JP5613518B2 - Endoscopic treatment tool - Google Patents

Endoscopic treatment tool Download PDF

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JP5613518B2
JP5613518B2 JP2010223292A JP2010223292A JP5613518B2 JP 5613518 B2 JP5613518 B2 JP 5613518B2 JP 2010223292 A JP2010223292 A JP 2010223292A JP 2010223292 A JP2010223292 A JP 2010223292A JP 5613518 B2 JP5613518 B2 JP 5613518B2
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liquid
treatment tool
endoscope
tip
sheath
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JP2012075657A (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

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.

内視鏡の鉗子チャンネルに内視鏡用の処置具を挿入し、内視鏡挿入部の先端に開口する鉗子口から処置具先端を突出させて、生体組織の切開・切除や、凝固させて止血する等の各種の処置が内視鏡の術式と共に行われる。このような処置として、例えば特許文献１に示される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先端には、棒状電極部と板状電極部からなる電極が設けられており、これら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への上記処置が可能となる。さらに、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。   Insert an endoscopic treatment tool into the forceps channel of the endoscope, project the distal end of the treatment tool from the forceps opening that opens at the distal end of the endoscope insertion section, and incise and excise biological tissue. Various treatments such as hemostasis are performed together with an endoscopic technique. As such a treatment, for example, a high-frequency treatment instrument as shown in Patent Document 1 is used. An electrode composed of a rod-like electrode part and a plate-like electrode part is provided at the distal end of the insertion part of the high-frequency treatment instrument of Patent Document 1, and a living body in which the electrode is brought into contact by applying a high-frequency current to these electrodes. The above treatment to the tissue becomes possible. Further, 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 of the sheath tip 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、切開部位から生じた出血量が多い場合には出血点を特定することが難しくなり、止血処置を行いにくくなる。その場合には、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、術者によって迅速に行われることが好ましい。しかしながら、上記高周波処置具においては、シース先端の開口から噴出される液が、その開口の前方に配置された板状電極部の平坦な裏面で遮られ、所望の目的部位への液供給が困難となる。そのため、出血を洗い流すのに時間が掛かり、出血点をなかなか明確にすることができない。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, it is difficult to specify a bleeding point and it is difficult to perform hemostasis treatment. In that case, it is necessary to wash the bleeding site and clarify the bleeding point. It is preferable that such a series of procedures of incision, washing, and hemostasis is promptly performed by an operator. However, in the above-described high-frequency treatment instrument, the liquid ejected from the opening at the distal end of the sheath is blocked by the flat back surface of the plate electrode portion arranged in front of the opening, and it is difficult to supply the liquid to a desired target site. It becomes. Therefore, it takes time to wash away the bleeding, and it is difficult to clarify the bleeding point. 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.

本発明は下記構成からなる。
内視鏡に用いられる内視鏡用処置具であって、
先端と基端と長手軸とを有し、電気絶縁性を有する管状部材からなるシースと、
前記シースの内部に前記長手軸の方向に進退自在に配置された導電性操作ワイヤと、
前記シースの基端側に設けられ、前記導電性操作ワイヤと前記シースとを前記長手軸方向に相対移動させる操作部と、
前記操作部側に設けられ、前記シース内へ液体を供給する液供給部と、
前記シース先端に設けられ前記液体を噴出する液体噴出口が形成されたキャップ部材と、
前記導電性操作ワイヤに接続され、前記キャップ部材を貫通して前記長手軸方向に摺動自在に支持された電極部と、
を具備し、
前記電極部は、前記キャップ部材に突没自在に配置された棒状電極と、該棒状電極の先端に接続され前記シース先端の正面視で放射方向に拡がる先端部材とを有し、
前記先端部材は、前記キャップ部材に形成された前記液体噴出口の延長軸線上に配置され、前記液体噴出口を前記シース先端の正面視で表出させることにより前記液体噴出口から噴出された液体を前記先端部材に干渉することなく前方へ通過させる送液領域を有する内視鏡用処置具。 The present invention has the following configuration.
The endoscopic treatment instrument used in the endoscope,
A sheath comprising a tubular member having a distal end, a proximal end, and a longitudinal axis, and having electrical insulation;
A conductive operation wire disposed in the sheath so as to be movable back and forth in the direction of the longitudinal axis;
An operating portion that is provided on the proximal end side of the sheath and relatively moves the conductive operating wire and the sheath in the longitudinal axis direction;
A liquid supply unit that is provided on the operation unit side and supplies a liquid into the sheath;
A cap member provided at a distal end of the sheath and formed with a liquid ejection port for ejecting the liquid;
An electrode part connected to the conductive operation wire, penetrating the cap member and supported slidably in the longitudinal axis direction;
Comprising
The electrode portion has a rod-like electrode that is freely projecting and retracting on the cap member, and a tip member that is connected to the tip of the rod-like electrode and expands in a radial direction in a front view of the sheath tip,
The tip member is disposed on an extension axis of the liquid jet port formed in the cap member, and the liquid jetted from the liquid jet port by exposing the liquid jet port in front view of the sheath tip An endoscopic treatment tool having a liquid feeding region that allows a tip to pass forward without interfering with the distal end member .

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図で、内視鏡用処置具としての高周波処置具の概略構成を示す外観図である。BRIEF DESCRIPTION OF THE DRAWINGS It is a figure for describing embodiment of this invention, and is an external view which shows schematic structure of the high frequency treatment tool as a treatment tool for endoscopes. 挿入部先端の斜視図である。It is a perspective view of an insertion part tip. シース先端の正面図である。It is a front view of the sheath tip. 図３のＡ−Ａ断面図である。It is AA sectional drawing of FIG. 図４のＢ−Ｂ断面図である。It is BB sectional drawing of FIG. 先端部材に液体噴出口を複数箇所に設けた構成例を示す正面図である。It is a front view which shows the structural example which provided the liquid jet nozzle in the front-end | tip member in multiple places. 多角形状の先端部材を示す正面図である。It is a front view showing a polygonal tip member. 先端部材の厚み方向に貫通する貫通孔を設けた先端部材を示す正面図である。It is a front view which shows the tip member which provided the through-hole penetrated in the thickness direction of a tip member. 液体の噴出方向に向かって先細りとする貫通孔を示す断面図である。It is sectional drawing which shows the through-hole which tapers toward the ejection direction of a liquid. 変形例の高周波処置具の操作部を示す外観図である。It is an external view which shows the operation part of the high frequency treatment tool of a modification. 図１０のＣ部の部分断面図である。It is a fragmentary sectional view of the C section of FIG. 図１１のＱ−Ｑ断面図である。It is QQ sectional drawing of FIG. 回転駆動される先端部材を示す正面図である。It is a front view which shows the front-end | tip member rotationally driven. （Ａ）は変形例の先端部材の斜視図、（Ｂ）は（Ａ）に示すＯ−Ａ断面図、（Ｃ）は（Ａ）に示すＯ−Ｂ断面図、（Ｄ）は（Ａ）に示すＯ−Ｃ断面図である。(A) is a perspective view of a tip member of a modification, (B) is an OA cross-sectional view shown in (A), (C) is an OB cross-sectional view shown in (A), and (D) is (A). It is OC sectional drawing shown in FIG. （Ａ）〜（Ｄ）は、先端部材の回転角度に応じて変化する液体の供給可能範囲を示す説明図である。(A)-(D) is explanatory drawing which shows the supply possible range of the liquid which changes according to the rotation angle of a front-end | tip member.

以下、本発明の実施形態について、図面を参照して詳細に説明する。
図１は本発明の実施形態を説明するための図で、内視鏡用処置具としての高周波処置具１００の概略構成を示す外観図である。
高周波処置具１００は、先端と基端と長手軸とを有し、電気絶縁性を有する管状部材からなるシース１１と、シース１１の内部に長手軸方向に進退自在に配置された導電性の操作ワイヤ１３と、シース１１の基端側に設けられ操作ワイヤ１３とシース１１とを長手軸方向に相対移動させる操作部１５とを備える。また、高周波処置具１００は、操作部１５側に設けられシース１１内へ洗浄液等の液体を供給する液供給部１７と、シース先端に設けられ液体を噴出する液体噴出口が形成された詳細を後述するキャップ部材１９と、操作ワイヤ１３に接続されたキャップ部材１９を長手軸方向に貫通して、長手軸方向に摺動自在に支持された電極部２１とを備える。上記電極部２１とシース１１は、図示しない内視鏡の鉗子チャンネルを介して体腔内に先端側から挿入される挿入部２３として構成される。 Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.
FIG. 1 is a view for explaining an embodiment of the present invention, and is an external view showing a schematic configuration of a high-frequency treatment instrument 100 as an endoscopic treatment instrument.
The high-frequency treatment instrument 100 has a distal end, a proximal end, and a longitudinal axis, a sheath 11 made of a tubular member having electrical insulation, and a conductive operation disposed inside the sheath 11 so as to be movable forward and backward in the longitudinal axis direction. The wire 13 and the operation part 15 provided on the proximal end side of the sheath 11 and relatively moving the operation wire 13 and the sheath 11 in the longitudinal axis direction are provided. The high-frequency treatment instrument 100 includes a liquid supply unit 17 that is provided on the operation unit 15 side and supplies a liquid such as a cleaning liquid into the sheath 11 and a liquid jet port that is provided at the distal end of the sheath and ejects the liquid. A cap member 19 which will be described later, and an electrode portion 21 that passes through the cap member 19 connected to the operation wire 13 in the longitudinal axis direction and is slidably supported in the longitudinal axis direction. The electrode portion 21 and the sheath 11 are configured as an insertion portion 23 that is inserted into the body cavity from the distal end side through a forceps channel of an endoscope (not shown).

操作部１５は、指掛け孔２５が設けられた軸部２７と、指掛け孔２９Ａ，２９Ｂが設けられ軸部２７に対してスライド可能に設けられたスライダ３１と、を有する。   The operation unit 15 includes a shaft portion 27 provided with the finger hook holes 25 and a slider 31 provided with finger hook holes 29A and 29B and slidable with respect to the shaft portion 27.

液供給部１７は、軸部２７の挿入部２３側に取り付けられ、シリンジ３３が接続されるコネクタ３５を有する。このコネクタ３５内に形成される送液流路３７は、挿入部２３の中を長手方向に沿って電極部２１まで連通されている。液供給部１７から供給する液体としては、例えば生理食塩水、グリセオール、ヒアルロン酸ナトリウム溶液等の液体が挙げられる。なお、図示例のシリンジ３３をコネクタ３５に直接取り付ける構成以外にも、チューブを介して送液ポンプ等の送液手段に接続された構成としてもよい。   The liquid supply part 17 is attached to the insertion part 23 side of the shaft part 27 and has a connector 35 to which a syringe 33 is connected. The liquid feeding flow path 37 formed in the connector 35 communicates with the electrode part 21 along the longitudinal direction in the insertion part 23. Examples of the liquid supplied from the liquid supply unit 17 include liquids such as physiological saline, glycerol, and sodium hyaluronate solution. In addition, it is good also as a structure connected to liquid feeding means, such as a liquid feeding pump, via the tube other than the structure which attaches the syringe 33 of the example of illustration to the connector 35 directly.

スライダ３１には、軸部２７及び挿入部２３に内包され、挿入部先端の電極部２１に接続される導電性の操作ワイヤ１３の基端部が固定される。また、スライダ３１には操作ワイヤ１３に導通する外部端子３９が設けられ、この外部端子３９には図示しない高周波電源に接続されて、電極部２１に高周波電流を供給する。   A base end portion of a conductive operation wire 13 that is included in the shaft portion 27 and the insertion portion 23 and connected to the electrode portion 21 at the distal end of the insertion portion is fixed to the slider 31. The slider 31 is provided with an external terminal 39 that is electrically connected to the operation wire 13. The external terminal 39 is connected to a high-frequency power source (not shown) and supplies a high-frequency current to the electrode unit 21.

図２に挿入部２３先端の斜視図、図３にシース１１先端の正面図を示した。
挿入部２３の先端には、絶縁性のキャップ部材１９と、キャップ部材１９を貫通する支持孔４１に挿通され、挿入部２３の長手軸方向に摺動自在に支持された電極部２１が配置される。 FIG. 2 is a perspective view of the distal end of the insertion portion 23, and FIG. 3 is a front view of the distal end of the sheath 11.
An insulating cap member 19 and an electrode portion 21 that is slidably supported in the longitudinal axis direction of the insertion portion 23 are arranged at the distal end of the insertion portion 23. The

キャップ部材１９には、キャップ部材の中心軸上でシース１１と同軸に穿設された上記の支持孔４１と、この支持孔４１を中心に軸対称配置され、電極部２１に向かって開口する２つの液体噴出口４３Ａ，４３Ｂが穿設されている。   The cap member 19 is provided with the support hole 41 formed coaxially with the sheath 11 on the central axis of the cap member, and is arranged symmetrically about the support hole 41 and opens toward the electrode portion 21. Two liquid jets 43A and 43B are formed.

電極部２１は、キャップ部材１９の支持孔４１から突没自在に配置される棒状電極４５と、棒状電極４５の先端に接続されシース１１先端の正面視で放射方向に拡がる先端部材４７とを有する。先端部材４７は、液体噴出口４３Ａ，４３Ｂの延長軸線上に位置する外縁の一部に、切り欠き部４９Ａ，４９Ｂが形成されている。この切り欠き部４９Ａ，４９Ｂは、液体噴出口４３Ａ，４３Ｂから噴出された液体を、先端部材４７に干渉することなく前方（液体の噴出先）へ通過させる送液領域となる。   The electrode portion 21 has a rod-like electrode 45 that is disposed so as to be able to project and retract from the support hole 41 of the cap member 19, and a tip member 47 that is connected to the tip of the rod-like electrode 45 and expands in the radial direction in front view of the sheath 11 tip. . The tip member 47 has notches 49A and 49B formed in part of the outer edge located on the extension axis of the liquid jets 43A and 43B. The cutout portions 49A and 49B serve as liquid feeding regions that allow the liquid ejected from the liquid ejection ports 43A and 43B to pass forward (liquid ejection destination) without interfering with the tip member 47.

つまり、先端部材４７は、シース１１先端の正面視で、円形状の外周部の一部を切り欠いて送液領域が配置された円板状の部材として構成される。また、先端部材４７の最大半径は、支持孔４１中心から液体噴出口４３Ａ，４３Ｂまでの半径距離より大きく、シース外径より小さくされている。先端部材４７は、半径距離を小さくすることが必要な部分にだけ、切り欠き部４９Ａ，４９Ｂを形成することにより、液体噴出口４３Ａ，４３Ｂを表出させつつ、先端部材４７の先端面積を大きく確保している。   That is, the distal end member 47 is configured as a disk-shaped member in which a liquid feeding region is arranged by cutting out a part of a circular outer peripheral portion in a front view of the distal end of the sheath 11. The maximum radius of the tip member 47 is larger than the radial distance from the center of the support hole 41 to the liquid jets 43A and 43B and smaller than the outer diameter of the sheath. The tip member 47 has a large tip area of the tip member 47 while exposing the liquid jets 43A and 43B by forming the notches 49A and 49B only in the portions where the radial distance needs to be reduced. Secured.

送液領域は、キャップ部材１９の複数位置に配置された液体噴出口４３Ａ，４３Ｂに対面する、先端部材４７の複数箇所に形成されており、棒状電極４５をキャップ部材１９の支持孔４１内に没入、又は突出させたいずれの状態でも、液体噴出口４３Ａ，４３Ｂをシース１１先端の正面視で表出させている。即ち、送液領域は、液体噴出口４３Ａ，４３Ｂの周位置に一致する位相でそれぞれ配置されている。   The liquid feeding regions are formed at a plurality of locations on the tip member 47 facing the liquid jets 43A and 43B arranged at a plurality of positions on the cap member 19, and the rod-shaped electrode 45 is placed in the support hole 41 of the cap member 19. In either the immersed state or the protruded state, the liquid ejection ports 43A and 43B are exposed in front view of the distal end of the sheath 11. That is, the liquid feeding regions are arranged at phases that coincide with the circumferential positions of the liquid jet nozzles 43A and 43B.

図４に図３のＡ−Ａ断面図を示した。
シース１１は、密巻コイル５１と、この密巻コイル５１の外周を被覆する絶縁性チューブ５３とを含んで全体が可撓性を有して形成されている。密巻コイル５１の先端は、キャップ部材１９の基端部が外嵌めされた状態で固定されている。キャップ部材１９の液体噴出口４３Ａ，４３Ｂは、送液流路３７となるシース１１内の空間に連通孔５５を通じて接続されている。 FIG. 4 is a cross-sectional view taken along the line AA in FIG.
The sheath 11 includes a closely wound coil 51 and an insulating tube 53 that covers the outer periphery of the closely wound coil 51, and is entirely formed with flexibility. The distal end of the closely wound coil 51 is fixed in a state in which the proximal end portion of the cap member 19 is externally fitted. The liquid jet outlets 43 </ b> A and 43 </ b> B of the cap member 19 are connected to the space in the sheath 11 serving as the liquid feeding passage 37 through the communication hole 55.

また、シース１１は、密巻コイル５１に絶縁性チューブを被覆する構成に限らず、密巻コイル５１を含まずにPTFE，PFA等の生体適合性を有する絶縁性のフッ素樹脂チューブのみで形成しても良い。   The sheath 11 is not limited to the configuration in which the closely wound coil 51 is covered with the insulating tube, and is formed only of an insulating fluororesin tube having biocompatibility such as PTFE and PFA without including the closely wound coil 51. May be.

棒状電極４５の基端部には、操作ワイヤ１３を固定するストッパ部５７を有する。ストッパ部５７は、キャップ部材１９の支持孔４１の基端側（先端部材４７とは反対側）に形成された段部５９に、ストッパ部５７の先端側（先端部材４７側）の端面５７ａが当接することで、棒状電極４５の突出量を規制する突出量規制部として機能する。つまり、操作部１５のスライダ３１と軸部２７の指掛け孔２５とを遠ざける操作を行うと、操作ワイヤ１３が挿入部２３の先端側へ移動して、ストッパ部５７が段部５９に当接する。この位置が電極部２１の最大突出位置となる。   At the base end portion of the rod-shaped electrode 45, a stopper portion 57 for fixing the operation wire 13 is provided. The stopper portion 57 has a stepped portion 59 formed on the base end side of the support hole 41 of the cap member 19 (on the side opposite to the tip member 47), and an end surface 57a on the tip end side (tip member 47 side) of the stopper portion 57 By abutting, it functions as a protrusion amount restricting portion that restricts the protrusion amount of the rod-shaped electrode 45. That is, when the operation of moving the slider 31 of the operation unit 15 away from the finger hooking hole 25 of the shaft portion 27 is performed, the operation wire 13 moves to the distal end side of the insertion portion 23 and the stopper portion 57 contacts the step portion 59. This position is the maximum protruding position of the electrode part 21.

一方、操作部１５のスライダ３１と軸部２７の指掛け孔２５を近づける操作を行うと、電極部２１の先端部材４７がキャップ部材１９の先端面６７（図４参照）に当接することで操作ワイヤ１３の移動が停止する。この場合、棒状電極４５がキャップ部材１９の支持孔４１に没入された状態となる。   On the other hand, when an operation of bringing the slider 31 of the operation portion 15 close to the finger hooking hole 25 of the shaft portion 27 is performed, the distal end member 47 of the electrode portion 21 comes into contact with the distal end surface 67 (see FIG. 4) of the cap member 19, thereby 13 stops moving. In this case, the rod-shaped electrode 45 is immersed in the support hole 41 of the cap member 19.

また、図４のＢ−Ｂ断面を図５に示すように、ストッパ部５７の外周の一部には凸部６１，６１が形成され、キャップ部材１９には凸部６１，６１に嵌合する凹部６２，６２が形成されている。これら凸部６１，６１と凹部６３，６３は、相互の嵌合によってキャップ部材１９と棒状電極４５との回転を規制する回転規制部となる。   Further, as shown in FIG. 5, the BB cross section of FIG. 4 is formed with convex portions 61, 61 on a part of the outer periphery of the stopper portion 57, and the cap member 19 is fitted to the convex portions 61, 61. Recesses 62, 62 are formed. The convex portions 61 and 61 and the concave portions 63 and 63 serve as a rotation restricting portion that restricts the rotation of the cap member 19 and the rod-shaped electrode 45 by mutual fitting.

つまり、棒状電極４５に同軸接続される部材であるストッパ部５７の断面形状と、このストッパ部５７が挿通されるキャップ部材１９の摺動孔６５の断面形状とを、それぞれ非回転対称形状とする。これにより、図３に示すように、先端部材４７は、棒状電極４５を中心とする回転位置が、液体噴出口４３Ａ，４３Ｂと切り欠き部４９Ａ，４９Ｂとが重なり合う位置に簡単な構成で規制される。なお、棒状電極４５の断面形状を非回転対称形状とし、支持孔４１の断面形状を同じ非回転対称形状とした構成にしてもよい。   That is, the cross-sectional shape of the stopper portion 57 that is a member coaxially connected to the rod-shaped electrode 45 and the cross-sectional shape of the sliding hole 65 of the cap member 19 through which the stopper portion 57 is inserted are each non-rotationally symmetric. . As a result, as shown in FIG. 3, the tip member 47 is restricted with a simple configuration such that the rotation position around the rod-shaped electrode 45 is a position where the liquid ejection ports 43A and 43B and the cutout portions 49A and 49B overlap. The The cross-sectional shape of the rod-shaped electrode 45 may be a non-rotation symmetric shape, and the cross-sectional shape of the support hole 41 may be the same non-rotation symmetric shape.

上記キャップ部材１９の摺動孔６５とストッパ部５７との間は、シール剤の塗布やＯリング等の適宜なシール部材によって水密構造又は流路抵抗が大きくなる構造とされている。液供給部１７のシリンジ３３からシース１１内の送液流路３７内に供給される液体は、連通孔５５を通じて液体噴出口４３Ａ，４３Ｂから噴出する。   Between the sliding hole 65 of the cap member 19 and the stopper portion 57, a watertight structure or a structure in which the flow path resistance is increased by an appropriate sealing member such as application of a sealing agent or an O-ring. The liquid supplied from the syringe 33 of the liquid supply unit 17 into the liquid feeding flow path 37 in the sheath 11 is ejected from the liquid ejection ports 43 </ b> A and 43 </ b> B through the communication hole 55.

電極部２１は、操作ワイヤ１３の進退に連動し、キャップ部材１９に先端部材４７の裏面が当接された収納状態と、キャップ部材１９に対して先端部材４７が離間した突出状態とに進退可能とされている。キャップ部材１９の前方端部からシース１１が前方に突出する構成とすれば、先端部材４７の収納状態において、シース１１の内側に先端部材４７が格納されて保護される。   The electrode portion 21 can be moved back and forth between the retracted state in which the back surface of the tip member 47 is in contact with the cap member 19 and the protruding state in which the tip member 47 is separated from the cap member 19 in conjunction with the advancement and retraction of the operation wire 13. It is said that. If the sheath 11 protrudes forward from the front end portion of the cap member 19, the distal end member 47 is stored and protected inside the sheath 11 when the distal end member 47 is stored.

以上説明した高周波処置具１００を使用する際は、内視鏡の処置具用チャンネルを介して、電極部２１を収納状態として体腔内の処置対象部位まで挿入する。そして、操作部１５によるスライド操作によって棒状電極４５をシース１１先端のキャップ部材１９から突出させた状態にして、電極部２１に高周波電流を所望のタイミングで印加し、電極部２１を使用して対象部位の切開や切除を行う。   When using the high-frequency treatment instrument 100 described above, the electrode portion 21 is inserted into the treatment target site in the body cavity via the treatment instrument channel of the endoscope. Then, the rod-like electrode 45 is projected from the cap member 19 at the distal end of the sheath 11 by the slide operation by the operation portion 15, a high-frequency current is applied to the electrode portion 21 at a desired timing, and the electrode portion 21 is used to Incision or excision of the site.

その際、生体組織から出血が生じた場合には、液供給部１７からシース１１を通じて生理食塩水を圧送し、液体噴出口４３Ａ，４３Ｂ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する。先端部材４７の先端面が導電性を有して形成される場合には、この先端面を出血部位に当接させて高周波電流を印加することで、生体組織を凝固させ、止血を行うまでの処置が連続して行える。また、別途に凝固用の処置具を鉗子孔に挿入して止血することもできる。   At that time, when bleeding occurs from the living tissue, the physiological saline is pumped from the liquid supply unit 17 through the sheath 11 and the physiological saline is ejected from the liquid ejection ports 43A and 43B. In this way, the target part is washed. When the distal end surface of the distal end member 47 is formed with conductivity, the distal end surface is brought into contact with the bleeding site and a high frequency current is applied to solidify the living tissue and stop hemostasis. Treatment can be performed continuously. In addition, hemostasis can be performed by separately inserting a coagulation treatment instrument into the forceps hole.

上記構成の高周波処置具１００によれば、液供給部１７からシース１１内を通じて供給される液体を、挿入部２３先端の液体噴出口４３Ａ，４３Ｂから電極部２１の先端部材４７の切り欠き部４９Ａ，４９Ｂを通して、所望の部位に向けて噴出させることができる。先端部材４７の後方から噴出された液体は、先端部材４７に干渉して遮られることなく、先端部材４７の前方に勢いよく直進する。このため、所望の部位に必要十分な液量を容易に供給できる。また、噴出する液体の直進性が高いため、送液のコントロール性能を向上できる。しかも、液体を遠方まで供給でき、より広い範囲の迅速かつ確実な液体供給が可能となる。   According to the high-frequency treatment instrument 100 having the above-described configuration, the liquid supplied from the liquid supply unit 17 through the sheath 11 is supplied from the liquid jets 43A and 43B at the distal end of the insertion unit 23 to the notch 49A of the distal end member 47 of the electrode unit 21. , 49B can be ejected toward a desired site. The liquid ejected from the rear of the tip member 47 advances straight ahead and forward of the tip member 47 without being blocked by interference with the tip member 47. For this reason, a necessary and sufficient amount of liquid can be easily supplied to a desired site. Moreover, since the straightness of the ejected liquid is high, the control performance of the liquid feeding can be improved. In addition, the liquid can be supplied to a distant place, and a wider and quicker liquid supply is possible.

また、上述したように、電極部２１の先端部材４７は、導電性を有して棒状電極４５と導通される構成にすることで、先端部材４７に高周波電流を印加することにより、先端部材４７を使用した止血処置が可能となる。洗浄が送液の目的である場合には、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。   Further, as described above, the tip member 47 of the electrode portion 21 is conductive and is electrically connected to the rod-like electrode 45, so that a high-frequency current is applied to the tip member 47, whereby the tip member 47. Hemostatic treatment using can be performed. When washing is the purpose of liquid feeding, the target site is washed quickly, 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.

また、先端部材４７の先端面積が大きくされているため、広い面積で一度に生体組織の凝固が行え、効率よく止血処理が行える。しかも、生体組織への引っ掛かり性の向上により処理性向上が図れる。   Further, since the tip area of the tip member 47 is increased, the living tissue can be coagulated at once in a wide area, and the hemostasis treatment can be performed efficiently. In addition, the processability can be improved by improving the catching property to the living tissue.

一方、先端部材４７の少なくとも一部が絶縁性を有することで、棒状電極４５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できる。この場合、例えば内視鏡的粘膜下層剥離術（Endoscopic submucosal dissection：ESD）を施す際に、剥離部以外の組織を保護できるので特に有用となる。   On the other hand, since at least a part of the tip member 47 has an insulating property, at the time of incision and excision by the rod-like electrode 45, a portion other than the treatment target portion can be protected by the insulating tip portion. In this case, for example, when endoscopic submucosal dissection (ESD) is performed, tissues other than the exfoliation part can be protected, which is particularly useful.

なお、液体噴出口４３Ａ，４３Ｂは、キャップ部材１９の支持孔４１を中心とする２箇所に設けているが、これに限らず、１箇所としてもよく、任意の複数箇所に設けてもよい。例えば、図６に、支持孔４１を中心とする周方向に等間隔で４つの液体噴出口４３Ａ，４３Ｂ，４３Ｃ，４３Ｄを設けた構成を示した。この場合、各液体噴出口４３Ａ，４３Ｂ，４３Ｃ，４３Ｄにそれぞれ対峙する位置に、先端部材４７Ａの切り欠き部４９Ａ，４９Ｂ，１９Ｃ，１９Ｄをそれぞれ形成する。この構成によれば、多数の液体噴出口によって液体をより広い範囲に均等に供給することができる。   In addition, although the liquid jet nozzles 43A and 43B are provided in two places centering on the support hole 41 of the cap member 19, it is not limited to this and may be provided in one place or in any plurality of places. For example, FIG. 6 shows a configuration in which four liquid outlets 43A, 43B, 43C, and 43D are provided at equal intervals in the circumferential direction around the support hole 41. In this case, the notch portions 49A, 49B, 19C, and 19D of the tip member 47A are formed at positions facing the liquid ejection ports 43A, 43B, 43C, and 43D, respectively. According to this configuration, the liquid can be evenly supplied to a wider range by the large number of liquid ejection ports.

また、電極部２１の先端部材４７の形状は、シース先端の正面視で円形としているが、棒状電極４５の長手軸と交差する少なくとも二方向に拡がる形状であれば他のいかなる形状であってもよい。例えば、図７に示すように前記正面視で多角形としてもよい。多角形にされた先端部材４７Ｃは、各液体噴出口４３Ａ，４３Ｂ，４３Ｃ，４３Ｄに対面する位置に切り欠き部６９を有しており、噴出される液体を遮ることがない。   Further, the shape of the tip member 47 of the electrode portion 21 is circular when viewed from the front of the sheath tip, but any other shape can be used as long as it extends in at least two directions intersecting the longitudinal axis of the rod-like electrode 45. Good. For example, as shown in FIG. 7, it is good also as a polygon by the said front view. The polygonal tip member 47C has a notch 69 at a position facing each liquid ejection port 43A, 43B, 43C, 43D, and does not block the ejected liquid.

その他にも、先端部材４７の形状は、正面視において、他の多角形や、星型等の回転対称図形、あるいは不規則な非円形の形状であってもよい。また、先端部材４７は、正面視の外周形状が円形、多角形等の板状に限らず、球状や半球状等、先端部材の前方端部から膨出する形状とされていてもよい。   In addition, the shape of the tip member 47 may be another polygonal shape, a rotationally symmetric figure such as a star shape, or an irregular non-circular shape in a front view. Further, the outer peripheral shape of the front end member 47 is not limited to a plate shape such as a circular shape or a polygonal shape, but may be a shape that bulges from the front end portion of the front end member, such as a spherical shape or a hemispherical shape.

液体噴出口の形状も、円形に限らずに任意の形状であってよい。また、液体噴出口を多数の小さい孔の集合から形成することもできる。   The shape of the liquid ejection port is not limited to a circle and may be an arbitrary shape. Also, the liquid spout can be formed from a collection of many small holes.

上記の各先端部材４７（４７Ａ，４７Ｂ，４７Ｃ，４７Ｄ）に形成される送液領域は、切り欠き部とする以外にも、図８に示すように、先端部材４７の厚み方向に貫通する貫通孔７１にすることができる。この貫通孔７１は、シース先端の正面視で液体噴出口４３を表出させる位置に配置することで、液体噴出口４３から噴出する液体を遮ることがない。また、環状の内周面を有する貫通孔７１にすることで、噴出する液体の整流性を高め、より遠方に液体を供給する効果が得られる。   The liquid feeding area formed in each of the tip members 47 (47A, 47B, 47C, 47D) is not only a notch, but also penetrates in the thickness direction of the tip member 47 as shown in FIG. The hole 71 can be formed. The through-hole 71 is disposed at a position where the liquid jet 43 is exposed when viewed from the front of the sheath tip, so that the liquid jetted from the liquid jet 43 is not blocked. In addition, by using the through hole 71 having an annular inner peripheral surface, it is possible to improve the rectifying property of the liquid to be ejected and to supply the liquid to a farther place.

そして、先端部材の送液領域を貫通孔とする場合、図９に示すように、液体の噴出方向に向かって先細の貫通孔７３にすることもできる。この場合、液供給部１７から一定の流量を供給すると、液体噴出時の流速が高められ、より遠方に液体を供給することができる。そのため、液体供給方向のコントロール性能をより向上できる。   And when making the liquid feeding area | region of a front-end | tip member into a through-hole, as shown in FIG. 9, it can also be set as the through-hole 73 tapered toward the ejection direction of a liquid. In this case, when a constant flow rate is supplied from the liquid supply unit 17, the flow velocity at the time of liquid ejection is increased, and the liquid can be supplied further away. Therefore, the control performance in the liquid supply direction can be further improved.

次に、キャップ部材１９と電極部２１の棒状電極４５とを、相対的に回転可能にした変形例を説明する。
図１０にこの変形例の高周波処置具２００の操作部１５を示す。以降の説明では、前述の図１〜図４と同じ部材については同一の符号を付与することで、その説明を省略又は簡略化する。 Next, a modification in which the cap member 19 and the rod-like electrode 45 of the electrode part 21 are relatively rotatable will be described.
FIG. 10 shows the operation unit 15 of the high-frequency treatment tool 200 of this modification. In the following description, the same members as those in FIGS. 1 to 4 described above are denoted by the same reference numerals, and the description thereof is omitted or simplified.

操作部１５に設けられた軸部２７Ａは、回転自在に軸支された回転つまみ７５を有している。回転つまみ７５は、操作ワイヤ１３をシース１１に対してシースの軸線方向に相対的に回転させる回転操作入力部となる。操作者は、この回転つまみ７５を回転操作することで、操作ワイヤ１３をシース１１に対して軸線方向を中心に回転させることができる。   The shaft portion 27A provided in the operation portion 15 has a rotary knob 75 that is rotatably supported. The rotation knob 75 serves as a rotation operation input unit that rotates the operation wire 13 relative to the sheath 11 in the axial direction of the sheath. The operator can rotate the operation knob 13 about the axial direction with respect to the sheath 11 by rotating the rotary knob 75.

なお、この場合には、図５に示されるストッパ部５７の凸部６１及びキャップ部材１９の凹部６３を設けず、ストッパ部５７がキャップ部材１９の摺動孔６５内で回転自在な支持構造にする（図視略）。   In this case, the convex portion 61 of the stopper portion 57 and the concave portion 63 of the cap member 19 shown in FIG. 5 are not provided, and the stopper portion 57 has a support structure that can rotate within the sliding hole 65 of the cap member 19. Do (not shown).

図１１に図１０のＣ部の部分断面図を示した。軸部２７Ａは、スライダ３１からコネクタ３５までの間の領域が、図中縦断面が円形状に形成されており、この領域内の中間位置で回転つまみ７５が回転自在に軸部２７Ａに支持されている。つまり、軸部２７Ａは、先端に指掛け孔２５を有してスライダ３１に挿通される一端側と、コネクタ３５に接続される他端側と、その中間の回転つまみ７５とが組み合わされて構成されている。   FIG. 11 shows a partial cross-sectional view of a portion C in FIG. In the shaft portion 27A, a region between the slider 31 and the connector 35 is formed in a circular shape in a longitudinal section in the drawing, and the rotary knob 75 is rotatably supported by the shaft portion 27A at an intermediate position in this region. ing. That is, the shaft portion 27A is configured by combining one end side inserted into the slider 31 with the finger hooking hole 25 at the tip, the other end side connected to the connector 35, and an intermediate rotary knob 75. ing.

回転つまみ７５は、円筒中心部に操作ワイヤ１３を挿通させる貫通孔８５を有する。また、回転つまみ７５は、一端側に形成した収容凹部８７ａに、軸部２７Ａの一端側に突出して形成された縮径部８９ａを嵌挿し、他端側に形成した収容凹部８７ｂに、軸部Ａの他端側に突出して形成された縮径部８９ｂを嵌挿することで、回転自在に支持される。   The rotary knob 75 has a through hole 85 through which the operation wire 13 is inserted in the center of the cylinder. Further, the rotary knob 75 is inserted into a receiving recess 87a formed on one end side, and a reduced diameter portion 89a formed protruding from one end side of the shaft portion 27A is inserted, and a shaft portion is inserted into the receiving recess 87b formed on the other end side. By inserting a reduced diameter portion 89b formed to protrude to the other end side of A, it is supported rotatably.

操作ワイヤ１３は、その一部に回転駆動用の固定子９１が固着され、回転つまみ７５の貫通孔８５に摺動自在に挿入されている。   The operation wire 13 has a rotational driving stator 91 fixed to a part of the operation wire 13 and is slidably inserted into the through hole 85 of the rotary knob 75.

図１２に図１１のＱ−Ｑ断面図を示した。回転つまみ７５に形成される貫通孔８５と固定子９１とは、スプライン構造によって互いに回転方向に規制された状態で組み合わされている。即ち、回転つまみ７５の貫通孔８５には長手方向に沿った直状の溝部９３が形成され、この溝部９３に挿入される直状の突片９５が固定子９１から半径方向外側に延設されている。溝部９３と突片９５は、操作ワイヤ１３の軸方向を中心に複数箇所に形成され、図示例では９０度毎に合計４箇所に形成している。   FIG. 12 shows a QQ cross-sectional view of FIG. The through-hole 85 and the stator 91 formed in the rotary knob 75 are combined in a state where they are regulated in the rotational direction by a spline structure. That is, a straight groove portion 93 is formed in the through hole 85 of the rotary knob 75 along the longitudinal direction, and a straight protrusion 95 inserted into the groove portion 93 is extended from the stator 91 outward in the radial direction. ing. The groove portion 93 and the projecting piece 95 are formed at a plurality of locations around the axial direction of the operation wire 13, and in the illustrated example, they are formed at a total of 4 locations every 90 degrees.

上記構成の回転つまみ７５は、図中矢印Ｐ方向に回転操作することで、固定子９１の突片９５が溝部９３から回転力を受け、操作ワイヤ１３を回転操作方向に回転駆動することができる。また、本構成例では、図１１に示すように、操作ワイヤ１３の先端に固着した先端駒９７が、スライダ３１に形成された収容部９９内で回転自在に支持されることで、操作ワイヤ１３は、スライダ３１と連動して軸方向に進退自在、かつ、スライダ３１に対して回転自在に支持される。   The rotary knob 75 configured as described above can be rotated in the direction of the arrow P in the drawing, so that the projecting piece 95 of the stator 91 receives a rotational force from the groove portion 93 and can rotate the operation wire 13 in the rotational operation direction. . Further, in the present configuration example, as shown in FIG. 11, the tip piece 97 fixed to the tip of the operation wire 13 is rotatably supported in the accommodating portion 99 formed in the slider 31, so that the operation wire 13 can be rotated. Is supported so as to be movable forward and backward in the axial direction in conjunction with the slider 31 and to be rotatable with respect to the slider 31.

回転つまみ７５によって回転駆動される操作ワイヤ１３は、シース１１先端側に配置された電極部２１（図４参照）を回転駆動する。即ち、回転つまみ７５は、電極部２１の棒状電極４５及び先端部材４７をキャップ部材１９に対して相対的に回転駆動する回転駆動手段として機能する。   The operation wire 13 that is rotationally driven by the rotary knob 75 rotationally drives the electrode portion 21 (see FIG. 4) disposed on the distal end side of the sheath 11. That is, the rotary knob 75 functions as a rotation driving unit that drives the rod-shaped electrode 45 and the tip member 47 of the electrode portion 21 to rotate relative to the cap member 19.

図１３に先端部材の正面図を示した。回転つまみ７５によって、棒状電極４５に接続される先端部材４７を、棒状電極４５を中心に回転駆動すると、先端部材４７の切り欠き部４９Ａ，４９Ｂの周位置を液体噴出口４３Ａ，４３Ｂに対して移動させることができる。   FIG. 13 shows a front view of the tip member. When the tip member 47 connected to the rod-like electrode 45 is driven to rotate around the rod-like electrode 45 by the rotary knob 75, the circumferential positions of the notches 49A and 49B of the tip member 47 are set with respect to the liquid jet nozzles 43A and 43B. Can be moved.

その結果、棒状電極４５をキャップ部材１９の支持孔４１内に没入させた状態としたき、液体噴出口４３Ａ，４３Ｂが先端部材４７によって閉塞される。この動作により、液体噴出口４３Ａ，４３Ｂからの液体噴出のオンオフを制御することができる。また、液体噴出口４３Ａ，４３Ｂの一部だけを先端部材４７によって閉塞させる場合には、液体噴出の流量を調整することができる。   As a result, when the rod-like electrode 45 is immersed in the support hole 41 of the cap member 19, the liquid ejection ports 43 </ b> A and 43 </ b> B are closed by the tip member 47. By this operation, on / off of the liquid ejection from the liquid ejection ports 43A and 43B can be controlled. Further, when only a part of the liquid ejection ports 43A and 43B is closed by the tip member 47, the flow rate of the liquid ejection can be adjusted.

つまり、液供給部１７から供給される液体を、回転つまみ７５の回転操作によって任意の流量に設定して供給できるため、必要な液量を必要なだけ、任意のタイミングで供給することができる。これにより、先端からの液体噴出を制御性よく自在に行え、高周波処置具２００の取り扱い性を向上できる。   That is, since the liquid supplied from the liquid supply unit 17 can be set and supplied at an arbitrary flow rate by rotating the rotary knob 75, the required amount of liquid can be supplied at any timing as necessary. Thereby, the liquid ejection from the tip can be freely performed with good controllability, and the handleability of the high-frequency treatment instrument 200 can be improved.

また、先端部材４７に向けて液体を噴出させる場合には、出血点の把握以外にも、先端部材４７や棒状電極４５に付着した残渣の除去が行える。   Further, when the liquid is ejected toward the tip member 47, in addition to grasping the bleeding point, the residue attached to the tip member 47 and the bar electrode 45 can be removed.

なお、先端部材４７のキャップ部材１９に対する回転角度位置は、回転つまみ７５による回転駆動された後、その回転角度位置で保持される。つまり、回転つまみ７５が次に回転操作されるまで先端部材４７の回転位置が規制される。   The rotational angle position of the tip member 47 relative to the cap member 19 is held at the rotational angle position after being driven to rotate by the rotary knob 75. That is, the rotation position of the tip member 47 is restricted until the rotation knob 75 is rotated next.

次に、回転自在な先端部材により、液体噴出の方向を制御する変形例について説明する。
図１４（Ａ）は本変形例の先端部材の斜視図、（Ｂ）は（Ａ）に示すＯ−Ａ断面図、（Ｃ）は（Ａ）に示すＯ−Ｂ断面図、（Ｄ）は（Ａ）に示すＯ−Ｃ断面図である。
本変形例の先端部材４７Ｄは、図１０〜図１２に示す回転駆動手段により棒状電極を中心に回転駆動される。そして、先端部材４７Ｄの前述したキャップ部材に対面する側となる裏面８１の周縁部８３が、図１４（Ｂ），（Ｃ），（Ｄ）に代表して示すように、先端部材４７Ｄの周方向に沿って異なる曲率に面取りされている。即ち、周縁部８３は、図１４（Ｂ）ではキャップ部材側に膨らむ凸状の曲率面として形成される。図１４（Ｄ）ではキャップ部材側とは反対側（液体噴出先側）に窪む凹状の曲率面として形成される。そして、図１４（Ｃ）では、それらの中間の傾斜平面に形成されている。 Next, a modification in which the direction of liquid ejection is controlled by a rotatable tip member will be described.
14A is a perspective view of the tip member of this modification, FIG. 14B is a cross-sectional view taken along the line OA shown in FIG. 14A, FIG. 14C is a cross-sectional view taken along the line OB shown in FIG. It is OC sectional drawing shown to (A).
The tip member 47D of this modification is rotationally driven around the rod-like electrode by the rotational driving means shown in FIGS. And the peripheral part 83 of the back surface 81 which becomes the side which faces the cap member mentioned above of the front end member 47D, as representatively shown in FIGS. 14 (B), (C), (D), the periphery of the front end member 47D. Chamfered with different curvatures along the direction. That is, the peripheral portion 83 is formed as a convex curvature surface that swells toward the cap member in FIG. In FIG. 14D, it is formed as a concave curvature surface that is recessed on the side opposite to the cap member side (liquid ejection destination side). And in FIG.14 (C), it forms in those intermediate | middle inclination planes.

先端部材４７Ｄの周縁部８３は、全周にわたって曲率面による面取りが施されている。そして、回転つまみ７５（図１０参照）の回転操作による先端部材４７Ｄの回転角度θに応じて、液体噴出口から噴出された液体が、先端部材４７Ｄを切り欠き部４９Ａ，４９Ｂを通じてそのまま通過したり、周縁部８３に当たって拡散したりするようになる。   The peripheral edge 83 of the tip member 47D is chamfered with a curvature surface over the entire circumference. Then, according to the rotation angle θ of the tip member 47D by the rotating operation of the rotary knob 75 (see FIG. 10), the liquid ejected from the liquid jet outlet passes through the tip member 47D as it is through the notches 49A and 49B. Then, it hits the peripheral portion 83 and diffuses.

図１５（Ａ）〜（Ｄ）には、先端部材の回転角度θに応じて変化する液体の供給可能範囲Ｗを示す説明図を示した。図１５（Ａ）は液体の噴出流が先端部材４７Ｄの切り欠き部４９Ａ（４９Ｂも同様）をそのまま通過して遠方まで供給される様子である。図１５（Ｂ）に示すように、先端部材４７Ｄを回転させて、液体の噴出流が先端部材４７Ｄの周縁部８３に当たる回転角度位置になると、キャップ部材側に膨らむ凸状の曲率面によって噴出流の方向が、先端部材４７先方の先端部材４７近傍に集中するように変化する。これにより、先端部材４７の先方から周囲の範囲に特に液体を多く供給することができる。   FIGS. 15A to 15D are explanatory views showing the liquid supplyable range W that changes in accordance with the rotation angle θ of the tip member. FIG. 15A shows a state in which the jet of liquid passes through the notch 49A (as well as 49B) of the tip member 47D and is supplied far away. As shown in FIG. 15B, when the tip member 47D is rotated and the liquid jet flow reaches a rotational angle position where it hits the peripheral edge 83 of the tip member 47D, the jet flow is caused by the convex curvature surface that swells to the cap member side. Of the tip member 47 changes so as to concentrate in the vicinity of the tip member 47 ahead of the tip member 47. As a result, a large amount of liquid can be supplied particularly from the tip of the tip member 47 to the surrounding area.

図１５（Ｃ）に示すように、先端部材４７Ｄを更に回転させて、周縁部８３が傾斜平面となる回転角度位置になると、噴出流の方向が先端部材４７Ｄの半径方向外側に集中する。そして、図１５（Ｄ）に示すように先端部材４７Ｄを更に回転させると、凹状の曲率面によって先端部材４７Ｄの半径方向外側からキャップ部材側に集中する。   As shown in FIG. 15C, when the tip member 47D is further rotated and the peripheral edge portion 83 reaches a rotational angle position where it becomes an inclined plane, the direction of the jet flow concentrates on the radially outer side of the tip member 47D. When the tip member 47D is further rotated as shown in FIG. 15 (D), the tip member 47D is concentrated from the radially outer side of the tip member 47D to the cap member side by the concave curvature surface.

このように、先端部材４７の回転角度に応じて、液体の供給範囲を所望の領域に変更でき、高周波処置具の使用シーンに応じて適切な液体供給先を選択することができる。これにより、噴出流の流量調整（強弱）によって液体供給先（遠方又は近傍）を変更する場合と比べて、遠方から近傍までの広い範囲を均等な液体供給量で送液が可能となる。従って、送液により、広い範囲をいち早く洗浄でき、例えば出血点の発見をより迅速に行うことができる。   As described above, the liquid supply range can be changed to a desired region according to the rotation angle of the tip member 47, and an appropriate liquid supply destination can be selected according to the use scene of the high-frequency treatment instrument. Thereby, compared with the case where the liquid supply destination (far or near) is changed by adjusting the flow rate (strong or weak) of the jet flow, the liquid can be fed in a wide range from the far to the near with a uniform liquid supply amount. Therefore, a wide range can be quickly washed by liquid feeding, and for example, a bleeding point can be found more quickly.

このように、本発明は上記の実施形態に限定されるものではなく、明細書の記載、並びに周知の技術に基づいて、当業者が変更、応用することも本発明の予定するところであり、保護を求める範囲に含まれる。   As described above, the present invention is not limited to the above-described embodiments, and modifications and applications by those skilled in the art based on the description of the specification and well-known techniques are also within the scope of the present invention. It is included in the range to calculate.

以上の通り、本明細書には次の事項が開示されている。
（１） 内視鏡に用いられる内視鏡処置具であって、
先端と基端と長手軸とを有し、電気絶縁性を有する管状部材からなるシースと、
前記シースの内部に前記長手軸の方向に進退自在に配置された導電性操作ワイヤと、
前記シースの基端側に設けられ、前記導電性操作ワイヤと前記シースとを前記長手軸方向に相対移動させる操作部と、
前記操作部側に設けられ、前記シース内へ液体を供給する液供給部と、
前記シース先端に設けられ前記液体を噴出する液体噴出口が形成されたキャップ部材と、
前記導電性操作ワイヤに接続され、前記キャップ部材を貫通して前記長手軸方向に摺動自在に支持された電極部と、
を具備し、
前記電極部は、前記キャップ部材に突没自在に配置された棒状電極と、該棒状電極の先端に接続され、該棒状電極の長手軸と交差する少なくとも二方向に拡がる形状の先端部材とを有し、
前記先端部材は、前記キャップ部材に形成された前記液体噴出口の延長軸線上に配置され前記液体噴出口から噴出された液体を通過させる送液領域を有する内視鏡用処置具。
この内視鏡用処置具によれば、先端部材の後方から噴射された液が先端部材で遮られず、先端部材の前方に直進するので、所望の部位に液体を供給することが容易となり、コントロール性能を向上できる。また、遠方まで液体を供給できるため、より広い範囲を迅速かつ確実に液体を供給することができる。 As described above, the following items are disclosed in this specification.
(1) An endoscope treatment tool used for an endoscope,
A sheath comprising a tubular member having a distal end, a proximal end, and a longitudinal axis, and having electrical insulation;
A conductive operation wire disposed in the sheath so as to be movable back and forth in the direction of the longitudinal axis;
An operating portion that is provided on the proximal end side of the sheath and relatively moves the conductive operating wire and the sheath in the longitudinal axis direction;
A liquid supply unit that is provided on the operation unit side and supplies a liquid into the sheath;
A cap member provided at a distal end of the sheath and formed with a liquid ejection port for ejecting the liquid;
An electrode part connected to the conductive operation wire, penetrating the cap member and supported slidably in the longitudinal axis direction;
Comprising
The electrode section includes a rod-like electrode that is disposed so as to protrude and retract on the cap member, and a tip member that is connected to the tip of the rod-like electrode and extends in at least two directions intersecting the longitudinal axis of the rod-like electrode. And
The treatment instrument for an endoscope, wherein the distal end member is disposed on an extension axis of the liquid ejection port formed in the cap member and has a liquid feeding region through which the liquid ejected from the liquid ejection port passes.
According to this endoscope treatment tool, since the liquid ejected from the rear of the tip member is not blocked by the tip member and goes straight forward of the tip member, it becomes easy to supply the liquid to a desired site, Control performance can be improved. Further, since the liquid can be supplied to a distant place, the liquid can be supplied quickly and reliably over a wider range.

（２） （１）の内視鏡用処置具であって、
前記先端部材の送液領域が、前記先端部材の外縁の一部に形成した切り欠き部である内視鏡用処置具。
この内視鏡用処置具によれば、外縁の一部を切り欠く簡単な構成で送液領域を形成できる。 (2) The endoscope treatment tool according to (1),
An endoscopic treatment tool in which a liquid feeding region of the tip member is a notch formed in a part of an outer edge of the tip member.
According to this endoscope treatment tool, the liquid feeding region can be formed with a simple configuration in which a part of the outer edge is cut out.

（３） （１）の内視鏡用処置具であって、
前記先端部材の送液領域が、前記先端部材の厚み方向に貫通する貫通孔である内視鏡用処置具。
この内視鏡用処置具によれば、先端部材に貫通孔を形成することで、噴出する液体の整流性を高めることができる。 (3) The endoscope treatment tool according to (1),
An endoscope treatment tool, wherein the liquid feeding region of the tip member is a through-hole penetrating in the thickness direction of the tip member.
According to this endoscope treatment tool, the flowability of the liquid to be ejected can be improved by forming the through hole in the distal end member.

（４） （１）〜（３）のいずれか１つの内視鏡用処置具であって、
前記液体噴出口が、前記キャップ部材の複数位置に配置され、
前記送液領域が、前記複数の液体噴出口の位置にそれぞれ対峙して前記先端部材の複数箇所に形成された内視鏡用処置具。
この内視鏡処置具によれば、液位帯噴出口を複数箇所に設けることで、液体をより広い範囲に均等に供給することができる。 (4) The treatment instrument for an endoscope according to any one of (1) to (3),
The liquid jets are arranged at a plurality of positions of the cap member;
An endoscopic treatment tool in which the liquid feeding region is formed at a plurality of locations of the tip member so as to face the positions of the plurality of liquid ejection ports, respectively.
According to this endoscope treatment tool, the liquid can be evenly supplied to a wider range by providing the liquid level zone jet outlets at a plurality of locations.

（５） （１）〜（４）のいずれか１つの内視鏡用処置具であって、
前記電極部の先端部材が、前記シース先端の正面視で、円形状の外周部の一部に前記送液領域が配置された形状を有する内視鏡用処置具。
この内視鏡用処置具によれば、先端部材を正面視で円形状にして先端面積を大きく確保しつつ、送液領域によって液体を所望の部位に噴出供給させることができる。 (5) The treatment instrument for an endoscope according to any one of (1) to (4),
A treatment instrument for an endoscope, wherein the distal end member of the electrode portion has a shape in which the liquid feeding region is arranged in a part of a circular outer peripheral portion in a front view of the sheath distal end.
According to this endoscope treatment tool, the tip member is circular in a front view, and a large tip area can be secured, while liquid can be ejected and supplied to a desired site through the liquid feeding region.

（６） （１）〜（５）のいずれか１つの内視鏡用処置具であって、
前記電極部の棒状電極に同軸接続される部材の断面形状と、該同軸接続される部材が挿通される前記キャップ部材の摺動孔の断面形状とが、それぞれ非回転対称形状である内視鏡用処置具。
この内視鏡処置具によれば、キャップ部材と棒状電極との回転規制が簡単な構造で実現できる。 (6) The endoscopic treatment tool according to any one of (1) to (5),
An endoscope in which a cross-sectional shape of a member coaxially connected to the rod-shaped electrode of the electrode portion and a cross-sectional shape of a sliding hole of the cap member through which the coaxially connected member is inserted are respectively non-rotation symmetric shapes Treatment tool.
According to this endoscope treatment tool, the rotation restriction between the cap member and the rod-shaped electrode can be realized with a simple structure.

（７） （１）〜（６）のいずれか１つの内視鏡用処置具であって、
前記キャップ部材と前記棒状電極とを相対的に回転駆動する回転駆動手段を備えた内視鏡用処置具。
この内視鏡処置具によれば、キャップ部材と棒状電極とを回転駆動手段により相対的に回転させ、先端部材を任意の回転角度に変更できる。このため、先端部材の送液領域と液体噴出口との周位置を変更でき、液体の噴出供給を制御できる。 (7) The endoscope treatment tool according to any one of (1) to (6),
An endoscope treatment tool comprising a rotation driving means for relatively rotating and driving the cap member and the rod-shaped electrode.
According to this endoscope treatment instrument, the tip member can be changed to an arbitrary rotation angle by relatively rotating the cap member and the rod-shaped electrode by the rotation driving means. For this reason, the circumferential position of the liquid feeding area | region of a front-end | tip member and a liquid jet nozzle can be changed, and the ejection supply of a liquid can be controlled.

（８） （７）の内視鏡用処置具であって、
前記回転駆動手段が、回転操作により前記導電性操作ワイヤを前記キャップ部材に対して軸線方向に相対的に回転させる回転操作入力部を前記操作部に備えた内視鏡用処置具。
この内視鏡処置具によれば操作部の回転操作入力部からの回転操作によって、液体の噴出供給を簡単に制御できる。 (8) The endoscope treatment tool according to (7),
An endoscope treatment tool, wherein the operation unit includes a rotation operation input unit that causes the rotation driving unit to rotate the conductive operation wire relative to the cap member in an axial direction by a rotation operation.
According to the endoscope treatment tool, the liquid supply can be easily controlled by the rotation operation from the rotation operation input unit of the operation unit.

（９） （８）の内視鏡処置具であって、
前記先端部材の前記キャップ部材に対面する側の周縁部が、周方向に沿って異なる曲率に面取りされた内視鏡用処置具。
この内視鏡処置具によれば、液体噴出口からの噴出液が先端部材の周縁部に当たったときに、液体の拡散方向を曲率に応じて変更できる。これにより、内視鏡用処置具の使用シーンに応じて適切な液体供給先を任意に選択することができる。 (9) The endoscope treatment tool according to (8),
A treatment instrument for an endoscope, wherein a peripheral edge portion of the tip member facing the cap member is chamfered with a different curvature along a circumferential direction.
According to this endoscope treatment tool, when the liquid ejected from the liquid ejection port hits the peripheral portion of the tip member, the liquid diffusion direction can be changed according to the curvature. Thereby, a suitable liquid supply destination can be arbitrarily selected according to the use scene of the treatment tool for endoscopes.

（１０） （１）〜（９）のいずれか１つの内視鏡用処置具であって、
前記先端部材が、導電性を有して前記棒状電極と導通された内視鏡用処置具。
この内視鏡用処置具によれば、導電性の先端部材に高周波電流を印加することにより、先端部材を使用した止血処置が可能となる。 (10) The treatment instrument for endoscope according to any one of (1) to (9),
An endoscopic treatment tool in which the distal end member has conductivity and is electrically connected to the rod-shaped electrode.
According to this endoscope treatment tool, a hemostatic treatment using a tip member can be performed by applying a high-frequency current to the conductive tip member.

（１１） （１）〜（９）のいずれか１つの内視鏡用処理具であって、
前記先端部材は、少なくとも一部が絶縁性を有する内視鏡用処置具。
この内視鏡用処置具によれば、棒状電極による切開・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できる。 (11) The endoscope processing tool according to any one of (1) to (9),
At least a part of the distal end member is an endoscope treatment tool.
According to this endoscopic treatment tool, it is possible to protect a part other than the part to be treated with the insulating tip when incising and excising with the rod-shaped electrode.

１１ シース
１３ 操作ワイヤ
１５ 操作部
１７ 液供給部
１９ キャップ部材
２１ 電極部
２３ 挿入部
２５ 指掛け孔
２７ 軸部
２９Ａ，２９Ｂ 指掛け孔
３１ スライダ
３３ シリンジ
３５ コネクタ
３７ 送液流路
３９ 外部端子
４１ 支持孔
４３Ａ，４３Ｂ 液体噴出口
４５ 棒状電極
４７ 先端部材
４７Ａ，４７Ｂ，４７Ｃ，４７Ｄ 先端部材
４９Ａ，４９Ｂ 切り欠き部
５３ 絶縁性チューブ
５７ ストッパ部
６１ 凸部
６３ 凹部
６５ 摺動孔
６７ 先端面
６９ 切り欠き部
７１，７３ 貫通孔
７５ 回転つまみ
８１ 裏面
８３ 周縁部
１００ 高周波処置具（内視鏡用処置具）
θ 回転角度
Ｗ 供給可能範囲 DESCRIPTION OF SYMBOLS 11 Sheath 13 Operation wire 15 Operation part 17 Liquid supply part 19 Cap member 21 Electrode part 23 Insertion part 25 Finger hook hole 27 Shaft part 29A, 29B Finger hook hole 31 Slider 33 Syringe 35 Connector 37 Liquid feed flow path 39 External terminal 41 Support hole 43A , 43B Liquid outlet 45 Bar electrode 47 Tip member 47A, 47B, 47C, 47D Tip member 49A, 49B Notch 53 Insulating tube 57 Stopper 61 Protrusion 63 Concave 65 Sliding hole 67 Tip surface 69 Notch 71 , 73 Through-hole 75 Rotary knob 81 Back surface 83 Peripheral portion 100 High frequency treatment instrument (endoscopic treatment instrument)
θ Rotation angle W Supplyable range

Claims (11)

内視鏡に用いられる内視鏡用処置具であって、
先端と基端と長手軸とを有し、電気絶縁性を有する管状部材からなるシースと、
前記シースの内部に前記長手軸の方向に進退自在に配置された導電性操作ワイヤと、
前記シースの基端側に設けられ、前記導電性操作ワイヤと前記シースとを前記長手軸方向に相対移動させる操作部と、
前記操作部側に設けられ、前記シース内へ液体を供給する液供給部と、
前記シース先端に設けられ前記液体を噴出する液体噴出口が形成されたキャップ部材と、
前記導電性操作ワイヤに接続され、前記キャップ部材を貫通して前記長手軸方向に摺動自在に支持された電極部と、
を具備し、
前記電極部は、前記キャップ部材に突没自在に配置された棒状電極と、該棒状電極の先端に接続され、該棒状電極の長手軸と交差する少なくとも二方向に拡がる形状の先端部材とを有し、
前記先端部材は、前記キャップ部材に形成された前記液体噴出口の延長軸線上に配置され、前記液体噴出口を前記シース先端の正面視で表出させることにより前記液体噴出口から噴出された液体を前記先端部材に干渉することなく前方へ通過させる送液領域を有する内視鏡用処置具。 The endoscopic treatment instrument used in the endoscope,
A sheath comprising a tubular member having a distal end, a proximal end, and a longitudinal axis, and having electrical insulation;
A conductive operation wire disposed in the sheath so as to be movable back and forth in the direction of the longitudinal axis;
An operating portion that is provided on the proximal end side of the sheath and relatively moves the conductive operating wire and the sheath in the longitudinal axis direction;
A liquid supply unit that is provided on the operation unit side and supplies a liquid into the sheath;
A cap member provided at a distal end of the sheath and formed with a liquid ejection port for ejecting the liquid;
An electrode part connected to the conductive operation wire, penetrating the cap member and supported slidably in the longitudinal axis direction;
Comprising
The electrode section includes a rod-like electrode that is disposed so as to protrude and retract on the cap member, and a tip member that is connected to the tip of the rod-like electrode and extends in at least two directions intersecting the longitudinal axis of the rod-like electrode. And
The tip member is disposed on an extension axis of the liquid jet port formed in the cap member, and the liquid jetted from the liquid jet port by exposing the liquid jet port in front view of the sheath tip An endoscopic treatment tool having a liquid feeding region that allows a tip to pass forward without interfering with the distal end member . 請求項１記載の内視鏡用処置具であって、
前記先端部材の送液領域が、前記先端部材の外縁の一部に形成した切り欠き部である内視鏡用処置具。 The endoscope treatment tool according to claim 1,
An endoscopic treatment tool in which a liquid feeding region of the tip member is a notch formed in a part of an outer edge of the tip member. 請求項１記載の内視鏡用処置具であって、
前記先端部材の送液領域が、前記先端部材の厚み方向に貫通する貫通孔である内視鏡用処置具。 The endoscope treatment tool according to claim 1,
An endoscope treatment tool, wherein the liquid feeding region of the tip member is a through-hole penetrating in the thickness direction of the tip member. 請求項１〜請求項３のいずれか１項記載の内視鏡用処置具であって、
前記液体噴出口が、前記キャップ部材の複数位置に配置され、
前記送液領域が、前記複数の液体噴出口の位置にそれぞれ対峙して前記先端部材の複数箇所に形成された内視鏡用処置具。 An endoscope treatment tool according to any one of claims 1 to 3,
The liquid jets are arranged at a plurality of positions of the cap member;
An endoscopic treatment tool in which the liquid feeding region is formed at a plurality of locations of the tip member so as to face the positions of the plurality of liquid ejection ports, respectively. 請求項１〜請求項４のいずれか１項記載の内視鏡用処置具であって、
前記電極部の先端部材が、前記シース先端の正面視で、円形状の外周部の一部に前記送液領域が配置された形状を有する内視鏡用処置具。 The treatment tool for endoscope according to any one of claims 1 to 4,
A treatment instrument for an endoscope, wherein the distal end member of the electrode portion has a shape in which the liquid feeding region is arranged in a part of a circular outer peripheral portion in a front view of the sheath distal end. 請求項１〜請求項５のいずれか１項記載の内視鏡用処置具であって、
前記電極部の棒状電極に同軸接続される部材の断面形状と、該同軸接続される部材が挿通される前記キャップ部材の摺動孔の断面形状とが、それぞれ非回転対称形状である内視鏡用処置具。 It is a treatment tool for endoscopes according to any one of claims 1 to 5,
An endoscope in which a cross-sectional shape of a member coaxially connected to the rod-shaped electrode of the electrode portion and a cross-sectional shape of a sliding hole of the cap member through which the coaxially connected member is inserted are respectively non-rotation symmetric shapes Treatment tool. 請求項１〜請求項６のいずれか１項記載の内視鏡用処置具であって、
前記キャップ部材と前記棒状電極とを相対的に回転駆動する回転駆動手段を備えた内視鏡用処置具。 An endoscope treatment tool according to any one of claims 1 to 6,
An endoscope treatment tool comprising a rotation driving means for relatively rotating and driving the cap member and the rod-shaped electrode. 請求項７記載の内視鏡用処置具であって、
前記回転駆動手段が、回転操作により前記導電性操作ワイヤを前記キャップ部材に対して軸線方向に相対的に回転させる回転操作入力部を前記操作部に備えた内視鏡用処置具。 The endoscope treatment tool according to claim 7,
An endoscope treatment tool, wherein the operation unit includes a rotation operation input unit that causes the rotation driving unit to rotate the conductive operation wire relative to the cap member in an axial direction by a rotation operation. 請求項７又は請求項８記載の内視鏡用処置具であって、
前記先端部材の前記キャップ部材に対面する側の周縁部が、周方向に沿って異なる曲率に面取りされた内視鏡用処置具。 A claim 7 or claim 8 endoscopic instrument according,
A treatment instrument for an endoscope, wherein a peripheral edge portion of the tip member facing the cap member is chamfered with a different curvature along a circumferential direction. 請求項１〜請求項９のいずれか１項記載の内視鏡用処置具であって、
前記先端部材が、導電性を有して前記棒状電極と導通された内視鏡用処置具。 An endoscopic treatment tool according to any one of claims 1 to 9,
An endoscopic treatment tool in which the distal end member has conductivity and is electrically connected to the rod-shaped electrode. 請求項１〜請求項９のいずれか１項記載の内視鏡用処理具であって、
前記先端部材は、少なくとも一部が絶縁性を有する内視鏡用処置具。 It is the processing tool for endoscopes of any one of Claims 1-9, Comprising:
At least a part of the distal end member is an endoscope treatment tool.
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