WO2016021230A1 - 高周波処置具 - Google Patents
高周波処置具 Download PDFInfo
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- WO2016021230A1 WO2016021230A1 PCT/JP2015/059951 JP2015059951W WO2016021230A1 WO 2016021230 A1 WO2016021230 A1 WO 2016021230A1 JP 2015059951 W JP2015059951 W JP 2015059951W WO 2016021230 A1 WO2016021230 A1 WO 2016021230A1
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- WIPO (PCT)
- Prior art keywords
- distal end
- sheath
- tip
- enlarged portion
- electrode member
- Prior art date
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B1/00131—Accessories for endoscopes
- A61B1/00133—Drive units for endoscopic tools inserted through or with the endoscope
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- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
- A61B1/018—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00238—Type of minimally invasive operation
- A61B2017/00269—Type of minimally invasive operation endoscopic mucosal resection EMR
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- A61B2218/001—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
- A61B2218/002—Irrigation
Definitions
- the present invention relates to a high-frequency treatment instrument.
- a high-frequency treatment instrument that treats a living tissue such as a mucous membrane by applying a high-frequency current is known (see, for example, Patent Document 1).
- an electrode is inserted and arranged in a sliding hole at the tip of a flexible sheath having electrical insulation so that it can advance and retreat in the axial direction, and the liquid that has been fed through the flexible sheath is slid. It has a structure that can be discharged from the distal end of the flexible sheath through a liquid feed opening communicating with the hole.
- the high-frequency treatment instrument when bleeding occurs during the high-frequency treatment by energizing the electrodes, the high-frequency treatment instrument is replaced by a liquid such as physiological saline discharged from the distal end of the flexible sheath without replacing the high-frequency treatment instrument. It can be washed and a hemostatic treatment can be performed quickly and reliably against bleeding during surgery.
- the high-frequency treatment instrument since the high-frequency treatment instrument is arranged so that the large-diameter portion provided at the tip of the electrode closes the liquid-feeding opening, the flow of the liquid is not greatly affected by the large-diameter portion by advancing the electrode. If the large-diameter portion is arranged away from the liquid-feeding opening as described above, the liquid can be discharged straight.
- the liquid ejection needs to be performed not only when the bleeding site is washed but also when it is locally injected into the submucosa, for example.
- the electrode in order to prevent the electrode from penetrating deeply into the submucosa, the electrode must be retracted, and in this case, the liquid discharge direction may not be determined.
- the present invention has been made in view of the above-described circumstances, and an object of the present invention is to provide a high-frequency treatment instrument that can discharge liquid straight even when the electrode is retracted.
- One embodiment of the present invention includes an elongated cylindrical sheath inserted into a body, an electrode member that is disposed so as to protrude and retract with respect to a distal end portion of the sheath, and to which a high-frequency current is supplied, and a longitudinal axis of the sheath.
- a liquid feeding means for feeding liquid from the proximal end side of the sheath toward the distal end side in a flow path formed along the flow path, and radially extending radially outward from the distal end of the electrode member,
- a distal end enlarged portion having a proximal end surface projecting and retracting with respect to the portion is provided, and the sheath extends to the proximal end side of the electrode member at a position where at least a part of the distal end enlarged portion is accommodated in the sheath.
- a restriction portion for restricting movement and a housing portion having an inner peripheral surface that forms a space in which at least a part of the distal end enlarged portion can be accommodated in the sheath; and at least a part of the distal end enlarged portion is the sheath.
- the base end surface of the part is abutted against the liquid fed through the flow path and flows radially outward, and the inner peripheral surface of the housing part is the base end surface of the electrode front end part
- a high frequency is formed in which a discharge port for discharging the liquid is formed between the outer peripheral surface of the distal end enlarged portion and the inner peripheral surface of the housing portion.
- treatment such as cutting of tissue in the body is performed by advancing the electrode member relative to the sheath and supplying a high-frequency current to the electrode member.
- the high-frequency current can be supplied by retracting the electrode member as much as possible until the movement of the electrode member toward the proximal end is restricted, so that only the distal end enlarged portion is exposed at the distal end of the sheath. Marking can be performed without making the ablation area deeper than necessary.
- the liquid feeding means When bleeding occurs at the site where the treatment is performed, the liquid feeding means is operated to discharge the liquid fed through the flow path provided in the sheath from the discharge port at the distal end of the sheath.
- the liquid can be discharged and cleaned in the vicinity of the bleeding site.
- the electrode member when the electrode member is retracted to the maximum with respect to the sheath, the distal end enlarged portion is at least partially accommodated in the accommodating portion, and the fluid flowing from the proximal end side toward the distal end side through the flow path is At least part of the flow is blocked by the base end surface of the distal end enlarged portion and flows outward in the radial direction, and then strikes the inner peripheral surface of the housing portion and is directed again in the direction along the longitudinal axis.
- the liquid is discharged in the longitudinal direction. That is, according to this aspect, the liquid can be discharged straight forward in the longitudinal axis direction even when the electrode member is retracted to the maximum. As a result, local injection can be performed straight without piercing the electrode member deeper than necessary.
- the abutting portion may be an abutting surface that abuts the base end surface of the distal end enlarged portion.
- the electrode member is retracted and the base end surface of the tip enlarged portion is abutted against the abutting surface, so that at least a part of the fluid discharged from the discharge port is blocked from flowing by the tip enlarged portion. After flowing outward in the radial direction, it is directed again in the direction along the longitudinal axis by the inner peripheral surface of the housing portion.
- a sliding hole is provided through which the electrode member is movably inserted through the abutting surface, and a part of the flow path is formed longitudinally on the inner peripheral surface of the sliding hole. Formed between the groove formed along the sliding hole and the electrode member arranged in the inserted state in the sliding hole, and the groove is formed from an outer peripheral surface of the tip enlarged portion arranged in the inserted state in the sliding hole. May extend radially outward.
- a plurality of the grooves may be provided at intervals in the circumferential direction.
- tip enlarged part may taper toward the base end side, and may have a taper surface part which contacts the opening of the said sliding hole in the said contact surface.
- the tip enlarged portion has a rotational shape centered on the longitudinal axis, and the abutting surface is inclined in a direction extending from the opening of the sliding hole toward the tip, and has at least three points.
- it may consist of an inclined surface that abuts the base end face of the tip enlarged portion. In this way, when the electrode member is retracted to the maximum extent, the base end surface of the tip enlarged portion abuts against the abutting surface made of an inclined surface at three or more points, and positioning of the electrode member and the sliding hole is easily performed. be able to.
- the one or more groove part notched in the longitudinal direction at least partially from the said base end surface may be provided in the outer peripheral surface of the said front-end
- FIG. 10 is a longitudinal sectional view showing the vicinity of the distal end of the sheath in a state in which the electrode member is advanced by showing a tenth modification of the high-frequency treatment instrument in FIG.
- FIG. 20 is a front view of the vicinity of the distal end of the sheath in a state in which the electrode member is advanced by showing a tenth modification of the high-frequency treatment tool in FIG. 1.
- FIG. 20 is a longitudinal sectional view of the vicinity of the distal end of the sheath in a state in which the electrode member is retracted, showing a tenth modification of the high-frequency treatment instrument in FIG. 1.
- FIG. 16 is a longitudinal sectional view of the vicinity of the distal end of a sheath in which the distal end tip is covered with a tube until the distal end of the tube and the distal end of the distal end tip are substantially at the same position, according to an eleventh modification of the high-frequency treatment instrument in FIG. It is a modification of the front-end
- the high-frequency treatment instrument 1 is a treatment instrument in which a distal end is introduced into a body through a channel provided in an insertion portion of an endoscope, for example, as shown in FIG. Formed into an elongated cylindrical shape that can be inserted into the sheath 2, a flexible sheath 2, an electrode member 3 that is advanced and retracted at the distal end of the sheath 2, and an operation of pushing and pulling the electrode member 3 toward the proximal end side of the sheath 2 And a liquid feeding means 5 for discharging liquid from the distal end of the sheath 2 via the inner hole 2a of the sheath 2.
- the sheath 2 is composed of a tube 2b and a tip 6 connected to the tip of the tube 2b.
- the tip 6 is a cylindrical member fixed so as to be positioned in front of the inner hole 2a of the tube 2b. More specifically, the tip 6 has a flat tip surface in the longitudinal direction and has a shape with rounded corners from the side surface to the tip surface.
- the tip tip 6 is provided with a sliding hole 6a for fitting the electrode member 3 so as to be movable, and one inside the sliding hole 6a along the longitudinal direction. As described above, for example, four grooves 6b are provided.
- the distal end surface 6 c of the distal end tip 6 is provided with an accommodating portion 6 d that is recessed one step deeper.
- the inner peripheral surface of the housing portion 6d is formed in a cylindrical inner surface along a direction substantially parallel to the longitudinal axis of the sheath 2.
- the tube 2b and the tip 6 are made of an electrically insulating material, the tip 6 may be made of a conductive material.
- the electrode member 3 has a round bar-like columnar part 3a having an outer diameter slightly smaller than the inner diameter of the sliding hole 6a of the tip 6 and radially extends radially outwardly at the tip of the columnar part 3a. And a tip enlarged portion 3b.
- the distal end enlarged portion 3b is formed in a substantially disk shape with a rounded peripheral edge on the distal end side.
- the tip enlarged portion 3b is made of a conductive material in the same manner as the columnar portion 3a here, but only the tip enlarged portion 3b may be made of an insulating material such as ceramic.
- the outer diameter dimension of the tip enlarged portion 3b is set larger than the diameter dimension of the sliding hole 6a and smaller than the inner diameter dimension of the accommodating portion 6d. Further, here, the thickness dimension of the distal end enlarged portion 3b is set larger than the depth dimension of the accommodating portion 6d as shown in FIG. Thereby, when the electrode member 3 is retracted, the base end surface 3c of the distal end enlarged portion 3b abuts against the bottom surface 6e of the accommodating portion 6d of the distal tip 6 and is locked so that it cannot be further retracted.
- the enlarged portion 3b is arranged in a state where a part of the distal end side is exposed from the accommodating portion 6d.
- a discharge port for discharging the liquid is formed between the outer peripheral surface of the tip enlarged portion 3b and the inner peripheral surface of the accommodating portion 6d.
- the distal end surface of the distal enlarged portion 3b is substantially identical to the distal end of the accommodating portion 6d. It may be located on a plane.
- the outer diameter dimension of the tip enlarged portion 3b is smaller than the radial dimension of the groove 6b formed around the sliding hole 6a.
- the operation unit 4 is provided on the proximal end side of the sheath 2 and has a handle 4b having a finger hooking hole 4a, and is movable with respect to the handle 4b in the longitudinal axis direction of the sheath 2.
- the movable portion 4c and the wire 4d that is disposed in the inner hole 2a of the sheath 2 and connects the movable portion 4c and the electrode member 3 are provided.
- reference numeral 4e denotes a finger hole provided in the movable portion 4c.
- the movable portion 4c When the movable portion 4c is moved to the distal end side of the sheath 2 with respect to the handle 4b, the pressing force is transmitted to the electrode member 3 through the wire 4d, and the electrode member 3 is moved in the direction of moving forward with respect to the distal tip 6. It is like that. Further, when the movable portion 4c is moved to the proximal end side with respect to the handle 4b, the traction force is transmitted to the electrode member 3 through the wire 4d, and the electrode member 3 is pulled in the sliding hole 6a of the distal tip 6. It can be made to retreat.
- the wire 4 d is connected to the electrode member 3 by a conductive stopper portion 7.
- the stopper 7 has an outer diameter larger than the inner diameter of the sliding hole 6a through which the columnar portion 3a of the electrode member 3 is inserted, and is formed on the inner surface of the tip 6 when the electrode member 3 is advanced. The amount of forward protrusion of the electrode member 3 is limited by hitting the step.
- a power source 15 is connected to the proximal end side of the wire 4d so that a high-frequency current can be supplied to the electrode member 3 via the wire 4d.
- the handle 4 b is provided with a connection port 8 that communicates with the inner hole 2 a of the sheath 2.
- the liquid feeding means 5 is a syringe or a water feeding pump connected to the connection port 8, and a liquid C such as physiological saline is fed into the inner hole 2 a of the sheath 2 by the operation of the liquid feeding means 5. .
- the four grooves 6 b form four flow paths 9 that are roughly partitioned by the columnar portions 3 a of the electrode member 3. .
- the four flow passages 9 are arranged at intervals in the circumferential direction of the columnar portion 3a, and each of the four flow passages 9 is connected to the tip tip 6 through the cylindrical flow passage 10 formed between the inner hole 2a of the sheath 2 and the wire 4d. It is open in front of. That is, the four flow paths 9 are respectively opened in an annular space between the accommodating portion 6d of the tip 6 and the tip enlarged portion 3b.
- the openings 9a of the respective channels 9 are discharged from the openings 9a as shown in FIG. 3 when the electrode member 3 is moved forward and the tip enlarged portion 3b is separated from the tip tip 6. Most of the liquid C is discharged straight ahead in the extension direction of the longitudinal axis of the sheath 2 beyond the distal end enlarged portion 3b.
- the electrode member 3 is retracted and the distal end enlarged portion 3b is accommodated in the accommodating portion 6d of the distal tip 6, the liquid C that has flowed through the four flow paths 9 as shown in FIG.
- the endoscope is operated with the electrode member 3 retracted to the maximum by operating the operation unit 4.
- the sheath 2 is introduced into the body from the distal end side through the channel of the insertion portion, and the distal end of the sheath 2 is projected from the distal end of the insertion portion of the endoscope.
- the operator performs the treatment while confirming the image acquired by the endoscope on the monitor.
- the electrode member 3 is retracted to the maximum extent, only the tip portion of the tip enlarged portion 3b is exposed in front of the tip tip 6, so that even if a high frequency current is applied to the electrode member 3 in this state, the tissue It is not deeply cut, and so-called marking can be performed in which only the tissue surface is cauterized.
- the operator presses the distal end surface 6c of the distal end tip 6 to a plurality of locations surrounding a region that is supposed to be a lesion to be excised in the endoscopic image displayed on the monitor to energize the lesion site to be excised.
- a mark surrounding the periphery can be formed, which can be used as a measure for subsequent treatment.
- the operation unit 4 is operated to cause the electrode member 3 to protrude from the distal end surface 6c of the distal end tip 6, and a high frequency current is applied to cut the tissue.
- the operation unit 4 is operated to bring the electrode member 3 into the maximum retracted state, and the tip 6 is inserted into the submucosa below the lesion site.
- the liquid feeding means 5 is operated to discharge the liquid C from the opening 9 a of the tip surface 6 c of the tip tip 6. As a result, the liquid C is locally injected into the submucosal layer, and the lesion site is lifted.
- the sheath 2 is extracted from the submucosal layer, the electrode member 3 is protruded by operating the operation unit 4 again, and the tissue around the lesion site is incised using the mark formed by the marking as a guide. Go. If there is bleeding in the middle of the incision, cleaning can be performed by operating the liquid feeding means 5 to discharge the liquid C from the opening 9a of the tip surface 6c of the tip 6.
- hemostasis may be performed by cauterizing the bleeding site with a high-frequency current.
- the electrode member 3 is retracted to the maximum and cauterized as in the case of marking. Accordingly, it is more preferable to discharge the liquid C in the state where the electrode member 3 is retracted to the maximum first, wash away the target portion, and immediately proceed to the hemostasis operation as it is.
- the enlarged-end portion 3b is accommodated in the accommodating portion 6d, whereby the flow path 9 formed on the bottom surface 6e of the accommodating portion 6d.
- the opening 9a is partially blocked by the tip enlarged portion 3b.
- the liquid C that has flowed through the flow path 9 is blocked by the distal end enlarged portion 3b, and the flow direction is once directed radially outward to be discharged into the storage portion 6d, and the storage portion 6d.
- the inner wall of the accommodating portion 6d and the outer periphery of the distal end enlarged portion 3b are formed in parallel to the longitudinal axis of the sheath 2, the flow of the liquid C flows between the inner wall of the accommodating portion 6d and the outer periphery of the distal end enlarged portion 3b. In the direction along the direction, i.e., the longitudinal direction, and discharged.
- the liquid C can be discharged in the direction in which the distal end of the sheath 2 is directed even when the electrode member 4 is retracted to the maximum.
- the liquid C can be discharged straight even when the electrode member 3 does not protrude, it is possible to prevent the electrode member 3 from coming in contact with surrounding tissues in the cleaning operation while moving the sheath 2. Can do.
- the tip 6 is again inserted into the lower mucosa.
- the liquid C is locally injected by being pressed against.
- the electrode member 3 can be locally injected while preventing the electrode member 3 from piercing the tissue more than necessary by retreating the electrode member 3 to the maximum and discharging the liquid C.
- grooves 6b are provided around the sliding hole 6a, and four flow paths 9 defined by the columnar portions 3a of the electrode member 3 fitted into the sliding hole 6a are formed.
- one or more arbitrary number of grooves 6b may be formed.
- channel 6b was provided in the circumferential direction at equal intervals, you may provide in unequal intervals.
- 15A to 15C show a case where a single groove 6b is provided.
- the flow path 9 is formed by the groove 6b connected to the slide hole 6a
- the slide hole 6a for movably fitting the electrode member 3 and the flow path 9 for flowing the liquid C are formed independently. You may decide to do it.
- a plurality of through holes 11 may be formed in parallel with the sliding hole 6a as shown in FIG.
- the cylindrical flow path 10 was formed between the inner surface 2a of the inner hole 2a of the sheath 2 and the wire 4d, an inner hole that forms the flow path 10 independently of the inner hole 2a in which the wire 4d is disposed ( (Not shown) may be provided.
- the opening 9a of the flow channel 9 is made larger than the outer diameter of the tip enlarged portion 3b. Also, it is formed so as to protrude outward in the radial direction, but it does not have to be protruded outward in the radial direction instead. That is, as shown in FIG. 6, the bottom surface 6e of the accommodating portion 6d that abuts the tip enlarged portion 3b against the tip tip 6 protrudes slightly forward from the opening 9a of the flow path 9, or as shown in FIGS.
- a step 3d and an inclined surface 3e are provided on the base end surface 3c of the distal end enlarged portion 3b, and the opening 9a of the flow path 9 is partially opened even when the distal end enlarged portion 3b is abutted against the bottom surface 6e. May be.
- the opening 9a of the flow path 9 is provided on the bottom surface 6e of the accommodating portion 6d.
- the diameter of the accommodating portion 6d is brought close to the outer diameter of the enlarged tip portion 3b, and the groove 6b is protruded radially outward from the inner surface of the accommodating portion 6d. May be.
- the base end surface 3c of the disk-shaped distal end enlarged portion 3b is abutted against the bottom surface 6e of the accommodating portion 6d by surface contact.
- the bottom surface 6e of the accommodating portion 6d may be formed in a tapered inner surface shape, and the base end surface 3c of the distal end enlarged portion 3b may be abutted by line contact.
- the electrode member 3 can be arranged coaxially (centered) with respect to the sliding hole 6a when the disc-shaped tip enlarged portion 3b is abutted against the bottom surface 6e of the accommodating portion 6d. Therefore, it is possible to prevent the circumferential deviation of the discharged liquid C.
- a tapered surface inclined surface 3e is provided on the back surface 3c of the substantially disk-shaped tip enlarged portion 3b, and an opening on the tip side of the sliding hole 6a is provided.
- the same effect can be obtained even if the back surface 3c is abutted by line contact.
- one or more notch-shaped grooves 11 extending to a middle position in the longitudinal axis direction are provided on the base end surface 3c of the substantially disk-shaped distal end enlarged portion 3b. May be.
- the direction of the flow of the liquid C that has entered the groove 11 from the flow path 9 is changed radially outward, and then the flow direction is corrected again in the longitudinal direction by the inner peripheral surface of the surrounding storage portion 6d. It is discharged in the direction forward. There is an advantage that the discharge amount can be increased by the groove 11.
- the number of grooves 11 may be any number as long as it is one or more. Further, the groove 11 may be a step as shown in FIG. 11, or may be an inclined surface as shown in FIG. Further, the width of the groove 11 may be narrow or wide. Moreover, the groove part 11 may be provided at equal intervals in the circumferential direction, and may be provided at unequal intervals. Further, the width and shape of the groove 11 may not be uniform.
- the base end surface 3c of the disk-shaped distal end enlarged portion 3b is abutted against the bottom surface 6e of the accommodating portion 6d, but instead of this, as shown in FIG. 7 may be provided with an abutting surface 12 that abuts the stepped portion on the base end side of 7.
- the abutment surface 12 may be provided at a plurality of locations at intervals in the circumferential direction, and the flow path 9 may be formed therebetween.
- the distal end surface 7 a of the stopper portion 7 may be formed in a tapered surface shape, and the electrode member 3 may be centered when abutting against the distal end tip 9.
- a sheath 2 in which the tip 2 is covered with the tube 2b until the tip of the tube 2b and the tip of the tip 6 are substantially at the same position may be employed.
- the shape is not limited to this, It is radial in the direction which cross
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Abstract
Description
この高周波処置具は、電気絶縁性を有する可撓性シースの先端の摺動孔に、軸方向に進退可能に電極を挿入配置し、可撓性シース内を送液されてきた液体を摺動孔に連通する送液開口部を介して可撓性シースの先端から吐出させることができる構造を有している。
本発明の一態様は、体内に挿入される細長い筒状のシースと、該シースの先端部に対して突没自在に配置され、高周波電流が供給される電極部材と、前記シースの長手軸に沿って形成された流路内を前記シースの基端側から先端側に向かって送液させる送液手段とを備え、前記電極部材の先端に径方向外方に放射状に延び、前記シースの先端部に対して突没させられる基端面を有する先端拡大部が設けられ、前記シースが、前記先端拡大部の少なくとも一部を前記シース内に収容させた位置で前記電極部材の基端側への移動を規制する規制部と、前記先端拡大部の少なくとも一部を前記シース内に収容可能な空間を形成する内周面を有する収容部とを備え、前記先端拡大部の少なくとも一部を前記シース内に収容させた位置では、前記先端拡大部の基端面が、前記流路を介して送液された液体を突き当てられて径方向外方に向かって流動させるとともに、前記収容部の前記内周面が、前記電極先端部の基端面に突き当たって径方向外方に流れ込んだ前記液体を突き当てられ、前記先端拡大部の外周面と前記収容部の前記内周面との間に、前記液体を放出させる放出口が形成される高周波処置具を提供する。
このようにすることで、電極部材を後退させて先端拡大部の基端面を突当面に突き当てることにより、放出口から放出される流体は、その少なくとも一部が先端拡大部によって流動を遮られて径方向外方に向かって流れた後に、収容部の内周面によって再度長手軸に沿う方向に指向させられる。
このようにすることで、周方向の複数の箇所から液体を放出することができ、液体の放出を周方向に偏りなく行うことができる。
このようにすることで、電極部材を最大限に後退させると、先端拡大部の基端面のテーパ面部が摺動孔の開口に突き当たることにより、電極部材と摺動孔との中心軸合わせを簡単に行うことができる。これにより、送液の偏りを改善することができる。
このようにすることで、電極部材を最大限に後退させると、先端拡大部の基端面が傾斜面からなる突当面に3点以上で突き当たり、電極部材と摺動孔との位置決めを簡単に行うことができる。
このようにすることで、溝部によって液体の流動面積を増大させ、送液量を増加させることができる。
本実施形態に係る高周波処置具1は、例えば、内視鏡の挿入部に設けられたチャネルを介して先端が体内に導入される処置具であって、図1に示されるように、チャネル内に挿入可能な細長い円筒状に形成され、可撓性を有するシース2と、該シース2の先端において進退させられる電極部材3と、該電極部材3をシース2の基端側において押し引きする操作部4と、シース2の内孔2aを経由してシース2の先端から液体を吐出させる送液手段5とを備えている。
ただし、先端拡大部3bの厚さ寸法を収容部6dの深さ寸法とほぼ同一に設定し、電極部材3を後退させたときに先端拡大部3bの先端面が収容部6dの先端と略同一平面上に位置するようにしてもよい。
送液手段5は、接続口8に接続されるシリンジあるいは送水ポンプ等であり、送液手段5の作動によって生理食塩水のような液体Cをシース2の内孔2aに送り込むようになっている。
本実施形態に係る高周波処置具1を使用して、内視鏡的粘膜下層剥離術を行うには、操作部4を操作して電極部材3を最大限に後退させた状態で、内視鏡の挿入部のチャネルを介してシース2を先端側から体内に導入していき、内視鏡の挿入部の先端からシース2の先端を突出させる。
切開途中で出血があった場合には、送液手段5を作動させて液体Cを先端チップ6の先端面6cの開口9aから吐出させることにより洗浄することができる。
このように電極部材3を最大限に後退させた状態で洗い流す場合には、先端拡大部3bが収容部6d内に収容されることにより、収容部6dの底面6eに形成されている流路9の開口9aが先端拡大部3bによって部分的に閉塞される。
また、図14に示されるように、ストッパ部7の先端面7aをテーパ面状に形成し、先端チップ9に突き当たる際に、電極部材3がセンタリングされるように構成してもよい。
2 シース
3 電極部材
3b 先端拡大部
3c 基端面
3e 傾斜面(テーパ面部)
5 送液手段
6a 摺動孔
6d 収容部
6e 底面(突当面)
9 流路
9a 開口
11 溝部、貫通孔
Claims (8)
- 体内に挿入される細長い筒状のシースと、
該シースの先端部に対して突没自在に配置され、高周波電流が供給される電極部材と、
前記シースの長手軸に沿って形成された流路内を前記シースの基端側から先端側に向かって送液させる送液手段とを備え、
前記電極部材の先端に径方向外方に放射状に延び、前記シースの先端部に対して突没させられる基端面を有する先端拡大部が設けられ、
前記シースが、前記先端拡大部の少なくとも一部を前記シース内に収容させた位置で前記電極部材の基端側への移動を規制する規制部と、前記先端拡大部の少なくとも一部を前記シース内に収容可能な空間を形成する内周面を有する収容部とを備え、
前記先端拡大部の少なくとも一部を前記シース内に収容させた位置では、前記先端拡大部の基端面が、前記流路を介して送液された液体を突き当てられて径方向外方に向かって流動させるとともに、前記収容部の前記内周面が、前記先端拡大部の基端面に突き当たって径方向外方に流れ込んだ前記液体を突き当てられ、前記先端拡大部の外周面と前記収容部の前記内周面との間に、前記液体を放出させる放出口が形成される高周波処置具。 - 前記規制部が、前記収容部に設けられて前記先端拡大部の基端面を突き当てる突当部を有し、
前記収容部の内周面が、前記長手軸に略平行に形成され、
前記先端拡大部の少なくとも一部を前記シース内に収容させた位置では、前記突当部に前記先端拡大部の基端面が突き当たった状態であり、
前記突当部に前記先端拡大部の基端面が突き当たった状態において、前記先端拡大部の先端面が前記シースの先端面と同一の位置または前記シースの先端面より突出した位置に位置決めされる請求項1に記載の高周波処置具。 - 前記突当部が、前記先端拡大部の前記基端面を突き当てる突当面である請求項2に記載の高周波処置具。
- 前記突当面を貫通して前記電極部材を移動可能に挿入する摺動孔が設けられ、
前記流路の一部が、前記摺動孔の内周面に長手方向に沿って形成された溝と前記摺動孔に挿入状態に配置された前記電極部材との間に形成され、
前記溝が、前記摺動孔に挿入状態に配置された先端拡大部の外周面よりも径方向外方に延びている請求項3に記載の高周波処置具。 - 前記溝が、周方向に間隔をあけて複数設けられている請求項4に記載の高周波処置具。
- 前記先端拡大部の基端面が、基端側に向かって先細になり、前記突当面における前記摺動孔の開口に突き当たるテーパ面部を有する請求項3から請求項5のいずれかに記載の高周波処置具。
- 前記先端拡大部が長手軸を中心とした回転形状を有し、
前記突当面が、前記摺動孔の開口から先端に向かって広がる方向に傾斜し、少なくとも3点において前記先端拡大部の基端面を突き当てる傾斜面からなる請求項3から請求項5のいずれかに記載の高周波処置具。 - 前記先端拡大部の外周面に、前記基端面から少なくとも部分的に長手方向に切り欠かれた1以上の溝部が設けられている請求項1から請求項7のいずれかに記載の高周波処置具。
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