JP5581062B2 - Endoscopic high-frequency treatment instrument - Google Patents

Description

  The present invention relates to a high-frequency treatment instrument for an endoscope.

  In the endoscopic high-frequency treatment tool used for mucosal dissection and exfoliation (ESD) using an endoscope, the tip protrusion electrode for incision treatment and the side fixed electrode for exfoliation treatment have the same flexibility. It is arrange | positioned at the front-end | tip part of a sheath.

  In such an endoscope high-frequency treatment instrument, in many cases, an electrically insulating tip body block is attached to the most distal portion of a flexible sheath that can be inserted into and removed from the endoscope treatment instrument insertion channel. A tip protrusion electrode is provided so as to freely protrude forward from the tip of the tip body block.

  In the flexible sheath, a conductive operation wire for advancing and retracting the tip protrusion / retraction electrode is inserted and arranged, and the side surface fixing electrode is an elongated line parallel to the axis from one side surface portion of the tip portion of the tip body block. It is fixedly provided in a state of being exposed on the outer surface in the form of a strip or a band (for example, Patent Document 1).

JP 2008-29667 A

  When performing a high-frequency cauterization treatment of a living tissue, it is necessary to prevent accidental cauterization of a living tissue that is not a treatment target. Therefore, when a high-frequency current is applied to the side fixed electrode, the tip protruding electrode is completely immersed in the tip main body block, and when the tip protruding electrode is protruded, the high frequency current is applied to the side fixed electrode. It is necessary to make a state where no current is applied.

  Therefore, in the invention described in Patent Document 1, an independent conductive wire that functions as a conductive member for the side surface fixing electrode is provided in the flexible sheath, separately from the operation wire that functions as a conductive member for the tip protruding and retracting electrode. The operation wire for energizing the tip protruding electrode and the conductive wire for energizing the side fixed electrode are arranged in parallel in the flexible sheath.

  However, in such a configuration, there is a problem that the operation of the operation wire is hindered by the conductive wire, and the operation of the projecting and retracting of the tip projecting electrode becomes unsatisfactory, or the electrical insulation at the distal end portion becomes uncertain.

  Therefore, in response to the advance / retreat operation of the operation wire, the distal end portion of the operation wire and the side surface fixed electrode are electrically connected to and separated from each other, so that one operation wire can be connected to both the front end projecting electrode and the side surface fixed electrode. It can be considered to function as a conductive member.

  However, in the endoscope high-frequency treatment instrument in which the side surface fixing electrode is provided on the outer surface in the form of an elongated line or strip parallel to the axis from one side surface of the distal end portion of the distal end main body block, the side surface fixing is performed. There is also a problem that it is not easy to securely fix the electrode (the adhesive peels off because of high temperature during high-frequency cauterization).

  In the present invention, a high-frequency current can be passed through both electrodes so that the high-frequency cauterization is not performed simultaneously with the tip protruding electrode and the side fixed electrode with only one operation wire, and the side fixed electrode An object of the present invention is to provide a high-frequency treatment instrument for an endoscope that can be assembled in a fixed state.

  In order to achieve the above object, an endoscopic high-frequency treatment instrument of the present invention is an electrically insulating tip attached to the most distal portion of a flexible sheath that can be removably inserted into a treatment instrument insertion channel of an endoscope. A main body block, a tip projecting / retracting electrode that can project forward and backward from the tip of the main body block, and an axially extending / retracting insertion through the flexible sheath so that it can be operated from the base end side of the flexible sheath. Conductive operation wire for projecting and retracting the tip projecting electrode forward from the tip body block, and the tip body block exposed from the one side of the tip body block to the outer surface in the form of an elongated line or strip parallel to the axis And a high-frequency treatment instrument for an endoscope provided with a side fixed electrode fixedly attached to a flexible sheath, and a conductive material having a larger diameter than both of the tip protruding electrode and the operation wire Led by The connecting body is mechanically and electrically connected, and at the axial line position of the tip body block, a tip side small-diameter hole having a diameter through which the tip protrusion electrode passes but cannot enter the conductive connector, and the conductive connector The rear large-diameter hole that passes through is formed in series, the tip of the side fixed electrode is bent back into a J shape, and the bent back portion is in the electrode holding groove formed in the tip body block The rear portion of the side fixed electrode is bent into the flexible sheath in the vicinity of the rear end position of the tip body block, and the operation wire is pushed from the rear to the front. When the conductive connecting member comes into contact with the rear end inlet of the front-side narrow hole from the rear side, the tip protrusion electrode does not protrude further forward and the gap between the operation wire and the side fixed electrode is Electrically shut off, operation wire is behind When the traction operation is performed, the conductive connecting member comes into contact with the rear portion of the side surface fixed electrode from the front, so that the tip protruding electrode is immersed in the tip main body portion and is not retracted further rearward. The operation wire and the side surface fixed electrode are electrically connected.

  The side surface fixing electrode may be exposed to the outer surface from only one side surface of the tip portion of the tip body block, and the electrode holding groove may be formed in a slit shape on the tip surface of the tip body block. Good.

  Also, two electrode passage holes in which the tip body block is fixed in a state of being fitted into the inner peripheral portion of the flexible sheath, and the side surface fixing electrode is formed in the flexible sheath with an interval in the axial direction. The electrode holding groove is formed on the outer peripheral portion of the tip body block, and the tip portion of the side fixed electrode that is bent back is passed through the front electrode of the two electrode passage holes. It may be fitted into the electrode holding groove in a state along the inner peripheral surface of the flexible sheath through the hole.

  According to the present invention, when the operation wire is pushed forward from the rear, the conductive connector contacts the rear end inlet of the front-side narrow hole from the rear, so that the tip protruding electrode is further forward. When the operation wire and the side fixed electrode are electrically disconnected from each other, and the operation wire is pulled from the rear, the conductive connector is moved to the rear portion of the side fixed electrode from the front. By abutting, the tip protrusion electrode is immersed in the tip main body portion and is not retracted further rearward, and the operation wire and the side fixed electrode are electrically connected, so one operation wire The high-frequency current can be applied to both electrodes so that the high-frequency cauterization is not performed simultaneously on the tip protruding electrode and the side fixed electrode, and the tip of the side fixed electrode is bent back into a J shape. That song The returned portion is fitted and held in the electrode holding groove formed in the tip body block, and the rear portion of the side fixed electrode is bent into the flexible sheath near the rear end position of the tip body block. Therefore, the side surface fixing electrode can be assembled in a surely fixed state.

It is side surface sectional drawing of the state which the front-end | tip protrusion electrode of the high frequency treatment tool for endoscopes which concerns on 1st Example of this invention protruded. It is a perspective view in the state where the tip projection electrode of the high frequency treatment instrument for endoscopes concerning the 1st example of the present invention projected. It is a single-piece | unit perspective view of the side fixed electrode of the high frequency treatment tool for endoscopes which concerns on 1st Example of this invention. It is side surface sectional drawing of the state which the tip protrusion electrode of the high frequency treatment tool for endoscopes which concerns on 1st Example of this invention was immersed. It is a perspective view in the state where the tip projection electrode of the high frequency treatment instrument for endoscopes concerning the 1st example of the present invention was immersed. It is side surface sectional drawing of the state which the front-end | tip protrusion electrode of the high frequency treatment tool for endoscopes which concerns on 2nd Example of this invention protruded. It is a perspective view in the state where the tip projection electrode of the high frequency treatment instrument for endoscopes concerning the 2nd example of the present invention projected. It is side surface sectional drawing of the state which the tip protrusion electrode of the high frequency treatment tool for endoscopes which concerns on 2nd Example of this invention was immersed. It is a perspective view in the state where the tip sunk electrode of the high frequency treatment instrument for endoscopes concerning the 2nd example of the present invention was immersed.

Embodiments of the present invention will be described below with reference to the drawings.
FIG. 1 and FIG. 2 are a side sectional view and a perspective view showing the vicinity of the distal end portion of the high-frequency treatment instrument for endoscope according to the first embodiment of the present invention.

  Reference numeral 1 denotes an electrically insulating flexible sheath that can be inserted into and removed from a treatment instrument insertion channel of an endoscope (not shown). The flexible sheath 1 is made of, for example, a tetrafluoroethylene resin tube or the like, and has an outer diameter size of, for example, about 2 mm and a total length of, for example, about 1-2 m.

  A distal end main body block 10 formed in a substantially cylindrical shape having an outer diameter size similar to that of the flexible sheath 1 is connected and fixed to the most distal end portion of the flexible sheath 1. The distal end main body block 10 is made of an electrically insulating material such as ceramics, and the vicinity of the rear end portion is inserted and fixed in the distal end portion of the flexible sheath 1.

      The tip body block 10 includes a tip projecting electrode 2 that can project forward from the tip of the tip body block 10, and a side fixed electrode that is exposed from one side surface of the tip body block 10 to an outer surface in the form of an elongated strip parallel to the axis. 3 is attached.

  The tip protruding electrode 2 and the side fixed electrode 3 are both made of a conductive metal such as stainless steel, for example, the tip protruding electrode 2 is formed in a round bar shape having a constant diameter, and the side fixed electrode 3 has a constant width. It is formed in the state which bent the board | plate material or strip | belt material of fixed thickness.

  In the flexible sheath 1, a conductive operation wire 4 for projecting and retracting the tip projecting electrode 2 forward from the tip body block 10 is inserted and disposed so as to be movable forward and backward in the axial direction. By operating the operation wire 4 forward and backward from the proximal end side of the flexible sheath 1, the distal end projecting electrode 2 can project forward from the distal end surface 10 a of the distal end main body block 10. The operation wire 4 is covered with an electrically insulating insulating tube 41 over its entire length.

  The operation wire 4 and the tip protruding electrode 2 are mechanically and electrically connected integrally by a conductive connection body 5 made of a short cylindrical conductive metal material. When the tip protrusion electrode 2 and the operation wire 4 are compared, the operation wire 4 has a larger outer diameter, and the conductive connector 5 is formed to have a larger outer diameter than both the tip protrusion electrode 2 and the operation wire 4. Yes.

  A front side small diameter hole 11 and a rear side large diameter hole 12 are formed in series at the axial position of the distal end main body block 10. The front-side narrow hole 11 is formed to have a diameter that allows the front-end protruding electrode 2 to pass through in the axial direction but is narrower than the outer diameter of the conductive connector 5 so that the conductive connector 5 cannot enter. The hole 12 is formed to have a diameter through which the conductive connector 5 can pass in the axial direction.

  As a result, the stepped portion 13 of the entrance portion from the rear large diameter hole 12 side to the front small diameter hole 11 at the rear end of the front small diameter hole 11 causes the conductive connector 5 to pass through the rear large diameter hole 12. This is a stopper when moving forward, and the conductive connecting body 5 is in contact with the step portion 13 so that the tip protruding electrode 2 is prevented from protruding further from the tip surface 10 a of the tip body block 10. Is done.

  As shown in FIG. 3, the side surface fixed electrode 3 has a band-shaped member having a constant width bent at the front end in a J-shape (front end return portion 31), and the rear end portion is approximately 90 °. (Back end bent portion 32).

  As shown in FIGS. 1 and 2, the side surface fixing electrode 3 is fitted into an electrode positioning groove 15 that is elongated in a direction parallel to the axis on only one side surface of the tip body block 10. Exposed on the outside.

  The tip bending return portion 31 of the side fixed electrode 3 is fitted and held in a slit-like electrode holding groove 14 formed in the tip body block 10 from the tip surface 10 a of the tip body block 10.

  The rear end bent portion 32 of the side surface fixed electrode 3 is bent into the inner flexible sheath 1 so as to engage with the rear end surface 10 b of the distal end main body block 10. Further, the portion near the rear end of the side surface fixed electrode 3 is dive inside the flexible sheath 1 and is pressed from the outside by the flexible sheath 1.

  In this way, the side fixed electrode 3 is pressed by the electrode positioning groove 15 in the width direction, and the front end bending return portion 31 and the rear end bending portion 32 are in contact with the front end main body block 10 in the front-rear direction.

  In the peeling direction from the distal end main body block 10, the distal end bending return portion 31 is fitted into the electrode holding groove 14 on the front side, and the rear end side portion is pressed by the flexible sheath 1. In this way, the side surface fixing electrode 3 is in a state of being securely fixed to the tip body block 10.

  As shown in FIGS. 1 and 2, the endoscope high-frequency treatment instrument configured as described above has the distal end projecting electrode 2 arranged at the distal end body block when the operation wire 4 is pushed forward from the rear. 10 protrudes forward from the tip surface 10a.

  Then, the conductive connector 5 located in the rear large-diameter hole 12 comes into contact with the step 13 at the rear end entrance of the front small-diameter hole 11 from the rear, so that the tip protruding electrode 2 protrudes further forward. It will be in a state that does not. In this state, since the conductive connecting body 5 is submerged in the rear large-diameter hole 12 and does not contact the side fixed electrode 3, the operation wire 4 and the side fixed electrode 3 are electrically disconnected.

  Therefore, when the operation wire 4 is connected to the high-frequency power source, only the high-frequency current is supplied to the tip protruding electrode 2 and not the side fixed electrode 3, so that it protrudes forward from the tip main body block 10. Mucosal dissection treatment or the like can be performed safely by the tip protrusion electrode 2.

  Next, as shown in FIGS. 4 and 5, when the operation wire 4 is pulled from behind, the tip protruding electrode 2 is drawn into the front side small diameter hole 11, and within the rear side large diameter hole 12. The retracting conductive connector 5 abuts the rear end bent portion 32 of the side surface fixed electrode 3 from the front at the rear end position of the front end main body block 10.

  As a result, the tip protrusion electrode 2 is in a state where it is immersed in the tip body block 10 and is not retracted further back, and the gap between the operation wire 4 and the side surface fixed electrode 3 is interposed via the conductive connector 5. It becomes electrically conductive, and the side surface fixed electrode 3 is in a state where a high-frequency current is passed. In this way, the rear end bent portion 32 serves both as a stopper for restricting the retraction of the front end projecting electrode 2 and the energizing contact to the side surface fixed electrode 3.

  Although a high-frequency current is also applied to the tip sunk electrode 2, the tip sunk electrode 2 is immersed in the tip body block 10, so that the high frequency treatment function is not exhibited. Accordingly, it is possible to safely perform the mucosal detachment treatment while performing high-frequency cauterization only with the side surface fixing electrode 3.

  6 and 7 show an endoscope high-frequency treatment instrument according to a second embodiment of the present invention, in which the flexible sheath 1 is inserted into and removed from the endoscope treatment instrument insertion channel. The main body sheath 1A is formed of a main body sheath 1A and a short front end sheath 1B connected to the front end of the main body sheath 1A so as to be rotatable around the axis. Reference numeral 6 denotes an insertion tube that is fixedly inserted into the main body sheath 1A in order to prevent the operation wire 4 from rattling.

  In this embodiment, the entire distal body block 10 is fixed in a state where it is fitted into the inner periphery of the distal sheath 1B. And the linear side surface fixed electrode 3 which consists of a conductive wire is comprised in the state exposed to an outer surface only between the two electrode passage holes 8 and 9 formed in the front-end | tip sheath 1B at intervals in the axial direction. Yes.

  An electrode positioning groove 15 ′ for fitting and holding the tip bending return portion 31 of the side surface fixed electrode 3 is formed on the outer peripheral portion of the tip body block 10, and the tip bending return portion 31 of the side surface fixing electrode 3 is It is fitted into the electrode holding groove 15 'through the front electrode passage hole 8 of the two electrode passage holes 8, 9 and along the inner peripheral surface of the distal sheath 1B, and is held by the distal sheath 1B from the outside. Is fixed there.

  The rear end bent portion 32 ′ of the side surface fixed electrode 3 introduced into the front end sheath 1 </ b> B through the rear electrode passage hole 9 is slightly smaller than the rear end surface 10 b of the front end main body block 10 as in the first embodiment. And bent into the flexible sheath 1 at the rear position.

  The extended portion of the conductive wire forming the side fixed electrode 3 is wound around the operation wire 4 along the operation wire 4 at a position adjacent to the rear side of the rear end portion of the distal sheath 1B. 33 is the winding part. The conductive wire and the operation wire 4 are electrically insulated by an insulation coating tube 41.

  As shown in FIGS. 6 and 7, the high-frequency treatment instrument for an endoscope according to the embodiment configured as described above is shown in FIGS. 8 and 9 when the operation wire 4 is pushed forward from the rear, and FIGS. 8 and 9. As shown, the operation wire 4 is operated in the same manner as in the first embodiment when the operation wire 4 is pulled from behind (the rear end bent portion 32 ′ of the side surface fixing electrode 3 is The retracting stopper of the submerged electrode 2 is also used as a contact point for contact with the side fixed electrode 3), and the operation wire 4 is rotated from the base end side in the direction around the axis so that the direction of the side fixed electrode 3 can be arbitrarily set. It can also be changed to

DESCRIPTION OF SYMBOLS 1 Flexible sheath 2 Tip protrusion electrode 3 Side surface fixed electrode 4 Operation wire 5 Conductive connection body 8, 9 Electrode passage hole 10 Tip body block 10a Tip surface 10b Rear end surface 11 Front side small diameter hole 12 Rear side large diameter hole 13 Step 14 Electrode holding groove 15, 15 ′ Electrode positioning groove 31 Bend at front end 32, 32 ′ Bend at rear end

Claims (4)

An electrically insulating tip body block attached to the most distal portion of the flexible sheath that can be inserted into and removed from the treatment instrument insertion channel of the endoscope;
A tip protruding electrode that can be protruded forward from the tip of the tip body block;
Conductiveness inserted in the flexible sheath so as to be capable of moving forward and backward in the axial direction, and for causing the tip protruding electrode to protrude forward from the tip main body block by an operation from the proximal end side of the flexible sheath. Operation wire,
A side surface fixing electrode fixedly attached to the front end body block and the flexible sheath is provided in a state of being exposed on the outer surface in the form of an elongated line or strip parallel to the axis from one side surface portion of the front end body block. In a high-frequency treatment instrument for endoscopes,
The tip protruding electrode and the operation wire are mechanically and electrically connected with a conductive connecting member made of a conductive material having a diameter larger than both of them,
At the axial position of the tip main body block, a front narrow hole having a diameter through which the tip projecting electrode passes but a conductive connector cannot enter, and a rear large hole having a diameter through which the conductive connector passes. And is formed through in series,
The tip of the side fixed electrode is bent back into a J shape, and the bent back portion is fitted and held in an electrode holding groove formed in the tip body block, and the rear side of the side fixed electrode is A portion is bent into the flexible sheath in the vicinity of the rear end position of the tip body block;
When the operation wire is pushed forward from the rear, the conductive connector contacts the rear end inlet of the front-side narrow hole from the rear, so that the tip protruding electrode does not protrude further forward. With the state, the operation wire and the side fixed electrode are electrically disconnected,
When the operation wire is pulled from behind, the conductive connector contacts the rear portion of the side surface fixing electrode from the front, so that the tip protruding electrode is inserted into the tip main body portion. As well as being in a state where it does not retract backward, the operation wire and the side surface fixing electrode are electrically connected.
An endoscopic high-frequency treatment instrument characterized by the above.   The high-frequency treatment instrument for an endoscope according to claim 1, wherein the side surface fixing electrode is exposed to the outer surface from only one side surface portion of the distal end portion of the distal end body block.   The high-frequency treatment instrument for endoscope according to claim 1 or 2, wherein the electrode holding groove is formed in a slit shape on a distal end surface of the distal end main body block.   Two electrodes in which the tip body block is fixed in a state of being fitted into the inner peripheral portion of the flexible sheath, and the side surface fixing electrode is formed on the flexible sheath with an interval in the axial direction. It is exposed to the outer surface only between the passage holes, the electrode holding groove is formed on the outer peripheral portion of the tip body block, and the bent back tip portion of the side surface fixing electrode is the one of the two electrode passage holes. The high-frequency treatment instrument for endoscope according to claim 1 or 2, which is fitted in the electrode holding groove in a state along the inner peripheral surface of the flexible sheath through the electrode passing hole on the front side of the endoscope.

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