JP2007068596A - High frequency treatment device - Google Patents

High frequency treatment device Download PDF

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JP2007068596A
JP2007068596A JP2005255869A JP2005255869A JP2007068596A JP 2007068596 A JP2007068596 A JP 2007068596A JP 2005255869 A JP2005255869 A JP 2005255869A JP 2005255869 A JP2005255869 A JP 2005255869A JP 2007068596 A JP2007068596 A JP 2007068596A
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frequency
cylindrical body
frequency knife
flexible sheath
knife
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JP4692166B2 (en
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Mamoru Machiya
守 町屋
Masayuki Oyatsu
昌行 大谷津
Atsushi Kaneki
敦 金木
Hidefumi Akaha
秀文 赤羽
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Fujinon Corp
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Fujinon Corp
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Priority to EP06016842.4A priority patent/EP1752108B1/en
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Abstract

<P>PROBLEM TO BE SOLVED: To provide a high frequency treatment device capable of regulating the projection amount of a high frequency knife composed of a rod-shaped electrode, securing stability of the high frequency knife when performing treatment such as incision, and supplying and discharging fluid while the treatment is performed. <P>SOLUTION: When the high frequency knife 13 is inserted into the through-hole 21 of a hard cylindrical body 20, the outer surfaces 15b of blade parts 15 provided to four parts are practically brought into slidable contact with the inner surface of the through-hole 21, and the high frequency knife 13 is aligned to the axis of the hard cylindrical body 20 and is stably held so as not to deflect indiscriminately even if external force acts on the distal end part of the rod-shaped electrode 14. A stopper surface 15c can advance to a position at which the stopper surface 15c abuts on the distal end face of the hard cylindrical body 20 when the high frequency knife 13 is inserted to the through-hole 21 of the hard cylindrical body 20, and can not enter anymore. Roughly sectorial communication paths 23 at four parts are formed between the blade parts 15 adjacent to each other. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

本発明は、内視鏡の処置具挿通チャンネル内に挿通されて、病変粘膜部の切開等の処置を行うために用いられる高周波処置具に関するものである。   The present invention relates to a high-frequency treatment instrument that is inserted into a treatment instrument insertion channel of an endoscope and used to perform treatment such as incision of a lesion mucosa.

内視鏡検査により食道，胃，十二指腸，大腸等の体腔内壁における粘膜部分に腫瘍等といった病変部が発見された場合、高周波処置具を用いてこの病変粘膜の部位を切除する処置が行われる。この場合、処置の安全性を確保するために、内視鏡による観察下において処置を行うが、このために用いられる高周波処置具は内視鏡の処置具挿通チャンネルに挿通させて処置すべき部位に導かれる。ここで、体腔内壁において、粘膜層の下部には粘膜下層が存在しており、筋層はこの粘膜下層により覆われている。そして、高周波処置具を用いて病変粘膜層を切開して除去する処置は、病変部に取り残しがないようにしなければならず、また筋層には何等のダメージを与えないようにしなければならない。   When a lesion, such as a tumor, is found in the mucosa in the inner wall of a body cavity such as the esophagus, stomach, duodenum, and large intestine by endoscopy, a treatment is performed to remove the lesion mucosa using a high-frequency treatment tool. In this case, in order to ensure the safety of the treatment, the treatment is performed under observation by an endoscope, and the high-frequency treatment tool used for this purpose is inserted into the treatment tool insertion channel of the endoscope to be treated. Led to. Here, in the inner wall of the body cavity, a submucosal layer exists below the mucosal layer, and the muscle layer is covered with the submucosal layer. Then, the treatment for incising and removing the lesioned mucosal layer using the high-frequency treatment instrument must ensure that the lesion is not left behind, and that the muscle layer is not damaged.

粘膜層の切開に用いられる高周波処置具は、棒状部を有する電極部材からなる高周波ナイフを可撓性シース内に装着することにより構成され、可撓性シースの基端部には操作手段が連結されており、この操作手段による遠隔操作で高周波ナイフを可撓性シースの先端から出没するように制御できる構成としている。そして、可撓性シースから突出させた高周波ナイフに通電することによって、粘膜を焼灼して切開することができる。   A high-frequency treatment instrument used for incision of a mucosal layer is configured by mounting a high-frequency knife made of an electrode member having a rod-shaped portion in a flexible sheath, and an operating means is connected to the proximal end portion of the flexible sheath The high-frequency knife can be controlled so as to protrude from the distal end of the flexible sheath by remote control using the operation means. And by energizing the high frequency knife protruded from the flexible sheath, the mucosa can be cauterized and incised.

高周波ナイフを構成する電極部材の構造としては、棒状の電極部材を真っ直ぐ延在させた針状ナイフと、棒状の電極部材の先端に大径電極部を連設するかまたは先端を概略Ｌ字状に曲折することによりフック部を形成したフックナイフとがある。針状ナイフは粘膜を突き刺すように操作されるものであり、また電極部材を水平移動させたり、スイング動作させたりするように作動させて、粘膜等を切開することになる。一方、フックナイフは粘膜等の組織を先端のフック部で引っ掛けて、内視鏡の挿入部側に引き込むように動作させることにより切開が行われる。   The structure of the electrode member constituting the high-frequency knife includes a needle-like knife in which a rod-like electrode member extends straightly, and a large-diameter electrode portion connected to the tip of the rod-like electrode member, or the tip is roughly L-shaped. There is a hook knife in which a hook portion is formed by bending it. The needle knife is operated so as to pierce the mucous membrane, and the electrode member is operated so as to move horizontally or swing, thereby incising the mucous membrane or the like. On the other hand, the hook knife is incised by hooking a tissue such as a mucous membrane with a hook part at the tip and pulling it to the insertion part side of the endoscope.

既に説明したように、高周波ナイフの通電時に、この高周波ナイフが筋層に対しては確実に非接触状態に保たれなければならない。針状ナイフを用いる場合には、この針状ナイフが可撓性シースの前方に位置しており、しかも粘膜に刺入されることになるから、処置を行う際に針状ナイフの先端が内視鏡の観察視野により捉えることができないことがある。従って、針状ナイフの可撓性シースからの突出長さ及びその方向が正確に制御されない限り、処置の安全性が確保できないことになる。   As already described, when the high-frequency knife is energized, it must be ensured that the high-frequency knife is not in contact with the muscle layer. When using a needle knife, the needle knife is positioned in front of the flexible sheath and is inserted into the mucous membrane. It may not be captured by the observation field of view of the endoscope. Therefore, unless the length of protrusion and the direction of the needle knife from the flexible sheath are accurately controlled, the safety of the treatment cannot be ensured.

これに対して、フックナイフは、内視鏡の観察下でフックの部位を粘膜等に引っ掛けるようになし、次いでこのフックナイフに高周波電流を流しながら処置具挿通チャンネル内に引き込むように動作させて粘膜を切開する。従って、フックナイフを操作している間は、このフックナイフの先端部を常に内視鏡の観察下で行うことができるので、通電状態にしたときに筋層に接触しないように操作することができる。   On the other hand, the hook knife is operated so that the hook part is hooked on the mucous membrane or the like under the observation of the endoscope, and then the hook knife is operated to be pulled into the treatment instrument insertion channel while flowing a high-frequency current. Open the mucous membrane. Therefore, while operating the hook knife, the tip of the hook knife can always be performed under observation by an endoscope, so that it can be operated so as not to contact the muscle layer when energized. it can.

ただし、フックナイフを用いる場合において、粘膜等の組織を引っ掛ける操作を円滑に行うために、フックナイフの先端部分の安定性が得られなければならない。そこで、作動時におけるフックナイフの安定を図る機構を備える構成としたものが特許文献１に提案されている。この特許文献１の高周波処置具は、可撓性シースの先端に電気絶縁部材を装着し、この電気絶縁部材に透孔を設けて、フックナイフを構成する電極部材における棒状の部位をこの透孔に挿通させるようになし、また先端のフック部は電気絶縁部材の先端外面に接離可能となっている。通電時には電極部材を可撓性シースから所定の長さ突出させるが、透孔の孔径と電極部材の外径との間の径差を最小限となし、しかも電極部材の突出長を規制することによって、電極部材を安定的に保持する構成としている。   However, when a hook knife is used, the stability of the tip portion of the hook knife must be obtained in order to smoothly perform the operation of hooking the tissue such as the mucous membrane. Therefore, Patent Document 1 proposes a configuration including a mechanism for stabilizing the hook knife during operation. In the high-frequency treatment instrument of Patent Document 1, an electrical insulating member is attached to the distal end of a flexible sheath, a through hole is provided in the electrical insulating member, and a rod-shaped portion of an electrode member constituting a hook knife is formed in the through hole. The hook portion at the tip can be brought into contact with and separated from the outer surface of the tip of the electrical insulating member. When energized, the electrode member is projected from the flexible sheath by a predetermined length, but the difference in diameter between the hole diameter of the through hole and the outer diameter of the electrode member is minimized, and the protruding length of the electrode member is restricted. Thus, the electrode member is stably held.

また、前述した電極部材を用いて病変部を切開する処置を施している間には出血が生じる場合があり、このために病変部が確認できなくなるおそれがある。そこで、電気絶縁部材に電極部材を挿通させる透孔とは別の開口を形成するか、または透孔を十字形状乃至三角形状とすることによって、電極部材の棒状部が進入できない、つまり電極部材で閉塞されない液体流出部を形成している。可撓性シースの基端部にシリンジを接続して、このシリンジに生理食塩水を充填し、このシリンジを操作することによって、出血部に向けて液体流出部から生理食塩水を噴出させて洗浄することができる。
特開２００４−３１３５３７号公報 In addition, bleeding may occur during the treatment for incising the lesion using the electrode member described above, and there is a possibility that the lesion cannot be confirmed. Therefore, by forming an opening different from the through-hole through which the electrode member is inserted into the electrical insulating member, or by forming the through-hole into a cross shape or a triangle shape, the rod-shaped portion of the electrode member cannot enter, that is, with the electrode member. The liquid outflow part which is not obstruct | occluded is formed. Connect a syringe to the base end of the flexible sheath, fill the syringe with physiological saline, and operate the syringe to eject the physiological saline from the liquid outflow part toward the bleeding part and wash it. can do.
JP 2004-313537 A

ところで、特許文献１の方式では、電極部材を構成するフックナイフにより粘膜や粘膜下層を引っ掛けて処置具挿通チャンネル内に向けて引き込むように操作し、次いでフックナイフに通電することにより、組織を焼灼して切断し、再び処置具挿通チャンネルからフックナイフを導出させるという操作を繰り返し行うことから、その操作が複雑かつ面倒になり、操作の効率性が得られない。従って、病変粘膜を除去する処置に長い時間が必要となり、その分だけ被検者の苦痛及び術者の負担が増大するおそれがある。また、フック部は常に外部に露出した状態となっており、例えば処置具挿通チャンネルに挿入する操作を行っている間に、電極部材に誤って通電されると、チャンネル内壁を損傷させる等といった問題点もある。   By the way, in the method of Patent Document 1, the tissue is cauterized by operating the hook knife constituting the electrode member so that the mucous membrane or the submucosa is pulled into the treatment instrument insertion channel and then energizing the hook knife. Then, the operation of cutting and re-deriving the hook knife from the treatment instrument insertion channel is repeated, so that the operation becomes complicated and troublesome, and the efficiency of the operation cannot be obtained. Therefore, it takes a long time for the treatment to remove the lesioned mucous membrane, and there is a risk that the pain of the subject and the burden on the operator will increase accordingly. In addition, the hook portion is always exposed to the outside. For example, if the electrode member is accidentally energized while performing an operation of inserting into the treatment instrument insertion channel, the inner wall of the channel may be damaged. There is also a point.

さらに、可撓性シースの先端に設けた電気絶縁部材には、電極部材が進入できない流体流出部を形成するために、複数の透孔を形成するか、または複雑な形状の透孔を形成している。ここで、電気絶縁部材は耐熱性の良好なもので形成する必要があり、このためにセラミック材で形成するのが望ましいが、セラミック材により前述した形状の透孔を形成するのは困難であるという問題点もある。   Furthermore, in order to form a fluid outflow part into which the electrode member cannot enter, a plurality of through holes or a complicatedly shaped through hole is formed in the electrically insulating member provided at the distal end of the flexible sheath. ing. Here, it is necessary to form the electrically insulating member with a material having good heat resistance. For this reason, it is desirable to form the electrically insulating member with a ceramic material. However, it is difficult to form the above-described through-hole with the ceramic material. There is also a problem.

本発明は以上の点に鑑みてなされたものであって、その目的とするところは、針状乃至棒状ナイフを用いた簡単な構成の高周波処置具によって、安全かつ効率的な処置を可能にすることにある。   The present invention has been made in view of the above points, and an object of the present invention is to enable safe and efficient treatment with a high-frequency treatment instrument having a simple configuration using a needle-like or bar-like knife. There is.

前述の目的を達成するために、本発明は、内視鏡の処置具挿通チャンネル内に挿通可能な可撓性シースと、この可撓性シースの内部に設けられ、可撓性コードの先端に高周波電流が印加される高周波ナイフを設けた処置具本体とから構成した高周波処置具であって、前記可撓性シース内には、電気絶縁性を有し、軸線方向に貫通する貫通孔を設けた硬質筒体が、その先端面をこの可撓性シースの先端面とほぼ一致させるようにして挿入・固定されており、前記高周波ナイフは、前記硬質筒体内に遊嵌状に挿通可能な棒状電極と、この棒状電極の基端側に円周方向に所定間隔毎に設けられ、外面が前記硬質筒体の内周面とほぼ接触する大きさの複数の羽根部と、この羽根部の基端部に形成され、前記硬質筒体の孔径より外周側に突出するストッパ面とを備え、前記ストッパ面が前記硬質筒体の端面に当接したときに、相隣接する羽根部間に前記可撓性シースの内外を連通させる連通路が形成される構成としたことをその特徴とするものである。   In order to achieve the above-described object, the present invention provides a flexible sheath that can be inserted into a treatment instrument insertion channel of an endoscope, and a flexible sheath provided inside the flexible sheath. A high-frequency treatment instrument comprising a treatment instrument body provided with a high-frequency knife to which a high-frequency current is applied, wherein the flexible sheath is provided with a through hole that has electrical insulation and penetrates in the axial direction. The rigid cylinder is inserted and fixed so that the distal end surface thereof substantially coincides with the distal end surface of the flexible sheath, and the high-frequency knife is a rod-like shape that can be freely inserted into the rigid barrel. An electrode, a plurality of blade portions provided at predetermined intervals in the circumferential direction on the proximal end side of the rod-shaped electrode, and having an outer surface substantially in contact with the inner peripheral surface of the hard cylindrical body, and a base of the blade portion A stop formed at the end and protruding outward from the hole diameter of the hard cylinder. When the stopper surface comes into contact with the end surface of the hard cylindrical body, a communication passage is formed between the adjacent blade portions so as to communicate the inside and outside of the flexible sheath. It is the feature.

以上のように、硬質筒体は円筒形状の極めて単純な形状のものからなり、この硬質筒体は、例えばセラミック材で容易に形成することができる。なお、この硬質筒体は必ずしもセラミック材で形成する必要はなく、耐熱性の良好な合成樹脂等で形成しても良い。一方、高周波ナイフは導電部材で構成されるものであり、加工が容易な金属材で棒状電極と羽根部及びストッパ面とを一体的に形成される。   As described above, the hard cylinder has a very simple cylindrical shape, and the hard cylinder can be easily formed of, for example, a ceramic material. The hard cylinder is not necessarily formed of a ceramic material, and may be formed of a synthetic resin having good heat resistance. On the other hand, the high-frequency knife is composed of a conductive member, and the rod-shaped electrode, the blade portion, and the stopper surface are integrally formed of a metal material that is easy to process.

可撓性コードを可撓性シース内で押し引き操作することによって、高周波ナイフを可撓性シースの内部に収納する状態と、この可撓性シースの先端から突出する状態とに変位させることができる。高周波ナイフが所定量突出すると、ストッパ面が硬質筒体の基端面と当接するから、この位置が高周波ナイフの最突出位置となり、切開等の処置はこの状態で実行される。従って、この最突出位置での高周波ナイフの棒状電極の突出長さを処置部位に応じて最適となるように設定する。例えば、粘膜剥離の処置を施す場合には、この棒状電極の突出長さは、粘膜の厚み寸法より長く、粘膜と粘膜下層の合計の厚み寸法より短いものとする。これによって、処置を行う際に安全性が確保され、かつ病変粘膜の取り残しをなくすことができる。   By pushing and pulling the flexible cord within the flexible sheath, the high-frequency knife can be displaced into a state where it is housed inside the flexible sheath and a state where it protrudes from the distal end of the flexible sheath. it can. When the high-frequency knife protrudes by a predetermined amount, the stopper surface comes into contact with the base end surface of the hard cylindrical body, so this position becomes the most protruding position of the high-frequency knife, and treatment such as incision is performed in this state. Therefore, the protruding length of the bar-shaped electrode of the high-frequency knife at the most protruding position is set to be optimal according to the treatment site. For example, when a mucosal detachment treatment is performed, the protruding length of the rod-like electrode is longer than the thickness of the mucosa and shorter than the total thickness of the mucosa and the submucosa. As a result, safety can be ensured when performing the treatment, and the lesion mucosa can be left behind.

高周波ナイフは、その棒状電極の基端側に複数の羽根部が設けられており、これら各羽根部の外面が硬質筒体の内面と実質的に当接するので、高周波ナイフは、可撓性シースに対して調芯されて振れ等が生じることなく、安定的に保持される。従って、この点からは羽根部の数を多くし、また幅寸法をできるだけ広くする方が望ましい。しかしながら、相隣接する羽根部間の間隔は可撓性シース内部をその外部に連通させる連通路となり、この連通路から体内に生理食塩水等の液体を供給したり、体内から吸引したりする。この連通路の通路面積を広くするには、逆に、羽根部の数を少なくし、かつその幅を狭くしなければならない。羽根部は最低限２箇所設けるが、好ましくは１２０°間隔で３箇所または９０°間隔で４箇所設けるようにする。また、羽根部の幅寸法は、切開等の処置を行う際に高周波ナイフに作用する外力に基づいて、その安定性が損なわれないもので、最小限の幅とする。また、高周波ナイフの安定性からは、各羽根部の外面が硬質筒体の貫通孔の内壁と摺接させるようにするのが望ましい。しかしながら、高周波ナイフを硬質筒体に容易に挿脱できるようにするために、その間に多少の隙間が生じていても良い。   The high-frequency knife is provided with a plurality of blade portions on the base end side of the rod-like electrode, and the outer surface of each blade portion substantially contacts the inner surface of the hard cylindrical body. Therefore, it can be held stably without causing vibration or the like. Therefore, from this point, it is desirable to increase the number of blade portions and make the width dimension as wide as possible. However, the interval between adjacent blade portions serves as a communication path that allows the inside of the flexible sheath to communicate with the outside, and a liquid such as physiological saline is supplied into the body from the communication path or sucked from the body. In order to increase the area of the communication path, on the contrary, the number of blade portions must be reduced and the width thereof must be reduced. At least two blade portions are provided, but preferably three at 120 ° intervals or four at 90 ° intervals. Further, the width of the blade portion is set to a minimum width because the stability is not impaired based on an external force acting on the high-frequency knife when performing a treatment such as incision. Further, from the viewpoint of the stability of the high-frequency knife, it is desirable that the outer surface of each blade portion is in sliding contact with the inner wall of the through hole of the hard cylindrical body. However, in order to allow the high-frequency knife to be easily inserted into and removed from the hard cylindrical body, a slight gap may be formed therebetween.

高周波ナイフが可撓性シース内に引き込まれているときには、それが硬質筒体より基端側に位置していることもある。この場合において、棒状電極の先端を円滑かつ確実に硬質筒体の貫通孔に導くためには、硬質筒体の基端側の位置に呼び込み部材を装着すれば良い。この呼び込み部材は、リング状の部材であって、その基端側端面が先端側に向けて傾斜するテーパ面とする。そして、この呼び込み部材は高周波ナイフを挿通できる内径を有するものとする。なお、この呼び込み部材は外部に露出しないことから、必ずしも電気絶縁部材で形成する必要はなく、プラスチック材や金属材等により容易に形成できる。   When the high-frequency knife is drawn into the flexible sheath, it may be located proximal to the rigid cylinder. In this case, in order to smoothly and surely guide the tip of the rod-like electrode to the through hole of the hard cylinder, a calling member may be attached at a position on the base end side of the hard cylinder. This attracting member is a ring-shaped member, and has a base end side end surface that is a tapered surface inclined toward the front end side. And this calling member shall have an internal diameter which can penetrate a high frequency knife. In addition, since this calling member is not exposed to the outside, it is not always necessary to form it with an electrically insulating member, and it can be easily formed with a plastic material, a metal material, or the like.

可撓性シースの先端面と硬質筒体の先端面とはほぼ同一平面となっており、これによって体腔内壁への当接面となる円環状の端壁が形成される。そして、処置具本体を体腔内壁に当接させたときに、その面圧をできるだけ小さくするために、この端壁は広い面積を確保する必要があり、この点からは硬質筒体の孔径をできるだけ小さくする方が望ましい。一方、硬質筒体の貫通孔内に、相隣接する羽根部間の部位に連通路が形成されており、この連通路の通路面積は大きい方が望ましい。従って、これらを勘案して、硬質筒体の内径を適宜設定することになる。   The distal end surface of the flexible sheath and the distal end surface of the hard cylindrical body are substantially flush with each other, thereby forming an annular end wall that serves as a contact surface against the inner wall of the body cavity. When the treatment instrument body is brought into contact with the inner wall of the body cavity, the end wall needs to have a large area in order to reduce the surface pressure as much as possible. From this point, the hole diameter of the hard cylindrical body should be as small as possible. It is desirable to make it smaller. On the other hand, a communicating path is formed in a portion between adjacent blade portions in the through-hole of the hard cylinder, and it is desirable that the communicating path has a larger passage area. Therefore, taking these into consideration, the inner diameter of the rigid cylinder is appropriately set.

以上の構成を採用することによって、簡単な構成の硬質筒体を可撓性シースに装着することにより、棒状の電極からなる高周波ナイフの突出量を規制でき、かつ切開等の処置を行う際に、高周波ナイフの安定性が確保されて安全かつ迅速な処置を可能にし、しかも処置を行っている間に流体の給排を行える等の効果を奏する。   By adopting the above configuration, it is possible to regulate the protruding amount of the high-frequency knife made of a rod-shaped electrode by attaching a hard tube with a simple configuration to the flexible sheath, and when performing treatment such as incision The stability of the high-frequency knife is ensured, and a safe and quick treatment is possible, and the fluid can be supplied and discharged during the treatment.

以下、図面に基づいて本発明の実施の形態について説明する。まず、図１に高周波処置具の全体構成を示し、図２にその要部拡大断面を示す。   Hereinafter, embodiments of the present invention will be described with reference to the drawings. First, FIG. 1 shows the overall configuration of the high-frequency treatment instrument, and FIG.

まず、図１及び図２において、１は高周波処置具であって、この高周波処置具１は長尺の可撓性シース２を有し、この可撓性シース２の基端部には接続パイプ３が連結されており、さらにこの接続パイプ３の他端には操作手段４が連結されている。操作手段４は接続パイプ３に連結した本体軸４ａと、この本体軸４ａに嵌合されて、本体軸４ａの軸線方向に摺動可能に設けたスライダ４ｂとから構成されている。スライダ４ｂには処置具本体１０を構成する可撓性コード１１の基端部が連結して設けられている。   First, in FIGS. 1 and 2, reference numeral 1 denotes a high-frequency treatment instrument. The high-frequency treatment instrument 1 has a long flexible sheath 2, and a connection pipe is connected to a proximal end portion of the flexible sheath 2. 3 is connected, and the operation means 4 is connected to the other end of the connection pipe 3. The operating means 4 includes a main body shaft 4a connected to the connection pipe 3, and a slider 4b fitted to the main body shaft 4a and provided to be slidable in the axial direction of the main body shaft 4a. A base end portion of a flexible cord 11 constituting the treatment instrument main body 10 is connected to the slider 4b.

可撓性コード１１は、外周部が絶縁被覆された可撓性部材からなる導電線部１１ａを有し、この導電線部１１ａの基端部はスライダ４ｂへの連結部から所定長さ突出して設けられており、その基端部に接点部１２が設けられ、この接点部１２は図示しない高周波電源装置に着脱可能に接続されている。図３に示したように、導電線部１１ａの先端には中空ワイヤ１１ｂが連結されている。この中空ワイヤ１１ｂは曲げ方向に可撓性を有する導電部材からなり、その外周面は絶縁部材で被覆されている。従って、導電線部１１ａと中空ワイヤ１１ｂとは電気的に導通されており、かつその外面は絶縁されている。   The flexible cord 11 has a conductive wire portion 11a made of a flexible member whose outer peripheral portion is covered with insulation, and a base end portion of the conductive wire portion 11a protrudes a predetermined length from a connecting portion to the slider 4b. The contact part 12 is provided in the base end part, and this contact part 12 is detachably connected to the high frequency power supply device which is not shown in figure. As shown in FIG. 3, a hollow wire 11b is connected to the tip of the conductive wire portion 11a. The hollow wire 11b is made of a conductive member having flexibility in the bending direction, and its outer peripheral surface is covered with an insulating member. Therefore, the conductive wire portion 11a and the hollow wire 11b are electrically connected, and the outer surface thereof is insulated.

導電線部１１ａと中空ワイヤ１１ｂとからなる可撓性コード１１は、スライダ４ｂへの取付部から接続パイプ３の内部を通り、可撓性シース２内に延在されている。また、可撓性シース２の先端部には高周波ナイフ１３が出没可能に設けられている。高周波ナイフ１３は、好ましくは先端が球形となった所定長さを有する硬質の針状乃至棒状の導電部材からなり、つまりフック部を有さない棒状電極１４と、この棒状電極１４の外周部に設けた羽根部１５とから構成される。そして、棒状電極１４の基端部は可撓性コード１１の中空ワイヤ１１ｂに挿入されており、これによって高周波ナイフ１３は中空ワイヤ１１ｂ及び導電線部１１ａを介して接点部１２と電気的に接続されている。この高周波ナイフ１３は、可撓性シース２から所定の長さ分が外部に露出しており、通電時にはこの部分が体内組織に作用して、この組織を焼灼して切開等の処置が行われる。   A flexible cord 11 composed of a conductive wire portion 11a and a hollow wire 11b extends from the attachment portion to the slider 4b through the inside of the connection pipe 3 and into the flexible sheath 2. In addition, a high-frequency knife 13 is provided at the distal end of the flexible sheath 2 so that it can appear and disappear. The high-frequency knife 13 is preferably made of a hard needle-like or rod-like conductive member having a predetermined length with a spherical tip, that is, a rod-like electrode 14 having no hook portion and an outer peripheral portion of the rod-like electrode 14. It is comprised from the provided blade | wing part 15. FIG. And the base end part of the rod-shaped electrode 14 is inserted in the hollow wire 11b of the flexible cord 11, whereby the high frequency knife 13 is electrically connected to the contact part 12 via the hollow wire 11b and the conductive wire part 11a. Has been. The high-frequency knife 13 is exposed to a predetermined length from the flexible sheath 2, and when energized, this portion acts on the body tissue and cauterizes the tissue to perform treatment such as incision. .

図３及び図４に示したように、可撓性シース２の先端部には、硬質筒体２０が挿入・固定されている。この硬質筒体２０は、電気絶縁性及び耐熱性の良好な部材、好ましくはセラミック材で構成される。硬質筒体２０の外面には螺旋状の突条２０ａが設けられており、従ってこの硬質筒体２０は可撓性シース２に螺挿されるようになっている。しかも、硬質筒体２０の外面と可撓性シース２の内面との間には接着剤が介装され、この接着と外面の突条２０ａとの作用によって、硬質筒体２０は可撓性シース２の先端側に向けて脱落することがないように固定されている。   As shown in FIGS. 3 and 4, a hard cylinder 20 is inserted and fixed at the distal end of the flexible sheath 2. The hard cylinder 20 is made of a member having good electrical insulation and heat resistance, preferably a ceramic material. A spiral protrusion 20 a is provided on the outer surface of the hard cylindrical body 20, so that the hard cylindrical body 20 is screwed into the flexible sheath 2. In addition, an adhesive is interposed between the outer surface of the hard cylindrical body 20 and the inner surface of the flexible sheath 2, and the rigid cylindrical body 20 is made to be flexible sheath by the action of the adhesion and the protrusions 20 a on the outer surface. It fixes so that it may not drop out toward the front end side of 2.

硬質筒体２０には高周波ナイフ１３を出没させるための貫通孔２１が軸線方向に貫通するように穿設されている。また、硬質筒体２０の両端面は、その軸線と直交する面となっている。この硬質筒体２０は、その先端面が可撓性シース２の先端面とほぼ同一の平面となる位置まで挿入されており、従ってこれら可撓性シース２と硬質筒体２０との先端面により可撓性シース２における先端面は円環状端壁Ｐを有する構成となる。硬質筒体２０の貫通孔２１の孔径は高周波ナイフ１３の外径より大きく、従って高周波ナイフ１３の棒状電極１４はこの貫通孔２１に対して遊嵌状態で挿通されることになる。   A through hole 21 for allowing the high-frequency knife 13 to appear and disappear is formed in the hard cylinder 20 so as to penetrate in the axial direction. Moreover, the both end surfaces of the hard cylinder 20 are surfaces orthogonal to the axis. The hard cylindrical body 20 is inserted to a position where the distal end surface thereof is substantially the same plane as the distal end surface of the flexible sheath 2, and accordingly, the distal end surfaces of the flexible sheath 2 and the hard cylindrical body 20 are inserted. The distal end surface of the flexible sheath 2 is configured to have an annular end wall P. The hole diameter of the through hole 21 of the hard cylindrical body 20 is larger than the outer diameter of the high frequency knife 13, so that the rod-like electrode 14 of the high frequency knife 13 is inserted into the through hole 21 in a loosely fitted state.

硬質筒体２０の基端部には、高周波ナイフ１３を貫通孔２１より基端側の位置から確実に貫通孔２１内に呼び込むための呼び込み部材２２が装着されている。この呼び込み部材２２はステンレス等から構成されるリング状の部材であり、その基端面は、外周側から内周側に向かうに応じて先端側に向けて傾斜するテーパ面２２ａとなっており、これによって高周波ナイフ１３が貫通孔２１内に呼び込まれることになる。つまり、高周波ナイフ１３は、常時においては、図５に示したように、硬質筒体２０より基端側に引き込まれており、この状態から図６に示したように、テーパ面２２ａに沿って貫通孔２１の方向に向けてガイドされて、棒状電極１４の先端がこの貫通孔２１内に導かれることになる。そして、テーパ面２２ａの最も小径となった部位は、高周波ナイフ１３を通過させる大きさとなっている。また、呼び込み部材２２の最小径部から先端側には落とし込み部２２ｂが形成されており、この落とし込み部２２ｂにより形成される大径となった円環状の端面が硬質筒体２０の基端面に当接している。従って、硬質筒体２０の端面における内側の部位を露出させている。その結果、高周波ナイフ１３の羽根部１５に形成したストッパ面１５ｃはこの硬質筒体２０の基端面に確実に当接することになる。   At the base end portion of the hard cylindrical body 20, a calling member 22 is attached for surely calling the high-frequency knife 13 into the through hole 21 from a position closer to the base end than the through hole 21. This attracting member 22 is a ring-shaped member made of stainless steel or the like, and its base end surface is a tapered surface 22a that is inclined toward the distal end side from the outer peripheral side toward the inner peripheral side. As a result, the high-frequency knife 13 is called into the through hole 21. That is, the high-frequency knife 13 is normally drawn to the proximal end side from the hard cylindrical body 20 as shown in FIG. 5, and from this state, as shown in FIG. 6, along the tapered surface 22a. Guided in the direction of the through hole 21, the tip of the rod-shaped electrode 14 is guided into the through hole 21. The portion of the tapered surface 22a having the smallest diameter is sized to allow the high-frequency knife 13 to pass therethrough. In addition, a drop portion 22b is formed on the distal end side from the minimum diameter portion of the calling member 22, and the annular end surface having a large diameter formed by the drop portion 22b contacts the base end surface of the hard cylindrical body 20. It touches. Accordingly, the inner part of the end surface of the hard cylinder 20 is exposed. As a result, the stopper surface 15 c formed on the blade portion 15 of the high-frequency knife 13 is surely brought into contact with the base end surface of the hard cylindrical body 20.

高周波ナイフ１３の棒状電極１４は可撓性コード１１における導電線部１１ａ及び中空ワイヤ１１ｂを介して接点部１２からの電源供給により高周波電流を流すことができるものである。棒状電極１４は、図７及び図８に示したように、所定の長さを有する直杆状の導電部材からなり、その先端は球面形状となっている。また、羽根部１５は棒状電極１４の基端側の位置に相互に９０°の角度位置に４個設けられ、これら羽根部１５は外方に向けて放射状に突出するようになっている。羽根部１５の先端面１５ａは、この羽根部１５を硬質筒体２０の貫通孔２１に導くための傾斜面となっており、また羽根部１５の外面１５ｂは、円周方向においては、貫通孔２１の曲率とほぼ一致する円弧形状となり、所定の長さを有している。従って、高周波ナイフ１３を硬質筒体２０の貫通孔２１内に挿入すると、４箇所設けた羽根部１５の外面１５ｂが貫通孔２１の内面と実質的に摺接することになる。その結果、高周波ナイフ１３は硬質筒体２０の軸線に対して調芯され、かつこの棒状電極１４の先端部分に外力が作用しても、みだりに振れないように安定的に保持される。   The rod-shaped electrode 14 of the high-frequency knife 13 can flow a high-frequency current by supplying power from the contact portion 12 through the conductive wire portion 11 a and the hollow wire 11 b in the flexible cord 11. As shown in FIGS. 7 and 8, the rod-shaped electrode 14 is formed of a straight rod-shaped conductive member having a predetermined length, and its tip has a spherical shape. In addition, four blade portions 15 are provided at 90 ° relative to each other at the base end side position of the rod-shaped electrode 14, and these blade portions 15 project radially outward. The tip surface 15a of the blade portion 15 is an inclined surface for guiding the blade portion 15 to the through hole 21 of the rigid cylindrical body 20, and the outer surface 15b of the blade portion 15 is a through hole in the circumferential direction. It has an arc shape that substantially matches the curvature of 21 and has a predetermined length. Therefore, when the high-frequency knife 13 is inserted into the through hole 21 of the hard cylindrical body 20, the outer surface 15 b of the four blade portions 15 is substantially in sliding contact with the inner surface of the through hole 21. As a result, the high-frequency knife 13 is aligned with respect to the axis of the hard cylindrical body 20, and even if an external force is applied to the tip portion of the rod-like electrode 14, it is stably held so that it does not shake excessively.

さらに、羽根部１５の基端側の部位は丈高となる段差が形成されており、この段差壁がストッパ面１５ｃとなる。このストッパ面１５ｃは、高周波ナイフ１３を硬質筒体２０の貫通孔２１に挿入したときに、このストッパ面１５ｃが硬質筒体２０の基端面と当接する位置までは進入可能であって、それ以上は突出できないようになっている。つまり、ストッパ面１５ｃは高周波ナイフ１３における棒状電極１４の可撓性シース２からの最突出長さを規定するものである。そして、高周波処置具１は体腔内壁における病変粘膜部を剥離するための処置として用いられるものであり、高周波ナイフ１３の棒状電極１４における可撓性シース２の先端を構成する円環状端壁Ｐからの最突出長さは、体腔内壁における粘膜の厚み寸法より長く、粘膜と粘膜下層との合計の厚みより短くなるように設定されている。   Further, a height difference is formed at the base end side portion of the blade portion 15, and this step wall serves as the stopper surface 15c. The stopper surface 15c can enter up to a position where the stopper surface 15c comes into contact with the base end surface of the hard cylinder 20 when the high-frequency knife 13 is inserted into the through hole 21 of the hard cylinder 20, and more. Can not protrude. In other words, the stopper surface 15 c defines the maximum protruding length of the rod-shaped electrode 14 from the flexible sheath 2 in the high-frequency knife 13. The high-frequency treatment instrument 1 is used as a treatment for peeling the lesion mucosa on the inner wall of the body cavity. From the annular end wall P constituting the tip of the flexible sheath 2 in the rod-shaped electrode 14 of the high-frequency knife 13 Is set to be longer than the thickness of the mucosa on the inner wall of the body cavity and shorter than the total thickness of the mucosa and the submucosa.

高周波ナイフ１３が最突出位置となったときに、図４から明らかなように、高周波ナイフ１３の軸の部分の外径と外周と硬質筒体２０の貫通孔２１の孔径との径差に基づいて、相隣接する羽根部１５，１５間の部位に４箇所の概略扇形の連通路２３が形成される。そして、高周波処置具１の基端側の部位に設けた接続パイプ３は接続口３ａを有するものであり、この接続口３ａには生理食塩水等の液体を供給するシリンジや、吸引配管等が接続されるようになっている。従って、接続口３ａに生理食塩水を充填したシリンジを接続しておき、高周波ナイフ１３が硬質筒体２０から最突出状態に、このシリンジを操作すると、連通路２３を介して棒状電極１４の周囲から生理食塩水が噴射されることになる。また、吸引配管が接続されると、連通路２３からの吸引が可能になる。また、高周波ナイフ１３を硬質筒体２０より基端側に配置した状態でも液体の供給及び吸引が可能となる。   When the high-frequency knife 13 is in the most projecting position, as is apparent from FIG. 4, it is based on the difference in diameter between the outer diameter and the outer periphery of the shaft portion of the high-frequency knife 13 and the hole diameter of the through hole 21 of the hard cylinder 20. Thus, four generally fan-shaped communication passages 23 are formed at portions between adjacent blade portions 15 and 15. And the connection pipe 3 provided in the site | part of the base end side of the high frequency treatment instrument 1 has the connection port 3a, The syringe which supplies liquids, such as a physiological saline, suction piping, etc. to this connection port 3a. Connected. Accordingly, when a syringe filled with physiological saline is connected to the connection port 3a and the high-frequency knife 13 is operated in the most protruding state from the hard cylinder 20, the periphery of the rod-shaped electrode 14 via the communication path 23 is operated. From here, physiological saline is injected. Further, when the suction pipe is connected, suction from the communication path 23 becomes possible. Further, liquid can be supplied and sucked even in a state where the high-frequency knife 13 is disposed on the base end side from the hard cylinder 20.

以上の構成を有する高周波処置具１は、図９に示したように、観察部Ｗを有する内視鏡挿入部Ｓに設けた処置具挿通チャンネルＣを介して体腔内に挿入され、例えば食道，胃，十二指腸，大腸等の体腔内壁に病変粘膜が存在する際には、この病変粘膜部を剥離して除去する処置を施すために用いられる。そこで、この病変粘膜を切除する処置の一例について説明する。この処置は、例えば、内視鏡検査の結果、粘膜に病変部が存在していることが確認されたときに行われることになる。   As shown in FIG. 9, the high-frequency treatment instrument 1 having the above configuration is inserted into a body cavity via a treatment instrument insertion channel C provided in an endoscope insertion part S having an observation part W. When a lesioned mucous membrane is present on the inner wall of a body cavity such as the stomach, duodenum, or large intestine, it is used to perform a treatment for peeling and removing the lesioned mucosa. Therefore, an example of a procedure for excising the lesioned mucosa will be described. This treatment is performed, for example, when it is confirmed as a result of endoscopy that a lesion is present in the mucous membrane.

まず、図１０に示したように、切除すべき病変部Ｄが存在している粘膜に、その病変粘膜領域Ｄを囲むようにマーキングする。このマーキングする領域は、病変部を完全に取り除くことができ、しかも健康な粘膜部分に対してはできるだけダメージを与えない範囲とする。マーキングは、例えば、病変粘膜領域Ｄの周囲の所要個所に焼灼スポットＢを施すことにより行うことができ、この焼灼スポットＢを形成するために、高周波処置具１を用いることができる。即ち、内視鏡挿入部Ｓの先端を病変粘膜領域Ｄの外縁部に対して所定の距離を隔てて対面させ、この状態で処置具挿通チャンネルＣに高周波処置具１を挿入して、その先端部を粘膜表面に当接させる。このときには、高周波ナイフ１３は図５に示したように硬質筒体２０より基端側の位置まで引き込んだ状態とする。この高周波処置具１の先端を構成する円環状端壁Ｐからは何等の部材も突出しておらず、この円環状端壁Ｐは粘膜表面に対して面接触する。   First, as shown in FIG. 10, the mucous membrane where the lesioned part D to be excised is marked so as to surround the lesioned mucosal region D. The area to be marked is a range in which the lesion can be completely removed and the healthy mucous membrane part is not damaged as much as possible. The marking can be performed, for example, by applying an ablation spot B to a required portion around the lesioned mucosa region D, and the high-frequency treatment instrument 1 can be used to form the ablation spot B. That is, the distal end of the endoscope insertion portion S faces the outer edge of the lesioned mucosa region D with a predetermined distance, and the high-frequency treatment instrument 1 is inserted into the treatment instrument insertion channel C in this state, and the distal end The part is brought into contact with the mucosal surface. At this time, the high-frequency knife 13 is in a state of being pulled to the position on the base end side from the hard cylinder 20 as shown in FIG. No member protrudes from the annular end wall P constituting the distal end of the high-frequency treatment instrument 1, and the annular end wall P is in surface contact with the mucosal surface.

この状態で、高周波処置具１の操作手段４を操作して、高周波ナイフ１３を突出させるが、高周波ナイフ１３における棒状電極１４の先端部は呼び込み部材２２のテーパ面２２ａにガイドされて、図６の状態を経て、確実に硬質筒体２０の貫通孔２１内に導かれる。この状態で、高周波ナイフ１３に高周波電流を印加すると、粘膜における高周波ナイフ１３が接触している部位が焼灼されて、マーキングが施されることになる。   In this state, the operating means 4 of the high-frequency treatment instrument 1 is operated to project the high-frequency knife 13, but the tip of the rod-like electrode 14 in the high-frequency knife 13 is guided by the tapered surface 22 a of the calling member 22, and FIG. Through this state, it is surely guided into the through hole 21 of the hard cylinder 20. When a high-frequency current is applied to the high-frequency knife 13 in this state, the portion of the mucosa that is in contact with the high-frequency knife 13 is cauterized and marking is performed.

ここで、このマーキングを行う際には、高周波ナイフ１３は粘膜層を貫通させる必要はなく、内視鏡挿入部Ｓによる観察部Ｗから得られる画像により認識できる程度にまで粘膜表面が焼灼させれば良い。つまり、高周波ナイフ１３が粘膜表面と接触しておればマーキングが形成される。勿論、操作手段４をフルストロークさせて、図４に示したように、高周波ナイフ１３が可撓性シース２から最も突出した位置になっていても、この高周波ナイフ１３が筋層と接触するおそれはない。なお、マーキングは他の処置具を用いて行うことができ、また粘膜における切除すべき領域が観察部Ｗにより認識できるようになっておれば、前述のように焼灼という手法を採らなくても良い。   Here, when performing this marking, the high-frequency knife 13 does not need to penetrate the mucosal layer, and the mucosal surface is cauterized to such an extent that it can be recognized from the image obtained from the observation part W by the endoscope insertion part S. It ’s fine. That is, if the high frequency knife 13 is in contact with the mucosal surface, a marking is formed. Of course, even if the operating means 4 is fully stroked and the high-frequency knife 13 is at the most protruding position from the flexible sheath 2 as shown in FIG. 4, the high-frequency knife 13 is in contact with the muscle layer. It is not. Note that marking can be performed using other treatment tools, and if the region to be excised in the mucous membrane can be recognized by the observation unit W, the technique of cauterization as described above may not be used. .

次に、図１１に示したように、病変粘膜領域Ｄの内部に生理食塩水の局注を行う。このためには、処置具挿通チャンネルから一度高周波処置具１を引き出し、これに代えて可撓性チューブの先端に注射針Ｎを設けた局注手段を処置具挿通チャンネルＣ内に挿通させる。ここで、筋層ＬＢと粘膜層ＬＵとの間には粘膜下層ＬＭが存在しており、注射針Ｎは粘膜層ＬＵを貫通して粘膜下層ＬＭにまで刺入して生理食塩水を注入する。その結果、粘膜下層ＬＭが膨出・***する。このように、粘膜下層ＬＭを膨隆させるのは、粘膜層ＬＵを筋層ＬＢから離間させて、円滑かつ安全に処置を行うためである。   Next, as shown in FIG. 11, saline is locally injected into the lesioned mucosa region D. For this purpose, the high-frequency treatment instrument 1 is once pulled out from the treatment instrument insertion channel, and instead of this, a local injection means provided with an injection needle N at the tip of the flexible tube is inserted into the treatment instrument insertion channel C. Here, the submucosa LM exists between the muscle layer LB and the mucosa layer LU, and the injection needle N penetrates the mucosa layer LU and penetrates into the submucosa LM to inject physiological saline. . As a result, the submucosa LM bulges and rises. The reason why the submucosal layer LM is thus bulged is to separate the mucosal layer LU from the muscle layer LB and perform a smooth and safe treatment.

粘膜下層ＬＭを十分膨隆させた後に、局注手段を処置具挿通チャンネルＣから抜き出して、高周波処置具１を再び挿通させる。そして、高周波処置具１の可撓性シース２及び硬質筒体２０の先端面２ａ，２０ａで形成される円環状端壁Ｐを病変粘膜領域Ｄの外縁部のいずれかに当接させる。ここで、円環状端壁Ｐを粘膜層ＬＭに正対させるようになし、かつこの円環状端壁Ｐが粘膜表面に軽く押し当てて、極力押圧力を作用させないようにする。   After sufficiently swelling the submucosa LM, the local injection means is extracted from the treatment instrument insertion channel C, and the high-frequency treatment instrument 1 is inserted again. Then, the annular end wall P formed by the flexible sheath 2 of the high-frequency treatment instrument 1 and the distal end surfaces 2a and 20a of the hard cylindrical body 20 is brought into contact with one of the outer edge portions of the lesion mucosa region D. Here, the annular end wall P is made to face the mucosal layer LM, and the annular end wall P is lightly pressed against the mucosal surface so that the pressing force is not applied as much as possible.

高周波処置具１の先端を粘膜表面に押し当てたときに、粘膜層ＬＭが押圧変形されないようにするために、円環状端壁Ｐの面積が広くする必要がある。ただし、高周波ナイフ１３は、その強度の点等からある程度の太さを持たせなければならず、この高周波ナイフ１３を硬質筒体２０の貫通孔２１に円滑に挿通させるためには、この貫通孔２１の孔径を最小限にしても限度となる。また、円環状端壁Ｐの内側には連通路２３が形成されており、この連通路２３の通路面積を十分確保した上で、ストッパ壁２２と硬質筒体２０の後端面２０ｂとの当接面積を安定的に確保するには、円環状端壁Ｐの面積は全体の８０％程度とするのが望ましい。これにより、高周波処置具１を粘膜層ＬＭに押し当てたときに、この粘膜表面は最小限度しか押圧変形されることがなく、筋層ＬＢまでの距離を十分確保できる。   In order to prevent the mucous membrane layer LM from being pressed and deformed when the distal end of the high-frequency treatment instrument 1 is pressed against the mucosal surface, it is necessary to increase the area of the annular end wall P. However, the high-frequency knife 13 must have a certain thickness due to its strength and the like. In order to smoothly insert the high-frequency knife 13 through the through-hole 21 of the hard cylindrical body 20, the through-hole Even if the hole diameter of 21 is minimized, there is a limit. In addition, a communication passage 23 is formed inside the annular end wall P, and the contact area between the stopper wall 22 and the rear end surface 20b of the hard cylindrical body 20 is secured after a sufficient passage area of the communication passage 23 is secured. In order to secure the area stably, the area of the annular end wall P is preferably about 80% of the whole. As a result, when the high-frequency treatment instrument 1 is pressed against the mucosal layer LM, the mucosal surface is only pressed and deformed to a minimum, and a sufficient distance to the muscle layer LB can be secured.

そして、操作手段４を操作して、高周波ナイフ１３を可撓性シース２の内部に設けた硬質筒体２０の貫通孔２１から突出させる。ここで、硬質筒体２０の基端面は、その軸線と直交する面となっているが、この硬質筒体２０の基端部には呼び込み部材２２が配置されているので、高周波ナイフ１３における棒状電極１４の先端部は確実にこの貫通孔２１内に導かれる。そして、この間に高周波ナイフ１３に高周波電流を流す。高周波ナイフ１３が最突出状態になると、図１２に示したように、高周波ナイフ１３は粘膜層ＬＵを貫通して、粘膜下層ＬＭにまで導かれ、もって病変粘膜領域Ｄの切開が開始される。この状態で、観察部Ｗによる観察下で、内視鏡挿入部Ｓを動かしたり、またそのアングル部を湾曲操作したりする操作によって、焼灼スポットＢに沿うように切開していく。   Then, the operating means 4 is operated to cause the high-frequency knife 13 to protrude from the through-hole 21 of the hard cylindrical body 20 provided inside the flexible sheath 2. Here, the proximal end surface of the hard cylindrical body 20 is a surface orthogonal to the axis thereof, but since the calling member 22 is disposed at the proximal end portion of the hard cylindrical body 20, the rod-like shape in the high-frequency knife 13 is used. The tip of the electrode 14 is reliably guided into the through hole 21. During this time, a high-frequency current is passed through the high-frequency knife 13. When the high-frequency knife 13 is in the most protruding state, as shown in FIG. 12, the high-frequency knife 13 passes through the mucosal layer LU and is guided to the submucosal layer LM, so that the incision of the lesioned mucosa region D is started. In this state, an incision is made along the cauterization spot B by moving the endoscope insertion portion S or bending the angle portion under observation by the observation portion W.

ここで、高周波ナイフ１３における羽根部１５のストッパ面１５ｃが硬質筒体２０の基端面と当接する位置までしか高周波ナイフ１３が突出せず、可撓性シース２からの最突出長さは粘膜層ＬＵの厚み寸法より大きく、粘膜層ＬＵ及び粘膜下層ＬＭとの合計の厚み寸法より短いものとして設定されている。また、局注により粘膜下層ＬＭを膨隆させていることから、円環状端壁Ｐが粘膜表面を極端に押圧変形させていない限り、粘膜層ＬＵを確実に切開することができ、しかも筋層ＬＢに対して何等のダメージを与えることなく、粘膜層ＬＵの切開が行われる。しかも、高周波ナイフ１３には４箇所の羽根部１５が設けられており、この羽根部１５の外面１５ｂは硬質筒体２０の貫通孔２１の内周壁とほぼ摺接するようになっているので、高周波ナイフ１３の可撓性シース２の先端からの突出部分は安定的に保持されており、切開時における粘膜層ＬＵから作用する反力等によって高周波ナイフ１３が振れたり、ふらついたりする等の動きが生じることがなく、可撓性シース２の中心軸線とほぼ一致する状態で安定的に保持される。このために、内視鏡挿入部Ｓの観察部Ｗによって高周波ナイフ１３の先端の位置が確認されなくても、処置を安全に行うことができる。その結果、図１３に示したように、病変粘膜領域Ｄの外周では粘膜層ＬＵが切開されて、粘膜下層ＬＭが露出した状態となる。なお、図１３においては、病変粘膜領域Ｄの全領域を一度に切開するようにしているが、病変粘膜領域Ｄが広い場合には、一部分を切開して、後述する剥離を行うようになし、この操作を複数回繰り返すようにするのが望ましい。   Here, the high-frequency knife 13 protrudes only to a position where the stopper surface 15c of the blade portion 15 of the high-frequency knife 13 comes into contact with the proximal end surface of the hard cylindrical body 20, and the maximum protruding length from the flexible sheath 2 is the mucosal layer. It is set to be larger than the thickness dimension of the LU and shorter than the total thickness dimension of the mucosa layer LU and the submucosa LM. Further, since the submucosal layer LM is bulged by local injection, the mucosal layer LU can be reliably incised as long as the annular end wall P does not extremely deform the mucosal surface, and the muscle layer LB Incision of the mucosal layer LU is performed without causing any damage. In addition, the high-frequency knife 13 is provided with four blade portions 15, and the outer surface 15 b of the blade portion 15 is substantially in sliding contact with the inner peripheral wall of the through-hole 21 of the hard cylindrical body 20. The protruding portion of the knife 13 from the distal end of the flexible sheath 2 is stably held, and the high-frequency knife 13 moves or fluctuates due to the reaction force acting from the mucosal layer LU at the time of incision. It does not occur and is stably held in a state substantially coincident with the central axis of the flexible sheath 2. For this reason, even if the position of the tip of the high frequency knife 13 is not confirmed by the observation part W of the endoscope insertion part S, the treatment can be performed safely. As a result, as shown in FIG. 13, the mucous membrane layer LU is incised on the outer periphery of the lesioned mucosa region D, and the submucosa LM is exposed. In FIG. 13, the entire lesioned mucosa region D is incised at a time, but when the lesioned mucosa region D is wide, a part of the lesioned mucosal region D is incised to perform exfoliation to be described later. It is desirable to repeat this operation a plurality of times.

病変粘膜領域Ｄの全周を切開しても、それだけでは粘膜層ＬＵを除去することはできない。即ち、粘膜層ＬＵと筋層ＬＢとの間は線維性の粘膜下層ＬＭで繋がっているので、この線維を切断することにより筋層ＬＢから剥離する必要がある。この粘膜剥離も高周波処置具１を用いて行うことができる。即ち、図１４に示したように、高周波処置具１の可撓性シース２から突出する高周波ナイフ１３を切開により生じた粘膜下層ＬＭの露出部分に進入させて、この高周波ナイフ１３を水平移動させたり、スイング動作させたりすることにより、粘膜下層ＬＭを切断するように動作させる。この動作は、内視鏡挿入部Ｓの先端部分を湾曲させる等の操作によって、容易に行うことができる。その結果、迅速かつ効率的に粘膜剥離が行われることになる。   Even if the entire circumference of the lesioned mucosa region D is incised, the mucosal layer LU cannot be removed by itself. That is, since the mucosal layer LU and the muscle layer LB are connected by the fibrous submucosa LM, it is necessary to separate the fiber from the muscle layer LB by cutting the fibers. This mucosal detachment can also be performed using the high-frequency treatment instrument 1. That is, as shown in FIG. 14, the high-frequency knife 13 protruding from the flexible sheath 2 of the high-frequency treatment instrument 1 is made to enter the exposed portion of the submucosa LM generated by the incision, and the high-frequency knife 13 is moved horizontally. Or by swinging, the submucosa LM is cut. This operation can be easily performed by an operation such as bending the distal end portion of the endoscope insertion portion S. As a result, mucosal detachment is performed quickly and efficiently.

前述した粘膜剥離を行っている間に、その処置箇所等が出血する可能性がある。このために、接続パイプ３の接続口３ａから可撓性シース２内に高圧で生理食塩水を供給する。硬質筒体２０の先端には、高周波ナイフ１３の相隣接する羽根部１５，１５間において、硬質筒体２０の貫通孔２１の内側に、接続口３ａに通じる連通路２３が開口している。従って、この連通路２３から出血個所に向けて生理食塩水を噴射することによって、出血部分を迅速に洗い流すことができる。この洗浄操作は、粘膜剥離の処置を継続している間に、つまり高周波ナイフ１３を可撓性シース２の先端から突出させたままで行える。   During the mucosal detachment described above, the treatment site or the like may bleed. For this purpose, physiological saline is supplied from the connection port 3a of the connection pipe 3 into the flexible sheath 2 at a high pressure. At the tip of the hard cylinder 20, a communication path 23 that opens to the connection port 3 a is opened inside the through hole 21 of the hard cylinder 20 between the adjacent blade portions 15, 15 of the high-frequency knife 13. Therefore, the bleeding part can be quickly washed away by injecting physiological saline from the communication path 23 toward the bleeding part. This washing operation can be performed while the mucosal peeling treatment is continued, that is, with the high-frequency knife 13 protruding from the distal end of the flexible sheath 2.

粘膜剥離を行う際に、生理食塩水を補給する必要がある。既に局注して、生理食塩水により病変粘膜領域Ｄを膨隆させているが、切開を行う間に供給した生理食塩水が流出したり、体内に吸収されたりして、膨隆部が収縮してしまうことがある。そこで、粘膜下層ＬＭを膨隆状態に維持させるために、生理食塩水を補給しながら粘膜剥離を行う。この生理食塩水の補給も連通路２３から行うことができる。このときには、高周波ナイフ１３を硬質筒体２０より基端側に引き込み、円環状端壁Ｐを粘膜下層ＬＭに当接させた状態とするようになし、接続パイプ３の接続口３ａから可撓性シース２を介して生理食塩水を注入すると、より効率的に生理食塩水を供給でき、粘膜下層ＬＭに向けて直接注入することができる。その結果、剥離しようとする粘膜下層ＬＭを膨隆状態に維持することができる。   When performing mucosal detachment, it is necessary to replenish physiological saline. Already topical, the lesioned mucosa region D is bulged with physiological saline, but the saline supplied during the incision flows out or is absorbed into the body, and the bulging part contracts. It may end up. Therefore, in order to maintain the submucosa LM in the bulging state, the mucous membrane is peeled off while supplying physiological saline. This replenishment of physiological saline can also be performed from the communication path 23. At this time, the high-frequency knife 13 is pulled toward the proximal end side from the hard cylindrical body 20 so that the annular end wall P is brought into contact with the submucosa LM, and flexibility is provided from the connection port 3a of the connection pipe 3. When physiological saline is injected through the sheath 2, the physiological saline can be supplied more efficiently and can be directly injected toward the submucosa LM. As a result, the submucosa LM to be peeled can be maintained in a bulging state.

このように、生理食塩水の追加補給は、処置具挿通チャンネルＣに挿通されている高周波処置具１を取り出して、注入手段を交換的に挿通させるという煩わしい操作を行う必要がなく、粘膜剥離処置が中断されることはない。従って、この点でも、処置の効率化，迅速化が図られる。しかも、円環状端壁Ｐから何等の部材も突出していないことから、溝２１の先端を粘膜下層ＬＭに当接させることができ、必要な箇所に向けて的確に生理食塩水を供給することができる。これによって、粘膜下層ＬＭを確実に膨隆状態に維持して、高周波ナイフ１３による粘膜剥離を安全かつ迅速に行うことができる。   As described above, the additional supply of the physiological saline does not require a troublesome operation of taking out the high-frequency treatment instrument 1 inserted through the treatment instrument insertion channel C and inserting the injection means in an exchangeable manner. Will not be interrupted. Therefore, also in this point, the efficiency and speed of treatment can be improved. In addition, since no member protrudes from the annular end wall P, the tip of the groove 21 can be brought into contact with the submucosa LM, and physiological saline can be accurately supplied toward a necessary location. it can. As a result, the submucosa LM can be reliably maintained in the bulging state, and the mucosal detachment by the high frequency knife 13 can be performed safely and promptly.

また、必要に応じて粘膜層ＬＵに負圧吸引力を作用させることもできる。吸引は粘膜剥離の処置を実行している間も、またこの処置前または処置後にも行われることがある。いずれにしても、接続口３ａに吸引配管を接続しておき、フットスイッチ等により吸引制御を行うことができる。従って、吸引が必要な場合には、フットスイッチを操作して、吸引配管に負圧を発生させるように作動すれば、連通路２３を介して体内からの吸引を行うことができる。   Further, if necessary, a negative pressure suction force can be applied to the mucosal layer LU. Aspiration may occur during the mucosal detachment procedure, and also before or after the procedure. In any case, suction piping can be connected to the connection port 3a and suction control can be performed by a foot switch or the like. Therefore, when suction is necessary, if the foot switch is operated so as to generate a negative pressure in the suction pipe, suction from the body can be performed via the communication path 23.

本発明の実施の一形態を示す高周波処置具の全体構成図である。1 is an overall configuration diagram of a high-frequency treatment tool showing an embodiment of the present invention. 図１の要部拡大断面図である。It is a principal part expanded sectional view of FIG. 高周波処置具の先端部分の拡大断面図である。It is an expanded sectional view of the tip part of a high frequency treatment instrument. 高周波処置具の正面図である。It is a front view of a high frequency treatment tool. 高周波ナイフを呼び込み部材より基端側に引き込んだ状態を示す図３と同様の断面図である。It is sectional drawing similar to FIG. 3 which shows the state which pulled in the high frequency knife to the base end side from the calling member. 高周波ナイフの棒状電極が呼び込み部材にガイドされている状態を示す図３と同様の断面図である。It is sectional drawing similar to FIG. 3 which shows the state by which the rod-shaped electrode of the high frequency knife is guided by the calling member. 高周波ナイフの平面図である。It is a top view of a high frequency knife. 高周波ナイフの正面図である。It is a front view of a high frequency knife. 本発明の実施の一形態を示す高周波処置具を内視鏡の処置具挿通チャンネルから導出させた状態を示す外観図である。1 is an external view showing a state in which a high-frequency treatment instrument showing an embodiment of the present invention is derived from a treatment instrument insertion channel of an endoscope. 病変粘膜領域にマーキングを施した状態を示す平面図である。It is a top view which shows the state which marked the lesioned-mucosa area | region. 病変粘膜領域に対して局注を行っている状態を示す組織の断面図である。It is sectional drawing of the structure | tissue which shows the state which is performing local injection with respect to a lesioned mucosa area | region. 高周波処置具を用いて切開を行っている状態を示す組織の断面図である。It is sectional drawing of the structure | tissue which shows the state which is incising using a high frequency treatment tool. 高周波処置具による切開が終了した状態を示す病変粘膜領域を含む平面図である。It is a top view including the lesioned mucosa area | region which shows the state which the incision by a high frequency treatment tool was complete | finished. 粘膜剥離を行っている状態を示す組織の断面図である。It is sectional drawing of the structure | tissue which shows the state which is performing mucous membrane peeling.

符号の説明Explanation of symbols

１ 高周波処置具 ２ 可撓性シース
３ 接続パイプ ４ 操作手段
１０ 処置具本体 １１ 可撓性コード
１３ 高周波ナイフ １４ 棒状電極
１５ 羽根部 １５ａ 先端面
１５ｂ 外面 １５ｃ ストッパ面
２０ 硬質筒体 ２１ 貫通孔
２２ 呼び込み部材 ２２ａ テーパ面
２２ｂ 落とし込み部 ２３ 連通路
Ｐ 円環状端壁

DESCRIPTION OF SYMBOLS 1 High frequency treatment tool 2 Flexible sheath 3 Connection pipe 4 Operation means 10 Treatment tool main body 11 Flexible cord 13 High frequency knife 14 Rod electrode 15 Blade | wing part 15a Tip surface 15b Outer surface 15c Stopper surface 20 Hard cylinder 21 Through-hole 22 Call-in Member 22a Tapered surface 22b Drop part 23 Communication path P Annular end wall

Claims (3)

内視鏡の処置具挿通チャンネル内に挿通可能な可撓性シースと、この可撓性シースの内部に設けられ、可撓性コードの先端に高周波電流が印加される高周波ナイフを設けた処置具本体とから構成した高周波処置具において、
前記可撓性シース内には、電気絶縁性を有し、軸線方向に貫通する貫通孔を設けた硬質筒体が、その先端面をこの可撓性シースの先端面とほぼ一致させるようにして挿入・固定されており、
前記高周波ナイフは、前記硬質筒体内に遊嵌状に挿通可能な棒状電極と、この棒状電極の基端側に円周方向に所定間隔毎に設けられ、外面が前記硬質筒体の内周面とほぼ接触する大きさの複数の羽根部と、この羽根部の基端部に形成され、前記硬質筒体の孔径より外周側に突出するストッパ面とを備え、
前記ストッパ面が前記硬質筒体の端面に当接したときに、相隣接する羽根部間に前記可撓性シースの内外を連通させる連通路が形成される
構成としたことを特徴とする高周波処置具。 A treatment tool provided with a flexible sheath that can be inserted into a treatment tool insertion channel of an endoscope, and a high-frequency knife that is provided inside the flexible sheath and that applies a high-frequency current to the distal end of the flexible cord In the high-frequency treatment instrument composed of the main body,
In the flexible sheath, a hard cylindrical body having electrical insulation and provided with a through hole penetrating in the axial direction is arranged so that the distal end surface thereof substantially coincides with the distal end surface of the flexible sheath. Inserted and fixed,
The high-frequency knife is provided with a rod-shaped electrode that can be freely inserted into the hard cylindrical body, and provided at predetermined intervals in the circumferential direction on the proximal end side of the rod-shaped electrode, and an outer surface is an inner circumferential surface of the hard cylindrical body. A plurality of blade portions that are substantially in contact with each other, and a stopper surface that is formed at the base end portion of the blade portions and protrudes to the outer peripheral side from the hole diameter of the hard cylindrical body,
A high-frequency treatment characterized in that when the stopper surface comes into contact with the end surface of the hard cylindrical body, a communication path is formed between the adjacent blade portions to communicate the inside and outside of the flexible sheath. Ingredients. 前記硬質筒体はセラミック材からなり、また前記高周波ナイフは金属材で形成され、前記羽根部は前記棒状電極に対して１２０°間隔で３箇所または９０°間隔で４箇所設ける構成としたことを特徴とする請求項１記載の高周波処置具。 The hard cylindrical body is made of a ceramic material, the high-frequency knife is formed of a metal material, and the blade portion is provided at three positions at 120 ° intervals or four positions at 90 ° intervals with respect to the rod-shaped electrodes. The high-frequency treatment tool according to claim 1, wherein 前記硬質筒体の前後の両端面はその軸線と直交する面を有し、前記可撓性シース内には、この硬質筒体の基端側の位置に、前記高周波ナイフの先端を前記硬質筒体の貫通孔に導くためのテーパ面を形成した呼び込み部材を装着する構成としたことを特徴とする請求項１または請求項２記載の高周波処置具。

The front and rear end surfaces of the hard cylinder have surfaces orthogonal to the axis thereof, and the distal end of the high-frequency knife is placed in the flexible sheath at a position on the proximal end side of the hard cylinder. The high-frequency treatment instrument according to claim 1 or 2, wherein a calling member having a tapered surface for guiding to a through-hole of the body is attached.

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JP2009112788A (en) * 2007-10-17 2009-05-28 Takashi Toyonaga High frequency tool
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JP2009112788A (en) * 2007-10-17 2009-05-28 Takashi Toyonaga High frequency tool
US11903630B2 (en) 2010-11-08 2024-02-20 Apyx Medical Corporation Electrosurgical apparatus with retractable blade
JP2011098211A (en) * 2011-01-15 2011-05-19 Japan Lifeline Co Ltd Puncture needle for ablation
JP2020505163A (en) * 2017-01-30 2020-02-20 アピックス メディカル コーポレーション Electrosurgical device with a flexible shaft
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EP4299024A1 (en) 2022-06-29 2024-01-03 FUJIFILM Corporation Endoscopic treatment tool and water supply member

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