JP5613513B2 - Endoscopic treatment tool - Google Patents

Endoscopic treatment tool Download PDF

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JP5613513B2
JP5613513B2 JP2010216110A JP2010216110A JP5613513B2 JP 5613513 B2 JP5613513 B2 JP 5613513B2 JP 2010216110 A JP2010216110 A JP 2010216110A JP 2010216110 A JP2010216110 A JP 2010216110A JP 5613513 B2 JP5613513 B2 JP 5613513B2
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electrode portion
rod
distal end
shaped electrode
liquid
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JP2012070793A (en
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伊藤　宏治
宏治 伊藤
敏彦 伊▲崎▼
敏彦 伊▲崎▼
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Fujifilm Corp
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/148—Probes or electrodes therefor having a short, rigid shaft for accessing the inner body transcutaneously, e.g. for neurosurgery or arthroscopy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00982—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1475—Electrodes retractable in or deployable from a housing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2218/00—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2218/001—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
    • A61B2218/002—Irrigation
    • A61B2218/003—Irrigation using a spray or a foam
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/0067—Catheters; Hollow probes characterised by the distal end, e.g. tips

Description

本発明は、内視鏡用処置具に関する。   The present invention relates to an endoscope treatment tool.

従来、内視鏡を介して処置具を使用することにより、生体組織を切開・切除したり、凝固させて止血するなどの処置が行われている。このような処置には、例えば特許文献１のような高周波処置具が用いられる。特許文献１の高周波処置具の挿入部の先端には、棒状電極部と板状電極部とを有する電極が設けられており、この電極に高周波電流を通電することにより、電極が当接された生体組織の処置が可能となる。
更に、特許文献１の高周波処置具には、送液手段が設けられており、挿入部のシースを介して生理食塩水がシース先端の開口から送出されることにより、処置部位が洗浄される。 2. Description of the Related Art Conventionally, treatments such as incision and excision of a living tissue or coagulation and hemostasis are performed by using a treatment tool via an endoscope. For such treatment, for example, a high-frequency treatment instrument such as that disclosed in Patent Document 1 is used. An electrode having a rod-like electrode portion and a plate-like electrode portion is provided at the distal end of the insertion portion of the high-frequency treatment instrument of Patent Document 1, and the electrode is brought into contact with the electrode by applying a high-frequency current to the electrode. Treatment of living tissue becomes possible.
Furthermore, the high-frequency treatment instrument of Patent Document 1 is provided with a liquid feeding means, and the treatment site is washed by sending physiological saline from the opening at the distal end of the sheath through the sheath of the insertion portion.

特開２００４−３１３５３７号公報JP 2004-313537 A

高周波処置具を用いて生体組織の切開を行う際に、切開部位から生じた出血量が多い場合には出血点が不明確になり、止血処置がやりにくい。このような場合には、出血部位を洗浄して出血点を明確にする必要がある。このような切開、洗浄、そして止血という一連の処置の流れは、迅速に行われることが好ましい。しかしながら、シース先端の開口から噴出される液が、開口よりも前方に配置された板状電極部の裏面で遮られるため、出血を洗い流すのに時間が掛かってしまう。すなわち、目的部位に液を直接供給することが困難であるため、出血点がなかなか明確にならない。このため、送液のコントロール性能の向上が望まれていた。   When incising a living tissue using a high-frequency treatment tool, if the amount of bleeding generated from the incision site is large, the bleeding point becomes unclear and it is difficult to perform hemostasis treatment. In such a case, it is necessary to clean the bleeding site by cleaning the bleeding site. It is preferable that such a series of procedures of incision, washing, and hemostasis is performed quickly. However, since the liquid ejected from the opening at the distal end of the sheath is blocked by the back surface of the plate electrode portion arranged in front of the opening, it takes time to wash away bleeding. That is, since it is difficult to supply the liquid directly to the target site, the bleeding point is not easily clarified. For this reason, improvement of the control performance of liquid feeding was desired.

本発明の目的は、送液性能が向上された内視鏡用処置具を提供することにある。   The objective of this invention is providing the treatment tool for endoscopes with which the liquid feeding performance was improved.

体腔内に先端側から挿入されるシースと、前記シース内を介した送液に用いられる送液開口が前方に向かって形成されて前記シースの先端に設けられるキャップ部材と、前記キャップ部材に挿通された状態で支持される棒状電極部と、前記棒状電極部の前方端部から少なくとも正面視で放射状に拡がる先端部とを有し、
前記送液開口は、前記棒状電極部が挿通される支持孔を兼ね、前記キャップ部材の正面視において前記支持孔から径方向に沿ってそれぞれ延びる複数の延出部を有し、前記棒状電極部が当該送液開口に挿通された状態で前記棒状電極部の周囲にそれぞれ形成される複数の区画に分割されており、
前記送液開口における前記区画の各々の少なくとも一部が前記先端部から露呈し、前記送液開口の露呈した部分は、前記支持孔の全長にわたって該支持孔の軸方向に沿って延び、前記シース内に連通する内視鏡用処置具。 A sheath inserted into the body cavity from the distal end side, a cap member that is formed forwardly to form a liquid feed opening used for feeding liquid through the sheath, and provided at the distal end of the sheath; and inserted into the cap member A rod-shaped electrode portion that is supported in a state where the rod-shaped electrode portion is supported, and a distal end portion that extends radially from the front end portion of the rod-shaped electrode portion at least in a front view,
The liquid supply opening also serves as a support hole through which the rod-shaped electrode portion is inserted, and has a plurality of extending portions extending in the radial direction from the support hole in a front view of the cap member, and the rod-shaped electrode portion Is divided into a plurality of sections formed around the rod-shaped electrode portion in a state of being inserted through the liquid feeding opening,
At least a part of each of the compartments in the liquid supply opening is exposed from the tip, and the exposed part of the liquid supply opening extends along the axial direction of the support hole over the entire length of the support hole, and the sheath Endoscopic treatment tool communicating with the inside.

本発明の内視鏡処置具によれば、送液性能を向上させることができる。   According to the endoscope treatment tool of the present invention, the liquid feeding performance can be improved.

本発明の実施形態を説明するための一例である処置具の外観図である。It is an external view of the treatment tool which is an example for demonstrating embodiment of this invention. 挿入部先端の正面図である。It is a front view of the insertion part tip. 図２のIII−III線断面図である。It is the III-III sectional view taken on the line of FIG. 挿入部先端近傍の斜視図である。It is a perspective view of the insertion part tip vicinity. 本発明の実施形態を説明するための他の例である処置具の先端の正面図である。It is a front view of the front-end | tip of the treatment tool which is another example for describing embodiment of this invention. 本発明の実施形態を説明するための他の例である処置具の先端の正面図である。It is a front view of the front-end | tip of the treatment tool which is another example for describing embodiment of this invention. 本発明の実施形態を説明するための他の例である処置具の先端の正面図である。It is a front view of the front-end | tip of the treatment tool which is another example for describing embodiment of this invention. 本発明の実施形態を説明するための他の例である処置具の先端の正面図である。It is a front view of the front-end | tip of the treatment tool which is another example for describing embodiment of this invention.

図１〜図４を参照して、本発明の実施形態を説明するための内視鏡用処置具の一例について説明する。
図１は、内視鏡用処置具としての高周波ナイフ１の概略構成を示す外観図である。高周波ナイフ１は、スライド操作によりナイフ部を押し引きする操作部２０と、図示しない内視鏡の処置具用チャンネルを介して体腔内に先端側から挿入され、先端にナイフ部が設けられた挿入部３０とを備えている。 With reference to FIGS. 1-4, an example of the treatment tool for endoscopes for demonstrating embodiment of this invention is demonstrated.
FIG. 1 is an external view showing a schematic configuration of a high-frequency knife 1 as an endoscope treatment tool. The high-frequency knife 1 is inserted into the body cavity from the distal end side through an operation portion 20 that pushes and pulls the knife portion by a slide operation, and a treatment instrument channel (not shown), and is inserted with a knife portion at the distal end. Part 30.

操作部２０は、指掛け孔２１Ａが設けられた軸部２１と、指掛け孔２２Ａ，２２Ａが設けられ、軸部２１に対してスライド可能に設けられたスライダ２２とを有する。軸部２１には、送液手段としてのシリンジ２４が取り付けられるコネクタ２５が設けられている。このコネクタ２５に連通する送液経路３５（図３）が軸部２１及び挿入部３０の内部に形成されている。スライダ２２には、軸部２１及び挿入部３０に内包される導電性のワイヤ２３（図３）の端部が固定されるとともに、外部端子２６が設けられている。この外部端子２６は、図示しない高周波電源に接続される。   The operation unit 20 includes a shaft part 21 provided with a finger hooking hole 21 </ b> A and a slider 22 provided with finger hooking holes 22 </ b> A and 22 </ b> A so as to be slidable with respect to the shaft part 21. The shaft portion 21 is provided with a connector 25 to which a syringe 24 as a liquid feeding means is attached. A liquid feeding path 35 (FIG. 3) communicating with the connector 25 is formed inside the shaft portion 21 and the insertion portion 30. The end portion of the conductive wire 23 (FIG. 3) contained in the shaft portion 21 and the insertion portion 30 is fixed to the slider 22, and an external terminal 26 is provided. The external terminal 26 is connected to a high frequency power source (not shown).

図２は、挿入部３０の先端の正面図である。図３は、図２のIII−III線断面図である。挿入部３０は、可撓性を有するシース３１と、シース３１の先端に設けられた絶縁性のキャップ部材３２と、キャップ部材３２に支持されるナイフ部４０とを有する。
シース３１は、例えば、密巻コイル３１１と、この密巻コイル３１１の外周を被覆する絶縁性チューブ３１２とを含んで形成されている。密巻コイル３１１の先端には、キャップ部材３２の基端部が外嵌状態で固定されている。シース３１内には、ワイヤ２３が挿通されており、ワイヤ２３の先端には導電性のストッパ部２３１が設けられている。このストッパ部２３１がキャップ部材３２に当接することにより、ワイヤ２３の先端部がシース３１内に保持されている。 FIG. 2 is a front view of the distal end of the insertion portion 30. 3 is a cross-sectional view taken along line III-III in FIG. The insertion portion 30 includes a flexible sheath 31, an insulating cap member 32 provided at the distal end of the sheath 31, and a knife portion 40 supported by the cap member 32.
The sheath 31 is formed including, for example, a closely wound coil 311 and an insulating tube 312 that covers the outer periphery of the closely wound coil 311. The proximal end portion of the cap member 32 is fixed to the distal end of the closely wound coil 311 in an externally fitted state. A wire 23 is inserted into the sheath 31, and a conductive stopper portion 231 is provided at the tip of the wire 23. When the stopper portion 231 comes into contact with the cap member 32, the distal end portion of the wire 23 is held in the sheath 31.

キャップ部材３２には、棒状電極部４１が挿通される支持孔３３と、前方に向かって開口する送液開口３４とが一体に形成されている。換言すると、送液開口３４は、支持孔３３を兼ねている。支持孔３３は、シース３１と同軸に形成されている。
送液開口３４は、図２のように正面視十字状に形成され、棒状電極部４１が挿通された状態で棒状電極部４１の周囲にそれぞれ形成される複数の延出部としての小区画３４１〜３４４に分割される。これらの小区画３４１〜３４４は、棒状電極部４１を中心としてキャップ部材３２の径方向にそれぞれ延び、キャップ部材３２の周方向において一定間隔で形成されている。このような送液開口３４は、シース３１内の送液経路３５と連通している。 The cap member 32 is integrally formed with a support hole 33 through which the rod-shaped electrode portion 41 is inserted and a liquid feed opening 34 that opens forward. In other words, the liquid feed opening 34 also serves as the support hole 33. The support hole 33 is formed coaxially with the sheath 31.
The liquid feed opening 34 is formed in a cross shape when viewed from the front as shown in FIG. 2, and a small section 341 as a plurality of extending portions formed around the rod-shaped electrode portion 41 in a state where the rod-shaped electrode portion 41 is inserted. It is divided into ˜344. These small sections 341 to 344 extend in the radial direction of the cap member 32 with the rod-shaped electrode portion 41 as the center, and are formed at regular intervals in the circumferential direction of the cap member 32. Such a liquid supply opening 34 communicates with a liquid supply path 35 in the sheath 31.

ナイフ部４０は、ストッパ部２３１に後方端部が固定された棒状電極部４１と、棒状電極部４１の前方端部に設けられる先端部としての先端電極部４２とを有する。棒状電極部４１は、操作部２０のスライド操作によるワイヤ２３の進退に連動し、支持孔３３の内部を摺動する。
先端電極部４２は、棒状電極部４１の前方端部から棒状電極部４１の軸心を中心として正面視放射状に拡がる円形の板状に形成される。先端電極部４２の先端面の面積は、止血処理を効率良く行ううえでは大きいことが好ましい。この先端電極部４２、送液開口３４、及び棒状電極部４１はそれぞれ、シース３１と同軸に設けられる。 The knife portion 40 includes a rod-shaped electrode portion 41 whose rear end portion is fixed to the stopper portion 231, and a tip electrode portion 42 as a tip portion provided at the front end portion of the rod-shaped electrode portion 41. The rod-shaped electrode part 41 slides inside the support hole 33 in conjunction with the advancement and retraction of the wire 23 by the slide operation of the operation part 20.
The tip electrode portion 42 is formed in a circular plate shape that radiates from the front end portion of the rod-shaped electrode portion 41 radially about the axis center of the rod-shaped electrode portion 41. The area of the tip surface of the tip electrode portion 42 is preferably large in order to efficiently perform hemostasis processing. The tip electrode part 42, the liquid supply opening 34, and the rod-like electrode part 41 are each provided coaxially with the sheath 31.

ここで、図２に示すように、キャップ部材３２の正面視において、先端電極部４２の外周から送液開口３４の一部が露呈する。すなわち、先端電極部４２の最小外径（本例では直径）Ｄ１は、送液開口３４の棒状電極部４１の軸心を中心とした最大外径Ｄ２よりも小さい。なお、送液開口３４の最大外径Ｄ２は、小区画３４１〜３４４を内包する最小円の直径を意味する。   Here, as shown in FIG. 2, in the front view of the cap member 32, a part of the liquid feeding opening 34 is exposed from the outer periphery of the tip electrode portion 42. That is, the minimum outer diameter (diameter in this example) D1 of the tip electrode portion 42 is smaller than the maximum outer diameter D2 centering on the axis of the rod-shaped electrode portion 41 of the liquid delivery opening 34. The maximum outer diameter D2 of the liquid feeding opening 34 means the diameter of the smallest circle that encloses the small sections 341 to 344.

ナイフ部４０は、ワイヤ２３の進退に連動し、キャップ部材３２に先端電極部４２の裏面が当接された収納状態と、キャップ部材３２に対して先端電極部４２が離間した突出状態とに進退可能とされている。なお、本例の構成にかかわらず、キャップ部材３２の前方端部からシース３１が前方に突出していてもよい。この場合には、収納状態においてシース３１の内側に先端電極部４２が格納される。   The knife portion 40 is interlocked with the advancement and retraction of the wire 23, and is advanced and retracted into a storage state in which the back surface of the tip electrode portion 42 is in contact with the cap member 32 and a protruding state in which the tip electrode portion 42 is separated from the cap member 32. It is possible. Regardless of the configuration of the present example, the sheath 31 may protrude forward from the front end of the cap member 32. In this case, the tip electrode portion 42 is stored inside the sheath 31 in the stored state.

以上説明した高周波ナイフ１を使用する際には、内視鏡の処置具用チャンネルを介して、ナイフ部４０を収納状態とした状態の高周波ナイフ１を体腔内の処置対象部位まで挿入する。そして、スライド操作によりナイフ部４０をシース３１に対して突出状態としてから、ナイフ部４０に高周波電流を印加し、棒状電極部４１を使用して対象部位の切開又は切除を行う。この際に出血があった場合には送液手段によりシース３１を通じて生理食塩水を圧送し、送液開口３４から生理食塩水を噴出させる。このようにして対象部位を洗浄してから、先端電極部４２の先端面を対象部位に当接させて生体組織を凝固させることで止血を行う。   When the high-frequency knife 1 described above is used, the high-frequency knife 1 in a state where the knife portion 40 is stored is inserted to the treatment target site in the body cavity via the treatment instrument channel of the endoscope. Then, after the knife portion 40 is projected from the sheath 31 by a slide operation, a high-frequency current is applied to the knife portion 40 and the target portion is incised or excised using the rod-shaped electrode portion 41. If bleeding occurs at this time, physiological saline is pumped through the sheath 31 by the liquid feeding means, and the physiological saline is ejected from the liquid feeding opening 34. After washing the target site in this way, hemostasis is performed by coagulating the living tissue by bringing the tip surface of the tip electrode portion 42 into contact with the target site.

図４は、挿入部３０先端近傍の斜視図であり、送液開口３４から生理食塩水が前方に噴射される状態を示す。このとき、送液開口３４から噴射された生理食塩水が先端電極部４２の外周部を越えて対象部位に向かって水勢が良好な状態で直進する。送液開口３４の一部が先端電極部４２の外周から露呈することにより、生理食塩水の噴射流は、先端電極部４２の外周部を越えて、対象部位又は対象部位近傍に集束する。このように所望の対象部位に直接にかつ確実に液が供給されるので、送液のコントロール性能が高い。これにより、対象部位が迅速に洗浄されるので、出血点が早く明らかになり、次の止血処理を迅速に行うことができる。なお、出血点の把握が容易なため、洗浄を行いながらの止血処置も行い得る。   FIG. 4 is a perspective view of the vicinity of the distal end of the insertion portion 30 and shows a state in which physiological saline is jetted forward from the liquid feeding opening 34. At this time, the physiological saline sprayed from the liquid feeding opening 34 goes straight over the outer peripheral portion of the tip electrode portion 42 toward the target portion with a good water flow. When a part of the liquid feed opening 34 is exposed from the outer periphery of the tip electrode portion 42, the saline flow is focused on the target site or the vicinity of the target site beyond the outer periphery of the tip electrode portion 42. As described above, since the liquid is directly and surely supplied to a desired target site, the liquid feeding control performance is high. As a result, the target site is quickly washed, so that the bleeding point becomes clear early, and the next hemostasis process can be performed quickly. In addition, since it is easy to grasp the bleeding point, a hemostatic treatment can be performed while washing.

図５は、本発明の実施形態を説明するための他の例である処置具の先端の正面図である。本例では、棒状電極部４１が挿通される支持孔３３とは別に２つの半円形状の送液開口４４が形成されている。送液開口４４，４４の集合により、送液開口のほぼ円形状の外周形状が把握される。これらの送液開口４４，４４を内包する最小円の直径Ｄ３に比較して、先端電極部４２の直径Ｄ１は小さい。このため、各送液開口４４から生理食塩水が前方に向かって真っ直ぐに噴射される。   FIG. 5 is a front view of the distal end of a treatment instrument which is another example for explaining the embodiment of the present invention. In this example, two semicircular liquid feeding openings 44 are formed separately from the support hole 33 through which the rod-shaped electrode portion 41 is inserted. By the collection of the liquid feeding openings 44, 44, the substantially circular outer peripheral shape of the liquid feeding opening is grasped. The diameter D1 of the tip electrode portion 42 is smaller than the diameter D3 of the minimum circle containing these liquid supply openings 44, 44. For this reason, the physiological saline is sprayed straightly from each liquid supply opening 44 toward the front.

図６は、本発明の実施形態を説明するための他の例である処置具の先端の正面図である。棒状電極部４１が挿通される支持孔を兼ねる送液開口５４は、三角形状に形成され、棒状電極部４１の周囲にそれぞれ形成される複数の小区画５４１〜５４３に分割される。これら小区画５４１〜５４３を内包する最小円の直径Ｄ４と比較して、先端電極部４２の直径Ｄ１は小さい。このため、送液開口４４から生理食塩水が前方に向かって直進する。   FIG. 6 is a front view of the distal end of a treatment instrument which is another example for explaining the embodiment of the present invention. The liquid supply opening 54 that also serves as a support hole through which the rod-shaped electrode portion 41 is inserted is formed in a triangular shape, and is divided into a plurality of small sections 541 to 543 formed around the rod-shaped electrode portion 41. The diameter D1 of the tip electrode portion 42 is smaller than the diameter D4 of the smallest circle that includes these small sections 541-543. For this reason, the physiological saline advances straight forward from the liquid feed opening 44.

図７は、本発明の実施形態を説明するための他の例である処置具の先端の正面図である。
上記の図６の例において送液開口５４が三角形状に形成されていたのに対して、図７では先端電極部５２が三角形状に形成されている。このような三角形状の先端電極部５２は、処置対象部位の面積が狭い場合でも、先端電極部５２の先端面を対象部位に対して斜めに傾けて、三角形の頂点部分を使用して止血などの処置が行えるという利点がある。この先端電極部５２の最小外径（三角形の内接円の直径）Ｄ５は、円弧状の２つの送液開口６４，６４を内包する最小円の直径Ｄ６に比較して小さい。このため、各送液開口６４から生理食塩水が前方に向かって直進する。 FIG. 7 is a front view of the distal end of a treatment instrument which is another example for explaining the embodiment of the present invention.
In the example of FIG. 6 described above, the liquid supply opening 54 is formed in a triangular shape, whereas in FIG. 7, the tip electrode portion 52 is formed in a triangular shape. Even if the area of the treatment target site is small, such a triangular tip electrode part 52 tilts the tip surface of the tip electrode part 52 obliquely with respect to the target site and uses the apex part of the triangle to stop bleeding. There is an advantage that the treatment can be performed. The minimum outer diameter (diameter of a triangular inscribed circle) D5 of the tip electrode portion 52 is smaller than the diameter D6 of the minimum circle that includes the two arc-shaped liquid supply openings 64, 64. For this reason, the physiological saline goes straight forward from each liquid feeding opening 64.

図８は、本発明の実施形態を説明するための他の例である処置具の先端の正面図である。図６と同様の送液開口５４と、図７と同様の先端電極部５２とは、いずれも三角形状に形成されている。先端電極部５２は、棒状電極部４１の軸心を中心とした円周上の基準位置からの位相が送液開口５４とは６０°相違するように設けられている。先端電極部５２の最小外径（三角形の内接円の直径）Ｄ５は、送液開口５４の小区画５４１〜５４３を内包する最小円の直径Ｄ４に比較して小さい。このため、送液開口５４から生理食塩水が前方に向かって直進する。   FIG. 8 is a front view of the distal end of a treatment instrument which is another example for explaining the embodiment of the present invention. Both the liquid feed opening 54 similar to FIG. 6 and the tip electrode portion 52 similar to FIG. 7 are formed in a triangular shape. The tip electrode portion 52 is provided such that the phase from the reference position on the circumference centered on the axis of the rod-shaped electrode portion 41 is 60 ° different from the liquid feed opening 54. The minimum outer diameter (diameter of a triangular inscribed circle) D5 of the tip electrode portion 52 is smaller than the diameter D4 of the minimum circle containing the small sections 541 to 543 of the liquid feeding opening 54. For this reason, the physiological saline advances straight forward from the liquid supply opening 54.

なお、先端電極部及び送液開口は、正面視において、円形、三角形の他、四角形、五角形などの多角形や、それ以外の回転対称図形（例えば星型、矢車型）、あるいは不規則な非円形の形状などであってもよい。送液開口は、多数の小さい孔の集合から形成されていてもよい。
また、先端電極部は、正面視の外周形状が円形、多角形等であって、その内部が貫通孔により抜けている形状とされていてもよい。この場合、その貫通孔から送液開口が露呈する。
更に、先端電極部は板状に限らず、球状や半球状など、棒状電極部の前方端部から膨出する形状とされていてもよい。つまり、先端電極部は少なくとも正面視において放射状に拡がる形状とされていればよい。
また更に、棒状電極部及びキャップ部材の支持孔の各断面形状は、円形に限らず、四角形や三角形などであってもよい。 In addition, the front electrode portion and the liquid supply opening may have a circular shape, a triangular shape, a polygonal shape such as a quadrilateral shape, a pentagonal shape, other rotationally symmetric figures (for example, a star shape, a squirrel shape), or an irregular non-circular shape. A circular shape or the like may be used. The liquid delivery opening may be formed from a collection of many small holes.
The tip electrode portion may have a circular shape, a polygonal shape, or the like when viewed from the front, and the inside of the tip electrode portion may be removed by a through hole. In this case, the liquid feeding opening is exposed from the through hole.
Furthermore, the tip electrode portion is not limited to a plate shape, and may have a shape bulging from the front end portion of the rod-like electrode portion, such as a spherical shape or a hemispherical shape. That is, the tip electrode part should just be made into the shape which expands radially in front view.
Furthermore, the cross-sectional shapes of the rod-shaped electrode portion and the support hole of the cap member are not limited to a circle, but may be a square or a triangle.

以上説明した構成ではナイフ部の先端部は先端電極部であったが、この先端電極部の代わりに、棒状電極部の前方端部から少なくとも正面視で放射状に拡がった形状の絶縁性部材が設けられていてもよい。この絶縁性部材は、先端電極部と同様に、種々の形状とされていてよい。このような絶縁性部材は、例えば、棒状電極部による切開の際に、切開対象とされた部位以外の部位を保護する役割を果たす。   In the configuration described above, the tip portion of the knife portion was the tip electrode portion, but instead of this tip electrode portion, an insulating member having a shape radially extending from the front end portion of the rod-like electrode portion at least in front view is provided. It may be done. This insulating member may have various shapes like the tip electrode portion. Such an insulating member plays a role of protecting a portion other than the portion to be incised, for example, at the time of incision by the rod-shaped electrode portion.

以上の通り、本明細書には次の事項が開示されている。
（１） 体腔内に先端側から挿入されるシースと、前記シース内を介した送液に用いられる送液開口が前方に向かって形成されて前記シースの先端に設けられるキャップ部材と、前記キャップ部材に挿通された状態で支持される棒状電極部と、前記棒状電極部の前方端部から少なくとも正面視で放射状に拡がる先端部とを有し、
前記キャップ部材の正面視において、前記送液開口の少なくとも一部が前記先端部から露呈する内視鏡用処置具。
この処置具によれば、先端部の後方から噴射された液が先端部で遮られてしまわずに、先端部前方に直進するので、より遠方まで液が噴射され、目的部位に液を直接供給することが可能となる。このように直進性に関して制御された噴射流により、送液のコントロール性能を向上させることができる。このため、対象部位の洗浄を迅速にかつ確実に行える。 As described above, the following items are disclosed in this specification.
(1) A sheath inserted into a body cavity from the distal end side, a cap member formed at the distal end of the sheath in which a liquid feeding opening used for liquid feeding through the sheath is formed forward, and the cap A rod-shaped electrode portion supported in a state of being inserted through the member, and a tip portion radially extending from the front end portion of the rod-shaped electrode portion at least in a front view,
An endoscope treatment tool in which at least a part of the liquid supply opening is exposed from the distal end portion in a front view of the cap member.
According to this treatment tool, the liquid sprayed from the back of the tip is not blocked by the tip, but goes straight forward of the tip, so that the liquid is sprayed farther and the liquid is directly supplied to the target site. It becomes possible to do. Thus, the control performance of liquid feeding can be improved by the jet flow controlled with respect to straightness. For this reason, the target part can be cleaned quickly and reliably.

（２） （１）の内視鏡用処理具であって、
前記送液開口は、正面視で、前記棒状電極部を中心として当該棒状電極部の径方向に沿ってそれぞれ延びる複数の延出部を有する内視鏡用処置具。
この処置具によれば、先端部を例えば正面視円形状などとして先端部の面積を大きく確保しつつ、送液開口の延出部によって、先端部外周から露呈する送液開口の部分を形成することができる（例えば図２の構成）。すなわち、細径の処置具にあっても、先端部による止血性能あるいは保護性能と、送液開口を介した送液性能とを良好なバランスで向上させることができる。 (2) The endoscope processing tool according to (1),
The liquid supply opening is a treatment instrument for an endoscope having a plurality of extending portions extending in the radial direction of the rod-shaped electrode portion around the rod-shaped electrode portion as viewed from the front.
According to this treatment tool, the portion of the liquid feed opening exposed from the outer periphery of the tip end portion is formed by the extending portion of the liquid feed opening while ensuring the area of the tip end portion with a circular shape when viewed from the front, for example. (For example, the configuration of FIG. 2). That is, even with a small-diameter treatment instrument, it is possible to improve the hemostasis performance or protection performance by the distal end portion and the liquid feeding performance through the liquid feeding opening with a good balance.

（３） （１）又は（２）の内視鏡用処理具であって、
前記先端部は、多角形状とされる内視鏡用処置具。
この処置具によれば、先端部の面積を大きく確保しても、送液開口を例えば正面視円形状などとすることで、多角形状とされた先端部の外周から送液開口の一部を露出させることができる（例えば図７の構成）。すなわち、細径の処置具にあっても、先端部による止血性能あるいは保護性能と、送液開口を介した送液性能とを良好なバランスで向上させることができる。 (3) The endoscope processing tool according to (1) or (2),
The distal end portion is an endoscope treatment tool having a polygonal shape.
According to this treatment tool, even if the area of the distal end portion is large, a part of the liquid delivery opening is formed from the outer periphery of the distal end portion having a polygonal shape by making the liquid delivery opening circular, for example, when viewed from the front. It can be exposed (for example, the structure of FIG. 7). That is, even with a small-diameter treatment instrument, it is possible to improve the hemostasis performance or protection performance by the distal end portion and the liquid feeding performance through the liquid feeding opening with a good balance.

（４） （１）から（３）のいずれか一項に記載の内視鏡用処理具であって、
前記先端部及び前記送液開口はいずれも、同一の回転対称図形とされ、互いの位相が相違する状態に設けられる内視鏡用処置具。
この処置具によれば、位相が相違することで、先端部と送液開口とが重ならない部分が形成される（例えば図８の構成）。すなわち、先端部の径方向の寸法を送液開口の径方向の寸法と同一程度に大きく確保でき、先端部による止血性能あるいは保護性能と、送液開口を介した送液性能とを良好なバランスで向上させることができる。 (4) The endoscope processing tool according to any one of (1) to (3),
An endoscope treatment tool in which the distal end portion and the liquid supply opening are both formed in the same rotationally symmetric figure and are in different phases.
According to this treatment instrument, a portion where the tip portion and the liquid delivery opening do not overlap is formed by the difference in phase (for example, the configuration of FIG. 8). That is, the radial dimension of the tip can be ensured to be as large as the radial dimension of the liquid delivery opening, and a good balance between the hemostatic performance or protection performance by the tip and the liquid delivery performance through the liquid delivery opening. Can be improved.

（５） （１）から（４）のいずれか一項に記載の内視鏡用処置具であって、
前記送液開口は、前記棒状電極部の周囲に複数設けられ、これら複数の送液開口の集合により、前記送液開口の外周形状が把握される内視鏡用処置具。
この処置具によれば、棒状電極部の周囲において、外周形状がほぼ円形の送液開口の集合を配置できるので（例えば、図５、図７の構成）、送液開口から噴出された噴射流の断面がほぼ円形となる。これにより、処置の対象部位を洗浄し易くなる。また、各送液開口の位置や形状等を決めることにより、噴射流を制御し易くなる。
なお、複数の送液開口が設けられている場合において、その複数の送液開口の集合から把握される外周形状は、必ずしも円形でなくてもよく、多角形状や十字状、星型などであってもよい。更には、複数の送液開口から特定の外周形状が把握されない構成、例えば、送液開口としての多数の小孔が散在する構成であってもよい。 (5) The treatment instrument for an endoscope according to any one of (1) to (4),
A treatment instrument for an endoscope in which a plurality of the liquid feeding openings are provided around the rod-shaped electrode portion, and an outer peripheral shape of the liquid feeding opening is grasped by a collection of the plurality of liquid feeding openings.
According to this treatment tool, a collection of liquid feeding openings having a substantially circular outer peripheral shape can be arranged around the rod-shaped electrode portion (for example, the configuration shown in FIGS. 5 and 7), so that the jet flow ejected from the liquid feeding opening The cross section of this becomes substantially circular. Thereby, it becomes easy to wash | clean the object site | part of treatment. Moreover, it becomes easy to control the jet flow by determining the position, shape and the like of each liquid feed opening.
In the case where a plurality of liquid feeding openings are provided, the outer peripheral shape grasped from the set of the plurality of liquid feeding openings does not necessarily have to be a circle, and may be a polygonal shape, a cross shape, a star shape, or the like. May be. Furthermore, a configuration in which a specific outer peripheral shape is not grasped from a plurality of liquid feeding openings, for example, a configuration in which a large number of small holes as liquid feeding openings are scattered may be used.

（６） （１）から（４）のいずれか一項に記載の内視鏡用処置具であって、
前記送液開口は、前記棒状電極部が挿通される支持孔を兼ね、かつ前記棒状電極部が当該送液開口に挿通された状態で前記棒状電極部の周囲にそれぞれ形成される複数の区画に分割される内視鏡用処置具。
この処置具によれば、送液開口が支持孔を兼ねていることで（例えば、図２、図６、図８）、細径のシースであっても送液開口及び支持孔のそれぞれの形成が容易となる。
また、複数区画のそれぞれの位置や形状等を決めることにより、噴射流を制御し易くなる。 (6) The treatment instrument for an endoscope according to any one of (1) to (4),
The liquid supply opening serves as a support hole through which the rod-shaped electrode portion is inserted, and is formed in a plurality of sections formed around the rod-shaped electrode portion in a state where the rod-shaped electrode portion is inserted into the liquid supply opening. Endoscopic treatment tool to be divided.
According to this treatment instrument, since the liquid supply opening also serves as the support hole (for example, FIG. 2, FIG. 6, FIG. 8), each of the liquid supply opening and the support hole is formed even if the sheath has a small diameter. Becomes easy.
Moreover, it becomes easy to control an injection flow by determining each position, shape, etc. of several division.

（７） （５）又は（６）の内視鏡用処置具であって、
前記複数の送液開口又は前記複数の区画は、前記キャップ部材の周方向において一定間隔で形成される内視鏡用処置具。
この処置具によれば、複数の送液開口又は複数の区画がキャップ部材の周方向で一定間隔で形成されることにより（例えば、図２、図５〜８の構成）噴射流がキャップ部材の周方向において均一化されるので、処置対象部位を洗浄し易くなる。 (7) The endoscopic treatment tool according to (5) or (6),
The treatment instrument for an endoscope, wherein the plurality of liquid feeding openings or the plurality of sections are formed at regular intervals in a circumferential direction of the cap member.
According to this treatment instrument, a plurality of liquid supply openings or a plurality of sections are formed at regular intervals in the circumferential direction of the cap member (for example, the configuration of FIGS. 2 and 5 to 8). Since it is made uniform in the circumferential direction, it becomes easy to wash the treatment target site.

（８） （１）から（７）のいずれか一項に記載の内視鏡用処置具であって、
前記先端部、前記送液開口、及び前記棒状電極部は、前記シースとそれぞれ同軸に設けられる内視鏡用処置具。
この処置具によれば、先端部、送液開口、及び棒状電極部のそれぞれの位置関係及び形状を規定し易くなる。 (8) The treatment instrument for an endoscope according to any one of (1) to (7),
The distal end portion, the liquid supply opening, and the rod-shaped electrode portion are endoscope treatment tools provided coaxially with the sheath.
According to this treatment tool, it becomes easy to define the positional relationship and shape of each of the distal end portion, the liquid feeding opening, and the rod-shaped electrode portion.

（９） （１）から（８）のいずれか一項に記載の内視鏡用処置具であって、
前記先端部は、導電性の部材とされる内視鏡用処置具。
この処置具によれば、導電性の先端部に高周波電流を印加することにより、先端部を使用した止血処置が可能となる。 (9) The treatment instrument for an endoscope according to any one of (1) to (8),
The distal end portion is an endoscopic treatment tool that is a conductive member.
According to this treatment tool, a hemostatic treatment using the tip can be performed by applying a high-frequency current to the conductive tip.

（１０） （１）から（８）のいずれか一項に記載の内視鏡用処置具であって、
前記先端部は、少なくとも一部が絶縁性の部材とされる内視鏡用処置具。
この処置具によれば、棒状電極部による切開・切除の際に、処置対象の部位以外の部位を絶縁性の先端部によって保護することが可能となる。 (10) The treatment instrument for an endoscope according to any one of (1) to (8),
At least a part of the distal end portion is an endoscope treatment tool.
According to this treatment tool, it is possible to protect a part other than the part to be treated by the insulating tip part at the time of incision and excision by the rod-shaped electrode part.

１ 高周波ナイフ（内視鏡用処置具）
２０ 操作部
２１ 軸部
２２ スライダ
２３ ワイヤ
２４ シリンジ
２５ コネクタ
２６ 外部端子
３０ 挿入部
３１ シース
３２ キャップ部材
３３ 支持孔
３４ 送液開口
３５ 送液経路
４０ ナイフ部
４１ 棒状電極部
４２ 先端電極部（先端部）
４４ 送液開口
５２ 先端電極部（先端部）
５４ 送液開口
６４ 送液開口
２３１ ストッパ部
３１１ 密巻コイル
３１２ 絶縁性チューブ
３４１〜３４４ 小区画
５４１〜５４３ 小区画
Ｄ１ 直径
Ｄ２ 最大外径
Ｄ３ 最小円の直径
Ｄ４ 最小円の直径
Ｄ５ 最小外径
Ｄ６ 最小円の直径 1 High-frequency knife (endoscopic instrument)
20 Operation part 21 Shaft part 22 Slider 23 Wire 24 Syringe 25 Connector 26 External terminal 30 Insertion part 31 Sheath 32 Cap member 33 Support hole 34 Liquid feed opening 35 Liquid feed path 40 Knife part 41 Rod-shaped electrode part 42 Tip electrode part (tip part) )
44 Liquid feed opening 52 Tip electrode part (tip part)
54 Liquid feed opening 64 Liquid feed opening 231 Stopper portion 311 Closely wound coil 312 Insulating tubes 341 to 344 Small section 541 to 543 Small section D1 Diameter D2 Maximum outer diameter D3 Minimum circle diameter D4 Minimum circle diameter D5 Minimum outer diameter D6 Minimum circle diameter

Claims (6)

体腔内に先端側から挿入されるシースと、前記シース内を介した送液に用いられる送液開口が前方に向かって形成されて前記シースの先端に設けられるキャップ部材と、前記キャップ部材に挿通された状態で支持される棒状電極部と、前記棒状電極部の前方端部から少なくとも正面視で放射状に拡がる先端部とを有し、
前記送液開口は、前記棒状電極部が挿通される支持孔を兼ね、前記キャップ部材の正面視において前記支持孔から径方向に沿ってそれぞれ延びる複数の延出部を有し、前記棒状電極部が当該送液開口に挿通された状態で前記棒状電極部の周囲にそれぞれ形成される複数の区画に分割されており、
前記送液開口における前記区画の各々の少なくとも一部が前記先端部から露呈し、前記送液開口の露呈した部分は、前記支持孔の全長にわたって該支持孔の軸方向に沿って延び、前記シース内に連通する内視鏡用処置具。 A sheath inserted into the body cavity from the distal end side, a cap member that is formed forwardly to form a liquid feed opening used for feeding liquid through the sheath, and provided at the distal end of the sheath; and inserted into the cap member A rod-shaped electrode portion that is supported in a state where the rod-shaped electrode portion is supported, and a distal end portion that extends radially from the front end portion of the rod-shaped electrode portion at least in a front view,
The liquid supply opening also serves as a support hole through which the rod-shaped electrode portion is inserted, and has a plurality of extending portions extending in the radial direction from the support hole in a front view of the cap member, and the rod-shaped electrode portion Is divided into a plurality of sections formed around the rod-shaped electrode portion in a state of being inserted through the liquid feeding opening,
At least a part of each of the compartments in the liquid supply opening is exposed from the tip, and the exposed part of the liquid supply opening extends along the axial direction of the support hole over the entire length of the support hole, and the sheath Endoscopic treatment tool communicating with the inside. 請求項１に記載の内視鏡用処理具であって、
前記先端部は、多角形状とされる内視鏡用処置具。 The endoscope processing tool according to claim 1,
The distal end portion is an endoscope treatment tool having a polygonal shape. 請求項１又は２に記載の内視鏡用処理具であって、
前記複数の送液開口又は前記複数の区画は、前記キャップ部材の周方向において一定間隔で形成される内視鏡用処置具。 It is the processing tool for endoscopes according to claim 1 or 2 ,
The treatment instrument for an endoscope, wherein the plurality of liquid feeding openings or the plurality of sections are formed at regular intervals in a circumferential direction of the cap member. 請求項１から３のいずれか一項に記載に記載の内視鏡用処理具であって、
前記先端部、前記送液開口、及び前記棒状電極部は、前記シースとそれぞれ同軸に設けられる内視鏡用処置具。 It is the processing tool for endoscopes as described in any one of Claim 1 to 3 ,
The distal end portion, the liquid supply opening, and the rod-shaped electrode portion are endoscope treatment tools provided coaxially with the sheath. 請求項１から４のいずれか一項に記載に記載の内視鏡用処理具であって、
前記先端部は、導電性の部材とされる内視鏡用処置具。 It is the processing tool for endoscopes as described in any one of Claim 1 to 4 , Comprising:
The distal end portion is an endoscopic treatment tool that is a conductive member. 請求項１から４のいずれか一項に記載に記載の内視鏡用処理具であって、
前記先端部は、少なくとも一部が絶縁性の部材とされる内視鏡用処置具。 It is the processing tool for endoscopes as described in any one of Claim 1 to 4 , Comprising:
At least a part of the distal end portion is an endoscope treatment tool.
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