FIG. Is in contact. Therefore, the site | part of the inner side in the cross section of the hard cylinder 120 is exposed. As a result, the stopper surface 15c formed in the blade portion 15 of the high frequency knife 113 comes into reliably contacting the basic end face of the hard cylinder 120.

The rod-shaped electrode 14 of the high frequency knife 113 can flow a high frequency current by supplying power from the contact portion 12 through the conductive wire portion 11a and the hollow wire 11b in the flexible cord 11. It is. As shown in FIG. 13 and FIG. 14, the rod-shaped electrode 14 consists of a straight-line conductive member which has a predetermined length, and the front-end | tip is spherical shape. Moreover, four blade parts 15 are provided in the position of the base end side of the rod-shaped electrode 14 at the angle of 90 degrees mutually, and these blade parts 15 protrude radially toward the outer side. The front end surface 15a of the blade portion 15 is an inclined surface for guiding the blade portion 15 to the through hole 121 of the hard cylinder 120, and the outer surface 15b of the blade portion 15. In the circumferential direction, the circular arc shape almost coincides with the curvature of the through hole 121, and has a predetermined length. Therefore, when the high-frequency knife 113 is inserted into the through hole 121 of the hard cylinder 120, the outer surface 15b of the four blade portions 15 provided is brought into substantially sliding contact with the inner surface of the through hole 121. do. As a result, the high frequency knife 113 is aligned with respect to the axis of the hard cylinder 120, and it is stably maintained so that it may not indiscriminately shake even if an external force acts on the front-end | tip part of this rod-shaped electrode 14.

Moreover, the step | step with which the site | part of the base end side of the blade part 15 becomes high height is formed, and this step wall becomes the stopper surface 15c. The stopper surface 15c enters the position where the stopper surface 15c comes into contact with the basic end surface of the hard cylinder 20 when the high frequency knife 113 is inserted into the through hole 121 of the hard cylinder 120. It is possible, and it is impossible to protrude more. That is, the stopper surface 15c defines the maximum protruding length from the flexible sheath 2 of the rod-shaped electrode 14 in the high frequency knife 113. And the high frequency treatment instrument 1 is used as a treatment for peeling the lesion mucosa in the body cavity inner wall, and constitutes the tip of the flexible sheath 2 in the rod-shaped electrode 14 of the high frequency knife 113. The maximum protrusion length from the annular end wall P to be set is longer than the thickness of the mucosa in the body cavity inner wall and shorter than the total thickness of the mucosa and the mucosa lower layer.

When the high frequency knife 113 is at the maximum protruding position, as is apparent from FIG. 10, the diameter difference between the outer diameter of the shaft portion of the high frequency knife 113 and the outer diameter and the hole diameter of the through hole 121 of the hard cylinder 120 is shown. Based on this, four substantially fan-shaped communication paths 123 are formed at portions between the blade portions 15 and 15 adjacent to each other. And the connection pipe 3 provided in the proximal end side part of the high frequency treatment tool 1 has a connection port 3a, and the connection port 3a is connected with the syringe which supplies liquids, such as a physiological saline solution, a suction pipe, etc. It is supposed to be. Therefore, when the syringe filled with physiological saline is connected to the connection port 3a, and the high frequency knife 113 operates this syringe in the state of maximum protrusion from the hard cylinder 120, the rod-shaped electrode ( Physiological saline is sprayed from around 14). In addition, when the suction pipe is connected, suction from the communication path 123 becomes possible. Moreover, even if the high frequency knife 113 is arrange | positioned from the hard cylinder 20 to the base end side, supply and aspiration of a liquid are attained.

The high frequency treatment instrument 1 having the above configuration is inserted into the body cavity through the treatment instrument insertion channel C provided to the endoscope insertion portion S having the observation portion W, as shown in FIG. When the lesion mucosa is present on the inner wall of the body cavity, the duodenum and the large intestine, it is used to perform the procedure of exfoliating and removing the lesion mucosa. Therefore, an example of the treatment which removes this lesion mucosa is demonstrated. This treatment is performed when, for example, an endoscopy shows that a lesion is present in the mucosa.

Therefore, as shown in FIG. 16, it marks so that the lesion mucosa area | region D may be enclosed in the mucosa in which the lesion part D to be excised exists. This marking area | region can remove a lesion part completely, and also it is the range which does not damage as much as possible about a healthy mucous membrane part. The marking can be performed, for example, by performing a cauterization spot B at a necessary location around the lesion mucosa region D. In order to form this cauterization spot B, the high frequency treatment instrument 1 can be used. have. That is, the tip of the endoscope insertion portion S is faced with a predetermined distance to the outer edge portion of the lesion mucosa region D, and the high frequency treatment instrument 1 is inserted into the treatment instrument insertion channel C in this state. The tip is inserted into contact with the mucosal surface. At this time, the needle knife (high frequency knife) 13 is drawn into the proximal end side position by the hard cylinder 20 as shown in FIG. 3 and FIG. No member also protrudes from the annular end wall P constituting the tip of the high frequency treatment instrument 1, and the annular end wall P is in surface contact with the mucosal surface.

In this state, the operation means 4 of the high frequency treatment tool 1 is operated to protrude the needle knife 13 and 113, and in the second embodiment, for example, the rod-shaped electrode 14 in the high frequency knife 113. The tip of the guide is guided to the tapered surface 122a of the drawing member 122, and is guided in the through hole 121 of the hard cylinder 120 reliably after passing through the state of FIG. When a high frequency current is applied to the high frequency knife 113 in this state, the site | part which the high frequency knife 113 in a mucous membrane contacts is cauterized, and marking is performed. Here, when performing this marking, the needle knife 13 and 113 do not need to penetrate the mucosa layer, and the mucosal surface is to the extent that can be recognized by the image obtained from the observation portion W by the endoscope insertion portion S. You can let them cauterize. That is, marking is formed when the needle knife 13, 113 is in contact with the mucosal surface. Of course, even if the needle knife 13, 113 is in the position which protrudes most from the flexible sheath 2 by making the operation means 4 full stroke, There is no fear of contact with the near floor. In addition, if marking can be performed using another treatment tool and the area | region to be cut off in the mucosa can be recognized by the observation part W, it is not necessary to employ the technique of cauterization as mentioned above.

Next, as shown in FIG. 17, a local injection of physiological saline is performed inside the lesion mucosa area | region D. Then, as shown in FIG. For this reason, the high frequency treatment instrument 1 is taken out from the treatment instrument insertion channel once, and a local injection means provided with the needle N at the tip of the flexible tube is inserted into the treatment instrument insertion channel C instead. Here, the submucosal layer LM exists between the muscle layer LB and the mucosal layer LU, and the needle N penetrates the mucosal layer LU to the lower mucosal layer LM to inject physiological saline. As a result, the mucosa lower layer LM expands and rises. The swelling of the mucosa lower layer LM is thus performed in order to separate the mucosa layer LU from the muscle layer LB and to perform the treatment smoothly and safely.

After sufficiently swelling the mucosa lower layer LM, the local scanning means is extracted from the treatment instrument insertion channel C, and the high frequency treatment instrument 1 is reinserted. And the annular end wall P formed from the flexible sheath 2 of the high frequency treatment tool 1, and the front end surfaces 2a and 20a of the hard cylinder 20 is attached to the outer edge of the lesion mucosa area D. Contact with one. Here, the annular end wall P is directly faced to the mucosa layer LM, and the annular end wall P is pressed lightly against the mucosa surface, and the pressing force is not exerted by the maximum force.

Here, in order to prevent the mucous membrane layer LM from being pressurized and deformed when the tip of the high frequency treatment tool 1 is pressed against the mucosa surface, the area of the annular end wall P needs to be widened. However, the needle-knives 13 and 113 must have a certain thickness from the point of the strength, and the needle-knives 13 and 113 pass through the through holes 21 of the hard cylinders 20 and 120. In order to smoothly insert into the 121, even if the hole diameters of the through-holes 21 and 121 are minimized, the annular end wall P is a high frequency treatment instrument as indicated by diagonal lines in Fig. 18A. It is the limit to make the area of maximum 90% with respect to the circle | corner O which comprises the outer-tip diameter of (1). Moreover, especially in 1st Embodiment, the communication path 24 is formed in the inner side of the annular end wall P, and the stopper wall 22 and the communication path 24 are fully secured in the state. In order to ensure the contact area of the rear end surface 20b of the rigid cylinder 20 stably, as shown by the oblique line in FIG. 18 (b), the area of the annular end wall P must be at least 65% or more. . Specifically, the area ratio of the toroidal end wall P is preferably about 80% (second embodiment) and about 85% (first embodiment), as indicated by diagonal lines in FIG. 18 (c). . Thereby, when the high frequency treatment instrument 1 is crimped with the mucosa layer LM, the mucosa surface is pressurized only to a minimum, and the distance to the root layer LB can be sufficiently secured.

And in 1st Embodiment, the operation means 4 is operated, the needle knife 13 protrudes from the front end of the stopper member 14, and the high frequency electric current flows to the needle knife 13 between them. When the needle knife 13 is in the maximum protruding state, as shown in FIG. 19, the needle knife 13 penetrates the mucosa layer LU and is guided to the lower mucosa layer LM, and the lesion mucosa area D Incision is initiated. Then, under the observation by the observation section W, the endoscope insertion section S is moved or cut to cover the cautery spot B by an operation of bending the angle section.

Here, since the needle knife 13 protrudes only to the position where the stopper protrusion 22 contacts the rear end face 20b of the hard cylinder 20, the maximum protruding length from the flexible sheath 2 is the mucosa layer LU. It is set larger than the thickness dimension of and shorter than the total thickness dimension of the mucosa layer LU and the mucosa lower layer LM.

Moreover, in 2nd Embodiment, the operation means 4 is operated and the high frequency knife 113 protrudes from the through-hole 121 of the hard cylinder 120 provided in the inside of the flexible sheath 2. Here, although the basic cross section of the hard cylinder 120 is a surface orthogonal to the axis line, since the drawing member 122 is arrange | positioned at the base end of this hard cylinder 120, the rod-shaped electrode in the high frequency knife 113 is carried out. The tip end portion 14 is reliably guided in the through hole 121. And a high frequency current flows through the high frequency knife 113 between them. When the high frequency knife 113 is in the maximum protruding state, as shown in FIG. 19, the high frequency knife 113 penetrates the mucosal layer LU and is guided to the lower mucosal layer LM, and the lesion mucosal region D is formed. Incision is initiated. In this state, under observation by the observation section W, the endoscope insertion section S is moved or cut to cover the cautery spot B by an operation of bending the angle section. Here, only the position where the stopper surface 15c of the blade part 15 in the high frequency knife 113 contacts the basic end surface of the hard cylinder 120, the high frequency knife 113 does not protrude, and the flexible sheath 2 ) Is set larger than the thickness dimension of the mucosa layer LU and shorter than the total thickness dimension of the mucosa layer LU and the mucosa lower layer LM.

In addition, since the mucosal lower layer LM is swollen by local scanning, the mucosa layer LU can be reliably incised unless the toric single wall P is extremely pressurized and deformed to the mucosa surface. The mucosa layer LU is incision without causing any damage to the (LB). In the first embodiment, the protruding portion from the tip of the flexible sheath 2 of the needle knife 13 is centered to coincide with the central axis of the flexible sheath 2 by the joining of the tapered surface described above. . In the second embodiment, four blade portions 15 are provided on the high-frequency knife 113, and the outer surface 15b of the blade portion 15 is an inner circumferential wall of the through hole 121 of the hard cylinder 120. Since it is made to come into sliding contact with, the protruding part from the tip of the flexible sheath 2 of the high frequency knife 113 is stably maintained, and the reaction force which acts from the mucous membrane layer LU at the time of incision is made. The high frequency knife 113 is stably maintained in a state substantially coincident with the central axis of the flexible sheath 2 without the occurrence of shaking or whistling.

Therefore, even if the position of the tip of the needle knife 13, 113 is not confirmed by the observation part W of the endoscope insertion part S, a procedure can be performed safely. As a result, as shown in FIG. 20, in the outer periphery of the lesion mucosa area | region D, the mucous membrane layer LU is cut | disconnected and it will be in the state which the mucosa lower layer LM exposed. In addition, in FIG. 20, although the whole area | region of the lesion mucosa area | region D is made to be incision at one time, when the lesion mucosa area | region D is wide, a part is cut and it is made to peel later, and this operation is performed in multiple times. It is desirable to repeat.

Even if the entire circumference of the lesion mucosa region D is cut, the mucosa layer LU cannot be removed by itself. That is, since the mucous membrane layer LU and the root layer LB are connected by the fibrous mucosa lower layer LM, it is necessary to peel this fiber from the root layer LB. This mucosal detachment can also be performed using the high frequency treatment instrument 1. That is, as shown in FIG. 21, the needle knife 13, 113 which protrudes from the flexible sheath 2 of the high frequency treatment instrument 1 enters into the exposed part of the submucosal layer LM generated by the incision, The needle knife 13, 113 is horizontally moved or the swing operation is performed to cut the mucosa lower layer LM. This operation can be easily performed by an operation such as bending the tip portion of the endoscope insertion portion S. FIG. As a result, mucosa peeling is performed quickly and efficiently.

There is a possibility that this treatment point or the like may bleed while the above-described mucosal detachment is performed and while the above-described incision is performed. For this reason, physiological saline is supplied at high pressure into the flexible sheath 2 from the connection port 3a of the connection pipe 3. In the first embodiment, a communication path 24 through the connection port 3a is opened in the hard cylinder 20 through-hole 21 between the stopper protrusions 22 and 22 on the front face of the hard cylinder 20. It is. In the second embodiment, the tip of the rigid cylinder 120 is connected to the inside of the rigid cylinder 120 through-hole 121 between the blade portions 15 and 15 of the high-frequency knife 113 that are adjacent to each other. The communication path 123 which communicates is opened. Therefore, the bleeding portion can be quickly cleaned by spraying physiological saline from the communication paths 24 and 123 toward the bleeding point. This washing operation can be performed while the treatment of the mucosa is continued, i.e., while the needle knife 13, 113 is protruded from the tip of the flexible sheath 2.

When performing mucosal peeling, it is necessary to replenish physiological saline. The lesion mucosa region D is already swollen with local saline by physiological saline, but the physiological saline supplied during the incision is leaked or absorbed into the body and the swelling part may contract. Therefore, in order to keep the mucosal underlayer LM in a swollen state, mucosal peeling is performed while supplying physiological saline. The physiological saline can also be supplied from the communication passages 24 and 123. At this time, the needle knife 13, 113 is drawn in from the hard cylinder 20, 120 to the base end side, and the annular end wall P is made to contact the mucosa lower layer LM, and the connection pipe ( When physiological saline is injected into the flexible sheath 2 from the connection port 3a of 3), physiological saline can be supplied more efficiently, and can be injected directly toward the mucosa lower layer LM. As a result, the mucosa lower layer LM to be peeled off can be kept in a swollen state.

In this way, the additional replenishment of physiological saline does not require the troublesome operation of taking out the high frequency treatment instrument 1 inserted in the treatment instrument insertion channel C and interchangeably inserting the syringe, and the mucosal detachment treatment is stopped. There is no work. Therefore, also at this point, the treatment can be made more efficient and faster. In addition, since no member protrudes from the toroidal end wall P, the tip of the grooves 21 and 121 can be brought into contact with the lower mucosa layer LM, and the physiological saline can be supplied precisely toward the required location. . Thereby, the mucosa lower layer LM can be kept swelled reliably, and the mucosa peeling by the needle knife 13 and 113 can be performed safely and quickly.

 In addition, a negative pressure suction force may be applied to the mucosal layer LU as necessary. Aspiration may be performed before or after the treatment of mucosal detachment. As a result, a suction pipe is connected to the connection port 3a, and suction control can be performed by a foot switch or the like. Therefore, when suction is required, when the foot switch is operated to generate negative pressure in the suction pipe, suction from the body can be performed through the communication paths 24 and 123.

By adopting the above configuration, by attaching a rigid cylindrical body having a simple configuration to the flexible sheath, it is possible to regulate the amount of protrusion of the high frequency knife made of a rod-shaped electrode, and to ensure the stability of the high frequency knife when performing an incision or the like and is safe. And the effect of enabling rapid treatment and further distributing the fluid while the treatment is being performed.

Claims (7)

A high frequency treatment instrument comprising a flexible sheath insertable into an instrument insertion channel of an endoscope, and a treatment instrument body provided inside the flexible sheath to form a high frequency knife to which a high frequency current is applied to the tip of the flexible cord: In the flexible sheath, a rigid cylinder having electrical insulation is inserted and fixed so that the shear surface is coplanar with the front end surface of the flexible sheath. The high frequency knife is provided with a plurality of radially radial portions having engagement portions at predetermined positions in the axial direction thereof. When the high frequency knife protrudes from the hard cylinder, the engagement portion of the blade portion and the rear end of the hard cylinder contact each other so that the high frequency knife is engaged and communicates the inner and outer sides of the flexible sheath between adjacent blade portions. A high frequency treatment instrument, characterized in that the configuration is formed. The method of claim 1, The hard cylinder has a larger hole diameter than the outer diameter of the high-frequency knife, the rear end portion of the hard cylinder forms a tapered surface shape inclined inward from the outer peripheral side toward the inner peripheral edge, The engaging portion is formed on the front end surface of the blade portion, the front end surface of the blade portion forms an inclined portion corresponding to the tapered surface of the hard cylinder, And a tapered surface of the blade portion and the tapered surface of the hard cylinder contact the high frequency knife when the high frequency knife projects from the hard cylinder. The method of claim 2, The hard tube is made of ceramic, and the blade portion is made of metal. The method of claim 2, A toroidal end wall is formed by the front end surface of the flexible sheath and the hard cylindrical shearing surface, and the annular end wall occupies an area of 65 to 90% of the circle formed at the outer end diameter. . The method of claim 1, The high frequency knife includes a rod-shaped electrode insertable in a form loosely inserted into the hard cylinder, and the plurality of blade portions provided at the proximal end of the rod-shaped electrode, Each of the plurality of blade portions has a size that the outer surface is in contact with the inner circumferential surface of the hard cylinder, and the front end surface of the blade portion has a stopper surface protruding outward from the hole diameter of the hard cylinder as the engaging portion. And the stopper surface contacts the end face of the hard cylinder when the high frequency knife protrudes from the hard cylinder to engage the high frequency knife. The method of claim 5, The hard cylinder is made of a ceramic material, and the high-frequency knife is made of a metal material, and the blade portion is provided at three places at 120 ° intervals or four at 90 ° intervals with respect to the rod-shaped electrode. High frequency first aid. The method of claim 5, Both end faces before and after the said hard cylinder have a surface orthogonal to the axis line, and in the said flexible sheath, the taper surface for guiding the tip of the said high frequency knife to the through-hole of the said hard cylinder is located in the position of the base end side of the said hard cylinder. A high frequency treatment instrument characterized in that the configuration for attaching the formed drawing member.

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