WO2016013255A1 - High-frequency medical instrument - Google Patents

High-frequency medical instrument Download PDF

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Publication number
WO2016013255A1
WO2016013255A1 PCT/JP2015/060054 JP2015060054W WO2016013255A1 WO 2016013255 A1 WO2016013255 A1 WO 2016013255A1 JP 2015060054 W JP2015060054 W JP 2015060054W WO 2016013255 A1 WO2016013255 A1 WO 2016013255A1
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Prior art keywords
sheath
electrode member
liquid
tip
distal end
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PCT/JP2015/060054
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French (fr)
Japanese (ja)
Inventor
史知 和家
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オリンパス株式会社
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Priority to JP2015562999A priority Critical patent/JPWO2016013255A1/en
Publication of WO2016013255A1 publication Critical patent/WO2016013255A1/en

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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

Definitions

  • the present invention relates to a high-frequency treatment instrument.
  • a high-frequency treatment instrument that treats a living tissue such as a mucous membrane by applying a high-frequency current is known (see, for example, Patent Document 1).
  • an electrode is inserted and arranged in a sliding hole at the tip of a flexible sheath having electrical insulation so that the electrode can advance and retreat in the axial direction, and the liquid fed through the flexible sheath is slid. It has a structure that can be discharged from the distal end of the flexible sheath through a liquid feeding opening communicating with the hole.
  • the high-frequency treatment instrument when bleeding occurs during the high-frequency treatment by energizing the electrodes, the high-frequency treatment instrument is replaced by a liquid such as physiological saline discharged from the distal end of the flexible sheath without replacing the high-frequency treatment instrument. It can be washed and a hemostatic treatment can be performed quickly and reliably against bleeding during surgery.
  • the high-frequency treatment instrument since the high-frequency treatment instrument is arranged so that the large-diameter portion provided at the tip of the electrode closes the liquid-feeding opening, the flow of the liquid is not greatly affected by the large-diameter portion by advancing the electrode. If the large-diameter portion is arranged away from the liquid-feeding opening as described above, the liquid can be discharged straight.
  • One embodiment of the present invention includes an elongated cylindrical sheath to be inserted into the body, an electrode member that is movably disposed in the longitudinal direction in the sheath, and to which a high-frequency current is supplied, and a proximal end side of the sheath.
  • a liquid feed means for feeding liquid via a flow path formed in the sheath, and a sliding hole for movably inserting and arranging the electrode member at the distal end of the sheath; and by the liquid feed means
  • a discharge port that discharges the liquid that has been fed is provided, and a tip portion that extends in a radially outward manner from the sliding hole is provided at the tip of the electrode member, and the discharge port is the tip.
  • a high-frequency treatment instrument formed in a shape and a position for changing the discharge angle of the liquid discharged forward with respect to the longitudinal axis in accordance with the distance from the distal end of the sheath.
  • treatment such as cutting of tissue in the body is performed by advancing the electrode member relative to the sheath to increase the amount of protrusion at the tip, and supplying a high-frequency current to the electrode member.
  • the hook-shaped tip is hooked on the surrounding tissue, so that the treatment can be performed stably without slipping.
  • the ablation area can be reduced even when a high-frequency current is supplied by retracting as much as possible until the tip of the electrode member comes into contact with the tip of the sheath so that only the tip of the electrode member is exposed at the tip of the sheath. Marking can be performed without being deeper than necessary.
  • the liquid feeding means When bleeding occurs at the site where treatment is performed, the liquid feeding means is operated to discharge the liquid fed through the flow passage penetrating the sheath in the longitudinal direction from the discharge port at the distal end of the sheath. By doing so, the liquid can be discharged and washed in the vicinity of the bleeding site.
  • the liquid discharge angle changes. Can be changed. For example, when a treatment is performed endoscopically, it is possible to change the position where the liquid is applied while cleaning the electrode member by moving the electrode member forward and backward.
  • the sheath when a liquid is locally injected into the submucosa, the sheath may be in a state where only the tip of the electrode member is exposed at the tip of the sheath so that the electrode does not pierce the tissue more than necessary. Since the liquid is discharged in a state where the tip of the tube is pressed against the surface of the tissue, the liquid can be locally injected into the submucosal layer regardless of the liquid discharge direction.
  • the discharge port may be formed so that the discharged liquid is discharged in a direction along the longitudinal axis in a state where the electrode member is separated from the distal end of the sheath.
  • the liquid feeding means with the electrode member advanced to the maximum extent, the liquid is discharged straight along the longitudinal axis of the sheath, and the liquid is washed at the target position. Etc. can be performed. Even if it is difficult to adjust the position of the electrode member in the advancing / retreating direction, the discharge along the longitudinal axis can be easily realized only by advancing it to the maximum extent.
  • the discharged liquid is discharged at an angle with respect to the longitudinal axis in a state where the electrode member is retracted to a position where the distal end portion abuts against the distal end of the sheath.
  • the discharge port may be formed at the same time.
  • the said discharge port may be provided with two or more at intervals in the circumferential direction around the said sliding hole.
  • the high-frequency treatment instrument 1 is a treatment instrument in which a distal end is introduced into a body through a channel provided in an insertion portion of an endoscope, for example, as shown in FIG. Formed into an elongated cylindrical shape that can be inserted into the sheath 2, a flexible sheath 2, an electrode member 3 that is advanced and retracted at the distal end of the sheath 2, and an operation of pushing and pulling the electrode member 3 toward the proximal end side of the sheath 2 And a liquid feeding means 5 for discharging liquid from the distal end of the sheath 2 via the inner hole 2a of the sheath 2.
  • a tip 6 is fixed to the tip of the sheath 2 so as to close the inner hole 2a.
  • the tip tip 6 is provided with a sliding hole 6a for inserting and arranging the electrode member 3 so as to be movable, and a plurality of inner surfaces of the sliding hole 6a along the longitudinal direction.
  • four grooves 6b are provided.
  • the sheath 2 and the tip end 6 are made of an electrically insulating material.
  • the electrode member 3 has a round bar-like columnar part 3a having an outer diameter slightly smaller than the inner diameter of the sliding hole 6a of the tip 6 and a bowl-like shape radially outward over the entire circumference at the tip of the columnar part 3a. And a leading end 3b that extends.
  • the distal end portion 3b is formed in a substantially disk shape with a rounded peripheral edge on the distal end side.
  • the outer diameter of the tip 3b is set to be larger than the diameter of the sliding hole 6a.
  • the movable portion 4c When the movable portion 4c is moved to the distal end side of the sheath 2 with respect to the handle 4b, the pressing force is transmitted to the electrode member 3 through the wire 4d, and the electrode member 3 is moved in the direction of moving forward with respect to the distal tip 6. It is like that.
  • the movable portion 4c When the movable portion 4c is moved to the proximal end side of the sheath 2 with respect to the handle 4b, the traction force is transmitted to the electrode member 3 through the wire 4d, and the electrode member 3 is drawn into the sliding hole 6a of the distal tip 6.
  • the handle 4 is provided with a connection port 8 that communicates with the inner hole 2 a of the sheath 2.
  • the liquid feeding means 5 is a syringe or a pump connected to the connection port 8, and a liquid such as physiological saline is fed into the inner hole 2 a of the sheath 2 by the operation of the liquid feeding means 5.
  • the four grooves 6b are roughly partitioned by the columnar portion 3a in a state where the columnar portion 3a of the electrode member 3 is fitted and arranged in the sliding hole 6a.
  • Four flow paths 9 are formed.
  • the four flow paths 9 are arranged at equal intervals in the circumferential direction of the columnar portion 3a, and each is formed between the inner hole 2a of the sheath 2 and the wire 4d as shown in FIG.
  • a cylindrical flow path 10 is opened in front of the tip 6. That is, the four flow paths 9 have respective discharge ports 9 a on the tip surface 6 c of the tip chip 6.
  • each flow channel 9 is separated from the discharge port 9a when the tip 3b of the electrode member 3 is moved forward and away from the tip surface 6c of the tip 6 as shown in FIG.
  • the discharge port 9a of each flow channel 9 is separated from the discharge port 9a when the tip 3b of the electrode member 3 is moved forward and away from the tip surface 6c of the tip 6 as shown in FIG.
  • the discharge port 9a of each flow channel 9 is separated from the discharge port 9a when the tip 3b of the electrode member 3 is moved forward and away from the tip surface 6c of the tip 6 as shown in FIG.
  • the discharge port 9a of each flow channel 9 is separated from the discharge port 9a when the tip 3b of the electrode member 3 is moved forward and away from the tip surface 6c of the tip 6 as shown in FIG.
  • the discharge port 9a of each flow channel 9 is separated from the discharge port 9a when the tip 3b of the electrode member 3 is moved forward and away from the tip surface 6c of the tip 6 as shown in FIG.
  • the discharge port 9a of each flow channel 9
  • each flow path 9 is opened to extend radially outward from the outer diameter of the tip portion 3 b of the electrode member 3.
  • the electrode member 3 is partially closed by the tip 3b when the electrode member 3 is retracted most.
  • the amount of protrusion of the discharge port 9a from the outer diameter of the distal end surface 3b is such that the liquid C that has flowed through the flow channel 10 in the inner hole 2a of the sheath 2 is divided into four flow channels 9 and the distal end surface 6c of the distal tip 6
  • the flow direction is changed radially outward by being blocked by the tip 3b, and the size is set so as to be discharged obliquely forward.
  • the operation unit 4 is operated to maximize the electrode member 3 as shown in FIG.
  • the sheath 2 is introduced into the body from the distal end side through a channel of the endoscope insertion portion (not shown), and the distal end of the sheath 2 is projected from the distal end of the insertion portion of the endoscope.
  • the operator removes the electrode member 3 by energizing the electrode member 3 while pressing the distal end surface 6c of the distal tip 6 to a plurality of places surrounding a portion that is supposed to be a lesion to be removed in the endoscopic image displayed on the monitor.
  • a mark surrounding the periphery of the lesion site to be formed can be formed, which can be used as a measure for subsequent treatment.
  • the operation unit 4 is operated to cause the electrode member 3 to protrude from the distal end surface 6c of the distal tip 6 as shown in FIG. Is inserted into the submucosa below the lesion site.
  • the operation unit 4 is operated to bring the electrode member 3 to the maximum retracted state, and the liquid feeding means 5 is operated to discharge the liquid C such as physiological saline from the discharge port 9a of the distal end surface 6c.
  • the liquid C is locally injected into the submucosal layer, and the lesion site is lifted.
  • the sheath 2 is extracted from the submucosal layer, the electrode member 3 is protruded by operating the operation unit 4 again, and the tissue around the lesion site is incised using the mark formed by the marking as a guide. Go. If there is bleeding in the middle of the incision, it can be cleaned by operating the liquid feeding means 4 to discharge the liquid C such as physiological saline from the discharge port 9a of the tip surface 6c of the tip 6.
  • the electrode member 3 is moved backward until the distal end portion 3b of the electrode member 3 abuts against the distal end surface 6c of the distal tip 6 by operating the operation portion 4. Thereby, the discharge port 9a of the flow path 9 is partially blocked by the tip portion 3b. Since the discharge port 9a of the flow channel 9 is formed so as to change the discharge direction of the liquid C when this state is reached, the liquid C changes its discharge direction from the front along the longitudinal axis of the sheath 2 to the sheath 2. It is changed to the diagonally forward direction inclined with respect to the longitudinal axis. Thereby, the position where the liquid C is applied can be changed without moving the endoscope, that is, without changing the endoscope image displayed on the monitor.
  • the high-frequency treatment instrument 1 branches the liquid C that has flowed through the flow path 10 in the inner hole 2a of the sheath 2 into the four flow paths 9 of the tip 6 and Since the liquid is discharged from the discharge port 9a, in the state where the electrode member 3 is retracted, the liquid C is branched and discharged in four directions obliquely forward, and the liquid C can be spread over a wider range. Therefore, there is an advantage that a wide range of bleeding can be quickly washed away.
  • grooves 6b are provided around the sliding hole 6a, and four flow paths 9 defined by the columnar portions 3a of the electrode member 3 inserted and arranged in the sliding hole 6a are formed.
  • one or more arbitrary number of grooves 6b may be formed.
  • channel 6b was provided in the circumferential direction at equal intervals, you may provide in unequal intervals.
  • the flow path is formed by the groove 6b connected to the slide hole 6a, the slide hole 6a in which the electrode member 3 is movably inserted and disposed and the flow path 9 in which the liquid C flows are formed independently. You may decide. In this case, a plurality of through holes 11 may be formed in parallel with the sliding hole 6a as shown in FIG. Moreover, although the cylindrical flow path 10 was formed between the inner surface 2a of the inner hole 2a of the sheath 2 and the wire 4d, an inner hole that forms the flow path 10 independently of the inner hole 2a in which the wire 4d is disposed ( (Not shown) may be provided.
  • the discharge port 9a of the flow channel 9 is partially blocked by the tip portion 3b of the electrode member 3 retracted to the maximum, so that the discharge port 9a of the flow channel 9 is blocked by the tip portion 3b.
  • the front end surface 6c that abuts the front end portion 3b of the electrode member 3 against the front end tip 6 protrudes slightly forward from the discharge port 9a of the flow path 9, or is shown in FIGS.
  • the step 3d and the inclined surface 3e are provided on the back surface 3c of the tip 3b, and the discharge port 9a of the flow channel 9 is partially opened even when the tip 3b is abutted against the tip 6c. It may be.
  • the discharge direction of the liquid C from the discharge port 9a of the flow path 9 is switched by maximally moving the electrode member 3 forward or backward, but instead, The discharge may be performed at an intermediate discharge angle at an intermediate position of advancement / retraction.
  • the discharge angle of the liquid C can be changed according to the position of the tip 3b of the electrode member 3, and the liquid C can be bathed without moving the field of view of the endoscope. The position or range of the object can be changed.
  • the shape is not limited and it is in the direction which cross
  • the shape may have any shape such as a spherical shape, a hemispherical shape, or a polygonal plate shape.

Abstract

The purpose of the present invention is to change a discharge angle of a fluid with a simple manipulation. Provided is a high-frequency medical instrument (1), comprising: a long and narrow cylindrical sheath (2) which is inserted within a body; an electrode member (3) which is positioned within the sheath (2) to be movable in the longitudinal axis direction, and whereto high-frequency current is supplied; and a fluid conveyance means which is connected to the base end side of the sheath (2), and which conveys a fluid via a flow path (9) which is formed in the longitudinal axis direction of the sheath (2). Disposed in the leading end of the sheath (2) are a sliding hole (6a) in which the electrode member (3) is inserted and positioned to be movable, and a discharge aperture (9a) which discharges a fluid (C) which is conveyed by the fluid conveyance means. Disposed in the leading end of the electrode member (3) is a leading end part (3b) which is bigger than the sliding hole (6a) and extends radially outward in a flange shape. The discharge aperture (9a) is formed in a shape and location which changes the discharge angle with respect to the longitudinal axis of the fluid (C) which is discharged forward, according to the distance of the leading end part (3b) from the leading end of the sheath (2).

Description

高周波処置具High frequency treatment tool
　本発明は、高周波処置具に関するものである。 The present invention relates to a high-frequency treatment instrument.
　従来、高周波電流を通電して粘膜等の生体組織を処置する高周波処置具が知られている（例えば、特許文献１参照。）。
　この高周波処置具は、電気絶縁性を有する可撓性シースの先端の摺動孔に、軸方向に進退可能に電極を挿入配置し、可撓性シース内を送液されてきた液体を摺動孔に連通する送液開口部を介して可撓性シースの先端から放出させることができる構造を有している。 2. Description of the Related Art Conventionally, a high-frequency treatment instrument that treats a living tissue such as a mucous membrane by applying a high-frequency current is known (see, for example, Patent Document 1).
In this high-frequency treatment instrument, an electrode is inserted and arranged in a sliding hole at the tip of a flexible sheath having electrical insulation so that the electrode can advance and retreat in the axial direction, and the liquid fed through the flexible sheath is slid. It has a structure that can be discharged from the distal end of the flexible sheath through a liquid feeding opening communicating with the hole.
　この高周波処置具によれば、電極に通電することによる高周波処置の最中に出血した場合に、高周波処置具を入れ替えることなく、可撓性シースの先端から放出される生理食塩水等の液体によって洗浄することができ、術中の出血に対して迅速、確実に止血処置を行うことができる。また、この高周波処置具は、電極の先端に設けた大径部が送液開口部を閉塞するように配置されるため、電極を前進させて液体の流れが大径部の影響を大きく受けないように大径部を送液開口部から離して配置すれば、液体を真っ直ぐに放出することができる。 According to this high-frequency treatment instrument, when bleeding occurs during the high-frequency treatment by energizing the electrodes, the high-frequency treatment instrument is replaced by a liquid such as physiological saline discharged from the distal end of the flexible sheath without replacing the high-frequency treatment instrument. It can be washed and a hemostatic treatment can be performed quickly and reliably against bleeding during surgery. In addition, since the high-frequency treatment instrument is arranged so that the large-diameter portion provided at the tip of the electrode closes the liquid-feeding opening, the flow of the liquid is not greatly affected by the large-diameter portion by advancing the electrode. If the large-diameter portion is arranged away from the liquid-feeding opening as described above, the liquid can be discharged straight.
特許第４３１５７２５号公報Japanese Patent No. 4315725
　しかしながら、出血部位を洗浄するには、液体を真っ直ぐに出血部位に向けて放出して洗浄を行うのみならず、液体をかける位置を移動させて洗浄することが要求される場合もある。
　本発明は上述した事情に鑑みてなされたものであって、簡易な操作で液体の放出角度を変化させることができる高周波処置具を提供することを目的としている。 However, in order to clean the bleeding site, it may be required not only to discharge the liquid straight toward the bleeding site and perform cleaning, but also to move the position where the liquid is applied to perform cleaning.
The present invention has been made in view of the above-described circumstances, and an object thereof is to provide a high-frequency treatment instrument capable of changing the liquid discharge angle by a simple operation.
　上記目的を達成するために、本発明は以下の手段を提供する。
　本発明の一態様は、体内に挿入される細長い筒状のシースと、該シース内に長手軸方向に移動可能に配置され、高周波電流が供給される電極部材と、前記シースの基端側に接続され、該シースに形成された流路を介して送液する送液手段とを備え、前記シースの先端に、前記電極部材を移動可能に挿入配置させる摺動孔と、前記送液手段によって送液されてきた液体を放出させる放出口とが設けられ、前記電極部材の先端に前記摺動孔より大きく径方向外方に鍔状に延びる先端部が設けられ、前記放出口が、前記先端部の前記シースの先端からの距離に応じて、前方に放出される液体の前記長手軸に対する放出角度を変化させる形状および位置に形成されている高周波処置具を提供する。 In order to achieve the above object, the present invention provides the following means.
One embodiment of the present invention includes an elongated cylindrical sheath to be inserted into the body, an electrode member that is movably disposed in the longitudinal direction in the sheath, and to which a high-frequency current is supplied, and a proximal end side of the sheath. A liquid feed means for feeding liquid via a flow path formed in the sheath, and a sliding hole for movably inserting and arranging the electrode member at the distal end of the sheath; and by the liquid feed means A discharge port that discharges the liquid that has been fed is provided, and a tip portion that extends in a radially outward manner from the sliding hole is provided at the tip of the electrode member, and the discharge port is the tip. There is provided a high-frequency treatment instrument formed in a shape and a position for changing the discharge angle of the liquid discharged forward with respect to the longitudinal axis in accordance with the distance from the distal end of the sheath.
　本態様によれば、体内の組織の切断等の処置は、シースに対して電極部材を前進させて先端部の突出量を増大させ、電極部材に高周波電流を供給することにより行われる。組織の切断や剥離を行う際に、鍔状の先端部を周辺組織に引っ掛けることにより、滑らずに安定して処置を行うことができる。また、シースの先端に電極部材の先端部が突き当たるまで最大限に後退させて、シースの先端に電極部材の先端部のみが露出した状態とすることにより、高周波電流を供給しても焼灼領域を必要以上に深くせずにマーキングを行うことができる。 According to this aspect, treatment such as cutting of tissue in the body is performed by advancing the electrode member relative to the sheath to increase the amount of protrusion at the tip, and supplying a high-frequency current to the electrode member. When the tissue is cut or peeled, the hook-shaped tip is hooked on the surrounding tissue, so that the treatment can be performed stably without slipping. In addition, the ablation area can be reduced even when a high-frequency current is supplied by retracting as much as possible until the tip of the electrode member comes into contact with the tip of the sheath so that only the tip of the electrode member is exposed at the tip of the sheath. Marking can be performed without being deeper than necessary.
　そして、処置を行っている部位において出血が生じた場合には、送液手段を作動させて、シースを長手方向に貫通する流路を介して送液した液体をシースの先端の放出口から放出させることにより、出血部位近傍に液体を放出して洗浄することができる。この場合において、電極部材をシースに対して進退させてシースの先端からの電極部材の先端部の距離を変化させると、液体の放出角度が変化するので、処置の対象に対して液体をかける位置を変化させることができる。例えば、経内視鏡的に処置を行う場合に、電極部材を進退させるだけで視野を固定したままで液体をかける位置を変化させ洗浄することができる。 When bleeding occurs at the site where treatment is performed, the liquid feeding means is operated to discharge the liquid fed through the flow passage penetrating the sheath in the longitudinal direction from the discharge port at the distal end of the sheath. By doing so, the liquid can be discharged and washed in the vicinity of the bleeding site. In this case, if the distance between the distal end of the electrode member and the distal end of the electrode member is changed with respect to the sheath by moving the electrode member forward and backward, the liquid discharge angle changes. Can be changed. For example, when a treatment is performed endoscopically, it is possible to change the position where the liquid is applied while cleaning the electrode member by moving the electrode member forward and backward.
　なお、粘膜下層に液体を局注する場合には、電極が必要以上に組織に刺さらないように、電極部材を後退させてシースの先端に電極部材の先端部のみが露出した状態としても、シースの先端を組織の表面に押し当てた状態で液体が放出されるため、液体の放出方向には関係なく、粘膜下層に液体を局注することができる。 In addition, when a liquid is locally injected into the submucosa, the sheath may be in a state where only the tip of the electrode member is exposed at the tip of the sheath so that the electrode does not pierce the tissue more than necessary. Since the liquid is discharged in a state where the tip of the tube is pressed against the surface of the tissue, the liquid can be locally injected into the submucosal layer regardless of the liquid discharge direction.
　上記態様においては、前記電極部材が前記シースの先端から離間させられた状態で、放出された液体が前記長手軸に沿う方向に放出されるように前記放出口が形成されていてもよい。
　このようにすることで、電極部材を最大限に前進させた状態で送液手段を作動させることにより、液体をシースの長手軸に沿って真っ直ぐに放出し、狙った位置に液体をかけて洗浄等を行うことができる。電極部材の進退方向の位置調節が困難であっても、最大限に前進させるだけで容易に、長手軸に沿う放出を実現することができる。 In the above aspect, the discharge port may be formed so that the discharged liquid is discharged in a direction along the longitudinal axis in a state where the electrode member is separated from the distal end of the sheath.
In this way, by operating the liquid feeding means with the electrode member advanced to the maximum extent, the liquid is discharged straight along the longitudinal axis of the sheath, and the liquid is washed at the target position. Etc. can be performed. Even if it is difficult to adjust the position of the electrode member in the advancing / retreating direction, the discharge along the longitudinal axis can be easily realized only by advancing it to the maximum extent.
　また、上記態様においては、前記先端部が前記シースの先端に突き当たる位置まで前記電極部材が後退させられた状態で、放出された液体が、前記長手軸に対して角度をなして放出されるように前記放出口が形成されていてもよい。
　このようにすることで、電極部材を最大限に後退させた状態で送液手段を作動させることにより、液体をシースの長手軸に対して斜め外方に放出し、液体をかける位置をずらすことができる。電極部材の進退方向の位置調節が困難であっても、最大限に後退させるだけで容易に、洗浄位置をずらずことができる。 Further, in the above aspect, the discharged liquid is discharged at an angle with respect to the longitudinal axis in a state where the electrode member is retracted to a position where the distal end portion abuts against the distal end of the sheath. The discharge port may be formed at the same time.
In this way, by operating the liquid feeding means with the electrode member retracted to the maximum, the liquid is discharged obliquely outward with respect to the longitudinal axis of the sheath, and the position where the liquid is applied is shifted. Can do. Even if it is difficult to adjust the position of the electrode member in the forward / backward direction, it is possible to easily shift the cleaning position only by retracting it to the maximum extent.
　また、上記態様においては、前記放出口が、前記摺動孔の回りに周方向に間隔をあけて複数設けられていてもよい。
　このようにすることで、電極部材を前進させて先端部をシースの先端から離した状態で送液手段を作動させることにより、各放出口から放出される液体を長手軸に沿う一方向に合流させて放出することができ、電極部材を後退させて先端部をシースの先端に近接させると、各放出口から放出される液体を異なる方向に広がるように放出することができる。これにより、液体をかける範囲を変化させることができる。 Moreover, in the said aspect, the said discharge port may be provided with two or more at intervals in the circumferential direction around the said sliding hole.
By doing this, the liquid delivery means is operated in a state where the electrode member is advanced and the tip portion is separated from the tip of the sheath, so that the liquid discharged from each discharge port joins in one direction along the longitudinal axis. When the electrode member is retracted and the tip is brought close to the tip of the sheath, the liquid discharged from each discharge port can be discharged so as to spread in different directions. Thereby, the range which applies a liquid can be changed.
　本発明によれば、簡易な操作で液体の放出角度を変化させることができるという効果を奏する。 According to the present invention, it is possible to change the liquid discharge angle with a simple operation.
本発明の一実施形態に係る高周波処置具を示す、一部を拡大縦断面図とした全体構成図である。BRIEF DESCRIPTION OF THE DRAWINGS It is the whole block diagram which made the expanded longitudinal cross-sectional view a part which shows the high frequency treatment tool which concerns on one Embodiment of this invention. 図１の高周波処置具をシースの先端側からみた、一部を切断した正面図である。It is the front view which cut | disconnected a part which looked at the high frequency treatment tool of FIG. 1 from the front end side of the sheath. 図１の高周波処置具の電極部材を前進させた状態のシースの先端近傍の縦断面図である。It is a longitudinal cross-sectional view of the tip vicinity of the sheath of the state which advanced the electrode member of the high frequency treatment tool of FIG. 図１の高周波処置具の電極部材を後退させた状態のシースの先端近傍の縦断面図である。FIG. 2 is a longitudinal sectional view of the vicinity of the distal end of the sheath in a state in which the electrode member of the high-frequency treatment instrument in FIG. 1 is retracted. 図１の高周波処置具の第１の変形例を示すシースの先端近傍の縦断面図である。It is a longitudinal cross-sectional view of the tip vicinity of the sheath which shows the 1st modification of the high frequency treatment tool of FIG. 図１の高周波処置具の第２の変形例を示すシースの先端近傍の縦断面図である。It is a longitudinal cross-sectional view of the tip vicinity of the sheath which shows the 2nd modification of the high frequency treatment tool of FIG. 図１の高周波処置具の第３の変形例を示すシースの先端近傍の縦断面図である。It is a longitudinal cross-sectional view of the tip vicinity of the sheath which shows the 3rd modification of the high frequency treatment tool of FIG. 図１の高周波処置具の第４の変形例を示すシースの先端近傍の縦断面図である。It is a longitudinal cross-sectional view of the tip vicinity of the sheath which shows the 4th modification of the high frequency treatment tool of FIG.
　本発明の一実施形態に係る高周波処置具１について、図面を参照して以下に説明する。
　本実施形態に係る高周波処置具１は、例えば、内視鏡の挿入部に設けられたチャネルを介して先端が体内に導入される処置具であって、図１に示されるように、チャネル内に挿入可能な細長い円筒状に形成され、可撓性を有するシース２と、該シース２の先端において進退させられる電極部材３と、該電極部材３をシース２の基端側において押し引きする操作部４と、シース２の内孔２ａを経由してシース２の先端から液体を放出させる送液手段５とを備えている。 A high-frequency treatment instrument 1 according to an embodiment of the present invention will be described below with reference to the drawings.
The high-frequency treatment instrument 1 according to the present embodiment is a treatment instrument in which a distal end is introduced into a body through a channel provided in an insertion portion of an endoscope, for example, as shown in FIG. Formed into an elongated cylindrical shape that can be inserted into the sheath 2, a flexible sheath 2, an electrode member 3 that is advanced and retracted at the distal end of the sheath 2, and an operation of pushing and pulling the electrode member 3 toward the proximal end side of the sheath 2 And a liquid feeding means 5 for discharging liquid from the distal end of the sheath 2 via the inner hole 2a of the sheath 2.
　シース２の先端には内孔２ａを閉塞するように先端チップ６が固定されている。先端チップ６には、図２に示されるように、電極部材３を移動可能に挿入配置させる摺動孔６ａが設けられているとともに、該摺動孔６ａの内面に長手方向に沿って複数、例えば、４カ所の溝６ｂが設けられている。シース２および先端チップ６は電気絶縁性の材料によって構成されている。 A tip 6 is fixed to the tip of the sheath 2 so as to close the inner hole 2a. As shown in FIG. 2, the tip tip 6 is provided with a sliding hole 6a for inserting and arranging the electrode member 3 so as to be movable, and a plurality of inner surfaces of the sliding hole 6a along the longitudinal direction. For example, four grooves 6b are provided. The sheath 2 and the tip end 6 are made of an electrically insulating material.
　電極部材３は、先端チップ６の摺動孔６ａの内径よりも若干小さな外径寸法を有する丸棒状の柱状部３ａと、該柱状部３ａの先端に全周にわたって径方向外方に鍔状に延びる先端部３ｂとを備えている。先端部３ｂは、その先端側の周縁が丸みを帯びた略円板状に形成されている。該先端部３ｂの外径寸法は、摺動孔６ａの径寸法より大きく設定されており、電極部材３が後退させられると、先端部３ｂの背面３ｃが先端チップ６の先端面６ｃに突き当たってそれ以上後退できないように係止されるようになっている。
　すなわち、電極部材３は、最大限に後退させられた状態で、先端チップ６の先端面６ｃよりも前方に先端部３ｂのみを露出させた状態に配置させられる。 The electrode member 3 has a round bar-like columnar part 3a having an outer diameter slightly smaller than the inner diameter of the sliding hole 6a of the tip 6 and a bowl-like shape radially outward over the entire circumference at the tip of the columnar part 3a. And a leading end 3b that extends. The distal end portion 3b is formed in a substantially disk shape with a rounded peripheral edge on the distal end side. The outer diameter of the tip 3b is set to be larger than the diameter of the sliding hole 6a. When the electrode member 3 is retracted, the back surface 3c of the tip 3b abuts against the tip 6c of the tip 6. It is locked so that it can no longer be retracted.
That is, the electrode member 3 is disposed in a state in which only the distal end portion 3b is exposed in front of the distal end surface 6c of the distal end tip 6 with the electrode member 3 retracted to the maximum extent.
　操作部４は、シース２の基端側に取り付けられ指かけ孔４ａを有するハンドル４ｂと、該ハンドル４ｂに対してシース２の長手軸方向に移動可能に設けられた可動部４ｃと、シース２の内孔２ａ内に配置され可動部４ｃと電極部材３とを連結するワイヤ４ｄと、高周波電源１２にケーブル４ｅを介して接続するプラグ４ｆとを備えている。図中符号４ｇは可動部４ｃに設けられた指かけ孔である。 The operation unit 4 includes a handle 4b attached to the proximal end side of the sheath 2 and having a finger hooking hole 4a, a movable unit 4c provided so as to be movable in the longitudinal axis direction of the sheath 2 with respect to the handle 4b, and the sheath 2 A wire 4d that is disposed in the inner hole 2a and connects the movable portion 4c and the electrode member 3 and a plug 4f that is connected to the high-frequency power source 12 via the cable 4e. In the figure, reference numeral 4g denotes a finger hole provided in the movable portion 4c.
　ハンドル４ｂに対して可動部４ｃをシース２の先端側に移動させると押圧力がワイヤ４ｄを介して電極部材３に伝達され、電極部材３が先端チップ６に対して前進する方向に移動させられるようになっている。また、ハンドル４ｂに対して可動部４ｃをシース２の基端側に移動させると、牽引力がワイヤ４ｄを介して電極部材３に伝達され、電極部材３が先端チップ６の摺動孔６ａに引き込まれる方向に後退させられるようになっている。そして、ハンドル４ｂに対して可動部４ｃを基端側に最大限に移動させると、電極部材３の先端部３ｂの背面３ｃが先端チップ６の先端面６ｃに突き当たって係止され、可動部４ｃがそれ以上移動できなくなるようになっている。 When the movable portion 4c is moved to the distal end side of the sheath 2 with respect to the handle 4b, the pressing force is transmitted to the electrode member 3 through the wire 4d, and the electrode member 3 is moved in the direction of moving forward with respect to the distal tip 6. It is like that. When the movable portion 4c is moved to the proximal end side of the sheath 2 with respect to the handle 4b, the traction force is transmitted to the electrode member 3 through the wire 4d, and the electrode member 3 is drawn into the sliding hole 6a of the distal tip 6. It is designed to be retracted in the direction of When the movable portion 4c is moved to the proximal end side with respect to the handle 4b as much as possible, the back surface 3c of the distal end portion 3b of the electrode member 3 abuts against the distal end surface 6c of the distal tip 6 and is locked. Can no longer move.
　ワイヤ４ｄは導電性のストッパ部７によって電極部材３に接続されている。ストッパ部７は電極部材３の柱状部３ａを挿通させる摺動孔６ａの内径寸法よりも大きな外径寸法を有し、電極部材３が前進させられたときに先端チップ６の内側面に突き当たって、電極部材３の前方への突出量を制限するようになっている。また、高周波電源１２から供給された高周波電流をプラグ４ｆおよびワイヤ４ｄを介して電極部材３に供給することができるようになっている。 The wire 4 d is connected to the electrode member 3 by a conductive stopper portion 7. The stopper portion 7 has an outer diameter dimension larger than the inner diameter dimension of the sliding hole 6a through which the columnar portion 3a of the electrode member 3 is inserted, and hits the inner surface of the tip 6 when the electrode member 3 is advanced. The amount of forward protrusion of the electrode member 3 is limited. Further, the high frequency current supplied from the high frequency power source 12 can be supplied to the electrode member 3 via the plug 4f and the wire 4d.
　ハンドル４には、シース２の内孔２ａに連絡する接続口８が設けられている。
　送液手段５は、接続口８に接続されるシリンジあるいはポンプ等であり、送液手段５の作動によって生理食塩水のような液体をシース２の内孔２ａに送り込むようになっている。 The handle 4 is provided with a connection port 8 that communicates with the inner hole 2 a of the sheath 2.
The liquid feeding means 5 is a syringe or a pump connected to the connection port 8, and a liquid such as physiological saline is fed into the inner hole 2 a of the sheath 2 by the operation of the liquid feeding means 5.
　本実施形態においては、図２に示されるように、電極部材３の柱状部３ａが摺動孔６ａに嵌合挿入配置された状態で、４カ所の溝６ｂは柱状部３ａによって概略区画された４つの流路９を形成している。４つの流路９は、柱状部３ａの周方向に等間隔をあけて配置され、それぞれが、図３に示されるように、シース２の内孔２ａとワイヤ４ｄとの間に形成されている円筒状の流路１０を先端チップ６の前方に開放している。すなわち、４つの流路９は、先端チップ６の先端面６ｃにそれぞれの放出口９ａを有している。 In the present embodiment, as shown in FIG. 2, the four grooves 6b are roughly partitioned by the columnar portion 3a in a state where the columnar portion 3a of the electrode member 3 is fitted and arranged in the sliding hole 6a. Four flow paths 9 are formed. The four flow paths 9 are arranged at equal intervals in the circumferential direction of the columnar portion 3a, and each is formed between the inner hole 2a of the sheath 2 and the wire 4d as shown in FIG. A cylindrical flow path 10 is opened in front of the tip 6. That is, the four flow paths 9 have respective discharge ports 9 a on the tip surface 6 c of the tip chip 6.
　そして、各流路９の放出口９ａは、電極部材３の先端部３ｂが前進させられて、先端チップ６の先端面６ｃから離れているときには、図３に示されるように、放出口９ａから放出される液体Ｃの多くが先端部３ｂを越えてシース２の長手軸の延長方向前方に放出され、先端部３ｂが先端チップ６の先端面６ｃに突き当たっているときには、図４に示されるように、先端部３ｂに突き当たってシース２の長手軸に対して傾斜した斜め前方に放出される位置および形状に形成されている。 Then, the discharge port 9a of each flow channel 9 is separated from the discharge port 9a when the tip 3b of the electrode member 3 is moved forward and away from the tip surface 6c of the tip 6 as shown in FIG. As shown in FIG. 4, when most of the liquid C to be discharged is discharged forward in the extending direction of the longitudinal axis of the sheath 2 beyond the distal end portion 3b and the distal end portion 3b is in contact with the distal end surface 6c of the distal end tip 6. In addition, it is formed in a position and a shape that abuts against the distal end portion 3 b and is discharged obliquely forward with respect to the longitudinal axis of the sheath 2.
　具体的には、各流路９の放出口９ａは、図２に示されるように、電極部材３の先端部３ｂの外径よりも径方向外方に延びて開口しており、図４に示されるように、電極部材３が最も後退させられた状態では先端部３ｂによって部分的に閉塞されるようになっている。先端面３ｂの外径からの放出口９ａの突出量は、シース２の内孔２ａ内の流路１０を流動してきた液体Ｃが４つの流路９に分かれて先端チップ６の先端面６ｃの放出口９ａから放出させられる際に、先端部３ｂによって堰き止められることにより流動方向を径方向外方に変化させられて、斜め前方にそれぞれ放出される程度の大きさに設定されている。 Specifically, as shown in FIG. 2, the discharge port 9 a of each flow path 9 is opened to extend radially outward from the outer diameter of the tip portion 3 b of the electrode member 3. As shown, the electrode member 3 is partially closed by the tip 3b when the electrode member 3 is retracted most. The amount of protrusion of the discharge port 9a from the outer diameter of the distal end surface 3b is such that the liquid C that has flowed through the flow channel 10 in the inner hole 2a of the sheath 2 is divided into four flow channels 9 and the distal end surface 6c of the distal tip 6 When discharged from the discharge port 9a, the flow direction is changed radially outward by being blocked by the tip 3b, and the size is set so as to be discharged obliquely forward.
　このように構成された本実施形態に係る高周波処置具１の作用について、以下に説明する。
　本実施形態に係る高周波処置具１を使用して、内視鏡的粘膜下層剥離術を行うには、操作部４を操作して、図４に示されるように、電極部材３を最大限に後退させた状態で、図示しない内視鏡の挿入部のチャネルを介してシース２を先端側から体内に導入していき、内視鏡の挿入部の先端からシース２の先端を突出させる。 The operation of the high-frequency treatment instrument 1 according to this embodiment configured as described above will be described below.
In order to perform endoscopic submucosal dissection using the high-frequency treatment tool 1 according to this embodiment, the operation unit 4 is operated to maximize the electrode member 3 as shown in FIG. In the retracted state, the sheath 2 is introduced into the body from the distal end side through a channel of the endoscope insertion portion (not shown), and the distal end of the sheath 2 is projected from the distal end of the insertion portion of the endoscope.
　これにより、シース２の先端に配置されている先端チップ６が内視鏡の視界に入るので、操作者は内視鏡により取得された画像を図示しないモニタで確認しながら、処置を行う。電極部材３を最大限に後退させた状態では、電極部材３の先端部３ｂのみが先端チップ６の先端面６ｃに露出しているので、この状態で電極部材３に高周波電流を印加しても組織が深く切り込まれることはなく、組織表面のみを焼酌するいわゆるマーキングを行うことができる。 Thereby, since the distal tip 6 disposed at the distal end of the sheath 2 enters the field of view of the endoscope, the operator performs a treatment while confirming an image acquired by the endoscope on a monitor (not shown). In the state in which the electrode member 3 is retracted to the maximum extent, only the tip portion 3b of the electrode member 3 is exposed on the tip surface 6c of the tip tip 6, so even if a high frequency current is applied to the electrode member 3 in this state The tissue is not deeply cut, and so-called marking that cauterizes only the tissue surface can be performed.
　すなわち、操作者はモニタに表示された内視鏡画像において切除すべき病変と思われる部位を取り囲む複数箇所に先端チップ６の先端面６ｃを押し当てて電極部材３に通電することにより、切除すべき病変部位の周囲を取り囲むマークを形成することができ、その後の処置の目安とすることができる。 That is, the operator removes the electrode member 3 by energizing the electrode member 3 while pressing the distal end surface 6c of the distal tip 6 to a plurality of places surrounding a portion that is supposed to be a lesion to be removed in the endoscopic image displayed on the monitor. A mark surrounding the periphery of the lesion site to be formed can be formed, which can be used as a measure for subsequent treatment.
　この後に、操作部４を操作して、図３に示されるように、電極部材３を先端チップ６の先端面６ｃから突出させ、高周波電流を印加することにより、組織を切開して先端チップ６を病変部位の下の粘膜下層まで刺し入れる。次いで、操作部４を操作して電極部材３を最大限に後退させた状態とし、送液手段５を作動させて生理食塩水等の液体Ｃを先端面６ｃの放出口９ａから放出させる。これにより、液体Ｃが粘膜下層に局注され、病変部位が浮上させられた状態となる。 Thereafter, the operation unit 4 is operated to cause the electrode member 3 to protrude from the distal end surface 6c of the distal tip 6 as shown in FIG. Is inserted into the submucosa below the lesion site. Next, the operation unit 4 is operated to bring the electrode member 3 to the maximum retracted state, and the liquid feeding means 5 is operated to discharge the liquid C such as physiological saline from the discharge port 9a of the distal end surface 6c. As a result, the liquid C is locally injected into the submucosal layer, and the lesion site is lifted.
　この状態で、シース２を粘膜下層から抜き出し、再度、操作部４を操作して電極部材３を突出させた状態として、マーキングにより形成されたマークを目安として病変部位の周囲の組織を切開していく。
　切開途中で出血があった場合には、送液手段４を作動させて生理食塩水等の液体Ｃを先端チップ６の先端面６ｃの放出口９ａから放出させることにより洗浄することができる。 In this state, the sheath 2 is extracted from the submucosal layer, the electrode member 3 is protruded by operating the operation unit 4 again, and the tissue around the lesion site is incised using the mark formed by the marking as a guide. Go.
If there is bleeding in the middle of the incision, it can be cleaned by operating the liquid feeding means 4 to discharge the liquid C such as physiological saline from the discharge port 9a of the tip surface 6c of the tip 6.
　この場合において、電極部材３を前進させ、先端部３ｂを先端チップ６の先端面６ｃから離間させた状態で生理食塩水等の液体Ｃを放出させると、図３に矢印で示されるように先端チップ６の流路９の放出口９ａから放出されたほぼ全ての液体Ｃが先端部３ｂを越えて前方に向けて放出される。したがって、内視鏡画像に表示されているシース２の先端が向かう方向に液体Ｃが放出されるので、液体Ｃをかける位置を狙いやすく、狙った箇所の出血を素早く洗い流すことができる。 In this case, when the electrode member 3 is advanced and the liquid C such as physiological saline is discharged in a state where the tip 3b is separated from the tip 6c of the tip 6, the tip as shown by the arrow in FIG. Almost all the liquid C discharged from the discharge port 9a of the flow path 9 of the chip 6 is discharged toward the front beyond the tip 3b. Therefore, since the liquid C is discharged in the direction in which the distal end of the sheath 2 displayed in the endoscopic image is directed, it is easy to aim at the position where the liquid C is applied, and it is possible to quickly wash away the bleeding at the target location.
　一方、出血が広範囲にわたる場合など、液体Ｃをかける位置を変化させたい場合がある。このような場合には、湾曲部を持たないシース２自体で先端を動かすことができないため、内視鏡の湾曲部の操作によってシース２の先端位置を移動する必要がある。しかしながら、内視鏡の湾曲部を操作する場合には内視鏡の視野が変化するためモニタに表示されている内視鏡画像も移動してしまう。 On the other hand, there are cases where it is desired to change the position where the liquid C is applied, such as when bleeding is widespread. In such a case, since the distal end cannot be moved by the sheath 2 itself having no bending portion, it is necessary to move the distal end position of the sheath 2 by operating the bending portion of the endoscope. However, when the bending portion of the endoscope is operated, the endoscope image displayed on the monitor also moves because the field of view of the endoscope changes.
　そこで、本実施形態に係る高周波処置具１では、操作部４を操作して電極部材３の先端部３ｂが先端チップ６の先端面６ｃに突き当たるまで電極部材３を後退させる。これにより、流路９の放出口９ａが先端部３ｂによって部分的に閉塞される。流路９の放出口９ａはこの状態となったときに液体Ｃの放出方向を変化させるように形成されているので、液体Ｃはその放出方向を、シース２の長手軸に沿う前方からシース２の長手軸に対して傾斜した斜め前方に変化させられる。これにより、内視鏡を動かすことなく、すなわち、モニタに表示されている内視鏡画像を変動させることなく、液体Ｃをかける位置を変化させることができる。 Therefore, in the high-frequency treatment instrument 1 according to this embodiment, the electrode member 3 is moved backward until the distal end portion 3b of the electrode member 3 abuts against the distal end surface 6c of the distal tip 6 by operating the operation portion 4. Thereby, the discharge port 9a of the flow path 9 is partially blocked by the tip portion 3b. Since the discharge port 9a of the flow channel 9 is formed so as to change the discharge direction of the liquid C when this state is reached, the liquid C changes its discharge direction from the front along the longitudinal axis of the sheath 2 to the sheath 2. It is changed to the diagonally forward direction inclined with respect to the longitudinal axis. Thereby, the position where the liquid C is applied can be changed without moving the endoscope, that is, without changing the endoscope image displayed on the monitor.
　特に、本実施形態に係る高周波処置具１は、シース２の内孔２ａ内の流路１０を流動してきた液体Ｃを先端チップ６の４つの流路９に分岐させて、各流路９の放出口９ａから放出させるので、電極部材３を後退させた状態では、液体Ｃは、斜め前方の４方向に分岐して放出され、より広範囲に液体Ｃを散布することができる。したがって、広範囲にわたる出血を迅速に洗い流すことができるという利点がある。 In particular, the high-frequency treatment instrument 1 according to the present embodiment branches the liquid C that has flowed through the flow path 10 in the inner hole 2a of the sheath 2 into the four flow paths 9 of the tip 6 and Since the liquid is discharged from the discharge port 9a, in the state where the electrode member 3 is retracted, the liquid C is branched and discharged in four directions obliquely forward, and the liquid C can be spread over a wider range. Therefore, there is an advantage that a wide range of bleeding can be quickly washed away.
　なお、患部の周囲の組織を切開する途中で、粘膜下層に局注した液体Ｃが他の部位に吸収される等して、病変部が沈んできた場合には、先端チップ６を再度、粘膜下層に押し当てて液体Ｃを局注することが行われる。この場合にも、電極部材３を最大限に後退させて液体Ｃを放出させることにより電極部材３が必要以上に組織に刺さらないようにすることができる。そして、この場合には先端チップ６の先端面６ｃの放出口９ａから放出された液体Ｃは、即座に粘膜下層組織に注入されるため、放出方向には関係なく確実に粘膜下層に局注される。 In the course of incising the tissue around the affected area, when the lesioned part sinks because the liquid C locally injected into the submucosal layer is absorbed by another site, the tip 6 is again inserted into the mucosa. The liquid C is locally injected by being pressed against the lower layer. Also in this case, it is possible to prevent the electrode member 3 from piercing the tissue more than necessary by retracting the electrode member 3 to the maximum and releasing the liquid C. In this case, since the liquid C discharged from the discharge port 9a of the tip surface 6c of the tip 6 is immediately injected into the submucosa tissue, it is surely injected locally into the submucosa regardless of the discharge direction. The
　また、本実施形態においては、摺動孔６ａの周囲に４つの溝６ｂを設け、摺動孔６ａに挿入配置される電極部材３の柱状部３ａによって区画された４つの流路９を形成することとしたが、これに代えて、１以上の任意の数の溝６ｂを形成してもよい。また、溝６ｂを周方向に等間隔に設けたが、不等間隔に設けてもよい。 Further, in the present embodiment, four grooves 6b are provided around the sliding hole 6a, and four flow paths 9 defined by the columnar portions 3a of the electrode member 3 inserted and arranged in the sliding hole 6a are formed. However, instead of this, one or more arbitrary number of grooves 6b may be formed. Moreover, although the groove | channel 6b was provided in the circumferential direction at equal intervals, you may provide in unequal intervals.
　また、摺動孔６ａに接続する溝６ｂによって流路を形成したが、電極部材３を移動可能に挿入配置させる摺動孔６ａと、液体Ｃを流動させる流路９とは、独立に形成することにしてもよい。この場合には図５に形成されるように摺動孔６ａに平行に複数の貫通孔１１を形成すればよい。また、シース２の内孔２ａ内面とワイヤ４ｄとの間に筒状の流路１０を形成したが、ワイヤ４ｄの配置される内孔２ａとは独立して流路１０を形成する内孔（図示略）を備えていてもよい。 In addition, although the flow path is formed by the groove 6b connected to the slide hole 6a, the slide hole 6a in which the electrode member 3 is movably inserted and disposed and the flow path 9 in which the liquid C flows are formed independently. You may decide. In this case, a plurality of through holes 11 may be formed in parallel with the sliding hole 6a as shown in FIG. Moreover, although the cylindrical flow path 10 was formed between the inner surface 2a of the inner hole 2a of the sheath 2 and the wire 4d, an inner hole that forms the flow path 10 independently of the inner hole 2a in which the wire 4d is disposed ( (Not shown) may be provided.
　また、本実施形態においては、最大限に後退させられた電極部材３の先端部３ｂによって流路９の放出口９ａを部分的に閉塞するために、流路９の放出口９ａを先端部３ｂの外径よりも径方向外方に突出させて形成したが、これに代えて、径方向外方に突出させなくてもよい。すなわち、図６に示されるように、先端チップ６に電極部材3の先端部３ｂを突き当てる先端面６ｃを流路９の放出口９ａより若干前方に突出させたり、図７および図８に示されるように、先端部３ｂの背面３ｃに段差３ｄや傾斜面３ｅを設けたりして、先端部３ｂを先端面６ｃに突き当てた状態でも流路９の放出口９ａを部分的に開口させることにしてもよい。 In the present embodiment, the discharge port 9a of the flow channel 9 is partially blocked by the tip portion 3b of the electrode member 3 retracted to the maximum, so that the discharge port 9a of the flow channel 9 is blocked by the tip portion 3b. However, instead of projecting outward in the radial direction, it is not necessary to project outward in the radial direction. That is, as shown in FIG. 6, the front end surface 6c that abuts the front end portion 3b of the electrode member 3 against the front end tip 6 protrudes slightly forward from the discharge port 9a of the flow path 9, or is shown in FIGS. As shown, the step 3d and the inclined surface 3e are provided on the back surface 3c of the tip 3b, and the discharge port 9a of the flow channel 9 is partially opened even when the tip 3b is abutted against the tip 6c. It may be.
　また、本実施形態においては、電極部材３を最大限に前進あるいは最大限に後退させることによって流路９の放出口９ａからの液体Ｃの放出方向を切り替えることとしたが、これに代えて、進退の途中位置において中途の放出角度で放出させてもよい。いずれの場合においても、本実施形態においては、電極部材３の先端部３ｂの位置に応じて液体Ｃの放出角度を変化させることができ、内視鏡の視野を動かすことなく、液体Ｃを浴びせる対象の位置あるいは範囲を変更することができる。 In the present embodiment, the discharge direction of the liquid C from the discharge port 9a of the flow path 9 is switched by maximally moving the electrode member 3 forward or backward, but instead, The discharge may be performed at an intermediate discharge angle at an intermediate position of advancement / retraction. In any case, in the present embodiment, the discharge angle of the liquid C can be changed according to the position of the tip 3b of the electrode member 3, and the liquid C can be bathed without moving the field of view of the endoscope. The position or range of the object can be changed.
　また、電極部材３の先端部３ｂが略円板状であるとして説明したが、その形状は限定されるものではなく、柱状部３ａの周方向の少なくとも一部において、長手軸に交差する方向に鍔状に延びる形状であれば、球状、半球状、多角形の板状等任意の形状を有していてもよい。 Moreover, although the front-end | tip part 3b of the electrode member 3 was demonstrated as substantially disc shape, the shape is not limited and it is in the direction which cross | intersects a longitudinal axis in at least one part of the circumferential direction of the columnar part 3a. As long as the shape extends in a bowl shape, it may have any shape such as a spherical shape, a hemispherical shape, or a polygonal plate shape.
　１　高周波処置具
　２　シース
　３　電極部材
　３ｂ　先端部
　５　送液手段
　６ａ　摺動孔
　９　流路
　９ａ　放出口 DESCRIPTION OF SYMBOLS 1 High frequency treatment tool 2 Sheath 3 Electrode member 3b Tip part 5 Liquid feeding means 6a Sliding hole 9 Flow path 9a Release port

Claims (4)

  1. 　体内に挿入される細長い筒状のシースと、
    　該シース内に長手軸方向に移動可能に配置され、高周波電流が供給される電極部材と、
    　前記シースの基端側に接続され、該シースに形成された流路を介して送液する送液手段とを備え、
    　前記シースの先端に、前記電極部材を移動可能に挿入配置させる摺動孔と、前記送液手段によって送液されてきた液体を放出させる放出口とが設けられ、
    　前記電極部材の先端に前記摺動孔より大きく径方向外方に鍔状に延びる先端部が設けられ、
    　前記放出口が、前記先端部の前記シースの先端からの距離に応じて、前方に放出される液体の前記長手軸に対する放出角度を変化させる形状および位置に形成されている高周波処置具。     An elongated cylindrical sheath inserted into the body;
    An electrode member disposed in the sheath so as to be movable in the longitudinal axis direction and supplied with a high-frequency current;
    A liquid feeding means connected to the proximal end side of the sheath and feeding liquid through a flow path formed in the sheath;
    Provided at the distal end of the sheath is a sliding hole for movably inserting and arranging the electrode member, and a discharge port for discharging the liquid fed by the liquid feeding means,
    The tip of the electrode member is provided with a tip portion extending in a bowl shape radially outwardly larger than the sliding hole,
    The high-frequency treatment instrument in which the discharge port is formed in a shape and a position that change the discharge angle of the liquid discharged forward with respect to the longitudinal axis according to the distance from the distal end of the sheath of the distal end portion.
  2. 　前記放出口は、前記電極部材が前記シースの先端から離間させられた状態で、放出された液体が前記長手軸に沿う方向に放出されるように形成されている請求項１に記載の高周波処置具。 2. The high-frequency treatment according to claim 1, wherein the discharge port is formed such that the discharged liquid is discharged in a direction along the longitudinal axis in a state where the electrode member is separated from a distal end of the sheath. Ingredients.
  3. 　前記放出口は、前記先端部が前記シースの先端に突き当たる位置まで前記電極部材が後退させられた状態で、放出された液体が、前記長手軸に対して角度をなして放出されるように形成されている請求項１または請求項２に記載の高周波処置具。 The discharge port is formed such that the discharged liquid is discharged at an angle with respect to the longitudinal axis in a state where the electrode member is retracted to a position where the distal end portion abuts against the distal end of the sheath. The high-frequency treatment instrument according to claim 1 or 2, wherein the high-frequency treatment instrument is provided.
  4. 　前記放出口が、前記摺動孔の回りに周方向に間隔をあけて複数設けられている請求項１から請求項３のいずれかに記載の高周波処置具。 The high-frequency treatment instrument according to any one of claims 1 to 3, wherein a plurality of the discharge ports are provided around the sliding hole at intervals in the circumferential direction.
PCT/JP2015/060054 2014-07-24 2015-03-31 High-frequency medical instrument WO2016013255A1 (en)

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2002301088A (en) * 2001-04-05 2002-10-15 Olympus Optical Co Ltd Endoscopic treatment device
JP2010046200A (en) * 2008-08-20 2010-03-04 Fujinon Corp High frequency treatment tool
JP2013111308A (en) * 2011-11-30 2013-06-10 Hoya Corp High frequency treatment instrument for endoscope

Family Cites Families (3)

* Cited by examiner, † Cited by third party
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JP2009112788A (en) * 2007-10-17 2009-05-28 Takashi Toyonaga High frequency tool
JP5613513B2 (en) * 2010-09-27 2014-10-22 富士フイルム株式会社 Endoscopic treatment tool
WO2014061701A1 (en) * 2012-10-17 2014-04-24 オリンパスメディカルシステムズ株式会社 High frequency knife

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2002301088A (en) * 2001-04-05 2002-10-15 Olympus Optical Co Ltd Endoscopic treatment device
JP2010046200A (en) * 2008-08-20 2010-03-04 Fujinon Corp High frequency treatment tool
JP2013111308A (en) * 2011-11-30 2013-06-10 Hoya Corp High frequency treatment instrument for endoscope

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