WO2017122607A1 - Instrument de traitement haute fréquence pour endoscope - Google Patents

Instrument de traitement haute fréquence pour endoscope Download PDF

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Publication number
WO2017122607A1
WO2017122607A1 PCT/JP2017/000395 JP2017000395W WO2017122607A1 WO 2017122607 A1 WO2017122607 A1 WO 2017122607A1 JP 2017000395 W JP2017000395 W JP 2017000395W WO 2017122607 A1 WO2017122607 A1 WO 2017122607A1
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Prior art keywords
knife
tip
frequency
wire
sheath
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PCT/JP2017/000395
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English (en)
Japanese (ja)
Inventor
憲幸 杉田
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Hoya株式会社
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Publication date
Application filed by Hoya株式会社 filed Critical Hoya株式会社
Priority to CN201790000013.6U priority Critical patent/CN207666692U/zh
Publication of WO2017122607A1 publication Critical patent/WO2017122607A1/fr

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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

Definitions

  • the present invention relates to an endoscope high-frequency treatment instrument that is used by being inserted into a treatment instrument insertion channel of an endoscope.
  • Endoscopic submucosal dissection is a method that can reliably remove a wide range of lesions such as early esophageal cancer, early gastric cancer, and early colorectal cancer using an endoscope.
  • the ESD technique consists of (1) marking the excision area of the lesion (marking), and (2) locally injecting a drug solution into the submucosa to remove the mucosal lesion.
  • Protrusions local injection
  • Incision / exfoliation the submucosal layer
  • a dedicated disposable endoscope treatment tool is used, for example, Japanese Patent Application Laid-Open No. 2010-42155 (hereinafter referred to as “Patent Document 1”).
  • Patent Document 1 Japanese Patent Application Laid-Open No. 2010-42155
  • an endoscopic treatment tool including a needle knife or the like that cuts off the mucous membrane by energizing a high-frequency current is used.
  • ESD is a treatment method for excision of a wide range of lesions at a time, so the treatment time is long and the technical difficulty is high. Therefore, bleeding is often accompanied when excising the mucous membrane.
  • the operator temporarily removes the endoscopic treatment tool for incision and detachment from the body cavity and replaces it with an endoscopic treatment tool for hemostasis to perform endoscopic hemostasis.
  • ESD requires a plurality of disposable treatment tools according to the application (according to each process), and if there is an unexpected bleeding or the like, it is necessary to take measures accordingly. Therefore, from the viewpoint of cost and procedure time, an endoscope treatment tool that can cope with a plurality of treatments (steps) has been desired.
  • Patent Document 2 proposes a high-frequency treatment instrument for an endoscope that can be used for a plurality of ESD treatments.
  • the endoscopic high-frequency treatment instrument described in Patent Document 2 includes a knife portion that changes the amount of protrusion from the distal end surface of the flexible sheath.
  • the knife part When the knife part is operated forward, it stops at a position where the protruding amount is about 2 mm suitable for incision and peeling treatment, and when it is retracted, the protruding amount is 0.5 mm suitable for marking and hemostasis treatment. Stop at the appropriate position.
  • FIG. 11A is a view showing a state in which the periphery of the mucosal lesion is incised using the endoscope high-frequency treatment tool described in Patent Document 2.
  • FIG. 11A in the endoscope high-frequency treatment instrument described in Patent Document 2, the mucous membrane may not come into contact with the distal end portion of the knife portion when the mucous membrane is pushed by the protruding member.
  • the tip of the knife part does not contact the mucous membrane, the incision of the mucous membrane by the tip is not performed, so that the depth of the mucosa to be cut is shallow.
  • the present invention has been made in view of the above circumstances, and an object of the present invention is to provide an endoscopic high-frequency treatment tool suitable for suppressing an increase in the number of incisions while suppressing an increase in the overall length of the knife portion. Is to provide.
  • An endoscope high-frequency treatment instrument has a flexible sheath that can be inserted into a treatment instrument insertion channel of an endoscope, and a conductive material that is fitted into the distal end of the flexible sheath.
  • a rod-shaped knife portion having conductivity that changes the amount of protrusion from the distal end surface of the sheath, and a contact portion to which a high-frequency power source for flowing a high-frequency current to the tip member and the knife portion can be connected via a wire. It is good also as a structure.
  • the knife portion is provided with a protruding member protruding from the side surface of the knife at a position retracted by a predetermined amount from the tip, and when the knife portion is retracted together with the wire, the protruding member contacts the tip member.
  • the distal end portion of the knife portion stops at a position protruding a predetermined amount from the distal end surface of the distal end member.
  • the protruding member has a tapered shape on the tip side.
  • the protruding member has, for example, a tapered shape or a chamfered shape on the tip side.
  • the protruding member may have a configuration in which the proximal end side forms a step with respect to the side surface of the knife portion.
  • the tip member may have a housing part for housing the protruding member on the tip side.
  • the projecting member is accommodated in the accommodating portion and stopped by contacting the wall portion defining the accommodating portion, and the distal end portion of the knife portion is the distal end of the distal end member. Stops at a position protruding a predetermined amount from the surface.
  • the predetermined amount is within a range of 0.3 mm to 0.7 mm, for example.
  • an endoscopic high-frequency treatment instrument that is suitable for suppressing an increase in the number of incisions while suppressing an increase in the overall length of the knife portion.
  • FIG. 3 is a cross-sectional view taken along line AA in FIG. 2. It is a figure explaining each treatment of ESD performed using the high frequency treatment tool for endoscopes concerning one embodiment of the present invention.
  • FIG. 1 it is an enlarged view which shows the structure of the front-end
  • FIG. 1A and FIG. 1B are an external view and a cross-sectional view, respectively, showing the configuration of an endoscopic high-frequency treatment instrument 1 according to an embodiment of the present invention.
  • an endoscopic high-frequency treatment instrument 1 includes a high-frequency knife 12, a wire 13 connected to the high-frequency knife 12, a sheath through which the knife 12 and the wire 13 are inserted (flexible sheath). ) 15, an operation unit 20 for operating the wire 13 and the sheath 15, etc., and the sheath 15 is inserted into a body cavity from a treatment instrument insertion channel of an endoscope (not shown) and used for an ESD procedure. .
  • the high-frequency knife 12 is a rod-like (eg, round bar-like) metal member such as SUS, and a high-frequency current is applied for incision / separation processing of the tissue in the body cavity.
  • the high-frequency knife 12 is configured to change the amount of protrusion from the distal end surface of the sheath 15 by being advanced and retracted by operation of the operation unit 20.
  • FIGS. 3A and 3B are enlarged views showing the configuration in the vicinity of the distal end portion of the high-frequency treatment instrument 1 for an endoscope.
  • 2A and 2B are an enlarged perspective view and an enlarged cross-sectional view showing a state when the high-frequency knife 12 is moved to a predetermined advance position (knife advance position) by the operation unit 20, respectively.
  • FIGS. 3A and 3B are an enlarged perspective view and an enlarged cross-sectional view showing a state when the high-frequency knife 12 is moved to a predetermined retracted position (knife retracted position) by the operation unit 20, respectively. .
  • the high-frequency knife 12 is provided with a protruding member 12b protruding from the side surface of the high-frequency knife 12 in the vicinity of the front end surface (knife front end surface 12a).
  • the base end of the high-frequency knife 12 is electrically and mechanically connected to the wire 13 via the connection member 14.
  • the protruding member 12b is a conical metal member having a through hole in the center portion.
  • the tip end side of the protruding member 12b has a tapered shape, and specifically has a parabolic taper shape as shown in FIGS. Further, the base end side of the protruding member 12b has a shape having a flat base end surface.
  • the protruding member 12b is welded at a position where the high-frequency knife 12 is inserted through the through-hole and retracted by a predetermined amount from the knife tip surface 12a (for example, a position 0.5 mm behind the knife tip surface 12a).
  • a predetermined amount for example, a position 0.5 mm behind the knife tip surface 12a.
  • the high-frequency knife 12 and the protruding member 12b are connected with a step (the side surface of the high-frequency knife 12 and the base end surface of the protruding member 12b form a right angle).
  • the outer diameter of the high-frequency knife 12 is formed as thin as about 0.3 mm in order to increase the density of the high-frequency current.
  • the outer diameter (outermost diameter) of the protruding member 12b is formed to be about 0.6 mm.
  • the high-frequency knife 12 and the protruding member 12b are configured as separate members, but in another embodiment, the high-frequency knife 12 and the protruding member 12b may be formed as an integral member.
  • the wire 13 is a metal wire such as SUS.
  • the wire 13 is inserted into the sheath 15 with its distal end connected to the proximal end of the high-frequency knife 12 by the connecting member 14.
  • the proximal end of the wire 13 extends to the operation unit 20.
  • the high-frequency knife 12 advances and retracts integrally with the wire 13, and the high-frequency with respect to the distal end surface of the sheath 15 (sheath distal end surface 15 a).
  • the protrusion amount of the knife 12 changes.
  • the connecting member 14 is a cylindrical metal member having an outer diameter larger than the outer diameter of the high-frequency knife 12 and the wire 13 and smaller than the inner diameter of the sheath 15.
  • a through hole extending along the longitudinal direction of the high-frequency knife 12 is formed at the center of the connecting member 14.
  • the through hole of the connection member 14 has a diameter on the distal end side (high frequency knife 12 side) slightly larger than the outer diameter of the high frequency knife 12, and a diameter on the proximal end side (wire 13 side) of the wire 13. It is slightly larger than the outer diameter.
  • the high-frequency knife 12 and the wire 13 are respectively inserted from the distal end side and the proximal end side of the through hole of the connection member 14 and then fixed to the connection member 14 by brazing, laser welding, or the like.
  • FIG. 4 is a cross-sectional view taken along the line AA in FIG.
  • the connecting member 14 is formed with a cross-shaped slit 14b extending from the distal end surface (connecting member distal end surface 14a) to the proximal end side.
  • the slit 14b functions as a part of a water supply channel for supplying the liquid to the sheath distal end surface 15a when the liquid is injected into the sheath 15.
  • the sheath 15 is an insulating and flexible tubular member made of a resin such as PTFE (polytetrafluoroethylene).
  • the sheath 15 is provided with markers 16 in the circumferential direction on the outer peripheral surface in the vicinity of the sheath distal end surface 15a in order to improve the visibility of the endoscope high-frequency treatment instrument 1 with respect to the inside of the body cavity. ing.
  • the outer peripheral end portion (edge portion) of the sheath distal end surface 15a is chamfered so that the mucous membrane in the body cavity is not damaged by the operation of the sheath 15 during the procedure (the chamfered portion 15b is formed).
  • a metal stopper (tip member) 17 such as SUS is fixed in the vicinity of the sheath tip surface 15a.
  • the stopper 17 is a cylindrical member having an outer diameter substantially the same as the inner diameter of the sheath 15, and a retaining protrusion is formed on the outer peripheral surface thereof.
  • the stopper 17 is press-fitted into the sheath 15 from the sheath distal end surface 15a and is fitted to the inner surface of the sheath 15, and is fixed at a position where the distal end surface of the stopper 17 (stopper distal end surface 17a) is substantially flush with the sheath distal end surface 15a. Has been.
  • a through hole 17c having a diameter larger than the outer diameter of the high-frequency knife 12 and smaller than the outer diameter of the protruding member 12b is formed along the longitudinal direction (advancing and retracting direction) of the high-frequency knife 12.
  • the high frequency knife 12 is inserted through the through hole 17c.
  • a protruding member accommodating portion 17d for accommodating the protruding member 12b is formed on the stopper distal end surface 17a side of the stopper 17.
  • the connecting member front end surface 14 a comes into contact with the base end surface (stopper base end surface 17 b) of the stopper 17.
  • the protruding amount of the high-frequency knife 12 is regulated (the high-frequency knife 12 stops at the knife advance position), and the high-frequency knife 12 does not protrude more than necessary from the sheath distal end surface 15a.
  • the protruding amount of the high-frequency knife 12 is maximized.
  • the maximum protrusion amount of the high-frequency knife 12 is set to 2 mm.
  • the liquid for example, cleaning water such as a chemical solution or physiological saline
  • the liquid is supplied to the through-hole 17c (the gap between the stopper 17 and the high-frequency knife 12) through the slit 14b. And is ejected to the outside from the sheath distal end surface 15a. That is, the through hole 17c functions as a part of a water supply channel for ejecting liquid from the sheath distal end surface 15a to the outside.
  • the projecting member 12b is accommodated in the projecting member accommodating portion 17d, and the base end surface of the projecting member 12b is accommodated in the projecting member.
  • the projecting member 12b stops by coming into contact with the wall defining the portion 17d.
  • the high-frequency knife 12 and the stopper 17 are electrically connected, the position of the high-frequency knife 12 is regulated (the high-frequency knife 12 stops at the knife retracted position), and the most distal end of the protruding member 12b is the stopper front end surface.
  • the position is substantially on the same plane as 17a. That is, at the knife retracted position, the distal end portion of the high-frequency knife 12 protrudes by 0.5 mm from the sheath distal end surface 15a (in other words, the stopper distal end surface 17a).
  • the stopper 17 may always be slidably in contact with the high-frequency knife 12 regardless of the position of the high-frequency knife 12. That is, the stopper 17 may be configured to be energized even when the high-frequency knife 12 is in a position other than the knife advance position.
  • the exposed area of the stopper tip surface 17a is much larger than the outer shape of the high-frequency knife 12 and the protruding member 12b. Therefore, a large area can be cauterized by supplying a high-frequency current to the high-frequency knife 12 and the stopper 17 in a state where the protruding member 12b is accommodated in the protruding member accommodating portion 17d. Specifically, marking treatment and hemostasis are performed. Treatment can be performed.
  • the operation unit 20 includes a main body 22 to which the sheath 15 is fixed, and a slider 24 to which the proximal end of the wire 13 is fixed.
  • the main body 22 is a rod-like member, and a guide groove 22a for sliding the slider 24 extends in the axial direction.
  • a ring 22b for hooking a finger during operation is provided on the base end side of the main body 22 .
  • a bend preventing tube 30 that guides the sheath 15 and prevents the bend is provided.
  • the slider 24 has a cylindrical portion 24a that surrounds the outer periphery of the main body 22, and a handle 24b on which a finger is hung during operation. Further, a plug (contact part) 26 connected to a high frequency power source (not shown) is attached to the slider 24. The proximal end portion of the wire 13 is connected and fixed to the plug 26 by a screw 26a inside the cylindrical portion 24a.
  • the slider 24 and the wire 13 are attached to the main body 22 so as to be slidable in the longitudinal direction of the high-frequency knife 12 and the wire 13 along the guide groove 22a. Accordingly, when the operator moves the slider 24 of the endoscope high-frequency treatment instrument 1 to the ring 22b side, the high-frequency knife 12 is retracted, and the protruding member 12b is received in the protruding member receiving portion 17d (see FIG. 3). When the slider 24 of the endoscope high-frequency treatment instrument 1 is moved toward the sheath distal end surface 15a, the high-frequency knife 12 moves forward (see FIG. 2). Further, the high frequency current supplied from the high frequency power source is supplied to the high frequency knife 12 through the conductive plug 26, the wire 13, and the connecting member 14.
  • a liquid inlet 32 is provided on the proximal end side (main body 22 side) of the anti-break tube 30.
  • a syringe, a water supply device or the like (not shown) is connected to the liquid inlet 32, and liquid such as a chemical solution or washing water is injected into the liquid inlet 32, whereby the liquid is supplied into the sheath 15.
  • the liquid supplied into the sheath 15 passes through the sheath 15 and is sent to the sheath distal end surface 15a side.
  • the slit 14b and the through hole 17c formed in the connecting member 14 (the gap between the stopper 17 and the high-frequency knife 12). ).
  • the tip of the through hole 17c is opened, so that liquid is ejected from the sheath tip surface 15a.
  • the liquid ejected from the sheath distal end surface 15a is used as a local injection solution for washing the high frequency knife 12 during the incision / peeling treatment of the mucous membrane in the body cavity or for local injection treatment.
  • FIG. 5 is a diagram for explaining each ESD treatment performed using the endoscope high-frequency treatment instrument 1.
  • FIG.5 (a) is a figure explaining the marking process performed using the high frequency treatment tool 1 for endoscopes which concerns on one Embodiment of this invention.
  • the marking treatment is a step of inserting the distal end portion of the endoscope into the body cavity of the patient, and marking the incision range around the lesion to be an ESD incision target.
  • the operator inserts the sheath 15 into the treatment instrument insertion channel of the endoscope with the distal end portion of the endoscope inserted into the body cavity of the patient, and projects the sheath 15 from the distal end portion of the endoscope.
  • the operator confirms the sheath distal end surface 15a and the position of the lesioned part by the endoscopic image, and retracts the sheath distal end surface 15a around the lesioned part with the high-frequency knife 12 retracted to the knife retracted position (see FIG. 3).
  • a high-frequency current is applied to the high-frequency knife 12 by pressing against the mucous membrane.
  • the high frequency current supplied to the high frequency knife 12 is also supplied to the stopper 17. For this reason, the mucous membrane in contact with the exposed portion of the stopper front end surface 17a is cauterized to form marking marks.
  • the tip portion of the high-frequency knife 12 protrudes 0.5 mm from the sheath tip surface 15a. Therefore, when the sheath distal end surface 15a is pressed against the mucous membrane around the lesioned part, the high-frequency knife 12 is slightly inserted into the mucous membrane. Thereby, since the high frequency knife 12 does not slip on the mucosal surface, the operator can form a marking mark at the aimed position.
  • the surgeon repeats the above operation a plurality of times to form a number of marking marks that can grasp the outer edge of the lesion, and ends the marking procedure.
  • a portion (mainly, a portion that is in contact with the mucosa among the members to be energized to which the high-frequency current is applied.
  • deposits such as hemoglobin and protein that have been thermally coagulated by cauterization may adhere to the stopper tip surface 17a).
  • the endoscopic high-frequency treatment instrument 1 is provided with an antifouling coating for preventing burning on the surface of a member that may be pressed against the mucous membrane during ESD treatment.
  • an antifouling coating is applied to the main surface region that appears on the exterior of the high-frequency knife 12, the protruding member 12 b, and the stopper 17.
  • the coating method include spin coating, dip coating, and spray coating.
  • FIG. 9 (a) and 9 (b) are an enlarged perspective view and an enlarged view showing the configuration in the vicinity of the distal end portion of the endoscope high-frequency treatment instrument 1 when the high-frequency knife 12 is moved to the knife advance position, respectively. It is sectional drawing.
  • the area indicated by hatching is the surface area to which antifouling coating is applied.
  • hatching is not used for areas other than the surface area (for example, even a cross section) for the sake of clarity of the surface area to which the antifouling coating is applied.
  • the material for the antifouling coating for example, a material having low affinity with carbon generated when the tissue in the body cavity is carbonized by cauterization is used.
  • a fluorine compound Teflon (registered trademark)
  • a silicon oxide compound silicon oxide compound
  • an organosilicon compound silicone
  • the antifouling coating By applying the antifouling coating to the region shown in FIG. 9, during the marking process, it becomes difficult for the deposits such as proteins to adhere to the high-frequency treatment instrument 1 for endoscope. This makes it difficult for the surgeon to hinder the treatment, so that the surgeon can easily perform an appropriate treatment. In addition, it is necessary to remove the sheath 15 from the endoscope and clean the deposit that has not been completely removed by the cleaning water sprayed from the sheath distal end surface 15a. Since it becomes difficult for the deposits to adhere due to the antifouling coating, the number of operations is reduced, so that the procedure time is shortened.
  • the antifouling coating may not be applied to the surface regions of all members of the high-frequency knife 12, the protruding member 12b, and the stopper 17. If the antifouling coating is applied to at least a part of the surface region (in particular, the stopper tip surface 17a) that appears on the outer appearance of the high-frequency knife 12 and the stopper 17 having a wide contact area with the mucous membrane, the adhesion of the adhered matter can be suppressed. An effect is obtained.
  • FIG.5 (b) is a figure explaining the local injection treatment performed using the high frequency treatment tool 1 for endoscopes which concerns on one Embodiment of this invention.
  • the local injection treatment is a process in which a liquid is locally injected into the submucosal layer of a lesion to be incised to raise the mucosa of the lesion to be incised.
  • the operator While confirming the position of the sheath distal end surface 15a and the lesioned part by the endoscopic image, the operator energizes the high frequency current with the high frequency knife 12 advanced to the knife advance position (see FIG. 2), Make a hole to insert 15a into the submucosa. Next, the operator inserts the sheath distal end surface 15a into the submucosal layer while the high-frequency knife 12 is retracted to the knife retracting position (see FIG. 3). When the operator inserts the sheath distal end surface 15a into the submucosal layer, the medical solution is injected from the liquid injection port 32, and in this state, the slider 24 is operated to slightly advance the high-frequency knife 12.
  • FIG.5 (c) is a figure explaining the incision treatment performed using the endoscope high frequency treatment tool 1 which concerns on one Embodiment of this invention.
  • the incision treatment is a process of incising the periphery of the lesion to be incised along the marking mark.
  • the surgeon advances the high-frequency knife 12 to the knife advance position (see FIG. 2) while confirming the position of the sheath distal end surface 15a and the marking mark by the endoscopic image, and in a state where the high-frequency current is applied, An incision is made by moving the surface 15a along the marking mark.
  • FIG. 11B is a diagram showing a state in which the periphery of the mucosal lesion is incised using the endoscope high-frequency treatment device 1 according to one embodiment of the present invention.
  • the protruding member 12 b has a base end surface that is orthogonal to the side surface of the high-frequency knife 12 and has a step. This level difference fits into the mucous membrane and functions as a kind of stopper. Therefore, during the incision (while the knife front end surface 12a is moved while being buried in the mucous membrane), the knife front end surface 12a does not accidentally come off the mucous membrane.
  • the tip side of the protruding member 12b is connected to the high-frequency knife 12 without a step (the side surface of the high-frequency knife 12 and the radiation tapered surface of the protruding member 12b form an obtuse angle).
  • the mucous membrane comes into contact with the vicinity of the boundary between the side surface of the high-frequency knife 12 and the radiation tapered surface of the protruding member 12b. Therefore, a mucous membrane having a depth of the entire length (2 mm) of the protruding portion of the high-frequency knife 12 protruding from the sheath distal end surface 15a is incised.
  • a necessary depth (here, 2 mm) can be incised without increasing the overall length of the high-frequency knife 12.
  • the occurrence of perforation of mucous membranes and the like is prevented, and the number of incisions is reduced, which in turn reduces the time required for the procedure.
  • Incision procedures often involve bleeding.
  • the surgeon performs the hemostasis treatment described below.
  • mucous membranes, blood, and the like adhere to the high-frequency knife 12, and the function as the knife may be reduced.
  • the operator pulls out the high-frequency knife 12 from the mucous membrane and injects liquid from the liquid injection port 32 to clean the knife front end surface 12a. That is, according to one embodiment of the present invention, it is possible to clean the knife front end surface 12a without taking out the endoscope high-frequency treatment instrument 1, and it is possible to perform hemostasis treatment.
  • the thickness of the antifouling coating applied to the high frequency knife 12 is thinner than the thickness of the antifouling coating applied to the stopper 17.
  • FIG.5 (d) is a figure explaining the peeling treatment performed using the high frequency treatment tool 1 for endoscopes which concerns on one Embodiment of this invention.
  • the exfoliation treatment is a step of removing the incised lesion part little by little.
  • the surgeon advances the high-frequency knife 12 to the knife advance position (see FIG. 2), and with the high-frequency current applied, lifts the incised lesion and cauterizes and peels off the submucosal layer of the incised lesion. To go. Similarly to the incision treatment, the protruding member 12b is appropriately caught in the mucous membrane during the peeling treatment. Therefore, the high frequency knife 12 does not slip out of the mucous membrane.
  • the high-frequency knife 12 and the protruding member 12b mainly come into contact with the mucous membrane as in the local injection / incision treatment. Therefore, it is effective to remove the adhering matter with washing water.
  • FIG. 5 (e) is a diagram illustrating hemostasis treatment performed using the endoscope high-frequency treatment instrument 1 according to one embodiment of the present invention.
  • the hemostatic treatment is a treatment for cauterizing the ulcer portion and the incision after exfoliating the lesioned part and cauterizing the bleeding site that bleeds during the exfoliation treatment.
  • the tip portion of the high-frequency knife 12 protrudes 0.5 mm from the sheath tip surface 15a. Therefore, when the sheath distal end surface 15a is pressed against the mucous membrane around the lesioned part, the high-frequency knife 12 is slightly inserted into the mucous membrane. Thereby, since the high frequency knife 12 does not slip on the mucosal surface, the operator can stop the target position accurately.
  • the embodiment of the present invention also includes contents appropriately combined with embodiments or the like clearly shown in the specification or obvious embodiments.
  • the protruding member 12b is provided on the proximal side of 0.5 mm from the knife distal end surface 12a, but the present invention is not limited to this.
  • the protruding member 12b may be provided within a range of 0.3 mm to 0.7 mm from the knife tip surface 12a.
  • the radiation taper shape is exemplified as the tapered shape on the tip side of the protruding member 12b.
  • the present invention is not limited to this.
  • 6 to 8 show side views of the protruding member 12b having other tapered shapes.
  • the projecting member 12 b may be a conical member having a linear tapered shape.
  • the protruding member 12b is a disk-shaped member, and is formed to be substantially tapered by the chamfering of the tip surface side by R-chamfering and C-chamfering. May be.
  • the tapered shape of the protruding member 12b is not limited to a radiation taper shape, a linear taper shape, or a chamfered shape.
  • the tapered shape of the protruding member 12b may be an exponential taper shape or a shape that can be defined by other functions, or may be a shape that approximates such a function.
  • FIG. 10 is an enlarged view showing the configuration in the vicinity of the distal end portion of the endoscope high-frequency treatment instrument 1 according to another embodiment.
  • FIG. 10 shows a state in which the high-frequency knife 12 has been moved to the knife retracted position.
  • the protruding member 12b is formed in a disc shape.
  • the tip end surface of the projection member 12b accommodated in the projection member accommodation portion 17d and the stopper tip end surface 17a are positioned on substantially the same plane. That is, in another embodiment, during the marking treatment and the hemostasis treatment, the distal end surface of the protruding member 12b having a large contact area with the mucous membrane is positioned substantially on the same surface as the stopper distal end surface 17a having a large contact area with the mucosa. . For this reason, there is a concern about the adhesion of deposits to these surfaces.
  • an antifouling coating is applied to the surface region indicated by hatching in FIG.

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  • Surgical Instruments (AREA)

Abstract

L'instrument de traitement haute fréquence pour endoscope (1) de l'invention est équipé d'une gaine flexible (15). Une butée (17) conductrice est ajustée à une extrémité avant de la gaine (15). Un câble (13) conducteur est inséré dans une partie interne de la gaine (15). Un couteau haute fréquence (12) en forme de tige conductrice, est connecté à une extrémité avant du câble (13). Lorsque le câble (13) est avancé ou retiré à l'intérieur de la gaine (15) au moyen d'une partie manipulation (20), la longueur de saillie du couteau (12) par rapport à une face extrémité avant (15a) de la gaine (15), varie. Une alimentation électrique haute fréquence est connectée à une partie contact (26), et un courant haute fréquence circule dans le couteau (12) et la butée (17) via le câble (13). Un élément saillie (12b) en saillie par rapport à une face latérale du couteau (12), est agencé en une position retrait de quantité prédéfinie à partir d'une face extrémité avant (12a) du couteau (12). Lorsque le câble (13) est retiré, l'élément saillie (12b) vient en contact avec la butée (17). La face extrémité avant (12a) du couteau (12), se trouve alors en saillie de quantité prédéfinie à partir d'une face extrémité avant (17a) de la butée (17). Le côté extrémité avant de l'élément saillie (12b) prend une forme fuselée. Par conséquent, les alentours de l'interface entre la face latérale du couteau haute fréquence (12) et une face de forme effilée de l'élément saillie (12b), viennent en contact avec la muqueuse, et il est possible d'inciser cette muqueuse.
PCT/JP2017/000395 2016-01-13 2017-01-10 Instrument de traitement haute fréquence pour endoscope WO2017122607A1 (fr)

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AU2019260152B2 (en) * 2018-04-23 2021-12-16 Micro-Tech (Nanjing) Co., Ltd. Multifunctional high-frequency electric knife

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JP6655398B2 (ja) 2020-02-26
JP2017123995A (ja) 2017-07-20

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