JP2022014940A - Endoscopic electrocautery treatment instrument - Google Patents

Abstract

To enable recognizing a shape of a vicinity position in a tip treatment part supporting member side of a tip treatment piece by a camera provided at a tip end of an insertion part of an endoscope, and enable recognizing a step just before entering of the tip treatment part supporting member into a living tissue.SOLUTION: An endoscopic electrocautery treatment instrument is configured to reciprocate and operate an operation wire 12 in a sheath 11 in a reciprocating manner, and to treat an affected part of a living tissue by a pair of tip treatment pieces 15, 16 supported by a tip treatment part supporting member 14 provided at a tip end of the sheath 11 and having a required voltage applied thereto. The tip treatment part is a massive form for surrounding a position of an arm part 14b side of tip side portions 15c, 16c of each tip treatment piece, and is composed of insulation materials or is insulated in an outer circumferential surface and has an insulating function. Also, the same includes stopper members 25, 26 that are brought into abutment and stop just before the tip treatment part supporting member 14 when the tip side portions are made enter an affected part inner side and treat the affected part, and has a stop/mark function serving as a mark for confirming the stop position.SELECTED DRAWING: Figure 3

Description

本発明は、内視鏡のチャネル内に挿脱され、内視鏡の挿入部とともに体腔内に挿入され生体組織の病変部の切開処置を行う先端処置部を有する内視鏡用電気焼灼処置具に関する。 INDUSTRIAL APPLICABILITY The present invention is an electrocautery treatment tool for an endoscope having an advanced treatment portion that is inserted into and removed from the channel of the endoscope and is inserted into the body cavity together with the insertion portion of the endoscope to perform an incision treatment for a lesion portion of a living tissue. Regarding.

内視鏡用電気焼灼処置具は、シースの先端部に先端処置部（刃部）を有し、シースを内視鏡のチャネル内に挿脱可能に収容され、内視鏡の挿入部とともに体腔内に挿入され、内視鏡の視野内で内視鏡の挿入部の先端より延出する先端処置部により、体腔内の病変部の治療（生体組織の患部の除去、サンプル採取、切除、止血等）を低侵襲で行うために使用される。 The electrocautery treatment tool for endoscopes has a tip treatment part (blade part) at the tip of the sheath, and the sheath is retractably housed in the channel of the endoscope, and the body cavity together with the insertion part of the endoscope. Treatment of lesions in the body cavity (removal of affected parts of living tissue, sampling, excision, hemostasis) by a tip treatment part that is inserted inside and extends from the tip of the insertion part of the endoscope in the field of view of the endoscope. Etc.) are used to perform minimally invasive.

以下の特許文献１－３の内視鏡用処置具に関する説明で使用する符号は、各特許文献中で使用している符号である。 The reference numerals used in the following description of the endoscopic treatment tool of Patent Documents 1-3 are the reference numerals used in the respective patent documents.

先行文献１に開示された内視鏡用処置具は、コイルシース４０と、コイルシース４０内に進退可能に配置された操作ワイヤ３０と、操作ワイヤ３０を進退操作する操作部５０と、コイルシース４０の先端に固定連結された保持枠２０（先端処置部支持部材）と、保持枠２０に回転軸３９で回動可能に支持される先端処置部としての一対の把持片１２，２２とを備える。この構成により、内視鏡用処置具は、コイルシース４０を前方へ移動することにより一対の把持片１２，２２を生体組織に表面から内方へ進出することができ、かつ、操作ワイヤ３０をコイルシース４０に対し、前進することにより把持片１２，２２を開くことができ、また、後退することにより把持片１２，２２を閉じることができる。 The endoscopic treatment tool disclosed in Prior Document 1 includes a coil sheath 40, an operation wire 30 arranged so as to be able to advance and retreat in the coil sheath 40, an operation unit 50 for advancing and retreating the operation wire 30, and a tip of the coil sheath 40. A holding frame 20 (tip treatment portion support member) fixedly connected to the holding frame 20 and a pair of gripping pieces 12 and 22 as tip treatment portions rotatably supported by the holding frame 20 by a rotation shaft 39 are provided. With this configuration, the endoscopic treatment tool can advance the pair of gripping pieces 12 and 22 inward from the surface to the living tissue by moving the coil sheath 40 forward, and the operation wire 30 is coil sheathed. With respect to 40, the gripping pieces 12 and 22 can be opened by moving forward, and the gripping pieces 12 and 22 can be closed by moving backward.

先行文献２に開示された内視鏡用処置具は、棒状の高周波ナイフ２と、ストッパ（接続筒）７により高周波ナイフ２と接続されたワイヤ３と、ワイヤ３の外周を被覆する内部シース４と、内部シース４の外周を被覆する外部シース５とを備え、全体移動を外部シース５で行い、外部シース５に対しワイヤ３または／および内部シース４を進退操作するように構成され、さらに、外部シース５の先端に設けられた絶縁体である第１当接部材９の中心孔に高周波ナイフ２が挿通され、内部シース４の先端に設けられ外部シース５内面を摺動する突出長調整部材８の筒部８Ｂ内にストッパ７が摺動可能に支持される構成である。 The treatment tool for an endoscope disclosed in the prior art 2 includes a rod-shaped high-frequency knife 2, a wire 3 connected to the high-frequency knife 2 by a stopper (connecting cylinder) 7, and an internal sheath 4 that covers the outer periphery of the wire 3. And an outer sheath 5 that covers the outer periphery of the inner sheath 4, the outer sheath 5 is used for the entire movement, and the wire 3 and / and the inner sheath 4 are moved forward and backward with respect to the outer sheath 5. A high-frequency knife 2 is inserted into the central hole of the first contact member 9, which is an insulator provided at the tip of the outer sheath 5, and a protrusion length adjusting member provided at the tip of the inner sheath 4 and sliding on the inner surface of the outer sheath 5. The stopper 7 is slidably supported in the tubular portion 8B of 8.

先行文献３に開示された内視鏡用処置具は、先端処置部である一対の鉗子カップ１３と、一方の鉗子カップ１３に設けられた針状部１２と、コイルシース１１の先端部に設けられ一対の鉗子カップ１３を開閉可能に支持する先端処置部支持部材１５と、先端が連結部材２０と一対の開閉リンク１８とを介して一対の鉗子カップ１３と連結された操作ワイヤ１４と、操作ワイヤ１４の外周を被覆するコイルシース１１と、コイルシース１１の外周を被覆する外部シース１０と、操作ワイヤ１４及びコイルシース１１を操作するためのスライダ（第１の操作部）５６と備えている。 The endoscopic treatment tool disclosed in Prior Document 3 is provided at a pair of forceps cups 13 which are tip treatment portions, a needle-shaped portion 12 provided on one forceps cup 13, and a tip portion of a coil sheath 11. A tip treatment portion support member 15 that supports the pair of forceps cups 13 so as to be openable and closable, an operation wire 14 whose tip is connected to the pair of forceps cups 13 via a connecting member 20 and a pair of open / close links 18, and an operation wire. A coil sheath 11 that covers the outer periphery of the coil sheath 14, an outer sheath 10 that covers the outer periphery of the coil sheath 11, and a slider (first operation unit) 56 for operating the operation wire 14 and the coil sheath 11 are provided.

特開２０１６－１１２０６３号公報Japanese Unexamined Patent Publication No. 2016-112063 特開２００８－２７２２０４号公報Japanese Unexamined Patent Publication No. 2008-272204 特開２００７－２８９６７３号公報Japanese Unexamined Patent Publication No. 2007-289673

しかしながら、特許文献１に記載された内視鏡用処置具によれば、例えば、生体組織の病変部の切開きの処置に際し、内視鏡の挿入部の先端部に備えるカメラにより先端部の先方を監視する映像では、一対の把持片１２，２２が生体組織の内方のどの位置まで進入しているか不明確であり、保持枠２０まで生体組織内に深く進入してしまうこともある。保持枠２０まで生体組織内に進入してしまうと、保持枠２０は、外側コーティングしているが内側はコーティングしておらず、また、コーティングが使っているうちに剥げてくることもあるため、この保持枠２０が患部に入りこんでしまうと、処置を行いたい部分以外の部分も保持枠２０により焼けてしまう。このため、把持片１２，２２よりも後端側の保持枠２０は患部に触れないようにしたいとう課題がある。 However, according to the treatment tool for endoscopes described in Patent Document 1, for example, when treating an incision in a lesion of a living tissue, a camera provided at the tip of the insertion portion of the endoscope is used to move the tip of the tip. In the video for monitoring, it is unclear to what position inside the living tissue the pair of gripping pieces 12 and 22 have entered, and the holding frame 20 may penetrate deeply into the living tissue. If the holding frame 20 enters the living tissue, the holding frame 20 is coated on the outside but not on the inside, and the coating may peel off during use. If the holding frame 20 gets into the affected part, the part other than the part to be treated is also burnt by the holding frame 20. Therefore, there is a problem that the holding frame 20 on the rear end side of the gripping pieces 12 and 22 does not touch the affected part.

そこで、特許文献１に記載された内視鏡用処置具について、特許文献２に記載された内視鏡用処置具の工夫に倣い改良できること、すなわち、高周波ナイフ２が第１当接部材９内に引退した位置から２段階の長さに突出する状態にすることができることにより、生体組織の病変部の切開の深さを２段階に調整でき、絶縁体である第１当接部材９は、端面部が生体組織の表面に接触して移動することで高周波ナイフ２を一定の深さで安定した移動を保障できる構成に倣い改良できることが望まれるが、特許文献１に記載された内視鏡用処置具にあっては、先端処置部と先端処置部支持部材とを有する構成であるので、特許文献２と同様の機能を有するような改良はできない。 Therefore, the endoscopic treatment tool described in Patent Document 1 can be improved by following the device of the endoscopic treatment tool described in Patent Document 2, that is, the high frequency knife 2 is inside the first contact member 9. The depth of the incision in the lesion of the living tissue can be adjusted in two stages by making it possible to project from the retired position to two stages of length, and the first contact member 9 which is an insulator can be used as an insulator. It is desired that the high-frequency knife 2 can be improved by following the configuration that can guarantee stable movement at a certain depth by moving the end face portion in contact with the surface of the living tissue, but the endoscope described in Patent Document 1 Since the treatment tool has a structure having a tip treatment portion and a tip treatment portion support member, it cannot be improved to have the same function as Patent Document 2.

特許文献３に記載された内視鏡用処置具は、絶縁体である外部シース１０の先端を生体組織の病変部に近接させ、針状部１２から支持部材１５の中程までが外部シース１０の先端内から突出することにより、針状部１２が先頭になって生体組織の病変部の切開き先端処置部支持部材４まで生体組織内に進入して一対の鉗子カップ１３が病変部を切り取ることができる。この内視鏡用処置具は、特許文献１に記載された内視鏡用処置具と同様に、生体組織の病変部の切開きの処置に際し、内視鏡の挿入部の先端部に備えるカメラにより先端部の先方を監視する映像では、一対の鉗子カップ８，８が生体組織の内方のどの位置まで進入しているか不明確であり、先端処置部支持部材４まで生体組織内に過度に深い位置まで進入してしまうこともある。 In the treatment tool for endoscopy described in Patent Document 3, the tip of the outer sheath 10 which is an insulator is brought close to the lesion part of the living tissue, and the outer sheath 10 is from the needle-shaped part 12 to the middle of the support member 15. By projecting from the tip of the tissue, the needle-shaped portion 12 becomes the head and the lesion portion of the living tissue is incised. be able to. Similar to the endoscopic treatment tool described in Patent Document 1, this endoscopic treatment tool is a camera provided at the tip of the insertion portion of the endoscope when treating an incision in a lesion portion of a living tissue. In the image of monitoring the tip of the tip, it is unclear to what position inside the living tissue the pair of forceps cups 8 and 8 have entered, and the tip treatment part support member 4 is excessively in the living tissue. It may go deep.

本発明は、上記課題を解決するためになされたもので、内視鏡の挿入部の先端部に備えるカメラにより、先端処置部の先端処置片の先端処置部支持部材寄りの近傍位置を形状認識でき、先端処置部支持部材が生体組織に進入する直前の段階を認識できる内視鏡用電気焼灼処置具を提供することを目的とする。 The present invention has been made to solve the above-mentioned problems, and the shape recognition of the position near the tip treatment portion support member of the tip treatment piece of the tip treatment portion by a camera provided at the tip of the insertion portion of the endoscope. It is an object of the present invention to provide an electrocautery treatment tool for an endoscope capable of recognizing the stage immediately before the tip treatment portion support member enters a living tissue.

本発明の第１の態様に係る内視鏡用電気焼灼処置具は、上記目的を達成するため、内視鏡のチャネルに挿脱される可撓性を有するコイルシースと、前記コイルシース内に進退可能に配置された導電性を有する操作ワイヤと、前記コイルシースおよび前記操作ワイヤの各後端側に連結され前記操作ワイヤを進退操作する操作部と、前記コイルシースの先端部に設けられた筒部と前記筒部より先端側に延在する対向一対の腕部とを有する処置部支持手段と、導電性材料より成形された一対の先端処置片を有し、一対の前記先端処置片が前記処置部支持手段の一対の前記腕部間に軸支されかつ前記操作ワイヤの進退と連動して開閉し、一対の前記先端処置片が所要の電圧を印加され生体組織の患部を処置する先端処置部とを備え、前記先端処置部は、各前記先端処置片の先端側部分の前記腕部寄りの位置を囲む塊状であって、絶縁材料よりなるかまたは外周面が絶縁されて絶縁機能を有するとともに、前記先端側部分を患部内方へ侵入させ患部を処置する際に前記処置部支持手段の手前で当接停止しかつ停止位置を確認するための目印となる停止・目印機能を有するストッパ部材を備えていることを特徴とする。 In order to achieve the above object, the electrocautery treatment tool for an endoscope according to the first aspect of the present invention has a flexible coil sheath that is inserted into and removed from the channel of the endoscope, and can move back and forth into the coil sheath. An operation wire having conductivity arranged in the coil sheath, an operation unit connected to each rear end side of the coil sheath and the operation wire to advance / retreat the operation wire, and a tubular portion provided at the tip of the coil sheath and the said. It has a treatment part support means having a pair of opposed arms extending from the cylinder part to the tip side, and a pair of tip treatment pieces molded from a conductive material, and the pair of tip treatment pieces support the treatment part. A tip treatment portion that is pivotally supported between the pair of arms of the means and opens and closes in conjunction with the advancement and retreat of the operation wire, and the pair of tip treatment pieces are applied with a required voltage to treat the affected portion of the biological tissue. The tip treatment portion is a lump that surrounds a position near the arm portion of the tip end side portion of each tip treatment piece, and is made of an insulating material or has an outer peripheral surface that is insulated to have an insulating function. Equipped with a stopper member having a stop / mark function that stops contacting in front of the treatment part support means and serves as a mark for confirming the stop position when the tip side portion is invaded into the affected part and the affected part is treated. It is characterized by being.

本発明の第２の態様に係る内視鏡用電気焼灼処置具は、第１の態様の構成に加え、前記先端処置部は、各前記先端処置片の先端側部分が対向面部を有するロッド状に形成されており、前記対向面部と反対側の外側面先端部に引掻き係止用の外側突起が形成されていることを特徴とする。 The electrocautery treatment tool for an endoscope according to the second aspect of the present invention has a rod shape in which the tip side portion of each tip treatment piece has a facing surface portion in addition to the configuration of the first aspect. It is characterized in that an outer protrusion for scratch locking is formed on the tip portion of the outer surface opposite to the facing surface portion.

本発明の第３の態様に係る内視鏡用電気焼灼処置具は、第１の態様の構成に加え、前記先端処置部は、一対の前記先端処置片の各前記先端側部分の先端部に互いに当接して閉じ合う半球体部を有し、各前記先端側部分の前記半球体部よりも前記腕部寄りの部分を棒状部として形成し前記棒状部に前記ストッパ部材を備えていることを特徴とする。 In the electrocautery treatment tool for an endoscope according to the third aspect of the present invention, in addition to the configuration of the first aspect, the tip treatment portion is attached to the tip portion of each of the tip treatment pieces of the pair of tip treatment pieces. It has hemispherical portions that are in contact with each other and close to each other, and a portion closer to the arm portion than the hemispherical portion of each of the tip end side portions is formed as a rod-shaped portion, and the rod-shaped portion is provided with the stopper member. It is a feature.

本発明の第４の態様に係る内視鏡用電気焼灼処置具は、第１の態様の構成に加え、前記先端処置部は、閉じた状態ではすれ違い状に重なる一対の前記先端処置片がＬ形板状に形成され、かつ閉じた状態では一方の前記先端処置片の先端部が他方の前記先端処置片の先端部よりもすれ違い方向に突出する先端側部分を有することを特徴とする。 In the electrocautery treatment tool for an endoscope according to the fourth aspect of the present invention, in addition to the configuration of the first aspect, the tip treatment portion has a pair of tip treatment pieces that overlap each other in a closed state. It is characterized in that it is formed in a shape plate shape, and in a closed state, the tip end portion of one of the tip treatment pieces has a tip end side portion that protrudes in a passing direction from the tip end portion of the other tip treatment piece.

本発明の第５の態様による内視鏡用電気焼灼処置具は、前述の態様に加え、前記先端処置片は、前記ストッパ部材を取り付けるためのくびれ部を有することを特徴とする。 The electrocautery treatment tool for an endoscope according to a fifth aspect of the present invention is characterized in that, in addition to the above-mentioned aspect, the tip treatment piece has a constricted portion for attaching the stopper member.

本発明によれば、内視鏡の挿入部の先端部に備えるカメラにより、先端処置部の先端処置片の先端処置部支持部材寄りの近傍位置を形状認識でき、先端処置部支持部材が生体組織に進入する直前の段階を認識できる内視鏡用電気焼灼処置具を提供することができる。 According to the present invention, the camera provided at the tip of the insertion portion of the endoscope can recognize the shape of the vicinity of the tip treatment portion of the tip treatment portion near the tip treatment portion support member, and the tip treatment portion support member is a biological tissue. It is possible to provide an electrocautery treatment tool for an endoscope that can recognize the stage immediately before entering.

本発明の実施形態１に係る内視鏡用電気焼灼処置具を含む内視鏡システムを説明するための図である。It is a figure for demonstrating the endoscope system which includes the electric cautery treatment tool for an endoscope which concerns on Embodiment 1 of this invention. 本発明の実施形態１に係る内視鏡用電気焼灼処置具の全体図である。It is an overall view of the electric cautery treatment tool for an endoscope which concerns on Embodiment 1 of this invention. 本発明の実施形態１の内視鏡用電気焼灼処置具に係り、図３（Ａ）は先端処置部が閉じた状態の処置部先端部を示す正面図、図３（Ｂ）は先端処置部が閉じた状態の処置部先端部を示す縦断正面図、図３（Ｃ）は先端処置部が開いた状態の処置部先端部を示す縦断正面図、図３（Ｄ）は図３（Ａ）におけるＩＩＩｄ－ＩＩＩｄ矢視縦断図である。Regarding the electrocautery treatment tool for an endoscope according to the first embodiment of the present invention, FIG. 3 (A) is a front view showing the tip of the treatment portion in a state where the tip treatment portion is closed, and FIG. 3 (B) is the tip treatment portion. 3 (C) is a vertical sectional front view showing the tip of the treatment portion in the closed state, FIG. 3 (C) is a vertical sectional front view showing the tip of the treatment portion in the open state of the tip treatment portion, and FIG. 3 (D) is FIG. 3 (A). It is a cross-sectional view taken along the line IIId-IIId. 図４（Ａ）－（Ｆ）は本発明の実施形態１に係る内視鏡用電気焼灼切開具を用いて行うＥＳＤの一連の手技の工程図である。4 (A)-(F) are process charts of a series of ESD procedures performed using the electrocautery incision tool for an endoscope according to the first embodiment of the present invention. 本発明の実施形態２の内視鏡用電気焼灼処置具に係り、図５（Ａ）は先端処置部が閉じた状態の処置具先端部を示す正面図、図５（Ｂ）は先端処置部が閉じた状態の処置具先端部を示す縦断正面図、図５（Ｃ）は先端処置部が開いた状態の処置具先端部を示す縦断正面図、図５（Ｄ）は図５（Ａ）におけるＹｄ－Ｙｄ矢視縦断図である。The present invention relates to the electric ablation treatment tool for an endoscope according to the second embodiment, FIG. 5 (A) is a front view showing a treatment tool tip portion in a state where the tip treatment portion is closed, and FIG. 5 (B) is a tip treatment portion. A vertical sectional front view showing the tip of the treatment tool in a closed state, FIG. 5 (C) is a vertical sectional front view showing the tip of the treatment tool in a state where the tip treatment portion is open, and FIG. 5 (D) is FIG. 5 (A). It is a vertical sectional view of Yd-Yd in. 本発明の実施形態３の内視鏡用電気焼灼処置具に係り、図６（Ａ）は先端処置部が閉じた状態の処置具先端部を示す正面図、図６（Ｂ）は先端処置部が閉じた状態の処置具先端部を示す縦断正面図、図６（Ｃ）は先端処置部が開いた状態の処置具先端部を示す縦断正面図、図６（Ｄ）は図６（Ａ）におけるＹＩｄ－ＹＩｄ矢視縦断図、図６（Ｅ）は図６（Ａ）におけるＹＩｅ矢視縦断図、図６（Ｆ）は図６（Ａ）におけるＹＩｆ矢視縦断図である。Regarding the electrocautery treatment tool for an endoscope according to the third embodiment of the present invention, FIG. 6A is a front view showing the tip portion of the treatment tool in a state where the tip treatment portion is closed, and FIG. 6B is a tip treatment portion. A vertical sectional front view showing the tip of the treatment tool in a closed state, FIG. 6 (C) is a vertical sectional front view showing the tip of the treatment tool in a state where the tip treatment portion is open, and FIG. 6 (D) is FIG. 6 (A). 6 (E) is a vertical profile of YIe in FIG. 6 (A), and FIG. 6 (F) is a vertical profile of YIf in FIG. 6 (A).

以下、本発明に係る内視鏡用電気焼灼処置具に係る実施形態について図面を参照して説明する。なお、以下の説明において、先端処置部が位置する側を先端側、操作部が位置する側を基端側と呼ぶ。 Hereinafter, embodiments of the electrocautery treatment tool for endoscopes according to the present invention will be described with reference to the drawings. In the following description, the side where the tip treatment portion is located is referred to as the tip side, and the side where the operation portion is located is referred to as the base end side.

［実施形態１］
［内視鏡システム］
図１は実施形態１に係る内視鏡用電気焼灼処置具が適用される内視鏡システム１を示す。内視鏡システム１は、生体の体腔内に挿入するための挿入部２と、基端部に設けられ挿入部２の先端を上下左右方向に湾曲操作するためのダイヤルを有する内視鏡操作部３と、挿入部２と内視鏡操作部３との間を接続するように配置された処置具導入部４とを備え、処置具導入部４から挿入部２の先端に向かって長手方向に形成された内視鏡チャネル５が形成され、内視鏡チャネル５内に、後述する内視鏡用電気焼灼処置具１０の生体患部の処置を行う先端処置部としての一対の先端処置片１５，１６およびシース１１を挿通し操作部１３より操作するように構成されている。 [Embodiment 1]
[Endoscope system]
FIG. 1 shows an endoscope system 1 to which the electrocautery treatment tool for an endoscope according to the first embodiment is applied. The endoscope system 1 has an insertion unit 2 for inserting into the body cavity of a living body, and an endoscope operation unit provided at the base end and having a dial for bending the tip of the insertion unit 2 in the vertical and horizontal directions. 3 and a treatment tool introduction unit 4 arranged so as to connect between the insertion unit 2 and the endoscope operation unit 3 are provided, and the treatment tool introduction unit 4 is provided in the longitudinal direction toward the tip of the insertion unit 2. The formed endoscope channel 5 is formed, and a pair of tip treatment pieces 15 as a tip treatment portion for treating a biologically affected portion of the endoscopic electrocautery treatment tool 10 described later in the endoscope channel 5. The 16 and the sheath 11 are configured to be operated by the insertion operation unit 13.

［内視鏡用電気焼灼処置具の基本的構成］
図２は実施形態１に係る内視鏡用電気焼灼処置具１０を示す。内視鏡用電気焼灼処置具１０は、一対の先端処置片１５，１６で体腔内の生体組織を挟みつつ所要の電流を通電し生体組織を電気焼灼し止血しつつ処置するものである。一対の先端処置片１５，１６に備えるストッパ部材２５，２６は特徴的構成である。 [Basic configuration of electrocautery treatment tool for endoscopes]
FIG. 2 shows an electrocautery treatment tool 10 for an endoscope according to the first embodiment. The electric ablation treatment tool 10 for an endoscope is a device for treating a living tissue while sandwiching the living tissue in a body cavity with a pair of tip treatment pieces 15 and 16 and energizing a required electric current to electrically ablate the living tissue to stop bleeding. The stopper members 25 and 26 provided in the pair of tip treatment pieces 15 and 16 have a characteristic configuration.

内視鏡用電気焼灼処置具１０は、内視鏡チャネル５に挿脱される可撓性を有する細長いシース１１と、シース１１内に進退可能に配置された操作ワイヤ１２と、操作ワイヤ１２を進退操作する操作部１３と、シース１１の先端に固定連結された処置部支持手段である先端処置部支持部材１４と、先端処置部支持部材１４に支持軸１８で回動可能に支持される先端処置部としての一対の先端処置片１５，１６とを備える。 The endoscopic electrocautery treatment tool 10 includes a flexible elongated sheath 11 that is inserted into and removed from the endoscope channel 5, an operation wire 12 that is movably arranged in the sheath 11, and an operation wire 12. The operation unit 13 for advancing and retreating operation, the tip treatment unit support member 14 which is a treatment unit support means fixedly connected to the tip of the sheath 11, and the tip rotatably supported by the tip treatment unit support member 14 by the support shaft 18. A pair of tip treatment pieces 15 and 16 as a treatment unit are provided.

シース１１は、長さが５００～２０００ｍｍ程度の、可撓性を有しかつ適度の腰の強さ（屈曲耐性）を有する細長筒状体である。本実施形態のシース１１は、コイルシース１１ａと、コイルシース１１ａの外面に被さる樹脂製外被１１ｂとで構成されている。樹脂製外被１１ｂは、ＰＴＦＥ、ＰＥＥＫ、ＰＰＳ、ポリエチレン、またはポリイミド、等よりなり可撓性・電気絶縁性を有する。コイルシース１１ａは、例えば断面形状が矩形であるステンレス線等の金属材を密着巻きしてなるコイルシースが用いられることが好ましい。 The sheath 11 is an elongated tubular body having a length of about 500 to 2000 mm, having flexibility and having appropriate waist strength (flexion resistance). The sheath 11 of the present embodiment is composed of a coil sheath 11a and a resin outer cover 11b that covers the outer surface of the coil sheath 11a. The resin outer cover 11b is made of PTFE, PEEK, PPS, polyethylene, polyimide, etc., and has flexibility and electrical insulation. As the coil sheath 11a, for example, it is preferable to use a coil sheath formed by tightly winding a metal material such as a stainless wire having a rectangular cross-sectional shape.

内視鏡用電気焼灼処置具１０は、コイルシース１１ａの内面と、先端処置部支持部材１４の外面に電気絶縁被膜が形成されている。樹脂製外被１１ｂが設けられない構成では、コイルシース１１ａの内外面に電気絶縁被膜が形成されていてもよい。 In the electrocautery treatment tool 10 for endoscopes, an electric insulating film is formed on the inner surface of the coil sheath 11a and the outer surface of the tip treatment portion support member 14. In the configuration in which the resin outer cover 11b is not provided, an electric insulating film may be formed on the inner and outer surfaces of the coil sheath 11a.

操作ワイヤ１２は、シース１１内に進退可能に緩く配置され、導電性であって回転追従性が大きなトルクワイヤからなる。操作ワイヤ１２は、例えば、全長がステンレス製であるか、またはステンレス製の基端側部分とナイチノール（ニッケルチタン合金）製の先端側部分とをステンレスパイプで接続してなるものであっても良い。 The operation wire 12 is loosely arranged in the sheath 11 so as to be able to move forward and backward, and is made of a torque wire that is conductive and has a large rotational followability. The operation wire 12 may have, for example, a total length made of stainless steel, or may be formed by connecting a base end side portion made of stainless steel and a tip end side portion made of nitinol (nickel titanium alloy) with a stainless steel pipe. ..

操作部１３は操作部本体１３ａとスライダ１３ｂとを有する。操作部本体１３ａはコイルシース１１ａの基端に先端部が連結されている。スライダ１３ｂは、操作部本体１３ａの側面部に設けられたスリットに対応する範囲で操作部本体１３ａに被嵌してスライドするように設けられ、操作部本体１３ａの先端面から内部に導入された操作ワイヤ１２の基端と連結されている。 The operation unit 13 has an operation unit main body 13a and a slider 13b. The tip of the operation unit body 13a is connected to the base end of the coil sheath 11a. The slider 13b is provided so as to be fitted to the operation unit main body 13a and slide in a range corresponding to the slit provided on the side surface portion of the operation unit main body 13a, and is introduced into the inside from the tip surface of the operation unit main body 13a. It is connected to the base end of the operation wire 12.

操作部１３は、操作部本体１３ａとスライダ１３ｂとを相対的にスライド操作（進退操作）することによって、操作ワイヤ１２をコイルシース１１ａに相対移動させることができ、スライダ１３ｂを図中の左方向（先端側）に移動させることにより操作ワイヤ１２を先端側にコイルシース１１ａに相対移動させ一対の先端処置片１５，１６を開くことができ、また、スライダ１３ｂを図中の右方向（基端側）に移動させることにより操作ワイヤ１２を基端側にコイルシース１１ａに相対移動させ一対の先端処置片１５，１６を閉じることができるように構成されている。もって、操作部１３は、操作ワイヤ１２をコイルシース１１ａに相対的に進退操作することができ、さらに、操作ワイヤ１２の進退操作を介して一対の先端処置片１５，１６を開閉することができるよう構成されている。 The operation unit 13 can move the operation wire 12 relative to the coil sheath 11a by relatively sliding (advancing / retreating) the operation unit main body 13a and the slider 13b, and the slider 13b is moved to the left in the drawing (advance / retreat operation). By moving the operation wire 12 to the tip side), the operation wire 12 can be moved relative to the coil sheath 11a to open the pair of tip treatment pieces 15 and 16, and the slider 13b can be moved to the right (base end side) in the drawing. The operation wire 12 is relatively moved to the coil sheath 11a toward the base end side, and the pair of tip treatment pieces 15 and 16 can be closed. Therefore, the operation unit 13 can operate the operation wire 12 relative to the coil sheath 11a, and can open and close the pair of tip treatment pieces 15 and 16 via the advance / retreat operation of the operation wire 12. It is configured.

図３（Ａ）に示すように、先端処置部支持部材１４は、コイルシース１１ａの先端部に被嵌・連結された筒部１４ａと、筒部１４ａより先端側に延在する対向一対の腕部１４ｂとを有する。一対の先端処置片１５，１６は先端処置部支持部材１４に開閉可能に支持される。一対の先端処置片１５，１６は、中程部分（交差部分）１５ａ，１６ａと基端側部分１５ｂ，１６ｂと先端側部分１５ｃ，１６ｃとに区分される形状を有する。先端側部分１５ｃ，１６ｃは先端外側に角状の突出部がある形状である。先端側部分１５ｃ，１６ｃを閉じた状態で針状メスやマーカーとして使用でき、開閉すると鋏として使用できる。 As shown in FIG. 3A, the tip treatment portion support member 14 includes a tubular portion 14a fitted and connected to the distal end portion of the coil sheath 11a and a pair of opposed arm portions extending toward the distal end side from the tubular portion 14a. It has 14b and. The pair of tip treatment pieces 15 and 16 are supported by the tip treatment portion support member 14 so as to be openable and closable. The pair of tip treatment pieces 15 and 16 have a shape divided into a middle portion (intersection portion) 15a and 16a, a proximal end side portion 15b and 16b, and a tip end side portion 15c and 16c. The tip side portions 15c and 16c have a shape having a square protruding portion on the outside of the tip. It can be used as a needle-shaped knife or marker with the tip side portions 15c and 16c closed, and can be used as scissors when opened and closed.

図３（Ｂ），（Ｃ），（Ｄ）に示すように、一対の先端処置片１５，１６は、機能的に先端側部分１５ｃ，１６ｃと中程部分１５ａ，１６ａと基端側部分１５ｂ，１６ｂとに区分される。 As shown in FIGS. 3B, 3C, and 3D, the pair of tip treatment pieces 15 and 16 functionally have a tip side portion 15c, 16c, a middle portion 15a, 16a, and a base end side portion 15b. , 16b.

一対の先端処置片１５，１６の各中程部分（交差部分）１５ａ，１６ａには軸孔を有し、２つの軸孔を合わせて先端処置部支持部材１４の一対の腕部１４ｂ，１４ｂの先端部間に位置され、かつ一対の腕部１４ｂ，１４ｂの先端部に設けられた一対の軸受用孔に一軸上に合わせ、一方の軸受用孔より他方の軸受用孔まで支持軸１８が通されている。 A shaft hole is provided in each of the middle portions (intersection portions) 15a and 16a of the pair of tip treatment pieces 15 and 16, and the two shaft holes are combined to form a pair of arm portions 14b and 14b of the tip treatment portion support member 14. The support shaft 18 is uniaxially aligned with a pair of bearing holes located between the tip portions and provided at the tip portions of the pair of arm portions 14b and 14b, and the support shaft 18 passes from one bearing hole to the other bearing hole. Has been done.

支持軸１８は、一対の腕部１４ｂ，１４ｂの軸受用孔に強制嵌着されてなるか、嵌着後にレーザー溶接により固着されており、一対の先端処置片１５，１６の中程部分（交差部分）１５ａ，１６ａの軸孔に対しては緩く嵌着されている。したがって、一対の先端処置片１５，１６は、中程部分（交差部分）１５ａ，１６ａが先端処置部支持部材１４の一対の腕部１４ｂ，１４ｂ間に軸支され、先端側部分１５ｃ，１６ｃが開閉可能である。 The support shaft 18 is either forcibly fitted into the bearing holes of the pair of arm portions 14b, 14b, or is fixed by laser welding after the fitting, and the middle portion (intersection) of the pair of tip treatment pieces 15 and 16. Part) It is loosely fitted to the shaft holes of 15a and 16a. Therefore, in the pair of tip treatment pieces 15 and 16, the middle portions (intersection portions) 15a and 16a are pivotally supported between the pair of arm portions 14b and 14b of the tip treatment portion support member 14, and the tip side portions 15c and 16c are provided. It can be opened and closed.

一対の先端処置片１５，１６の各基端部は、一対の開閉作動用リンク１９，２０の各先端部とピン軸２２，２３で連結され、さらに一対の開閉作動用リンク１９，２０の各基端部は進退伝動リンク２１の先端部とピン軸２４で連結され、進退伝動リンク２１は操作ワイヤ１２と連結されている。 Each base end portion of the pair of tip treatment pieces 15 and 16 is connected to each tip portion of the pair of opening / closing actuating links 19 and 20 by pin shafts 22 and 23, and further each of the pair of opening / closing actuating links 19 and 20. The base end portion is connected to the tip end portion of the advance / retreat transmission link 21 by a pin shaft 24, and the advance / retreat transmission link 21 is connected to the operation wire 12.

詳細には、一方の先端処置片１５の基端側部分１５ｂに設けられたピン軸孔と一方の開閉作動用リンク１９の先端部に設けられたピン軸孔とにピン軸２２が通され止着されることにより、一方の先端処置片１５と一方の開閉作動用リンク１９とが連結されている。他方の先端処置片１６の基端側部分１６ｂに設けられたピン軸孔と他方の開閉作動用リンク２０の先端部に設けられたピン軸孔とが重ね合され、これらピン軸孔にピン軸２３が通され止着されている。これにより、他方の先端処置片１６と他方の開閉作動用リンク２０とが連結されている。したがって、先端処置片１５，１６の基端側部分１５ｂ，１６ｂと開閉作動用リンク１９，２０は菱形に連鎖している。 Specifically, the pin shaft 22 is passed through the pin shaft hole provided in the proximal end side portion 15b of one of the tip treatment pieces 15 and the pin shaft hole provided in the tip portion of the opening / closing operation link 19 to stop the pin shaft 22. By being worn, one tip treatment piece 15 and one opening / closing operation link 19 are connected. The pin shaft hole provided in the proximal end side portion 16b of the other tip treatment piece 16 and the pin shaft hole provided in the tip portion of the other opening / closing operation link 20 are superposed, and the pin shaft is formed in these pin shaft holes. 23 is passed through and stopped. As a result, the other tip treatment piece 16 and the other opening / closing actuating link 20 are connected. Therefore, the base end side portions 15b and 16b of the tip treatment pieces 15 and 16 and the opening / closing operation links 19 and 20 are linked in a diamond shape.

さらに、一対の開閉作動用リンク１９，２０の各基端部に設けられたピン軸孔が進退伝動リンク２１の先端部に設けられたピン軸孔の両側に重ね合され、これら軸孔にピン軸２４が通され止着されることにより、一対の開閉作動用リンク１９，２０と開閉作動用リンク１９とが連結されている。 Further, the pin shaft holes provided at the base ends of the pair of opening / closing actuating links 19 and 20 are overlapped on both sides of the pin shaft holes provided at the tip ends of the advancing / retreating transmission link 21, and the pins are formed in these shaft holes. The pair of open / close operation links 19 and 20 and the open / close operation link 19 are connected by the shaft 24 being passed through and fastened.

進退伝動リンク２１は、外形がロッド状であり、基端面より軸方向に内方にワイヤ受け入れ穴を有し、ワイヤ受け入れ穴に操作ワイヤ１２の先端部が嵌入され進退伝動リンク２１の側面より締め付けねじをねじ込むか、あるいは銀ロウ付け、ハンダ付け、カシメ、等により連結固定され、もって、進退伝動リンク２１と操作ワイヤ１２とが連結されている。 The advancing / retreating transmission link 21 has a rod-like outer shape, has a wire receiving hole inward in the axial direction from the base end surface, and the tip of the operation wire 12 is fitted into the wire receiving hole and tightened from the side surface of the advancing / retreating transmission link 21. The screw is screwed in, or it is connected and fixed by silver brazing, soldering, caulking, etc., so that the advancing / retreating transmission link 21 and the operation wire 12 are connected.

したがって、操作ワイヤ１２がシース１１に対して基端方向に相対移動されると、開閉作動用リンク１９，２０の交差角が小さくなると、一対の先端処置片１５，１６の基端側部分１５ｂ，１６ｂの交差角も小さくなり、これにより、一対の先端処置片１５，１６の先端側部分１５ｃ，１６ｃが閉じていき（図３（Ｂ））、また、開閉作動用リンク１９，２０の交差角が大きくなると、一対の先端処置片１５，１６の基端側部分１５ｂ，１６ｂも交差角が大きくなり、これにより、一対の先端処置片１５，１６の先端側部分１５ｃ，１６ｃが扇状に開いていく（図３（Ａ））。もって、操作ワイヤ１２がシース１１に対して相対移動されると、一対の先端処置片１５，１６の先端側部分１５ｃ，１６ｃが扇状に開閉するようになっている。 Therefore, when the operation wire 12 is relatively moved toward the proximal end with respect to the sheath 11, when the crossing angle of the opening / closing actuating links 19 and 20 becomes smaller, the proximal end side portion 15b of the pair of tip treatment pieces 15 and 16 The crossing angle of 16b is also reduced, whereby the tip side portions 15c and 16c of the pair of tip treatment pieces 15 and 16 are closed (FIG. 3B), and the crossing angle of the opening / closing actuating links 19 and 20 is also reduced. As the value increases, the crossing angles of the base end side portions 15b and 16b of the pair of tip treatment pieces 15 and 16 also increase, whereby the tip end side portions 15c and 16c of the pair of tip treatment pieces 15 and 16 open in a fan shape. Go (Fig. 3 (A)). Therefore, when the operation wire 12 is relatively moved with respect to the sheath 11, the tip side portions 15c and 16c of the pair of tip treatment pieces 15 and 16 open and close in a fan shape.

各腕部１４ｂの対向面部の先端部に支持軸１８を取り巻くように設けられた一対の環状突出座１４ｃ，１４ｃが一対の先端処置片１５，１６の中程部分１５ａ，１６ａに当接している。これにより、一対の先端処置片１５，１６が横振れ・横ずれがなく円滑に回動することを保障されている。 A pair of annular projecting seats 14c, 14c provided around the support shaft 18 at the tip of the facing surface portion of each arm portion 14b are in contact with the middle portions 15a, 16a of the pair of tip treatment pieces 15, 16. .. This guarantees that the pair of tip treatment pieces 15 and 16 rotate smoothly without lateral vibration or lateral displacement.

その他の基本的構成を説明する。先端処置部支持部材１４と一対の先端処置片１５，１６は、ステンレス製またはナイチノール（ニッケルチタン合金）製であり、先端処置部支持部材１４と、シース１１の樹脂製外被１１ｂとに親水性被膜が形成され、もって、一対の先端切開片１５，１６からシース１１までが体腔内に引き攣りなく円滑に導入できるようになっている。 Other basic configurations will be described. The tip treatment portion support member 14 and the pair of tip treatment pieces 15 and 16 are made of stainless steel or nitinol (nickel titanium alloy), and are hydrophilic to the tip treatment portion support member 14 and the resin outer cover 11b of the sheath 11. A coating is formed so that the pair of tip incisions 15, 16 to the sheath 11 can be smoothly introduced into the body cavity without twitching.

先端処置部支持部材１４の筒部１４ａとコイルシース１１ａの先端部とが溶接、ロウ付け、またはハンダ付けにより連結されている。なお、コイルシース１１ａの先端部の外形を研削して小径部を設け、この小径部に筒部１４ａを被嵌し固定連結してもよい。 The tubular portion 14a of the tip treatment portion support member 14 and the tip portion of the coil sheath 11a are connected by welding, brazing, or soldering. The outer shape of the tip of the coil sheath 11a may be ground to provide a small diameter portion, and the tubular portion 14a may be fitted and fixedly connected to the small diameter portion.

したがって、操作ワイヤ１２を進退操作することにより、一対の先端処置片１５，１６の先端側部分１５ｃ，１６ｃを扇状に開閉することができ、かつ閉じるときに、高周波電流を通電して体腔内の生体組織を電気焼灼し止血しつつ切開する等の処置を行うようことができる。 Therefore, by moving the operation wire 12 forward and backward, the tip side portions 15c and 16c of the pair of tip treatment pieces 15 and 16 can be opened and closed in a fan shape, and when the operation wire 12 is closed, a high frequency current is applied to the inside of the body cavity. Treatments such as electrocauterizing the living tissue to stop bleeding and making an incision can be performed.

［内視鏡用電気焼灼処置具の特徴的構成］
一対の先端切開片１５，１６は、導電性材料より成形される。各先端側部分１５ｃ，１６ｃは、対向面部１５ｄ，１６ｄを有する長さ方向に垂直な断面が矩形であるロッド状に形成されている。一対の先端切開片１５，１６は、操作ワイヤ１２を介して給電されて電極面となり、対向面部１５ｄ，１６ｄのみでなく、各先端側部分１５ｃ，１６ｃの全長・全周面において生体組織に対して電気焼灼が行われる。 [Characteristic configuration of electrocautery treatment tool for endoscopes]
The pair of tip incisions 15, 16 are formed from a conductive material. The tip side portions 15c and 16c are formed in a rod shape having a facing surface portions 15d and 16d and having a rectangular cross section perpendicular to the length direction. The pair of tip incision pieces 15 and 16 are fed via the operation wire 12 to become electrode surfaces, and are applied to the living tissue not only on the facing surface portions 15d and 16d but also on the total length and the entire peripheral surface of the tip side portions 15c and 16c. Electric cauterization is performed.

各先端側部分１５ｃ，１６ｃは、対向面部１５ｄ，１６ｄと反対側の外側面先端部に引掻き係止用兼マーキング用の外側突起１５ｅ，１６ｅが形成されている。外側突起１５ｅ，１６ｅは、先端切開片１５，１６を閉じた状態で側方に移動させてメスとして切開処置を行うときに、粘膜に対して滑らずに引っ掛かる機能を有する。 In each of the tip side portions 15c and 16c, outer protrusions 15e and 16e for scratch locking and marking are formed on the outer surface tip portions on the opposite side to the facing surface portions 15d and 16d. The outer protrusions 15e and 16e have a function of being caught on the mucous membrane without slipping when the tip incision pieces 15 and 16 are moved laterally in a closed state to perform an incision procedure as a scalpel.

また、各先端側部分１５ｃ，１６ｃは、対向面部１５ｄ，１６ｄの先端部に間隔保持用の内側突起１５ｆ，１６ｆを有する。各基端側部分１５ｂ，１６ｂは、開閉作動用リンク１９，２０と進退伝動リンク２１を介し操作ワイヤ１２と連結されている。 Further, each of the tip side portions 15c and 16c has inner protrusions 15f and 16f for maintaining a gap at the tip portions of the facing surface portions 15d and 16d. The base end side portions 15b and 16b are connected to the operation wire 12 via the opening / closing operation links 19 and 20 and the advance / retreat transmission link 21.

各先端側部分１５ｃ，１６ｃは、操作ワイヤ１２の進退動作力を受けて開閉し、かつ操作ワイヤ１２が最引退状態のときに、閉じた状態になり、各対向面部１５ｄ，１６ｄが平行状態でかつ近接した状態に保持される。 The tip side portions 15c and 16c are opened and closed by receiving the advancing and retreating motion force of the operating wire 12, and are closed when the operating wire 12 is in the retired state, and the facing surface portions 15d and 16d are in a parallel state. And it is kept in close proximity.

各先端側部分１５ｃ，１６ｃが閉じた状態では、内側突起１５ｆ，１６ｆ同士が当接して対向面部１５ｄ，１６ｄ間の隙間ｃが例えば０．２－１．０ｍｍの微小寸法が保持されるように近接している。 When the tip side portions 15c and 16c are closed, the inner protrusions 15f and 16f are in contact with each other so that the gap c between the facing surface portions 15d and 16d holds a minute dimension of, for example, 0.2-1.0 mm. Close to each other.

内側突起１５ｆ，１６ｆは、対向面部１５ｄ，１６ｄの先端部ではなく、基端部または中途部に設けられても良い。また、外側突起１５ｅ，１６ｅはいずれか一方が設けられていればよい。また、内側突起１５ｆ，１６ｆはいずれか一方が設けられていればよい。 The inner protrusions 15f and 16f may be provided at the base end portion or the middle portion instead of the tip end portions of the facing surface portions 15d and 16d. Further, either one of the outer protrusions 15e and 16e may be provided. Further, either one of the inner protrusions 15f and 16f may be provided.

内側突起１５ｆ，１６ｆは、対向面部１５ｄ，１６ｄの先端部に設けられている場合、隙間間隔を保持する機能に加え、一対の先端処置片１５，１６が扇状に開いた状態から閉じていくときに、粘膜引き止め機能を有する。粘膜引き止め機能とは、一対の先端処置片１５，１６が扇状に開いた状態から閉じていく際に、対向面部１５ｄ，１６ｄ間に挟み込まれた位置にある病変部が対向面部１５ｄ，１６ｄからの圧迫を受けて対向面部１５ｄ，１６ｄ間の先端方向に逃げてしまわないように病変部の粘膜に引っ掛かり引き留める機能である。 When the inner protrusions 15f and 16f are provided at the tips of the facing surface portions 15d and 16d, in addition to the function of maintaining the gap spacing, when the pair of tip treatment pieces 15 and 16 are closed from the fan-shaped open state. In addition, it has a mucosal retaining function. The mucosal restraining function is that when a pair of tip treatment pieces 15 and 16 are closed from a fan-shaped open state, a lesion portion located between the facing surface portions 15d and 16d is located from the facing surface portions 15d and 16d. It is a function of catching and holding on the mucous membrane of the lesion so as not to escape in the direction of the tip between the facing surfaces 15d and 16d under pressure.

内側突起１５ｆ，１６ｆは、粘膜剥離処理の際に、操作ワイヤ１２を基端側に手加減することなく引くと、操作ワイヤ１２が最引退状態となり、先端側部分１５ｃ，１６ｃが閉じ内側突起１５ｆ，１６ｆ同士が当接することで、各対向面部１５ｄ，１６ｄが略平行に近接した状態に保持される。 When the operation wire 12 is pulled toward the base end side of the inner protrusions 15f and 16f in the mucosal peeling process, the operation wire 12 is in the most retired state, and the tip side portions 15c and 16c are closed and the inner protrusions 15f and 16f are closed. When the 16fs come into contact with each other, the facing surface portions 15d and 16d are held in a state of being close to each other substantially in parallel.

先端処置部である先端処置片１５，１６は、各先端側部分１５ｃ，１６ｃの腕部１４ｂ寄りの一部が他部よりも断面積が僅かに小さいくびれ部１５ｇ，１６ｇとなっており、この１５ｇ，１６ｇに串刺し状にストッパ部材２５，２６を備えている。くびれ部１５ｇ，１６ｇは、ストッパ部材２５，２６を設ける位置を規定しているとともに、ストッパ部材２５，２６を移動不能に停止させる機能を有する。 The tip treatment pieces 15 and 16 which are the tip treatment portions have constricted portions 15g and 16g in which a part of the tip side portions 15c and 16c near the arm portion 14b has a slightly smaller cross-sectional area than the other portions. The stopper members 25 and 26 are provided on 15 g and 16 g in a skewered shape. The constricted portions 15g and 16g define the positions where the stopper members 25 and 26 are provided, and have a function of immovably stopping the stopper members 25 and 26.

ストッパ部材２５，２６は、腕部１４ｂ寄りのくびれ部１５ｇ，１６ｇを囲む塊状であって、絶縁材料よりなるかまたは外周面が絶縁されて絶縁機能を有するとともに、先端側部分１５ｃ，１６ｃを患部内方へ侵入させ患部を処置する際に処置部支持部材１４の手前で当接停止しかつ停止位置を確認するための目印となる停止・目印機能を有する。 The stopper members 25 and 26 are lumpy surrounding the constricted portions 15g and 16g near the arm portion 14b, and are made of an insulating material or have an insulating outer peripheral surface and have an insulating function, and the tip side portions 15c and 16c are the affected portions. It has a stop / mark function that serves as a mark for contacting and stopping in front of the treatment part support member 14 and confirming the stop position when the affected part is treated by invading inward.

ストッパ部材２５，２６は、例えば熱収縮性を有するチューブをリング状に切断し先端処置片１５，１６の先端側部分１５ｃ，１６ｃの先端より挿通し当該リング状の部材を先端側部分１５ｃ，１６ｃの処置部支持手段１４の手前位置に移動して加熱することにより熱収縮させて固定してなるか、あるいはエポキシ系接着剤を先端側部分１５ｃ，１６ｃの処置部支持手段１４の手前位置に一巻きにした団子状に形成してなるか、更には紫外線硬化樹脂を先端側部分１５ｃ，１６ｃの処置部支持部材１４の手前位置に一巻きに塗布し紫外線を照射して固化してなる。 For example, the stopper members 25 and 26 are formed by cutting a heat-shrinkable tube into a ring shape and inserting the stopper members 25 and 26 from the tips of the tip side portions 15c and 16c of the tip treatment pieces 15 and 16 to insert the ring-shaped member into the tip side portions 15c and 16c. It is fixed by heat-shrinking it by moving it to the front position of the treatment part support means 14 and heating it, or the epoxy adhesive is placed in the front position of the treatment part support means 14 of the tip side portions 15c and 16c. It is formed in the shape of a rolled dumpling, or is formed by applying an ultraviolet curable resin to the front position of the treatment portion support member 14 of the tip side portions 15c and 16c in one roll and irradiating with ultraviolet rays to solidify.

［先端処置片１５，１６からなる先端処置部の機能］
先端処置片１５，１６からなる先端処置部は、ストッパ部材２５，２６を有するので、内視鏡の挿入部の先端部に備えるカメラにより、先端処置部の先端処置片の先端処置部支持部材寄りの近傍位置を形状認識でき、先端処置部支持部材が生体組織に進入する直前の段階を認識できる。また、先端処置片１５，１６からなる先端処置部は、先端処置部支持部材が生体組織に進入する位置に当接するとストッパ部材２５，２６が挿入抵抗を増し、挿入抵抗を増す感触が操作者の手に伝わるので、この点からも先端処置部支持部材が生体組織に進入しようとする瞬間が分かり、先端処置部支持部材が生体組織に進入することを防止できる。 [Function of tip treatment section consisting of tip treatment pieces 15 and 16]
Since the tip treatment portion composed of the tip treatment pieces 15 and 16 has stopper members 25 and 26, the tip treatment portion of the tip treatment portion is closer to the tip treatment portion support member by the camera provided at the tip portion of the insertion portion of the endoscope. The shape can be recognized in the vicinity of the position, and the stage immediately before the tip treatment portion support member enters the living tissue can be recognized. Further, in the tip treatment section composed of the tip treatment pieces 15 and 16, when the tip treatment section support member comes into contact with the position where the tip treatment section support member enters the living tissue, the stopper members 25 and 26 increase the insertion resistance, and the operator feels that the insertion resistance is increased. From this point as well, the moment when the tip treatment part support member tries to enter the living tissue can be known, and the tip treatment part support member can be prevented from entering the living tissue.

さらに、先端処置部支持部材１４が生体組織に進入するのを未然に防げることにより、先端処置部支持部材１４の内側が絶縁コーティングされておらず、外側の絶縁コーティングが使っているうちに剥げてくることもあって、この先端処置部支持部材１４が患部に入りこんでしまうと、処置を行いたい部分以外の部分も先端処置部支持部材１４により焼けてしまうという恐れが解消される。 Further, by preventing the tip treatment portion support member 14 from entering the living tissue, the inside of the tip treatment portion support member 14 is not insulatingly coated, and the outer insulating coating is peeled off while being used. If the tip treatment portion support member 14 gets into the affected area, there is no possibility that the portion other than the portion to be treated will be burnt by the tip treatment portion support member 14.

先端処置片１５，１６からなる先端処置部は、各先端処置片１５，１６の先端側部分１５ｃ，１６ｃが対向面部を有するロッド状に形成されており、対向面部と反対側の外側面先端部に引掻き係止用兼マーキング用の外側突起１５ｅ，１６ｅが形成されており、その上、ストッパ部材２５，２６を有するので、内視鏡的粘膜下層剥離術（ＥＳＤ；Ｅｎｄｏｓｃｏｐｉｃ Ｓｕｂｍｕｃｏｓａｌ Ｄｉｓｓｅｃｔｉｏｎ）の手技において、電気焼灼によるマーキング機能と切開機能と閉じ合せ止血機能と血管切断回避機能とを有し、操作性に優れる。 The tip treatment portion composed of the tip treatment pieces 15 and 16 is formed in a rod shape in which the tip side portions 15c and 16c of the tip treatment pieces 15 and 16 have facing surfaces, and the outer surface tip portion on the opposite side to the facing surface portion. The outer protrusions 15e and 16e for scratch locking and marking are formed on the surface, and the stopper members 25 and 26 are provided. Therefore, in the procedure of endoscopic submucosal dissection (ESD). It has a marking function by electrocautery, an incision function, a closed hemostasis function, and a blood vessel cutting avoidance function, and is excellent in operability.

［マーキング機能］
ＥＳＤの手技における最初の処置は、図４（Ａ）に示すように、病変部Ａ周辺に切開範囲を決めるための点状のマーク（マーキング痕）ｍを周配置に適数個（例えば６～１２個）付すことである。このため、内視鏡システム１の挿入部２を患者の体腔内に挿入し、内視鏡画像によって病変部Ａの位置を確認し、内視鏡チャネル５に挿通されたシース１１の先端部の先端処置部（一対の先端処置片１５，１６）を内視鏡先端部から突出し、例えば外側突起１５ｅまたは１６ｅを病変部Ａの周辺の粘膜に押し当て、先端処置部に高周波電流を通電する。これにより、外側突起１５ｅまたは１６ｅにより病変部Ａの周辺の粘膜の押し当て位置が僅かに差し込まれ、外側突起１５ｅまたは１６ｅが粘膜表面で滑らないため狙った位置に電気焼灼されてマーキング痕ｍが形成される。その後、高周波電流を遮電し外側突起１５ｅまたは１６ｅを粘膜から離れさせ、外側突起１５ｅまたは１６ｅを、病変部Ａの周辺の粘膜の次の押し当て位置へ移動して押し当てマーキング痕ｍを形成することを繰り返し、点状のマーキング痕ｍを周配置に適数個を形成し、マーキング処置を終了する。続いて、図５（Ｂ）に示すように、病変部の粘膜下層にヒアルロン酸等の液体を局所注射する。内視鏡用電気焼灼切開具１０をヒアルロン酸等の液体を給送できる内視鏡用注射具Ｇと交換し病変部Ａの粘膜下層に向けてマーキング痕ｍの外側位置に位置させて刺し込み、薬液を注入すると病変部の粘膜を浮き上がらせることができる。 [Marking function]
As shown in FIG. 4A, the first treatment in the ESD procedure is to place an appropriate number of dot-shaped marks (marking marks) m around the lesion A to determine the incision range (for example, 6 to 6). 12). Therefore, the insertion portion 2 of the endoscopic system 1 is inserted into the body cavity of the patient, the position of the lesion portion A is confirmed by the endoscopic image, and the tip portion of the sheath 11 inserted into the endoscopic channel 5 is inserted. The tip treatment portion (a pair of tip treatment pieces 15, 16) is projected from the tip of the endoscope, and for example, the lateral protrusion 15e or 16e is pressed against the mucous membrane around the lesion A, and a high frequency current is applied to the tip treatment portion. As a result, the pressing position of the mucous membrane around the lesion A is slightly inserted by the outer protrusion 15e or 16e, and the outer protrusion 15e or 16e does not slip on the mucosal surface, so that the marking mark m is electrocauterized at the target position. It is formed. After that, the high-frequency current is shielded to separate the outer protrusion 15e or 16e from the mucous membrane, and the outer protrusion 15e or 16e is moved to the next pressing position of the mucous membrane around the lesion A to form a pressing marking mark m. This is repeated to form an appropriate number of dot-shaped marking marks m in a circumferential arrangement, and the marking procedure is completed. Subsequently, as shown in FIG. 5 (B), a liquid such as hyaluronic acid is locally injected into the submucosal layer of the lesion. Replace the endoscopic electrocautery incision tool 10 with an endoscopic injection tool G that can feed a liquid such as hyaluronic acid, and insert it at the outer position of the marking mark m toward the submucosal layer of the lesion A. , The mucous membrane of the lesion can be raised by injecting the drug solution.

［切開機能］
病変部Ａの粘膜を浮き上がらせた後は、図４（Ｃ）に示すように、マーキング痕ｍの外周位置の粘膜に環状凹部Ｒを処置する。このため、再び、内視鏡用電気焼灼処置具１０と交換し、外側突起１５ｅおよび／または１６ｅを病変部Ａの周辺の粘膜に押し当て、先端処置部に高周波電流を通電し、マーキング痕ｍの外周を一回りさせる。これにより、外側突起１５ｅおよび／または１６ｅにより病変部Ａの周辺の粘膜の押し当て位置が僅かに差し込まれ、外側突起１５ｅまたは１６ｅが粘膜表面で滑らないため狙った位置に電気焼灼されて環状凹部Ｒを処置することができる。 [Incision function]
After the mucous membrane of the lesion A is raised, the annular recess R is treated on the mucous membrane at the outer peripheral position of the marking mark m as shown in FIG. 4 (C). Therefore, the endoscopic electrocautery treatment tool 10 is replaced again, the lateral protrusions 15e and / or 16e are pressed against the mucous membrane around the lesion A, a high-frequency current is applied to the tip treatment portion, and the marking mark m. Make a round of the outer circumference of. As a result, the pressing position of the mucous membrane around the lesion A is slightly inserted by the outer protrusions 15e and / or 16e, and the outer protrusions 15e or 16e are electrocauterized to the target position because they do not slip on the mucosal surface. R can be treated.

［剥離機能］
環状凹部Ｒを切開した後は、続いて、図４（Ｄ）に示すように、病変部Ａを少しずつ剥ぎ取る。このため、内視鏡用電気焼灼処置具１０の一対の先端処置片１５，１６を開閉することにより患部を挟んで通電することにより切開を行う。 [Peeling function]
After making the incision in the annular recess R, the lesion A is subsequently stripped off little by little, as shown in FIG. 4 (D). Therefore, the incision is made by opening and closing the pair of tip treatment pieces 15 and 16 of the electrocautery treatment tool 10 for an endoscope and energizing the affected part.

剥離機能としては、一対の先端切開片１５，１６に別の動作を与える方法であっても良く、例えば一対の先端処置片１５，１６を閉じて外側突起１５ｅ，１６ｅの両方を環状凹部Ｒに合わせ、病変部Ａの粘膜下層に向けて高周波電流を通電させて電気焼灼により若干寸法刺し込む毎に、一対の先端処置片１５，１６を小さな角度開いて切り開き幅を大きくし閉じることを繰り返してもよく、一対の先端切開片１５，１６を閉じて環状凹部Ｒの一端から直径方向の他端まで電気焼灼により病変部Ａの粘膜下層に突き刺してから一対の先端切開片１５，１６の開き、開いたまま差し込み位置まで引く動作とする場合でもよい。 As the peeling function, a method of giving another operation to the pair of tip incision pieces 15 and 16 may be used. For example, the pair of tip treatment pieces 15 and 16 are closed and both the outer protrusions 15e and 16e are formed into the annular recess R. At the same time, each time a high-frequency current is applied to the submucosal layer of the lesion A and a slight dimension is inserted by electrocautery, the pair of tip treatment pieces 15 and 16 are opened at a small angle to widen and close the incision repeatedly. It is also possible to close the pair of tip incisions 15 and 16 and pierce the submucosal layer of the lesion A from one end of the annular recess R to the other end in the radial direction by electrocautery, and then open the pair of tip incisions 15 and 16. It may be the operation of pulling to the insertion position while it is open.

［閉じ合せ止血機能］
病変部Ａを取り除いた後は、続いて、図４（Ｅ），（Ｆ）に示すように、病変部Ａを取り除いた生体表面を止血する。このため、一対の先端処置片１５，１６を適度の扇状に開いて病変部Ａを挟み込む状態になるよう生体表面に押し当て、高周波電流を供給し電気焼灼を行いつつ、操作ワイヤ１２を基端側に引くと、操作ワイヤ１２が最引退状態となり、一対の先端処置片１５，１６を緩速度で閉じて病変部Ａを取り除いた表面を挟み込む所定秒数電気焼灼を維持して止血する。 [Closed hemostatic function]
After removing the lesion A, hemostasis is subsequently performed on the surface of the living body from which the lesion A has been removed, as shown in FIGS. 4 (E) and 4 (F). Therefore, the pair of tip treatment pieces 15 and 16 are opened in an appropriate fan shape and pressed against the surface of the living body so as to sandwich the lesion A, and a high-frequency current is supplied to perform electrocautery while the operation wire 12 is the base end. When pulled to the side, the operation wire 12 is in the fully retracted state, and the pair of tip treatment pieces 15 and 16 are closed at a slow speed to stop bleeding by maintaining electrocautery for a predetermined number of seconds to sandwich the surface from which the lesion A has been removed.

対向面部１５ｄ，１６ｄ間の間隔ｃが０．２－１．０ｍｍであると、対向面部１５ｄ，１６ｄ間でのジュール熱が高密度に発生し、対向面部１５ｄ，１６ｄに挟まれる病変部組織の粘膜がジュール熱により多量の泡に変わり、この泡が対向面部１５ｄ，１６ｄ間の熱を奪い取るように切除方向へ流れるので対向面部１５ｄ，１６ｄを良好に放熱させることになる。これにより、給電される対向面部１５ｄ，１６ｄ間にジュール熱が発生し対向面部１５ｄ，１６ｄに振れる粘膜が多量の泡を発生させて分解し、多量の泡を熱とともに切除方向へ流れさせることになり、病変部を健全な生体組織から安全に分離するよう処置することができる。 When the distance c between the facing surface portions 15d and 16d is 0.2-1.0 mm, Joule heat is generated at high density between the facing surface portions 15d and 16d, and the lesion tissue sandwiched between the facing surface portions 15d and 16d is sandwiched between the facing surface portions 15d and 16d. The mucous membrane is transformed into a large amount of bubbles by Joule heat, and these bubbles flow in the excision direction so as to take away the heat between the facing surface portions 15d and 16d, so that the facing surface portions 15d and 16d are satisfactorily dissipated. As a result, Joule heat is generated between the facing surface portions 15d and 16d to be fed, and the mucous membrane swinging on the facing surface portions 15d and 16d generates a large amount of bubbles and decomposes, and a large amount of bubbles flow in the cutting direction together with the heat. The lesion can be treated to be safely separated from healthy living tissue.

［実施形態２］
実施形態２の内視鏡用電気焼灼処置具は、図５に示すように、シース１１と、操作ワイヤ１２と、操作部１３と、処置部支持部材１４と、図２，図３に示す一対の先端処置片１５，１６に替えて、一対の先端処置片１５Ａ，１６Ａよりなる先端処置部とを備えている。図５に示す各構成要素について、図３に示す対応している各構成要素と同一のものは説明を省略し、併せて、符号についても同一の符号を流用する。 [Embodiment 2]
As shown in FIG. 5, the electrocautery treatment tool for an endoscope according to the second embodiment includes a sheath 11, an operation wire 12, an operation unit 13, a treatment unit support member 14, and a pair shown in FIGS. 2 and 3. Instead of the tip treatment pieces 15 and 16, the tip treatment portion is provided with a pair of tip treatment pieces 15A and 16A. Regarding each component shown in FIG. 5, the same as each corresponding component shown in FIG. 3 will be omitted from the description, and the same reference numerals will be used for the reference numerals.

［先端処置片１５Ａ，１６Ａからなる先端処置部の構成］
先端処置部である先端処置片１５Ａ，１６Ａの各先端側部分は、先端部に互いに当接して閉じ合う半球体部１５ｈ，１６ｈを有し、各前記先端側部分の半球体部１５ｈ，１６ｈよりも腕部１４ｂ寄りの部分が対向面を有する棒状部１５ｉ，１６ｉとからなり、さらに棒状部１５ｉ，１６ｉの腕部１４ｂ寄りの一部分がくびれ部１５ｊ，１６ｊとなっていて、このくびれ部１５ｊ，１６ｊに図３と同一のストッパ部材２５，２６を備えている。 [Structure of tip treatment section consisting of tip treatment pieces 15A and 16A]
Each of the tip treatment pieces 15A and 16A, which is the tip treatment portion, has hemispherical portions 15h and 16h that abut and close to each other at the tip portion, and from the hemisphere portions 15h and 16h of the tip side portions. The portion closer to the arm portion 14b is composed of rod-shaped portions 15i and 16i having facing surfaces, and a part of the rod-shaped portions 15i and 16i closer to the arm portion 14b is a constricted portion 15j and 16j. 16j is provided with the same stopper members 25 and 26 as in FIG.

［先端処置片１５Ａ，１６Ａがストッパ部材２５，２６を有することによる機能］
先端処置片１５Ａ，１６Ａからなる先端処置部は、実施形態１と同様に、ストッパ部材２５，２６を有するので、実施形態１において説明した先端処置片１５，１６と同様に、内視鏡の挿入部の先端部に備えるカメラにより、先端処置部の先端処置片の先端処置部支持部材寄りの近傍位置を形状認識でき、先端処置部支持部材が生体組織に進入する直前の段階を認識でき、これにより、カメラにより半球体部１５ｈ，１６ｈの侵入位置を把握し易く、切開処置がし易くなる。 [Function by having the tip treatment pieces 15A and 16A have the stopper members 25 and 26]
Since the tip treatment portion composed of the tip treatment pieces 15A and 16A has the stopper members 25 and 26 as in the first embodiment, the endoscope is inserted in the same manner as the tip treatment pieces 15 and 16 described in the first embodiment. The camera provided at the tip of the part can recognize the shape of the position near the tip treatment part support member of the tip treatment piece of the tip treatment part, and can recognize the stage immediately before the tip treatment part support member enters the living tissue. This makes it easier for the camera to grasp the intrusion positions of the hemisphere portions 15h and 16h, and facilitates the incision procedure.

半球体部１５ｈ，１６ｈは、先端処置片１５Ａ，１６Ａを閉じることにより球体状に重なる状態になり、この状態で電気焼灼を行いつつ生体組織に真っすぐに進入することができる。ストッパ部材２５，２６が生体組織に近接すると、この近接するタイミングを内視鏡の挿入部の先端部に備えるカメラにより認識することができる。また、電気焼灼を行なわないストッパ部材２５，２６が生体組織に当接した場合には、当接した感触が処置者の手に伝達されるから、先端処置片支持部材１４を生体組織に進入するのを未然に防止できる。 The hemispherical portions 15h and 16h are in a state of overlapping in a spherical shape by closing the tip treatment pieces 15A and 16A, and in this state, they can enter the living tissue straight while performing electrocautery. When the stopper members 25 and 26 are close to the living tissue, the timing of the close proximity can be recognized by a camera provided at the tip of the insertion portion of the endoscope. Further, when the stopper members 25 and 26 that are not electrocauterized come into contact with the living tissue, the touch of the contact is transmitted to the hands of the treating person, so that the advanced treatment piece supporting member 14 enters the living tissue. Can be prevented.

また、半球体部１５ｈ，１６ｈが球体状に重なる状態（先端処置片１５Ａ，１６Ａを閉じた状態）で生体組織の所要深さに進入した状態から、先端塊１５ｈ、１６ｈのいずれかを患部に引き掛けてスライドさせて切開することや、先端処置片１５Ａ，１６Ａを開閉することにより患部を挟んで電気焼灼を行いつつ生体組織を切り開いていくことができる。 Further, from the state where the hemispherical portions 15h and 16h are overlapped in a spherical shape (the state in which the tip treatment pieces 15A and 16A are closed) and have entered the required depth of the biological tissue, either the tip mass 15h or 16h is applied to the affected portion. By hooking and sliding to make an incision, or by opening and closing the tip treatment pieces 15A and 16A, it is possible to cut open the living tissue while performing electrocautery while sandwiching the affected part.

［実施形態３］
実施形態３の内視鏡用電気焼灼処置具は、図６に示すように、シース１１と、操作ワイヤ１２と、操作部１３と、処置部支持手段１４と、図２，図３に示す一対の先端処置片１５，１６に替えて、一対の先端処置片１５Ｂ，１６Ｂよりなる先端処置部とを備えている。図６に示す各構成要素について、図３に示す対応している各構成要素と同一のものは説明を省略し、併せて、符号についても同一の符号を流用する。 [Embodiment 3]
As shown in FIG. 6, the electrocautery treatment tool for an endoscope according to the third embodiment includes a sheath 11, an operation wire 12, an operation unit 13, a treatment unit support means 14, and a pair shown in FIGS. 2 and 3. In place of the tip treatment pieces 15 and 16, the tip treatment portion is provided with a pair of tip treatment pieces 15B and 16B. Regarding each component shown in FIG. 6, the same as each corresponding component shown in FIG. 3 will be omitted from the description, and the same reference numerals will be used for the reference numerals.

［先端処置片１５Ｂ，１６Ｂからなる先端処置部の構成］
先端処置部である先端処置片１５Ｂ，１６Ｂは、開いた状態では先端部が互いに接近する方向に折れ曲がったＬ形板状に形成されかつ閉じた状態ではすれ違い状に重なる先端側部分１５ｋ，１６ｋを有する。 [Structure of tip treatment section consisting of tip treatment pieces 15B and 16B]
The tip treatment pieces 15B and 16B, which are the tip treatment portions, are formed in an L-shaped plate shape in which the tip portions are bent in a direction in which the tip portions approach each other in the open state, and the tip side portions 15k and 16k are overlapped in a passing shape in the closed state. Have.

先端側部分１５ｋ，１６ｋは、Ｌ形であるから開いた状態（図６（Ｃ））で生体組織の病変部を挟むように進入し、電気焼灼によりナイフ機能を発揮し病変部の両側方の粘膜をその奥の正常な生体組織から切り剥がすことができ、先側部分１５ｋ１，１６ｋ１が互いに近接する状態に閉じると病変部を取り囲む状態になり、さらに、すれ違い完全に閉じていく過程では、電気焼灼によりナイフ機能を発揮し病変部とその奥の正常な生体組織との間を切り剥がすことができる。 Since the tip side portions 15k and 16k are L-shaped, they enter so as to sandwich the lesion part of the living tissue in an open state (FIG. 6 (C)), and exert a knife function by electrocautery to exert a knife function on both sides of the lesion part. The mucous membrane can be cut off from the normal living tissue in the back, and when the distal parts 15k1 and 16k1 are closed close to each other, they surround the lesion, and in the process of completely closing each other, electricity is applied. By ablation, it exerts a knife function and can cut off between the lesion and the normal living tissue behind it.

各先端側部分１５ｋ，１６ｋのＬ形に折れ曲がった先側部分１５ｋ１，１６ｋ１は、取り囲んだ病変部を外側に逃がさず、内側に取り込む機能を有する。
各先端側部分１５ｋ，１６ｋは、閉じた状態では一方の先端処置片の先端部が他方の先端処置片の先端部よりもすれ違い方向に突出する側方突出部１５ｍ，１６ｍを有する。 The tip side portions 15k1, 16k1 bent into an L shape of the tip side portions 15k and 16k have a function of taking in the surrounding lesions inward without letting them escape to the outside.
The tip side portions 15k and 16k have lateral protrusions 15m and 16m in which the tip portion of one tip treatment piece protrudes in the passing direction from the tip portion of the other tip treatment piece in the closed state.

側方突出部１５ｍ，１６ｍは、実施形態１および図３に示す外側突起１５ｅ，１６ｅと同様に、粘膜に対して滑らずに引っ掛かる機能を有する。すなわち、図４（Ｄ）に示すように、病変部Ａを少しずつ剥ぎ取るため、一対の先端処置片１５Ｂ，１６Ｂを閉じた状態で側方突出部１５ｍ，１６ｍのいずれか一方を用いて病変部Ａの周りの所要組織に引掛けて環状凹部Ｒを切り開くことができる。 The lateral protrusions 15m and 16m have a function of being caught on the mucous membrane without slipping, similar to the outer protrusions 15e and 16e shown in the first and third embodiments. That is, as shown in FIG. 4 (D), in order to peel off the lesion A little by little, the lesion is made by using either one of the lateral protrusions 15m and 16m with the pair of tip treatment pieces 15B and 16B closed. The annular recess R can be cut open by hooking on the required tissue around the portion A.

［先端処置片１５Ｂ，１６Ｂがストッパ部材２５，２６を有することによる機能］
先端処置片１５Ｂ，１６Ｂからなる先端処置部は、図３と同様に、ストッパ部材２５，２６を有するので、実施形態１において説明した先端処置片１５，１６と同様に、内視鏡の挿入部の先端部に備えるカメラにより、先端処置部である先端処置片１５ｋ，１６ｋの先端処置部支持部材１４寄りの近傍位置を形状認識でき、先端処置部支持部材１４が生体組織に進入する直前の段階を認識できる。これにより、先端処置部支持部材１４が生体組織に進入するのを未然に防げて先端処置片１５，１６による鉗子として行う処置を把握し易く、切開等の処置がし易くなる。 [Function by having the tip treatment pieces 15B and 16B have the stopper members 25 and 26]
Since the tip treatment portion composed of the tip treatment pieces 15B and 16B has the stopper members 25 and 26 as in FIG. 3, the insertion portion of the endoscope is similar to the tip treatment pieces 15 and 16 described in the first embodiment. With the camera provided at the tip of the tip, the shape of the tip treatment pieces 15k and 16k near the tip treatment support member 14 can be recognized, and the stage immediately before the tip treatment support member 14 enters the living tissue. Can be recognized. As a result, the tip treatment portion support member 14 can be prevented from entering the living tissue, and the treatment performed as forceps by the tip treatment pieces 15 and 16 can be easily grasped, and the treatment such as incision can be easily performed.

本発明によれば、内視鏡の挿入部の先端部に備えるカメラにより、先端処置部の先端処置片の先端処置部支持部材寄りの近傍位置を形状認識でき、先端処置部支持部材が生体組織に進入する直前の段階を認識できるという効果を有し、操作性に優れる内視鏡用電気焼灼処置具を提供することができる。 According to the present invention, the camera provided at the tip of the insertion portion of the endoscope can recognize the shape of the vicinity of the tip treatment portion of the tip treatment portion near the tip treatment portion support member, and the tip treatment portion support member is a biological tissue. It is possible to provide an electrocautery treatment tool for an endoscope, which has an effect of being able to recognize the stage immediately before entering the endoscope and has excellent operability.

１…内視鏡システム、
２…挿入部、
３…内視鏡操作部、
４…処置具導入部、
５…内視鏡チャネル、
１０…内視鏡用電気焼灼処置具、
１１…シース、
１１ａ…コイルシース、
１１ｂ…樹脂製外被、
１２…操作ワイヤ、
１３…操作部、
１３ａ…操作部本体、
１３ｂ…スライダ、
１４…先端処置部支持部材、
１４ａ…筒部、
１４ｂ…腕部、
１４ｃ…環状突出座、
１５，１６…先端処置片、
１５Ａ，１６Ａ…先端処置片、
１５Ｂ，１６Ｂ…先端処置片、
１５ａ，１６ａ…中程部分、
１５ｂ，１６ｂ…基端側部分、
１５ｃ，１６ｃ…先端側部分、
１５ｄ，１６ｄ…対向面部、
１５ｅ，１６ｅ…外側突起、
１５ｆ，１６ｆ…内側突起、
１５ｇ，１６ｇ…くびれ部、
１５ｈ，１６ｈ…半球体部、
１５ｉ，１６ｉ…棒状部、
１５ｊ，１６ｊ…くびれ部、
１５ｋ，１６ｋ…先端側部分、
１５ｍ，１６ｍ…側方突出部、
１５ｎ，１６ｎ…くびれ部、
１８…支持軸、
１９，２０…開閉作動用リンク、
２１…進退伝動リンク、
２２，２３，２４…ピン軸、
２５，２６…ストッパ部材、
ｃ…隙間。 1 ... Endoscope system,
2 ... Insertion part,
3 ... Endoscope operation unit,
4 ... Treatment tool introduction part,
5 ... Endoscopic channel,
10 ... Electric cautery treatment tool for endoscopes,
11 ... Sheath,
11a ... Coil sheath,
11b ... Resin jacket,
12 ... Operation wire,
13 ... Operation unit,
13a ... Operation unit body,
13b ... Slider,
14 ... Tip treatment part support member,
14a ... Cylinder,
14b ... arm,
14c ... Circular protrusion,
15, 16 ... Tip treatment piece,
15A, 16A ... Tip treatment piece,
15B, 16B ... Tip treatment piece,
15a, 16a ... Middle part,
15b, 16b ... Base end side part,
15c, 16c ... Tip side part,
15d, 16d ... Facing surface,
15e, 16e ... outer protrusion,
15f, 16f ... Inner protrusion,
15g, 16g ... Constriction,
15h, 16h ... Hemisphere,
15i, 16i ... Rod-shaped part,
15j, 16j ... Constriction,
15k, 16k ... Tip side part,
15m, 16m ... Lateral protrusions,
15n, 16n ... Constriction,
18 ... Support shaft,
19, 20 ... Link for opening / closing operation,
21 ... Advance / retreat transmission link,
22, 23, 24 ... Pin axis,
25, 26 ... Stopper member,
c ... Gap.

Claims (5)

内視鏡のチャネルに挿脱される可撓性を有するコイルシースと、
前記コイルシース内に進退可能に配置された導電性を有する操作ワイヤと、
前記コイルシースおよび前記操作ワイヤの各後端側に連結され前記操作ワイヤを進退操作する操作部と、
前記コイルシースの先端部に設けられた筒部と前記筒部より先端側に延在する対向一対の腕部とを有する処置部支持手段と、
導電性材料より成形された一対の先端処置片を有し、一対の前記先端処置片が前記処置部支持手段の一対の前記腕部間に軸支されかつ前記操作ワイヤの進退と連動して開閉し、一対の前記先端処置片が所要の電圧を印加され生体組織の患部を処置する先端処置部とを備え、
前記先端処置部は、各前記先端処置片の先端側部分の前記腕部寄りの位置を囲む塊状であって、絶縁材料よりなるかまたは外周面が絶縁されて絶縁機能を有するとともに、前記先端側部分を患部内方へ侵入させ患部を処置する際に前記処置部支持手段の手前で当接停止しかつ停止位置を確認するための目印となる停止・目印機能を有するストッパ部材を備えている
ことを特徴とする内視鏡用電気焼灼処置具。 A flexible coil sheath that can be inserted into and removed from the endoscope channel,
A conductive operation wire arranged in the coil sheath so as to be able to move forward and backward,
An operation unit connected to each rear end side of the coil sheath and the operation wire to advance / retreat the operation wire, and an operation unit.
A treatment portion support means having a tubular portion provided at the tip end portion of the coil sheath and a pair of opposed arm portions extending toward the distal end side from the tubular portion.
It has a pair of tip treatment pieces molded from a conductive material, and the pair of tip treatment pieces are pivotally supported between the pair of arms of the treatment portion support means and opened and closed in conjunction with the advance and retreat of the operation wire. The pair of tip treatment pieces is provided with a tip treatment section for treating the affected portion of the living tissue by applying a required voltage.
The tip treatment portion is a lump that surrounds the position near the arm portion of the tip end side portion of each tip treatment piece, and is made of an insulating material or has an outer peripheral surface that is insulated to have an insulating function and the tip end side. When the affected part is invaded into the affected area and the affected area is treated, the stopper member having a stop / mark function that stops the contact in front of the treatment part support means and serves as a mark for confirming the stop position shall be provided. An electric ablation treatment tool for endoscopes. 前記先端処置部は、各前記先端処置片の先端側部分が対向面部を有するロッド状に形成されており、前記対向面部と反対側の外側面先端部に引掻き係止用の外側突起が形成されている
ことを特徴とする請求項１に記載の内視鏡用電気焼灼処置具。 The tip treatment portion is formed in a rod shape in which the tip end side portion of each tip treatment piece has a facing surface portion, and an outer protrusion for scratch locking is formed on the outer surface tip portion on the opposite side to the facing surface portion. The electric ablation treatment tool for an endoscope according to claim 1. 前記先端処置部は、一対の前記先端処置片の各前記先端側部分の先端部に互いに当接して閉じ合う半球体部を有し、各前記先端側部分の前記半球体部よりも前記腕部寄りの部分を棒状部として形成し前記棒状部に前記ストッパ部材を備えている
ことを特徴とする請求項１に記載の内視鏡用電気焼灼処置具。 The tip treatment portion has a hemispherical portion that abuts and closes the tip portion of each of the tip side portions of the pair of tip treatment pieces, and the arm portion is more than the hemisphere portion of each tip side portion. The electric ablation treatment tool for an endoscope according to claim 1, wherein a portion closer to the rod is formed as a rod-shaped portion, and the rod-shaped portion is provided with the stopper member. 前記先端処置部は、閉じた状態ではすれ違い状に重なる一対の前記先端処置片がＬ形板状に形成され、かつ閉じた状態では一方の前記先端処置片の先端部が他方の前記先端処置片の先端部よりもすれ違い方向に突出する側方突出部を有する
ことを特徴とする請求項１に記載の内視鏡用電気焼灼処置具。 In the tip treatment portion, a pair of tip treatment pieces that are overlapped in a passing shape in a closed state are formed in an L-shaped plate shape, and in a closed state, the tip portion of one tip treatment piece is the other tip treatment piece. The electric ablation treatment tool for an endoscope according to claim 1, further comprising a lateral protrusion that protrudes in a passing direction from the tip of the endoscope. 前記先端処置片は、前記ストッパ部材を取り付けるためのくびれ部を有する
ことを特徴とする請求項１から４のいずれかに記載の内視鏡用電気焼灼処置具。 The electrocautery treatment tool for an endoscope according to any one of claims 1 to 4, wherein the tip treatment piece has a constricted portion for attaching the stopper member.

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