JP2001190564A - Medical treatment instrument - Google Patents
Medical treatment instrumentInfo
- Publication number
- JP2001190564A JP2001190564A JP2000003759A JP2000003759A JP2001190564A JP 2001190564 A JP2001190564 A JP 2001190564A JP 2000003759 A JP2000003759 A JP 2000003759A JP 2000003759 A JP2000003759 A JP 2000003759A JP 2001190564 A JP2001190564 A JP 2001190564A
- Authority
- JP
- Japan
- Prior art keywords
- treatment
- incision
- coagulation
- present
- heat
- Prior art date
- Legal status (The legal status 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 status listed.)
- Granted
Links
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- Surgical Instruments (AREA)
Abstract
Description
【０００１】[0001]
【発明の属する技術分野】本発明は、体腔内に挿入して
例えば血管や臓器等の体腔内組織を凝固及び、または切
開等を行う際に使用される外科手術用鉗子等の医療用処
置具に関する。BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a medical treatment tool such as a surgical forceps used for coagulating and / or incising a body cavity such as a blood vessel or an organ by being inserted into the body cavity. About.
【０００２】[0002]
【従来の技術】患者の体腔内組織を凝固切開する処置具
として、例えばＵＳＰ５，７９２，１３７には半導体か
らなる発熱素子の一部がメス状の切刃を備えたものが示
されている。2. Description of the Related Art As a treatment tool for coagulating and incising tissue in a body cavity of a patient, for example, U.S. Pat. No. 5,792,137 discloses a device in which a part of a heating element made of a semiconductor has a female cutting blade.
【０００３】また、ＵＳＰ５，７１６，３６６には縫合
器における組織接触面の一部が熱エレメントからなり、
更に切断路内を動作する切断エレメントを備えたものが
示されている。In US Pat. No. 5,716,366, a part of a tissue contacting surface of a suture instrument is composed of a heat element.
Further shown is one with a cutting element operating in the cutting path.
【０００４】[0004]
【発明が解決しようとする課題】ＵＳＰ５，７９２，１
３７の処置具では、発熱素子自体の一部に鋭利なメス状
の切刃が設けられているため、この処置具で生体組織を
強力に把持した場合には擬固する前に生体組織を切断
し、出血を来すおそれがある。SUMMARY OF THE INVENTION USP 5,792,1
In the treatment tool of No. 37, a sharp scalpel-shaped cutting blade is provided in a part of the heating element itself. Therefore, when the living tissue is strongly grasped by this treatment tool, the living tissue is cut before being imitated. And may cause bleeding.
【０００５】さらに、この処置具で生体組織を切断しな
い程度の弱い力で把持した場合には、血管等の生体組織
を確実には閉塞できないために、その後の切断操作でや
はり出血を来す問題がある。[0005] Furthermore, when the living body tissue is gripped with such a weak force that it does not cut the living tissue, the living tissue such as blood vessels cannot be reliably closed, so that the subsequent cutting operation also causes bleeding. There is.
【０００６】また、ＵＳＰ５，７１６，３６６の縫合器
では、切断エレメントが鋭利な刃で構成されているの
で、刃の切れ味を継続して維持することが難しい問題が
ある。そのため、縫合器自体を滅菌して再使用すること
ができないので、コストが非常に高くなる問題がある。In the suturing device of US Pat. No. 5,716,366, since the cutting element is constituted by a sharp blade, there is a problem that it is difficult to maintain the sharpness of the blade continuously. Therefore, the suturing device itself cannot be sterilized and cannot be reused, resulting in a problem of extremely high cost.
【０００７】本発明は上記事情に着目してなされたもの
で、その目的は、一対の処置部材間で把持した血管等の
生体組織を確実に凝固することができ、かつ凝固した生
体組織を確実に切開することができるとともに、再使用
可能で、低コストを実現可能な医療用処置具を提供する
ことにある。The present invention has been made in view of the above circumstances, and has as its object to surely coagulate living tissue such as blood vessels grasped between a pair of treatment members, and to reliably coagulate living tissue. Another object of the present invention is to provide a medical treatment tool that can be incised at a low cost, is reusable, and can be realized at low cost.
【０００８】[0008]
【課題を解決するための手段】本発明は、先端部に生体
組織を把持する開閉可能な把持部が配設され、基端部に
前記把持部を開閉操作する手元側の操作部が配設された
医療用処置具において、通電されて熱を発生する凝固処
置用熱発生部および切開処置用熱発生部を前記把持部に
それぞれ設けたことを特徴とする医療用処置具である。
そして、本発明では、凝固時には凝固処置用熱発生部を
通電加熱させ、一対の把持部間に把持された血管等の生
体組織を凝固処置用熱発生部の熱によって凝固させる。
その後、切開処置用熱発生部を通電加熱させ、凝固部分
を切開するようにしたものである。According to the present invention, an openable / closable gripping portion for gripping a living tissue is provided at a distal end portion, and an operation portion on a hand side for opening / closing the gripping portion is provided at a proximal end portion. The medical treatment tool according to claim 1, wherein a heat generation unit for coagulation treatment and a heat generation unit for incision treatment, which generate heat when energized, are provided on the holding unit.
In the present invention, during coagulation, the coagulation treatment heat generation unit is energized and heated, and the living tissue such as a blood vessel grasped between the pair of grasping units is coagulated by the heat of the coagulation treatment heat generation unit.
Thereafter, the heat generating section for incision treatment is heated by energization to cut off the solidified portion.
【０００９】[0009]
【発明の実施の形態】以下、本発明の第１の実施の形態
を図１および図２を参照して説明する。図１は本実施の
形態の医療用処置具１のシステム全体の概略構成を示す
ものである。本実施の形態の医療用処置具１のシステム
には鉗子２と、この鉗子２に接続された電源装置３とが
設けられている。DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS A first embodiment of the present invention will be described below with reference to FIGS. FIG. 1 shows a schematic configuration of an entire system of a medical treatment tool 1 according to the present embodiment. The system of the medical treatment tool 1 according to the present embodiment includes a forceps 2 and a power supply device 3 connected to the forceps 2.
【００１０】ここで、鉗子２の本体４には２つの鋏構成
部材５，６が設けられている。これらの鋏構成部材５，
６は中途部分が略交差する状態に重ねられている。さら
に、両鋏構成部材５，６の交差部には両鋏構成部材５，
６を回動自在に連結する支軸７が配設されている。Here, two scissors constituting members 5 and 6 are provided on the main body 4 of the forceps 2. These scissor components 5,
Reference numeral 6 is superimposed such that the halfway portions substantially intersect. Further, at the intersection of both scissors constituent members 5, 6, both scissors constituent members 5,
A support shaft 7 for rotatably connecting the support shafts 6 is provided.
【００１１】また、鉗子本体４の先端部には生体組織を
把持する開閉可能な一対の把持部８，９を備えた処置部
１０が配設されている。この処置部１０は剥離鉗子と略
同じ形状に成形されている。A treatment section 10 having a pair of openable and closable grips 8 and 9 for gripping a living tissue is disposed at the distal end of the forceps body 4. The treatment section 10 is formed in substantially the same shape as the peeling forceps.
【００１２】さらに、各鋏構成部材５，６の基端部には
略楕円形状の手指挿入リング１１，１２が形成されてい
る。そして、これらの手指挿入リング１１，１２の部分
によって一対の把持部８，９を開閉操作する手元側の操
作部１３が形成されている。Furthermore, finger insertion rings 11 and 12 having a substantially elliptical shape are formed at the base ends of the scissors constituting members 5 and 6, respectively. The finger insertion rings 11 and 12 form a hand-side operation unit 13 for opening and closing the pair of grips 8 and 9.
【００１３】また、鉗子本体４の各把持部８，９には、
図２に示すように生体組織との接触面側に略平板状で幅
広な矩形断面の凝固処置用熱発生部１４，１５がそれぞ
れ配設されている。これらの凝固処置用熱発生部１４，
１５は、例えばセラミックヒーターや、ＰＴＣヒーター
（positive temperature coefficient材料で形成され
たヒーター）等のように通電されて熱を発生する発熱体
によって形成されている。Each of the gripping portions 8 and 9 of the forceps body 4 has
As shown in FIG. 2, heat-generating units 14 and 15 for coagulation treatment having a substantially flat and wide rectangular cross section are disposed on the contact surface side with the living tissue. These coagulation treatment heat generating parts 14,
Reference numeral 15 is formed by a heating element that is energized and generates heat, such as a ceramic heater or a PTC heater (a heater formed of a positive temperature coefficient material).
【００１４】また、一方の把持部８の凝固処置用熱発生
部１４における生体組織との接触面側には略平滑な平滑
面１４ａが形成されている。さらに、他方の把持部９の
凝固処置用熱発生部１５における生体組織との接触面側
にも同様に略平滑な平滑面１５ａが形成されている。A substantially smooth surface 14a is formed on the surface of one of the gripping portions 8 which is in contact with the living tissue in the heat generating portion 14 for coagulation treatment. Further, a substantially smooth surface 15a is similarly formed on the contact surface of the other gripping portion 9 with the living tissue in the heat generating portion 15 for coagulation treatment.
【００１５】また、把持部９側の凝固処置用熱発生部１
５には平滑面１５ａの略中央部位に把持部９の中心線方
向に沿って延出された凹部１６が形成されている。この
凹部１６内には切開処置用熱発生部１７が配設されてい
る。この切開処置用熱発生部１７は、例えばニクロム線
のように通電されて熱を発生する断面略円形の発熱ワイ
ヤによって形成されている。なお、切開処置用熱発生部
１７の外端面の位置は、凝固処置用熱発生部１５の外表
面の平滑面１５ａと略一致するように配置されている。Further, the heat generating unit 1 for coagulation treatment on the gripping unit 9 side
5, a concave portion 16 is formed at a substantially central portion of the smooth surface 15a and extends along the center line direction of the grip portion 9. An incision treatment heat generation unit 17 is provided in the recess 16. The incision treatment heat generating section 17 is formed of a heat generating wire having a substantially circular cross section, which is energized like a nichrome wire and generates heat. Note that the position of the outer end surface of the incision treatment heat generation unit 17 is arranged so as to substantially coincide with the smooth surface 15 a of the outer surface of the coagulation treatment heat generation unit 15.
【００１６】さらに、凝固処置用熱発生部１４，１５の
外面の平滑面１４ａ，１５ａ（生体との接触面）には生
体組織の焦げ付きを防止するテフロンコーティング層１
８，１９がそれぞれ形成されている。Further, a Teflon coating layer 1 for preventing scorching of the living tissue is provided on the smooth surfaces 14a, 15a (contact surfaces with the living body) on the outer surfaces of the heat generating portions 14, 15 for coagulation treatment.
8, 19 are formed respectively.
【００１７】また、図１に示すように一方の鋏構成部材
５には１本のリード線２１が、他方の鋏構成部材６には
２本のリード線２２、２３がそれぞれ配設されている。
ここで、リード線２１の先端部は凝固処置用熱発生部１
４に接続されている。さらに、リード線２２の先端部は
凝固処置用熱発生部１５に、またリード線２３の先端部
は切開処置用熱発生部１７にそれぞれ接続されている。As shown in FIG. 1, one lead wire 21 is provided on one scissor constituting member 5, and two lead wires 22 and 23 are provided on the other scissor constituting member 6, respectively. .
Here, the leading end of the lead wire 21 is the heat generating unit 1 for coagulation treatment.
4 is connected. Further, the distal end of the lead wire 22 is connected to the heat generating unit 15 for coagulation treatment, and the distal end of the lead wire 23 is connected to the heat generating unit 17 for incision treatment.
【００１８】また、鋏構成部材５側の手指挿入リング１
１の外周面には１つのコード接続部２４が突設されてい
る。さらに、鋏構成部材６側の手指挿入リング１２の外
周面には２つのコード接続部２５，２６が突設されてい
る。そして、鋏構成部材５側のコード接続部２４にはリ
ード線２１の基端部が接続されており、リード線２２，
２３は鋏構成部材６側のコード接続部２５，２６とそれ
ぞれ接続されている。A finger insertion ring 1 on the scissors constituting member 5 side
One cord connecting portion 24 is protruded from one outer peripheral surface. Further, two cord connecting portions 25 and 26 are protruded from the outer peripheral surface of the finger insertion ring 12 on the scissor constituting member 6 side. The base end of the lead wire 21 is connected to the cord connecting portion 24 on the side of the scissors component member 5.
Reference numeral 23 is connected to the cord connecting portions 25 and 26 on the scissor constituting member 6 side, respectively.
【００１９】さらに、これらコード接続部２４，２５，
２６には一端が電源装置３に接続された接続コード２
７，２８，２９の他端部が着脱自在に連結されている。
なお、電源装置３にはフットスイッチ３２がコード３３
を介して接続されている。このフットスイッチ３２には
切開出力操作部３０と凝固出力操作部３１とが設けられ
ている。Further, the cord connection portions 24, 25,
26 is a connection cord 2 having one end connected to the power supply 3.
The other ends of 7, 28 and 29 are detachably connected.
The power switch 3 has a cord 33
Connected through. The foot switch 32 is provided with an incision output operation unit 30 and a coagulation output operation unit 31.
【００２０】次に、上記構成の本実施の形態の医療用処
置具１の作用について説明する。まず、鉗子２の先端部
の処置部１０を閉じた状態で図示しない血管等の被処置
部を含む生体組織に差し込む。その後、一対の把持部
８，９を開くことにより、血管等の被処置部を他の生体
組織から剥離して露出させる。Next, the operation of the medical treatment instrument 1 according to the present embodiment having the above configuration will be described. First, in a state where the treatment section 10 at the distal end of the forceps 2 is closed, the treatment section 10 is inserted into a living tissue including a treatment target such as a blood vessel (not shown). Thereafter, by opening the pair of gripping portions 8 and 9, the portion to be treated such as a blood vessel is peeled off from another living tissue and exposed.
【００２１】続いて、剥離した血管等を鉗子２の各把持
部８，９間で凝固処置に適正な加圧力で圧迫した状態で
把持する。この状態で、フットスイッチ３２の凝固出力
操作部３１を操作する。これにより、凝固処置用熱発生
部１４と凝固処置用熱発生部１５とが通電されて熱を発
生する。このときの凝固処置用熱発生部１４，１５の熱
によって把持部８，９間の血管等の被処置部位が凝固処
置され、十分に熱凝固される。Subsequently, the detached blood vessel or the like is gripped between the gripping portions 8 and 9 of the forceps 2 while being pressed with a pressing force appropriate for the coagulation treatment. In this state, the coagulation output operation unit 31 of the foot switch 32 is operated. Thereby, the heat generation unit for coagulation treatment 14 and the heat generation unit for coagulation treatment 15 are energized to generate heat. At this time, the treatment site such as the blood vessel between the grasping portions 8 and 9 is subjected to the coagulation treatment by the heat of the coagulation treatment heat generating portions 14 and 15 and is sufficiently thermally coagulated.
【００２２】その後、これに引き続いてフットスイッチ
３２の切開出力操作部３０を操作する。これにより、切
開処置用熱発生部１７が通電されて熱を発生する。この
切開処置用熱発生部１７は凝固処置用熱発生部１４、凝
固処置用熱発生部１５と比較して高温に発熱するように
なっている。そのため、凝固された血管等の被処置部位
の一部がこのときの切開処置用熱発生部１７の熱によっ
て局所的に加熱切断される。Thereafter, subsequently, the incision output operation section 30 of the foot switch 32 is operated. As a result, the incision treatment heat generation unit 17 is energized to generate heat. The incision treatment heat generation unit 17 generates heat at a higher temperature than the coagulation treatment heat generation unit 14 and the coagulation treatment heat generation unit 15. Therefore, a part of the treatment target site such as the coagulated blood vessel is locally heated and cut by the heat of the incision treatment heat generation unit 17 at this time.
【００２３】そこで、上記構成のものにあっては次の効
果を奏する。すなわち、本実施の形態の医療用処置具１
では鉗子本体４の各把持部８，９に幅広な凝固処置用熱
発生部１４、凝固処置用熱発生部１５をそれぞれ配設し
たので、鉗子本体４の各把持部８，９間で把持された血
管等の被処置部位を適正な加圧力で圧迫した状態でこれ
らの凝固処置用熱発生部１４，１５の熱によって確実に
熱凝固することができる。Therefore, the above configuration has the following effects. That is, the medical treatment tool 1 of the present embodiment
In the first embodiment, the wide heat generating portion 14 for coagulation treatment and the heat generating portion 15 for coagulation treatment are provided on the holding portions 8 and 9 of the forceps body 4, respectively, so that the holding member 8 and 9 are held between the holding portions 8 and 9 of the forceps body 4. In the state in which a treatment site such as a blood vessel is compressed with an appropriate pressing force, heat can be reliably coagulated by the heat of these coagulation treatment heat generation units 14 and 15.
【００２４】さらに、把持部９側の凝固処置用熱発生部
１５の平滑面１５ａに凹部１６を形成し、この凹部１６
内に切開処置用熱発生部１７を配設したので、凝固処置
用熱発生部１４，１５の熱によって血管等の被処置部位
を熱凝固させた後、凝固した血管等の被処置部位の組織
を切開処置用熱発生部１７の発熱により直ちに切断する
ことができる。そのため、生体組織を刃物で切断する場
合のように使用の繰返しによって切開能が次第に劣化し
て再使用ができなくなるおそれがなく、コスト的にも有
利となる。Further, a concave portion 16 is formed in the smooth surface 15a of the heat generating portion 15 for coagulation treatment on the grip portion 9 side.
Since the incision treatment heat generation unit 17 is disposed in the inside, the treatment site such as a blood vessel is thermally coagulated by the heat of the coagulation treatment heat generation units 14 and 15, and then the tissue of the treatment site such as a coagulated blood vessel is treated. Can be immediately cut by the heat generated by the heat generating section 17 for incision treatment. Therefore, unlike the case where a living tissue is cut with a blade, there is no possibility that the incision ability is gradually deteriorated due to repetition of use and cannot be reused, which is advantageous in cost.
【００２５】また、図３（Ａ）は本発明の第２の実施の
形態を示すものである。本実施の形態は第１の実施の形
態（図１および図２参照）の医療用処置具１における鉗
子２の先端の処置部１０の構成を次の通り変更したもの
である。FIG. 3A shows a second embodiment of the present invention. In the present embodiment, the configuration of the treatment section 10 at the distal end of the forceps 2 in the medical treatment tool 1 of the first embodiment (see FIGS. 1 and 2) is changed as follows.
【００２６】すなわち、本実施の形態では、把持部９側
の凝固処置用熱発生部１５における平滑面１５ａの側端
に凹部１６が配置され、この凹部１６内に切開処置用熱
発生部１７が配設されている。なお、これ以外の部分の
構成は第１の実施の形態と同様である。That is, in the present embodiment, the concave portion 16 is disposed at the side end of the smooth surface 15a of the coagulation treatment heat generating portion 15 on the grip portion 9 side, and the incision treatment heat generating portion 17 is provided in the concave portion 16. It is arranged. The configuration of other parts is the same as that of the first embodiment.
【００２７】次に、上記構成における作用について説明
する。本実施の形態の鉗子２を使用して第１の実施の形
態と同様の処置を行う場合には、次のような作業が行わ
れる。まず、第１の実施の形態と同様の手順で鉗子２を
操作して体腔内組織の血管等の被処置部位を剥離し、剥
離した血管等を鉗子２の各把持部８，９間で凝固処置に
適正な加圧力で圧迫した状態で把持する。この状態で、
凝固処置用熱発生部１４と凝固処置用熱発生部１５とが
通電加熱され、把持部８，９間の血管等の被処置部位が
熱凝固される。Next, the operation of the above configuration will be described. When the same treatment as in the first embodiment is performed using the forceps 2 of the present embodiment, the following operation is performed. First, by operating the forceps 2 in the same procedure as in the first embodiment, a treatment site such as a blood vessel in a body cavity tissue is peeled, and the peeled blood vessel or the like is coagulated between the grasping portions 8 and 9 of the forceps 2. The patient is grasped while pressing with appropriate pressure for treatment. In this state,
The heat generating unit for coagulation treatment 14 and the heat generating unit for coagulation treatment 15 are energized and heated, so that a treatment target site such as a blood vessel between the gripping parts 8 and 9 is thermally coagulated.
【００２８】その後、一旦、把持部８，９を開いて凝固
状態を確認した後、これに引き続いて切開処置用熱発生
部１７を凝固した処置部位の中心位置に合わせてセット
した状態で、把持部８，９を再度閉じる。この状態で、
フットスイッチ３２の切開出力操作部３０を操作する。
これにより、切開処置用熱発生部１７が通電加熱され、
凝固された血管等の被処置部位の一部がこのときの切開
処置用熱発生部１７の熱によって局所的に加熱切断され
る。Thereafter, once the gripping portions 8 and 9 are opened to check the coagulation state, the incision treatment heat generating portion 17 is subsequently set to match the center position of the coagulated treatment site, and then the gripping is performed. Parts 8 and 9 are closed again. In this state,
The incision output operation section 30 of the foot switch 32 is operated.
Thereby, the incision treatment heat generation unit 17 is energized and heated,
A part of the treatment target such as a coagulated blood vessel is locally heated and cut by the heat of the incision treatment heat generation unit 17 at this time.
【００２９】そこで、上記構成のものにあっては次の効
果を奏する。すなわち、本実施の形態の鉗子２では把持
部９側の切開処置用熱発生部１７を凝固処置用熱発生部
１５上の側端に配置したので、鉗子２の先端の処置部１
０を側方から目視することにより、把持部９側の切開処
置用熱発生部１７を簡単に確認できる。そのため、一
旦、凝固した生体組織を後から切開する場合に、鋏を操
作する場合のように切断位置を術者の意のままに合わせ
易くなり、安全に切開操作を行うことができる。Therefore, the above configuration has the following effects. That is, in the forceps 2 of the present embodiment, since the incision treatment heat generation unit 17 on the gripping unit 9 side is disposed at the side end on the coagulation treatment heat generation unit 15, the treatment unit 1 at the tip of the forceps 2 is disposed.
By observing 0 from the side, the incision treatment heat generation unit 17 on the grip unit 9 side can be easily confirmed. Therefore, when the coagulated living tissue is once incised later, it is easy to adjust the cutting position as desired by the surgeon as in the case of operating scissors, and the incision operation can be performed safely.
【００３０】また、図３（Ｂ）は本発明の第３の実施の
形態を示すものである。本実施の形態は第１の実施の形
態（図１および図２参照）の医療用処置具１における鉗
子２の先端の処置部１０の構成を次の通り変更したもの
である。FIG. 3B shows a third embodiment of the present invention. In the present embodiment, the configuration of the treatment section 10 at the distal end of the forceps 2 in the medical treatment tool 1 of the first embodiment (see FIGS. 1 and 2) is changed as follows.
【００３１】すなわち、第１の実施の形態では把持部９
側の凝固処置用熱発生部１５のみに切開処置用熱発生部
１７を配設した構成を示したが、本実施の形態ではこれ
に加えて把持部８の凝固処置用熱発生部１４にも同様に
平滑面１４ａの略中央部位に把持部８の中心線方向に沿
って延出された凹部１６を形成し、この凹部１６内に切
開処置用熱発生部１７を配設したものである。That is, in the first embodiment, the grip 9
Although the configuration in which the incision treatment heat generation unit 17 is disposed only in the coagulation treatment heat generation unit 15 on the side is shown, in this embodiment, in addition to this, the coagulation treatment heat generation unit 14 of the gripper 8 is also provided. Similarly, a concave portion 16 extending along the center line direction of the grip portion 8 is formed at a substantially central portion of the smooth surface 14a, and a heat generating portion 17 for incision treatment is disposed in the concave portion 16.
【００３２】次に、上記構成における作用について説明
する。本実施の形態の鉗子２を使用して第１の実施の形
態と同様の処置を行う場合には、次のような作業が行わ
れる。まず、第１の実施の形態と同様の手順で鉗子２を
操作して体腔内組織の血管等の被処置部位を剥離し、剥
離した血管等を鉗子２の各把持部８，９間で凝固処置に
適正な加圧力で圧迫した状態で把持する。この状態で、
凝固処置用熱発生部１４と凝固処置用熱発生部１５とが
通電加熱され、把持部８，９間の血管等の被処置部位が
熱凝固される。Next, the operation of the above configuration will be described. When the same treatment as in the first embodiment is performed using the forceps 2 of the present embodiment, the following operation is performed. First, by operating the forceps 2 in the same procedure as in the first embodiment, a treatment site such as a blood vessel in a body cavity tissue is peeled, and the peeled blood vessel or the like is coagulated between the grasping portions 8 and 9 of the forceps 2. The patient is grasped while pressing with appropriate pressure for treatment. In this state,
The heat generating unit for coagulation treatment 14 and the heat generating unit for coagulation treatment 15 are energized and heated, so that a treatment target site such as a blood vessel between the gripping parts 8 and 9 is thermally coagulated.
【００３３】その後、これに引き続いてフットスイッチ
３２の切開出力操作部３０を操作する。これにより、両
方の把持部８，９の切開処置用熱発生部１７が同時に通
電加熱され、凝固された血管等の被処置部位の一部がこ
のときの両側の切開処置用熱発生部１７の熱によって局
所的に加熱切断される。Thereafter, subsequently, the incision output operation section 30 of the foot switch 32 is operated. As a result, the heat generating portions 17 for incision treatment of both grip portions 8 and 9 are energized and heated at the same time, and a part of the portion to be treated such as a coagulated blood vessel is partially heated by heat generation portions 17 for incision treatment on both sides. It is locally heated and cut by heat.
【００３４】そこで、上記構成のものにあっては次の効
果を奏する。すなわち、本実施の形態の鉗子２では把持
部９側の凝固処置用熱発生部１５および把持部８側の凝
固処置用熱発生部１４の両方にそれぞれ切開処置用熱発
生部１７を配設したので、両側の切開処置用熱発生部１
７から血管等の被処置部位の熱凝固部に局所的に熱を集
中することができる。そのため、凝固された血管等の被
処置部位の熱凝固部を両側の切開処置用熱発生部１７の
発熱により、容易に切開することができるので、熱凝固
した生体組織をさらに切開し易くなり、処置時間の短縮
が図れる。Therefore, the above configuration has the following effects. That is, in the forceps 2 of the present embodiment, the incision treatment heat generation unit 17 is disposed on both the coagulation treatment heat generation unit 15 on the grip unit 9 side and the coagulation treatment heat generation unit 14 on the grip unit 8 side. Therefore, the incision treatment heat generating parts 1 on both sides
7, heat can be locally concentrated on the heat-coagulated portion of the portion to be treated such as a blood vessel. Therefore, it is possible to easily incise the heat-coagulated portion of the treatment target site such as a coagulated blood vessel by the heat generated by the incision treatment heat generation units 17 on both sides, and thus it becomes easier to incise the heat-coagulated biological tissue, The treatment time can be reduced.
【００３５】また、図３（Ｃ）は本発明の第４の実施の
形態を示すものである。本実施の形態は第１の実施の形
態（図１および図２参照）の医療用処置具１における鉗
子２の先端の処置部１０の構成を次の通り変更したもの
である。FIG. 3C shows a fourth embodiment of the present invention. In the present embodiment, the configuration of the treatment section 10 at the distal end of the forceps 2 in the medical treatment tool 1 of the first embodiment (see FIGS. 1 and 2) is changed as follows.
【００３６】すなわち、第１の実施の形態では把持部９
側の凝固処置用熱発生部１５の平滑面１５ａの略中央部
位に凹部１６を形成し、この凹部１６内に切開処置用熱
発生部１７を配設するとともに、把持部８側の凝固処置
用熱発生部１４における凝固処置用熱発生部１５との対
向面には平滑面１４ａのみを設ける構成を示したが、本
実施の形態では把持部８側の凝固処置用熱発生部１４の
平滑面１４ａにおける把持部９側の切開処置用熱発生部
１７との対向部位に、例えば多孔質からなるセラミック
のような断熱材３４を配設したものである。That is, in the first embodiment, the grip 9
A concave portion 16 is formed at a substantially central portion of the smooth surface 15a of the heat generating portion 15 for coagulation treatment on the side, and a heat generating portion 17 for incision treatment is disposed in the concave portion 16 and the heat generating portion 17 for coagulation treatment on the grip portion 8 side. Although the configuration in which only the smooth surface 14a is provided on the surface of the heat generating unit 14 facing the coagulation treatment heat generating unit 15 has been described, in the present embodiment, the smooth surface of the coagulation treatment heat generating unit 14 on the grip portion 8 side is shown. A heat insulating material 34 made of, for example, a porous ceramic is provided at a portion 14a of the gripping portion 9 facing the incision treatment heat generating portion 17 on the grip portion 9 side.
【００３７】そこで、本実施の形態の鉗子２では切開処
置用熱発生部１７が通電加熱され、切開処置用熱発生部
１７が発熱した際に、把持部８側の凝固処置用熱発生部
１４の平滑面１４ａの断熱材３４によって切開処置用熱
発生部１７の熱が把持部８側に逃げることを防ぐことが
できる。そのため、切開処置用熱発生部１７の熱を鉗子
２の各把持部８，９間の血管等の被処置部位の熱凝固部
に集中的に作用させることができるので、熱凝固した生
体組織を切開し易くなる効果がある。Therefore, in the forceps 2 of the present embodiment, when the heat generating section 17 for incision treatment is energized and heated, and the heat generating section 17 for incision treatment generates heat, the heat generating section 14 for coagulation treatment on the grip portion 8 side is heated. The heat of the incision treatment heat generation unit 17 can be prevented from escaping to the holding unit 8 side by the heat insulating material 34 on the smooth surface 14a. Therefore, the heat of the incision treatment heat generation unit 17 can be intensively applied to the heat coagulation unit of the treatment target site such as a blood vessel between the grasping units 8 and 9 of the forceps 2, and the heat coagulated biological tissue is removed. This has the effect of making it easier to cut.
【００３８】また、図３（Ｄ）は本発明の第５の実施の
形態を示すものである。本実施の形態は第１の実施の形
態（図１および図２参照）の医療用処置具１における鉗
子２の先端の処置部１０の構成を次の通り変更したもの
である。FIG. 3D shows a fifth embodiment of the present invention. In the present embodiment, the configuration of the treatment section 10 at the distal end of the forceps 2 in the medical treatment tool 1 of the first embodiment (see FIGS. 1 and 2) is changed as follows.
【００３９】すなわち、本実施の形態では一対の把持部
８，９のうちの一方の把持部８のみに凝固処置用熱発生
部１４を設け、他方の把持部９における生体組織との接
触面９ａ側には略中央部位に把持部９の中心線方向に沿
って延出された凹部９ｂを形成し、この凹部９ｂ内に切
開処置用熱発生部１７を配設したものである。That is, in the present embodiment, only one of the pair of grips 8, 9 is provided with the heat generating portion 14 for coagulation treatment, and the other grip 9 has a contact surface 9 a with the living tissue. On the side, a concave portion 9b extending substantially in the center line direction of the grip portion 9 is formed at a substantially central portion, and the incision treatment heat generating portion 17 is disposed in the concave portion 9b.
【００４０】そして、本実施の形態でも第１の実施の形
態と略同様の効果が得られる。なお、把持部９における
生体組織との接触面９ａ側にテフロンコーティング層を
設けてもよい。さらに、凝固処置用熱発生部は把持部９
側のみに設け、ここに切開処置用熱発生部１７を配設す
る構成にしてもよい。In this embodiment, substantially the same effects as in the first embodiment can be obtained. It should be noted that a Teflon coating layer may be provided on the grip portion 9 on the side of the contact surface 9a with the living tissue. Further, the heat generating unit for the coagulation treatment is provided by the gripper 9.
The incision treatment heat generating unit 17 may be provided only on the side.
【００４１】また、図４乃至図６（Ａ），（Ｂ）は本発
明の第６の実施の形態を示すものである。本実施の形態
では第１の実施の形態（図１および図２参照）の医療用
処置具１における鉗子２の構成を次の通り変更したもの
である。FIGS. 4 to 6A and 6B show a sixth embodiment of the present invention. In the present embodiment, the configuration of the forceps 2 in the medical treatment tool 1 of the first embodiment (see FIGS. 1 and 2) is changed as follows.
【００４２】すなわち、本実施の形態の鉗子２では把持
部９側の切開処置用熱発生部１７を図５（Ａ），（Ｂ）
に示す待機位置と、図６（Ａ），（Ｂ）に示す使用位置
とに移動可能にしたものである。That is, in the forceps 2 of the present embodiment, the incision treatment heat generating section 17 on the gripping section 9 side is connected to the forceps 2 shown in FIGS.
6 and a use position shown in FIGS. 6A and 6B.
【００４３】ここで、本実施の形態の鉗子２には図５
（Ａ），（Ｂ）に示すように把持部９側に切開処置用熱
発生部１７の移動用の空間３５が形成されている。さら
に、把持部９側の凝固処置用熱発生部１５にはこの移動
用空間３５に連通する間隙３５ａが中心線上に設けられ
ている。Here, the forceps 2 of the present embodiment includes
As shown in (A) and (B), a space 35 for moving the incision treatment heat generating unit 17 is formed on the gripping unit 9 side. Further, a gap 35 a communicating with the moving space 35 is provided on the center line of the coagulation treatment heat generation unit 15 on the gripping unit 9 side.
【００４４】また、把持部９側の移動用空間３５の内部
には切開処置用熱発生部１７の移動をガイドする前部お
よび後部の２つの三角形状のガイド部材３６がそれぞれ
固定されている。Further, two triangular guide members 36, a front part and a rear part, for guiding the movement of the incision treatment heat generating part 17 are fixed inside the moving space 35 on the grip part 9 side.
【００４５】さらに、切開処置用熱発生部１７は支持部
材３７によって支持されている。この支持部材３７の前
端部及び後端部にはガイド部材３６の傾斜面と接する円
柱状の滑り部材３７ａ，３７ｂがそれぞれ固定されてい
る。そして、切開処置用熱発生部１７は支持部材３７の
滑り部材３７ａ，３７ｂがガイド部材３６の傾斜面に沿
って移動する状態で、図５（Ａ），（Ｂ）に示す待機位
置と、図６（Ａ），（Ｂ）に示す使用位置とに移動可能
に保持されている。ここで、図５（Ａ），（Ｂ）に示す
待機位置では切開処置用熱発生部１７は把持部８の凝固
処置用熱発生部１４から離れた状態で保持されている。
そして、図６（Ａ），（Ｂ）に示す使用位置では切開処
置用熱発生部１７は把持部８の凝固処置用熱発生部１４
に当接される方向に移動されるようになっている。The incision treatment heat generating section 17 is supported by a support member 37. Cylindrical sliding members 37a and 37b that are in contact with the inclined surface of the guide member 36 are fixed to the front end and the rear end of the support member 37, respectively. Then, the incision treatment heat generating unit 17 is in a state in which the sliding members 37a and 37b of the support member 37 move along the inclined surface of the guide member 36, and a standby position shown in FIGS. 6 (A) and 6 (B). Here, in the standby position shown in FIGS. 5A and 5B, the incision treatment heat generation unit 17 is held in a state separated from the coagulation treatment heat generation unit 14 of the grasping unit 8.
In the use position shown in FIGS. 6A and 6B, the incision treatment heat generation unit 17 is the coagulation treatment heat generation unit 14 of the gripper 8.
It is adapted to be moved in the direction in which it comes into contact.
【００４６】また、鋏構成部材６の支軸７と手指挿入リ
ング１２との間には前後方向に進退する操作レバー３８
が配設されている。この操作レバー３８は図４中に実線
で示す前進位置から同図中に点線で示す後退位置まで進
退可能に支持されている。An operating lever 38 which moves back and forth between the support shaft 7 of the scissors constituting member 6 and the finger insertion ring 12 in the front-rear direction.
Are arranged. The operation lever 38 is supported so as to be able to advance and retreat from a forward position indicated by a solid line in FIG. 4 to a retracted position indicated by a dotted line in FIG.
【００４７】さらに、この操作レバー３８には切開処置
用熱発生部１７を移動操作する操作ワイヤ３９の基端部
が固定されている。この操作ワイヤ３９の先端部は支持
部材３７の後端に固定されている。そして、操作レバー
３８は図４中に実線で示す前進位置で保持されている場
合には切開処置用熱発生部１７は図５（Ａ），（Ｂ）に
示す待機位置で保持されるようになっている。また、操
作レバー３８が図４中に点線で示す後退位置まで移動操
作された場合には切開処置用熱発生部１７は図６
（Ａ），（Ｂ）に示す使用位置に移動されるようになっ
ている。Further, a base end of an operation wire 39 for moving the incision treatment heat generating unit 17 is fixed to the operation lever 38. The distal end of the operation wire 39 is fixed to the rear end of the support member 37. When the operation lever 38 is held at the forward position shown by the solid line in FIG. 4, the incision treatment heat generating unit 17 is held at the standby position shown in FIGS. 5A and 5B. Has become. When the operation lever 38 is moved to the retracted position shown by the dotted line in FIG.
They are moved to the use positions shown in FIGS.
【００４８】次に、上記構成における作用について説明
する。本実施の形態の鉗子２を使用して第１の実施の形
態と同様の処置を行う場合には、次のような作業が行わ
れる。まず、鋏構成部材６の操作レバー３８は通常は図
４中に実線で示す前進位置で保持され、切開処置用熱発
生部１７は図５（Ａ），（Ｂ）に示す待機位置で保持さ
れる。この状態で、第１の実施の形態と同様の手順で鉗
子２を操作して体腔内組織の血管等の被処置部位を剥離
し、把持部８，９間で把持して熱凝固を行う。Next, the operation of the above configuration will be described. When the same treatment as in the first embodiment is performed using the forceps 2 of the present embodiment, the following operation is performed. First, the operating lever 38 of the scissors component 6 is normally held at a forward position shown by a solid line in FIG. 4, and the incision treatment heat generating section 17 is held at a standby position shown in FIGS. 5 (A) and 5 (B). You. In this state, the forceps 2 are operated in the same procedure as in the first embodiment to exfoliate a treatment site such as a blood vessel of a tissue in a body cavity, and grasp between the grasping portions 8 and 9 to perform thermal coagulation.
【００４９】その後、これに引き続いて操作レバー３８
が図４中に実線で示す前進位置から点線で示す後退位置
に移動操作される。このとき、操作レバー３８の後退動
作にともない操作ワイヤ３９が後方に引かれ、支持部材
３７の滑り部材３７ａ，３７ｂが傾斜部材３８の傾斜部
に沿って後方に傾斜移動する。その結果、切開処置用熱
発生部１７は図６（Ａ），（Ｂ）に示す使用位置に移動
され、この切開処置用熱発生部１７が凝固処置用熱発生
部１４に当接される。Thereafter, subsequently, the operation lever 38
Is operated to move from the forward position indicated by the solid line in FIG. 4 to the retracted position indicated by the dotted line. At this time, the operation wire 39 is pulled backward with the retreat operation of the operation lever 38, and the sliding members 37a and 37b of the support member 37 are inclined and moved backward along the inclined portion of the inclined member 38. As a result, the incision treatment heat generation unit 17 is moved to the use position shown in FIGS. 6A and 6B, and the incision treatment heat generation unit 17 is brought into contact with the coagulation treatment heat generation unit 14.
【００５０】この状態で、フットスイッチ３２の切開出
力操作部３０を操作すると切開処置用熱発生部１７が通
電加熱され、熱凝固された生体組織が切開処置用熱発生
部１７の熱によって切断される。In this state, when the incision output operation section 30 of the foot switch 32 is operated, the incision treatment heat generating section 17 is energized and heated, and the heat-coagulated living tissue is cut by the heat of the incision treatment heat generation section 17. You.
【００５１】そこで、上記構成のものにあっては次の効
果を奏する。すなわち、本実施の形態の鉗子２では切開
処置用熱発生部１７を図５（Ａ），（Ｂ）に示す待機位
置と、図６（Ａ），（Ｂ）に示す使用位置とに移動可能
にしたので、熱凝固された生体組織を切開する場合には
切開処置用熱発生部１７を図６（Ａ），（Ｂ）に示す使
用位置に移動させ、凝固処置用熱発生部１４に当接させ
て密着させることができる。そのため、熱凝固された生
体組織を熱的に確実に切断することができ、生体組織が
切れ残ることがなくなる効果がある。Therefore, the above configuration has the following effects. That is, in the forceps 2 of the present embodiment, the incision treatment heat generation unit 17 can be moved between the standby position shown in FIGS. 5A and 5B and the use position shown in FIGS. 6A and 6B. Therefore, when incising the heat-coagulated living tissue, the incision treatment heat generation unit 17 is moved to the use position shown in FIGS. It can be brought into contact with and brought into close contact with it. Therefore, the heat-coagulated living tissue can be thermally reliably cut, and there is an effect that the living tissue does not remain uncut.
【００５２】また、図７および図８は本発明の第７の実
施の形態を示すものである。本実施の形態は第６の実施
の形態（図４乃至図６（Ａ），（Ｂ）参照）の医療用処
置具１の構成を次の通り変更したものである。FIGS. 7 and 8 show a seventh embodiment of the present invention. In the present embodiment, the configuration of the medical treatment tool 1 of the sixth embodiment (see FIGS. 4 to 6A and 6B) is changed as follows.
【００５３】すなわち、本実施の形態の鉗子２では第６
の実施の形態で示した操作レバー３８の後退位置に切開
処置用熱発生部１７のオンオフ操作用のスイッチ手段４
０がさらに配設されている。このスイッチ手段４０には
リード線４１の一端部が接続されている。このリード線
４１の他端部は鋏構成部材６の手指挿入リング１２の外
周面に突設されたコード接続部４２の内端部に接続され
ている。このコード接続部４２の外端部には、接続コー
ド４３の一端が着脱自在に連結されている。この接続コ
ード４３の他端部は電源装置３に接続されている。That is, in the forceps 2 of the present embodiment, the sixth
In the retracted position of the operation lever 38 shown in the embodiment, the switch means 4 for ON / OFF operation of the incision treatment heat generation unit 17 is provided.
0 is further provided. One end of a lead wire 41 is connected to the switch means 40. The other end of the lead wire 41 is connected to the inner end of a cord connecting portion 42 protruding from the outer peripheral surface of the finger insertion ring 12 of the scissors constituting member 6. One end of a connection cord 43 is detachably connected to an outer end of the cord connection section 42. The other end of the connection cord 43 is connected to the power supply 3.
【００５４】また、電源装置３には凝固出力操作部４４
を備えたフットスイッチ４５がコード４６を介して接続
されている。さらに、電源装置３の内部には図８に示す
ように、出力回路４７、制御回路４８及び検知回路４９
がそれぞれ設けられている。ここで、制御回路４８には
出力回路４７と、検知回路４９と、電源装置３の操作パ
ネルに配設されたパネル入力・表示部５３と、フットス
イッチ４５とがそれぞれ接続されている。なお、制御回
路４８はパネル入力・表示部５３とはデータの入力およ
び出力が双方向に行われるように接続されている。そし
て、パネル入力・表示部５３では出力または温度の設定
入力や、その設定温度の表示などが行われるようになっ
ている。The power supply device 3 has a coagulation output operation section 44.
Is connected through a cord 46. Further, as shown in FIG. 8, an output circuit 47, a control circuit 48, and a detection circuit 49 are provided inside the power supply device 3.
Are provided respectively. Here, an output circuit 47, a detection circuit 49, a panel input / display unit 53 provided on an operation panel of the power supply device 3, and a foot switch 45 are connected to the control circuit 48, respectively. The control circuit 48 is connected to the panel input / display unit 53 so that data input and output are performed bidirectionally. The panel input / display unit 53 is used to input an output or set temperature, display the set temperature, and the like.
【００５５】さらに、電源装置３に設けられている接続
コネクタ５０の内端部側は出力回路４７とは３本の出力
ライン５１で接続され、検知回路４９とは検知ライン５
２で接続されている。Further, the inner end side of the connector 50 provided in the power supply device 3 is connected to the output circuit 47 by three output lines 51, and the detection circuit 49 is connected to the detection line 5.
2 connected.
【００５６】次に、上記構成における作用について説明
する。本実施の形態の鉗子２を使用して第１の実施の形
態と同様の処置を行う場合には、次のような作業が行わ
れる。まず、第６の実施の形態と同様に鋏構成部材６の
操作レバー３８が図７中に実線で示す前進位置で保持さ
れ、切開処置用熱発生部１７が待機位置で保持されてい
る状態（図５（Ａ），（Ｂ）に示す）で、第１の実施の
形態と同様の手順で鉗子２を操作して体腔内組織の血管
等の被処置部位を剥離し、把持部８，９間で把持する。
このとき、フットスイッチ４５の凝固出力操作部４４を
操作することにより、凝固処置用熱発生部１４と凝固処
置用熱発生部１５が通電加熱され、血管等の被処置部位
が熱凝固される。Next, the operation of the above configuration will be described. When the same treatment as in the first embodiment is performed using the forceps 2 of the present embodiment, the following operation is performed. First, similarly to the sixth embodiment, the operation lever 38 of the scissors component 6 is held at the forward position shown by the solid line in FIG. 7, and the incision treatment heat generating unit 17 is held at the standby position ( 5 (A) and 5 (B)), by operating the forceps 2 in the same procedure as in the first embodiment, the treatment site such as a blood vessel in the body cavity tissue is peeled off, and the grip portions 8 and 9 are removed. Hold between.
At this time, by operating the coagulation output operation unit 44 of the foot switch 45, the coagulation treatment heat generation unit 14 and the coagulation treatment heat generation unit 15 are energized and heated, and the treatment site such as a blood vessel is thermally coagulated.
【００５７】その後、これに引き続いて操作レバー３８
が図７中に実線で示す前進位置から点線で示す後退位置
に移動操作される。このとき、操作レバー３８の後退動
作にともない操作ワイヤ３９が後方に引かれ、切開処置
用熱発生部１７が図６（Ａ），（Ｂ）に示す使用位置に
移動されてこの切開処置用熱発生部１７が凝固処置用熱
発生部１４に当接される。さらに、操作レバー３８が後
退位置に移動操作されるとスイッチ手段４０が作動し、
このスイッチ手段４０から信号が出力される。このと
き、スイッチ手段４０から出力される信号は電源装置３
の検知回路４９に入力される。そのため、この検知回路
４９によって操作レバー３８が後退位置に移動した状態
が検知される。この操作レバー３８が後退位置に移動し
た作動状態の検知時には、制御回路４８が出力回路４７
の出力を制御し、切開処置用熱発生部１７が通電加熱さ
れ、熱凝固された生体組織が切開処置用熱発生部１７の
熱によって切断される。Thereafter, following this, the operation lever 38
Is moved from the forward position indicated by the solid line to the retracted position indicated by the dotted line in FIG. At this time, the operation wire 39 is pulled backward with the retreating operation of the operation lever 38, and the incision treatment heat generating unit 17 is moved to the use position shown in FIGS. The generator 17 is brought into contact with the heat generator 14 for coagulation treatment. Further, when the operation lever 38 is moved to the retracted position, the switch means 40 is operated, and
A signal is output from the switch means 40. At this time, the signal output from the switch means 40 is
Is input to the detection circuit 49. Therefore, the state where the operation lever 38 has moved to the retracted position is detected by the detection circuit 49. When detecting that the operating lever 38 has moved to the retracted position, the control circuit 48 outputs the output circuit 47.
Is controlled, the incision treatment heat generation unit 17 is energized and heated, and the heat-coagulated living tissue is cut by the heat of the incision treatment heat generation unit 17.
【００５８】そこで、上記構成のものにあっては次の効
果を奏する。すなわち、本実施の形態の医療用処置具１
では操作レバー３８を後退位置まで操作すると同時にス
イッチ手段４０が作動し、電源装置３の出力を切り換え
るようにしている。そのため、フットスイッチ４５の踏
み間違えによって凝固処置用熱発生部１４，１５と、切
開処置用熱発生部１７とを誤って作動させるおそれがな
く、安全に凝固、切開操作を行える効果がある。Therefore, the above configuration has the following effects. That is, the medical treatment tool 1 of the present embodiment
In this case, the switch means 40 is operated at the same time when the operation lever 38 is operated to the retreat position, and the output of the power supply device 3 is switched. Therefore, there is no possibility that the coagulation treatment heat generation units 14 and 15 and the incision treatment heat generation unit 17 may be erroneously operated due to a wrong step on the foot switch 45, and the coagulation and cutting operation can be performed safely.
【００５９】また、図９（Ａ），（Ｂ）は本発明の第８
の実施の形態を示すものである。本実施の形態は、医療
用処置具として内視鏡下手術に使用される手術用処置具
５４に本発明を適用したものである。図９（Ａ）は手術
用処置具５４全体の概略構成を示すものである。FIGS. 9A and 9B show an eighth embodiment of the present invention.
1 shows an embodiment of the present invention. In the present embodiment, the present invention is applied to a surgical treatment tool 54 used for endoscopic surgery as a medical treatment tool. FIG. 9A shows a schematic configuration of the entire surgical treatment tool 54.
【００６０】本実施の形態の処置具５４には、図示しな
いトラカール外套管を通して生体内に挿入される細長い
挿入部５５と、この挿入部５５の基端部に連結された手
元側の操作部５６とが設けられている。The treatment tool 54 of this embodiment includes an elongated insertion portion 55 inserted into a living body through a trocar mantle tube (not shown), and an operation portion 56 on the proximal side connected to the base end of the insertion portion 55. Are provided.
【００６１】また、挿入部５５には管状の挿入管体５７
が設けられている。この挿入管体５７内には挿入部５５
の軸方向に相対運動される駆動軸５８が挿通されてい
る。さらに、挿入部５５の先端部には処置部５９が配設
されている。この処置部５９には開閉可能な一対の把持
部材６０ａ，６０ｂが設けられている。ここで、一対の
把持部材６０ａ，６０ｂは例えばカム機構等の図示しな
い駆動機構を介して駆動軸５８の先端部に連結されてい
る。そして、駆動軸５８の進退動作に伴ない駆動機構を
介して処置部５９の把持部材６０ａ，６０ｂ間が開閉駆
動されるようになっている。The insertion portion 55 has a tubular insertion tube 57.
Is provided. In this insertion tube 57, an insertion portion 55 is provided.
A drive shaft 58 which is relatively moved in the axial direction is inserted. Further, a treatment section 59 is provided at the distal end of the insertion section 55. The treatment section 59 is provided with a pair of gripping members 60a and 60b that can be opened and closed. Here, the pair of gripping members 60a and 60b are connected to the distal end of the drive shaft 58 via a drive mechanism (not shown) such as a cam mechanism. Then, the opening and closing drive between the gripping members 60a and 60b of the treatment section 59 is performed via a drive mechanism accompanying the advance / retreat operation of the drive shaft 58.
【００６２】また、本実施の形態の把持部材６０ａ，６
０ｂは第６の実施の形態（図４乃至図６（Ａ），（Ｂ）
参照）の鉗子２における各把持部８，９と略同様に構成
される。The grip members 60a, 60a of this embodiment
0b denotes the sixth embodiment (FIGS. 4 to 6A and 6B).
) Of the forceps 2 are substantially the same as those of the grippers 8 and 9 of the forceps 2 of FIG.
【００６３】すなわち、本実施の形態の把持部材６０
ａ，６０ｂの内部には第６の実施の形態の各把持部８，
９と同様に図５（Ａ），（Ｂ）、図６（Ａ），（Ｂ）に
示す凝固処置用熱発生部１４、凝固処置用熱発生部１
５、切開処置用熱発生部１７、及び支持部材３７、滑り
部材３７ａ，３７ｂ、ガイド部材３６、操作ワイヤ３９
が備えられている。That is, the gripping member 60 of the present embodiment
a, 60b, each of the gripping portions 8 of the sixth embodiment,
9 (A), 5 (B), 6 (A), 6 (B), the coagulation treatment heat generation unit 14 and the coagulation treatment heat generation unit 1 as in FIG.
5. Heat generating unit 17 for incision treatment, support member 37, sliding members 37a and 37b, guide member 36, operation wire 39
Is provided.
【００６４】また、手元側操作部５６には挿入部５５の
基端部を回転自在に保持する操作部本体６２が設けられ
ている。この操作部本体６２には固定ハンドル６３が一
体的に形成されている。なお、操作部本体６２の先端部
には挿入部５５の基端部を回転操作する回転操作ノブ６
４が配設されている。The hand-side operation section 56 is provided with an operation section main body 62 for rotatably holding the base end of the insertion section 55. A fixed handle 63 is formed integrally with the operation section main body 62. A rotation operation knob 6 for rotating the base end of the insertion section 55 is provided at the distal end of the operation section main body 62.
4 are provided.
【００６５】さらに、固定ハンドル６３には可動ハンド
ル６５の連結部が支軸６６を介して回動自在に連結され
ている。この可動ハンドル６５には駆動軸５８の基端部
が連結されている。Further, a connecting portion of the movable handle 65 is rotatably connected to the fixed handle 63 via a support shaft 66. The base end of the drive shaft 58 is connected to the movable handle 65.
【００６６】また、固定ハンドル６３の末端部には操作
者の手指が挿入可能な第１の指当てリング６７ａが形成
されている。さらに、可動ハンドル６５の末端部には同
様に操作者の手指が挿入可能な第２の指当てリング６７
ｂが形成されている。そして、固定ハンドル６３に対す
る可動ハンドル６５の開閉（回動）操作にともない駆動
軸５８が軸心方向に沿って進退駆動され、処置部５９の
把持部材６０間が開閉駆動されるようになっている。A first finger rest ring 67a into which the operator's finger can be inserted is formed at the end of the fixed handle 63. Further, a second finger rest ring 67 into which the operator's finger can be similarly inserted is provided at the end of the movable handle 65.
b is formed. Then, with the opening and closing (rotating) operation of the movable handle 65 with respect to the fixed handle 63, the drive shaft 58 is driven to advance and retreat along the axial direction, and the gap between the grip members 60 of the treatment section 59 is opened and closed. .
【００６７】さらに、本実施の形態の固定ハンドル６３
には切開処置用熱発生部１７を図５（Ａ），（Ｂ）に示
す待機位置と、図６（Ａ），（Ｂ）に示す使用位置とに
移動操作する操作レバー６１が配設されている。この操
作レバー６１は図９（Ａ）中に実線で示す前進位置から
同図中に点線で示す後退位置まで進退可能に支持されて
いる。そして、このレバー６１の操作にともない切開処
置用熱発生部１７が凝固処置用熱発生部１４に対して接
離する方向に移動するようになっている。Further, the fixed handle 63 of the present embodiment
Is provided with an operation lever 61 for operating the incision treatment heat generating portion 17 between a standby position shown in FIGS. 5A and 5B and a use position shown in FIGS. 6A and 6B. ing. The operation lever 61 is supported so as to be able to advance and retreat from a forward position indicated by a solid line in FIG. 9A to a retracted position indicated by a dotted line in FIG. With the operation of the lever 61, the incision treatment heat generation unit 17 moves in a direction in which the incision treatment heat generation unit 17 approaches and separates from the coagulation treatment heat generation unit 14.
【００６８】次に、上記構成の作用について説明する。
本実施の形態の手術用処置具５４の使用時には固定ハン
ドル６３のリング６７ａ内および可動ハンドル６５のリ
ング６７ｂ内にそれぞれ操作者の手指が挿入される。こ
の状態で、固定ハンドル６３に対して可動ハンドル６５
を回動させる。このときの可動ハンドル６５の回動操作
にともない駆動軸５８が挿入部５５に対し軸方向に運動
し、駆動機構を介して挿入部５５の先端の処置部５９の
把持部材６０ａ，６０ｂ間が開閉駆動される。Next, the operation of the above configuration will be described.
When using the surgical treatment tool 54 of the present embodiment, the fingers of the operator are inserted into the ring 67a of the fixed handle 63 and the ring 67b of the movable handle 65, respectively. In this state, the movable handle 65 is
Is rotated. At this time, the drive shaft 58 moves in the axial direction with respect to the insertion portion 55 in accordance with the rotation operation of the movable handle 65, and the opening and closing between the grip members 60a and 60b of the treatment portion 59 at the distal end of the insertion portion 55 via the drive mechanism. Driven.
【００６９】さらに、リング６７ａ，６７ｂに挿入して
いる以外の手指でレバー６１を操作することにより切開
処置用熱発生部１７の操作ワイヤ３９が挿入部５５に対
し軸方向に運動し、切開処置用熱発生部１７が把持部６
０ａに備えられた凝固処置用熱発生部１４の組織把持面
に対して接離する方向に移動操作される。Further, by operating the lever 61 with fingers other than those inserted into the rings 67a and 67b, the operating wire 39 of the heat generating section 17 for incision treatment moves in the axial direction with respect to the insertion section 55, and the incision treatment is performed. Heat generating part 17 is used as gripping part 6
The moving operation is performed in a direction in which the heat generating unit 14 for coagulation treatment provided at 0a comes into contact with or separates from the tissue gripping surface.
【００７０】また、本実施の形態の処置具５４を使用し
て第６の実施の形態と同様に生体組織における血管等の
被処置部を処置する場合には第６の実施の形態と同様の
操作で、体腔内組織の血管等の被処置部位を剥離し、把
持部６０ａ，６０ｂで把持して熱凝固を行う。When a treatment target such as a blood vessel in a living tissue is treated using the treatment tool 54 of the present embodiment in the same manner as in the sixth embodiment, the same treatment as in the sixth embodiment is performed. By the operation, a treatment site such as a blood vessel of a body cavity tissue is peeled off, and is grasped by the grasping portions 60a and 60b to perform thermal coagulation.
【００７１】これに引き続いてレバー６１を図９（Ａ）
中で実線位置から点線位置まで移動操作すると、ワイヤ
３９が後方に引かれ、支持部材３７に固定された滑り部
材３７ａ，３７ｂが傾斜部材３８の傾斜部に沿って後方
に傾斜移動する。その結果、図６（Ａ），（Ｂ）に示す
ように切開処置用熱発生部１７が凝固処置用熱発生部１
４に当接する。この状態でフットスイッチ３２の切開出
力操作部３０を操作することにより、切開処置用熱発生
部１７が通電加熱され、熱凝固された組織が切断され
る。Subsequently, the lever 61 is moved to the position shown in FIG.
When the moving operation is performed from the solid line position to the dotted line position, the wire 39 is pulled backward, and the sliding members 37a and 37b fixed to the support member 37 are inclined and moved backward along the inclined portion of the inclined member 38. As a result, as shown in FIGS. 6A and 6B, the incision treatment heat generation unit 17 is replaced by the coagulation treatment heat generation unit 1.
Contact 4 By operating the incision output operation section 30 of the foot switch 32 in this state, the incision treatment heat generating section 17 is energized and heated, and the thermally coagulated tissue is cut.
【００７２】そこで、上記構成のものにあっては次の効
果を奏する。すなわち、本実施の形態の処置具５４では
切開処置用熱発生部１７を凝固処置用熱発生部１４の中
心線上で突没するようにしたため、熱凝固された生体組
織を熱的に確実に切断することができ、生体組織の切れ
残りが生じず、処置時間の短縮が図れる。Therefore, the above configuration has the following effects. That is, in the treatment instrument 54 of the present embodiment, the heat generating section 17 for incision treatment is protruded and retracted on the center line of the heat generation section 14 for coagulation treatment. As a result, the living tissue does not remain, and the treatment time can be shortened.
【００７３】また、図１０および図１１（Ａ），（Ｂ）
は本発明の第９の実施の形態を示すものである。図１０
は本実施の形態の医療用処置具７１である鉗子７２の構
成を示すものである。FIG. 10 and FIGS. 11A and 11B
Shows a ninth embodiment of the present invention. FIG.
Shows a configuration of a forceps 72 which is a medical treatment tool 71 of the present embodiment.
【００７４】ここで、鉗子７２の本体７３には２つの鋏
構成部材７４，７５が設けられている。これらの鋏構成
部材７４，７５は中途部分が略交差する状態に重ねられ
ている。さらに、両鋏構成部材７４，７５の交差部には
両鋏構成部材７４，７５を回動自在に連結する支軸７６
が配設されている。Here, the main body 73 of the forceps 72 is provided with two scissors constituting members 74 and 75. These scissors constituting members 74 and 75 are overlapped so that the middle portions substantially intersect. Further, a support shaft 76 for rotatably connecting the scissor members 74 and 75 is provided at the intersection of the scissor members 74 and 75.
Are arranged.
【００７５】また、鉗子本体７３の先端部には生体組織
を把持する開閉可能な一対の把持部７７，７８を備えた
処置部７９が配設されている。この処置部７９は剥離鉗
子と略同じ形状に成形されている。A treatment section 79 having a pair of openable and closable grips 77 and 78 for gripping a living tissue is provided at the distal end of the forceps body 73. The treatment section 79 is formed in substantially the same shape as the peeling forceps.
【００７６】さらに、各鋏構成部材７４，７５の基端部
には略楕円形状の手指挿入リング８０，８１が形成され
ている。そして、これらの手指挿入リング８０，８１の
部分によって一対の把持部７７，７８を開閉操作する手
元側の操作部８２が形成されている。Further, substantially oval finger insertion rings 80, 81 are formed at the base ends of the scissors constituting members 74, 75. The finger insertion rings 80 and 81 form a hand-side operation unit 82 that opens and closes the pair of grips 77 and 78.
【００７７】また、鉗子本体７３の処置部７９には、図
１１（Ａ）に示すように略円弧状に緩く湾曲された湾曲
部８３が形成されている。さらに、鉗子本体７３の各把
持部７７，７８には、図１１（Ｂ）に示すように生体組
織との接触面側に略平板状で幅広な矩形断面の凝固処置
用熱発生部８４，８５がそれぞれ配設されている。これ
らの凝固処置用熱発生部８４，８５は、例えばセラミッ
クヒーターや、ＰＴＣヒーター等のように通電されて熱
を発生する発熱体によって形成されている。The treatment section 79 of the forceps main body 73 is formed with a curved portion 83 which is gently curved in a substantially arc shape as shown in FIG. Further, as shown in FIG. 11 (B), the gripping portions 77 and 78 of the forceps body 73 are provided with heat generating portions 84 and 85 for coagulation treatment having a substantially rectangular cross section and a substantially flat plate shape on the contact surface side with the living tissue. Are arranged respectively. These heat generating portions 84 and 85 for coagulation treatment are formed of a heating element that is energized and generates heat, such as a ceramic heater or a PTC heater.
【００７８】なお、凝固処置用熱発生部８４，８５の外
面（生体との接触面）には生体組織の焦げ付きを防止す
るテフロンコーティング層８６，８７がそれぞれ形成さ
れている。The outer surfaces (contact surfaces with the living body) of the heat generating portions 84, 85 for coagulation treatment are formed with Teflon coating layers 86, 87 for preventing scorching of the living tissue, respectively.
【００７９】さらに、処置部７９の各把持部７７，７８
における幅方向の中央部分には、図１１（Ａ）に示すよ
うに湾曲部８３の湾曲形状に沿って円弧状に緩く湾曲さ
れた間隙８８が設けられている。この間隙８８は凝固処
置用熱発生部８４，８５まで同じ幅で貫通する状態で形
成されている。なお、この間隙８８の先端部は各把持部
７７，７８の先端部で開放された構造となっている。Further, the gripping portions 77 and 78 of the treatment section 79
11A, a gap 88 that is loosely curved in an arc shape along the curved shape of the curved portion 83 is provided as shown in FIG. The gap 88 is formed so as to penetrate the coagulation treatment heat generating portions 84 and 85 with the same width. The distal end of the gap 88 is open at the distal ends of the gripping portions 77 and 78.
【００８０】また、図１０に示すように一方の鋏構成部
材７４には１本のリード線８９が、他方の鋏構成部材７
５にも１本のリード線９０がそれぞれ配設されている。
ここで、リード線８９の先端部は凝固処置用熱発生部８
４に、リード線９０の先端部は凝固処置用熱発生部８５
にそれぞれ接続されている。As shown in FIG. 10, one scissor member 74 has one lead wire 89 and the other scissor member 7 has one lead wire 89.
5 is also provided with one lead wire 90, respectively.
Here, the distal end of the lead wire 89 is a heat generating portion 8 for coagulation treatment.
4, the distal end of the lead wire 90 is a heat generating portion 85 for coagulation treatment.
Connected to each other.
【００８１】さらに、鋏構成部材７４側の手指挿入リン
グ８０の外周面には１つのコード接続部９１が突設され
ている。さらに、鋏構成部材７５側の手指挿入リング８
１の外周面にも１つのコード接続部９２が突設されてい
る。そして、鋏構成部材７４側のコード接続部９１には
リード線８９の基端部が接続されており、リード線９０
は鋏構成部材７５側のコード接続部９２と接続されてい
る。Further, one cord connecting portion 91 is protruded from the outer peripheral surface of the finger insertion ring 80 on the scissors constituting member 74 side. Further, the finger insertion ring 8 on the side of the scissors constituent member 75
One cord connecting portion 92 is also protruded from one outer peripheral surface. The base end of the lead wire 89 is connected to the cord connecting portion 91 on the side of the scissors constituent member 74, and the lead wire 90
Is connected to the cord connecting portion 92 on the scissor constituting member 75 side.
【００８２】次に、上記構成の本実施の形態の医療用処
置具７１の作用について説明する。まず、鉗子７２の先
端部の処置部７９を閉じた状態で図示しない血管等の被
処置部を含む生体組織に差し込む。その後、一対の把持
部７７，７８を開くことにより、血管等の被処置部を他
の生体組織から剥離して露出させる。Next, the operation of the medical treatment instrument 71 of the present embodiment having the above-described configuration will be described. First, in a state where the treatment section 79 at the distal end of the forceps 72 is closed, the treatment section 79 is inserted into a living tissue including a treatment target such as a blood vessel (not shown). Thereafter, by opening the pair of grip portions 77 and 78, the treatment target portion such as a blood vessel is peeled off from another living tissue and exposed.
【００８３】続いて、剥離した血管等を鉗子７２の各把
持部７７，７８間で凝固処置に適正な加圧力で圧迫した
状態で把持する。この状態で、図示しない電源装置を出
力すると各把持部７７，７８の凝固処置用熱発生部８
４，８５が通電されて熱を発生する。このときの凝固処
置用熱発生部８４，８５の熱によって把持部７７，７８
間の血管等の被処置部位が十分に熱凝固される。Subsequently, the detached blood vessel or the like is gripped between the gripping portions 77 and 78 of the forceps 72 while being pressed with a pressing force appropriate for the coagulation treatment. In this state, when a power supply device (not shown) is output, the heat generating units 8 for coagulation treatment of the grip portions 77 and 78 are output.
4, 85 are energized to generate heat. At this time, the gripping portions 77, 78 are heated by the heat of the coagulation treatment heat generating portions 84, 85.
The site to be treated, such as an intervening blood vessel, is sufficiently thermally coagulated.
【００８４】その後、この状態で、図示しない外科用メ
スや、高周波メスを処置部７９の各把持部７７，７８の
間隙８８に差し込んで凝固された血管等の被処置部位の
切開が行われる。Thereafter, in this state, an unillustrated surgical scalpel or a high-frequency scalpel is inserted into the gap 88 between the grasping portions 77 and 78 of the treatment portion 79, and a portion to be treated such as a coagulated blood vessel is cut.
【００８５】そこで、上記構成のものにあっては次の効
果を奏する。すなわち、本実施の形態の医療用処置具１
では鉗子本体７３の各把持部７７，７８に幅広な凝固処
置用熱発生部８４，８５を配設したので、鉗子本体７３
の各把持部７７，７８間で把持された血管等の被処置部
位を適正な加圧力で圧迫した状態でこれらの凝固処置用
熱発生部８４，８５の熱によって確実に熱凝固すること
ができる。Therefore, the above configuration has the following effects. That is, the medical treatment tool 1 of the present embodiment
In this embodiment, the heat generating portions 84 and 85 for coagulation treatment are provided on the holding portions 77 and 78 of the forceps body 73, respectively.
In a state in which a treatment site such as a blood vessel grasped between the grasping portions 77 and 78 is pressed with an appropriate pressing force, the heat of the coagulation treatment heat generating portions 84 and 85 can reliably coagulate the heat. .
【００８６】さらに、本実施の形態では処置部７９の各
把持部７７，７８における幅方向の中央部分に間隙８８
を設けたので、血管等の被処置部位を熱凝固させた後、
処置部７９における把持部７７，７８の間隙８８に外科
用メスや、高周波メスのような別の切開手段を挿入して
凝固した血管等の被処置部位の組織を切断することがで
きる。そのため、特に開腹手術なとでは簡単迅速に処置
することができる。また、被処置部位の組織の凝固機能
と切開機能とを一つの器械で行う機械に比べて構成が簡
単になり、コスト的にも有利となる。Further, in the present embodiment, a gap 88 is provided at the central portion in the width direction of each of the holding portions 77 and 78 of the treatment portion 79.
After heat-coagulating the treatment site such as blood vessels,
By inserting another incision means such as a surgical scalpel or a high-frequency scalpel into the gap 88 between the grasping portions 77 and 78 in the treatment section 79, it is possible to cut the tissue at the treatment site such as a coagulated blood vessel. Therefore, it is possible to perform the treatment easily and quickly especially in the case of laparotomy. In addition, the configuration is simpler than that of a machine that performs the coagulation function and the incision function of the tissue at the site to be treated with one instrument, which is advantageous in cost.
【００８７】また、図１２（Ａ），（Ｂ）は本発明の第
１０の実施の形態を示すものである。本実施の形態は第
９の実施の形態（図１０および図１１（Ａ），（Ｂ）参
照）の医療用処置具７１における鉗子７２の先端の処置
部７９の構成を次の通り変更したものである。FIGS. 12A and 12B show a tenth embodiment of the present invention. In the present embodiment, the configuration of the treatment section 79 at the tip of the forceps 72 in the medical treatment tool 71 of the ninth embodiment (see FIGS. 10 and 11A and 11B) is changed as follows. It is.
【００８８】すなわち、本実施の形態では、一方の鋏構
成部材７４の把持部７７側には間隙８８を設けず、他方
の鋏構成部材７５の把持部７８側のみに間隙８８を設け
たものである。That is, in the present embodiment, the gap 88 is not provided on the grip portion 77 side of one scissor component member 74, but is provided only on the grip portion 78 side of the other scissor component member 75. is there.
【００８９】次に、上記構成における作用について説明
する。本実施の形態の鉗子７２を使用して第９の実施の
形態と同様の処置を行う場合には、次のような作業が行
われる。まず、第９の実施の形態と同様の手順で鉗子７
２を操作して、体腔内組織の血管等の被処置部位を剥離
し、把持部７７，７８で把持して熱凝固を行う。Next, the operation of the above configuration will be described. When the same treatment as in the ninth embodiment is performed using the forceps 72 of the present embodiment, the following operation is performed. First, the forceps 7 are applied in the same procedure as in the ninth embodiment.
2 is operated to exfoliate a treatment site such as a blood vessel of a tissue in a body cavity, and to perform thermal coagulation by gripping the gripping portions 77 and 78.
【００９０】その後、この状態で、図示しない外科用メ
スや、高周波メスを処置部７９の一方の把持部７８の間
隙８８に差し込んで凝固された血管等の被処置部位の切
開が行われる。Thereafter, in this state, a surgical scalpel or a high-frequency scalpel (not shown) is inserted into the gap 88 of one of the grasping portions 78 of the treatment section 79, and an incision is made in a treatment site such as a coagulated blood vessel.
【００９１】そこで、上記構成のものにあっては次の効
果を奏する。すなわち、本実施の形態では外科用メス
や、高周波メスを間隙８８に挿入した際に、メスの先端
は処置部７９の把持部７７の凝固処置用熱発生部８４の
表面に押し当たってそれ以後の挿入操作が止められる。
そのため、メスの先端が間隙８８の外に突き抜けること
が防止されるので、被処置部以外の部分を切開してしま
うおそれがなく、安全である。Therefore, the above configuration has the following effects. That is, in the present embodiment, when a surgical scalpel or a high-frequency scalpel is inserted into the gap 88, the tip of the scalpel is pressed against the surface of the coagulation treatment heat generating portion 84 of the grip portion 77 of the treatment portion 79 and thereafter. Is stopped.
For this reason, the tip of the scalpel is prevented from penetrating out of the gap 88, so that there is no risk of incising a portion other than the portion to be treated, which is safe.
【００９２】また、図１３は本発明の第１１の実施の形
態を示すものである。本実施の形態は第９の実施の形態
（図１０および図１１（Ａ），（Ｂ）参照）の医療用処
置具７１における鉗子７２の先端の処置部７９の構成を
次の通り変更したものである。FIG. 13 shows an eleventh embodiment of the present invention. In the present embodiment, the configuration of the treatment section 79 at the tip of the forceps 72 in the medical treatment tool 71 of the ninth embodiment (see FIGS. 10 and 11A and 11B) is changed as follows. It is.
【００９３】すなわち、本実施の形態でも第１０の実施
の形態（図１２（Ａ），（Ｂ）参照）と同様に、一方の
鋏構成部材７４の把持部７７側には間隙８８を設けず、
他方の鋏構成部材７５の把持部７８側のみに間隙８８を
設けている。さらに、本実施の形態ではこれに加えて鋏
構成部材７４の把持部７７側には把持部７８側の間隙８
８と対応する部位に、例えばタングステンのような超硬
金属からなる受け部材９３が代わりに配設されている。That is, in the present embodiment, similarly to the tenth embodiment (see FIGS. 12A and 12B), no gap 88 is provided on the gripping portion 77 side of one scissor constituting member 74. ,
A gap 88 is provided only on the gripping portion 78 side of the other scissors constituting member 75. Further, in the present embodiment, in addition to this, a gap 8 on the gripping portion 78 side of the scissor constituent member 74 is provided.
8, a receiving member 93 made of a hard metal such as tungsten is provided instead.
【００９４】次に、上記構成における作用について説明
する。本実施の形態の鉗子７２を使用して第９の実施の
形態と同様の処置を行う場合には、次のような作業が行
われる。まず、第９の実施の形態と同様の手順で鉗子７
２を操作して、体腔内組織の血管等の被処置部位を剥離
し、把持部７７，７８で把持して熱凝固を行う。Next, the operation of the above configuration will be described. When the same treatment as in the ninth embodiment is performed using the forceps 72 of the present embodiment, the following operation is performed. First, the forceps 7 are applied in the same procedure as in the ninth embodiment.
2 is operated to exfoliate a treatment site such as a blood vessel of a tissue in a body cavity, and to perform thermal coagulation by gripping the gripping portions 77 and 78.
【００９５】その後、この状態で、図示しない外科用メ
スや、高周波メスを処置部７９の一方の把持部７８の間
隙８８に差し込んで凝固された血管等の被処置部位の切
開が行われる。Thereafter, in this state, a surgical scalpel (not shown) or a high-frequency scalpel is inserted into the gap 88 of the one gripping portion 78 of the treatment portion 79 to cut a portion to be treated such as a coagulated blood vessel.
【００９６】そこで、上記構成のものにあっては次の効
果を奏する。すなわち、本実施の形態では外科用メス
や、高周波メスを間隙８８に挿入した際に、メスの先端
は把持部７７の受け部材９３の表面に押し当たってそれ
以後の挿入操作が止められる。そのため、メスの先端が
間隙８８の外に突き抜けることが防止されるので、被処
置部以外の部分を切開してしまうおそれがなく、安全で
ある。Therefore, the above configuration has the following effects. That is, in the present embodiment, when a surgical scalpel or a high-frequency scalpel is inserted into the gap 88, the tip of the scalpel is pressed against the surface of the receiving member 93 of the grip portion 77, and the subsequent insertion operation is stopped. For this reason, the tip of the scalpel is prevented from penetrating out of the gap 88, so that there is no risk of incising a portion other than the portion to be treated, which is safe.
【００９７】さらに、本実施の形態では受け部材２５が
超硬金属材料で構成されるため、メス先端が受け部材２
５に押し当たるときに表面に生じる傷などによる劣化を
防ぐことができる。Further, in this embodiment, since the receiving member 25 is made of a hard metal material, the tip of the scalpel is
5 can be prevented from deteriorating due to scratches or the like that occur on the surface.
【００９８】また、図１４は本発明の第１２の実施の形
態を示すものである。本実施の形態は第９の実施の形態
（図１０および図１１（Ａ），（Ｂ）参照）の医療用処
置具７１における鉗子７２の先端の処置部７９の構成を
次の通り変更したものである。FIG. 14 shows a twelfth embodiment of the present invention. In the present embodiment, the configuration of the treatment section 79 at the tip of the forceps 72 in the medical treatment tool 71 of the ninth embodiment (see FIGS. 10 and 11A and 11B) is changed as follows. It is.
【００９９】すなわち、本実施の形態では、処置部７９
の各把持部７７，７８の間隙８８の先端部を閉止する閉
止部９４を設け、各把持部７７，７８の間隙８８の先端
部が開放されていない構成にしたものである。That is, in the present embodiment, the treatment section 79
A closing portion 94 for closing the tip of the gap 88 between the grips 77, 78 is provided, and the tip of the gap 88 between the grips 77, 78 is not opened.
【０１００】そこで、上記構成のものにあっては外科用
メスや、高周波メスを間隙８８に挿入して処置部位を切
開する際に、メスの移動範囲は間隙８８の先端部の閉止
部９４と、この間隙８８の終端部９５との間で規制され
る。そのため、特に肝臓などの実質臓器を凝固して切開
する場合などで、間隙８８の先端部側にメスが移動して
切開目的部位以外の凝固されていない部位などを切開し
て出血させてしまうおそれがなく、安全に処置すること
ができる効果がある。Therefore, in the above configuration, when a surgical scalpel or a high-frequency scalpel is inserted into the gap 88 to incise the treatment site, the range of movement of the scalpel is equal to the closing portion 94 at the distal end of the gap 88. , Between the end portion 95 of the gap 88. Therefore, in particular, when a solid organ such as the liver is coagulated and incised, the scalpel may move to the distal end side of the gap 88 to cut and bleed a non-coagulated part other than the target part of the incision. There is no effect, and there is an effect that treatment can be performed safely.
【０１０１】また、図１５は本発明の第１３の実施の形
態を示すものである。本実施の形態は第９の実施の形態
（図１０および図１１（Ａ），（Ｂ）参照）の医療用処
置具７１における鉗子７２の先端の処置部７９を高周波
処置用に変更したものである。FIG. 15 shows a thirteenth embodiment of the present invention. In the present embodiment, the treatment section 79 at the distal end of the forceps 72 in the medical treatment tool 71 of the ninth embodiment (see FIGS. 10 and 11A and 11B) is changed for high-frequency treatment. is there.
【０１０２】すなわち、本実施の形態では、鉗子７２に
おける鉗子本体７３は全体が絶縁材で構成されている。
さらに、鉗子本体７３の各把持部７７，７８には間隙８
８の内面側に絶縁材で覆われる絶縁部９６，９７がそれ
ぞれ形成される構造となっている。That is, in this embodiment, the entire forceps body 73 of the forceps 72 is made of an insulating material.
Further, a gap 8 is provided between each of the gripping portions 77 and 78 of the forceps body 73.
Insulating portions 96 and 97 which are covered with an insulating material are formed on the inner surface side of 8.
【０１０３】また、各把持部７７，７８には間隙８８の
両側の絶縁部９６，９７の外側に断面矩形の一対の電極
９８，９９が対向する位置にそれぞれ配設されている。
ここで、各電極９８，９９はリード線を介して図示しな
い高周波電源装置に接続されている。Further, a pair of electrodes 98, 99 having a rectangular cross section are disposed on the gripping portions 77, 78 at positions facing the outside of the insulating portions 96, 97 on both sides of the gap 88, respectively.
Here, each of the electrodes 98 and 99 is connected to a high-frequency power supply (not shown) via a lead wire.
【０１０４】次に、上記構成における作用について説明
する。本実施の形態の鉗子７２を使用して第９の実施の
形態と同様の処置を行う場合には、次のような作業が行
われる。まず、第９の実施の形態と同様の手順で鉗子７
２を操作して、体腔内組織の血管等の被処置部位を剥離
し、把持部７７，７８で把持したのち、各把持部７７，
７８の電極９８，９９間で高周波通電して凝固を行う。Next, the operation of the above configuration will be described. When the same treatment as in the ninth embodiment is performed using the forceps 72 of the present embodiment, the following operation is performed. First, the forceps 7 are applied in the same procedure as in the ninth embodiment.
2 is operated to exfoliate a treatment site such as a blood vessel of a tissue in a body cavity, and then to be gripped by gripping portions 77 and 78;
High-frequency current is applied between the 78 electrodes 98 and 99 to perform coagulation.
【０１０５】その後、この状態で、図示しない外科用メ
スや、高周波メスを処置部７９の一方の把持部７８の間
隙８８に差し込んで凝固された血管等の被処置部位の切
開が行われる。Thereafter, in this state, a surgical scalpel (not shown) or a high-frequency scalpel is inserted into the gap 88 of one of the grasping portions 78 of the treatment section 79, and a portion to be treated such as a coagulated blood vessel is cut.
【０１０６】そこで、上記構成のものにあっては次の効
果を奏する。すなわち、本実施の形態の鉗子７２では高
周波によるバイポーラ通電により処置部位を凝固すると
同時に、高周波電源装置をモノポーラに切り換えること
により、高周波メスで凝固部位を切断することができ
る。そのため、一台の電源装置で凝固および切開が可能
であり、コスト的に有利となる。Therefore, the above configuration has the following effects. That is, in the forceps 72 of the present embodiment, the coagulated portion can be cut by the high-frequency scalpel by switching the high-frequency power supply device to monopolar at the same time as coagulating the treatment portion by bipolar energization by high frequency. Therefore, coagulation and incision are possible with one power supply device, which is advantageous in cost.
【０１０７】また、図１６は本発明の第１４の実施の形
態を示すものである。本実施の形態は第９の実施の形態
（図１０および図１１（Ａ），（Ｂ）参照）の医療用処
置具７１の構成を次の通り変更したものである。FIG. 16 shows a fourteenth embodiment of the present invention. In the present embodiment, the configuration of the medical treatment tool 71 of the ninth embodiment (see FIGS. 10 and 11A and 11B) is changed as follows.
【０１０８】すなわち、本実施の形態では、第１３の実
施の形態（図１５参照）と同様に鉗子７２の先端の処置
部７９に高周波処置用の電極９８，９９を設けた構成に
変更し、高周波通電により生体組織を凝固する構成にし
たものである。ここで、一方の把持部７７側の電極９８
は、リード線８９を介して鋏構成部材７４側の手指挿入
リング８０のコード接続部９１の内端部に接続されてい
る。さらに、他方の把持部７８側の電極９９は、リード
線９０を介して鋏構成部材７５側の手指挿入リング８１
のコード接続部９２の内端部に接続されている。That is, in the present embodiment, similarly to the thirteenth embodiment (see FIG. 15), the configuration is changed to a configuration in which electrodes 98 and 99 for high-frequency treatment are provided on the treatment section 79 at the distal end of the forceps 72. In this configuration, the living tissue is coagulated by high-frequency current. Here, the electrode 98 on one gripping portion 77 side
Is connected to the inner end of the cord connecting portion 91 of the finger insertion ring 80 on the scissors constituting member 74 side via the lead wire 89. Further, the electrode 99 on the other gripping portion 78 side is connected to the finger insertion ring 81 on the scissor constituting member 75 side via the lead wire 90.
Is connected to the inner end of the cord connection portion 92 of the first embodiment.
【０１０９】また、コード接続部９１の外端部には、接
続コード１００の一端が、コード接続部９２の外端部に
は、接続コード１０１の一端がそれぞれ着脱自在に連結
されている。これらの接続コード１００，１０１の他端
部は高周波電源装置１０２と接続されている。Further, one end of a connection cord 100 is detachably connected to the outer end of the cord connection portion 91, and one end of the connection cord 101 is detachably connected to the outer end of the cord connection portion 92. The other ends of these connection cords 100 and 101 are connected to a high-frequency power supply 102.
【０１１０】また、高周波電源装置１０２の接続コード
１０１の途中には切替え装置１０３が介設されている。
この切替え装置１０３には高周波メス１０４がコード１
０５を介して接続されている。そして、高周波メス１０
４はこの切替え装置１０３を経由して高周波電源装置１
０２と接続されている。なお、高周波電源装置１０２に
はコード１０６を介してフットスイッチ１０７が接続さ
れている。このフットスイッチ１０７には切開出力操作
部１０８と凝固出力操作部１０９とが設けられている。A switching device 103 is provided in the middle of the connection cord 101 of the high-frequency power supply device 102.
In this switching device 103, a high-frequency knife 104
05. And high-frequency knife 10
4 is a high-frequency power supply 1 via this switching device 103.
02 is connected. Note that a foot switch 107 is connected to the high-frequency power supply device 102 via a cord 106. The foot switch 107 is provided with an incision output operation unit 108 and a coagulation output operation unit 109.
【０１１１】次に、上記構成における作用について説明
する。本実施の形態の鉗子７２を使用して第１３の実施
の形態と同様の処置を行う場合には、次のような作業が
行われる。まず、第９の実施の形態と同様の手順で鉗子
７２を操作して、体腔内組織の血管等の被処置部位を剥
離し、把持部７７，７８で把持したのち、フットスイッ
チ１０７における凝固出力操作部１０９を操作する。こ
れにより、電極９８と９９との間で高周波通電して把持
部７７，７８間の血管等の被処置部位の凝固を行う。Next, the operation of the above configuration will be described. When the same treatment as in the thirteenth embodiment is performed using the forceps 72 of the present embodiment, the following operation is performed. First, the forceps 72 is operated in the same procedure as in the ninth embodiment to exfoliate a treatment site such as a blood vessel of a body cavity tissue, and is grasped by the grasping portions 77 and 78. The operation unit 109 is operated. As a result, high-frequency current is applied between the electrodes 98 and 99 to coagulate a treatment site such as a blood vessel between the grip portions 77 and 78.
【０１１２】その後、この状態で、高周波メス１０４を
処置部７９の各把持部７７，７８の間隙８８に差し込ん
で切替え装置１０３の通電経路を切り換え、フットスイ
ッチ１０７における切開出力操作部１０８を操作するこ
とにより、高周波メス１０４から鉗子７２における電極
９９に切開電力が通電されて被処置部位が切開される。Thereafter, in this state, the high-frequency scalpel 104 is inserted into the gap 88 between the grips 77 and 78 of the treatment section 79 to switch the energization path of the switching device 103, and the incision output operation section 108 of the foot switch 107 is operated. As a result, incision power is supplied from the high-frequency scalpel 104 to the electrode 99 of the forceps 72, and the treatment site is incised.
【０１１３】そこで、上記構成のものにあっては次の効
果を奏する。すなわち、本実施の形態の鉗子７２では血
管等の被処置部位を切開する際に、モノポーラに切り換
えることなく、バイポーラだけで被処置部位の切開処置
ができ、安全な処置が可能になる。Thus, the above configuration has the following effects. That is, with the forceps 72 of the present embodiment, when incising a treatment site such as a blood vessel, the incision treatment of the treatment site can be performed only with the bipolar without switching to the monopolar, and a safe treatment can be performed.
【０１１４】また、図１７および図１８（Ａ），（Ｂ）
は本発明の第１５の実施の形態を示すものである。図１
７は本実施の形態の医療用処置具である凝固切開処置具
１１１の構成を示すものである。FIGS. 17 and 18 (A) and (B)
Shows a fifteenth embodiment of the present invention. FIG.
Reference numeral 7 denotes a configuration of a coagulation / incision treatment tool 111 which is a medical treatment tool of the present embodiment.
【０１１５】ここで、凝固切開処置具１１１の本体１１
２には２つの鋏構成部材１１３，１１４が設けられてい
る。これらの鋏構成部材１１３，１１４は中途部分が略
交差する状態に重ねられている。さらに、両鋏構成部材
１１３，１１４の交差部には両鋏構成部材１１３，１１
４を回動自在に連結する支軸１１５が配設されている。Here, the main body 11 of the coagulation / incision treatment instrument 111
2 is provided with two scissors constituting members 113 and 114. These scissors constituting members 113 and 114 are superimposed such that the middle portions substantially intersect. Further, at the intersection of both scissors constituent members 113 and 114, both scissors constituent members 113 and 11 are provided.
A support shaft 115 for rotatably connecting the shafts 4 is provided.
【０１１６】また、処置具本体１１２の先端部には生体
組織を把持する開閉可能な一対のジョー１１６，１１７
を備えた処置部１１８が配設されている。さらに、各鋏
構成部材１１３，１１４の基端部には略楕円形状の手指
挿入リング１１９，１２０が形成されている。そして、
これらの手指挿入リング１１９，１２０の部分によって
一対のジョー１１６，１１７を開閉操作する手元側の操
作部１２１が形成されている。Further, a pair of openable and closable jaws 116 and 117 for grasping a living tissue is provided at the distal end of the treatment instrument main body 112.
Is provided. Further, finger insertion rings 119 and 120 having a substantially elliptical shape are formed at the base ends of the scissors constituting members 113 and 114. And
These finger insertion rings 119 and 120 form a hand-side operation unit 121 for opening and closing the pair of jaws 116 and 117.
【０１１７】また、各ジョー１１６，１１７には生体組
織Ｈを凝固するためのヒーター１２２，１２３が設けら
れている。各ヒーター１２２，１２３には生体組織の滑
り止めのための歯部１２４が設けられている。なお、ヒ
ーター１２２，１２３はセラミックヒーター、ＰＴＣヒ
ーター、半導体ヒーター、電熱線など、公知のヒーター
手段のいずれでも構わない。The jaws 116 and 117 are provided with heaters 122 and 123 for coagulating the living tissue H. Each of the heaters 122 and 123 is provided with a tooth portion 124 for preventing a living tissue from slipping. Note that the heaters 122 and 123 may be any of known heater means such as a ceramic heater, a PTC heater, a semiconductor heater, and a heating wire.
【０１１８】また、操作部１２１の各手指挿入リング１
１９，１２０にはコード接続部１２５，１２６がそれぞ
れ突設されている。ここで、一方のコード接続部１２５
の内端部にはヒーター１２２、他方のコード接続部１２
６の内端部にはヒーター１２３がそれぞれリード線を介
して接続されている。さらに、コード接続部１２５，１
２６の外端部には各ヒーター１２２，１２３に通電する
ための接続コードが接続されている。Each finger insertion ring 1 of the operation unit 121
19 and 120 are provided with cord connection portions 125 and 126, respectively. Here, one cord connection unit 125
The heater 122 and the other cord connection 12
A heater 123 is connected to the inner end of each of the heaters 6 via a lead wire. Further, the cord connection sections 125, 1
A connection cord for supplying electricity to each of the heaters 122 and 123 is connected to an outer end of the heater 26.
【０１１９】また、各ジョー１１６，１１７には生体組
織Ｈを切開する切開処置用のハサミブレード１２７，１
２８がそれぞれ設けられている。これらのハサミブレー
ド１２７，１２８は、図１８（Ｂ）に示すように略Ｕ字
状の断面形状に形成されている。そして、各ハサミブレ
ード１２７，１２８は、各ジョー１１６，１１７の外周
面側を囲む状態で各ジョー１１６，１１７に装着されて
いる。The jaws 116 and 117 are provided with scissor blades 127 and 1 for incision for incising the living tissue H.
28 are provided respectively. These scissor blades 127 and 128 are formed in a substantially U-shaped cross-sectional shape as shown in FIG. The scissor blades 127 and 128 are mounted on the jaws 116 and 117 so as to surround the outer peripheral surfaces of the jaws 116 and 117, respectively.
【０１２０】また、各ジョー１１６，１１７の両側面に
はハサミブレード１２７，１２８を前後方向に移動可能
にガイドするスライド溝１２９，１３０が形成されてい
る。さらに、各ハサミブレード１２７，１２８にはこの
スライド溝１２９，１３０に挿入されるガイド突起１２
７ａ，１２８ａが突設されている。そして、各ハサミブ
レード１２７，１２８はジョー１１６，１１７の各スラ
イド溝１２９，１３０に沿って前後にそれぞれスライド
可能に支持されている。なお、各ハサミブレード１２
７，１２８のＵ字状断面の一側部側には鋭利な刃部１２
７ｂ，１２８ｂがそれぞれ形成されている。Further, slide grooves 129 and 130 are formed on both side surfaces of the jaws 116 and 117 to guide the scissors blades 127 and 128 movably in the front-rear direction. Further, each of the scissor blades 127 and 128 has a guide projection 12 inserted into the slide groove 129 or 130.
7a and 128a protrude. The scissor blades 127 and 128 are supported so as to be slidable back and forth along the slide grooves 129 and 130 of the jaws 116 and 117, respectively. Each scissor blade 12
A sharp blade 12 is provided on one side of the U-shaped section
7b and 128b are formed respectively.
【０１２１】また、各ハサミブレード１２７，１２８に
は操作棒１３１，１３２の先端部が連結されている。こ
れらの操作棒１３１，１３２の基端部は操作部１２１の
近傍側に配置されたレバー１３３，１３４に連結されて
いる。そして、各レバー１３３，１３４の前後方向のス
ライド操作にともない操作棒１３１，１３２を介して各
ハサミブレード１２７，１２８がジョー１１６，１１７
のスライド溝１２９，１３０に沿って前後にそれぞれス
ライド操作されるようになっている。Further, tip ends of operation rods 131 and 132 are connected to the scissor blades 127 and 128, respectively. The base ends of the operation rods 131 and 132 are connected to levers 133 and 134 arranged near the operation unit 121. The respective scissor blades 127 and 128 are moved by the jaws 116 and 117 via the operation rods 131 and 132 in accordance with the sliding operation of the levers 133 and 134 in the front-rear direction.
Are slid back and forth along the slide grooves 129 and 130 of FIG.
【０１２２】次に、上記構成の作用について説明する。
本実施の形態の凝固切開処置具１１１の使用時には、生
体組織Ｈの切開時以外の通常時はハサミブレード１２
７，１２８は図１７に示すように処置具本体１１２の手
元側に引き戻された待機位置で保持されている。この状
態で、操作部１２１によってジョー１１６，１１７を開
いたのち、図１７に示すように、ジョー１１６，１１７
を閉じ、上下のヒーター１２２，１２３間で生体組織Ｈ
を把持する。このとき、ハサミブレード１２７，１２８
は生体組織Ｈとは非接触の状態で保持される。そして、
この状態で、上下のヒーター１２２，１２３が通電加熱
され、上下のヒーター１２２，１２３間の生体組織Ｈの
凝固を行う。Next, the operation of the above configuration will be described.
At the time of using the coagulation / incision treatment tool 111 of the present embodiment, the scissor blade 12 is normally used except for the incision of the living tissue H.
Reference numerals 7 and 128 are held at the standby position where they are pulled back to the hand side of the treatment instrument main body 112 as shown in FIG. In this state, after the jaws 116 and 117 are opened by the operation unit 121, the jaws 116 and 117 are opened as shown in FIG.
To close the living tissue H between the upper and lower heaters 122 and 123.
To grip. At this time, scissor blades 127 and 128
Is held in a state of non-contact with the living tissue H. And
In this state, the upper and lower heaters 122 and 123 are energized and heated to coagulate the living tissue H between the upper and lower heaters 122 and 123.
【０１２３】次に、一旦、ジョー１１６，１１７を開い
た後、各ハサミブレード１２７，１２８のレバー１３
３，１３４を先端側に向けて押出し操作して、図１８
（Ａ）に示すようにハサミブレード１２７，１２８をジ
ョー１１６，１１７の先端位置まで移動させる。Next, once the jaws 116 and 117 are opened, the levers 13 of the scissor blades 127 and 128 are opened.
By pushing the 3,134 toward the distal end, FIG.
As shown in (A), the scissor blades 127 and 128 are moved to the tip positions of the jaws 116 and 117.
【０１２４】その状態で、ジョー１１６，１１７を閉じ
ることにより、上下のハサミブレード１２７，１２８間
であたかもハサミのように生体組織Ｈが剪断されて切開
される。In this state, by closing the jaws 116 and 117, the living tissue H is sheared between the upper and lower scissor blades 127 and 128 like a scissor and cut.
【０１２５】そこで、上記構成のものにあっては次の効
果を奏する。すなわち、本実施の形態では処置具本体１
１２の処置部１１８の各ジョー１１６，１１７に生体組
織Ｈを凝固するためのヒーター１２２，１２３を設ける
とともに、生体組織Ｈを切開する切開処置用のハサミブ
レード１２７，１２８を各ジョー１１６，１１７の前後
方向に移動可能に設けている。そのため、ハサミブレー
ド１２７，１２８を図１７に示すように処置具本体１１
２の手元側に引き戻された待機位置で保持している状態
で、生体組織Ｈの凝固処置を行い、ハサミブレード１２
７，１２８を図１８（Ａ）に示すようにジョー１１６，
１１７の先端位置まで移動させた状態で、生体組織Ｈの
切開処置を行うことができる。したがって、本実施の形
態では処置具本体１１２の処置部１１８の各ジョー１１
６，１１７の先端部で凝固処置と、切開処置とを行うこ
とができるので、繊細な処置ができる効果がある。Therefore, the above configuration has the following effects. That is, in the present embodiment, the treatment instrument main body 1
Heaters 122 and 123 for coagulating the living tissue H are provided in the jaws 116 and 117 of the 12 treatment sections 118, and scissor blades 127 and 128 for incision treatment for cutting the living tissue H are attached to the jaws 116 and 117. It is provided movably in the front-back direction. Therefore, the scissor blades 127 and 128 are connected to the treatment tool main body 11 as shown in FIG.
In the state where the living tissue H is held at the standby position pulled back to the hand side of FIG.
7 and 128, as shown in FIG.
The incision treatment of the living tissue H can be performed in a state where the living tissue H has been moved to the tip position of 117. Therefore, in the present embodiment, each jaw 11 of the treatment section 118 of the treatment instrument main body 112 is
Since the coagulation treatment and the incision treatment can be performed at the distal end of 6,117, there is an effect that a delicate treatment can be performed.
【０１２６】さらに、生体組織Ｈの切開処置を行う場合
には鋏構成部材１１３，１１４をハサミのように開閉す
る動作で生体組織Ｈの切開処置ができるため、操作性が
よく、一層、繊細な切開処置が可能となる。Further, when performing the incision treatment of the living tissue H, since the incision treatment of the living tissue H can be performed by opening and closing the scissors constituting members 113 and 114 like scissors, the operability is good and the delicateness is further improved. An incision procedure becomes possible.
【０１２７】また、図１９は本発明の第１６の実施の形
態を示すものである。本実施の形態は第１５の実施の形
態（図１７および図１８（Ａ），（Ｂ）参照）の凝固切
開処置具１１１における処置具本体１１２の先端部の処
置部１１８の構成を次の通り変更したものである。FIG. 19 shows a sixteenth embodiment of the present invention. In the present embodiment, the configuration of the treatment section 118 at the distal end of the treatment instrument main body 112 in the coagulation / incision treatment instrument 111 of the fifteenth embodiment (see FIGS. 17 and 18A and 18B) is as follows. It has been changed.
【０１２８】すなわち、本実施の形態では、第１５の実
施の形態のヒーター１２２，１２３を廃してジョー１１
６，１１７自体によってバイポーラ電極１３５を構成し
たものである。また、ジョー１１６，１１７とナイフブ
レード１２７，１２８との間には絶縁層１３６，１３７
が設けられ、凝固時にナイフブレード１２７，１２８に
電流が流れないように構成されている。That is, in this embodiment, the heaters 122 and 123 of the fifteenth embodiment are eliminated and the jaw 11
6, 117 itself constitutes a bipolar electrode 135. Insulating layers 136, 137 are provided between the jaws 116, 117 and the knife blades 127, 128.
Is provided so that current does not flow through the knife blades 127 and 128 during coagulation.
【０１２９】そして、本実施の形態では処置具本体１１
２の処置部１１８の各ジョー１１６，１１７の先端部の
バイポーラ電極１３５で凝固処置を行うとともに、両側
のジョー１１６，１１７のナイフブレード１２７，１２
８によって切開処置を行うことができる。そのため、本
実施の形態でも第１５の実施の形態の凝固切開処置具１
１１と同様に処置具本体１１２の処置部１１８の各ジョ
ー１１６，１１７の先端部で凝固処置と、切開処置とを
行うことができるので、繊細な処置ができる効果があ
る。In the present embodiment, the treatment tool main body 11
The coagulation treatment is performed by the bipolar electrode 135 at the tip of each of the jaws 116 and 117 of the second treatment section 118, and the knife blades 127 and 12 of the jaws 116 and 117 on both sides are performed.
8, an incision procedure can be performed. Therefore, also in this embodiment, the coagulation / incision treatment tool 1 according to the fifteenth embodiment is used.
As in the case of 11, the coagulation treatment and the incision treatment can be performed at the distal ends of the jaws 116 and 117 of the treatment portion 118 of the treatment instrument main body 112, so that there is an effect that a delicate treatment can be performed.
【０１３０】また、図２０は本発明の第１７の実施の形
態を示すものである。本実施の形態は第１６の実施の形
態（図１９参照）の凝固切開処置具１１１における処置
具本体１１２の先端部の処置部１１８の片側のジョー１
１７のみにナイフブレード１２８を設けたものである。FIG. 20 shows a seventeenth embodiment of the present invention. In this embodiment, the jaw 1 on one side of the treatment section 118 at the distal end of the treatment instrument main body 112 in the coagulation / incision treatment instrument 111 of the sixteenth embodiment (see FIG. 19).
17 is provided with a knife blade 128 only.
【０１３１】そして、本実施の形態では処置具本体１１
２の処置部１１８の各ジョー１１６，１１７の先端部の
バイポーラ電極１３５で凝固処置を行うとともに、片側
のジョー１１７のナイフブレード１２８によって切開処
置を行うことができる。そのため、本実施の形態でも第
１６の実施の形態の凝固切開処置具１１１と同様に、繊
細な処置ができる効果がある。In this embodiment, the treatment tool main body 11
The coagulation treatment can be performed by the bipolar electrode 135 at the distal end of each of the jaws 116 and 117 of the second treatment section 118, and the incision treatment can be performed by the knife blade 128 of the jaw 117 on one side. Therefore, in the present embodiment, there is an effect that a delicate treatment can be performed as in the case of the coagulation / incision treatment tool 111 of the sixteenth embodiment.
【０１３２】なお、本実施の形態のナイフブレード１２
８に切開電流を通電し、ナイフブレード１２８に通電加
熱することにより、生体組織Ｈの切開処置を行う構成に
してもよい。The knife blade 12 according to the present embodiment is
The incision treatment of the living tissue H may be performed by applying an incision current to the knife 8 and energizing and heating the knife blade 128.
【０１３３】また、図２１は本発明の第１８の実施の形
態を示すものである。本実施の形態は第１５の実施の形
態（図１７および図１８（Ａ），（Ｂ）参照）の凝固切
開処置具１１１における処置具本体１１２の先端部の処
置部１１８の構成を次の通り変更したものである。FIG. 21 shows an eighteenth embodiment of the present invention. In the present embodiment, the configuration of the treatment section 118 at the distal end of the treatment instrument main body 112 in the coagulation / incision treatment instrument 111 of the fifteenth embodiment (see FIGS. 17 and 18A and 18B) is as follows. It has been changed.
【０１３４】すなわち、本実施の形態では、処置部１１
８の両側のジョー１１６，１１７の各ナイフブレード１
２７，１２８の先端部に例えばニクロム線などの切開処
置用熱発生部１３８を設け、この切開処置用熱発生部１
３８によって切開処置を行う構成にしたものである。That is, in the present embodiment, the treatment section 11
8 each knife blade 1 of jaws 116, 117 on both sides
An incision treatment heat generating section 138 such as a nichrome wire is provided at the tip of each of the 27 and 128.
The incision procedure is performed by using the incision procedure 38.
【０１３５】そして、本実施の形態では処置具本体１１
２の処置部１１８の各ジョー１１６，１１７の先端部の
バイポーラ電極１３５で凝固処置を行うとともに、両側
のジョー１１６，１１７の各切開処置用熱発生部１３８
によって切開処置を行うことができる。そのため、本実
施の形態でも第１５の実施の形態の凝固切開処置具１１
１と同様に処置具本体１１２の処置部１１８の各ジョー
１１６，１１７の先端部で凝固処置と、切開処置とを行
うことができるので、繊細な処置ができる効果がある。In this embodiment, the treatment tool main body 11
The coagulation treatment is performed by the bipolar electrode 135 at the distal end of each of the jaws 116 and 117 of the second treatment unit 118, and the incision treatment heat generating units 138 of the jaws 116 and 117 on both sides.
Can perform an incision procedure. Therefore, also in this embodiment, the coagulation / incision treatment tool 11 of the fifteenth embodiment is used.
As in 1, the coagulation treatment and the incision treatment can be performed at the distal ends of the jaws 116 and 117 of the treatment section 118 of the treatment instrument main body 112, so that there is an effect that a delicate treatment can be performed.
【０１３６】また、図２２および図２３（Ａ），（Ｂ）
は本発明の第１９の実施の形態を示すものである。本実
施の形態は第１５の実施の形態（図１７および図１８
（Ａ），（Ｂ）参照）の凝固切開処置具１１１における
処置具本体１１２の先端部の処置部１１８の構成を次の
通り変更したものである。FIGS. 22 and 23 (A) and (B)
Shows a nineteenth embodiment of the present invention. This embodiment corresponds to the fifteenth embodiment (FIGS. 17 and 18).
The configuration of the treatment section 118 at the distal end of the treatment instrument main body 112 in the coagulation / incision treatment instrument 111 in (A) and (B) is changed as follows.
【０１３７】すなわち、本実施の形態の処置部１１８の
一方のジョー１１７には、図２３（Ａ）に示すように他
方のジョー１１６と噛み合う側の把持面１４１の一部に
面状の発熱素子１４２が設けられている。In other words, as shown in FIG. 23A, one jaw 117 of the treatment section 118 of this embodiment has a planar heating element on a part of the gripping surface 141 on the side that meshes with the other jaw 116. 142 is provided.
【０１３８】さらに、このジョー１１７の把持面１４１
の略中心部位にはジョー１１７の中心線方向に延出され
る切開具ガイド溝１４３が形成されている。この切開具
ガイド溝１４３は発熱素子１４２を越えてこの把持面１
４１の先端側から末端側に亘って延設されている。そし
て、この切開具ガイド溝１４３には第１５の実施の形態
のハサミブレード１２７，１２８とは異なる構成の切開
具１４４がこの切開具ガイド溝１４３に沿ってスライド
自在に配設されている。Furthermore, the grip surface 141 of the jaw 117
An incision guide groove 143 extending in the center line direction of the jaw 117 is formed substantially at the center of the jaw 117. The cutting tool guide groove 143 extends over the heating element 142 and
41 extends from the distal end side to the distal end side. An incision tool 144 having a configuration different from that of the scissors blades 127 and 128 of the fifteenth embodiment is slidably provided in the incision tool guide groove 143 along the incision tool guide groove 143.
【０１３９】この切開具１４４には棒状の柄部１４５の
先端部に切開具ガイド溝１４３の外部側に突出されるフ
ック部１４６が連結されている。このフック部１４６に
はニクロムワイヤー１４７が取り付けられている。さら
に、切開具１４４の柄部１４７の末端側には図２２に示
すように切開具ガイド溝１４３の外部側に突出される指
掛け部１４８が形成されている。A hook 146 protruding outside the incision tool guide groove 143 is connected to the tip of the rod-shaped handle 145 to the incision tool 144. A nichrome wire 147 is attached to the hook 146. Further, a finger hook 148 is formed on the distal end side of the handle 147 of the incision tool 144 so as to protrude outside the incision tool guide groove 143 as shown in FIG.
【０１４０】また、ジョー１１６側には、図２３（Ｂ）
に示すように対向するジョー１１７の把持面１４１と噛
み合う把持面１４９の一部に面状の発熱素子１５０が設
けられている。さらに、このジョー１１６の把持面１４
９の略中心部位には切開具１４４のフック部１４６が挿
入されるフック部ガイド溝１５１が形成されている。こ
のフック部ガイド溝１５１は発熱素子１５０の長手方向
の長さを越えて把持面１４９の先端側から末端側に亘っ
て延設されている。そして、このフック部ガイド溝１５
１の深さは一対のジョー１１６，１１７を噛み合わせた
ときに切開具１４４の先端側のフック部１４６がほぼ埋
没する寸法に設定されている。Also, on the side of the jaw 116, FIG.
As shown in FIG. 7, a planar heating element 150 is provided on a part of the gripping surface 149 that meshes with the gripping surface 141 of the opposing jaw 117. Further, the grip surface 14 of the jaw 116
A hook guide groove 151 into which the hook 146 of the incision tool 144 is inserted is formed at a substantially central portion of 9. The hook guide groove 151 extends from the distal end to the distal end of the holding surface 149 beyond the longitudinal length of the heating element 150. And this hook part guide groove 15
The depth of 1 is set to such a size that the hook portion 146 on the distal end side of the cutting device 144 is substantially buried when the pair of jaws 116 and 117 are engaged.
【０１４１】また、一対のジョー１１６，１１７の各把
持面１４１及び１４９と発熱素子１４２及び１５０の表
面には滑り止めのための細かい凹凸１５２が形成されて
いる。Further, fine irregularities 152 for preventing slippage are formed on the surfaces of the gripping surfaces 141 and 149 of the pair of jaws 116 and 117 and the surfaces of the heating elements 142 and 150.
【０１４２】さらに、発熱素子１４２及び１５０にはそ
れぞれ通電用ケーブル１５３及び１５４が接続され、手
指挿入リング１１９，１２０からそれぞれ引き出されて
いる。なお、ニクロムワイヤー１４７にも通電用ケーブ
ル１５５が接続されている。この通電用ケーブル１５５
は手指挿入リング１２０から引き出されている。そし
て、引き出された各通電用ケーブル１５３，１５４，１
５５は図示しない通電用電源に接続されている。Further, power supply cables 153 and 154 are connected to the heat generating elements 142 and 150, respectively, and are drawn out from the finger insertion rings 119 and 120, respectively. Note that the energizing cable 155 is also connected to the nichrome wire 147. This energizing cable 155
Is pulled out of the finger insertion ring 120. Then, each of the drawn out current supply cables 153, 154, 1
Reference numeral 55 is connected to a power supply (not shown).
【０１４３】次に、上記構成の作用について説明する。
本実施の形態では、凝固切開処置具１１１の使用時には
予め切開具１４４の先端側フック部はジョー１１７の切
開具ガイド溝１４３の先端側の終端部位置に移動させた
待機位置で保持される。この状態で、手元側の操作部１
２１の手指挿入リング１１９，１２０に手指を挿入して
処置具本体１１２のジョー１１６，１１７を開閉操作
し、目的部位（例えば血管）を一対のジョー１１６，１
１７間で把持する。この状態で、発熱素子１４２、１５
０に通電し、発熱素子１４２、１５０を発熱させて血管
を凝固する。Next, the operation of the above configuration will be described.
In the present embodiment, when the coagulation / incision treatment instrument 111 is used, the distal hook portion of the incision instrument 144 is held at the standby position in which the jaw 117 has been moved to the end of the incision instrument guide groove 143 on the distal end side in advance. In this state, the operation unit 1
The fingers are inserted into the finger insertion rings 119 and 120 of 21 to open and close the jaws 116 and 117 of the treatment instrument main body 112, and the target site (for example, a blood vessel) is paired with the pair of jaws 116 and 1.
Hold between 17 places. In this state, the heating elements 142, 15
0 is applied, causing the heating elements 142 and 150 to generate heat, thereby coagulating the blood vessel.
【０１４４】続いて、この把持状態を維持したまま、ニ
クロムワイヤー１４７に通電する。そして、ニクロムワ
イヤー１４７が発熱した状態で指掛け部１４８を末端側
に引いてニクロムワイヤー１４７をジョー１１７の先端
側から末端側へ移動させる。これにより、血管の凝固部
分がニクロムワイヤー１４７によって切開される。Subsequently, while maintaining this gripping state, electricity is supplied to the nichrome wire 147. Then, with the nichrome wire 147 generating heat, the finger hook 148 is pulled toward the distal end, and the nichrome wire 147 is moved from the distal end to the distal end of the jaw 117. Thus, the coagulated portion of the blood vessel is incised by the nichrome wire 147.
【０１４５】そこで、上記構成のものにあっては次の効
果を奏する。すなわち、本実施の形態では、目的部位を
把持したまま凝固と切開を連続的に行えるので、切開時
の位置決め操作が不要で、また切開部位を誤る心配も無
い。従って、術者の負担が減り、且つ凝固切開処置の精
度が向上する。Therefore, the above configuration has the following effects. That is, in the present embodiment, since coagulation and incision can be performed continuously while holding the target site, there is no need for a positioning operation at the time of incision, and there is no fear that the incision site is mistaken. Therefore, the burden on the operator is reduced, and the accuracy of the coagulation and incision procedure is improved.
【０１４６】さらに、本発明は上記実施の形態に限定さ
れるものではなく、本発明の要旨を逸脱しない範囲で種
々変形実施できることは勿論である。次に、本出願の他
の特徴的な技術事項を下記の通り付記する。 記 （付記項１） 処置具本体の先端部に開閉可能な一対の
開閉要素を備えた処置部が配設され、前記処置具本体の
基端部に前記一対の開閉要素を開閉操作する手元側の操
作部が配設された医療用処置具において、前記処置部の
前記開閉要素に配置される生体組織を把持する把持部
と、これら把持部に設けられ、通電加熱されて前記把持
部間に把持された生体組織を凝固および、または切開す
る複数の熱発生部とを具備したことを特徴とする医療用
処置具。Furthermore, the present invention is not limited to the above-described embodiment, and it goes without saying that various modifications can be made without departing from the spirit of the present invention. Next, other characteristic technical matters of the present application will be additionally described as follows. (Appendix 1) A treatment section provided with a pair of openable and closable elements at the distal end of the treatment tool main body, and a proximal side for opening and closing the pair of openable and closable elements at a base end of the treatment tool main body. In the medical treatment tool in which the operating unit is disposed, a gripping unit that grips the living tissue disposed on the opening / closing element of the treatment unit, and provided on these gripping units, is electrically heated and interposed between the gripping units. A medical treatment tool comprising: a plurality of heat generating parts for coagulating and / or incising a grasped living tissue.
【０１４７】（付記項２） 付記項１において、把持部
の少なくとも一方に生体組織との接触面積が異なる複数
の熱発生部を設けた。(Additional Item 2) In the additional item 1, at least one of the gripping portions is provided with a plurality of heat generating portions having different contact areas with the living tissue.
【０１４８】（付記項３） 付記項１にさらに熱発生部
に通電する電源装置を備えた医療用処置装置において、
複数の熱発生部にそれぞれ独立して電力を供給する出力
回路を備えた。(Additional Item 3) In the medical treatment apparatus further provided with a power supply device for energizing the heat generating section,
An output circuit for independently supplying power to the plurality of heat generating units was provided.
【０１４９】（付記項４） 付記項１において、少なく
とも一つの熱発生部が前記把持部の開閉方向と同じ方向
に移動させる熱発生部移動手段を備えた。(Additional Item 4) In the additional item 1, a heat generating portion moving means for moving at least one heat generating portion in the same direction as the opening and closing direction of the grip portion is provided.
【０１５０】（付記項５） 付記項４において前記手元
側の操作部に熱発生部の移動を操作する操作手段を設け
た。(Additional Item 5) In the additional item 4, an operation means for operating the movement of the heat generating unit is provided in the operation unit on the hand side.
【０１５１】（付記項１〜５の発明の属する技術分野）
本発明は、体腔内に挿入して例えば血管や臓器等の体
腔内組織を凝固及び、または切開等を行う際に使用され
る外科手術用鉗子等の医療用処置具に関する。(Technical field to which the inventions of Supplementary Items 1 to 5 belong)
TECHNICAL FIELD The present invention relates to a medical treatment tool such as a surgical forceps which is inserted into a body cavity to coagulate and / or incise a body cavity such as a blood vessel or an organ.
【０１５２】（付記項１〜５の従来技術） 患者の体腔
内組織を凝固切開する処置具として、例えば米国特許Ｕ
ＳＰ５，７９２，１３７には半導体からなる発熱素子の
一部がメス状の切刃を備えたものが示されている。(Prior Art in Additional Items 1 to 5) As a treatment tool for coagulating and incising tissue in a body cavity of a patient, for example, US Patent
SP5, 792, and 137 show that a part of a heating element made of a semiconductor has a female cutting blade.
【０１５３】また、米国特許ＵＳＰ５，７１６，３６６
には縫合器における組織接触面の一部が熱エレメントか
らなり、更に切断路内を動作する切断エレメントを備え
たものが示されている。Further, US Pat. No. 5,716,366
Discloses a suture device in which a part of the tissue contacting surface of the suture instrument is composed of a heating element and further includes a cutting element operating in a cutting path.
【０１５４】（付記項１〜５が解決しようとする課題）
米国特許ＵＳＰ５，７９２，１３７の処置具では、発
熱素子自体の一部に鋭利なメス状の切刃が設けられてい
るため、組織を強力に把持した場合には擬固する前に組
織を切断し出血を来す恐れが有る。一方、組織を切断し
ない程度に弱く組織を把持した場合には、血管等を確実
に閉塞できないために、その後の切断操作にてやはり出
血を来す問題が有る。(Problems to be Solved by Additional Items 1 to 5)
In the treatment tool of US Pat. No. 5,792,137, a sharp scalpel-shaped cutting blade is provided in a part of the heating element itself. Therefore, when the tissue is strongly grasped, the tissue is cut before it is falsely fixed. Bleeding may occur. On the other hand, if the tissue is gripped weak enough not to cut the tissue, blood vessels and the like cannot be reliably closed, and there is still a problem that bleeding occurs in the subsequent cutting operation.
【０１５５】また、米国特許ＵＳＰ５，７１６，３６６
の縫合器では、切断エレメントが鋭利な刃で構成されて
おり、刃の切れ味を継続して維持することが出来ないた
め縫合器自体を滅菌して再使用することが出来ず、コス
トが非常に高くなる問題が有る。Further, US Pat. No. 5,716,366
In the suturing device, the cutting element is composed of a sharp blade, and it is not possible to maintain the sharpness of the blade continuously, so that the suturing device itself cannot be sterilized and reused. There is a problem that becomes expensive.
【０１５６】（付記項１〜５の目的） 本発明は上記事
情に着目してなされたもので、その目的は、一対の処置
部材間で把持した血管等の生体組織を確実に凝固するこ
とが出来ると共に、凝固した組織を確実に切開すると同
時に再使用可能で低コストを実現可能な医療用処置具を
提供することに有る。(Objects of Supplementary Items 1 to 5) The present invention has been made in view of the above circumstances, and an object thereof is to coagulate living tissues such as blood vessels grasped between a pair of treatment members without fail. Another object of the present invention is to provide a medical treatment tool which can be used at the same time as incision of coagulated tissue, and which can be re-used at a low cost.
【０１５７】（付記項１の課題を解決するための手段）
処置具本体の先端部に開閉可能な一対の開閉要素を備
えた処置部が配設され、前記処置具本体の基端部に前記
一対の開閉要素を開閉操作する手元側の操作部が配設さ
れた医療用処置具において、前記処置部の前記開閉要素
に配置される生体組織を把持する把持部と、これら把持
部に設けられ、通電加熱されて前記把持部間に把持され
た生体組織を凝固および、または切開する複数の熱発生
部とを具備したことを特徴とする医療用処置具である。(Means for Solving the Problem in Additional Item 1)
A treatment section having a pair of openable and closable elements is disposed at the distal end of the treatment instrument main body, and a hand-side operation section for opening and closing the pair of openable and closable elements is disposed at a base end of the treatment instrument main body. In the medical treatment tool, a grasping portion for grasping a living tissue disposed on the opening / closing element of the treatment section, and a living tissue provided on these grasping portions, energized and heated and grasped between the grasping portions, A medical treatment instrument comprising a plurality of heat generating portions for coagulating and / or incising.
【０１５８】（付記項１の作用） そして、凝固時には
処置部における一部の熱発生部を通電加熱させ、一対の
把持部間に把持された血管等の組織を熱発生部の熱によ
って凝固させる。その後、処置部における別の熱発生部
を通電加熱させ、前記凝固部分を切開するようにしたも
のである。(Function of Supplementary Item 1) At the time of coagulation, a part of the heat generating portion in the treatment section is heated by energization, and the tissue such as a blood vessel gripped between the pair of gripping portions is coagulated by the heat of the heat generating portion. . Thereafter, another heat generating part in the treatment part is energized and heated, so that the coagulated part is incised.
【０１５９】（付記項１〜５の効果） 本発明によれば
処置部の各開閉要素における把持部に複数の発熱部を設
け、一対の把持部間に把持された生体組織を一部の熱発
生部の熱によって凝固すると共に、別の熱発生部熱発生
部の熱によって組織を切開するようにしたので、確実に
熱凝固および切開ができると共に、切開手段の切開能の
劣化を来すことのない医療用処置具を提供することがで
きる。(Effects of Supplementary Items 1 to 5) According to the present invention, a plurality of heat-generating portions are provided in the grip portion of each opening / closing element of the treatment section, and the living tissue gripped between the pair of grip portions is partially heated. In addition to coagulation by the heat of the generating part, the tissue is incised by the heat of another heat generating part heat generating part, so that the heat coagulation and incision can be performed reliably and the incision ability of the incising means is deteriorated. A medical treatment tool without the need.
【０１６０】（付記項６） 処置具本体の先端部に開閉
可能な一対の開閉要素を備えた処置部が配設され、前記
処置具本体の基端部に前記一対の開閉要素を開閉操作す
る手元側の操作部が配設された医療用処置具において、
前記処置部の前記開閉要素に配置される生体組繊を把持
する把持部と、これら把持部の少なくとも一方に設けら
れ、通電加熱されて前記把持部間に把持された生体組織
を凝固するの熱発生部と前記少なくとも一方の把持部に
設けられた間隙と、を具備したことを特徴とする医療用
処置具。(Additional Item 6) A treatment section having a pair of openable and closable elements is provided at the distal end of the treatment instrument main body, and the pair of openable and closable elements are opened and closed at the base end of the treatment instrument main body. In the medical treatment tool in which the operation unit on the hand side is arranged,
A grip for gripping a living tissue placed on the opening / closing element of the treatment section, and a heat provided on at least one of these grips, which is energized and heated to coagulate the living tissue gripped between the grips. A medical treatment tool comprising: a generator; and a gap provided in at least one of the grips.
【０１６１】（付記項７） 処置具本体の先端部に開閉
可能な一対の開閉要素を備えた処置部が配設され、前記
処置具本体の基端部に前記一対の開閉要素を開閉操作す
る手元側の操作部が配設された医療用処置具において、
前記処置部の前記開閉要素に配置される生体組織を把持
する把持部と、これら把持部に設けられ、高周波通電さ
れる電極部と、前記少なくとも一方の把持部に設けられ
た間隙と、を具備したことを特徴とする医療用処置具。(Additional Item 7) A treatment section having a pair of openable and closable elements is provided at the distal end of the treatment instrument main body, and the pair of openable and closable elements are opened and closed at the base end of the treatment instrument main body. In the medical treatment tool in which the operation unit on the hand side is arranged,
A grip portion for gripping a living tissue disposed on the opening / closing element of the treatment section, an electrode portion provided on these grip portions and energized with high frequency, and a gap provided on the at least one grip portion, A medical treatment tool characterized in that:
【０１６２】（付記項６、７の発明の属する技術分野）
本発明は、体腔内に挿入して例えば血管や臓器等の体
腔内組織を凝固及び、または切開等を行う際に使用され
る外科手術用鉗子等の医療用処置具に関する。(Technical field to which the inventions of Supplementary Notes 6 and 7 belong)
TECHNICAL FIELD The present invention relates to a medical treatment tool such as a surgical forceps which is inserted into a body cavity to coagulate and / or incise a body cavity such as a blood vessel or an organ.
【０１６３】（付記項６、７の従来技術） 患者の体腔
内組織を凝固切開する処置具として、例えば米国特許Ｕ
ＳＰ５，７９２，１３７には半導体からなる発熱素子の
一部がメス状の切刃を備えたものが示されている。(Prior Art in Additional Items 6 and 7) As a treatment tool for coagulating and incising tissue in a body cavity of a patient, for example, US Pat.
SP5, 792, and 137 show that a part of a heating element made of a semiconductor has a female cutting blade.
【０１６４】また、米国特許ＵＳＰ５，７１６，３６６
には縫合器における組織接触面の一部が熱エレメントか
らなり、更に切断路内を動作する切断エレメントを備え
たものが示されている。Also, US Pat. No. 5,716,366
Discloses a suture device in which a part of the tissue contacting surface of the suture instrument is composed of a heating element and further includes a cutting element operating in a cutting path.
【０１６５】（付記項６、７が解決しようとする課題）
米国特許ＵＳＰ５，７９２，１３７の処置具では、発
熱素子自体の一部に鋭利なメス状の切刃が設けられてい
るため、組織を強力に把持した場合には凝固する前に組
織を切断し出血を来す恐れが有る。一方、組織を切断し
ない程度に弱く組織を把持した場合には、血管等を確実
に閉塞できないために、その後の切断操作にてやはり出
血を来す問題が有る。(Problems to be Solved by Additional Items 6 and 7)
In the treatment tool of US Pat. No. 5,792,137, since a sharp scalpel-shaped cutting blade is provided in a part of the heating element itself, when the tissue is strongly grasped, the tissue is cut before coagulation. There is a risk of bleeding. On the other hand, if the tissue is gripped weak enough not to cut the tissue, blood vessels and the like cannot be reliably closed, and there is still a problem that bleeding occurs in the subsequent cutting operation.
【０１６６】また、米国特許ＵＳＰ５，７１６，３６６
の縫合器では、切断エレメントが鋭利な刃で構成されて
おり、刃の切れ味を継続して維持することが出来ないた
め縫合器自体を滅菌して再使用することが出来ず、コス
トが非常に高くなる問題が有る。Further, US Pat. No. 5,716,366
In the suturing device, the cutting element is composed of a sharp blade, and it is not possible to maintain the sharpness of the blade continuously, so that the suturing device itself cannot be sterilized and reused. There is a problem that becomes expensive.
【０１６７】さらに両者ともに凝固手段および切開手段
を一つの器械に組み込んでいるために、構成が非常に複
雑になるという問題があった。In addition, since both of them incorporate the coagulation means and the incision means in one instrument, there is a problem that the configuration becomes very complicated.
【０１６８】（付記項６、７の目的） 本発明は上記事
情に着目してなされたもので、その目的は、一対の処置
部材間で把持した血管等の生体組織を確実に凝固するこ
とが出来ると共に、凝固した組織を確実に切開すると同
時に再使用可能で簡単な構成で低コストを実現可能な医
療用処置具を提供することに有る。(Objects of Supplementary Items 6 and 7) The present invention has been made in view of the above circumstances, and an object of the present invention is to coagulate living tissues such as blood vessels grasped between a pair of treatment members without fail. It is an object of the present invention to provide a medical treatment tool that can be used as well as reliably incising coagulated tissue and that can be reused and that can be implemented at a low cost with a simple configuration.
【０１６９】（付記項６、７の課題を解決するための手
段） 処置具本体の先端部に開閉可能な一対の開閉要素
を備えた処置部が配設され、前記処置具本体の基端部に
前記一対の開閉要素を開閉操作する手元側の操作部が配
設された医療用処置具において、前記処置部の前記開閉
要素に配置される生体組織を把持する把持部と、これら
把持部の少なくとも一方に設けられ、通電加熱されて前
記把持部間に把持された生体組織を凝固するの熱発生部
と前記少なくとも一方の把持部に設けられた間隙とを具
備したことを特徴とする医療用処置具である。(Means for Solving the Problems in Supplementary Items 6 and 7) A treatment section provided with a pair of openable and closable elements is provided at a distal end portion of the treatment instrument main body, and a base end portion of the treatment instrument main body is provided. In a medical treatment tool provided with a hand-side operation unit for opening and closing the pair of opening and closing elements, a gripping unit for gripping a living tissue arranged on the opening and closing element of the treatment unit, A medical device, comprising: a heat generating portion provided on at least one of the living tissue to be heated and energized to coagulate a living tissue held between the holding portions; and a gap provided on the at least one holding portion. It is a treatment tool.
【０１７０】（付記項６、７の作用） そして、凝固時
には処置部における一対の熱発生部を通電加熱させ、把
持部間に把持された血管等の組織を熱発生部の熱によっ
て凝固させる。その後、把持部の間隙に別の切開手段を
挿入し、前記凝固部分を切開するようにしたものであ
る。(Operation of Supplementary Items 6 and 7) At the time of coagulation, a pair of heat generating sections in the treatment section are energized and heated, and a tissue such as a blood vessel grasped between the grasping sections is coagulated by the heat of the heat generating section. Thereafter, another incision means is inserted into the gap between the gripping portions to incise the solidified portion.
【０１７１】（付記項６、７の効果） 本発明によれば
処置部の各開閉要素における把持部に発熱部または高周
波通電部を設け、一対の把持部間に把持された生体組織
を熱発生部の熱または高周波通電によって凝固すると共
に、把持部に設けられた間隙に別の切開手術を挿入し、
組織を切開するようにしたので、確実に凝固および切開
ができると共に、簡単な構成でコスト的に有利な医療用
処置具を提供することができる。(Effects of Supplementary Items 6 and 7) According to the present invention, a heating section or a high-frequency power supply section is provided in the grip section of each opening / closing element of the treatment section, and the living tissue gripped between the pair of grip sections generates heat. While coagulated by heat or high-frequency current of the part, another incision surgery is inserted into the gap provided in the grip part,
Since the tissue is incised, it is possible to reliably coagulate and incise, and to provide a medical treatment tool with a simple configuration and advantageous in cost.
【０１７２】（付記項８） 互いに開閉する一対のジョ
ーを有し、前記ジョーの少なくとも一方に凝固部と切開
部を有する凝固切開処置具において、前記切開部が凝固
部に対して操作手段によって凝固部の近くまで選択的に
スライド可能であるとともに、ジョーの開閉にともない
切開可能なことを特徴とする凝固切関処置具。(Supplementary Item 8) In a coagulation / incision treatment instrument having a pair of jaws that open and close with each other, and at least one of the jaws has a coagulation portion and an incision portion, the incision portion is coagulated with respect to the coagulation portion by operating means. A coagulation cutting instrument, which can be selectively slid to near a part and can be cut open when the jaw is opened and closed.
【０１７３】（付記項９） 付記項８において、前記凝
固部にヒーターを有するもの。(Additional Item 9) The device according to Additional Item 8, wherein the solidification portion has a heater.
【０１７４】（付記項１０） 付記項８において、前記
切開部が剪断刃であるもの。(Additional Item 10) In the additional item 8, the incision is a shearing blade.
【０１７５】（付記項１１） 付記項１０において、前
記切開部がさらに上下１組からなるハサミ状剪断刃であ
るもの。(Additional Item 11) In the additional item 10, the incision portion is a pair of upper and lower scissor-shaped shearing blades.
【０１７６】（付記項１２） 付記項８において、前記
凝固部にバイポーラ電極を有するもの。(Additional Item 12) In the additional item 8, the solidification portion has a bipolar electrode.
【０１７７】（付記項１３） 付記項８において、前記
切開部が切開用の電熱線で形成されたもの。(Additional Item 13) In the additional item 8, the incision is formed by a heating wire for incision.
【０１７８】（付記項８〜１３の従来技術） 従来、特
開平１１−１３７５６３のようにジョーの凝固部と切開
部（ハサミ）を備えることで、一つの処置具で凝固切開
可能なものがあった。(Conventional Techniques of Supplementary Items 8 to 13) Conventionally, as disclosed in Japanese Patent Application Laid-Open No. H11-137563, by providing a coagulation portion and an incision portion (scissors) of a jaw, there is a device which can perform coagulation and incision with one treatment tool. Was.
【０１７９】一方、特開平９−１０８２３４、特願平８
−１９９１８９のように凝固ジョー部にナイフブレード
がスライドするものがあった。On the other hand, Japanese Patent Application Laid-Open No. Hei 9-108234 and Japanese Patent Application No.
In some cases, the knife blade slides in the solidified jaw as in -199189.
【０１８０】（付記項８〜１３が解決しようとする課
題） しかし、前者の先行技術は凝固部と切開部の位置
があらかじめ決まっているため、処置具の先端部ではあ
らかじめ決まっている凝固が切開のどちらか一方しか処
置できなかった。しかし、通常、処置具では正確で繊細
な処置を行うため、見やすくて細い先端部を使用するこ
とが望まれており、前記の点は非常に大きな問題点であ
った。(Problems to be Solved by Additional Items 8 to 13) However, in the former prior art, since the positions of the coagulation portion and the incision portion are predetermined, the predetermined coagulation is incised at the distal end portion of the treatment tool. Only one of them could be treated. However, in order to perform an accurate and delicate treatment with a treatment tool, it is usually desired to use a thin and easy-to-view distal end, which is a very serious problem.
【０１８１】一方、後者ではナイフブレードで押しなが
ら切開するため細かい操作ができず、ハサミに比べると
煩雑で操作性が悪いという問題があった。On the other hand, in the latter case, since the incision is made while pushing with the knife blade, fine operations cannot be performed, and there is a problem that the operation is complicated and the operability is poor as compared with scissors.
【０１８２】（付記項８〜１３の目的） 上記問題を考
慮して、本願は繊細な処置が可能な先端部で凝固・切開
のいずれも可能で、かつ切開についてはハサミ状の動作
とすることで、操作性の良い凝固切開処置具を提供する
ことを目的とするものである。(Purpose of Supplementary Items 8 to 13) In consideration of the above problems, the present application is intended to perform both coagulation and incision at the distal end where a delicate treatment can be performed, and to make the incision a scissor-like operation. Accordingly, an object of the present invention is to provide a coagulation / incision treatment tool with good operability.
【０１８３】（付記項１４） 先端部に開閉自在に設け
た一対の開閉手段を備えた処置具であって、一対の開閉
手段の噛み合う面に設けた凝固手段と、同面に設けた切
開手段とを有し、切開手段が凝固手段面の長手方向に移
動可能としたことを特徴とする凝固切開処置具。(Additional Item 14) A treatment tool provided with a pair of opening / closing means provided at the distal end so as to be openable and closable, wherein a coagulating means provided on a surface where the pair of opening / closing means mesh, and a cutting means provided on the same surface Wherein the incision means is movable in the longitudinal direction of the surface of the coagulation means.
【０１８４】（付記項１５） 凝固手段が面状の発熱体
で、切開手段が線状の発熱体である付記項１．の凝固切
開処置具。(Additional Item 15) Additional Item 1. The solidifying means is a planar heating element and the incision means is a linear heating element. Coagulation and incision treatment device.
【０１８５】（付記項１４，１５の従来技術） 特開平
１１−１３７５６３に示されるような鋏の噛み合い部分
に凝固手段と切開手段をシリーズに配置した処置具があ
った。(Prior art of Supplementary items 14 and 15) There is a treatment tool in which a coagulating means and an incising means are arranged in series at a meshing portion of scissors as disclosed in JP-A-11-137563.
【０１８６】（付記項１４，１５が解決しようとする課
題） 凝固手段と切開手段がシリーズに配置されている
ため、凝固操作の後、一度鋏の噛み合いを開いて、凝固
部に切開手段を合わせながら鋏を閉じて切開操作を行わ
なくてはならない。このため操作が煩雑になり、また、
凝固部と切開部の位置ズレが生じるおそれもある。(Problems to be Solved by Additional Items 14 and 15) Since the coagulation means and the incision means are arranged in series, after the coagulation operation, the scissors are once opened to engage the incision means with the coagulation part. The scissors must be closed and the incision performed. This complicates the operation,
There is a possibility that a positional shift between the coagulation part and the incision part may occur.
【０１８７】（付記項１４，１５の目的） 本発明は、
凝固した部位を簡便且つ正確に切開できる凝固切開処置
具を提供することを目的とする。(Object of Supplementary Items 14 and 15)
It is an object of the present invention to provide a coagulation / incision treatment tool that can easily and accurately incise a coagulated site.
【０１８８】（付記項１４，１５の課題を解決するため
の手段と作用） 処置具先端部の開閉手段の噛み合う面
に凝固手段と切開手段を設け、切開手段が凝固手段の長
手方向に移動するようにした。これによって所望の部位
を開閉手段で把持し凝固した後、把持したままの状態で
切開手段を移動させることで凝固部位を確実に切開でき
る。(Means and Action for Solving the Problems of Supplementary Items 14 and 15) Coagulation means and incision means are provided on the surface of the distal end of the treatment tool where the opening and closing means mesh with each other, and the incision means moves in the longitudinal direction of the coagulation means. I did it. Thus, after the desired portion is grasped and solidified by the opening / closing means, the incision means is moved while the grasping is being performed, so that the coagulated portion can be reliably incised.
【０１８９】[0189]
【発明の効果】本発明によれば、生体組織を把持する開
閉可能な把持部に通電されて熱を発生する凝固処置用熱
発生部および切開処置用熱発生部をそれぞれ設けたの
で、把持部で把持した血管等の生体組織を確実に凝固す
ることができ、かつ凝固した生体組織を確実に切開する
ことができるとともに、生体組織を切開する切開能の劣
化を防止して再使用可能で、低コストを実現することが
できる。According to the present invention, the heat generating portion for coagulation treatment and the heat generating portion for incision treatment are provided, each of which is energized and generates heat when the openable and closable gripping portion for gripping the living tissue is provided. The living tissue such as blood vessels grasped with can be reliably coagulated, and the coagulated living tissue can be reliably incised. Low cost can be realized.
【図１】 本発明の第１の実施の形態の医療用処置具の
システム全体の概略構成図。FIG. 1 is a schematic configuration diagram of an entire system of a medical treatment tool according to a first embodiment of the present invention.
【図２】 図１のＩＩ−ＩＩ線断面図。FIG. 2 is a sectional view taken along line II-II of FIG.
【図３】 （Ａ）は本発明の第２の実施の形態を示す要
部の縦断面図、（Ｂ）は本発明の第３の実施の形態を示
す要部の縦断面図、（Ｃ）は本発明の第４の実施の形態
を示す要部の縦断面図、（Ｄ）は本発明の第５の実施の
形態を示す要部の縦断面図。FIG. 3A is a longitudinal sectional view of a main part showing a second embodiment of the present invention, FIG. 3B is a longitudinal sectional view of a main part showing a third embodiment of the present invention, FIG. () Is a longitudinal sectional view of a main part showing a fourth embodiment of the present invention, and (D) is a longitudinal sectional view of a main part showing a fifth embodiment of the present invention.
【図４】 本発明の第６の実施の形態を示す鉗子全体の
平面図。FIG. 4 is a plan view of the entire forceps showing a sixth embodiment of the present invention.
【図５】 （Ａ）は第６の実施の形態の鉗子における切
開処置用熱発生部が凝固処置用熱発生部から離れた待機
位置で保持されている状態を示す図４のＶＡ−ＶＡ線断
面図、（Ｂ）は（Ａ）のＶＢ−ＶＢ線断面図。FIG. 5A is a VA-VA line of FIG. 4 showing a state in which the incision treatment heat generation unit of the forceps of the sixth embodiment is held at a standby position away from the coagulation treatment heat generation unit; FIG. 3B is a cross-sectional view, and FIG.
【図６】 （Ａ）は第６の実施の形態の鉗子における切
開処置用熱発生部が凝固処置用熱発生部に当接された状
態を示す鋏構成部材の要部の縦断面図、（Ｂ）は（Ａ）
のＶＩＢ−ＶＩＢ線断面図。FIG. 6A is a longitudinal cross-sectional view of a main part of a scissor component, showing a state in which a heat generation unit for incision treatment is in contact with a heat generation unit for coagulation treatment in a forceps according to a sixth embodiment; B) is (A)
VIB-VIB line sectional view of FIG.
【図７】 本発明の第７の実施の形態の医療用処置具の
システム全体の概略構成図。FIG. 7 is a schematic configuration diagram of an entire system of a medical treatment tool according to a seventh embodiment of the present invention.
【図８】 第７の実施の形態の医療用処置具のシステム
における電源装置の電気回路を示す概略構成図。FIG. 8 is a schematic configuration diagram showing an electric circuit of a power supply device in a medical treatment instrument system according to a seventh embodiment.
【図９】 本発明の第８の実施の形態の医療用処置具を
示すもので、（Ａ）は医療用処置具全体の側面図、
（Ｂ）は処置部の把持部材の開状態を示す要部の側面
図。FIG. 9 shows a medical treatment tool according to an eighth embodiment of the present invention, wherein (A) is a side view of the entire medical treatment tool,
(B) is a side view of a main part showing an open state of a grasping member of the treatment section.
【図１０】 本発明の第９の実施の形態の医療用処置具
を示す全体の側面図。FIG. 10 is an overall side view showing a medical treatment tool according to a ninth embodiment of the present invention.
【図１１】 （Ａ）は第９の実施の形態の医療用処置具
の開閉要素の湾曲部を示す要部の平面図、（Ｂ）は処置
部の横断面図。FIG. 11A is a plan view of a main part showing a curved portion of an opening / closing element of a medical treatment tool according to a ninth embodiment, and FIG. 11B is a cross-sectional view of the treatment unit.
【図１２】 本発明の第１０の実施の形態の医療用処置
具を示すもので、（Ａ）は医療用処置具の開閉要素の湾
曲部を示す要部の平面図、（Ｂ）は湾曲部の横断面図。FIGS. 12A and 12B show a medical treatment tool according to a tenth embodiment of the present invention, wherein FIG. 12A is a plan view of a main part showing a curved portion of an opening / closing element of the medical treatment instrument, and FIG. FIG.
【図１３】 本発明の第１１の実施の形態の医療用処置
具を示す要部の横断面図。FIG. 13 is a cross-sectional view of a main part showing a medical treatment tool according to an eleventh embodiment of the present invention.
【図１４】 本発明の第１２の実施の形態の医療用処置
具の開閉要素の湾曲部を示す要部の平面図。FIG. 14 is a plan view of a main part showing a curved portion of an opening / closing element of a medical treatment tool according to a twelfth embodiment of the present invention.
【図１５】 本発明の第１３の実施の形態の医療用処置
具を示す要部の横断面図。FIG. 15 is a cross-sectional view of a main part showing a medical treatment tool according to a thirteenth embodiment of the present invention.
【図１６】 本発明の第１４の実施の形態の医療用処置
具のシステム全体の概略構成図。FIG. 16 is a schematic configuration diagram of an entire system of a medical treatment tool according to a fourteenth embodiment of the present invention.
【図１７】 本発明の第１５の実施の形態の医療用処置
具を示す全体の平面図。FIG. 17 is an overall plan view showing a medical treatment tool according to a fifteenth embodiment of the present invention.
【図１８】 （Ａ）は第１５の実施の形態の医療用処置
具のハサミブレードが先端側にスライドされた状態を示
す平面図、（Ｂ）は（Ａ）の１８Ｂ−１８Ｂ線断面図。18A is a plan view showing a state in which the scissors blade of the medical treatment tool according to the fifteenth embodiment is slid to the distal end side, and FIG. 18B is a cross-sectional view taken along line 18B-18B in FIG.
【図１９】 本発明の第１６の実施の形態の医療用処置
具を示す要部の横断面図。FIG. 19 is a cross-sectional view of a main part showing a medical treatment tool according to a sixteenth embodiment of the present invention.
【図２０】 本発明の第１７の実施の形態の医療用処置
具を示す要部の横断面図。FIG. 20 is a cross-sectional view of a main part showing a medical treatment tool according to a seventeenth embodiment of the present invention.
【図２１】 本発明の第１８の実施の形態の凝固切開処
置具を示す全体の平面図。FIG. 21 is an overall plan view showing a coagulation / incision treatment tool according to an eighteenth embodiment of the present invention.
【図２２】 本発明の第１９の実施の形態の凝固切開処
置具を示す全体の平面図。FIG. 22 is an overall plan view showing a coagulation / incision treatment device according to a nineteenth embodiment of the present invention.
【図２３】 （Ａ）は第１９の実施の形態の凝固切開処
置具における一方のジョーの把持面の発熱素子の取付け
状態を示す斜視図、（Ｂ）は凝固切開処置具における他
方のジョーの把持面のガイド溝を示す斜視図。FIG. 23A is a perspective view showing a state in which a heating element is attached to a gripping surface of one jaw of the coagulation / incision treatment tool according to the nineteenth embodiment, and FIG. FIG. 3 is a perspective view showing a guide groove on a grip surface.
２ 鉗子（処置具） ４ 鉗子本体 ８，９ 把持部 １３ 操作部 １４，１５ 凝固処置用熱発生部 １７ 切開処置用熱発生部 2 forceps (treatment instrument) 4 forceps body 8, 9 gripper 13 operation unit 14, 15 heat generator for coagulation treatment 17 heat generator for incision treatment
───────────────────────────────────────────────────── フロントページの続き (72)発明者 飯田 浩司 東京都渋谷区幡ヶ谷２丁目43番２号 オリ ンパス光学工業株式会社内 Ｆターム(参考） 4C060 FF01 KK03 KK04 KK15 KK22 KK23 MM24 MM25 ────────────────────────────────────────────────── ─── Continued on the front page (72) Inventor Koji Iida F-term (reference) 4C060 FF01 KK03 KK04 KK15 KK22 KK23 MM24 MM25 in 2-43-2 Hatagaya, Shibuya-ku, Tokyo
Claims (1)
把持部が配設され、基端部に前記把持部を開閉操作する
手元側の操作部が配設された医療用処置具において、 通電されて熱を発生する凝固処置用熱発生部および切開
処置用熱発生部を前記把持部にそれぞれ設けたことを特
徴とする医療用処置具。1. A medical treatment tool comprising: a distal end portion provided with an openable / closable gripping portion for gripping a living tissue; and a proximal end portion provided with a hand-side operation portion for opening and closing the gripping portion. A medical treatment tool, wherein a heat generation part for coagulation treatment and a heat generation part for incision treatment, which generate heat when energized, are provided on the gripping part, respectively.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP2000003759A JP4315557B2 (en) | 2000-01-12 | 2000-01-12 | Medical treatment tool |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP2000003759A JP4315557B2 (en) | 2000-01-12 | 2000-01-12 | Medical treatment tool |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| JP2001190564A true JP2001190564A (en) | 2001-07-17 |
| JP4315557B2 JP4315557B2 (en) | 2009-08-19 |
Family
ID=18532648
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| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP2000003759A Expired - Fee Related JP4315557B2 (en) | 2000-01-12 | 2000-01-12 | Medical treatment tool |
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| Country | Link |
|---|---|
| JP (1) | JP4315557B2 (en) |
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