JP6087230B2 - MEDICAL TREATMENT TOOL AND MEDICAL TREATMENT DEVICE - Google Patents

Description

  The present invention is, for example, treatment using laser light in abdominal surgery, thoracic surgery, gynecology, urology, otolaryngology (pharynx, larynx, cervical region) such as colostomy. The present invention relates to a medical treatment tool and a medical treatment device for performing treatment with an electric knife.

  Conventionally, for incision for excision of a treatment target site, a laser knife using a laser beam that is opened in a non-contact manner, an electric knife etc. that burns the incision site by energizing a high-frequency current, etc. are used. Each had its own characteristics, and was used properly according to the treatment content.

  Specifically, in the case of a laser knife, it is possible to perform a non-contact high-speed incision with a fine spot of laser light and to perform an incision while performing hemostasis. On the other hand, in the case of an electric scalpel, the incision site is burned out with the blade electrode for the electric scalpel, so that the cauterization and hemostasis action at the incision site is excellent.

  However, replacing the laser knife and the electric knife in the operation according to the operation contents has a problem that the burden on the patient becomes large. As a countermeasure, for example, in Patent Document 1, the electric knife and the laser knife can be switched. There has been proposed a minimally invasive medical treatment tool that can be used properly without replacing the laser scalpel and the electric scalpel during surgery by using the above-described medical surgical tool.

  In addition, as a surgical procedure that can reduce the burden on the patient, for example, a coelomic surgery is adopted. For example, when performing a surgical operation on an organ in the abdomen, a body cavity endoscope is provided with several through holes in the abdomen, and surgical tools such as forceps and a scalpel and a body cavity mirror are inserted into the through hole, and a body cavity image is displayed. It is a method of treatment while confirming. Such a coelomic surgical operation is less burdensome on the patient and quicker to recover than an open operation in which the abdomen is largely opened as in the past.

  In this way, in endoscopic surgery such as coelomic surgery, the surgical tool is also operated while operating the endoscope, so in order to replace the laser knife and electric knife in the operation according to the operation contents, Very cumbersome and time consuming. Therefore, by using the medical surgical instrument that can switch between the electric knife and the laser knife proposed in the above-mentioned Patent Document 1, the burden on the patient compared with the case where the laser knife and the electric knife are replaced during the operation according to the contents of the operation. It is thought that it can be significantly reduced.

  However, in the medical surgical instrument proposed in Patent Document 1, the metal cover provided at the tip of the laser probe is a blade electrode of an electric knife, but since this metal cover is in front of the laser emission port, the cutting function by the laser There was a problem that was damaged.

JP 2012-105766 A

  In view of the above-described problems, the present invention provides a medical treatment tool and a medical treatment device that can be used by switching between the function of a laser knife and the function of an electric knife with a simple apparatus configuration. Objective.

  The present invention relates to a medical treatment instrument to be inserted into a body, a hollow hollow waveguide that guides a laser beam that can be cut in a non-contact manner on a treatment target portion of a living body to be treated, and the hollow guide An electric scalpel blade electrode that functions by energizing through the counter electrode in contact with the living body at the tip of the wave tube, and the electric scalpel blade electrode is irradiated with the laser light in the hollow waveguide A diffusion reflecting means disposed on the laser beam irradiation path for diffusing the reflected laser beam reflected by the blade electrode for the electric knife and spaced from the emission end of the laser beam. The knife blade electrode is formed on the irradiation surface irradiated with the laser beam.

  The above-mentioned counter electrode is arranged together with the blade electrode for the electric scalpel in the medical treatment instrument, and the counter electrode constituting the bipolar electric scalpel or the electrode electrode blade blade as a counter electrode plate separately from the medical treatment instrument And a counter electrode constituting a monopolar type electric knife.

According to the present invention, the function of the laser knife and the function of the electric knife can be switched and used during the treatment with a simple device configuration.
Specifically, a medical treatment instrument inserted into a body, a hollow waveguide that guides laser light that can be cut in a non-contact manner on a treatment target portion of a living body that is a treatment target, and the hollow waveguide At the tip of the tube, it is configured with a blade electrode for an electric knife that functions by energizing through the counter electrode that is in contact with the living body, so that laser light is guided directly into the hollow hollow waveguide tube, It is possible to switch between the function of the laser knife and the function of the electric knife with a simple device configuration by energizing between the counter electrode in contact with the living body to be treated and the blade electrode for the electric knife. it can. For example, it can be used by a method suitable for the treatment content, such as incising efficiently with a laser knife and stopping the bleeding site with an electric knife.

  Therefore, even if the surgical tool replacement is very complicated and time-consuming, it can be performed using an appropriate scalpel according to the operation content without replacing the surgical tool, thereby reducing the burden on the patient. Thus, a minimally invasive medical treatment tool can be configured.

  In addition, the electric scalpel blade electrode is spaced from the emission end of the hollow waveguide to which the laser light is irradiated, and is disposed on the laser light irradiation path so that an unintended living body by the laser scalpel is disposed. Burnout can be prevented.

  Specifically, the electric scalpel blade electrode is disposed at a predetermined interval from the emission end of the hollow waveguide that irradiates the laser light, and disposed on the laser light irradiation path. An operation target site to be incised is disposed between the laser beam and the exit end of the hollow waveguide, and an efficient and accurate incision can be performed in a non-contact manner with a laser beam.

  In addition, since the electric scalpel blade electrode is arranged on the laser light irradiation path, the laser light is blocked by the electric scalpel blade electrode. Even if it exists, there is no possibility that the laser beam will reach the deep part of the living tissue or the back of the incision target and burn out to an unintended depth or part, and the treatment can be performed safely.

  Further, for example, if the reflected laser light reflected by the electric scalpel blade electrode concentrates on an unintended location, there is a risk of incising an unintended location such as a chest wall or an abdominal wall. The diffused reflection means for diffusing the reflected laser light reflected by the electric knife blade electrode is formed on the irradiation surface to which the laser beam is irradiated, so that the laser beam is emitted from the electric knife blade electrode. The reflected laser light reflected by the irradiated surface is diffused, and there is no risk of incision by concentrating on an unintended location, so that the treatment can be performed safely.

The diffuse reflection means can be composed of irregularities formed on the irradiation surface irradiated with the laser beam in the electric knife blade electrode, a roughened surface, a coating with low smoothness, and the like.
In addition, when the diffuse reflection means is formed with the unevenness formed on the surface, the diffuse reflection means can be configured in various manners such as arranging the uneven shape with the direction of the uneven shape changing and arranging unevenness with different shapes. Furthermore, it is more preferable that the concavo-convex shape is smaller than the spot of the irradiated laser beam.

  In addition, the laser beam can be guided directly into the hollow conductive hollow waveguide tube, and the conductive hollow waveguide itself made of a metal material can be used as a conductor. Compared to the case where the body and the body are separately provided, the shaft diameter is reduced, and the burden on the living body can be reduced.

As an aspect of the present invention, the treatment instrument main body is provided with the blade electrode for the electric knife,
The counter electrode can be a monopolar treatment tool that is configured separately from the treatment tool body and is configured by a counter electrode plate that is in contact with a living body that is a treatment target. Alternatively, the counter electrode may be a bipolar treatment instrument provided in a treatment instrument body together with the electric knife blade electrode as a bipolar electrode.

  Thus, as a medical treatment instrument, for example, a treatment instrument of the type that utilizes the advantages of the monopolar type and the bipolar type depending on the treatment object and treatment content, such as the conduction mode between the blade electrode for the electric knife and the counter electrode. By using, appropriate treatment according to the treatment content can be performed.

As an aspect of the present invention, the electric knife blade electrode can be provided with vibration means for applying vibration.
Note that the vibration means may be built in the blade electrode for the electric knife, or provided on a support shaft or the like that supports the blade electrode for the electric knife, but the laser beam emitted from the emission end of the hollow waveguide As long as the light is not affected by vibration, it may be provided at any position.

  According to the present invention, the diffuse reflecting means formed on the electric knife blade electrode vibrated by the vibrating means also vibrates, so that the diffusibility of the reflected laser beam is improved and the laser beam is irradiated on the electric knife blade electrode. The reflected laser beam reflected from the irradiated surface can be operated more safely without cutting an unintended location.

Further, as an aspect of the present invention, it is possible to provide a burn prevention means for preventing the electric scalpel blade electrode from burning.
The burn prevention means is to provide a surface processing such as a fluororesin film or a photocatalyst formed on the surface of the blade electrode for the electric knife, or a portion having a different resistance value (impedance) on the surface of the blade electrode for the electric knife. This can be a means for preventing scorching.

  If an incision piece or blood adheres to the blade electrode for an electric scalpel heated by laser irradiation or energization, the function as an electric scalpel deteriorates, but the electric scalpel blade electrode is burnt by providing a means for preventing scorching. It becomes difficult to prevent the function of the electric knife from being deteriorated due to scorching.

In addition, as an aspect of the present invention, a gripping portion gripped by an operator and an outer fitting portion that is rotatable with respect to the gripping portion are provided, and the laser irradiation can be performed on the outer fitting portion from the tip of the outer fitting portion. In addition, the hollow waveguide can be disposed on the distal end of the outer fitting portion, and the blade electrode for the electric knife can be disposed on the irradiation path of the irradiated laser light.
According to the present invention, the direction of the electric scalpel blade electrode with respect to the grasping portion can be adjusted, and a medical treatment instrument with good operability can be configured.

Further, as an aspect of the present invention, it is possible to provide an interval adjusting means for adjusting an interval from the distal end of the hollow waveguide to the electric knife blade electrode.
According to the present invention, for example, even in the thinnest organ such as the visceral serosa and the wall serosa, the distance from the distal end of the hollow waveguide to the electrosurgical blade electrode is increased according to the thickness of the treatment target location. It can be adjusted and more appropriate treatment can be performed.

Further, as an aspect of the present invention, the grip portion can be provided with an ON / OFF switching means for switching ON / OFF of energization to the electric knife blade electrode.
According to the present invention, for example, after an efficient incision with a laser scalpel, an appropriate treatment according to the treatment method is performed such that the blade electrode for an electric scalpel is immediately energized to function as an electric scalpel and the bleeding site is stopped. It can be done promptly.

Further, as an aspect of the present invention, it is possible to include a discharge path that allows discharge of the atmosphere in the body cavity to be treated to the outside, and a conduction restriction unit that restricts conduction of the discharge path.
In general, in body cavity surgery, in order to secure a surgical field, biogas is supplied into the body cavity and the treatment is performed in a pressurized state, but it is oily by incision with a laser beam or hemostasis with a blade electrode for an electric knife. Alternatively, the visual field of the surgical field may be lost due to the generation of a large amount of mist (smoke) having carbonized particles.

  However, according to the present invention, the atmosphere such as smoke in the body cavity to be treated is discharged to the outside through the discharge path, so that the conduction in the discharge path is restricted by the conduction restriction means while securing the field of view. The pressure state can be maintained.

  Further, the present invention provides a laser oscillator that is a laser light source that generates laser light, a device main body that includes a high-frequency oscillator that oscillates a high-frequency current, a medical treatment instrument described above, a counter electrode that contacts a living body, , A waveguide cable connecting the laser oscillator and the medical treatment instrument, a conductive line connecting the medical treatment instrument and the counter electrode, the high-frequency oscillator, and the discharge path, Atmosphere discharging means for discharging the atmosphere conducted through the discharge path to the outside, gas supply means for conducting the hollow waveguide and supplying gas into a body cavity to be treated, at least the atmosphere discharging means, The medical treatment apparatus includes a gas supply unit and a control unit that is connected to the conduction regulating unit and controls a pressure in a body cavity to be treated.

  According to this invention, the gas supply means supplies gas into the body cavity by controlling the pressure in the body cavity to be treated by the control unit to which the atmosphere discharge means, the gas supply means, and the conduction restriction means are connected. At the same time, in the body cavity to be treated, an atmosphere such as a large amount of mist (smoke) having oily or carbonized particles is discharged to the outside through the discharge path by the atmosphere discharge means, and the discharge path is secured by the conduction restriction means while ensuring the visibility. It is possible to maintain the pressurized state in the body cavity by regulating the conduction.

Further, by supplying gas into the body cavity with the gas supply means, it is possible to prevent the scattered matter and body fluid at the surgical site that has been incised or the smoke that fills the body cavity from entering the hollow waveguide. Therefore, it is possible to prevent the scattering performance and the body fluid, the smoke filled in the body cavity, etc. in the incised treatment site from entering the hollow waveguide and degrading the waveguide performance. Furthermore, the visual field around the treatment site can be secured by the gas ejected from the hollow waveguide under the body cavity mirror.
The atmosphere discharge means and the gas supply means may be configured separately from the apparatus main body, or may be disposed inside the apparatus main body.

  According to the present invention, it is possible to provide a medical treatment tool and a medical processing apparatus that can be used by switching the functions of a laser knife and an electric knife with a simple device configuration. As a result, the burden on the patient is reduced as compared with the prior art, and safer treatment can be performed.

Explanatory drawing about a monopolar type medical treatment tool. The perspective view of a monopolar type medical treatment device. An explanatory view of a blade tip. Explanatory drawing of a hollow waveguide. The schematic diagram of the use condition of a monopolar type medical treatment device. Schematic explaining the use condition of a monopolar type medical treatment tool. Explanatory drawing about a bipolar type medical treatment tool. Explanatory drawing about another bipolar type medical treatment tool. Explanatory drawing about another bipolar type medical treatment tool. The schematic of the use condition of another bipolar medical treatment apparatus.

This embodiment of the present invention will be described below with reference to the drawings.
FIG. 1 is an explanatory view of a monopolar medical treatment instrument 10. Specifically, FIG. 1A shows a plan view of the monopolar medical treatment instrument 10, and FIG. 1B is a cross-sectional view of the monopolar medical treatment instrument 10 taken along the line AA in FIG. FIG.1 (c) has shown the BB arrow line view in Fig.1 (a). In FIG. 1C, the blade electrode 53 is indicated by a dotted line.

  FIG. 1 (d) shows an enlarged view of a portion a in FIG. 1 (b), and FIG. 1 (e) shows an enlarged view of a portion b in FIG. 1 (b). Further, in FIG. 1B, the blade tip tip 50 at the rear end position is shown by a solid line, and the blade tip tip 50 at the tip end side is shown by a broken line.

  FIG. 2 is a perspective view of the medical treatment apparatus 1, and FIG. 3 is an explanatory view of the blade tip tips 50 and 150. Specifically, FIG. 3A shows an enlarged perspective view of the blade tip chip 50, and FIG. 3B shows an enlarged perspective view of the blade tip chip 150.

  FIG. 4 is an explanatory diagram of the hollow waveguide 300, FIG. 5 is a schematic diagram illustrating a usage state of the medical treatment apparatus 1, and FIG. 6 is a schematic diagram illustrating a usage situation of the monopolar medical treatment instrument 10. ing. FIG. 4 illustrates a state in which a part of the hollow waveguide 300 in the circumferential direction is transmitted in order to facilitate understanding of the layer configuration of the hollow waveguide 300.

  As shown in FIG. 5, the medical treatment device 1 is a device having both the function of a laser knife and the function of an electric knife, and a laser oscillator 1 a that is a laser light source that generates carbon dioxide laser light L by a carbon dioxide laser, and an electric knife. A high-frequency oscillator 1b that oscillates a high-frequency current, a gas supply 1c that supplies carbon dioxide through a connection cable 60, an exhaust gas inhaler 1d that inhales smoke generated in the body cavity through an exhaust duct H to be described later, and a control unit 7. And a monopolar medical treatment instrument 10 that functions as an electric knife and a connection cable 60 that connects the apparatus main body 2 and the monopolar medical treatment instrument 10. The foot pedal 8 shown in FIG. 2 controls the oscillation of the carbon dioxide laser beam L in the laser oscillator 1a. (See FIGS. 2 and 5).

  As described above, the apparatus main body 2 is a rectangular parallelepiped casing that is long in the depth direction and the vertical direction, and includes the laser oscillator 1a, the high-frequency oscillator 1b, the gas supply device 1c, the exhaust gas suction device 1d, and the control unit 7 therein. The operation panel 4 is provided on the front side of the upper surface 2a, and the foot pedal 8 is connected to the lower part via a cable.

  A foot pedal 8, an operation panel 4, a laser oscillator 1a, a high frequency oscillator 1b, a gas supply device 1c, and an exhaust gas suction device 1d are connected to the control unit 7, and these are controlled by the control unit 7.

  In the present specification, since the gas supply device 1c has high bioabsorbability, it is quickly absorbed after the operation even if it is supplied into the body cavity. It is supplied as a gas flowing into 300a, but it may be air, nitrogen, an inert gas, or a gas containing carbon dioxide in these gases.

A caster 3 is provided at the lower part of the apparatus main body 2, and a handle 5 provided on the front side of the operation panel 4 can be gripped to easily move to a desired position and be fixed in position.
Further, a holder 6 for locking the monopolar medical treatment instrument 10 is provided on the side of the operation panel 4.

  The connection cable 60 whose base end portion protrudes upward in the vertical direction from the rear side of the upper surface 2a of the apparatus main body 2 includes a waveguide cable 61, a conductive cable 62, a gas supply cable 63, and an exhaust gas suction cable 64. (See FIG. 5).

The waveguide cable 61 is connected to the laser oscillator 1 a inside the apparatus main body 2, and guides the carbon dioxide laser light L oscillated by the laser oscillator 1 a to the monopolar medical treatment instrument 10 attached to the tip of the connection cable 60. Can do.
The conductive cable 62 is connected to the high-frequency oscillator 1 b inside the apparatus main body 2, and can conduct a high-frequency current oscillated by the high-frequency oscillator 1 b to the blade tip chip 50 of the monopolar medical treatment instrument 10.

The gas supply cable 63 is connected to the gas supply device 1 c inside the apparatus main body 2, and can conduct carbon dioxide supplied from the gas supply device 1 c to the emission port 40 a via the laser probe 40.
Further, the exhaust gas suction cable 64 is connected to an exhaust gas inhaler 1d inside the apparatus main body 2, and is sucked through an exhaust duct H (see FIGS. 1D and 1E) described later in the monopolar medical treatment instrument 10. The smoke thus smoke can be conducted to the exhaust gas inhaler 1d.

The connection cable 60 is supported by a support pole 2 b provided in the vertical direction on the upper surface 2 a of the apparatus main body 2.
Although not shown in FIG. 2, the counter electrode coated wire 71 (FIG. 5) having the counter electrode 70 (FIG. 5) connected to the tip is also connected to the high frequency oscillator 1 b of the medical treatment apparatus 1.

  The monopolar medical treatment instrument 10 connected to the distal end of the connection cable 60 includes a grip 20 held by an operator, an outer cover 30 rotatably attached to the grip 20, and straddling the grip 20 and the outer cover 30. The laser probe 40 is arranged, and the blade tip chip 50 is arranged in front of the emission port 40 a formed by the tip portion of the laser probe 40.

  The grip 20 is made of resin gripped by the practitioner, and includes a connector 21, an exhaust switch 22, an electric female switch 23, and a fitted portion 24 in order from the rear end side (left side in FIG. 1A). ing.

  The connection connector 21 is a connector for connecting the laser probe 40 and the connection cable 60, and the exhaust switch 22 switches ON / OFF of an exhaust gas inhaler 1d described later and a control valve disposed in an internal space 26 described later. Is a switch for switching between opening and closing.

  The electric knife switch 23 is a switch for switching ON / OFF of energization to the blade tip chip 50 in order to use the blade tip chip 50 as an electric knife.

  The fitted portion 24 allows the outer cover 30 to be fitted, and the locking groove allows the locking ball 25 to be locked across the locking groove 31 a formed in the rotation fitting portion 31 of the outer cover 30. 24 a is formed in the circumferential direction on the outer peripheral surface of the rear end side of the fitted portion 24.

  Inside the grip 20, an insertion space of the laser probe 40 is allowed, and a substantially X-shaped internal space 26 is formed on the outside of the inserted laser probe 40 to constitute an exhaust duct H that allows smoke to pass. ing. As will be described later, the internal space 26 communicates with the internal space 34 of the outer cover 30 to constitute the exhaust duct H. However, the internal space 26 includes a control valve (not shown), and the exhaust valve H is electrically connected by the control valve. It is regulated.

  The outer cover 30 includes, in order from the rear end side, a rotation fitting portion 31 whose diameter has been increased, and a cover main body 32, and an adjustment ring 33 that is externally fitted to the cover main body 32.

  In addition, inside the outer cover 30, the insertion of the laser probe 40 is permitted, and the outside X of the inserted laser probe 40 is configured to have a substantially X-shaped inner space 34 that constitutes an exhaust duct H that allows smoke to flow. The insertion portion 35 for inserting the support shaft 51 of the blade tip 50 is formed.

  The rotation fitting portion 31 is a diameter-expanded portion that is rotatably fitted to the fitted portion 24 of the grip 20, and is a lock that allows a lock ball 25 formed in the circumferential direction to be locked on the inner surface. A groove 31a is formed. Further, the rotation fitting portion 31 has a substantially hexagonal outer shape in a side view, and a non-slip concave portion 31b for preventing slip is formed on the outer periphery. A plurality of locking balls 25 that are locked across the locking groove 24a of the fitted portion 24 and the locking groove 31a of the rotary fitting portion 31 are arranged in the circumferential direction.

  The cover main body 32 has a cylindrical shape that is substantially the same diameter as the grip 20 and forms an internal space 34 that is substantially X-shaped in side view. Further, a shaft support that allows the insertion of the support shaft 51 of the blade tip tip 50 is formed in one of the thick portions forming the internal space 34 that is substantially X-shaped in a side view, by forming a through hole that extends over substantially the entire length of the cover body 32. A portion 35 is formed.

The rear end side of the insertion portion 35 is provided with a slide hole 35 a that penetrates outward in the radial direction and allows the insertion of the connecting pin 52 that connects the support shaft 51 of the blade tip 50 and the adjustment ring 33. . As shown in FIG. 1D, the slide hole 35 a is formed in a long hole shape that is long in the axial direction X so that the blade electrode 53 can slide in the axial direction X.
As shown in FIG. 1E, the adjustment ring 33 is configured to slide in the axial direction X and to fix the sliding position in the axial direction X by an engagement groove (not shown).

  The laser probe 40 is inserted through the center portion of the X-shaped side view in the inner space 26 of the grip 20 and the inner space 34 of the outer cover 30, and the outer peripheral surface of the hollow waveguide 300 is covered with a resin insulating coating. doing.

  The laser probe 40 passes through the inside of the grip 20 and the outer cover 30 and is connected via the connection connector 21 disposed at the rear end side of the grip 20, that is, the lower end of the apparatus main body 2 side as described above. The waveguide 60 communicates with the waveguide cable 61 constituting the cable 60.

  The hollow waveguide 300 constituting the laser probe 40 will be described in detail. As shown in FIG. 4, the hollow waveguide 300 includes a stainless steel tube 310 serving as a base material and a diameter from the radially outward direction on the inner surface of the stainless steel tube 310. The conductive metal layer 320 and the dielectric thin film 330 are arranged in order in the inward direction. A waveguide space 300a is formed inside the hollow.

  Gold, silver or copper is suitable for the conductive metal layer 320 formed on the inner surface of the stainless steel tube 310. These metal materials are materials having higher conductivity than stainless steel and high reflectivity with respect to the carbon dioxide laser beam L. Such a conductive metal layer 320 can be formed on the inner surface of the stainless steel tube 310 by plating or rolling.

The dielectric thin film 330 formed on the inner surface of the conductive metal layer 320 is a dielectric material having an appropriate thickness for efficiently reflecting and transmitting the carbon dioxide laser beam L in the hollow waveguide 300, and is formed of, for example, a cyclic olefin polymer. Thin film.
The hollow waveguide 300 configured in this manner has high electrical conductivity due to the stainless steel tube 310 and the conductive metal layer 320, and can improve the transmission efficiency of the carbon dioxide laser light L guided through the waveguide space 300a. .

The blade tip chip 50 includes a blade electrode 53 disposed at a predetermined interval in the irradiation direction of the carbon dioxide laser beam L emitted from the emission port 40a of the laser probe 40, and a support shaft that supports the blade electrode 53 at the predetermined position. 51.
The support shaft 51 that supports the blade electrode 53 has a rod shape that is inserted into the insertion portion 35 and includes the above-described connecting pin 52 in the vicinity of the rear end.

  The blade electrode 53 is bent in a reverse shape when viewed from the side, and has a substantially drop-like shape when viewed from the side larger than the emission port 40a of the laser probe 40. A support shaft 51 is implanted in the upper small-diameter portion. Further, the blade electrode 53 increases in thickness from the small diameter portion toward the large diameter portion, and as shown in FIG. 3A, the side irradiated with the carbon dioxide laser beam L, that is, the support shaft 51 is implanted. On the irradiated surface 53a, which is the surface on the irradiated side, a reflection unevenness 54 is formed on which the irradiated carbon dioxide laser beam L is diffused and reflected. The reflection irregularities 54 are formed in a number of substantially square frustums smaller than the spot of the irradiated carbon dioxide laser beam L, and a plurality of substantially square frustums are arranged in parallel. The blade electrode 53 incorporates a vibration mechanism (not shown).

In addition, each reflection unevenness | corrugation 54 may be arrange | positioned by changing an arrangement angle and a convex shape, and also the structure which the reflection unevenness | corrugation 54 drives may be sufficient.
Further, the irradiation surface 53a of the blade electrode 53 having the reflection unevenness 54 is provided with a photocatalytic coating that acts in a dark place.
Further, the blade tip 50 is made of a conductive metal material and is electrically connected to the conductive cable 62 constituting the connection cable 60 by an electric circuit (not shown).

  As described above, the waveguide cable 61 constituting the connection cable 60 protruding in the vertical direction from the upper surface 2a of the apparatus body 2 is a cable having a predetermined length and flexibility, and can transmit the carbon dioxide laser light L. It consists of a hollow or solid optical fiber and a protective tube that covers it.

  The monopolar medical treatment instrument 10 assembled with the grip 20, outer cover 30, laser probe 40, and blade tip chip 50 configured in this way has an X-shaped internal space 34 and an internal space 26 communicating with each other. The laser probe 40 is inserted through the center in a side view, and an exhaust duct H is formed at an outer portion thereof. The exhaust duct H is connected to the exhaust gas suction cable 64 constituting the connection cable 60 via the connection connector 21, and is configured to be conductive to the exhaust gas suction device 1d.

  Further, the support shaft 51 of the blade tip tip 50 is inserted into the insertion portion 35 of the outer cover 30 and is connected to the adjustment ring 33 that is fitted on the cover body 32 by a connection pin 52 that passes through the slide hole 35 a of the insertion portion 35. Therefore, by rotating the adjustment ring 33 in the circumferential direction and sliding in the axial direction X while being restricted by a spiral groove 55 (not shown) formed in the outer cover 30, in FIGS. The blade tip 50 can be slid from the rear end position shown by a solid line to the tip side position shown by a broken line, and can be fixed at a desired slide position.

  Further, the outer cover 30 is rotatably fitted to the grip 20 by a locking ball 25 that is locked across the locking groove 31a of the rotation fitting portion 31 and the locking groove 24a of the fitted portion 24. Therefore, the outer cover 30 can be rotated with respect to the grip 20 in a desired rotation direction. Therefore, the direction of the blade electrode 53 of the blade tip 50 in which the support shaft 51 is inserted into the insertion portion 35 of the outer cover 30 can be adjusted to a desired direction as the outer cover 30 rotates.

  The monopolar medical treatment instrument 10 configured as described above irradiates the carbon dioxide laser light L that conducts the laser probe 40 from the emission port 40a of the laser probe 40 to function as a laser knife, and depresses the electric knife switch 23. By energizing the blade tip chip 50, the blade electrode 53 can function as an electric knife.

  At this time, since the carbon dioxide laser beam L irradiated from the emission port 40a of the laser probe 40 is reflected by the reflection irregularities 54 formed on the irradiation surface 53a of the blade electrode 53, the reflected laser light R reflected by the reflection irregularities 54 is diffused. And reflected (see the enlarged view of FIG. 6c).

  Further, since the blade electrode 53 incorporates a vibration mechanism, when the vibration mechanism is activated, the reflection unevenness 54 is also ultrasonically vibrated together with the blade electrode 53, so that the reflected laser light R reflected by the reflection unevenness 54 is also generated by the vibration mechanism. It will vibrate with the vibration.

  Furthermore, since the photocatalyst coating acting in the dark place is applied to the irradiation surface 53a of the blade electrode 53 having the reflection unevenness 54, even when heated by irradiation with the carbon dioxide laser light L or energization of the blade tip 50, The irradiation surface 53a of the blade electrode 53 can be prevented from being burnt.

As shown in FIG. 5, the medical treatment apparatus 1 having the monopolar medical treatment instrument 10 configured as described above firstly covers a patient M, which is a treatment target, with a covering for a counter electrode plate connected to a high-frequency oscillator 1 b. A counter electrode plate 70 functioning as a counter electrode attached to the tip of the electric wire 71 is attached.
In addition, the conductive cable 62 connected to the high-frequency oscillator 1 b and the waveguide cable 61 connected to the laser oscillator 1 a are connected to the monopolar medical treatment instrument 10 as a connection cable 60.

  In this state, a high-frequency current is applied by the high-frequency oscillator 1b, and the blade electrode 53 of the monopolar medical treatment instrument 10 is brought into contact with the treatment site of the patient M, so that the high-frequency oscillator 1b, the conductive cable 62, and the blade tip are provided. 50, the patient M, the counter electrode plate 70, and the counter electrode coated electric wire 71 constitute an energizing circuit, and a high frequency current is energized in the energizing circuit, and the blade electrode 53 that contacts the patient M constitutes an electric knife that performs incision or cauterization hemostasis. be able to.

  In addition, the monopolar medical treatment instrument 10 attached to the tip of the connection cable 60 constituted by the waveguide cable 61 connected to the laser oscillator 1a is configured so that the carbon dioxide laser beam L output from the laser oscillator 1a is converted into the waveguide cable 61. And the waveguide space 300a of the hollow waveguide 300 constituting the laser probe 40 attached to the monopolar medical treatment instrument 10 is guided, and the carbon dioxide laser beam L is irradiated forward from the emission port 40a of the laser probe 40. Can function as a laser knife.

  Further, since the blade electrode 53 of the blade tip chip 50 is arranged in front of the irradiation direction of the laser probe 40 and on the optical axis of the carbon dioxide laser light L, the irradiated carbon dioxide laser light L is emitted from the blade electrode 53. And is not irradiated beyond the blade electrode 53, and it is possible to prevent inadvertent incision behind the incision site.

A method of using the medical treatment apparatus 1 will be described with FIG. 6, which is a schematic view of a coelomic surgery using the medical treatment apparatus 1.
As described above, the counter electrode plate 70 is attached to the back of the patient M to establish continuity with the living body, and the connection cable 60 is connected to the monopolar medical treatment instrument 10 so that the medical treatment apparatus 1 can perform the treatment. After that, a hole for inserting the monopolar medical treatment tool 10 and the body cavity endoscope 100 is opened in the abdomen of the patient M in the body cavity surgery, and the cylindrical trocar 110 is inserted.

  The body cavity mirror 100 is inserted into one trocar 110, and the monopolar medical treatment instrument 10 is inserted into the other trocar 110. Then, while confirming the image in the body cavity displayed on the monitor 101 connected to the body cavity mirror 100, a high frequency current is applied to the periphery of the affected part P to be incised by the high frequency oscillator 1b, thereby electrically connecting the blade electrode 53. The blade electrode 53 is inserted into the lower part of the living tissue of the affected part P by making an incision by functioning as a female electrode.

  At this time, in the body cavity, carbon dioxide supplied by the gas supplier 1c conducts the waveguide space 300a of the hollow waveguide 300 constituting the laser probe 40, and the emission port 40a of the laser probe 40 enters the body cavity. Supplied and is in a predetermined pressure state.

  In this state, the foot pedal 8 is stepped on and operated to oscillate the carbon dioxide laser light L by the laser oscillator 1a and propagate the carbon dioxide laser light L into the waveguide space 300a constituting the laser probe 40. The carbon dioxide laser beam L is irradiated from the emission port 40 a of the laser probe 40, the periphery of the affected part P interposed between the laser probe 40 and the blade electrode 53 is incised, and the affected part P is excised.

  Further, when the blade electrode 53 is applied to the bleeding site in the excised diseased part P and the electric knife switch 23 is pressed, the blade electrode 53 is energized and functions as an electric knife to stop cauterization.

  A monitor connected to the body cavity mirror 100 generates a large amount of mist (smoke) having oily or carbonized particles by excision of the affected part P with the carbon dioxide laser beam L and cauterization and hemostasis of the blade electrode 53 functioning as an electric knife. The field of view of the surgical field in the body cavity confirmed by the image displayed on 101 may disappear, but when the exhaust switch 22 is pressed, the control valve disposed in the internal space 26 is opened and the exhaust gas inhaler 1d The generated mist is discharged outside in order to operate. In addition, when discharging mist, carbon dioxide is supplied by the gas supply device 1c, and the control valve is controlled to be closed after exhausting, so that the pressurized state in the body cavity is maintained.

  As described above, the monopolar medical treatment instrument 10 inserted into the body includes the laser probe 40 including the hollow waveguide 300 that guides the carbon dioxide laser light L that can be cut in a non-contact manner, and the tip of the hollow waveguide 300. The counter electrode plate 70 is in contact with the living body of the patient M to be treated through the hollow waveguide 300 which is configured of the blade electrode 53 disposed on the extension and has conductivity and also guides the carbon dioxide laser light L. By passing a high-frequency current between the blade electrode 53 and the blade electrode 53, the function of the laser knife and the function of the electric knife can be switched with a simple apparatus configuration.

  Specifically, since the laser probe 40 is configured by the hollow waveguide 300 that guides the carbon dioxide laser light L that can be cut in a non-contact manner, and the blade electrode 53 is disposed on the distal end extension of the hollow waveguide 300, By guiding the carbon dioxide laser light L in the region of the waveguide space 300a of the hollow waveguide 300 and passing a high-frequency current between the counter electrode 70 in contact with the living body of the patient M and the blade electrode 53, With a simple apparatus configuration, the function of the laser knife and the function of the electric knife can be switched and used. For example, it can be used in a method suitable for the operation content, such as making an incision efficiently with the function of the laser knife and suppressing the incision width to a small extent, and stopping bleeding in a wide range with the function of the electric knife. .

  Further, since carbon dioxide laser light can be guided directly into the hollow hollow waveguide 300 and the hollow waveguide 300 itself made of a metal material can be used as a conductor, for example, the waveguide and the conductor. As compared with the case where these are separately provided, the shaft diameter is reduced, and the burden on the living body can be reduced.

  Therefore, in the above-described colostomy surgery, in general, replacement of a surgical instrument is very complicated and troublesome, but the surgical instrument can be replaced by using the monopolar medical treatment instrument 10 according to the present invention. In addition, it is possible to perform an operation using a suitable scalpel function according to the operation content, and to perform a highly invasive operation that can reduce the burden on the patient.

  Further, the blade electrode 53 is spaced apart from the emission port 40a of the laser probe 40 constituted by the hollow waveguide 300 that guides the carbon dioxide laser light L, and is disposed on the far side on the irradiation path of the carbon dioxide laser light L. Thus, unintentional incision of the living body by the laser knife can be prevented.

  Specifically, the blade electrode 53 is spaced from the emission port 40a of the laser probe 40 constituted by the hollow waveguide 300 that guides the carbon dioxide laser light L, and is disposed on the irradiation path of the carbon dioxide laser light L. The affected part P to be incised is disposed between the emission port 40a of the laser probe 40 and the blade electrode 53, and the carbon dioxide laser light L can be used to efficiently and accurately perform the incision.

  Further, since the blade electrode 53 is disposed on the irradiation path of the carbon dioxide laser light L, the carbon dioxide laser light L is blocked by the blade electrode 53. There is no possibility that the gas laser beam L reaches the deep part of the living tissue and is irradiated to an unintended depth or location, and the treatment can be performed safely. Thus, the blade electrode 53 acts not only as an electric knife electrode but also as a light shielding plate for shielding the carbon dioxide laser light L.

  Further, since the hollow waveguide 300 constituting the laser probe 40 is composed of a stainless steel tube 310 and a conductive metal layer 320 having higher conductivity than stainless steel covering its inner peripheral surface, the conductive metal layer 320 is In addition, since the reflectance of the inner wall of the hollow waveguide 300 is also increased, the waveguide performance of the hollow waveguide 300 that guides the carbon dioxide laser beam L can be improved.

  In addition, a carbon dioxide laser is used as the carbon dioxide laser light L guided in the hollow waveguide 300. The carbon dioxide laser light L has a small divergence angle and a high energy density, so that it is more efficient and has a narrow incision width. It can be performed. Moreover, since the carbon dioxide laser light L is highly absorbed by water and does not penetrate deeply into the living tissue, there is little influence on the normal tissue and the post-operative patient burden can be further reduced.

  Furthermore, the carbon dioxide supplied by the gas supply device 1c also flows in a predetermined flow rate together with the waveguide space 300a of the hollow waveguide 300 constituting the laser probe 40, so that the scattered matter, body fluid, or body cavity of the incised affected part P It is possible to prevent the waveguide efficiency of the carbon dioxide laser light L from decreasing without smoke or the like filling the inside of the hollow waveguide 300 entering the waveguide space 300a. Furthermore, a visual field around the affected area P can be secured under a body cavity endoscope.

  Further, the reflection unevenness 54 for diffusing the reflected laser beam R is formed on the surface of the irradiation surface 53 a on which the carbon dioxide laser beam L is irradiated on the blade electrode 53, so that the irradiation of the blade electrode 53 with the carbon dioxide laser beam L is performed. The reflected laser light R reflected by the surface 53a is diffused, and there is no risk of incision by concentrating on an unintended location, so that the treatment can be performed safely.

  In addition, since the blade electrode 53 incorporates a vibration mechanism that imparts vibration, the reflection unevenness 54 formed on the blade electrode 53 that vibrates by the vibration mechanism also vibrates, so that the diffusibility of the reflected laser light R is improved, and the blade By the reflected laser beam R reflected on the surface of the irradiation surface 53a irradiated with the carbon dioxide laser beam L at the electrode 53, it is possible to perform the treatment more safely without cutting an unintended portion.

  In addition, since the photocatalytic coating is applied to the irradiation surface 53a of the blade electrode 53, an incision piece or blood adheres to the blade electrode 53 heated by laser irradiation or energization, and the function as an electric knife is deteriorated. There is no.

  In addition, a grip 20 held by an operator and an outer cover 30 that is rotatable with respect to the grip 20 are provided, and the laser probe 40 is disposed on the outer cover 30 so that the carbon dioxide laser light L can be irradiated from the tip of the outer cover 30. At the same time, by using the monopolar medical treatment instrument 10 in which the blade electrode 53 is disposed on the irradiation path of the irradiated carbon dioxide laser beam L at the tip of the outer cover 30, the orientation of the blade electrode 53 with respect to the grip 20 is facilitated. It can be adjusted and operability can be improved.

  Further, by providing an adjustment ring 33 that adjusts the distance from the emission port 40a of the laser probe 40 to the blade electrode 53, for example, even in the thinnest organ such as visceral serosa or wall serosa Depending on the thickness of the outer cover 30, the distance from the tip of the outer cover 30 to the blade electrode 53 can be adjusted, and more appropriate treatment can be performed.

  Furthermore, since the grip 20 is provided with the electric knife switch 23 for switching ON / OFF of the energization to the blade electrode 53, for example, after an efficient incision with a laser knife, the electric knife is quickly operated, and the bleeding point Thus, appropriate treatment according to the treatment method can be promptly performed.

  In general intra-body cavity surgery, in order to secure a surgical field, gas such as carbon dioxide is supplied into the body cavity and the operation is performed in a pressurized state. However, by incision by the carbon dioxide laser beam L and hemostasis by the blade electrode 53, A large amount of mist (smoke) having oily or carbonized particles may be generated, and the visual field of the surgical field to be confirmed by the image in the body cavity displayed on the monitor 101 may be lost. By exhausting the smoke in the body cavity to be treated to the outside through the exhaust duct H by providing the exhaust duct H that allows discharge of air and the control valve disposed in the internal space 26 that restricts conduction of the exhaust duct H. While securing the field of view, it is possible to maintain the pressurized state in the body cavity by restricting the conduction of the exhaust duct H with the control valve disposed in the internal space 26.

  Further, in the medical treatment apparatus 1, the apparatus main body 2 including therein a laser oscillator 1a that is a laser light source that generates the carbon dioxide laser light L and a high-frequency oscillator 1b that oscillates a high-frequency current, and the above-described monopolar medical use The treatment instrument 10, the counter electrode 70 that contacts the patient M, the waveguide cable 61 that connects the laser oscillator 1a and the monopolar medical treatment instrument 10, and each of the monopolar medical treatment instrument 10 and the counter electrode 70 Conduction is performed by connecting the conductive cable 62 connected to the high-frequency oscillator 1b and the exhaust duct H, and connecting the laser probe 40 to the exhaust gas inhaler 1d that discharges the smoke that has been conducted through the exhaust duct H to the outside. A gas supply device 1c that supplies carbon dioxide into the body cavity, and at least an exhaust gas inhaler 1d, a gas supply device 1c, and a control valve disposed in the internal space 26 The controller 7 is connected and controls the pressure in the body cavity to be treated, so that the gas supply device 1c supplies carbon dioxide into the body cavity and arranges smoke in the body cavity to be treated in the internal space 26. While restricting the continuity of the exhaust duct H with the control valve, the exhaust gas inhaler 1d discharges to the outside through the exhaust duct H, and the visibility can be secured while maintaining the pressurized state in the body cavity.

  In addition, by supplying carbon dioxide into the body cavity with the gas supply device 1c, scattered matter and body fluid at the incised surgical site, smoke filled in the body cavity, and the like are introduced into the hollow waveguide 300 constituting the laser probe 40. Intrusion into the wave space 300a can be prevented. Therefore, it is possible to prevent the guided wave performance from deteriorating due to the scattered matter and body fluid at the surgical site that has been cut open, smoke that fills in the body cavity, and the like entering the laser probe 40. Furthermore, the visual field around the treatment site can be secured by carbon dioxide ejected from the laser probe 40 under the body cavity endoscope.

  In addition, although the photocatalyst coating which acts in the dark place was given to the irradiation surface 53a of the blade electrode 53, the burning by the blade electrode 53 was prevented, but as shown in FIG.3 (b), the irradiation surface 153a of the blade electrode 153 is shown. In addition, two types of striped plating 154 (154a, 154b) having different impedances, such as conductive plating and non-conductive plating, may be alternately arranged to prevent the blade electrode 153 from being burnt.

  Further, in this case, a plasma effect occurs between the two types of striped plating 154 (154a, 154b) having different impedances applied to the irradiation surface 153a of the blade electrode 153, and the blade electrode 153 is cauterized as an electric knife. The hemostatic action can be improved.

In correspondence between the configuration of the present invention and the above-described embodiment,
The medical treatment instrument of the present invention corresponds to a monopolar medical treatment instrument 10 and bipolar medical treatment instruments 10a and 10b described later,
Similarly,
The treatment target part corresponds to the affected part P,
The hollow waveguide corresponds to the laser probe 40,
The living body corresponds to the patient M,
The electrodes correspond to the counter electrode plate 70 and a bipolar electrode 80 described later,
The blade electrode for the electric knife corresponds to the blade electrode 53,
The emission end corresponds to the tip emission port 40a,
The diffuse reflection means corresponds to the reflection unevenness 54,
The vibration means corresponds to the vibration mechanism built in the blade electrode 53, and
The burn prevention means corresponds to the photocatalytic coating applied to the blade electrode 53,
The gripping part corresponds to the grip 20,
The outer fitting portion corresponds to the outer cover 30,
The interval adjusting means corresponds to the adjusting ring 33,
The ON / OFF switching means corresponds to the electric knife switch 23,
The discharge path corresponds to the exhaust duct H,
The conduction regulating means corresponds to the control valve arranged in the internal space 26,
The conductive line corresponds to the conductive cable 62,
The atmosphere discharge means corresponds to the exhaust gas inhaler 1d,
The gas supply means corresponds to the gas supplier 1c,
The present invention is not limited only to the configuration of the above-described embodiment, and many embodiments can be obtained.

For example, in the above description, the reflection unevenness 54 is formed on the irradiation surface 53a of the blade electrode 53 in order to diffuse the reflected laser light R. However, the irradiation surface 53a is roughened or painted with low smoothness or the like. Then, the reflected laser light R may be diffused.
Furthermore, the shape of the projections and depressions 54 formed on the surface may be changed while changing the shape such as the height and angle, or changing the arrangement direction. Moreover, the uneven reflection unevenness 54 may be moved.

Further, the photocatalytic coating is applied to the blade electrode 53 to prevent the blade electrode 53 from burning, but a fluororesin film may be formed on the surface of the blade electrode 53.
Further, although the gas supply device 1c and the exhaust gas suction device 1d are arranged in the apparatus main body 2, the gas supply device 1c and the exhaust gas suction device 1d may be configured separately from the device main body 2.

  Furthermore, in the above description, a vibration mechanism for applying vibration to the blade electrode 53 is incorporated in the blade electrode 53, but the support shaft 51 may be provided, and carbon dioxide irradiated from the emission port 40 a of the laser probe 40. As long as the gas laser beam L is not affected by vibration, the gas laser beam L may be provided at any position.

  Furthermore, in the above description, the counter electrode plate 70 is attached to the patient M to be treated, a high-frequency current is applied by the high-frequency oscillator 1b, and the blade electrode 53 of the monopolar medical treatment instrument 10 is applied to the treatment location of the patient M. By bringing them into contact with each other, the high-frequency oscillator 1b, the conductive cable 62, the blade tip chip 50, the patient M, the counter electrode plate 70, and the counter electrode plate-coated electric wire 71 constitute an energization circuit, and the blade electrode 53 in contact with the patient M cuts or cauterizes. Although the electric knife for hemostasis is configured, the functions of the counter electrode plate 70 and the counter electrode coated electric wire 71 may be provided in the medical treatment instrument.

  As shown in FIG. 7, the bipolar medical treatment instrument 10 a having the functions of the counter electrode plate 70 and the counter electrode covered electric wire 71 has a bipolar electrode 80 on the outer cover 30 that supports the blade tip 50 with the shaft support portion 35. It comprises and comprises. The bipolar electrode 80 includes a substantially C-shaped electrode main body 81 in plan view and a support shaft 82 planted from the electrode main body 81, and the shaft support portion 36 formed adjacent to the shaft support portion 35 in the circumferential direction has a support shaft. 82 is inserted and attached to the outer cover 30.

  In the mounted state in which the support shaft 82 is mounted on the shaft support portion 36, the electrode body 81 is disposed between the emission port 40 a of the laser probe 40 and the blade electrode 53 of the blade tip chip 50. The support shaft 82 of the bipolar electrode 80 is connected to the high-frequency oscillator 1 b by an electric circuit in place of the counter electrode coated wire 71 inside the outer cover 30.

  In the bipolar medical treatment instrument 10a including the bipolar electrode 80 configured as described above, the affected part P is sandwiched between the electrode body 81 of the bipolar electrode 80 and the blade electrode 53 of the blade tip 50, and the electrode body 81 and By bringing the blade electrode 53 into contact with the affected area P, the high-frequency oscillator 1b, the conductive cable 62, the blade tip chip 50, the affected area P, and the bipolar electrode 80 constitute an energizing circuit, and the blade electrode 53 in contact with the affected area P is electrically connected. By functioning as a scalpel, the affected part P in contact can be incised or cauterized.

  Further, as described above, the blade electrode 53 can adjust the distance between the emission port 40a of the laser probe 40 and the blade electrode 53 by an operation of rotating the adjustment ring 33 in the circumferential direction (FIGS. 7D and 7D). e)), that is, the distance between the blade electrode 53 and the electrode body 81 can be adjusted by the above operation of the adjustment ring 33. For example, even in the thinnest organ such as the visceral serosa or the wall serosa, the blade The affected part P can be incised or cauterized and stopped by being sandwiched between the electrode 53 and the electrode body 81 and functioning reliably as an electric knife.

  The electrode body 81 of the bipolar electrode 80 is not limited to a substantially C shape in a plan view, but may be an appropriate one as long as it does not block the progress of the laser light L emitted from the emission port 40a of the laser probe 40, such as an O type or a U type in plan view. Can be formed.

Furthermore, another bipolar medical treatment instrument 10b as shown in FIGS. 8 to 10 may be used.
Specifically, the bipolar medical treatment instrument 10b includes an outer tube 90 having a blade electrode 53 at the tip, a connecting terminal 13 disposed at the rear, and a hollow waveguide 300, and an inner electrode having a bipolar electrode 80 at the tip. A pipe 91 and a grip 92 that allows the outer pipe 90 to be inserted are configured.

  The outer tube 90 bends in a reverse shape when viewed from the side, and has a blade electrode 53 formed in a substantially drop-like shape when viewed from the side larger than an emission port 91a of the inner tube 91, which will be described later, in front of the axial center of the outer tube 90. It is supported by the support shaft 51 so as to be disposed, and functions as a sheath tube that allows the inner tube 91 formed by the hollow waveguide 300 to be inserted therein.

Further, as shown in FIG. 10, a connection terminal 13 that allows connection of the conductive cable 62 connected to the high-frequency oscillator 1b is provided behind the outer tube 90.
The inner tube 91 inserted into the outer tube 90 is constituted by the hollow waveguide 300 and is formed in a straight tubular shape that is longer in the axial direction than the outer tube 90.

  At the tip of the inner tube 91 is a bipolar electrode 80 having a passage hole 83 that allows the laser light L guided through the inner tube 91 to pass therethrough, and is formed in a substantially ring shape that is bent in a reverse shape when viewed from the side. It has. The bipolar electrode 80 and the inner tube 91 are formed so that the outer diameters of the bipolar electrode 80 and the inner tube 91 are smaller than the inner diameter of the outer tube 90 so that the bipolar electrode 80 can pass through the hollow portion of the outer tube 90 together with the inner tube 91. .

  At the rear end of the inner tube 91, a connection cable 94 composed of a waveguide cable 61 connected to the laser oscillator 1a and a bipolar electrode covered electric wire 72 connected to the high frequency oscillator 1b is connected via a connection connector 93. Are configured to be connected.

  In addition, while allowing the inner pipe 91 to be inserted therein, an inner pipe that passes through the inner circumference of the outer pipe 90 and the inner pipe of the outer pipe 90 that conducts to the blade electrode 53 by the connection cable 94 connected to the connection terminal 13. An insulating process (not shown) is performed between the outer peripheral surface 91 and the outer peripheral surface.

  The grip 92 includes a grip portion 92a gripped by the practitioner and a grip body 92b through which the outer tube 90 penetrates in a substantially horizontal direction.

  The bipolar medical treatment instrument 10b constituted by each component as described above connects the conductive cable 62 to the connection terminal 13 of the outer tube 90 attached to the grip 92, and as shown in FIG. The inner tube 91 is inserted into the outer tube 90 from the side. Then, a connection cable 94 composed of the waveguide cable 61 and the bipolar electrode covered electric wire 72 is connected to the rear end of the inner tube 91 via the connection connector 93.

  The bipolar medical treatment instrument 10b assembled in this way is applied to the living body sandwiched between the blade electrode 53 and the bipolar electrode 80 by energizing the conductive cable 62 and the bipolar electrode covered electric wire 72. In addition to functioning as an electric knife, the laser light L can be passed through the inner tube 91 formed by the hollow waveguide 300 so that the treatment site of the living body can be treated with the laser light L.

  The inner tube 91 inserted into the outer tube 90 is adjusted between the bipolar electrode 80 and the blade electrode 53 as shown in the enlarged view of FIG. The interval and the interval between the emission port 91a of the inner tube 91 and the blade electrode 53 can be adjusted, for example, according to the treatment site. For example, the axial distance can be adjusted by rotating the adjustment ring 33 in the circumferential direction by a fixing pin fixed to the adjustment ring 33 described in FIG. 1D and a spiral groove formed in the outer cover 30. .

  Further, it goes without saying that the same effect as the monopolar medical treatment instrument 10 is obtained, but the outer diameter of the bipolar electrode 80 is smaller than the outer diameter shape of the inner tube 91, and the inner tube 91 having the bipolar electrode 80 is formed. Since the inside of the outer tube 90 is inserted and the bipolar electrode 80 is disposed at a predetermined position, the interval between the bipolar electrode 80 and the blade electrode 53 is set, and the interval between the emission port 91a of the inner tube 91 and the blade electrode 53 is set. Can be adjusted, for example, according to the treatment site. This adjustment of the axial interval can also be realized by using the configuration described in FIG.

DESCRIPTION OF SYMBOLS 1 ... Medical treatment apparatus 1a ... Laser oscillator 1b ... High frequency oscillator 1c ... Gas supply 1d ... Exhaust gas inhaler 2 ... Apparatus main body 7 ... Control part 10 ... Monopolar type medical treatment tool 10a, 10b ... Bipolar type medical treatment Tool 20 ... Grip 23 ... Electric knife switch 30 ... Outer cover 33 ... Adjusting ring 40 ... Laser probe 40a ... End exit port 53 ... Blade electrode 53a ... Illumination surface 54 ... Reflection unevenness 61 ... Waveguide cable 62 ... Conductive cable 70 ... Counter electrode 80 ... Bipolar electrode H ... Exhaust duct L ... Laser beam M ... Patient P ... Affected site R ... Reflected laser beam

Claims (10)

A medical treatment instrument inserted into the body,
A hollow hollow waveguide that guides laser light that can be cut in a non-contact manner in a treatment target portion of a living body that is a treatment target;
At the tip of the hollow waveguide, it is configured with a blade electrode for an electric knife that functions by energizing through the counter electrode that contacts the living body,
The electric knife blade electrode,
A predetermined interval from the emitting end for irradiating the laser beam in the hollow waveguide, and disposed on the irradiation path of the laser beam,
Diffuse reflection means for diffusing the reflected laser light that the irradiated laser light is reflected by the blade electrode for the electric knife,
A medical treatment instrument formed on an irradiation surface irradiated with the laser light in the electric knife blade electrode. The blade electrode for the electric knife is provided in the treatment instrument body,
The medical treatment instrument according to claim 1, wherein the counter electrode is a monopolar treatment instrument configured separately from the treatment instrument body and configured by a counter electrode plate that is in contact with a living body that is a treatment target. The medical treatment instrument according to claim 1, wherein the counter electrode is a bipolar electrode, and is a bipolar treatment instrument provided in a treatment instrument body together with the electric knife blade electrode. The medical treatment instrument according to any one of claims 1 to 3, further comprising a vibration unit that applies vibration to the blade electrode for the electric knife. The medical treatment tool according to any one of claims 1 to 4, further comprising a burn prevention means for preventing the scalpel blade electrode from burning. A grasping portion grasped by the surgeon;
The gripping portion includes a rotatable outer fitting portion,
In the outer fitting part,
While arranging the hollow waveguide so that the laser irradiation is possible from the tip of the outer fitting portion,
At the tip of the outer fitting part,
The medical treatment instrument according to any one of claims 1 to 5, wherein the electric knife blade electrode is disposed on an irradiation path of the irradiated laser beam. The medical treatment instrument according to claim 6, further comprising a gap adjusting unit that adjusts a gap from a tip of the hollow waveguide to the blade electrode for the electric knife. In the gripping part,
The medical treatment instrument according to claim 6 or 7, further comprising ON / OFF switching means for switching ON / OFF of energization to the electric knife blade electrode. A discharge path that allows the discharge of the atmosphere in the body cavity to be treated to the outside;
The medical treatment instrument according to any one of claims 1 to 8, further comprising conduction restriction means for regulating conduction of the discharge path. An apparatus main body internally provided with a laser oscillator that is a laser light source that generates laser light, and a high-frequency oscillator that oscillates a high-frequency current;
The medical treatment tool according to claim 9,
A counter electrode in contact with the living body;
A waveguide cable connecting the laser oscillator and the medical treatment instrument;
Each of the medical treatment tool and the counter electrode, and a conductive line connecting the high-frequency oscillator,
Atmosphere discharge means for conducting to the discharge path and discharging the atmosphere conducted through the discharge path to the outside;
Gas supply means for conducting the hollow waveguide and supplying gas into a body cavity to be treated;
A medical treatment apparatus comprising at least a control unit connected to the atmosphere discharging unit, the gas supply unit, and the conduction regulating unit and controlling a pressure in a body cavity to be treated.

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