JPH04329944A - High-frequency incision apparatus - Google Patents

Abstract

PURPOSE:To prevent the bending of a knife for incision and the disabling of the knife to stick out otherwise caused by a forceps erecting device when the forceps erecting device is operated by arranging a second stopper member for regulating a retraction final end of the knife at a specified position in a flexible tube from the tip thereof. CONSTITUTION:In a high frequency incision apparatus 1, knife 6 already sticks out of the tip of an endoscope 25 when a forceps erecting device 28 starts an erecting operation as a second stopper member 5 is positioned at a point within 20mm from the tip of a flexible tube 2, and hence, there is limited possibility of bending the knife 6 with the forceps erecting device 28. In addition, there is no operation of the forceps erecting device 28 ahead of the knife 6, and thus, there is no possibility that the knife 6 may be caught at the bending part 28a of the forceps erecting device 28, thereby disabling the protrusion thereof from the tip of the high-frequency incision apparatus 1.

Description

[Detailed description of the invention]

0001

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a high-frequency cutting tool that is inserted endoscopically into a body cavity to incise, for example, the duodenal papilla.

0002

[Prior Art] Conventionally, when incising the duodenal papilla,
A high-frequency cutting tool as shown in Japanese Utility Model Publication No. 59-17290 is known. This involves inserting an electrode wire into a flexible tube that has electrical insulation properties, exposing the tip of the wire to the outer wall surface of the tip of the tube, and
By pulling the wire, the distal end of the tube is curved, and the exposed wire portion is stretched to form an incision. When incising the duodenal papilla using this high-frequency incision tool,
The tip of the high-frequency incision tool is inserted into the bile duct, the incision is brought into contact with the duodenal papilla, and a high-frequency current is passed between the electrode wire and the human body.

However, when the papilla is narrowed, it becomes difficult to insert the tip of the incision tool into the bile duct, and the duodenal papilla may not be incised at the incision site. In such a case,
An initial incision is made using a high-frequency incision tool such as that shown in Japanese Utility Model Publication No. 0787 and Japanese Utility Model Application Publication No. 191012/1983. As shown in FIG. 5, this high-frequency incision tool 80 is constructed by providing a needle-like knife 82 for high-frequency incision within the distal end of a flexible tube 81 having electrical insulation properties. Further, a needle-shaped knife 82 is provided so as to be able to protrude and retract from the tip of the flexible tube 81, and a tip member 86 is provided in the tip of the flexible tube 81.
is provided. The operation of pushing and retracting the knife 82 is performed by an operation wire 83. The operating wire 83 has one end connected to the proximal end of the knife 82 and the other end connected to the wire operating handle 85 of the operating section 84 provided at the proximal end of the flexible tube 81.
By moving the wire operation handle 85 forward and backward, the wire 83 is pushed and pulled, and the knife 82 can be operated in a manner that it can be freely protruded and retracted from the tip member 86. Further, a regulating portion 87 is provided at the base end of the knife 82, and by bringing this regulating portion 87 into contact with the tip member 86, the length of the knife 82 protruding from the tip of the flexible tube 81 is regulated. It is something. Further, a stopper 88 is provided on the proximal end side of the wire operating handle 85 in the operating section 84.
5 is moved back and brought into contact with the stopper 88, thereby restricting the withdrawal of the operating wire 83 and suppressing further retreat of the knife within the flexible tube 81.

0004

[Problems to be Solved by the Invention] When inserting the high-frequency cutting tool 80 endoscopically into a body cavity, first, the knife 82 is pulled into the flexible tube 81, as shown in FIG. The high-frequency cutting tool 80 is inserted into the channel 91 of the endoscope 90 in the closed state, and the distal end of the high-frequency cutting tool 80 is made to protrude from the distal end of the endoscope 90. After that, the high frequency cutting tool 8
0 is curved by raising the forceps raising device 92, and brought closer to the target site to be incised. Then, the knife 82 inside the flexible tube 81 is pushed out from the tip of the high-frequency incision tool 80 by wire manipulation to incise the target region.

However, in the conventional high-frequency cutting tool 80, the wire operating handle 8 set in the operating section 84
5 does not necessarily match the retraction length x of the knife 82 into the flexible tube 81 due to the bending of the operating wire 83 within the flexible tube 81. There are cases where the knife 82 is retracted too far into the flexible tube 81 and the knife 82 is positioned on the forceps lifting device 92 when the forceps lifting device 92 is operated to raise. In such a case, there is a risk that the knife 82 may be bent due to the raising operation of the forceps raising device 92. Furthermore, if the knife 82 is pulled too far into the flexible tube 81, the forceps lifting device 92 will be erected in front of the knife 82, and the knife 82 will be forced out of the flexible tube 81 by wire manipulation. At the time, knife 82
There is also a possibility that the forceps may get caught in the curved portion 93 of the forceps lifting device 92 and may not protrude from the tip of the high-frequency cutting tool 80.

[0006] The present invention has been made in view of the above-mentioned circumstances, and its purpose is to:
The forceps elevator may bend the cutting knife,
An object of the present invention is to provide a high-frequency cutting tool that can prevent the device from becoming unable to protrude.

[0007]

[Means for Solving the Problems] In order to solve the above problems, the present invention provides an electrically insulating flexible tube that can be inserted into a channel of an endoscope, and a flexible tube inside the distal end of the flexible tube. a high-frequency incision knife provided so as to be protrusive and retractable from the tip thereof; an operating wire connected to the knife for protruding and retracting the knife; and a first knife provided on the flexible tube for regulating the forward end of the knife. a second stopper member provided on the flexible tube and regulating a retracting end of the knife;
The knife comes into contact with the first stopper member to restrict the length of the knife protruding from the tip of the flexible tube, and the second stopper member
a stopper receiving portion that comes into contact with the second stopper member to suppress further retreat of the knife, and the second stopper member is located within the flexible tube and located 20 minutes from the tip of the flexible tube.
It is provided at a position within mm.

[0008]

[Function] With the above structure, the second stopper member prevents the high-frequency cutting knife from being pulled into the flexible tube too much, so that the high-frequency cutting knife is inserted into the channel of the endoscope and the tip of the high-frequency cutting knife is inserted into the channel of the endoscope. When the endoscope is raised by the forceps lifting device, the knife is already located within the tip of the flexible tube protruding from the tip of the endoscope.

[0009]

Embodiments Hereinafter, embodiments of the present invention will be described with reference to the drawings.

FIGS. 1 and 2 show a first embodiment of the present invention. As shown in FIG.
It consists of an electrically insulating flexible tube 2 that is inserted into the flexible tube 2, and an operating section 3 provided at the proximal end of the flexible tube 2. The operating unit 3 is electrically connected to a high frequency generator (not shown) via a cord (not shown).

A cylindrical first stopper member 4 is fitted into the distal end of the flexible tube 2 . Further, a cylindrical second stopper member 5 is fitted within the flexible tube 2 on the proximal side of the first stopper member 4 and at a distance L from the tip of the flexible tube 2. , the distance L is within 20 mm. A needle-like knife 6 for high-frequency cutting is accommodated in a space 8 sandwiched between the first stopper member 4 and the second stopper member 5. A high frequency current from the high frequency generator is supplied to the knife 6 via the operating section 3 and an operating wire 14 which will be described later.

A step portion 12 is provided on the inner surface of the hole 9 of the first stopper member 4, and a large diameter portion 11 and a small diameter portion 10 are formed within the hole 9 by this step portion 12. Further, the first stopper member 4 is adapted to guide the knife 6 to the outside of the flexible tube 2 through the hole 9.

A stopper receiving portion 7 that can come into contact with the step portion 12 of the first stopper member 4 and the second stopper member 5 is provided at the base end of the knife 6 . Further, the knife 6 is inserted into the flexible tube 2 through the stopper receiving portion 7 and passes through the hole 16 of the second stopper member 5 into the space 8.
It is connected to one end of the operating wire 14 guided inside. Further, the other end of the operating wire 14 is connected to a wire operating handle 15 provided on the operating section 3 and slidable along the axial direction thereof. That is, by pushing and pulling the wire 14 by moving the wire operating handle 15 forward and backward, the knife 6 can be operated so as to be protrusive and retractable from the tip of the flexible tube 2, and the stopper receiving portion 7 of the knife 6 can be moved into the space 8. It can be advanced and retreated only by the robot.

[0014] A cock 17 for liquid feeding is interposed between the flexible tube 2 and the operating part 3, and the high-frequency cutting tool 1
Through this cock 17, a chemical solution or the like can be sent to the tip of the flexible tube 2 and discharged from the tip opening 13 to the outside. In addition, the liquid feeding cock 17 includes a cock body 18 that is rotatable about the long axis of the flexible tube 2, and a cock body 18 that is rotatable about the long axis of the flexible tube 2.
The base portion 19 is provided in the flexible tube 2 and extends in a direction perpendicular to the long axis of the flexible tube 2. The cap portion 19 is composed of a cap body 19a provided at the top and a flexible portion 19b provided at the bottom of the cap body 19a and having a blade 20 therein. The flexible portion 19b allows the base portion 19 to be directed in any direction. Note that if the flexible portion 19b is made of a material that has a tendency to bend, the base portion 19
It is beneficial to be able to hold it in any direction.

Next, the operation of the high frequency cutting tool 1 having the above structure will be explained.

First, when the wire operating handle 15 is advanced to push the operating wire 14 forward, the knife 6 moves within the space 8 toward the tip of the flexible tube 2 and the first stopper member 4 The flexible tube is guided through the hole 9 into the tip opening 13 of the flexible tube and protrudes to the outside. At this time, the stopper receiving part 7 provided at the base end of the knife 6 is also guided inside the large diameter part 11 of the hole 9, but as the stopper receiving part 7 hits the stepped part 12, the knife 6 Further protrusion to the outside is suppressed.

Conversely, when the wire operating handle 15 is retracted and the operating wire 14 is pulled back, the knife 6 moves within the space 8 toward the proximal end of the flexible tube 2, but the knife 6 moves toward the base end of the flexible tube 2. By abutting the portion 7 against the second stopper member 5, further retreat within the flexible tube 2 is suppressed.

Next, an endoscope through which the high-frequency incision tool 1 having the above structure is inserted will be explained.

As shown in FIG. 2, a tip component 27 incorporating an optical observation system is provided at the tip of the endoscope 25, and a forceps lifting device 28 is provided in this tip component 27. ing. The forceps lifting device 28 is rotatably fixed to the tip component 27 by a resin pin 29 in order to reduce sliding resistance and prevent rust. Furthermore, the endoscope 25 has a forceps channel 26 through which the high-frequency cutting tool 1 is inserted. The outer tube 30 forming the forceps channel 26 is connected to the tip component 27 by a base 31, so that the forceps channel 26 can be
It communicates with a forceps guide hole 32 that is provided in the distal end component 27 and guides forceps etc. to the outside of the endoscope 25 . Further, in order to improve the forceps insertion performance, the hole diameter D near the exit of the forceps guide hole 32 is formed larger than the inner diameter d of the forceps channel 26. Inner diameter d of forceps channel 26
is formed to be 2 mm to 5.5 mm, and the hole diameter D near the exit of the forceps guide hole 32 is formed to be approximately 1.1 times the inner diameter d of the channel 26.

Next, the operation when the high-frequency cutting instrument 1 is inserted into the endoscope 25 and used will be explained.

First, with the knife 6 pulled into the flexible tube 2, the high-frequency cutting tool 1 is inserted into the forceps channel 26 of the endoscope 5.
The distal end of the high-frequency cutting tool 1 is made to protrude from the distal end of the endoscope 25 through the forceps guide hole 32 of the distal end component 27 . Thereafter, the tip of the high-frequency incision tool 1 is curved by raising the forceps lifting device 28 and brought close to the target site to be incised, for example, the duodenal papilla. At this time, the knife 6 is already attached to the endoscope. It is located within the distal end of the flexible tube 2 protruding from the distal end of the flexible tube 25. That is, in normal incision work, the length of the tip of the high-frequency cutting tool 1 that protrudes from the tip of the endoscope is often 20 mm or more, and the high-frequency cutting tool 1 in this embodiment has a length of 20 mm or more.
Since the stopper member 5 is located within 20 mm from the tip of the flexible tube 2, the knife 6 already protrudes from the tip of the endoscope 25 when the forceps lifting device 28 is raised. .

After the above operation, the knife 6 in the flexible tube 2 is pushed out from the tip of the high-frequency cutting instrument 1 by the wire operation described above, pierces the tissue of the target region, and the knife 6
The incision is made while supplying high-frequency current to the area.

As explained above, according to the high-frequency cutting tool 1 of this embodiment, when the forceps lifting device 28 is activated, the knife 6 is already inside the tip of the flexible tube 2 protruding from the tip of the endoscope 25. Due to its position, there is less risk of the knife 6 being bent by the forceps elevator. Further, since the forceps lifting device 28 is not operated in front of the knife 6, the knife 6
will not get caught in the curved portion 28a of the forceps lifting device and become unable to protrude from the tip of the high-frequency cutting tool 1.

FIG. 3 shows a second embodiment of the invention. In the high-frequency cutting tool 40 of this embodiment, the length of the space 8 in which the knife 6 is accommodated is equal to the sum of the length of the knife 6 and the length of the stopper receiving part 7, and the flexibility of the second stopper member 5 is The distance from the tip of the tube 2 is further shortened compared to the first embodiment. The other configurations are the same as the first embodiment.

With the above configuration, the retraction distance of the knife 6 within the flexible tube 2 is shorter than in the first embodiment, so that
When the forceps lifting device 28 is activated, the knife 6 is positioned further forward within the distal end portion of the flexible tube 2 protruding from the distal end of the endoscope 25. The risk of the knife 6 being bent is therefore lower than in the first embodiment.

FIG. 4 shows a third embodiment of the present invention. The high-frequency cutting tool 45 of this embodiment has a cylindrical tip member 46 that is integrally formed with the first stopper member 4 and the second stopper member 5 and is fitted into the tip of the flexible tube 2. . The other configurations are the same as the second embodiment.

With the above configuration, the knife 6 is surrounded by the side wall of the hard tip member 46, so when the knife 6 is positioned on the forceps lifting device 28, it is possible to accidentally lift the forceps lifting device 28. Even if it is activated, the knife 6 will not be bent.

[0028]

[Effects of the Invention] As explained above, according to the present invention,
When the forceps lifting device is operated, the cutting knife can be prevented from being bent or unable to be ejected by the forceps lifting device.

[Brief explanation of drawings]

FIG. 1 is a partial cross-sectional view of a high-frequency cutting tool showing a first embodiment of the present invention.

FIG. 2 is a cross-sectional view showing the high-frequency cutting tool of FIG. 1 inserted into an endoscope and raised.

FIG. 3 is a cross-sectional view showing the vicinity of the tip of a high-frequency cutting instrument according to a second embodiment of the present invention.

FIG. 4 is a cross-sectional view showing the vicinity of the tip of a high-frequency cutting tool according to a third embodiment of the present invention.

FIG. 5 is a partial cross-sectional view showing a conventional example of a high-frequency cutting tool.

FIG. 6 is a schematic view showing the high-frequency cutting tool of FIG. 5 inserted into an endoscope and raised.

[Explanation of symbols]

1, 40, 45...High frequency cutting tool 2...Flexible tube 4...First stopper member 5...Second stopper member 6...knife 7...Stopper receiving part 14...Operation wire 25...Endoscope 26...Channel

Claims (1)

[Claims] Claim 1: An electrically insulating flexible tube that can be inserted into a channel of an endoscope, and a knife for high-frequency incision that is provided in the tip of the flexible tube so that it can be protruded and retracted from the tip of the flexible tube. ,
an operating wire connected to the knife to perform a thrusting and retracting operation of the knife; a first stopper member provided on the flexible tube for regulating the forward end of the knife; and a first stopper member provided on the flexible tube for regulating the backward end of the knife. a second stopper member that comes into contact with the first stopper member to restrict the length of the knife protruding from the tip of the flexible tube, and a second stopper member that comes into contact with the second stopper member to restrict the length of the knife protruding from the tip of the flexible tube and a stopper receiving portion for suppressing further retreat of the second stopper member, the second stopper member being located within the flexible tube and located 2 minutes from the distal end of the flexible tube.
A high-frequency cutting tool characterized by being provided at a position within 0 mm.