JP4543017B2 - Endoscopic high-frequency incision tool - Google Patents

Description

Translated fromJapanese

本発明は、内視鏡の処置具案内管路内に通して使用される内視鏡用鋏型高周波切開具に関する。  The present invention relates to a scissors-type high-frequency incision tool for an endoscope that is used by being passed through a treatment instrument guide line of an endoscope.

内視鏡用高周波切開具としては、使用目的によって各種の形状のものがあるが、例えば粘膜下層剥離術を行うためのものとしては、シースの先端位置に前方に向かって並列に並んで配置された一対の高周波電極を、シースの後端側からの遠隔操作で開閉することができるようにした鋏型の電極を有する内視鏡用鋏型高周波切開具が用いられている（例えば、特許文献１）。
特開２００３−２９９６６７公報There are various types of endoscopic high-frequency incisions depending on the purpose of use, but for example, for performing submucosal dissection, they are arranged in parallel in the forward direction at the distal end of the sheath. An endoscopic scissors high-frequency incision tool having a scissors-shaped electrode that can be opened and closed by remote control from the rear end side of the sheath is used (for example, Patent Documents) 1).
JP 2003-299667 A

内視鏡用鋏型高周波切開具を用いて粘膜下層剥離術を行う際には、予め内視鏡用高周波ナイフ等で表面が切開された粘膜の切開面に、図１６に示されるように鋏型高周波切開具を差し込んでから、鋏型の一対の高周波電極ａに高周波電流を通電して、表面粘膜と粘膜下の筋層ｂとの間の筋状繊維等を切開する処置が行われる。しかし、粘膜下の筋層ｂに触れる高周波電極ａの先端部分で筋層ｂが焼灼されて穿孔してしまう恐れがある。そこで、鋏型の高周波電極ａのあい対向する面以外の部分に電気絶縁性のコーティング等を施して電気絶縁することが考えられるが、そのように構成しても、図１６に矢印Ａで示されるように、高周波電極ａのあい対向する金属露出面の前端部分から前方に漏洩する高周波電流により、筋層ｂを焼灼して損傷してしまう恐れがある。  When performing submucosal dissection using a scissors-type high-frequency incision tool for an endoscope, as shown in FIG. 16, an incision surface of the mucous membrane whose surface has been incised in advance with a high-frequency knife for endoscope, etc. After inserting the high frequency incision tool, a high frequency current is applied to the pair of saddle type high frequency electrodes a to incise the muscle fibers and the like between the surface mucosa and the submucosal muscle layer b. However, the muscle layer b may be cauterized and perforated at the tip portion of the high-frequency electrode a touching the muscle layer b below the mucous membrane. Therefore, it is conceivable to electrically insulate by applying an electrically insulating coating or the like to portions other than the opposing surfaces of the saddle-shaped high-frequency electrode a. Even in such a configuration, it is indicated by an arrow A in FIG. As described above, the muscle layer b may be cauterized and damaged by the high-frequency current leaking forward from the front end portion of the metal exposed surface facing the high-frequency electrode a.

本発明はそのような問題を解決するためになされたものであり、粘膜下層剥離術を行う際に、鋏型の高周波電極の先端部分に触れる筋層等を高周波焼灼する恐れのない安全性の高い内視鏡用鋏型高周波切開具を提供することを目的とする。  The present invention has been made to solve such a problem, and when performing submucosal dissection, there is no risk of high-frequency cauterization of the muscle layer or the like that touches the distal end portion of the heel-shaped high-frequency electrode. An object of the present invention is to provide a high-frequency endoscopic scissors high-frequency incision tool.

本発明は、内視鏡の処置具案内管に挿脱されるシースの先端に、前方に向かって開閉する導電金属製の一対の高周波電極が設けられた内視鏡用鋏型高周波切開具において、一対の高周波電極の各々の対向面のみに導電金属を露出させて他の部分の表面を電気絶縁すると共に、一対の高周波電極のうち一方の高周波電極を直線状に形成し、他方の高周波電極を一方の高周波電極に沿って直線状に延びると共に一方の高周波電極の先端部を絶縁突起により覆う形状に形成し、一対の高周波電極が閉じた状態を前方からみたとき、一方の高周波電極の導電金属露出面が絶縁突起の背後に隠れる状態に位置させることを特徴とする。This onsetMing, the distal end of the sheath to be inserted into and removed from the treatment instrument guide tube of the endoscope, endoscopic scissors high-frequency incision instrument is a pair of high-frequency electrode made of a conductive metal for opening and closing toward the front is provided In this case, the conductive metal is exposed only on the opposing surfaces of the pair of high-frequency electrodes to electrically insulate the surface of the other part, and one high-frequency electrode of the pair of high-frequency electrodesis linearly formed, and the other high- frequency electrodeis formed. When the electrode is formed in a shape that extends linearly along one high-frequency electrode and the tip of one high-frequency electrode is covered with an insulating protrusion, and when the pair of high-frequency electrodes are viewed from the front, The conductive metal exposed surface is positioned so as to behidden behind the insulating protrusion .

なお、絶縁突起が、側方から見たとき他方の高周波電極の長手方向に対して略垂直方向に突出する形状に形成されていてもよく、側方から見たとき前方に向かって凸の略円弧状に形成されていてもよい。他方の高周波電極の絶縁突起部分付近が、直線状部分の電極幅より幅広に形成されていてもよく、一方の高周波電極の先端領域付近も、直線状部分の電極幅より幅広に形成されていてもよい。絶縁突起が略球状に形成されていてもよい。Incidentally, insulation protrusion may be formed in a shape protruding in a direction substantially perpendicular to the longitudinal direction ofthe other high-frequency electrode when viewed from the side, convex towards the front when viewed from the side It may be formed in a substantially arc shape. Near the insulating protrusion ofthe other high-frequency electrode may also be formed wider than theelectrode widthof the linear portion, near the tip region ofone high-frequency electrode also have been formed wider than theelectrode widthof the linear portion Also good. The insulating protrusion may be formed in a substantially spherical shape.

また、一方の高周波電極の導電金属露出面の先端付近が、先側ほど他方の高周波電極から遠ざかるカーブ状に形成されると共に、他方の高周波電極の導電金属露出面の先端付近が一方の高周波電極の導電金属露出面に沿うカーブ状に形成されて、そのカーブに沿うカーブ状に絶縁突起が突出形成されていてもよい。なお、一対の高周波電極が閉状態のときに互いに向かい合う各高周波電極の対向位置に、一定の幅で対向方向に向かって突出する凸形の断面形状の直線状の電極刃部が前後方向に真っ直ぐに形成されて、高周波電極の電極刃部の突端対向面のみに導電金属面が露出し、高周波電極のその他の面には全面に不活性材からなる電気絶縁性コーティング皮膜が被覆されていてもよい。Also, near the tip of the conductive metal exposed surface ofone of the high-frequency electrode is formed in a curved shape away fromthe other high-frequency electrode as the front side, near the tip of the conductive metal exposed surface ofthe other high-frequency electrode ofone high-frequency electrode The conductive protrusion may be formed in a curved shape along the exposed conductive metal surface, and the insulating protrusion may be formed so as to protrude along the curved shape. In addition, at the opposing position of the high-frequency electrodes facing each other when the pair of high-frequency electrodes are in the closed state, a straight electrode blade portion having a convex cross-sectional shape that protrudes in the opposing direction with a certain width is straight in the front-rear direction. Even if the conductive metal surface is exposed only on the projecting end facing surface of the electrode blade portion of the high frequency electrode, and the other surface of the high frequency electrode is covered with an electrically insulating coating film made of an inert material on the entire surface. Good.

本発明の内視鏡用鋏型高周波切開具によれば、一対の高周波電極の各々の対向面のみに導電金属を露出させて他の部分の表面を電気絶縁すると共に、一対の高周波電極のうち他方の高周波電極の最先端部分から一方の高周波電極の先端領域の前方位置に突出する絶縁突起を設けたことにより、粘膜下層剥離術を行う際に、鋏型の高周波電極の先端部分に触れる筋層等を高周波焼灼する恐れがなくなり、優れた安全性を確保することができる。
According to the scissors-type high-frequency incision tool for endoscopes of the present invention, the conductive metal is exposed only on the opposing surfaces of the pair of high-frequency electrodes to electrically insulate the surfaces of the other portions,A muscle that touches the tip of the saddle-shaped high-frequency electrode when performing submucosal dissection by providing an insulating protrusion that protrudes from the most advanced portion of theother high-frequency electrode to the front of the tip region ofone high-frequency electrode. There is no risk of high-frequency cauterization of the layers and the like, and excellent safety can be ensured.

以下、図面を参照して本発明の実施の形態を具体的に説明する。
図１と図２は、本発明の第１の実施の形態の内視鏡用鋏型高周波切開具の先端部分の側面断面図と斜視図である。
１は、内視鏡の処置具案内管に挿脱自在な可撓性シースであり、ステンレス線を密着巻きしたコイルパイプにより形成されている。可撓性シース１の外周面には、電気絶縁性の可撓性チューブからなるシース外皮２が全長に被覆され、可撓性シース１の先端に固定的に取り付けられた先端口金３の外周にシース外皮２の先端が緊縛固定されている。４は、可撓性シース１内に緩く挿通された導電性の操作ワイヤーであり、可撓性シース１の基端に連結された操作部からの操作により、軸方向に進退させることができ、また軸周りに回転させることができる。Embodiments of the present invention will be specifically described below with reference to the drawings.
1 and 2 are a side sectional view and a perspective view of the distal end portion of the scissors-type high-frequency incision tool for an endoscope according to the first embodiment of the present invention.
Reference numeral 1 denotes a flexible sheath that can be inserted into and removed from a treatment instrument guide tube of an endoscope, and is formed of a coil pipe in which a stainless wire is tightly wound. The outer peripheral surface of the flexible sheath 1 is covered with the entire length of a sheathouter skin 2 made of an electrically insulating flexible tube, and is attached to the outer periphery of thedistal end cap 3 fixedly attached to the distal end of the flexible sheath 1. The distal end of the sheathouter skin 2 is fixed and fixed. 4 is a conductive operation wire that is loosely inserted into the flexible sheath 1, and can be advanced and retracted in the axial direction by an operation from the operation unit connected to the base end of the flexible sheath 1. It can also be rotated around an axis.

５は、先端口金３に対して軸方向に移動することはできないが、軸周りに回転自在に先端口金３に連結された先端支持枠であり、先端支持枠５に形成されたスリット７の先端部分に、一対の高周波電極６Ａ，６Ｂが支軸８を中心に回動自在に前方に向かって開閉自在に支持されている。９は、高周波電極６Ａ，６Ｂを開閉駆動するための公知のリンク機構であり、操作ワイヤー４の先端がリンク機構９に連結されている。その結果、操作部において操作ワイヤー４を進退操作すれば高周波電極６Ａ，６Ｂが支軸８を中心に開閉し、操作ワイヤー４を軸周りに回転操作すれば、先端支持枠５や高周波電極６Ａ，６Ｂ等が一体となって先端口金３の軸周りに回転する。また、操作部側において操作ワイヤー４を高周波電源に接続することにより、操作ワイヤー４を経由して高周波電極６Ａ，６Ｂに高周波電流を通電することができる。図１には、一対の高周波電極６Ａ，６Ｂが開いた状態が示されているが、閉じた状態も二点鎖線で図示されている。なお、一対の高周波電極６Ａ，６Ｂの開閉駆動をリンク機構９以外の機構で行ってもよい。  Reference numeral 5 denotes a tip support frame that cannot be moved in the axial direction with respect to thetip cap 3 but is connected to thetip cap 3 so as to be rotatable around the axis, and the tip of theslit 7 formed in thetip support frame 5. A pair of high-frequency electrodes 6A and 6B are supported on the portion so as to be pivotable about thesupport shaft 8 so as to be openable and closable forward. 9 is a known link mechanism for opening and closing the high-frequency electrodes 6A and 6B, and the distal end of the operation wire 4 is connected to thelink mechanism 9. As a result, if the operation wire 4 is moved forward and backward in the operation portion, thehigh frequency electrodes 6A and 6B open and close around thesupport shaft 8, and if the operation wire 4 is rotated around the axis, thetip support frame 5 and thehigh frequency electrodes 6A and6A 6B and the like rotate together around the axis of thetip cap 3. Further, by connecting the operation wire 4 to a high frequency power source on the operation unit side, it is possible to pass a high frequency current to thehigh frequency electrodes 6A and 6B via the operation wire 4. FIG. 1 shows a state in which the pair of high-frequency electrodes 6A and 6B are open, but the closed state is also indicated by a two-dot chain line. The pair of high-frequency electrodes 6A and 6B may be opened and closed by a mechanism other than thelink mechanism 9.

各高周波電極６Ａ，６Ｂには、一対の高周波電極６Ａ，６Ｂが閉じられた状態のときに互いに向かい合う位置（対向位置）に、一定の幅で対向方向に向かって突出する凸形の断面形状の直線状の電極刃部６ｂＡ，６ｂＢが前後方向に真っ直ぐに形成されて、各高周波電極６Ａ，６Ｂの電極刃部６ｂＡ，６ｂＢの突端対向面のみに金属面が露出し（導電金属露出面６ｃＡ，６ｃＢ）、各高周波電極６Ａ，６Ｂのその他の面には各々全面に一つながりに、例えばフッ素樹脂等のような化学的及び熱的に安定性が大きいいわゆる不活性の合成樹脂材からなる電気絶縁性コーティング皮膜１０が被覆されている。電気絶縁性コーティング皮膜１０部分は全図について砂目状に表示してある。このようにして電極刃部６ｂＡ，６ｂＢの導電金属露出面６ｃＡ，６ｃＢのみが金属露出面になっていることにより、粘膜剥離処置の際に切開が必要な生体組織だけを安全に高周波切開することができる。  Each of the high-frequency electrodes 6A and 6B has a convex cross-sectional shape that protrudes in a facing direction with a certain width at a position (opposing position) that faces each other when the pair of high-frequency electrodes 6A and 6B are closed. The straight electrode blade portions 6bA and 6bB are formed straight in the front-rear direction, and the metal surface is exposed only on the projecting end facing surface of the electrode blade portions 6bA and 6bB of the high-frequency electrodes 6A and 6B (conductive metal exposed surface 6cA, 6cB), the other surfaces of the high-frequency electrodes 6A and 6B are connected to the entire surface and electrically insulated from a so-called inert synthetic resin material having a large chemical and thermal stability such as a fluororesin.Coating 10 is coated. The portion of the electrically insulatingcoating film 10 is displayed in a grainy manner for all drawings. In this way, only the conductive metal exposed surfaces 6cA and 6cB of the electrode blade portions 6bA and 6bB are the metal exposed surfaces, so that only high-frequency incision can be safely performed on only the living tissue that requires incision during the mucosal detachment treatment. Can do.

一対の高周波電極６Ａ，６Ｂのうち第１の高周波電極６Ａの最先端部分には、その高周波電極６Ａの先端領域６ａＡを電気絶縁してさらにそこから第２の高周波電極６Ｂの先端領域６ａＢの前方位置に突出するように、第１の高周波電極６Ａの長手方向に対して略垂直方向にＬ型に突出する絶縁突起６ｘが設けられている。絶縁突起６ｘは、図１に二点鎖線で示されるように一対の高周波電極６Ａ，６Ｂが閉じた状態を前方（図１において左方）から見たときに、第１の高周波電極６Ａの導電金属露出面６ｃＡだけでなく第２の高周波電極６Ｂの導電金属露出面６ｃＢが絶縁突起６ｘの背後に隠れる大きさに形成されていて、絶縁突起６ｘの全面が電気絶縁性コーティング皮膜１０で被覆されている。  Of the pair of high-frequency electrodes 6A and 6B, the tip portion of the first high-frequency electrode 6A is electrically insulated from the tip region 6aA of the high-frequency electrode 6A and further forward from the tip region 6aB of the second high-frequency electrode 6B.Insulating projections 6x projecting in an L shape in a direction substantially perpendicular to the longitudinal direction of the first high-frequency electrode 6A are provided so as to project to the position. Theinsulating protrusion 6x is a conductive member of the first high-frequency electrode 6A when viewed from the front (left side in FIG. 1) when the pair of high-frequency electrodes 6A and 6B are closed as shown by a two-dot chain line in FIG. In addition to the exposed metal surface 6cA, the conductive metal exposed surface 6cB of the second high-frequency electrode 6B is formed in a size hidden behind theinsulating protrusion 6x, and the entire surface of theinsulating protrusion 6x is covered with the electrically insulatingcoating film 10. ing.

その結果、本発明の内視鏡用鋏型高周波切開具を内視鏡の処置具案内管に通して粘膜下層剥離術を行う際に、図３に示されるように、一対の高周波電極６Ａ，６Ｂの最先端部分が粘膜下の筋層３０に触れる状態で一対の高周波電極６Ａ，６Ｂに高周波電流が通電されても、絶縁突起６ｘが導電金属露出面６ｃＡ，６ｃＢの前方に位置していることにより導電金属露出面６ｃＡ，６ｃＢが筋層３０に触れないので、筋層３０が高周波焼灼されて損傷する恐れがなく、筋状繊維３１だけを焼灼切断して粘膜下層剥離術を安全に行うことができる。また、粘膜下層剥離術を行うに際して、図４に示されるように、絶縁突起６ｘを筋状繊維３１に引っかけて内視鏡２０を湾曲操作等で首振り動作させることで、筋状繊維３１を滑ることなく容易にたぐり寄せることができる効果もある。２１は処置具案内管である。  As a result, when the submucosal dissection is performed by passing the scissors-type high-frequency incision instrument for endoscope of the present invention through the treatment instrument guide tube of the endoscope, as shown in FIG. Even when a high-frequency current is applied to the pair of high-frequency electrodes 6A and 6B in a state where the most distal portion of 6B is in contact with themuscle layer 30 below the mucous membrane, theinsulating protrusion 6x is located in front of the exposed conductive metal surfaces 6cA and 6cB. As a result, the conductive metal exposed surfaces 6cA and 6cB do not touch themuscle layer 30, so that themuscle layer 30 is not cautiously damaged by high-frequency cauterization, and only themuscle fibers 31 are cauterized and cut to safely perform the submucosal layer exfoliation. be able to. Further, when performing submucosal dissection, as shown in FIG. 4, the endoscopic 20 is swung by a bending operation or the like by hooking theinsulating protrusion 6x on thestreak fiber 31, so that thestreak fiber 31 is There is also an effect that can be easily crushed without slipping.Reference numeral 21 denotes a treatment instrument guide tube.

図５と図６は、本発明の第２の実施の形態の内視鏡用鋏型高周波切開具の先端部分の側面断面図と斜視図であり、絶縁突起６ｘが側方から見たとき前方に向かって凸の略円弧状に形成されている。その結果、第１の実施の形態と同様の効果に加えて、図５に示されるように、絶縁突起６ｘが生体組織の表面に押し付けられた状態で移動する際に生体組織に食い込むことなく生体組織の表面に沿ってスムーズに移動し易いメリットがある。また、この実施の形態においては、各高周波電極６Ａ，６Ｂの電極刃部６ｂＡ，６ｂＢを横切る電極横断溝６ｅＡ，６ｅＢが複数形成されていて、その電極横断溝６ｅＡ，６ｅＢにも電気絶縁性コーティング皮膜１０が他の部分とつながった状態に被覆され、それによって電気絶縁性コーティング皮膜１０の耐剥離強度が大きくされている。その他の構成は前記の第１の実施の形態と同様である。  5 and 6 are a side sectional view and a perspective view of the distal end portion of the scissors-type high-frequency incision tool for endoscope according to the second embodiment of the present invention, and the front side when theinsulating protrusion 6x is viewed from the side. It is formed in a substantially arc shape that protrudes toward the surface. As a result, in addition to the same effects as those of the first embodiment, as shown in FIG. 5, the living body tissue does not bite into the living tissue when theinsulating protrusion 6x moves while being pressed against the surface of the living tissue. There is an advantage that it is easy to move smoothly along the surface of the tissue. In this embodiment, a plurality of electrode transverse grooves 6eA, 6eB are formed across the electrode blade portions 6bA, 6bB of the high-frequency electrodes 6A, 6B, and the electrode transverse grooves 6eA, 6eB are also electrically insulatingly coated. Thefilm 10 is coated in a state of being connected to other parts, thereby increasing the peel resistance of the electrically insulatingcoating film 10. Other configurations are the same as those in the first embodiment.

図７は、本発明の第３の実施の形態の内視鏡用鋏型高周波切開具の先端部分の斜視図であり、各高周波電極６Ａ，６Ｂの先端領域６ａＡ，６ａＢの幅と絶縁突起６ｘの幅を、それより後方の各高周波電極６Ａ，６Ｂの幅より幅広に形成したものである。その他の構成は前記の第１の実施の形態と同様である。このように構成することにより、第１の実施の形態と同様の効果に加えて、切開済みの粘膜が切開部に覆いかぶさるのを各先端領域６ａＡ，６ａＢの幅広部で押し退けて、切開部を内視鏡観察し易い状態で粘膜下層剥離術を行うことができる効果がある。  FIG. 7 is a perspective view of the distal end portion of the scissors-type high-frequency incision tool for an endoscope according to the third embodiment of the present invention. The widths of the distal end regions 6aA and 6aB of the respective high-frequency electrodes 6A and 6B and theinsulating protrusions 6x. Is formed wider than the width of each of the high-frequency electrodes 6A and 6B behind it. Other configurations are the same as those in the first embodiment. With this configuration, in addition to the same effects as those of the first embodiment, the incised portion is pushed away by the wide portions of the tip regions 6aA and 6aB so that the incised mucosa covers the incised portion. There is an effect that it is possible to perform submucosal dissection in a state in which endoscopic observation is easy.

図８は、本発明の第４の実施の形態の内視鏡用鋏型高周波切開具の先端部分の斜視図であり、絶縁突起６ｘを略球状に形成したものである。その他の構成は前記の第１の実施の形態と同様である。このように構成すると、第１の実施の形態と同様の効果に加えて、絶縁突起６ｘで粘膜をスムーズに押し広げることができる効果がある。なお、球状以外の形状で絶縁突起６ｘ部分をそれ以外の部分の高周波電極６Ａ，６Ｂの幅より幅広に形成してもよい。  FIG. 8 is a perspective view of the distal end portion of the scissors-type high-frequency incision tool for an endoscope according to the fourth embodiment of the present invention, in which the insulatingprotrusion 6x is formed in a substantially spherical shape. Other configurations are the same as those in the first embodiment. If comprised in this way, in addition to the effect similar to 1st Embodiment, there exists an effect which can expand a mucous membrane smoothly by theinsulation protrusion 6x. The insulatingprotrusion 6x may be formed in a shape other than a spherical shape and wider than the width of the high-frequency electrodes 6A and 6B in other portions.

図９、図１０及び図１１は、本発明の第５の実施の形態の内視鏡用鋏型高周波切開具の先端部分の側面断面図、平面図及び斜視図であり、絶縁突起６ｘが形成されていない第２の高周波電極６Ｂの導電金属露出面６ｃＢの先端部分を、先側ほど第１の高周波電極６から遠ざかるカーブ状の形状に形成すると共に、絶縁突起６ｘが形成されている第１の高周波電極６Ａの導電金属露出面６ｃＡの先端部分を、第２の高周波電極６Ｂの導電金属露出面６ｃＢに沿うカーブ状の形状に形成して、そのカーブに沿うカーブ状に絶縁突起６ｘを第１の高周波電極６Ａから突出形成したものである。このような形状に構成することにより、第１の実施の形態の効果に加えて、一対の高周波電極６Ａ，６Ｂで微小血管や出血源を摘み易くなるメリットがある。なお、各高周波電極６Ａ，６Ｂの先端領域６ａＡ，６ａＢは第３の実施の形態と同様に幅広に形成してある。  9, 10, and 11 are a side sectional view, a plan view, and a perspective view of the distal end portion of the scissors-type high-frequency incision tool for endoscope according to the fifth embodiment of the present invention, and an insulatingprotrusion 6x is formed. The tip of the conductive metal exposed surface 6cB of the second high-frequency electrode 6B that is not formed is formed in a curved shape that is farther away from the first high-frequency electrode 6 toward the front side, and the first is provided with the insulatingprotrusion 6x. The tip portion of the conductive metal exposed surface 6cA of thehigh frequency electrode 6A is formed in a curved shape along the conductive metal exposed surface 6cB of the secondhigh frequency electrode 6B, and the insulatingprotrusions 6x are formed in a curved shape along the curve. 1 projecting from thehigh frequency electrode 6A. By configuring in such a shape, in addition to the effect of the first embodiment, there is a merit that it becomes easy to pick a microvessel or a bleeding source with the pair of high-frequency electrodes 6A and 6B. The tip regions 6aA and 6aB of the high-frequency electrodes 6A and 6B are formed wide as in the third embodiment.

また、この実施の形態においては、図９のＡ−Ａ線における断面を図示する図１２に示されるように、高周波電極６Ａの導電金属露出面６ｃＡより僅かに低い位置に導電金属露出面６ｃＡの両側に平面部６ｄＡが形成されている。第２の高周波電極６Ｂ側も同様である。その結果、図１３に示されるように、切開部位の周囲の組織を一対の高周波電極６Ａ，６Ｂの平面部６ｄＡ，６ｄＢで挟み付けて固定したり、血管を圧迫して血流を遮断することができ、導電金属露出面６ｃＡ，６ｃＢにおいて安定した状態で焼灼、切開処置を行うことができる。  Further, in this embodiment, as shown in FIG. 12 illustrating a cross section taken along the line AA of FIG. 9, the conductive metal exposed surface 6cA is positioned slightly lower than the conductive metal exposed surface 6cA of thehigh frequency electrode 6A. Flat portions 6dA are formed on both sides. The same applies to the second high-frequency electrode 6B side. As a result, as shown in FIG. 13, the tissue around the incision site is sandwiched and fixed between the flat portions 6dA and 6dB of the pair of high-frequency electrodes 6A and 6B, or the blood flow is blocked by pressing the blood vessels. Cauterization and incision treatment can be performed in a stable state on the conductive metal exposed surfaces 6cA and 6cB.

図１４は、本発明の第６の実施の形態の内視鏡用鋏型高周波切開具の先端部分の斜視図であり、絶縁突起６ｘＡ，６ｘＢを、第１の高周波電極６Ａと第２の高周波電極６Ｂの各々の最先端部分の異なる半幅位置に各々形成したものである。その他の構成は前記の第１の実施の形態と同様である。このように、絶縁突起６ｘＡ，６ｘＢを各高周波電極６Ａ，６Ｂから突出形成することにより、第１の実施の形態と同様の効果に加えて、図１５に示されるように、粘膜等を必要に応じて絶縁突起６ｘＡ，６ｘＢで挟み付けて把持することができる。  FIG. 14 is a perspective view of the distal end portion of the scissors-type high-frequency incision tool for an endoscope according to the sixth embodiment of the present invention. Each of theelectrodes 6B is formed at a different half-width position in the most distal portion. Other configurations are the same as those of the first embodiment. Thus, by forming the insulating protrusions 6xA and 6xB from the high-frequency electrodes 6A and 6B, in addition to the same effects as those of the first embodiment, as shown in FIG. Accordingly, the insulating protrusions 6xA and 6xB can be sandwiched and held.

なお、本発明は各実施の形態の構成に限定されるものではなく、例えば電極刃部６ｂＡ，６ｂＢが直線状でなくてもよく、その幅が全体に一定でなくてもよい。また、第１と第２の高周波電極６Ａ，６Ｂの間を電気絶縁して、高周波電源の正極と負極とに分けて接続するいわゆるバイポーラ型の内視鏡用鋏型高周波切開具に適用することもできる。  In addition, this invention is not limited to the structure of each embodiment, For example, electrode blade part 6bA, 6bB may not be linear, and the width | variety may not be constant on the whole. The first and second high-frequency electrodes 6A and 6B are electrically insulated from each other and applied to a so-called bipolar type high-frequency incision tool for an endoscope which is connected to a positive electrode and a negative electrode of a high-frequency power source. You can also.

本発明の第１の実施の形態の内視鏡用鋏型高周波切開具の先端部分の側面断面図。The side sectional view of the tip part of the scissors type high frequency incision tool for endoscopes of the 1st embodiment of the present invention.本発明の第１の実施の形態の内視鏡用鋏型高周波切開具の先端部分の斜視図。The perspective view of the front-end | tip part of the scissors type | mold high frequency incision tool for endoscopes of the 1st Embodiment of this invention.本発明の第１の実施の形態の内視鏡用鋏型高周波切開具の使用状態の側面断面図。The side sectional view of the use state of the scissors type high frequency incision tool for endoscopes according to the first embodiment of the present invention.本発明の第１の実施の形態の内視鏡用鋏型高周波切開具の使用状態の概略図。The schematic diagram of the use condition of the scissors type high frequency incision tool for endoscopes of a 1st embodiment of the present invention.本発明の第２の実施の形態の内視鏡用鋏型高周波切開具の先端部分の側面断面図。Side surface sectional drawing of the front-end | tip part of the scissors type | mold high frequency incision tool for endoscopes of the 2nd Embodiment of this invention.本発明の第２の実施の形態の内視鏡用鋏型高周波切開具の先端部分の斜視図。The perspective view of the front-end | tip part of the scissors type | mold high frequency incision tool for endoscopes of the 2nd Embodiment of this invention.本発明の第３の実施の形態の内視鏡用鋏型高周波切開具の先端部分の斜視図。The perspective view of the front-end | tip part of the scissors type | mold high frequency incision tool for endoscopes of the 3rd Embodiment of this invention.本発明の第４の実施の形態の内視鏡用鋏型高周波切開具の先端部分の斜視図。The perspective view of the front-end | tip part of the scissors type | mold high frequency incision tool for endoscopes of the 4th Embodiment of this invention.本発明の第５の実施の形態の内視鏡用鋏型高周波切開具の先端部分の側面断面図。Side surface sectional drawing of the front-end | tip part of the scissors type | mold high frequency incision tool for endoscopes of the 5th Embodiment of this invention.本発明の第５の実施の形態の内視鏡用鋏型高周波切開具の先端部分の平面図。The top view of the front-end | tip part of the scissors type | mold high frequency incision tool for endoscopes of the 5th Embodiment of this invention.本発明の第５の実施の形態の内視鏡用鋏型高周波切開具の先端部分の斜視図。The perspective view of the front-end | tip part of the scissors type | mold high frequency incision tool for endoscopes of the 5th Embodiment of this invention.本発明の第５の実施の形態の内視鏡用鋏型高周波切開具の図９のＡ−Ａ線における断面図。Sectional drawing in the AA of FIG. 9 of the scissors type | mold high frequency incision tool for endoscopes of the 5th Embodiment of this invention.本発明の第５の実施の形態の内視鏡用鋏型高周波切開具の使用状態の断面図。Sectional drawing of the use condition of the scissors type | mold high frequency incision tool for endoscopes of the 5th Embodiment of this invention.本発明の第６の実施の形態の内視鏡用鋏型高周波切開具の先端部分の斜視図。The perspective view of the front-end | tip part of the scissors type | mold high frequency incision tool for endoscopes of the 6th Embodiment of this invention.本発明の第６の実施の形態の内視鏡用鋏型高周波切開具の先端部分の使用状態の略示図。The schematic diagram of the use condition of the front-end | tip part of the scissors type | mold high frequency incision tool for endoscopes of the 6th Embodiment of this invention.従来の内視鏡用鋏型高周波切開具の使用状態の概略図。Schematic of the use condition of the conventional scissors type | mold high frequency incision tool for endoscopes.

符号の説明Explanation of symbols

１…可撓性シース
２…シース外皮
４…操作ワイヤー
６Ａ，６Ｂ…高周波電極
６ａＡ，６ａＢ…先端領域
６ｂＡ，６ｂＢ…電極刃部
６ｃＡ，６ｃＢ…導電金属露出面
６ｘ，６ｘＡ，６ｘＢ…絶縁突起
８…支軸
１０…電気絶縁性コーティング皮膜DESCRIPTION OF SYMBOLS 1 ...Flexible sheath 2 ... Sheath outer skin 4 ...Operation wire 6A, 6B ... High frequency electrode 6aA, 6aB ... Tip area 6bA, 6bB ... Electrode blade part 6cA, 6cB ... Conductive metal exposedsurface 6x, 6xA, 6xB ...Insulation protrusion 8 ...Spindle 10 ... Electrically insulating coating film

Claims (8)

Translated fromJapanese

内視鏡の処置具案内管に挿脱されるシースの先端に、前方に向かって開閉する導電金属製の一対の高周波電極が設けられた内視鏡用鋏型高周波切開具において、
前記一対の高周波電極の各々の対向面のみに前記導電金属を露出させて他の部分の表面を電気絶縁すると共に、前記一対の高周波電極のうち一方の高周波電極を直線状に形成し、他方の高周波電極を前記一方の高周波電極に沿って直線状に延びると共に前記一方の高周波電極の先端部を絶縁突起により覆う形状に形成し、前記一対の高周波電極が閉じた状態を前方からみたとき、前記一方の高周波電極の導電金属露出面が前記絶縁突起の背後に隠れる状態に位置させることを特徴とする内視鏡用鋏型高周波切開具。In a scissors-type high-frequency incision tool for an endoscope provided with a pair of high-frequency electrodes made of a conductive metal that opens and closes forward at the distal end of a sheath inserted into and removed from the treatment instrument guide tube of the endoscope,
The conductive metal is exposed only on the opposing surface of each of the pair of high-frequency electrodes to electrically insulate the surface of the other portion, and one high-frequency electrode of the pair of high-frequency electrodesis formed linearly, When the high-frequency electrode extends linearly along the one high-frequency electrode and has a shape in which the tip of the one high-frequency electrode is covered with an insulating protrusion, the closed state of the pair of high-frequency electrodes is viewed from the front,A scissors-type high-frequency incision tool for an endoscope, wherein the conductive metal exposed surface ofone of the high-frequency electrodes is positioned soas to be hidden behind the insulating protrusion. 請求項１に記載された内視鏡用鋏型高周波切開具において、前記絶縁突起が、側方から見たとき前記他方の高周波電極の長手方向に対して略垂直方向に突出する形状に形成されている内視鏡用鋏型高周波切開具。The scissors-type high-frequency incision tool for endoscope according to claim 1, wherein the insulating projection is formed in a shape projecting in a direction substantially perpendicular to the longitudinal direction of theother high-frequency electrode when viewed from the side. A scissors-type high-frequency incision tool for endoscopes. 請求項１に記載された内視鏡用鋏型高周波切開具において、前記絶縁突起が、側方から見たとき前方に向かって凸の略円弧状に形成されている内視鏡用鋏型高周波切開具。  The endoscopic scissors high-frequency incision device according to claim 1, wherein the insulating projections are formed in a substantially arc shape convex forward when viewed from the side. Cutting tool. 請求項１から３の何れかに記載された内視鏡用鋏型高周波切開具において、前記他方の高周波電極の前記絶縁突起部分付近が、前記直線状部分の電極幅より幅広に形成されている内視鏡用鋏型高周波切開具。The endoscopic scissors-type high-frequency incision instrument according to any one of claims 1 to 3, wherein the vicinity of the insulating projection portion of theother high-frequency electrode is formed wider thanthe electrode width of thelinear portion . A scissors-type high-frequency incision tool for endoscope. 請求項４に記載された内視鏡用鋏型高周波切開具において、前記一方の高周波電極の先端領域付近が、前記直線状部分の電極幅より幅広に形成されている内視鏡用鋏型高周波切開具。5. The scissors-type high frequency incision tool for endoscopes according to claim 4, wherein the vicinity of the tip region of theone high-frequency electrode is formed wider thanthe electrode width of thelinear portion. Cutting tool. 請求項４に記載された内視鏡用鋏型高周波切開具において、前記絶縁突起が略球状に形成されている内視鏡用鋏型高周波切開具。  The scissors-type high frequency incision tool for endoscopes according to claim 4, wherein the insulating projections are formed in a substantially spherical shape. 請求項１に記載された内視鏡用鋏型高周波切開具において、前記一方の高周波電極の導電金属露出面の先端付近が、先側ほど前記他方の高周波電極から遠ざかるカーブ状に形成されると共に、前記他方の高周波電極の導電金属露出面の先端付近が前記一方の高周波電極の導電金属露出面に沿うカーブ状に形成されて、そのカーブに沿うカーブ状に前記絶縁突起が突出形成されている内視鏡用鋏型高周波切開具。In endoscopic scissors high-frequency surgical tool according to claim 1, near the tip of the conductive metal exposed surface of theone of the high-frequency electrode is formed in a curved shape away from theother high-frequency electrode as the front side the formed onthe other curve-shaped along the conductive metal exposed surface of the conductive metal exposed surface near the tip is theone of the high-frequency electrode of the high-frequency electrode, the insulating projection is protruded curve shape along its curve A scissors-type high-frequency incision tool for endoscope. 請求項１から７の何れかに記載された内視鏡用鋏型高周波切開具において、前記一対の高周波電極が閉状態のときに互いに向かい合う前記各高周波電極の対向位置に、一定の幅で対向方向に向かって突出する凸形の断面形状の直線状の電極刃部が前後方向に真っ直ぐに形成されて、前記高周波電極の電極刃部の突端対向面のみに前記導電金属面が露出し、前記高周波電極のその他の面には全面に不活性材からなる電気絶縁性コーティング皮膜が被覆されている内視鏡用鋏型高周波切開具。  The endoscopic scissors-type high-frequency incision device according to any one of claims 1 to 7, wherein the pair of high-frequency electrodes face each other at positions facing each other when the pair of high-frequency electrodes are closed with a certain width. A linear electrode blade portion having a convex cross-sectional shape protruding in the direction is formed straight in the front-rear direction, and the conductive metal surface is exposed only on the projecting end facing surface of the electrode blade portion of the high-frequency electrode, A scissors-type high-frequency incision tool for an endoscope in which the other surface of the high-frequency electrode is covered with an electrically insulating coating film made of an inert material on the entire surface.

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