JP2013158492A - Tool for high frequency wave treatment - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a tool for a high frequency wave treatment making the treatment easy irrespective of the position of an affected part, and without having any bad effect on his healthy area other than the affected part.SOLUTION: A tool for a high frequency wave treatment includes a treatment section, an operation wire having the treatment section at its leading end, and a first flexible tube where the operation wire is slidably inserted through. A second flexible tube for adjusting the operation conditions of the treatment section is detachably extending from the first flexible tube. As the operation conditions of the treatment section can be adjusted by such structure, treatment can become easier, regardless of the position of an affected region. Further the treatment tool reduces the possibility of having any harmful effect on regions other than the affected part.

Description

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

  The high-frequency treatment tool is used for treatment performed using a high-frequency current at a lesion site in the body. Generally, a high-frequency treatment instrument is a treatment that treats an affected area by applying a high-frequency current to a flexible tube that is inserted into a body cavity, an operation wire that is inserted into the flexible tube so as to freely advance and retract, and a distal end portion of the operation wire. A high-frequency application unit that applies a high-frequency current in contact with the operation wire, and an operation unit that is attached to the proximal end of the flexible tube and operates the treatment unit via the operation wire.

  This high-frequency treatment instrument performs treatment such as separation and hemostasis of an affected part by flowing a high-frequency current from an external high-frequency power supply device to the operation wire and a treatment part attached to the distal end of the operation wire via a high-frequency power supply connection cord. Is what you do.

  As such a high-frequency treatment instrument, there is disclosed a device having a needle-like electrode in a treatment portion, and protruding the needle-like electrode from the flexible tube main body to an arbitrary length and then performing a treatment such as separation of the affected portion. (For example, refer to Patent Document 1).

  In the high-frequency treatment instrument of Patent Document 1, it is necessary to make the needle-like electrode protrude once from the flexible tube main body and then adjust the protrusion length according to the treatment site. In such an operation, it is difficult to protrude the needle electrode by a desired length. For this reason, there is a problem that the needle-shaped electrode is protruded too much, and it is difficult to accurately aim at the affected part when the affected part is treated.

  In order to solve such a problem, the high-frequency electrode is exposed from the side surface near the tip of the electrically insulating flexible sheath (Patent Document 2), or the metal exposed portion on the surface of the electrode rod There has been proposed a high-frequency treatment instrument in which all other parts are electrically insulatively coated (Patent Document 3).

JP-A-4-329944 Japanese Patent No. 4275004 Japanese Patent No. 4725808

  However, although the high-frequency treatment tool of Patent Document 2 can prevent damage to healthy tissues other than the affected part, it is necessary to rotate the treatment part according to the affected part. Further, there is no problem when the treatment is performed in the horizontal direction with respect to the tissue, but when the treatment is performed in the vertical direction with respect to the tissue, the treatment may be difficult depending on the affected part.

  Moreover, in the high frequency treatment tool of patent document 3, since a high frequency current concentrates on a metal exposure part, damage to healthy tissues other than the affected part by a leakage current can be prevented. However, if high-frequency current is continuously applied to the metal part, heat energy is generated, and even if the electrically insulating coating is applied, there is a possibility of adversely affecting healthy tissues other than the affected part.

  This invention is made | formed in view of such a subject, and provides the high frequency treatment tool which a treatment becomes easy irrespective of the position of an affected part. Moreover, the high frequency treatment tool which does not have a bad influence on healthy tissues other than an affected part is provided.

  Such an object is achieved by the present invention described below.

The present invention is a high-frequency treatment instrument comprising a treatment portion, an operation wire having the treatment portion at a tip, and a first flexible tube through which the operation wire is slidably inserted.
The first flexible tube is detachably provided with a second flexible tube that adjusts the operating state of the treatment portion.

  The second flexible tube may have a slit that penetrates the surface or a recess that does not penetrate on the outer periphery.

  At least one of the proximal end portion of the treatment portion and the distal end portion of the operation wire may be insulated.

  The tip of the first flexible tube may have a shape that prevents the second flexible tube from moving forward.

  A rear end of the second flexible tube may have a first stopper that prevents the second flexible tube from moving forward.

  The operation wire may include a second stopper that prevents the treatment portion and the operation wire from moving forward.

  The distal end of the second flexible tube may have a shape that prevents the treatment portion from retreating.

  The diameter of the rear end of the treatment part may be smaller than the diameter of the treatment part on the front end side.

  According to the present invention, since the operating state of the treatment part can be adjusted, it is possible to facilitate the treatment regardless of the position of the affected part. In addition, adverse effects on healthy tissues other than the affected area can be reduced.

It is a front view of the high frequency treatment tool concerning the embodiment of the present invention. It is a side view of the high frequency treatment tool concerning the embodiment of the present invention. It is an enlarged view which shows the 1st state which protruded the treatment part of the high frequency treatment tool which concerns on embodiment of this invention. (A) is a front view of the front-end | tip part of the high frequency treatment tool in a 1st state, (b) is a partial longitudinal cross-sectional view which showed the inside of the 1st flexible tube. It is an enlarged view which shows the 2nd state which the treatment part front-end | tip of the high frequency treatment tool which concerns on embodiment of this invention protruded from the 2nd flexible tube. (A) is a front view of the front-end | tip part of the high frequency treatment tool in a 2nd state, (b) is a partial longitudinal cross-sectional view which showed the inside of the 1st flexible tube. It is an enlarged view which shows the 3rd state which accommodated the treatment part of the high frequency treatment tool which concerns on embodiment of this invention in the 2nd flexible tube. (A) is a front view of the front-end | tip part of the high frequency treatment tool in a 3rd state, (b) is a partial longitudinal cross-sectional view which showed the inside of the 1st flexible tube. It is an enlarged view which shows the 4th state by which the 2nd flexible tube of the high frequency treatment tool which concerns on embodiment of this invention was accommodated in the 1st flexible tube. (A) is a front view of the front-end | tip part of the high frequency treatment tool in a 4th state, (b) is a partial longitudinal cross-sectional view which showed the inside of the 1st flexible tube.

  Hereinafter, preferred embodiments of the high-frequency treatment device of the present invention will be described in detail with reference to the drawings.

  The high-frequency treatment instrument 1 of this embodiment is an instrument that is used by being inserted through a lumen (lumen) of an endoscope and treating an affected area by applying a high-frequency current.

  As shown in FIGS. 1 and 2, the high-frequency treatment device 1 of the present embodiment includes a first flexible tube 2 inserted into a body cavity, and an electrically conductive material inserted through the first flexible tube 2 so as to freely advance and retract. It has an operation wire 3, a treatment portion 4 disposed at the distal end portion of the operation wire 3 and treating the affected area by applying a high frequency current, and an operation portion 5 attached to the proximal end portion of the first flexible tube 2. Yes.

  The first flexible tube 2 is a long tube that occupies most of the entire length of the high-frequency treatment instrument 1. The first flexible tube 2 connects the operation unit 5 and the treatment unit 4 and enables access to a lesion site of the treatment unit 4.

Any first flexible tube 2 may be used as long as it has flexibility. Examples of the material of the first flexible tube 2 include a conductive material such as stainless steel, a fluorine resin, a polyolefin resin such as polyethylene and polypropylene, a polyamide resin, a polyimide resin, a polyurethane resin, and a polycarbonate resin. Examples thereof include resins. Among these, the use of a fluororesin is preferable because it is excellent in slidability with the forceps hole of the endoscope through which the first flexible tube 2 is inserted.
When using a conductive material, it is preferable to coat the inner surface of the first flexible tube 2 with an insulating material.

  Although the dimension of the 1st flexible tube 2 changes with endoscopes to be used, for example, it is preferable that a length is 1500-2500 mm and an outer diameter is in the range of 1.5-3 mm. If the length is within the above range, the high-frequency treatment instrument 1 can be used by being inserted into the lumen (lumen) of the endoscope. Moreover, if an outer diameter is below the said upper limit, the penetration property to the forceps hole of an endoscope will become more favorable.

  The tip 21 of the first flexible tube 2 has a shape that prevents the advancement of the second flexible tube 6 described later. By having the shape which prevents the advance of the 2nd flexible tube 6 in the front-end | tip 21 of the 1st flexible tube 2, even if the operation part 5 is advanced too much, the 2nd flexible tube 6 is a 1st flexible tube. No deviation from 2.

  In the present embodiment, the tip 21 of the first flexible tube 2 is formed so that the opening diameter is smaller than the inner diameter of the first flexible tube 2. That is, as shown in FIGS. 3 to 6, the tip 21 of the first flexible tube 2 is formed to extend perpendicular to the axial direction. And the advancement from the 1st flexible tube 2 of the 2nd flexible tube 6 can be prevented because the 1st stopper 62 demonstrated later by this front-end | tip 21 is latched. In the present embodiment, it has been described that the tip 21 extends at right angles to the axial direction. However, the present invention is not limited to this. For example, the inner diameter of the first flexible tube gradually decreases toward the tip. It may be.

  The operation wire 3 is a wire line inserted through the lumen of the first flexible tube 2. The distal end of the operation wire 3 is connected to the treatment unit 4. The proximal end of the operation wire 3 is connected to the operation unit 5. Thus, as will be described later, the treatment section 4 can be driven and operated via the operation wire 3 by operating the operation section 5.

  Examples of the material of the operation wire 3 include metal materials such as stainless steel, titanium and titanium alloys, poly (paraphenylenebenzobisoxazole) (PBO), polyetheretherketone (PEEK), polyphenylene sulfide (PPS), poly Examples thereof include polymer fibers such as butylene terephthalate (PBT), polyimide (PI), and polytetrafluoroethylene (PTFE).

  For example, the length of the operation wire 3 is preferably in the range of 1600 to 2600 mm. If the length is within the above range, the treatment section 4 can be driven and operated via the operation wire 3 by operating the operation section 5.

  The operation wire 3 has a second stopper 31 that prevents the treatment section 4 and the operation wire 3 from moving forward. By having the second stopper 31 that prevents the treatment section 4 and the operation wire 3 from moving forward, the treatment section 4 and the operation wire 3 do not advance more than a predetermined length even if the operation section 5 is excessively advanced. In addition, by providing the second stopper 31, the second flexible tube 6 can be advanced when the operation unit 5 is operated to advance.

  In the present embodiment, the outer diameter of the second stopper 31 is formed larger than the inner diameter on the proximal end side of the second flexible tube 6. That is, as shown in FIGS. 3 to 6, the second stopper 31 has an annular convex shape at the distal end portion of the operation wire 3. For this reason, the portion of the operation wire 3 closer to the proximal end than the second stopper 31 does not enter the lumen of the second flexible tube 6. Therefore, when the operation wire 3 is advanced, first, the second stopper 31 comes into contact with the proximal end portion of the second flexible tube 6 to advance the second flexible tube 6. As described above, the second flexible tube 6 is prevented from advancing when the first stopper 62 is locked to the tip 21 of the first flexible tube 2. For this reason, the advance of the operation wire 3 is also prevented. In addition, although this embodiment demonstrated that the 2nd stopper was cyclic | annular convex shape, this invention is not limited to this, For example, the some convex part may be formed in the base end part of the operation wire. .

  The treatment section 4 is disposed at the distal end of the first flexible tube 2 and is driven by the advancement / retraction of the operation wire 3. The treatment section 4 is a device that treats an affected area by applying a high-frequency current. In order to apply a high frequency current to the treatment section 4, a power supply terminal 7 to which a high frequency current cord (not shown) is attached is provided protruding from the high frequency treatment instrument 1.

  Although the specific configuration of the treatment portion 4 is not particularly limited, in the present embodiment, the treatment portion 4 includes the most advanced spherical portion 41, a rod-like portion 42 connected to the proximal end side of the spherical portion 41, and a proximal end of the rod-like portion 42. It is comprised from the insulation part 43 connected to the side. The proximal end of the insulating portion 43 is connected to the distal end of the operation wire 3. As the operation wire 3 advances, the treatment section 4 protrudes, presses the treatment section 4 against the affected area, and incises this while applying high-frequency current to the affected area. The shape of the treatment portion is not limited to this, and may be, for example, a needle shape or a hook shape.

  Examples of the material for the treatment section 4 include conductive materials such as stainless steel. In particular, it is preferable to use a material having a high electrical conductivity for the treatment portion that supplies high-frequency current to the tissue through the treatment portion 4.

  In the present embodiment, the insulating portion 43 of the treatment portion 4 is configured by covering the proximal end portion of the rod-like portion 42 with an insulating tube. By providing the insulating portion 43 on the proximal end side of the treatment portion 4, as will be described later, when the treatment portion 4 is entirely projected, the metal portion is formed from the slit 61 penetrating the outer peripheral surface of the second flexible tube 6. Will not be exposed. Since the metal portion is not exposed from the slit 61 penetrating the surface of the outer periphery of the second flexible tube 6, it is possible to energize only the treatment portion 4 in front of the second flexible tube 6. As shown in FIG. 4, when the treatment portion 4 is housed in the second flexible tube 6, the insulating portion 43 retreats, so that the tissue is removed from the portion located in the slit 61 portion that penetrates the second flexible tube 6. Can be energized.

  The outer diameter of the rod-shaped part 42 is smaller than the outer diameter of the spherical part 41. Since the outer diameter of the rod-shaped portion 42 is smaller than the outer diameter of the spherical portion 41, the spherical portion 41 can be fitted into the second flexible tube 6, and the second possible portion can be obtained when the operation wire 3 is retracted. The flexible tube 6 can be stored in the first flexible tube 2.

  The operation unit 5 is provided at the proximal end of the first flexible tube 2 and adjusts the protruding length of the treatment unit 4. The operation unit 5 includes a shaft portion 51 and a slider portion 52 that is slidably engaged with the shaft portion 51.

  The shaft portion 51 has a cylindrical shape. The proximal end of the first flexible tube 2 is connected to the distal end portion of the shaft portion 51. Further, the operation wire 3 is inserted into the shaft portion 51.

  The slider portion 52 is a member that moves the operation wire 3 and the treatment portion 4 forward and backward. In the present embodiment, as shown in FIG. 1, the slider portion 52 has a cylindrical shape in which the outer periphery at the center in the longitudinal direction is recessed. The slider portion 52 is attached to the shaft portion 51 and slides in the longitudinal direction of the shaft portion 51. A proximal end portion of the operation wire 3 is fixed to the slider portion 52. Therefore, when the slider portion 52 is slid in the front-rear direction with respect to the shaft portion 51, the operation wire 3 moves back and forth.

  As shown in FIG. 3 to FIG. 6, a second flexible tube 6 that adjusts the operating state of the treatment section 4 is detachably protruded from the first flexible tube 2 of the present embodiment. By providing the second flexible tube 6 on the first flexible tube 2, the treatment portion 4 can be covered freely with the second flexible tube 6, and the length of the treatment portion 4 desired by the operator can be obtained. Can be adjusted.

  Here, adjusting the operating state of the treatment section includes adjusting the protrusion length of the treatment section and adjusting the range of the portion of the treatment section exposed to the outside.

  Any second flexible tube 6 may be used as long as it has flexibility. Examples of the material of the second flexible tube 6 include fluorine resins, polyolefin resins such as polyethylene and polypropylene, polyamide resins, polyimide resins, polyurethane resins, and polycarbonate resins.

  Moreover, although the dimension of the 2nd flexible tube 6 changes with shapes and dimensions of the treatment part 4, for example, it is preferable that length is in the range of 2-5 mm and an outer diameter is 1.5-2.5 mm.

  In this embodiment, the 2nd flexible tube 6 has the slit 61 which penetrates the surface on an outer periphery. By having the slit 61 penetrating the surface on the outer periphery of the second flexible tube 6, even when the treatment section 4 is stored in the second flexible tube 6, the slit 61 passing through the second flexible tube 6 The tissue can be energized from the position where it is located, and the affected area can be treated. That is, the slit 61 of the second flexible tube 3 serves to adjust the size of the portion of the treatment portion 4 exposed to the outside.

  In the present embodiment, a slit that penetrates the surface is provided on the outer periphery of the second flexible tube, but a recess that does not penetrate may be provided. In this case, the treatment portion is not exposed to the outside, but the portion where the recess is formed is thin, so that the tissue can be energized.

  A rear end of the second flexible tube 6 has a first stopper 62 that prevents the second flexible tube 6 from moving forward. By having the first stopper 62 that prevents the second flexible tube 6 from moving forward, the second flexible tube 6 does not deviate from the first flexible tube 2 even if the operation portion 5 is excessively advanced.

  In the present embodiment, the first stopper 62 is formed so that the outer diameter of the proximal end portion of the second flexible tube 6 is larger than the outer diameter of the distal end portion. That is, as shown in FIGS. 3 to 6, the first stopper 62 is formed by forming the base end portion of the second flexible tube 6 in a flange shape. The first stopper 62 is in contact with and locked with the tip 21 of the first flexible tube 2 described above, thereby preventing the second flexible tube 6 from dropping from the first flexible tube 2. The shape of the first stopper is not limited to this, and for example, it may be formed so that the outer diameter of the second flexible tube 6 gradually increases toward the base end.

  Next, the usage method of the high frequency treatment tool 1 of this embodiment is demonstrated. First, the high-frequency treatment tool 1 is inserted from the forceps hole of the endoscope. Then, the distal end 21 of the first flexible tube 2 is guided to the vicinity of the affected part while observing the image of the endoscope.

  After guiding the distal end 21 of the high-frequency treatment instrument 1 to the affected area, the operation section 5 at the hand is operated forward, and the treatment section 4 is set to the state shown in FIG. 3 (first state). That is, the spherical portion 41 and the rod-shaped portion 42 are projected from the tips of the first flexible tube 2 and the second flexible tube 6. Such a first state is suitable for a treatment such as incising mucosal tissue around the lesion.

  In the first state, the insulating portion 43 is located in the second flexible tube 6. For this reason, the high frequency current does not leak from the slit 61, and the treatment can be performed only by the distal end portion of the treatment portion 4.

  Further, the slider 52 is slid to the proximal end side to change the treatment section 4 from the first state to the state shown in FIG. 4 (second state). That is, the treatment section 4 is protruded until only approximately half of the distal end side of the spherical section 41 is exposed from the distal end of the second flexible tube 6. Such a second state is suitable for a treatment in which the submucosal layer in the lesion excision range is peeled off.

  Further, the slider 52 is slid to change the treatment section 4 from the second state to the state shown in FIG. 5 (third state). That is, the distal end of the spherical portion 41 of the treatment section 4 is aligned with the distal end of the second flexible tube 6, and the treatment section 4 does not protrude from the distal end of the second flexible tube 6. When a high frequency current is applied in this state, the high frequency current leaks from the slit 72 to the surface of the second flexible tube. Such a third state is suitable for a treatment such as marking for indicating the extent of the lesion excision range.

  As described above, the high-frequency treatment instrument 1 of the present embodiment can adjust the protrusion length of the treatment portion 4 from the second flexible tube 6 and select treatments suitable for various situations of the affected portion depending on the difference of the protrusion state (operation state). can do.

  Further, when the high-frequency treatment instrument 1 is inserted into and removed from the forceps hole of the endoscope, the treatment section 4 and the second flexible tube 6 are housed in the first flexible tube 2 as shown in FIG. 4 state), the treatment section 4 can be protected during handling such as insertion / extraction.

  The present invention has been described based on the embodiments. It is to be understood by those skilled in the art that these embodiments are merely examples, and that various modifications are possible and that such modifications are within the scope of the present invention.

DESCRIPTION OF SYMBOLS 1 High frequency treatment tool 2 1st flexible tube 21 The front-end | tip of 1st flexible tube 3 Operation wire 31 2nd stopper 4 Treatment part 41 Spherical part 42 Rod-shaped part 43 Insulation tube 5 Operation part 51 Shaft part 52 Slider part 6 2nd possible Flexible tube 61 Slit 62 First stopper 7 Power supply terminal

Claims (8)

A high-frequency treatment instrument comprising a treatment part, an operation wire having the treatment part at a distal end, and a first flexible tube through which the operation wire is slidably inserted,
A high-frequency treatment instrument, wherein a second flexible tube for adjusting an operating state of the treatment portion is detachably provided on the first flexible tube.   The high-frequency treatment instrument according to claim 1, wherein the second flexible tube has a slit that penetrates the surface or a recess that does not penetrate on the outer periphery.   The high-frequency treatment tool according to claim 1 or 2, wherein at least one of a proximal end portion of the treatment portion and a distal end portion of the operation wire is coated with insulation.   The high-frequency treatment instrument according to any one of claims 1 to 3, wherein a distal end of the first flexible tube has a shape that prevents the second flexible tube from moving forward. 5. The high-frequency treatment device according to claim 1, further comprising a first stopper that prevents the second flexible tube from advancing at a rear end of the second flexible tube. The high frequency treatment tool according to any one of claims 1 to 4, wherein the operation wire includes a second stopper that prevents the treatment portion and the operation wire from moving forward.   The high-frequency treatment instrument according to any one of claims 1 to 6, wherein a distal end of the second flexible tube has a shape that prevents the treatment portion from retreating.   The high frequency treatment tool according to any one of claims 1 to 7, wherein a diameter of a rear end of the treatment portion is smaller than a diameter of a distal end side of the treatment portion.

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