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WO2016013255A1 - Instrument médical haute fréquence - Google Patents

Instrument médical haute fréquence Download PDF

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Publication number
WO2016013255A1
WO2016013255A1 PCT/JP2015/060054 JP2015060054W WO2016013255A1 WO 2016013255 A1 WO2016013255 A1 WO 2016013255A1 JP 2015060054 W JP2015060054 W JP 2015060054W WO 2016013255 A1 WO2016013255 A1 WO 2016013255A1
Authority
WO
WIPO (PCT)
Prior art keywords
sheath
electrode member
liquid
tip
distal end
Prior art date
Application number
PCT/JP2015/060054
Other languages
English (en)
Japanese (ja)
Inventor
史知 和家
Original Assignee
オリンパス株式会社
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by オリンパス株式会社 filed Critical オリンパス株式会社
Priority to JP2015562999A priority Critical patent/JPWO2016013255A1/ja
Publication of WO2016013255A1 publication Critical patent/WO2016013255A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current

Definitions

  • the present invention relates to a high-frequency treatment instrument.
  • a high-frequency treatment instrument that treats a living tissue such as a mucous membrane by applying a high-frequency current is known (see, for example, Patent Document 1).
  • an electrode is inserted and arranged in a sliding hole at the tip of a flexible sheath having electrical insulation so that the electrode can advance and retreat in the axial direction, and the liquid fed through the flexible sheath is slid. It has a structure that can be discharged from the distal end of the flexible sheath through a liquid feeding opening communicating with the hole.
  • the high-frequency treatment instrument when bleeding occurs during the high-frequency treatment by energizing the electrodes, the high-frequency treatment instrument is replaced by a liquid such as physiological saline discharged from the distal end of the flexible sheath without replacing the high-frequency treatment instrument. It can be washed and a hemostatic treatment can be performed quickly and reliably against bleeding during surgery.
  • the high-frequency treatment instrument since the high-frequency treatment instrument is arranged so that the large-diameter portion provided at the tip of the electrode closes the liquid-feeding opening, the flow of the liquid is not greatly affected by the large-diameter portion by advancing the electrode. If the large-diameter portion is arranged away from the liquid-feeding opening as described above, the liquid can be discharged straight.
  • One embodiment of the present invention includes an elongated cylindrical sheath to be inserted into the body, an electrode member that is movably disposed in the longitudinal direction in the sheath, and to which a high-frequency current is supplied, and a proximal end side of the sheath.
  • a liquid feed means for feeding liquid via a flow path formed in the sheath, and a sliding hole for movably inserting and arranging the electrode member at the distal end of the sheath; and by the liquid feed means
  • a discharge port that discharges the liquid that has been fed is provided, and a tip portion that extends in a radially outward manner from the sliding hole is provided at the tip of the electrode member, and the discharge port is the tip.
  • a high-frequency treatment instrument formed in a shape and a position for changing the discharge angle of the liquid discharged forward with respect to the longitudinal axis in accordance with the distance from the distal end of the sheath.
  • treatment such as cutting of tissue in the body is performed by advancing the electrode member relative to the sheath to increase the amount of protrusion at the tip, and supplying a high-frequency current to the electrode member.
  • the hook-shaped tip is hooked on the surrounding tissue, so that the treatment can be performed stably without slipping.
  • the ablation area can be reduced even when a high-frequency current is supplied by retracting as much as possible until the tip of the electrode member comes into contact with the tip of the sheath so that only the tip of the electrode member is exposed at the tip of the sheath. Marking can be performed without being deeper than necessary.
  • the liquid feeding means When bleeding occurs at the site where treatment is performed, the liquid feeding means is operated to discharge the liquid fed through the flow passage penetrating the sheath in the longitudinal direction from the discharge port at the distal end of the sheath. By doing so, the liquid can be discharged and washed in the vicinity of the bleeding site.
  • the liquid discharge angle changes. Can be changed. For example, when a treatment is performed endoscopically, it is possible to change the position where the liquid is applied while cleaning the electrode member by moving the electrode member forward and backward.
  • the sheath when a liquid is locally injected into the submucosa, the sheath may be in a state where only the tip of the electrode member is exposed at the tip of the sheath so that the electrode does not pierce the tissue more than necessary. Since the liquid is discharged in a state where the tip of the tube is pressed against the surface of the tissue, the liquid can be locally injected into the submucosal layer regardless of the liquid discharge direction.
  • the discharge port may be formed so that the discharged liquid is discharged in a direction along the longitudinal axis in a state where the electrode member is separated from the distal end of the sheath.
  • the liquid feeding means with the electrode member advanced to the maximum extent, the liquid is discharged straight along the longitudinal axis of the sheath, and the liquid is washed at the target position. Etc. can be performed. Even if it is difficult to adjust the position of the electrode member in the advancing / retreating direction, the discharge along the longitudinal axis can be easily realized only by advancing it to the maximum extent.
  • the discharged liquid is discharged at an angle with respect to the longitudinal axis in a state where the electrode member is retracted to a position where the distal end portion abuts against the distal end of the sheath.
  • the discharge port may be formed at the same time.
  • the said discharge port may be provided with two or more at intervals in the circumferential direction around the said sliding hole.
  • the high-frequency treatment instrument 1 is a treatment instrument in which a distal end is introduced into a body through a channel provided in an insertion portion of an endoscope, for example, as shown in FIG. Formed into an elongated cylindrical shape that can be inserted into the sheath 2, a flexible sheath 2, an electrode member 3 that is advanced and retracted at the distal end of the sheath 2, and an operation of pushing and pulling the electrode member 3 toward the proximal end side of the sheath 2 And a liquid feeding means 5 for discharging liquid from the distal end of the sheath 2 via the inner hole 2a of the sheath 2.
  • a tip 6 is fixed to the tip of the sheath 2 so as to close the inner hole 2a.
  • the tip tip 6 is provided with a sliding hole 6a for inserting and arranging the electrode member 3 so as to be movable, and a plurality of inner surfaces of the sliding hole 6a along the longitudinal direction.
  • four grooves 6b are provided.
  • the sheath 2 and the tip end 6 are made of an electrically insulating material.
  • the electrode member 3 has a round bar-like columnar part 3a having an outer diameter slightly smaller than the inner diameter of the sliding hole 6a of the tip 6 and a bowl-like shape radially outward over the entire circumference at the tip of the columnar part 3a. And a leading end 3b that extends.
  • the distal end portion 3b is formed in a substantially disk shape with a rounded peripheral edge on the distal end side.
  • the outer diameter of the tip 3b is set to be larger than the diameter of the sliding hole 6a.
  • the movable portion 4c When the movable portion 4c is moved to the distal end side of the sheath 2 with respect to the handle 4b, the pressing force is transmitted to the electrode member 3 through the wire 4d, and the electrode member 3 is moved in the direction of moving forward with respect to the distal tip 6. It is like that.
  • the movable portion 4c When the movable portion 4c is moved to the proximal end side of the sheath 2 with respect to the handle 4b, the traction force is transmitted to the electrode member 3 through the wire 4d, and the electrode member 3 is drawn into the sliding hole 6a of the distal tip 6.
  • the handle 4 is provided with a connection port 8 that communicates with the inner hole 2 a of the sheath 2.
  • the liquid feeding means 5 is a syringe or a pump connected to the connection port 8, and a liquid such as physiological saline is fed into the inner hole 2 a of the sheath 2 by the operation of the liquid feeding means 5.
  • the four grooves 6b are roughly partitioned by the columnar portion 3a in a state where the columnar portion 3a of the electrode member 3 is fitted and arranged in the sliding hole 6a.
  • Four flow paths 9 are formed.
  • the four flow paths 9 are arranged at equal intervals in the circumferential direction of the columnar portion 3a, and each is formed between the inner hole 2a of the sheath 2 and the wire 4d as shown in FIG.
  • a cylindrical flow path 10 is opened in front of the tip 6. That is, the four flow paths 9 have respective discharge ports 9 a on the tip surface 6 c of the tip chip 6.
  • each flow channel 9 is separated from the discharge port 9a when the tip 3b of the electrode member 3 is moved forward and away from the tip surface 6c of the tip 6 as shown in FIG.
  • the discharge port 9a of each flow channel 9 is separated from the discharge port 9a when the tip 3b of the electrode member 3 is moved forward and away from the tip surface 6c of the tip 6 as shown in FIG.
  • the discharge port 9a of each flow channel 9 is separated from the discharge port 9a when the tip 3b of the electrode member 3 is moved forward and away from the tip surface 6c of the tip 6 as shown in FIG.
  • the discharge port 9a of each flow channel 9 is separated from the discharge port 9a when the tip 3b of the electrode member 3 is moved forward and away from the tip surface 6c of the tip 6 as shown in FIG.
  • the discharge port 9a of each flow channel 9 is separated from the discharge port 9a when the tip 3b of the electrode member 3 is moved forward and away from the tip surface 6c of the tip 6 as shown in FIG.
  • the discharge port 9a of each flow channel 9
  • each flow path 9 is opened to extend radially outward from the outer diameter of the tip portion 3 b of the electrode member 3.
  • the electrode member 3 is partially closed by the tip 3b when the electrode member 3 is retracted most.
  • the amount of protrusion of the discharge port 9a from the outer diameter of the distal end surface 3b is such that the liquid C that has flowed through the flow channel 10 in the inner hole 2a of the sheath 2 is divided into four flow channels 9 and the distal end surface 6c of the distal tip 6
  • the flow direction is changed radially outward by being blocked by the tip 3b, and the size is set so as to be discharged obliquely forward.
  • the operation unit 4 is operated to maximize the electrode member 3 as shown in FIG.
  • the sheath 2 is introduced into the body from the distal end side through a channel of the endoscope insertion portion (not shown), and the distal end of the sheath 2 is projected from the distal end of the insertion portion of the endoscope.
  • the operator removes the electrode member 3 by energizing the electrode member 3 while pressing the distal end surface 6c of the distal tip 6 to a plurality of places surrounding a portion that is supposed to be a lesion to be removed in the endoscopic image displayed on the monitor.
  • a mark surrounding the periphery of the lesion site to be formed can be formed, which can be used as a measure for subsequent treatment.
  • the operation unit 4 is operated to cause the electrode member 3 to protrude from the distal end surface 6c of the distal tip 6 as shown in FIG. Is inserted into the submucosa below the lesion site.
  • the operation unit 4 is operated to bring the electrode member 3 to the maximum retracted state, and the liquid feeding means 5 is operated to discharge the liquid C such as physiological saline from the discharge port 9a of the distal end surface 6c.
  • the liquid C is locally injected into the submucosal layer, and the lesion site is lifted.
  • the sheath 2 is extracted from the submucosal layer, the electrode member 3 is protruded by operating the operation unit 4 again, and the tissue around the lesion site is incised using the mark formed by the marking as a guide. Go. If there is bleeding in the middle of the incision, it can be cleaned by operating the liquid feeding means 4 to discharge the liquid C such as physiological saline from the discharge port 9a of the tip surface 6c of the tip 6.
  • the electrode member 3 is moved backward until the distal end portion 3b of the electrode member 3 abuts against the distal end surface 6c of the distal tip 6 by operating the operation portion 4. Thereby, the discharge port 9a of the flow path 9 is partially blocked by the tip portion 3b. Since the discharge port 9a of the flow channel 9 is formed so as to change the discharge direction of the liquid C when this state is reached, the liquid C changes its discharge direction from the front along the longitudinal axis of the sheath 2 to the sheath 2. It is changed to the diagonally forward direction inclined with respect to the longitudinal axis. Thereby, the position where the liquid C is applied can be changed without moving the endoscope, that is, without changing the endoscope image displayed on the monitor.
  • the high-frequency treatment instrument 1 branches the liquid C that has flowed through the flow path 10 in the inner hole 2a of the sheath 2 into the four flow paths 9 of the tip 6 and Since the liquid is discharged from the discharge port 9a, in the state where the electrode member 3 is retracted, the liquid C is branched and discharged in four directions obliquely forward, and the liquid C can be spread over a wider range. Therefore, there is an advantage that a wide range of bleeding can be quickly washed away.
  • grooves 6b are provided around the sliding hole 6a, and four flow paths 9 defined by the columnar portions 3a of the electrode member 3 inserted and arranged in the sliding hole 6a are formed.
  • one or more arbitrary number of grooves 6b may be formed.
  • channel 6b was provided in the circumferential direction at equal intervals, you may provide in unequal intervals.
  • the flow path is formed by the groove 6b connected to the slide hole 6a, the slide hole 6a in which the electrode member 3 is movably inserted and disposed and the flow path 9 in which the liquid C flows are formed independently. You may decide. In this case, a plurality of through holes 11 may be formed in parallel with the sliding hole 6a as shown in FIG. Moreover, although the cylindrical flow path 10 was formed between the inner surface 2a of the inner hole 2a of the sheath 2 and the wire 4d, an inner hole that forms the flow path 10 independently of the inner hole 2a in which the wire 4d is disposed ( (Not shown) may be provided.
  • the discharge port 9a of the flow channel 9 is partially blocked by the tip portion 3b of the electrode member 3 retracted to the maximum, so that the discharge port 9a of the flow channel 9 is blocked by the tip portion 3b.
  • the front end surface 6c that abuts the front end portion 3b of the electrode member 3 against the front end tip 6 protrudes slightly forward from the discharge port 9a of the flow path 9, or is shown in FIGS.
  • the step 3d and the inclined surface 3e are provided on the back surface 3c of the tip 3b, and the discharge port 9a of the flow channel 9 is partially opened even when the tip 3b is abutted against the tip 6c. It may be.
  • the discharge direction of the liquid C from the discharge port 9a of the flow path 9 is switched by maximally moving the electrode member 3 forward or backward, but instead, The discharge may be performed at an intermediate discharge angle at an intermediate position of advancement / retraction.
  • the discharge angle of the liquid C can be changed according to the position of the tip 3b of the electrode member 3, and the liquid C can be bathed without moving the field of view of the endoscope. The position or range of the object can be changed.
  • the shape is not limited and it is in the direction which cross
  • the shape may have any shape such as a spherical shape, a hemispherical shape, or a polygonal plate shape.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Molecular Biology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Plasma & Fusion (AREA)
  • Physics & Mathematics (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Otolaryngology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)
  • Endoscopes (AREA)

Abstract

L'objectif de la présente invention est de modifier un angle de décharge d'un fluide avec une simple manipulation. L'invention concerne un instrument médical haute fréquence (1), comprenant : une gaine cylindrique, longue et étroite (2) qui est insérée à l'intérieur d'un corps ; un élément d'électrode (3) qui est positionné à l'intérieur de la gaine (2) pour être mobile dans la direction de l'axe longitudinal, et auquel un courant haute fréquence est fourni ; et un moyen de transport de fluide qui est relié au côté extrémité de base de la gaine (2), et qui transporte un fluide par l'intermédiaire d'une voie d'écoulement (9) qui est formée dans la direction de l'axe longitudinal de la gaine (2). Un trou de coulissement (6a) dans lequel l'élément électrode (3) est inséré et positionné de manière à être mobile et une ouverture de décharge (9a) qui décharge un fluide (C) transporté par le moyen de transport de fluide sont disposés dans l'extrémité avant de la gaine (2). Une partie extrémité avant (3b) qui est plus grande que le trou de coulissement (6a) et s'étend radialement vers l'extérieur en une forme de bride est disposée dans l'extrémité avant de l'élément électrode (3). L'ouverture de décharge (9a) est formée en une forme et à un emplacement qui change l'angle de décharge par rapport à l'axe longitudinal du fluide (C) qui est déchargé vers l'avant, en fonction de la distance de la partie extrémité avant (3b) par rapport à l'extrémité avant de la gaine (2).
PCT/JP2015/060054 2014-07-24 2015-03-31 Instrument médical haute fréquence WO2016013255A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
JP2015562999A JPWO2016013255A1 (ja) 2014-07-24 2015-03-31 高周波処置具

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
JP2014-150920 2014-07-24
JP2014150920 2014-07-24

Publications (1)

Publication Number Publication Date
WO2016013255A1 true WO2016013255A1 (fr) 2016-01-28

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PCT/JP2015/060054 WO2016013255A1 (fr) 2014-07-24 2015-03-31 Instrument médical haute fréquence

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JP (1) JPWO2016013255A1 (fr)
WO (1) WO2016013255A1 (fr)

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2002301088A (ja) * 2001-04-05 2002-10-15 Olympus Optical Co Ltd 内視鏡用治療装置
JP2010046200A (ja) * 2008-08-20 2010-03-04 Fujinon Corp 高周波処置具
JP2013111308A (ja) * 2011-11-30 2013-06-10 Hoya Corp 内視鏡用高周波処置具

Family Cites Families (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2009112788A (ja) * 2007-10-17 2009-05-28 Takashi Toyonaga 高周波処置具
JP5613513B2 (ja) * 2010-09-27 2014-10-22 富士フイルム株式会社 内視鏡用処置具
WO2014061701A1 (fr) * 2012-10-17 2014-04-24 オリンパスメディカルシステムズ株式会社 Scalpel à haute fréquence

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2002301088A (ja) * 2001-04-05 2002-10-15 Olympus Optical Co Ltd 内視鏡用治療装置
JP2010046200A (ja) * 2008-08-20 2010-03-04 Fujinon Corp 高周波処置具
JP2013111308A (ja) * 2011-11-30 2013-06-10 Hoya Corp 内視鏡用高周波処置具

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