Background technique
In the past, there are a kind of endoscopes, were inserted into human body, had object lens, illuminating lens in front end, in body cavityIt is observed, and is inserted from channel and importing in body cavity is disposed via the disposition instrument for leading to front end side from side on handSet instrument.As the disposition for using such endoscope, there is known ESD (endoscopic mucosal lower layer decollement), EMR (endoscopeMucosectomy).
There is knife, snare in through disposition instrument used in endoscope.Knife is for cutting body cavity surface.In order to carry out essenceThin excision operation, needs knife being stably fixed to sheath, and the operation that the operation portion of side on hand carries out is reliably transmitted.SnareHave cricoid line, for surrounding the protrusion of body cavity surface with ring, and reduces tie tight the root of protrusion of ring diameter and cut off.For the loop wire of snare, Le beam is carried out in order to tense the root of lesion, and loop wire is enable to pass in and out from sheath,Loop wire needs are made of the line for capableing of flexible deformation.Any disposition instrument is powered as from side on hand, generates electric current for body cavity tableThe high-frequency treatment instrument that face cuts off and burns etc. come using.
As by knife used in endoscope, there are high-frequency treatment instrument disclosed in patent document 1.The cutter for sheath,Be configured to inside the sheath it is prominent and in the needle electrode of front end external high-frequency electric current.The knife is in order to limit by needle-shapedThe overhang for the knife that electrode is constituted and the stability for ensuring to carry out to cut the position of the knife of disposition, being provided in sheath hasThe hard cylinder in the aperture bigger than the outer diameter of knife, and the position of the side on hand of knife is provided with multiple restriction protrusions.Pass through hardCylinder and restriction protrusion carry out face contact, protrusion length of the knife from the front end face of sheath can be limited, so that knife steadily be protectedIt holds in the long axis center of sheath.
As by snare used in endoscope, there are high frequency snares disclosed in patent document 2.The snare has sheathWith the loop wire in the logical electric conductivity for being configured to retreat of sheath interpolation.The snare is in order to pass through high-frequency electrical for the root of lesionIt flows not bleeding and reliably burns central part and strangle disconnected, the termination electrode before guard leading end is provided with.In addition, the snare in order toThe degree that stress is concentrated to the bending returning part of loop wire front end is reduced, passes through front end blade in the front end of loop wire.
Knife is used for ESD (endoscopic mucosal lower layer decollement).ESD have by endoscope gradually remove it is gastralIn the surgical procedure of lesion, the advantages of capable of subtly cutting off lesion.However on the other hand, disposition spends the time, externallyThe technology of section doctor also requires.Snare is used for EMR (endoscopic mucosal resection art).EMR is passing through endoscope ring packetIt encloses lesion and tenses in the surgical procedure that is cut off, excision can be easy to carry out in wide scope.But only accuratelyExcision target site is difficult, and is also limited to be able to use the shape of the lesion of EMR.
Therefore, following methods are had studied, that is, firstly, cutting around target lesion portion using knife by its a small amount of removing, InKnife is temporarily changed to snare after endoscope extraction, by the way that the ring of snare is placed on the position separated with knife and tenses lesionThus portion maintains the excision precision of lesion and realizes the shortening of operation time.
As the disposition instrument for such surgical procedure, proposes and the front end of the loop wire of snare is provided with pointed noseDispose instrument.Patent Document 3 discloses a kind of endoscope-use high frequency snare, have sheath and when being directed in sheath intoThe snare ring of row flexible deformation and constriction.For the snare, penetrated through in the front end portion of the snare ring with the front end portion of lineState is fixedly mounted the front end blade of electrical insulating property, protrudes line forwards from front end blade, and the protrusion is made to become stickTermination electrode before shape.The bar-shaped forward end electrode of the snare can be used as knife.In the case where using as knife, front end is leftPoint snare ring is imported in sheath, only make front end portion from sheath it is prominent as incision with knife come using.
When carrying out ESD using knife, in order to subtly cut off lesion, knife front end is needed not shake in surgical procedureConstruction.In addition, needing the front end by knife steady in order to which the reliable in action of operation portion on hand to be transferred to the operation portion of front endSurely it is fixed on guard leading end portion.On the other hand, it is desirable in addition to when disposition, no matter be switched on, is non-energized, disposition portion is kept, can be prominent from guard leading end when disposition in sheath, it can be moved along sheath long axis, in order to avoid lesion is delivered to instrument will be disposedDuring portion, it is not intended in make endoscope disposition instrument insert channel in, in body cavity injury.
In addition, in the disposition instrument that knife portion is set to the front end of snare as knife in use, the side on hand in knife portion is by energyThe snare that the line of enough flexible deformations is constituted, after being cut with knife portion, expansion snare ring strangles beam lesion, considers above situation, needsGuard leading end portion is fixed in knife portion.
As the construction that knife portion is fixed on to sheath, Patent Document 4 discloses configure frictional resistance in sheath to applyThe construction of made component.Frictional resistance is applied using the outer peripheral surface of sheath inner peripheral surface and the operation lines being connected with knife portion by becomingComponent flatten construction, become generate the load based on frictional resistance and use knife when knife portion fixture construction.
Patent document 1: Japanese Unexamined Patent Publication 2007-044393 bulletin
Patent document 2: Japanese Unexamined Patent Publication 11-347045 bulletin
Patent document 3: Japanese Unexamined Patent Publication 2010-131100 bulletin
Patent document 4: Japanese Unexamined Patent Publication 2007-319424 bulletin
In the high frequency knife shown in patent document 1, in order to which knife is fixed on guard leading end, sheath is provided with hard cylinderBody, and restriction protrusion is provided on knife.Pass through the face contact fixing cutter of hard cylinder and limiter.For such structureWhen, the components number for disposing instrument increases.In addition, since the face contact that knife passes through hard cylinder and limiter is fixed completely, instituteKnife can not be made longerly prominent after the prominent specific length in guard leading end face.
Termination electrode is used as knife before the high frequency snare as shown in patent document 2 is not scheduled to, so for front end electricityThe fixed mechanism of pole is undisclosed.
In the high frequency snare shown in patent document 3, front end knife portion is consolidated by contact of the front end blade with guard leading endIt is fixed.The front end blade of electrical insulating property is set to the snare ring that front end side is leaned on than guard leading end face.Therefore, exist using front end knife portionWhen being disposed in body cavity, due to guard leading end face and front end blade contact, so knife portion will not be imported into inside sheath, it canStablize cutter position.But when the disposition instrument that this disposition instrument is inserted through to endoscope inserts channel, it is located at body cavity in disposition instrumentWhen interior non-disposition portion, knife portion exposes from sheath always, so even around being also possible to hurt when non-energized.
Patent Document 4 discloses a kind of endoscopic treatment instrument, the frictional resistance applying units of flexible elastic forcePart is crushed by the inner peripheral surface of sheath and the outer peripheral surface of operation lines and is pressed into configuration in sheath with the state of flexible deformationFront end nearby in.In the disposition instrument, component and flexibility can be applied in the frictional resistance of operation lines, elastic force with frictional resistanceFront end is disposed piece and adjusts from the protrusion length stabilisation of the front end of sheath, is maintained and appoints by the mode of sheath acted on each otherMeaning length.In addition, Patent Document 4 discloses apply component to frictional resistance to increase the frictional resistance with sheathImplement surface treatment in the region of operation lines of getting along well contact.In the knife fixing means shown in patent document 4, it is following inconvenient to generate,That is, not only when using knife, but also in all sequence of operations, such as make that knife is prominent to outside sheath, storage knife, handle is graspedMake to become weight.In addition, components number also will increase, and it also requires fixed friction resistance applies the method for component or for preventing from rubbingIt wipes resistance and applies the mechanism that component is stretched out to outside sheath.
However, using disposition instrument is practical be operated when, in order to cut and by knife portion be inserted into tissue intoWhich kind of in the case where row embedment, if sheath is identical always in length direction appearance, it is difficult to that tissue degree judged to be embedded to.CauseThis, excessively presses on tissue for disposition instrument, is as a result likely to result in the danger of tissue perforation.
Specific embodiment
Endoscope-use high-frequency treatment instrument of the invention is inserted through the disposition instrument insert channel of endoscope, is used for endoceliac markKnow, cut, strangle the modus operandis such as disposition, ESD, EMR such as beam.High-frequency treatment instrument has knife portion and snare portion in distal side.It is inciting somebody to actionHigh-frequency treatment instrument as knife in use, the knife portion of front end can only be made steadily to protrude from guard leading end, by high-frequency treatment instrumentAs snare in use, as snare portion, such as it can make to be formed as cricoid electric conductivity line from sheath protrusion.Hereinafter, sometimesEndoscope-use high-frequency treatment instrument is referred to as " disposition instrument ".
As shown in Figure 1 and Figure 2, endoscope-use high-frequency treatment instrument of the invention includes sheath 5；Thread 4, configurationIn the sheath 5；Electric conductivity line 2 has the First Line portion 2A extended respectively along the far and near direction of sheath 5 and the second line portion2B, and the proximal end of First Line portion 2A and the proximal end of the second line portion 2B are fixed on thread 4；Electric conductivity front end blade1, link respectively with the distal end of the distal end of First Line portion 2A and the second line portion 2B；And electric conductivity connector 3,Thread 4, First Line portion 2A and the second line portion 2B are connected.Endoscope-use high-frequency treatment instrument of the invention has to sheath 5A part of inner wall implements the surface treatment of surface treatment, electric conductivity connector 3, First Line portion 2A, the second line portion 2BAnd at least one party in electric conductivity front end blade 1 can contact with surface treatment.One of blade 1 in electric conductivity front endPoint from sheath 5 it is prominent in the state of, electric conductivity connector 3 that thread 4, First Line portion 2A and the second line portion 2B are connected, theThe inner wall of one line portion 2A, the second line portion 2B and at least one party and sheath 5 in electric conductivity front end blade 1 implement at surfaceThe part of reason contacts.In this way, being configured to by the component for configuring in sheath 5 and the inner wall of sheath 5 implements surface treatmentPart contact, can steadily fix electric conductivity front end blade 1 by the front end of sheath 5, only make electric conductivity front end blade 1 fromSheath 5 is prominent.In addition, distal side refers to that the endoceliac front end side for being inserted into endoscope, proximal lateral refer to the phase of distal sideIt tosses about, is the side on hand for carrying out endoscope, the operation for disposing instrument.In addition, unless stated otherwise, " length " refers to sheath in distanceLength on direction (long axis direction of sheath).Hereinafter, " electric conductivity connector " is known as " connector ", " electric conductivity line " is claimedFor " line ", " electric conductivity front end blade " is known as " front end blade ".
Sheath 5 is can be in the hollow part of the strip of internal receipt of wire shape object 4, electric conductivity line 2.The inner surface of sheath 5At least one party for having and being accommodated in the electric conductivity connector 3 of inside, electric conductivity line 2, electric conductivity front end blade 1 of sheath 5Contact, and it is capable of fixing the superficiality and intensity of the degree of electric conductivity connector 3, electric conductivity line 2, electric conductivity front end blade 1.AndAnd preferably sheath 5 balancedly has both: can insert the surface smoothness inserted in channel, along place in the disposition instrument of endoscopeIt sets the curved flexibility of shape of instrument insert channel lumen and reliably arrives the rigidity for reaching disposition object tissue.
As the material of sheath 5, for example, using the cylinder formed by spiral helicine metal, synthetic resin, by short tubularThe cylinder that connector links multiple cylinders so as to rotation, formed by synthetic resin in long axis direction.As formation sheathSynthetic resin, polyolefin resins such as the polyamides such as nylon, polypropylene (PP), polyethylene (PE), poly- can be used for exampleThe aromatic polyethers ketone resins, polyimides tree such as the polyester resin such as ethylene glycol terephthalate (PET), polyether-ether-ketone (PEEK)Rouge, polytetrafluoroethylene (PTFE) (PTFE), tetrafluoroethylene-perfluoroalkyl vinyl ether copolymer (PFA), ethylene-tetrafluoroethylene copolymerizationFluororesin such as object (ETFE) etc..
The length of sheath 5 can according to the length of endoscope suitably set, it is however generally that, majority be 1650mm~2300mm.It is preferred that the outer diameter of sheath 5 be 1.8mm or more and 3.5mm hereinafter, the internal diameter of sheath 5 be 1.2mm or more and 3.0mm withUnder.Flexibility, the rigidity of sheath 5 can not only be controlled by the material of sheath, can also be controlled by thickness.Sheath 5Thickness can be selected according to the material used, but when the material of sheath is fluororesin, it is preferably unilateral with a thickness of 0.2mm withOn.
The outer diameter and internal diameter of sheath 5 can be constant, or cone cell or along its length with different multipleDiameter.Fig. 3 indicates the configuration example of the front end portion of the disposition instrument of the constant inner diameter of sheath 5, and Fig. 4 indicates the internal diameter of sheath 5 notThe configuration example of the front end portion of constant disposition instrument.Fig. 3 and Fig. 4 indicate a part of electric conductivity front end blade 1 from sheath 5Prominent and line 2 is accommodated in the example of the disposition instrument of the state of the inside of sheath 5.
For endoscope-use high-frequency treatment instrument, in electric conductivity front end, blade 1 is at least distally configured at than sheath 5Distal end is by the position of distal side and the proximal lateral of electric conductivity front end blade 1 is configured in the state of the inside of sheath 5, to conductionProperty connector 3, electric conductivity line 2, any of electric conductivity front end blade 1 or the sheath 5 of multiple and sheath 5 inner wall contactPosition implement surface treatment.As a result, when a part of electric conductivity front end blade 1 is prominent from sheath 5, protected by configuringComponent and the contact of the inner wall of sheath 5 in set 5, can more stably fix electric conductivity front end blade 1.That is, passing through electric conductivityThe surface treating part of any of connector 3, electric conductivity line 2, electric conductivity front end blade 1 or multiple and sheath 5 inner wallThe contact divided, can more stably keep the state outstanding of electric conductivity front end blade 1.Describe surface treatment in detail later.
Thread 4 is disposed on the bar (referring to Fig.1) in sheath 5.Thread 4 and handle 6 and electric conductivity line 2 connectIt connects, for making electric conductivity line 2 in the inside and outside movement of sheath 5, or for the rotation process of 6 side of handle to be transferred to electric conductivity line2 sides.Thread 4 can also be with the movement of electric conductivity line 2 to moving except sheath 5.
It is preferred that the thread 4 being accommodated in sheath 5 is made of the material for capableing of flexible deformation.As long as the elasticity of thread 4For shape along follow endoscope disposition instrument insert channel deformation sheath 5 and changed degree elasticity.As long as thread 4 is the material for capableing of flexible deformation, it is not particularly limited, it is the superlastic such as alloy that Ni-Ti (NiTi), which can be used,The resins such as the polyamide resins such as metals, the nylon such as the stainless steels such as property alloy, SUS303, SUS304.Thread 4 can be by oneComponent is formed, multiple components can also be engaged in the midway of the long axis direction of thread 4 etc..When midway engages, as long as adoptingIt will be engaged between wire rod with common joint method.Joint method is for example had the welding combined using metal tube riveting, meltedThe methods of apply, bond.Thread 4 can be single line, be also possible to the twisted wire for being further twisted together single line.If single line, then holdEasily manufacture.If twisted wire, then it can be improved the intensity of thread 4, therefore can be by operations such as the rotations of 6 side of handle more reliablyIt is transferred to front end.The length of thread 4 needs to insert channel than the disposition instrument of endoscope long.
Electric conductivity line 2 is the bar extended along far and near direction, by exposing at least part from the distal side of sheath 5To be used as the snare of disposition instrument.Electric conductivity line 2 have respectively along sheath 5 far and near direction extend First Line portion 2A withAnd the proximal end of the second line portion 2B, the proximal end of First Line portion 2A and the second line portion 2B are fixed on thread 4.If First LineThe proximal end of portion 2A and the proximal end of the second line portion 2B are fixed relative to thread 4, then can directly connect with thread 4It connects, can also engage indirectly.Each proximal end of First Line portion 2A and the second line portion 2B include First Line portion 2A or secondThe proximal end of line portion 2B, such as the part preferably within the 30mm of proximal end, are more preferably the portions within the 20mm of proximal endPoint.In addition, each distal end of First Line portion 2A and the second line portion 2B include the remote of First Line portion 2A or the second line portion 2BEnd, such as the part preferably within the 30mm of distal end, are more preferably the parts within the 20mm of distal end.
As shown in Figure 3 and 4, it is preferably leaned in the distal end of electric conductivity front end blade 1 being at least distally configured at than sheath 5The position of the distal side and proximal lateral of electric conductivity front end blade 1 is configured in the state of the inside of sheath 5, First Line portion 2A'sThe contact of the inner wall of at least one position and sheath 5, at least one position of the second line portion 2B and the inner wall contact of sheath 5.As a result,Electric conductivity front end blade 1 can be more steadily fixed on to the front end of sheath 5.
Electric conductivity line 2 can be formed as First Line portion 2A and the second line portion 2B and extend relative to along the far and near direction of sheath 5Line in line it is symmetrical, can also be formed as asymmetric.It is preferably cyclic annular, wherein preferred both ends for the shape of electric conductivity line 2It is fixed on the ring-type of the distal end of thread 4.Ring-type for example refers to the ring-type comprising the snare portion closure including knife portion, can be circleShape, ellipse, polygon etc..Aftermentioned bending section can be arranged by online 2 midway bending or complications etc. becomes shapeChange.For example, can be contacted by a part and sheath 5 for making line 2, the electric conductivity front end blade 1 linked with electric conductivity line 2 is consolidatedIt is set to prominent from the front end of sheath 5.
It is preferred that position electric conductivity line 2 and that sheath 5 contacts is position at each the one of First Line portion 2A and the second line portion 2B.When keeping front end blade 1 prominent from sheath 5, for line to be more securely fixed on to sheath 5.Can also online 2 proximal lateral,Part between distal side and proximal lateral contacts multiple positions and sheath 5.Since cricoid line 2 has the internal diameter than sheath 5Big ring diameter, so ring is folded if line 2 is accommodated in sheath 5, so that multiple positions of line 2 and sheath 5 contact.It is preferred thatFirst Line portion 2A and the second line portion 2B is symmetrically contacted with sheath 5 relative to the long axis direction substantial line of sheath 5.
It is preferred that First Line portion 2A and the second line portion 2B are formed as one by electric conductivity line 2 in distal end.Thereby, it is possible to willThe structure of electric conductivity line 2 simplifies.Alternatively, electric conductivity line 2 or First Line portion 2A and the second line portion 2B are seperated components.ByThis, can make the material for constituting First Line portion 2A and the second line portion 2B different and increase the complex-shaped etc. of snare by design circleThe freedom degree of set.
The electric conductivity line 2 of thread 4 is preferably fixed to by conductive and be capable of the material of flexible deformation and formed.It is conductiveProperty line 2 the following degree of elastic demand: from the front end of sheath 5 it is prominent after, it is predetermined to be used as snare, therefore for example needFor the degree for being recovered to tubular shape.In addition, preferably line 2 is to be easy be bent to add in order to be suitably set bending sectionThe material of work.Material for electric conductivity line 2, it is preferable to use Ni-Ti (NiTi) be the superelastic alloy such as alloy, SUS303,The metals such as the stainless steels such as SUS304.
The length of electric conductivity line 2, diameter can suitably be selected according to the purposes of snare.It is preferred that the length of electric conductivity line 2 is60mm or more and 200mm or less.Wherein, preferably with the length of the coupling part of thread 4 be 2mm or more and 10mm or less.It is excellentThe diameter for selecting electric conductivity line 2 is 0.2mm or more and 1.0mm or less.
The connection of thread 4 and electric conductivity line 2 can be carried out by common joint method, can be directly connected to, can alsoTo be connected via connecting component.Joint method for example has through the methods of the welding of metal tube riveting combination, deposition, bonding.WhenWill flexible deformation metal wire both ends and thread 4 connect when, preferably via metal tube connect.
Electric conductivity connector 3 can be set to the interconnecting piece of above-mentioned thread 4 and electric conductivity line 2.Electric conductivity connector 3 canTo be the connecting component for the connection of thread 4 and electric conductivity line 2, it is also possible to be set to the proximal lateral of electric conductivity line 2Electroconductive component near interconnecting piece.It is preferred that electric conductivity connector 3 is by the stainless steel and other metal materials structure such as SUS303, SUS304At.The shape of electric conductivity connector 3 can spherical, oval spherical, polyhedral, column, cone cell, they are composedShape, or overall length bending or broadening can be made etc..It is preferred that the length in the far and near direction of the sheath 5 of electric conductivity connector 3 is2.0mm or more and 10.0mm or less.
It is preferred that being at least distally configured at the distal end than sheath 5 by distal side and electric conductivity in electric conductivity front end blade 1The proximal lateral of front end blade 1 is configured in the state of the inside of sheath 5, and electric conductivity connector 3 and sheath 5 contact.It is preferred that conductiveProperty connector 3 and sheath 5 contact position be electric conductivity connector 3 at least front end side, be more preferably overall length.Before makingWhen holding blade 1 prominent from sheath 5, for that line 2 more securely can be fixed on sheath 5.Electric conductivity connector 3 can integrally byConductive material is constituted, and a part of can also be made of conductive material, other parts are made of non-conductive material.Connector3 are formed to ensure the electric conductivity between thread 4 and line 2.Connector 3 can be for example outer surface by electric conductivity materialThe construction that material is constituted and the conductive material and sheath 5 contact, or the outer surface of connector 3 is by non-conductive materialThe construction that composition and the non-conductive material and sheath 5 contact.
Front end blade 1 has the part i.e. knife portion used as high frequency knife.Front end blade 1 is remote with First Line portion 2A respectivelyHold the connection of the distal end of end and the second line portion 2B.Front end blade 1 is formed by conductive material.It is preferred that front end knifePiece 1 is made of stainless steel and other metal materials such as SUS303, SUS304.The shape of front end blade 1 can be matched with the purposes of knifeAnd it suitably selects.For example, can be spherical, oval spherical, column, cone cell, the shape for being composed them, or make front endLateral bend or broadening etc..The length in the far and near direction of the sheath 5 of front end blade 1 can according to the purposes of disposition instrument, from sheath 5The protrusion length of front end face and suitably select, but preferably 2.0mm or more and 5.0mm or less.Electric conductivity front end blade 1 is configured atDispose the farthest end side of instrument.
The connection of electric conductivity line 2 and front end blade 1 can be carried out by common linking method, can be directly connected to,It can be connected via other component.For example, existing through the methods of the welding of metal tube riveting combination, deposition, bonding.Wherein,It is preferred that having opening portion by electric conductivity front end blade 1, a part of electric conductivity line 2 is located in the opening portion, thus by conductiveProperty front end blade 1 and electric conductivity line 2 link.Electric conductivity blade 1 and electric conductivity line 2 are efficiently linked as a result,.It is more preferably logicalIt crosses the proximal lateral in front end blade 1 and is provided with opening portion, a part of electric conductivity line 2 is located in the opening portion, thus by conductiveProperty front end blade 1 and electric conductivity line 2 link.
Opening portion can be formed by the way that through hole, recess etc. is arranged in front end blade 1.As shown in Fig. 2, being to pass through in opening portionWhen through-hole 11, the risk that front end blade 1 falls off in surgical procedure can be reduced, when opening portion is recess, can will be manufacturedSimplify.Particular for by through hole 11 being arranged and and the through hole 11 inserts electric conductivity line 2 by electric conductivity in front end blade 1The mode that line 2 and front end blade 1 link, is preferred for line 2 and is formed as First Line portion 2A and the second line portion 2B in distal endThe situation of one.On the other hand, preferably conductive when the First Line portion 2A of electric conductivity line 2 and the second line portion 2B are seperated componentsProperty line 2 and front end blade 1 by welding, deposition, bonding link.
Front end blade 1 can be rotated relative to electric conductivity line 2, can also along 2 long axis direction can move, alsoIt can be fixed completely.The long axis direction of line 2 refers to the direction along line 2.Front end blade 1 can along 2 long axis direction moveIt is dynamic, refer to online 2 when being fixed on the circle of thread 4 for both ends, front end blade 1 can be moved along the circumferential direction of the circle.
It is preferred that the depth direction of the opening portion of front end blade 1 is the direction different with the far and near direction of sheath 5, more preferablyIt is the direction vertical with the far and near direction of sheath 5.Thereby, it is possible to front end blade 1 is configured at than electric conductivity line 2 by distal sidePosition.
As shown in figure 5, the opening portion of front end blade 1 may be set to be the insert road inserted for line 2.In Fig. 5, insertThe entrance and exit on road is set to the proximal face of front end blade 1.Thereby, it is possible to for line 2 a part configuration with sheath 5The mode in the vertical direction in far and near direction.
It is preferred that the distal end of electric conductivity front end blade 1 being at least distally configured at than sheath 5 by the position of distal side andThe proximal lateral of electric conductivity front end blade 1 is configured in the state of the inside of sheath 5, and front end blade 1 and sheath 5 contact.Before it is preferred thatPosition end blade 1 and that sheath 5 contacts is the knife portion end of front end blade 1, the i.e. proximal lateral of front end blade 1.Make front endWhen blade 1 is prominent from sheath 5, for that line 2 more securely can be fixed on sheath 5.Front end blade 1 can be to be whole by conductionProperty material constitute, or a part be made of conductive material, other parts are made of non-conductive material.Front end bladeAs long as 1 is formed to ensure the electric conductivity between line 2 and knife portion.Front end blade 1 can be for example outer surface by conductionProperty material constitute, the construction that the conductive material and sheath 5 contact, or the outer surface of the proximal lateral of front end blade 1 byNon-conductive material is constituted, the construction that the non-conductive material and sheath 5 contact.
It is all conductive by the front end blade 1 for making the line used as snare 2 and using as knife, will be of the inventionDisposition instrument as snare in use, can online 2 distal side there is no dielectric position and efficiently carry out Le beam,It burns.
Online 2 it can also be provided with bending section.Thereby, it is possible to according to the size of lesion, shape, the type of surgical procedureAnd it is suitably designed the shape of snare, and electric conductivity front end blade 1 can be made reliably prominent and be more stably fixed at shieldThe front end of set 5.Bending section is for example formed by by line bending or engage 2 or more tapes angularly and.Bending sectionIt can be provided only with one, also can be set multiple.In addition, bending section can be formed as polyline shaped, it can also be formed as bentIt is linear.
As shown in Fig. 2, having in the second line portion 2B second curved it is preferred that line 2 has the first bending section 22 in First Line portion 2APars convoluta 23.Online 2 setting bending section in this way, the design freedom for disposing the shape of the snare of instrument increases, and can makeElectric conductivity front end blade 1 is reliably prominent and can be more stably fixed at the front end of sheath 5.In Fig. 2, the first bending section 22The position of distal side is leaned at the center for being set to the far and near direction than line 2 with the second bending section 23.
It is preferred that online 2 when being housed in sheath 5, the first bending section 22 and the second bending section 23 are contacted with the inner wall of sheath 5.Thereby, it is possible to pass through the inner wall of sheath 5 more stably fixing line 2.
It is preferred that online 2 in sheath 5 when exposing outside, the first bending section 22 and the second bending section 23 are formed towards sheath 5Radially inner side protrusion.As a result, in First Line portion 2A, in the position for leaning on proximal lateral than the first bending section 22, line 2 is easy to diameterTo outside extend, in the second line portion 2B, in the position for leaning on proximal lateral than the second bending section 23, line 2 is easy to radial outerSide extends, and thus, it is possible to increase the diameter on the direction vertical with the far and near direction of sheath 5 of snare.In addition, bending section courtIt is protruded to the radially inner side of sheath 5, refers to the protrusion for being configured with bending section towards the inside of sheath 5.Diameter of the line 2 towards sheath 5It protrudes outward, refers to that line 2 is the ring-type for expanding extension outward.
The far and near direction position of first bending section 22 and the second bending section 23 can match and appropriate with the shape of snareSetting, but at least one party preferably in the first bending section 22 and the second bending section 23 is set to the distal end of line 2, more preferablyFirst bending section 22 and the second bending section 23 are all set in distal end.Thereby, it is possible in the looser of the far and near direction of sheath 5Range expand snare diameter.In addition, the bending section of electric conductivity line 2 can be according to the performance of required snare and in any positionInstall the bending section of any number.
A part of the inner wall of sheath 5 is provided with surface treatment.For high-frequency treatment instrument, in front end blade1 distal end being at least distally configured at than sheath 5 is by the position of distal side and the proximal lateral of front end blade 1 is configured at sheath 5Inside in the state of, electric conductivity connector 3, First Line portion 2A, the second line portion 2B and at least one party in front end blade 1 andSurface treatment contact.High-frequency treatment instrument can stably keep the state outstanding of electric conductivity front end blade 1 as a result,.
Fig. 6~Figure 13 indicates the various configuration examples for being provided with the sheath 5 of surface treatment 7.Fig. 6 indicates sheath 5Internal diameter is formed as constant in long axis direction and First Line portion 2A in the state that a part of front end blade 1 is prominent from sheath 5The mode contacted with the second line portion 2B with surface treatment 7.Fig. 7 indicates that the internal diameter of sheath 5 is formed as constant in long axis directionAnd the mode that a part of blade 1 is contacted from the state lower front end blade 1 outstanding of sheath 5 and surface treatment 7 in front end.Be formed as constant in long axis direction and in a part of front end blade 1 from the shape outstanding of sheath 5 Fig. 8 shows the internal diameter of sheath 5The mode that electric conductivity connector 3 and surface treatment 7 contact under state.Fig. 9, Figure 12 and Figure 13 expression are provided in sheath 5Small diameter portion and First Line portion 2A and the second line portion 2B and path in the state that a part of front end blade 1 is prominent from sheath 5The mode that the surface treatment 7 in portion contacts.Figure 10 indicates sheath 5 to be provided with small diameter portion and at one of front end blade 1Divide the mode contacted from the surface treatment 7 of the state lower front end blade 1 outstanding of sheath 5 and small diameter portion.Figure 11 expression is being protectedSet 5 is provided with small diameter portion and electric conductivity connector 3 and surface in the state that a part of front end blade 1 is prominent from sheath 5Handle the mode that part 7 contacts.
It is preferred that the surface treatment 7 of sheath 5 is bigger than non-process partial frictional resistance.The portion in sheath 5 is configured as a result,Part is big when being fixed on the power of surface treatment 7 than non-process, electric conductivity front end blade 1 can be more stably fixed at sheath5 front end.It is preferred that surface treatment 7 is at least set to the part within the distal end 100mm apart from sheath 5, more preferably onlyIt is set to the part within the distal end 100mm apart from sheath 5.Additionally, it is preferred that the frictional resistance in sheath 5 is bigger than non-process partPart be formed in such region.
In order to improve sheath 5 inner wall frictional resistance, there are roughening, assign the methods of adherence.For example, passing throughThe property learned or the surface for physically handling sheath 5, assign the hydrophilic groups such as hydroxyl, carboxyl, carbonyl, so as to the table to sheath 5Face assigns adherence or reduces the flatness on the surface of sheath 5.As this processing, Tetra etching (registered trademark) is enumeratedProcessing, Fluoro bonding (registered trademark) processing, corona treatment etc..For example, if using Tetra etching process, FluoroAdhesion process then can assign hydrophilic group to the surface of fluororesin, if using corona treatment, it can be to polyamide resinThe surface of rouge, polyolefin resin, polyester resin, aromatic polyether ketone resin, polyimide resin etc. assigns hydrophilic group.Therefore,At this point, it is preferred that the surface treatment 7 of sheath 5 is by surface there is the resin of hydrophilic group to constitute.On the other hand, as by sheathThe method of 5 surface roughening is able to use etching process, blasting treatment etc..
It is preferred that the surface treatment 7 of sheath 5 is compared with non-process part, appearance changes, the surface treatment of sheath 5Part 7 and non-process part have different appearances.Except colouring, fade, in addition to transparence, opacification, the variation of appearance also includesOuter diameter variation, surface roughening.Thereby, it is possible to play the effect for becoming the identifier of the standard to the embedment amount of tissue.In faceIt is critically important that there are difference for when color difference and non-process part, can semi-transparently colour, can also colour nontransparently.If shieldSet 5 has color originally, then color difference, lighter, color bleach can also be made to play function by surface treatmentEnergy.When sheath 5 has multiple color originally, can also only be played on this basis in surface treatment 7 blend colorFunction.In addition to this, outer diameter variation can also be made to function by surface treatment.Outer diameter can increase, and also can reduce.When outer diameter increases, preferably the wall thickness of sheath 5 is 0.5mm hereinafter, when outer diameter reduces, and the wall thickness of preferably sheath 5 does not become0.2mm or less.In addition to this, the surface roughening of sheath 5 can also be made by being surface-treated, appearance changes to play functionEnergy.It is preferred that being formed in distal end apart from sheath 5 by being surface-treated to compare with non-process part the different part of appearancePosition within 100mm is more preferably only formed in the part within the distal end 100mm apart from sheath 5.
It is preferred that surface treatment 7 is to implement one of hydrophilic group imparting processing, etching process, blasting treatment processingOr the part of a variety of processing.Thereby, it is possible to steadily carry out the increase of the variation of appearance, frictional resistance, and will be before electric conductivityEnd blade 1 is stably fixed to the front end of sheath 5.In addition, can also play the effect as identifier, which becomes measurementDispose embedment amount from instrument to surgical procedure part standard.By combining a variety of methods, surface treatment 7 can be also dramatically increasedVariation/difference of appearance, frictional resistance.Alternatively, it is also possible to implement surface treatment 7 by respectively different methodThe variation of appearance and the increase of frictional resistance.Thereby, it is possible to the changing units and frictional resistance of the inside and outside differentiation color in sheath 5Increase part or change the length of surface treatment 7 respectively, so as to increase design freedom.As hydrophilicBase imparting processing enumerates Tetra etching process, Fluoro adhesion process, corona treatment etc. as described above like that.It is logicalTetra etching process, Fluoro adhesion process are crossed, when sheath 5 before treatment is transparent, after processing, sheath 5 is coloured to brownColor.By etching process, blasting treatment, corona treatment, after processing, 5 gonorrhoea of sheath is coloured to translucent white.
It is preferred that surface treatment 7 is the part of the distal end comprising sheath 5.When being surface-treated thereby, it is possible to saveTrouble and will surface treatment simplify.For above-mentioned surface treatment, it is difficult to be carried out in the inside and outside part of sheath 5, such as be dipped in medical fluidIn, irradiation light, throw fine grained etc..For example, applied etc. to be surface-treated the distal end for not feeding through to sheath 5 distally, it is non-Often trouble.Therefore, by surface treatment reach comprising sheath 5 distal end part, can save deprotection distal end trouble, and incite somebody to actionProcessing simplifies.
The position for being preferably disposed on the surface treatment 7 of sheath 5 is outstanding from sheath 5 in a part of front end blade 1Under state and in the portion contacted in connector 3, the line 2 comprising First Line portion 2A and the second line portion 2B, front end blade 1 and sheath 5The whole region of position.It is therefore preferable that front end blade 1 be at least distally configured at than sheath 5 distal end lean on distal side positionAnd the proximal lateral of front end blade 1 is configured in the state of the inside of sheath 5, connector 3, First Line portion 2A, the second line portion 2BAnd front end blade 3 is all contacted with surface treatment 7.As a result, when front end blade 1 to be fixed on to the front end of sheath 5, energyIt is enough more securely to fix.
The diameter on the direction vertical with the length direction of sheath 5 of electric conductivity connector 3 and electric conductivity front end blade1 diameter on the direction vertical with the length direction of sheath 5 is not particularly limited.Electric conductivity connector 3 with sheath 5Diameter on the vertical direction of length direction, with electric conductivity front end blade 1 on the direction vertical with the length direction of sheath 5Diameter in either or both sides may be the construction smaller than the internal diameter of sheath 5.Alternatively, electric conductivity connector 3Diameter on the direction vertical with the length direction of sheath 5 hangs down with electric conductivity front end blade 1 in the length direction with sheath 5Either in diameter on straight direction or both sides may be the construction bigger than the internal diameter of sheath 5.In addition, shield at this timeThe internal diameter of set 5 refers to internal diameter of the sheath 5 in the state of zero load, that is, neither from the inside of sheath 5 nor outside sheath 5Side applies the internal diameter in the state of load.The length direction of sheath 5 is identical with the long axis direction of sheath 5.
It is preferred that the diameter on the direction vertical with the length direction of sheath 5 of electric conductivity connector 3 and/or leadingThe internal diameter or sheath 5 of the diameter on the direction vertical with the length direction of sheath 5 of electrical front end blade 1 than sheath 5Small diameter portion is big, and preferably its excessive (excessive point) is within 0.5mm.If excessive big, it is easy to cause the deformation of sheath 5, Ke NengwuElectric conductivity front end blade 1 is stably fixed to the front end of sheath 5 by method.The diameter and electric conductivity front end knife of electric conductivity connector 3The diameter of piece 1 may be the same or different.
It is preferred that the size of the internal diameter of sheath 5 is non-constant in long axis direction.That is, it is preferred that the size of the internal diameter of sheath 5 is in long axisDirection change is provided with small diameter portion in a part of the long axis direction of sheath 5.At this point, front end blade 1 a part from sheathIn the state that 5 is prominent, electric conductivity connector 3, First Line portion 2A, the second line portion 2B and at least one party in front end blade 1 andSmall diameter portion contact, thus, it is possible to more stably keep the state outstanding of electric conductivity front end blade 1.The path of more preferred sheath 5Portion is set to surface treatment 7.
When the size of the internal diameter of sheath 5 changes along long axis direction, sheath 5 is provided with small diameter portion and large-diameter portion.At this point,The internal diameter of sheath 5 can continuously be reduced from the proximal lateral of sheath 5 towards distal side from large-diameter portion to small diameter portion, can also be non-Continuously reduce.When for the former, as shown in Fig. 4, Figure 13, sheath 5 be provided with internal diameter large-diameter portion 53 and small diameter portion 51 itBetween the tapering 52 that slowly changes.When for the latter, as shown in figs. 9 to 12, in the range from large-diameter portion to small diameter portion, sheath 5Internal diameter change in a stage-like manner.When the internal diameter of sheath 5 changes in a stage-like manner, it can also become 2 from large-diameter portion to small diameter portionAbove step difference.For example, sheath 5 also can have large-diameter portion, central diameter portion and small diameter portion.Furthermore it is preferred that in small diameter portion and greatlyThe internal diameter of sheath 5 is formed in long axis direction constant in diameter portion (or there are also central diameter portions).
It is preferred that the tapering that sheath 5 has internal diameter non-constant.It is preferred that in tapering, the internal diameter of sheath 5 towards distal side decrescence.ThisWhen, at least one party in preferably First Line portion 2A and the second line portion 2B contacts in the inner wall of tapering and sheath 5.Online 2 are imported intoWhen in sheath 5, First Line portion 2A, the second line portion 2B are contacted in the inner wall of tapering and sheath 5, and thus, it is possible to by electric conductivity front end knifePiece 1 is stably fixed to the front end of sheath 5, can only make electric conductivity front end blade 1 prominent from sheath 5.More preferred First LineAt least one position of portion 2A is contacted in the inner wall of tapering and sheath 5, and at least one position of the second line portion 2B is in tapering and shieldThe inner wall contact of set 5.Thereby, it is possible to electric conductivity front end blade 1 is more stably fixed to the front end of sheath 5.
It is preferred that the position of distal side is leaned at the center that the small diameter portion of sheath 5, tapering are set to the far and near direction than sheath 5.Such asShown in Fig. 4 and Figure 13, preferably sheath 5 becomes smaller in 52 internal diameter of tapering towards distal side.As a result, since electric conductivity line 2 passes through shieldThe tapering 52 of set 5 is easy and the inner wall of sheath 5 contacts, so electric conductivity line can steadily be fixed by the tapering 52 of sheath 52.For example, it is preferable to which the length of small diameter portion is more than 0mm and is 5.0mm or less.For example, it is preferable to which the length in tapering is more than 0mm and is5.0mm following.For example, it is preferable to which the length that small diameter portion and tapering are added together is 1.0mm or more and 5.0mm or less.
It is preferred that tapering 52 be configured at small diameter portion 51 near proximal lateral (more preferred most proximal end).At this point, it is preferred that tapering 52It is connected to large-diameter portion 53.As a result, since electric conductivity line 2 is easy by small diameter portion 51 and 52 both sides of tapering and the inner wall of sheath 5 connectsTouching, so electric conductivity line 2 further can be fixed steadily.It is preferred that sheath 5 is since distal side according to small diameter portion 51, tapering52, the sequence internal diameter of large-diameter portion 53 is sequentially increased.
It although not shown, but can also be bigger than small diameter portion in position setting internal diameter of the ratio small diameter portion of sheath 5 by distal sidePart.In addition, the distal end in sheath 5 or tapering is consistent with the distal end of sheath 5.At this point, the distal end in tapering becomes small diameter portion.
It is preferred that small diameter portion is at least set to range as defined in the distal side opening portion i.e. distal end apart from sheath 5, such as preferablyThe range being at least set within the distal end 5.0mm apart from sheath 5.The range can according to the length of electric conductivity front end blade 1,Desired knife length is suitably determined.It is preferred that small diameter portion is arranged with the distal end specific length apart from sheath 5, such as preferably 1.0mmAbove and 5.0mm or less.The length of small diameter portion can be very small, or the inner cavity of sheath 5 is remote from large-diameter portion to sheath 5The shape of end side decrement.
It is preferred that the size of the internal diameter of sheath 5 is non-constant in length direction.Particularly preferred sheath 5 is configured with path in its distal endPortion.It is preferred that the internal diameter of the small diameter portion of the distal side of sheath 5 is 1.2mm or more and 2.5mm or less.It is preferred that large diameter portion and small diameter portionDifference in internal diameters is 0.2mm or more and 0.4mm or less.The small diameter portion of the distal side of sheath 5 is set in this way, is made as snare portionElectric conductivity line 2 it is not too big from the power required when prominent of sheath 5, in addition, prominent from sheath 5 in the front end blade 1 as knife portionIt is readily and stably fixed in the state of out.
As shown in figs. 9 to 12, tapering can not also be set in sheath 5, the inner cavity for being formed as sheath 5 becomes in a stage-like mannerChange.At this point, being formed with more than one step difference from large-diameter portion towards small diameter portion in the inner cavity of sheath 5.Small diameter portion, tapering canSo that protecting pipe shrinks and formed, the pipe of different inner diameters can also be connected and be formed.In addition, in order to form small diameter portion, tapering,It can also will be in other component insertion tube.
When small diameter portion is arranged in the inner cavity of sheath 5, it is preferably arranged to, surface treatment 7 is set to small diameter portion at leastA part, preferably over the whole installation surface treatment 7 of small diameter portion.When tapering, central diameter portion is arranged in the inner cavity of sheath 5,It is preferred that being also provided with surface treatment 7 in tapering, a part in central diameter portion or entirety.Surface treatment 7 can also and inLarge-diameter portion.For example, as shown in figure 13, parallel by the long axis direction of the discord sheath 5 in the inner wall of the small diameter portion of sheath 5Part is tapering, and surface treatment 7, electric conductivity connector 3, electric conductivity line 2, any in electric conductivity front end blade 1 is arrangedA or multiple and surface treatment 7 contacts, and can more securely fix front end blade 1.It is provided in the distal end of sheath 5 smallWhen diameter portion, the part large-diameter portion in addition to small diameter portion of sheath 5 can be made.It can also there are the changes of the size of internal diameter in large-diameter portionThe part of change.
As shown in Figure 6 to 8, in 5 not set small diameter portion of sheath, electric conductivity connector 3 and sheath 5 length directionDiameter on vertical direction, with electric conductivity front end blade 1 in the diameter on the direction vertical with the length direction of sheath 5Either or both sides can also be bigger than the internal diameter of sheath 5.If electric conductivity connector 3 and/or electric conductivity front end blade 1It is formed in this way, then when a part of electric conductivity front end blade 1 is prominent from sheath 5, electric conductivity connector 3, electric conductivity front end knifeEither in piece 1 or both sides are contacted in a manner of widening the inner wall of sheath 5, and thus, it is possible to by electric conductivity front end blade1 is stably fixed to the front end of sheath 5, can only make electric conductivity front end blade 1 prominent from sheath 5.At this point, it is preferred that electric conductivity connectsThe diameter on the direction vertical with the length direction of sheath 5 of fitting 3 and/or electric conductivity front end blade 1 and shieldDiameter on the vertical direction of the length direction of set 5 is bigger than the internal diameter of sheath 5, and excess is within 0.5mm.Electric conductivity connector3 diameter and the diameter of electric conductivity front end blade 1 may be the same or different.
For disposition instrument of the invention, in the disposition instrument insert channel insert disposition instrument of endoscope, it is conducted into bodyInside use.In order not to make to dispose the position injury in instrument insert channel, other than intracorporal lesion, even if preferably non-energizedWhen, front end blade 1, line 2 are also accommodated in sheath 5.
Disposition instrument is fed to endoceliac lesion, and in disposition, operation handle 6 makes front end blade 1 before sheath 5Distal process goes out.At this point, at least one party, conduction in a part of electric conductivity front end blade 1, First Line portion 2A and the second line portion 2BProperty connector 3 in either or multi-party and sheath 5 inner wall contact in the state of, to the energization of front end blade 1, by front end knifePiece 1 is as high frequency knife for disposing.Due to when using knife, a part of electric conductivity front end blade 1, First Line portion 2A and secondEither at least one party, electric conductivity connector 3 in line portion 2B or in many ways it is fixed on sheath 5, as long as so not to precedingThe power of the application of blade 1 by force is held, then can carry out the incision by knife, mark by the operation of common handle 6 in dispositionDeng disposition.
Also, instrument will disposed as snare in use, operation handle 6 keeps electric conductivity line 2 prominent from the front end of sheath 5.Whenever in the electric conductivity front end blade 1, First Line portion 2A and the second line portion 2B with the contact of the inner wall of sheath 5 at least one party, leadEither in electric connection part 3 or in many ways prominent from the front end of sheath 5, the pressing force of operation handle 6 tends to reduce.It is leadingIt is electrically connected internal diameter hour of the part 3 than sheath 5, at least one party in front end blade 1, First Line portion 2A and the second line portion 2B is than shieldAfter set 5 is prominent, it can swimmingly make line 2 prominent.At this point, the portion to be played a role due to the power for line 2 to be fixed on sheath 5Position is at least one party in electric conductivity front end blade 1, First Line portion 2A and the second line portion 2B, so using after they are protrudedIt is difficult to play a role in the power that front end blade 1 is fixed on sheath 5.
By operation handle 6, the ring of snare is wound to the lesion for needing to strangle beam, snare is imported into closely by operation handle 6The lesion of the ring contact of snare is burnt in end side, and applying power.After burning, snare portion and knife portion are receivedIt is contained in sheath 5, disposition instrument is extracted from internal.
This application claims based on preferential at Japanese patent application filed on July 19th, 2017 the 2017-139881stThe interests of power.The full content of the specification of Japanese patent application filed on July 19th, 2017 the 2017-139881stIt is quoted by the application for referring to.