WO2018025360A1

WO2018025360A1 - Catheter for endoscope

Info

Publication number: WO2018025360A1
Application number: PCT/JP2016/072869
Authority: WO
Inventors: 清一中島; 誠保坂
Original assignee: 山科精器株式会社; 国立大学法人大阪大学
Priority date: 2016-08-03
Filing date: 2016-08-03
Publication date: 2018-02-08

Abstract

The purpose of the present invention is to provide a catheter which has a simple structure while being multi-functional, such as being capable of adsorption, traction, coagulation, and hemostasis of a tissue of a lifeform. Provided is a catheter for an endoscope, comprising: a hole which is disposed in proximity to a distal end of a tube part; and an energy element which is disposed within the tube part to the proximal end side of the hole. The energy element further comprises: an energy emission part which is positioned in a cavity within the tube part and is capable of emitting a prescribed energy; and a communication path which is formed to include a portion of a surface of the energy emission part and which facilitates communication between the hole and a region within the tube part to the proximal end side of the energy emission part.

Description

Endoscopic catheter

The present invention relates to an endoscopic catheter having multiple functions such as washing, suction, incision, cauterization, coagulation, hemostasis, and smoke exhaustion.

Conventionally, an endoscope catheter having functions such as washing, suction, incision, cauterization, coagulation, hemostasis, and smoke exhaustion in a body cavity of a patient has been put to practical use (for example, Patent Document 1). In this technique, a hole is provided near the distal end of the distal end of the endoscope catheter, and there are a plurality of holes having a diameter smaller than the inner diameter of the catheter. Further, an energy element is further provided in the vicinity of the distal end of the catheter.

International Publication No. 2011/114902 Pamphlet

However, in the above catheter, the electrode as the energy element is exposed from the tip. For this reason, for example, when a living tissue is coagulated and hemostatically generated by generating a high-frequency current from the electrode of the catheter, the high-frequency current diffuses in the living body from the tip electrode, and the living tissue in a range not intended by the operator There was a possibility of coagulation. In addition, in order to control the range of thermal damage, it may be required to coagulate by slightly pulling up the living tissue. However, in the above catheter, a portion where the tissue is thin is suitable for coagulation while being pressed. In some cases, it was difficult to solidify by pulling up.

The technology of the present disclosure has been made in view of the above circumstances, and the purpose thereof is a simple structure, such as cleaning, aspiration, incision, cauterization, coagulation, hemostasis, and smoke exhaustion in a patient's body cavity. It is providing the endoscope catheter which can exhibit these functions more efficiently while having many functions of these.

In the present invention for solving the above-described problems, a hole is provided in the vicinity of the distal end of the tube portion, and an energy element is disposed on the proximal end side of the hole inside the tube portion. In addition, this energy element has an energy generating part capable of generating predetermined energy in a cavity inside the pipe part. In the present invention, the region on the hole side of the energy generating portion and the proximal end side of the energy generating portion in the pipe portion are communicated with each other by the communication path formed by including the surface of the energy generating portion in part. The most characteristic feature is that cleaning, suction, smoke emission, and the like can be performed through this communication portion.

More specifically, the endoscope catheter according to the present disclosure includes a hole provided near the distal end of the tube part, and an energy element provided on the proximal end side of the hole inside the tube part. An endoscopic catheter, wherein the energy element is disposed in a cavity inside the tube portion and is capable of generating a predetermined energy, and includes a surface of the energy generation portion and a hole and a tube. And a communication passage that allows the region on the proximal end side of the energy generating portion in the portion to communicate.

According to this, after arranging the energy generating part of the energy element in the cavity inside the tube part of the catheter, it becomes possible to perform functions such as cleaning, suction, and smoke exhausting well through the communication path. . Then, it is possible to perform an efficient treatment such as sucking the living tissue from the hole and selectively cutting, cauterizing, coagulating, and hemostasing the sucked living tissue by the energy generated from the energy generating unit.

Further, the communication path may be formed by the outer shape of the energy generating part and the inner wall of the pipe part. The energy generating part has a cylindrical shape that is substantially the same diameter as the inner diameter of the tube part, and the communication path is formed by a groove provided on a side surface of the cylindrical energy generating part and an inner wall of the pipe part. May be. As a result, an endoscope catheter having a simple structure but capable of adsorbing, pulling, coagulating, and hemostasis of a living tissue is realized.

Furthermore, the energy generated by the energy generating unit may include any of heat, a current having a predetermined frequency, an electromagnetic wave, a laser beam, and a sound wave. Thereby, the various electric currents, electromagnetic waves, and sound waves generated from the energy element can be used for treatment of living tissue.

Also, the hole may be an opening at the distal end of the tube portion of the cavity inside the tube portion. According to this, it is possible to satisfactorily perform functions such as suction and traction by bringing the distal end of the catheter into contact with the living tissue as it is. Further, since the tube portion of the catheter generally has a cylindrical shape, the opening of the distal end is used as a hole rather than providing a hole on the side surface, thereby improving the adhesion with the living tissue at the time of suction. It becomes possible. As a result, the biological tissue can be sucked and pulled more efficiently.

Furthermore, the distal end of the energy generation unit is disposed at a proximal end side by a predetermined distance from the hole, and by sucking the gas or liquid in the tube unit from the region of the tube unit on the proximal end side of the energy generation unit, It is possible to suck the living tissue from the hole, and when sucking the living tissue from the hole, the sucked tissue can enter the inside of the tube part from the hole and come into contact with the distal end of the energy generating part. Good. According to this, it becomes possible to selectively and more reliably treat the living tissue that has been sucked and entered the inside of the tube portion by the energy generating portion.

Furthermore, the tube portion may be formed so as to be able to be inserted into a treatment instrument channel provided in a flexible endoscope or an endoscope overtube into which a flexible endoscope is inserted. Then, cooperation between the endoscopic catheter described above and the flexible endoscope or the endoscope overtube can be realized, and more efficient endoscopic treatment can be realized. Is possible.

According to the technology disclosed herein, it has a simple structure and has multiple functions such as cleaning, suction, incision, cauterization, coagulation, hemostasis, and smoke exhaustion in the body cavity of a patient, and more effectively exerts these functions. An endoscopic catheter capable of this can be provided.

It is a figure which shows schematic structure of the catheter for endoscopes in one Embodiment. It is a front view of the catheter for endoscopes in one embodiment. It is a perspective view of the catheter for endoscopes in one embodiment. It is a figure which shows the example at the time of attracting | sucking a biological tissue using the catheter for endoscopes in one Embodiment. It is a front view of the catheter for endoscopes in one modification. It is a front view of the catheter for endoscopes in one modification.

Hereinafter, embodiments of the present invention will be described with reference to the drawings. First, terms in the following description will be described. “Open abdominal surgery” is an operation performed by opening a patient's living body. “Fine (micro) surgery” is an operation that requires a fine operation as performed under a microscope. Small tissues such as cranial nerves and microvessels are targeted for surgery. “Surgery under the microscope” is an operation using an endoscope.

Also, the “endoscope” is a medical instrument that observes the inside of a living body with an optical system. There are rigid endoscopes and flexible endoscopes as endoscopes. A “rigid endoscope” is an endoscope having a rigid structure in which lenses are attached to both ends of a cylinder. Examples of rigid scopes include cystoscopes, thoracoscopes, and laparoscopes. The “soft mirror” is an endoscope having flexibility using a soft material. There are two types of flexible mirrors, one using an optical fiber as an optical system and the other using a CCD (Charged-Coupled Device). Examples of the flexible endoscope include a bronchoscope, an upper digestive tract endoscope, a small intestine endoscope, and a large intestine endoscope.

Here, in the above surgery, forceps that can coagulate or stop hemostasis of a living tissue using a high-frequency current may be used. Examples of the forceps include “a type in which an electrode is pressed against a living tissue (knife electrode)” and “a type in which a living tissue is picked and gripped like tweezers (hemostatic forceps)”. Many of these have a monopolar structure, and forceps serve as one electrode, and an electric current flows between electrodes called a counter electrode that is in separate contact with the living body.

Examples of the endoscope catheter using the knife electrode described above include a treatment instrument that can discharge the cleaning liquid from the tip thereof. However, in this type of endoscope catheter, the distal end of the tube portion is on the proximal end side of the electrode portion, and the knife portion protrudes from the opening at the distal end of the tube portion.

Therefore, even when the opening and the living tissue are brought into contact with each other, it is difficult to improve the adhesion, and the living tissue cannot be suitably sucked or pulled. In addition, if the pressing force of the knife electrode against the living tissue is strong or the output of the high-frequency current is too high, the coagulation of the living tissue has progressed too much, and tissue perforation may occur after the treatment. Further, in the above configuration, since the high-frequency current diffuses into the living tissue, there is a possibility that the coagulation range is widened and thermal damage is caused even to a normal tissue.

In addition, the hemostatic forceps do not have a washing / suction function, and if the amount of bleeding is large, blood cannot be removed, so that it is difficult to identify the bleeding point and the hemostatic treatment cannot be performed. In this case, it is necessary to perform treatment while using both the jet function (discharging of the cleaning liquid) and the suction function of the endoscope, so that the operation of the hemostatic forceps becomes complicated. In addition, when a hemostatic forceps is used, high-frequency current is diffused in the living body, so that the coagulation range is widened, and there is a risk of heat damage even to normal tissue.

FIG. 1 shows a schematic configuration diagram of an endoscope catheter 1 according to an embodiment of the present invention as viewed from the side. FIG. 2 shows a front view of the catheter 1. FIG. 3 shows a perspective view of the catheter 1. In the following description, the end surface 10a side of the tube portion 10 of the catheter 1 is referred to as the distal end side of the catheter 1, and the other end side (not shown) of the catheter 1 is referred to as the proximal end side of the catheter 1.

As shown in FIGS. 1 to 3, the catheter 1 has a small-diameter tube portion 10. The tube part 10 is a hollow cylindrical member formed of a soft resin having flexibility, strength, low friction, insulation, and the like. Examples of the material for forming the tube portion 10 include polyvinyl chloride, polyethylene, polyester, polyurethane, polyamide, silicone resin, PTFE, PFA, polypropylene, nylon, polyetheretherketone (PEEK), and POM. These materials may be used alone or in combination with other materials.

The length of the tube part 10 is 2000 to 2500 mm as an example. Moreover, the outer diameter of the pipe part 10 is 2.6 mm as an example. The outer diameter of the tube portion 10 is not limited to this, and can be configured to be about 1 to 5 mm. For this reason, the catheter 1 can be inserted into a treatment instrument channel of a general endoscope or an endoscope overtube, and the distal end side of the catheter 1 can be inserted from the treatment instrument port at the distal end of the endoscope overtube. The end face 10a can be protruded and used as an endoscopic treatment tool.

The end face 10a on the distal end side of the tube part 10 is open. Further, the electrode 20 is disposed in the cavity inside the tube portion 10 so as to be in contact with the inner wall 10b of the tube portion 10. The electrode 20 corresponds to an example of the energy generation unit in the present embodiment. In FIG. 1, the inner wall 10b of the pipe part 10 is shown with a dashed-two dotted line. The electrode 20 has a columnar shape that is substantially the same diameter as the inner diameter of the tube portion 10, and is fitted to the tube portion 10 in a so-called simmering state. As an example, the distance from the end surface 10a on the distal end side of the tube portion 10 to the surface 20b on the distal end side of the electrode 20 is 1.5 mm. The electrode 20 is connected to the lead wire 40 on the proximal end side of the catheter 1.

The lead wire 40 extends to the proximal end of the catheter 1 (not shown) and is connected to an electrosurgical device (high frequency generator) (not shown). The electrode 20 generates a high-frequency current by electric power supplied from the electrosurgical device via the lead wire 40. When the catheter 1 is inserted into the body cavity of the patient, a counter electrode plate (not shown) may be attached to the patient's body side. Thereby, various treatments for the patient's living tissue can be performed using the high-frequency current generated from the electrode 20. Here, the energy device in the present embodiment includes the electrode 20 and the lead wire 40.

Here, as shown in FIG. 1 to FIG. 3, a recess 30 extending from the distal end side to the proximal end side of the tube portion 10 is formed on the outer peripheral surface of the electrode 20. In FIG. 1, the recessed part 30 is shown with a dotted line. As shown in FIG. 2, three recesses 30 are provided on the outer peripheral surface of the electrode 20 at intervals of about 120 degrees. In addition, the number of the recessed parts 30 is not restricted to this. In this configuration, a space is formed between the recess 30 and the inner wall 10 b of the tube portion 10. When this space forms the flow path 50, gas (air, etc.) and fluid (body fluid, cleaning liquid, etc.) flowing from the opening of the end face 10 a on the distal end side pass through the flow path 50 in the tube portion 10. Thus, the tube portion 10 can be moved to the proximal end side.

Also, in the tube part 10, gas or fluid can be supplied from the proximal end side, pass through the flow channel 50, and discharged from the opening of the end surface 10 a on the distal end side of the tube part 10. The opening of the end face 10a on the distal end side of the tube portion 10 corresponds to an example of a hole provided in the vicinity of the distal end of the tube portion in this embodiment. Further, the flow path 50 formed by the concave portion 30 of the electrode 20 and the inner wall 10b of the tube portion 10 corresponds to a communication path in this embodiment. In this embodiment, the recess 30 is provided so as to extend in parallel to the longitudinal direction of the tube portion 10, that is, the direction of the axis AX (indicated by the alternate long and short dash line in FIG. 1). It can also be provided so as to extend in a shape.

In the present embodiment, for example, the posture of the tube unit 10 is controlled so that the end surface 10 a on the distal end side of the tube unit 10 faces the biological tissue in the body cavity of the patient, and the tube unit 10 is connected via the flow path 50. By sucking air from the distal end side to the proximal end side, it is possible to adsorb biological tissue to the opening of the end face 10a. The living tissue can be pulled by the tube portion 10 by using this adsorption force. In addition, by appropriately controlling the above suction force, it is possible to draw (invade) the living tissue into the tube portion 10 from the opening of the end face 10a.

FIG. 4 shows an example of a state in which the biological tissue 100 is drawn into the tube portion 10 from the opening of the end surface 10a of the tube portion 10. As shown in FIG. 4, by supplying power to the electrode 20 in a state in which the living tissue 100 is drawn into the tube portion 10, the living tissue 100 drawn into the tube portion 10 from the electrode 20 in the tube portion 10 is supplied. A high-frequency current can be selectively supplied. Thereby, the biological tissue 100 is heated and solidified by the high frequency current.

At this time, it is desirable that the living tissue 100 drawn into the tube portion 10 is brought into contact with the electrode 20. Thereby, the high frequency current can be more intensively supplied to the part of the living tissue 100 that is in contact with the electrode 20, and the part can be solidified more reliably. For example, when there is a bleeding point in the biological tissue 100 drawn into the tube unit 10, the biological tissue 100 is adsorbed in the tube unit 10 so that the electrode 20 and the bleeding point come into contact with each other. The hemostasis of the living tissue 100 can be pinpointed by the flowing high-frequency current.

As described above, in the present embodiment, the living tissue 100 can be drawn into the space between the end surface 10a on the distal end side of the tube portion 10 and the electrode 20, and the coagulation and hemostasis can be selectively performed depending on the target location. Treatment can be performed. Further, unlike the conventional forceps, the electrode 20 is not exposed from the end face 10a on the distal end side of the tube portion 10, but is disposed in the tube portion 10, and the tube portion 10 is electrically insulated. Yes.

Thereby, it is possible to suppress the high-frequency current generated from the electrode 20 from diffusing into the living tissue 100 outside the tube portion 10. For this reason, the range in which the high-frequency current flows from the electrode 20 to the living tissue 100 can be limited to the inside of the tube portion 10, and a stronger high-frequency current is supplied to the living tissue 100 drawn into the tube portion 10. can do.

The opening of the end face 10a on the distal end side of the tube portion 10 may stick to the living tissue 100 by inserting the catheter 1 in this embodiment into the body cavity of the patient and sucking it with a negative pressure of −10 kPa or more. all right. When the suction negative pressure is further increased, the living tissue 100 attached to the opening of the end face 10 a on the distal end side of the tube portion 10 is drawn into the tube portion 10. It has been found that the amount of the living tissue 100 drawn into the tube portion 10 increases as the negative pressure increases. Further, it was found that the biological tissue 100 was in contact with the surface 20b on the distal end side of the electrode 20 in the tube portion 10 by suction with a negative pressure of −30 kPa or more. At this time, the living tissue 100 can be sufficiently pulled by the tube portion 10. In addition, it is understood that the biological tissue 100 can be coagulated by supplying power of 30 to 120 W to the electrode 20 and flowing high-frequency current from the electrode 20 to the biological tissue 100. It was. The relationship between the negative pressure of the suction and the amount of drawing of the living tissue 100 into the tube portion 10 is merely an example, and the negative pressure depends on the thickness of the inner wall 10b of the tube portion 10 and the type and state of the living tissue 100. The pressure can be changed as appropriate.

The above is the description of the present embodiment. However, the configuration of the endoscope catheter according to the present invention is not limited to that shown in the above embodiment, and is identical to the technical idea of the present invention. Various changes are possible within a range that is not lost. For example, in the above embodiment, the electrode 20 is fitted in the tube portion 10 in a squeeze state, but a gap is provided between the side surface of the electrode 20 and the inner wall 10b of the tube portion 10 to prevent gaps between the gaps and intermediate gaps. The electrode 20 may be slidably disposed in the tube portion 10 in a state. For example, the electrode 20 and the flow path 50 can have various shapes. FIG. 5 shows a front view of the catheter 1 as a modification of the above. In FIG. 5, the same components as those in the above embodiment are given the same reference numerals, and detailed description thereof is omitted.

In the example shown in FIG. 5, the shape of the electrode 20 is a hexagonal column, and the cross section in a plane perpendicular to the axis AX is a hexagon. In addition, in the front view shown in FIG. 5, the electrode 20 is disposed in the tube portion 10 so that the hexagonal apex of the cross section of the electrode 20 is substantially in contact with the inner wall 10 b of the tube portion 10 of the catheter 1. In this case, a space formed between the side surface 20 a of the electrode 20 and the inner wall 10 b becomes the flow path 50.

As yet another modification, as shown in FIG. 6, the electrode 20 is formed to have a cylindrical shape that is substantially the same diameter as the inner diameter of the tube portion 10, and the electrode 20 is further connected to the distal end of the electrode 20. It is good also as a structure which provides the flow path 60 penetrated from the side to the proximal end side. As described above, since the flow path is formed so as to partially include the surface of the electrode 20, suction, adsorption, traction, and the like of the living tissue can be suitably performed. Here, the surface of the electrode includes not only the side surface of the electrode facing the inner wall of the catheter tube, but also the front surface of the electrode and the inner surface of the hole penetrating the electrode.

Furthermore, in the above catheter, heat may be supplied to the living tissue by a heating element that generates heat when electric power is supplied instead of the electrode. Moreover, you may supply an ultrasonic wave and a shock wave to a biological tissue with the ultrasonic element which generate | occur | produces an ultrasonic wave instead of an electrode. Furthermore, electromagnetic waves may be supplied from the electrodes to the living tissue. As this electromagnetic wave, it is possible to use electromagnetic waves of various frequencies and characteristics such as microwaves, radio waves, and laser light. Furthermore, when performing hemostasis of a living tissue or ablation of a tumor using the electrode, APC (Argon Plasma Coagulation) that separately supplies argon gas can be employed.

In the present invention, the distance between the electrode 20 and the end face 10a on the distal end side of the tube portion 10 is adjusted by providing the electrode 20 in the tube portion 10 so as to be movable in the longitudinal direction of the tube portion 10. Then, the suction force when performing suction using the flow path 50 formed between the recess 30 of the power 20 and the inner wall 10b of the tube portion 10 and the traction force when the living tissue is adsorbed in the tube portion 10 are obtained. Can be adjusted. In addition, the contact state between the living tissue and the electrode 20 can be adjusted.

In the above embodiment, the opening in the end face 10a of the pipe portion 10 is used as a hole. However, the structure of the hole is not limited to the above. For example, the end surface 10a of the tube portion 10 may be closed, and a hole may be separately provided on the side surface or end surface of the tube portion 10. The diameter and number of holes can also be changed. Furthermore, the shape of the tip of the tube portion 10 may be a tip shape different from the cylindrical shape, and a hole may be provided at any part of the tip shape. Furthermore, the end surface 10a of the pipe part 10 does not need to be an end face perpendicular to the axis of the pipe part 10, and may be configured to have an inclination with respect to the axis of the pipe part 10. In addition, the shape of the distal end of the tube portion 10 does not have to be a shape obtained by simply cutting a cylinder, and may be appropriately processed such as adding a taper or R to the tip.

Furthermore, in the above, the catheter 1 is formed using a soft resin. However, the tube portion 10 of the catheter 1 is formed as a metallic tubular member, and an insulating member is disposed on the inner wall 10b of the tube portion 10 to form the electrode 20. It may be configured so that the high-frequency current generated from the gas does not diffuse outside the tube portion 10. Moreover, the catheter 1 of the present invention is useful for hemostasis treatment in the digestive tract cavity, and can be used for treatment in microsurgery and endoscopic surgery. Here, surgery in brain surgery or vascular surgery is assumed as the microsurgery. As the endoscopic surgery, laparoscopic surgery, thoracoscopic surgery using a rigid endoscope, digestive endoscopic surgery using a flexible endoscope, bronchoscopic surgery, and the like are assumed.

DESCRIPTION OF SYMBOLS 1 Catheter 10 Tube part

10a End surface

10b Inner wall 20 Electrode 30

Recess

50, 60 Flow path

Claims

A hole provided near the distal end of the tube,
An endoscopic catheter comprising: an energy element provided on a proximal end side of the hole in the tube portion;
The energy element is disposed in a cavity inside the pipe part and is formed to include a part of the energy generation part capable of generating a predetermined energy and a surface of the energy generation part, and the energy in the hole and the pipe part. An endoscopic catheter, comprising: a communication path that allows a region on the proximal end side of the generation unit to communicate.
2. The endoscope catheter according to claim 1, wherein the communication path is formed by an outer shape of the energy generating portion and an inner wall of the tube portion.
The energy generating part has a cylindrical shape having substantially the same diameter as the inner diameter of the pipe part,
3. The endoscope catheter according to claim 2, wherein the communication path is formed by a groove provided on a side surface of the cylindrical energy generation unit and an inner wall of the tube unit.
4. The endoscope according to claim 1, wherein the energy generated by the energy generating unit includes any one of heat, a current having a predetermined frequency, an electromagnetic wave, a laser beam, and a sound wave. catheter.
The endoscopic catheter according to any one of claims 1 to 4, wherein the hole is an opening at a distal end of the tube portion of a cavity inside the tube portion.
The distal end of the energy generating unit is disposed at a proximal end side by a predetermined distance from the hole,
By sucking the gas or liquid in the tube portion from the proximal end side region of the energy generating portion in the tube portion, it is possible to suck a living tissue from the hole,
2. When the biological tissue is sucked from the hole, the sucked tissue enters the inside of the tube part from the hole and can contact the distal end of the energy generating part. The endoscope catheter according to claim 5.
7. The tube according to claim 1, wherein the tube portion is formed so as to be able to be inserted into a treatment instrument channel provided in a flexible endoscope or an endoscope overtube into which the flexible endoscope is inserted. The endoscope catheter according to claim 1.