JPH1119085A - Forceps type electric treatment instrument - Google Patents

Abstract

(57) [Summary] [Problem] To easily sandwich a living tissue piece at a collection site even when a collection site in a body cavity is substantially flat without the disadvantages of a monopolar electric treatment instrument. To provide a bipolar forceps-type electric treatment instrument that can be burned out. SOLUTION: A flexible sheath 4 which can be inserted into a body, and a cup-shaped recess 24 which is attached to a distal end side of the sheath 4 and are formed respectively, can be freely opened and closed so that both recesses 24 face each other. A pair of forceps pieces 12 connected to the first pair of forceps pieces 12, first electrodes 32 respectively formed on the distal side edges of the recesses 24 of the pair of forceps pieces 12, and in a state where the pair of forceps pieces 12 are closed, The second electrode 30 is housed in the recess 34 without contacting the first electrode 32 and is formed of a tapered projection.
And a voltage supply means 40 connected to the proximal end side of the sheath 4 so as to supply a high-frequency voltage between the first electrode 30 and the second electrode 32, and controls opening and closing of the pair of forceps pieces. Open / close control means 13, 17, 18, 20.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a forceps-type electric treatment instrument, and more particularly, to grasping a tissue piece such as a lesion in a body cavity using a cup-shaped forceps and flowing a high-frequency current between the forceps. The present invention relates to a bipolar forceps-type electric treatment instrument capable of burning off the base of a tissue piece by means of the device, thereby enabling treatment of a lesion and collection of the tissue piece.

[0002]

2. Description of the Related Art Biopsy forceps are used to histologically diagnose whether a lesion in a body cavity is benign or malignant. Conventional biopsy forceps are disclosed, for example, in Japanese Patent Application Laid-Open No. 59-9055.
As disclosed in Japanese Unexamined Patent Application Publication No. HEI 3 (1995) -1995 and Japanese Unexamined Patent Application Publication No. Hei 5-42159, a type in which a pair of cup-shaped forceps pieces are opened and closed and cut by an edge of the cup is known.

[0003] However, the biopsy forceps of the type that is cut by the edge of the cup has a problem that the sharp edge portion is likely to damage normal tissue other than the lesion. Also, with this type of biopsy forceps, the sharpness of the edge portion is reduced by several samplings, and the engagement of the edge portion is displaced, resulting in a sharp decrease in sharpness, making it impossible to collect well. It has the problem of becoming.

Therefore, as shown in Japanese Utility Model Laid-Open No. 62-186,708, a monopolar forceps-type electric treatment instrument has been proposed. In this monopolar electric treatment instrument, an electrode is provided on a cup-shaped forceps piece inserted into a body cavity, an electrode plate constituting another electrode is arranged in contact with the outside of a patient, and a high voltage is applied between these electrodes. Is applied. By pinching the tissue piece with the cup-shaped forceps piece, current is concentrated on the base of the picked tissue piece, and the affected tissue in that portion can be coagulated and necrotic and burned off. The burned-out tissue piece remains inside the cup-shaped forceps piece and can be collected.

[0005]

However, in the monopolar forceps-type electric treatment instrument disclosed in the above publication, since the electric current completely penetrates the patient's body because of the monopolar type, the forceps piece is used. There is a possibility that an arc may be generated from a target electrode to an unintended part, or an electric current flowing through the body of a patient may become stray and damage tissue that should not be damaged. In addition, since the unipolar type requires a relatively high voltage, the arc may cause excessive tissue destruction.

Therefore, a bipolar electric treatment instrument in which a pair of cup-shaped forceps pieces are used as separate electrodes and a high-frequency voltage is applied between these electrodes can be considered, but even the tissue to be collected is burned. As a result, there is a possibility that the examination of the collected tissue cannot be performed accurately.

[0007] In the conventional electric treatment instrument, a pair of forceps pieces are closed to pick up a tissue piece at a collection site such as a lesion. There is a problem that it is difficult to pick up a biological tissue piece at a site.

The present invention has been made in view of such circumstances, and does not have the inconveniences of the monopolar electric treatment instrument, and furthermore, even when the collection and treatment site in the body cavity is substantially flat, the living body of the collection and treatment site can be used. An object of the present invention is to provide a bipolar forceps-type electric treatment instrument capable of easily sandwiching a tissue piece and easily coagulating necrosis and burning out of an affected part.

[0009]

In order to achieve the above object, a forceps-type electric treatment instrument according to the present invention has a flexible sheath that can be inserted into a body, and is mounted on a distal end side of the sheath. Cup-shaped recesses are respectively formed, a pair of forceps pieces that are connected to be openable and closable so that the two recesses face each other, and a pair of forceps pieces formed on the distal end side edges of the recesses of the pair of forceps pieces. A first electrode, a second electrode formed of a protrusion having a tapered tip, and housed in the recess without being in contact with the first electrode in a state in which the pair of forceps pieces are closed; A voltage supply unit connected to a proximal end side of the sheath so as to supply a high-frequency voltage to the second electrode; and an open / close control unit for controlling opening / closing of the pair of forceps pieces.

In the present invention, in order to form the first electrode on the tip side of each forceps piece, each forceps piece is formed of an insulating member, and a conductive film is formed only on the tip side. good. Alternatively, each forceps piece may be formed of a conductive member, and an insulating film may be formed except for the tip side.

In the present invention, the distal end side of the forceps piece on which the first electrode is formed may be an edge portion or an outer peripheral surface as long as it is the distal end side.

The conductive member constituting the forceps piece is preferably a metal having excellent thermal and corrosion resistance, such as stainless steel, carbon steel, gold, silver, platinum, nickel, and aluminum. The insulating film formed on the surface of the forceps piece made of such a conductive member is not particularly limited, but a ceramic coating film of alumina, titanium nitride, titanium carbide, etc., a glass coating film, a synthetic diamond film, a polyimide resin And a fluorine-based resin are preferred from the viewpoint of heat resistance. Examples of the coating method include an ion plating method, a plasma or flame spray deposition method, an immersion method, and a coating method.

As the insulating member constituting the forceps piece, ceramics such as alumina, titanium nitride, and titanium carbide; polyimide, polyetherimide, polyethersulfone, and fluororesin are preferable from the viewpoint of heat resistance. The conductive film formed on the surface of the forceps piece made of such an insulating member is not particularly limited, but may be silver, copper, or the like.
Gold, platinum and the like are preferred. This is because the conductivity is high. Examples of the coating method include a metal plating method, a sputtering method, an evaporation method, and a coating method.

In the present invention, the second electrode is formed of a conductive member having a tapered projection, and its material is not particularly limited, but silver, copper, gold, platinum, stainless steel, or the like is used. preferable. This is because the conductivity is high. Also,
The tip of the second electrode is preferably needle-shaped. The minimum gap between the tip of the tapered second electrode and the first electrode is set to 0.degree. So that the insulation is ensured when there is nothing between the electrodes and the living tissue is interposed therebetween. It is preferably from 2 to 2.0 mm, and more preferably from 0.4 to 1.5 mm.

It is preferable that the base end of the second electrode is held by an insulating member and is insulated from the forceps piece. Further, in the present invention, it is preferable that a connecting portion for opening and closing the pair of forceps pieces is formed of an insulating member.

In the present invention, the opening / closing control means for controlling the opening and closing of the pair of forceps pieces is not particularly limited. A link mechanism for converting the reciprocating movement of the forceps into an opening and closing movement between the forceps pieces, and an operating unit connected to the proximal end of the flexible elongate member for operating the elongate movement of the elongate member in the sheath. preferable.

In the present invention, the frequency of the high-frequency voltage supplied from the voltage supply means is not particularly limited.
The power is preferably about 0 kHz to 800 kHz, and the power is preferably about 5 to 35 watts.

[0018]

In order to collect, for example, coagulated necrosis of a diseased tissue and a living tissue using the forceps-type electric treatment device according to the present invention, first, the distal end of the treatment device is removed by using an endoscope or the like. Guide to near the sampling site such as a lesion in the inside. Next, the pair of forceps pieces is rotated in the opening direction to expose the second electrode made of a tapered projection, and the tip is pierced into the living tissue at the collection site to lift the collection site. And
Operate the operating unit connected to the outer proximal end of the sheath,
The pair of forceps pieces attached to the distal end of the sheath are rotated in the closing direction. By closing the pair of forceps pieces, the living tissue piece at the sampling site is sandwiched and positioned in the cup-shaped first and second recesses formed in the forceps pieces. The base of the piece of living tissue at the picked up site is sandwiched between the first electrodes on the tip side of each forceps piece.

Next, a high frequency voltage is applied between the first electrode and the second electrode from a voltage supply means connected to the proximal end side of the sheath through a conductive wire or the like wired in the sheath. When a high-frequency voltage is applied between these electrodes, the current density is the highest at the minimum gap between the tip of the second electrode and the first electrode, that is, at the base of the tissue piece sandwiched between the forceps pieces. Get higher. As a result, an electric current flows only in the base portion of the tissue piece sandwiched between the forceps pieces and heats, so that the base portion is burned off. This heating also causes hemostasis and coagulation necrosis of the cut portion. The cut biopsy piece remains in the recess of the forceps piece. Therefore, if the treatment instrument is taken out of the body cavity with the forceps pieces closed, the collection of the biopsy tissue piece is completed.

In the present invention, an electric current flows only through the living tissue sandwiched between the electrodes formed on the distal side edge of the forceps piece.
Therefore, compared with the monopolar type, the cauterization of the living tissue is less, and the coagulation necrosis of the lesion and the excision of the tissue piece can be reliably performed with a small electric power. Electrodes are formed only in portions necessary for energization, and the inside of the cup-shaped recess of the forceps piece in which the cut living tissue piece is stored is insulated, so that the cut living tissue piece is not damaged. . Further, in the present invention, since the second electrode is constituted by a projection having a tapered tip, the tip of the second electrode can be pierced into a living tissue collection site when the living tissue is collected. As a result, the collection site can be easily lifted, and the forceps piece is closed while being lifted and fixed, so that the tissue piece at the collection site can be easily sandwiched by the forceps pieces, and excision and energization can be performed.

Further, in the present invention, the second electrode is housed inside the forceps piece so as not to contact the first electrode, so that a short circuit between them can be effectively prevented.

[0022]

DESCRIPTION OF THE PREFERRED EMBODIMENTS The present invention will be described below based on embodiments shown in the drawings.

FIG. 1 is a schematic view of a forceps-type electric treatment instrument according to one embodiment of the present invention, FIG. 2 is a schematic cross-sectional view of a main part on the distal end side of the forceps-type electric treatment instrument shown in FIG. 1, and FIG. 2 is a plan view of a forceps piece shown in FIG. 2, FIG. 4 is a schematic cross-sectional view of a main part on a distal end side showing a use state of the forceps-type electric treatment instrument according to the embodiment, and FIG. FIG. 6 is a schematic view of a forceps-type electric treatment instrument according to another embodiment of the present invention.

First Embodiment As shown in FIG. 1, a forceps-type electric treatment instrument 2 according to the present embodiment has a sheath 4 that can be inserted into the body. Sheath 4
Has a lumen inside and is made of a flexible material. The material constituting the sheath 4 is not particularly limited as long as it is an electrically insulating material having flexibility, and polyethylene, polypropylene, polyvinyl chloride, polyurethane,
Plastics such as polyamide, polyester, polycarbonate, and polyethersulfone can be used, and a material having an appropriate elastic modulus can be selected according to the purpose.

The outer diameter of the sheath 4 is not particularly limited.
Preferably, it is 1.0 to 5.0 mm, more preferably 1.
5 to 3.0 mm. The thickness of the sheath is not particularly limited, but is preferably 0.1 to 1.5 mm, and more preferably 0.2 to 1.0 mm.

As shown in FIGS. 1 and 2, a support member 6 is fixed to the distal end of the sheath 4 (the side to be inserted into the body) by means such as adhesion or fusion. The support 6 is made of an insulating material such as ceramic, polyimide, polyethersulfone, or a fluorine-based resin, and has a pair of support pieces 8 and 8 projecting in the axial direction.

At the distal ends of the support pieces 8, 8, a fulcrum shaft 10 is provided.
And a pair of forceps pieces 1
Each of the link pieces 13 and 13 is rotatably mounted. As shown in FIG.
3, a disk-shaped insulating spacer 35 is mounted, and these insulations are maintained. The fulcrum shaft 10 and the insulating spacer 35 are made of, for example, a heat-resistant plastic such as polyimide, polyether sulfone, or a fluorine-based resin.

In the present embodiment, a second electrode 30 made of a needle-like projection having a tapered tip is joined to the distal end side of the insulating spacer 35 by means such as adhesion or fusion. Alternatively, the second electrode 30 and the spacer 35 may be formed integrally with a conductive member, and only the outer peripheral surface of the spacer 35 may be covered with an insulating film. Alternatively, the second electrode 30 and the spacer 35 may be integrally formed of an insulating member, and only the outer peripheral surface of the second electrode 30 may be covered with a conductive film.
The details of how to make this are the same as in the case of the first electrode 32 described later, and a description thereof will be omitted.

As shown in FIG. 1, another link piece 17, 17 is connected to the link piece 13, 13 of each forceps piece 12, 12 in a pantograph shape. The distal end of the longitudinal member 18 is connected. The longitudinal member 18 is attached so as to be able to advance and retreat in the longitudinal direction X along the lumen inside the sheath 4. The longitudinal member 18 has sufficient flexibility so that an operating force can be transmitted along the longitudinal direction X and can be bent together with the sheath 4 in the radial direction of the sheath 4. I have. Further, the longitudinal member 18 is preferably made of an insulating material.
As the longitudinal member 18 that satisfies such a requirement, a rod made of a plastic such as polyamide, polyacetal, or a fluororesin, or stainless steel coated with an insulating material can be used.

The proximal end of the elongate member 18 is connected to a handle 22 movably mounted in the longitudinal direction X with respect to an operation unit 20 arranged outside the body. The operation unit 20
The outer diameter of the sheath 4 is such that it can be easily held by one hand, and the proximal end of the sheath 4 is joined by means of adhesion or fusion. In addition, it may be formed integrally with the sheath 4. The material of the operation unit 20 is made of the same insulating material as the sheath 4.

By moving the handle 22 forward and backward in the longitudinal direction X with respect to the operation unit 20, the longitudinal member 18 moves in the lumen of the sheath 4 along the arrow X direction, and the links 17 and 19 are operated. , The forceps pieces 12, 12
And open / close them can be controlled.

As shown in FIGS. 1 and 4, each forceps piece 12, 1
2, cup-shaped recesses 24, 24 are respectively formed. Although the volume of each recess 24 is not particularly limited,
It is determined according to the volume of the living tissue piece to be collected and the like, and each is preferably about 0.5 to 33.0 mm ³ , more preferably about 1.0 to 18.0 mm ³ . Each recess 24, 2
4 so that each of the link pieces 1 of the forceps pieces 12
3 and 13 are rotatably mounted on the fulcrum shaft 10.

As shown in FIG. 3, the first electrode 3 is provided on the distal end side edge of the recess 24 of each forceps piece 12, 12, respectively.
2, 32 are formed. The electrode area of each of the electrodes 32 is not particularly limited, but is 0.3 to 8.0 mm.
It is preferably ² .

In this embodiment, as shown in FIG. 5, with the forceps pieces 12 and 12 closed, the second electrode 30 formed of a needle-like projection is housed in the cup-shaped recess 24. Thus, the length is adjusted so that the first electrode 32 and the second electrode 30 are not short-circuited. Also, the minimum gap t between the tip of the tapered second electrode 30 and the first electrode 32
Is set to be 0.4 to 1.5 mm. This is to ensure insulation in a state where there is nothing between them, and to supply electricity with a living tissue interposed therebetween.

The first electrodes 32, 32 formed on the forceps pieces 12, 12 are connected to the distal ends of first conductive wires (not shown) extending through the sheath so as to have the same potential. The second electrode 30 made of a needle-like projection is connected to a distal end of a second conductive wire (not shown) extending through the sheath. The first conductive line and the second conductive line are insulated and coated so as to be mutually insulated.

The proximal end of each conductive wire is connected to a high-frequency power source 40 as a voltage supply means via an electric cord 42 branched from the operation unit 20. Is applied with a high-frequency voltage.

The frequency of the high-frequency voltage supplied from the high-frequency power supply 40 is not particularly limited.
0 kHz is preferable, and the electric power is preferably 5-35.
About watts.

In the present embodiment, each forceps piece 12, 12
It is made of stainless steel, and all parts other than the parts corresponding to the first electrodes 32, 32 are covered with an insulating film. In the present embodiment, the insulating film employs a ceramic coating film such as alumina. This ceramic coating film can be formed by an ion plating method or the like. The thickness of the insulating film is determined by the forceps pieces 12 and 12.
The thickness is such that the insulating property is maintained.
01 to 0.06 mm.

To collect, for example, a living tissue at a lesion using the forceps-type electric treatment instrument 2 according to the present embodiment, first, the distal end of the treatment instrument 2 is moved by using an endoscope or the like as shown in FIG. Is guided to the vicinity of the lesion 52 in the body cavity 50 shown in FIG. Next, FIG.
As shown in (2), the pair of forceps pieces 12 and 12 are rotated in the opening direction Y to expose the second electrode 30 formed of a tapered tip, and the tip is pierced into the living tissue at the sampling site to collect the sample. Lift the part. Then, by operating the operation unit 20 shown in FIG. 1 connected to the outside end of the sheath 4,
A pair of forceps pieces 12, 12 attached to the distal end of the sheath 4
Is rotated in the closing direction. By closing the pair of forceps pieces 12, 12, the living tissue piece at the collection site is sandwiched,
It is positioned in a cup-shaped recess 24 formed in the forceps pieces 12, 12. As shown in FIG. 4, the base of the picked-up living tissue piece at the collection site is sandwiched between the first electrodes 32 at the distal end edges of the forceps pieces 12.

Next, a high-frequency voltage is applied between the first electrode 32 and the second electrode 30 from a high-frequency power source 40 connected to the proximal end side of the sheath 4 through a conductive wire or the like wired in the sheath 4. When a high-frequency voltage is applied between the electrodes 30 and 32, the portion of the minimum gap between the tip of the second electrode 30 and the first electrode 32, that is, the tissue piece sandwiched between the forceps pieces 12, 12 The current density is highest at the base. As a result, an electric current flows only in the base portion of the tissue piece sandwiched between the forceps pieces 12, and the tissue piece is heated, and the base portion is burnt off. This heating also causes coagulation necrosis and hemostasis around the cut. The cut biopsy tissue remains in the recess 24 of the forceps pieces 12, 12. Therefore, if the treatment instrument is taken out of the body cavity outside the body cavity with the forceps pieces 12 and 12 closed, the collection of the biopsy tissue piece is completed.

In this embodiment, current flows only through the base of the sandwiched tissue piece. Therefore, compared with the monopolar system, the cauterization of the living tissue is reduced, and the tissue piece can be reliably removed with a small electric power. The electrodes 30 and 32 are formed only in the portions necessary for energization, and the inside of the cup-shaped recess 24 of the forceps piece accommodating the cut living tissue piece is insulated. No damage to the piece.

Further, in the present embodiment, since the second electrode 30 is formed of a needle-like projection, the tip of the second electrode 30 can be pierced into the living tissue collection site when the living tissue is collected. As a result, the sampling site can be easily lifted, and the forceps pieces 12 and
12 is closed, the tissue piece at the sampling site can be easily replaced with the forceps piece 1
It can be pinched and resected at 2,12.

In this embodiment, since the second electrode 30 is housed inside the forceps pieces 12 so as not to contact the first electrode 32, it is possible to effectively prevent a short circuit therebetween. it can.

Second Embodiment In this embodiment, as shown in FIG.
Opening and closing control means for controlling opening and closing of the forceps piece 1
It has two flexible filaments 18a that are directly connected to the link pieces 13 and 13 of the second and the second. The proximal end of the flexible filament 18a is connected to the handle 22. The two filaments 18a are insulated from each other, and each of the filaments 18a has a built-in conductive wire. The proximal end of each conductive wire is code 4
2 connects the first electrode 32 shown in FIG. Also, the second electrode 30
Are electrically connected to an insulative coated filament 34 containing a conductive wire, and the filament 34 is connected to a cord 42. Other configurations and operations are the same as those of the first embodiment.

The present invention is not limited to the above-described embodiment, but can be variously modified within the scope of the present invention.

For example, in the above embodiment, the forceps piece 1
2 and 12 are made of a conductive material, and the portions other than the portions corresponding to the electrodes 32 and 32 are covered with an insulating film.
Each of the forceps pieces 12, 12 may be formed of an insulating member, and a conductive film may be formed only on the tip side edge corresponding to the first electrode 32 of each forceps piece 12.

The shape of the second electrode 30 is not particularly limited as long as the tip is tapered, and various shapes can be considered.

[0048]

As described above, according to the present invention, a current flows only through the living tissue sandwiched between the electrodes formed on the distal end side of the forceps piece. Therefore, as compared with the monopolar system, cauterization of the living tissue is less, and the coagulation necrosis of the affected tissue and the excision of the tissue piece can be reliably performed with a small output. Electrodes are formed only in portions necessary for energization, and the inside of the cup-shaped recess of the forceps piece in which the cut living tissue piece is stored is insulated, so that the cut living tissue piece is not damaged. . Further, in the present invention, since the second electrode is constituted by a projection having a tapered tip, the tip of the second electrode can be pierced into a living tissue collection site when the living tissue is collected. As a result, the collection site can be easily lifted, and the forceps piece is closed in a state of being lifted and fixed, so that the tissue piece at the collection site can be easily sandwiched and resected.

[Brief description of the drawings]

FIG. 1 is a schematic view of a forceps-type electric treatment instrument according to an embodiment of the present invention.

FIG. 2 is a schematic cross-sectional view of a main part on the distal end side of the forceps-type electric treatment instrument shown in FIG.

FIG. 3 is a plan view of the forceps piece shown in FIG. 2;

FIG. 4 is a schematic cross-sectional view of a main part on the distal end side showing a use state of the forceps-type electric treatment instrument according to the embodiment.

FIG. 5 is a cross-sectional view of a main part from a direction indicated by a line V shown in FIG. 4;

FIG. 6 is a schematic view of a forceps-type electric treatment instrument according to another embodiment of the present invention.

[Explanation of symbols]

 2 ... forceps type electric treatment instrument 4 ... sheath 10 ... fulcrum shaft 12 ... forceps piece 18 ... longitudinal member 20 ... operation part 22 ... handle 24 ... recess 30 ... second electrode 32 ... first electrode

Claims (1)

[Claims] 1. A flexible sheath that can be inserted into a body, and a cup-shaped recess mounted on a distal end side of the sheath and formed to be open and closed so that both recesses face each other. A pair of forceps pieces, a first electrode respectively formed on the tip side of the pair of forceps pieces, and in a state where the pair of forceps pieces are closed, without contacting the first electrode in the recess. A second electrode formed of a tapered protrusion, and a voltage supply connected to a proximal end side of the sheath so as to supply a high-frequency voltage between the first electrode and the second electrode. Means for controlling the opening and closing of the pair of forceps pieces.