JP3730796B2 - Receptoscope device - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a reject scope device that performs incision, excision, transpiration, and the like of body tissue by electroablation under an endoscope.
[0002]
[Prior art]
In general, a resectoscope is used for transurethral resection (TUR) and transcervical resection (TCR), and is observed in an elongated hollow sheath inserted into a body cavity. An optical endoscope (also referred to as a scope), which is an endoscope for medical use, and an electrode unit for excising a living tissue are mainly provided.
[0003]
In the reject scope, a high-frequency current is applied to the electrode of the electrode unit arranged at the opening of the distal end of the sheath while observing the surface of the lesion with the scope, and the electrode is advanced and retracted by operating the operation unit. It is the structure which performs the treatment with respect to a part.
[0004]
For example, in Japanese Utility Model Publication No. 4-45694, a hard heat-resistant member is interposed between the distal end portion of the electrical insulating member and the strand so as to adhere to the outer periphery of the strand in order to prevent the electrical insulating material from burning. An electrode for a treatment instrument for a rigid endoscope is disclosed.
[0005]
[Problems to be solved by the invention]
However, in the treatment tool electrode of the rigid endoscope disclosed in the Japanese Utility Model Publication No. 4-45694, when the treatment is performed by moving the electrode back and forth by operating the operation portion, the electrode and the electrode support portion are formed of a hard member. The electrode only moved parallel to the scope insertion axis.
[0006]
For this reason, when performing a treatment on a lesion facing the front of the scope, it was necessary to remove the lesion little by little by repeatedly moving the electrode back and forth. And the burden on patients was great.
[0007]
The present invention has been made in view of the above circumstances, and by changing the positional relationship between the electrode to be treated and the scope insertion axis, an effective treatment can be performed on a lesioned part located in front of the scope. It aims to provide a gectoscopy device.
[0008]
[Means for Solving the Problems]
A reject scope apparatus according to the present invention includes an elongated hollow sheath inserted into a body cavity, a scope inserted into the sheath with a predetermined insertion axis to observe the inside of the body cavity, and the scope together with the scope. An electrode unit inserted in a sheath and having an electrode formed in a loop shape for excising or coagulating the tissue in the body cavity using a high-frequency current and an electrode support portion supporting the electrode; and the electrode unit The electrode or the electrode support part is configured to be formed in a loop shape with respect to the lesion part facing the scope by changing the positional relationship of the electrode with respect to the insertion axis of the scope. And an elastic member having elasticity for disposing the electrode at a desired site .
[0009]
According to this configuration, by changing the positional relationship between the electrode and the scope insertion axis, not only treatment for a lesion portion in a positional relationship parallel to the scope insertion axis but also treatment for a lesion portion facing the front of the scope. Can also be done.
[0010]
DETAILED DESCRIPTION OF THE INVENTION
Embodiments of the present invention will be specifically described below with reference to the drawings.
1 to 3 relate to one embodiment of the present invention, FIG. 1 is an explanatory view showing a reject scope device, FIG. 2 is an explanatory view showing a configuration of an electrode unit, and FIG. 3 is a view explaining an operation of the electrode unit. It is.
[0011]
As shown in FIG. 1, a reject scope device 1 includes a hollow sheath 2 having a through-hole, a scope 3 for observing a lesioned part and the like, and an electrode unit for observing the lesioned part. 4 and a handle scope 5 that constitutes an operation unit, and a high-frequency power supply device 7 that is a means for energizing a treatment electrode 41 of an electrode unit 4 to be described later.
[0012]
The sheath 2 is composed of, for example, an insertion portion 21 that is inserted into a body cavity via the urethra, and a hand main body portion 22 provided at the rear end of the insertion portion 21, and a side peripheral portion of the hand main body portion 22. Is provided with a water supply cap 23 with a cock for supplying the perfusate to the treatment section.
[0013]
The scope 3 and the electrode unit 4 are inserted and disposed in the insertion portion 21, and a distal end member formed of an insulating member such as a hard resin member at the distal end of the insertion portion 21. 24 is provided.
[0014]
The scope 3 is an elongated, rigid insertion tube 31 that is inserted into the insertion portion 21 and the distal end member 24 with a built-in observation optical system, and a proximal portion 32 that is disposed at the proximal end of the insertion tube 31. It consists of An eyepiece 33 for visual observation by an operator is provided at the proximal end of the hand 32, and a light guide (not shown) that supplies illumination light for observation to the observation site is provided on the side of the hand 32. There is provided a light guide connection portion 34 to which is detachably connected.
[0015]
As shown in FIGS. 1 and 2, the electrode unit 4 inserted and arranged in the insertion portion 21 includes a treatment electrode 41 in which a hard metal member positioned on the distal end side is formed in a loop shape, and a scope of the treatment electrode 41. The electrode support portion 42 that constitutes the support portion with a metal member such as a superelastic member having elasticity that holds the positional relationship with respect to the insertion shaft 3 in a changeable manner, and a hard and through hole that holds the base end of the electrode support portion 42. The front end side has a bifurcated arm member 43 having a bifurcated end and an elongated metal pipe 44 having the bifurcated arm member 43 disposed at the front end.
[0016]
The outer periphery of the metal pipe 44 is covered with an insulating tube (not shown), and the base end portion of the metal pipe 44 is exposed as an electrode connecting portion at the rear end portion of the insulating tube.
[0017]
The electrode unit 4 is disposed in the insertion portion 21 so as to be able to advance and retract, and the treatment electrode 41 is disposed so as to protrude and retract with respect to the distal end opening 25 of the sheath 2. The proximal end portion of the metal pipe 44 provided with the treatment electrode 41, the electrode support portion 42, and the bifurcated arm member 43 on the distal end side is inserted through the insertion portion 21 and the hand main body portion 22 so that the hand main body portion 22 It extends from the base end surface and is disposed on a slider 53 described later.
[0018]
The handle portion 5 is detachably connected to the proximal main body portion 22 of the sheath 2, and protrudes rearward from the rear end surface of the sheath connection portion 51 so that the insertion tube 31 is inserted therethrough. The guide pipe 52 and the substantially pipe-shaped slider 53 slidably held by the guide pipe 52 are mainly formed.
[0019]
The slider 53 is detachably provided with an electrode fixing portion 54 that is an electrical connection portion with the electrode connection portion that forms the rear end portion of the electrode unit 4 and a power cord 71 extending from the high-frequency power supply device 7. A high-frequency power connector 55 to be connected and a ring-shaped thumb hook ring 56 for hooking the operator's thumb are provided.
[0020]
The slider 53 and the sheath connecting portion 51 are connected via a leaf spring 57. That is, one end of the leaf spring 57 is fixed to a lever-shaped finger hook 58 integrally fixed to the sheath connecting portion 51, and the other end is fixed to the slider 53. Accordingly, the slider 53 is always urged toward the eyepiece 33 by the leaf spring 57.
[0021]
Accordingly, by appropriately operating the thumb ring 56 provided on the slider 53, the slider 53 is advanced and retracted, and the treatment electrode 41 of the electrode unit 4 is advanced and retracted from the distal end opening 25 of the sheath 2. It is supposed to move.
[0022]
The high-frequency power connector 55 and the electrode fixing portion 54 are electrically connected by, for example, a lead wire 61 shown by a broken line. For this reason, by connecting the power cord 71 of the high frequency power supply device 7 to the high frequency power supply connector 55, the treatment electrode 41 of the electrode unit 4 is energized to treat the lesioned part.
[0023]
Also, a slider positioning fixing member 62 is provided at the base end portion of the guide tube 52. The slider positioning fixing member 62 prevents the slider 53 from falling off the guide tube 52, and the guide The proximal portion 32 of the insertion tube 31 inserted into the tube 52 is integrally fixed to the slider positioning fixing member 62.
[0024]
The operation of the reject scope device 1 configured as described above will be described.
First, the insertion portion 21 constituting the sheath 2 of the reject scope 6 is inserted from the urethra. Then, while observing the inside of the urethra through the eyepiece 33 of the scope 3 arranged in the sheath 2, for example, the distal end opening 25 of the distal end member 24 faces the lesioned part facing the scope 3. Arrange to do.
[0025]
Next, the surgeon appropriately operates the thumb ring 56 provided on the slider 53 while observing the lesioned part and the treatment electrode 41 of the electrode unit 4 through the eyepiece 33, so that the treatment electrode 41 is moved to the lesioned part. Move it closer to.
[0026]
Then, the treatment electrode 41 comes into contact with the lesion, the elastic electrode support 42 is deformed, and the positional relationship between the treatment electrode 41 and the scope insertion axis is changed as shown in FIG. It is placed at the site desired by the surgeon.
[0027]
Next, after confirming the positional relationship between the treatment electrode 41 and the lesioned part, energization of the treatment electrode 41 is started and the thumb ring 56 is appropriately operated. At this time, the treatment electrode 41 is moved as indicated by an arrow by the operation of the thumb ring 56 and the elastic force of the electrode support portion 42 or the weight of the treatment electrode 41, so that the lesion part facing the scope 3 is rooted. We perform treatment to remove from part.
[0028]
When performing a treatment on a lesion part in a positional relationship parallel to the scope insertion axis, the operator appropriately operates the thumb hook ring 56 while observing the lesion part and the treatment electrode 41 through the eyepiece 33, Treatment is performed by moving the treatment electrode 41 parallel to the scope insertion axis.
[0029]
Then, after the treatment is completed, the surface layer state of the lesion is observed with the scope 3, and when the treatment is completed, the reject scope 6 is removed from the urethra and the procedure is finished.
[0030]
Thus, by forming the electrode support portion that constitutes the electrode unit that is inserted into the sheath of the reject scope with an elastic member, the positional relationship of the treatment electrode that constitutes the electrode unit with respect to the scope insertion axis is increased. Since the position of the treatment electrode with respect to the scope insertion axis changes, the treatment desired by the operator can be performed on a lesion portion facing the scope inserted and disposed in the sheath.
[0031]
In addition, a treatment portion can be treated by moving the treatment electrode parallel to the scope insertion axis even for a lesion portion in a positional relationship parallel to the scope insertion axis.
[0032]
As a result, the treatment can be performed smoothly regardless of the positional relationship of the lesioned part parallel to the scope insertion axis or the positional relationship facing the scope, thereby reducing the burden on the operator and the patient.
[0033]
Instead of forming the entire electrode support 42 constituting the electrode unit 4 with an elastic metal member, the treatment electrode 41 is provided by providing an elastic metal member at a part or both ends of the electrode support 42. It may be configured to change the positional relationship between the scope and the scope insertion axis.
[0034]
Further, the electrode support portion 42 of the electrode unit 4 is constituted by a coil member 46 as shown in FIG. 4, or the coil member 46 is disposed in a part of the electrode support portion 42 to insert the treatment electrode 41 and the scope. You may make it the structure which changes the positional relationship with an axis | shaft.
[0035]
Furthermore, instead of using the electrode support portion 42 of the electrode unit 4 as a member having elasticity or providing the electrode support portion 42 with a member having elasticity, the treatment electrode is a member having elasticity as shown in FIG. For example, the coil member 47 or the like may be used, or the coil member 47 may be disposed on a part of the treatment electrode 47 to change the positional relationship between the treatment electrode 41 and the scope insertion shaft.
[0036]
As a result, as shown in FIG. 6, the positional relationship of the coil member 47, which is a treatment electrode, with respect to the scope insertion axis can be changed, the positional relationship of the coil member 47 with respect to the scope insertion axis changes, and the shape of the lesioned part is changed. Correspondingly, the coil member 47 is elastically deformed, and the treatment for the lesioned part facing the scope inserted and arranged in the sheath can be performed smoothly.
[0037]
In the configuration in which the positional relationship between the treatment electrode 41 and the scope insertion shaft is changed, a shape memory alloy that changes its shape by a change in current value, temperature, or the like may be used instead of providing an elastic member. .
[0038]
By the way, US Pat. No. 4,060,087 shows a configuration of a reject scope having a single or multiple shank cutting loop that cuts a target tissue using a pair of electrodes.
[0039]
In the reject scope including this pair of electrodes, the electrode and the electrode support portion are formed of a hard member, so that the pair of electrodes do not contact the treatment portion evenly, resulting in an electrical loss. The desired treatment cannot be performed, or the electrode is bitten into the treatment portion by hand-operating so that the pair of electrodes are in uniform contact with the treatment portion, and the electrode is moved in parallel with the scope insertion axis. The problem that it became difficult occurred.
Therefore, there has been a demand for a reject scope including a pair of electrodes that eliminates electrical loss and can perform treatment smoothly.
[0040]
7 and 8 relate to an embodiment of a reject scope having a pair of electrodes that can be treated smoothly without electrical loss, and FIG. 7 illustrates the structure of a reject scope having a plurality of electrode portions. FIG. 8 is a diagram for explaining the operation of the reject scope shown in FIG.
[0041]
As shown in FIGS. 7 and 8, the reject scope 6 </ b> A of the present embodiment is positioned on the proximal side with respect to the first electrode unit 81 including the first electrode 80 located on the distal end side. This is a bipolar-type reject scope in which a so-called pair of electrodes 80, 83 having a second electrode unit 82 including a second electrode 83 is disposed so as to be movable forward and backward with respect to the insertion portion 21. The first electrode unit 81 and the second electrode unit 82 are electrically insulated from each other by an insulating tube or the like (not shown).
[0042]
The first electrode unit 81 has a first electrode 80 that is a treatment electrode in which a hard metal member located at the tip is formed in a loop shape, and the positional relationship of the first electrode 80 with respect to the insertion axis of the scope 3 can be freely changed. A first electrode support portion 84 formed of a metal member such as a superelastic member having elasticity that constitutes the support portion to be held, and a hard and bifurcated arm member 85 having a through hole that holds the base end of the first electrode support portion 84. And an elongated metal pipe 86 having the bifurcated arm member 85 disposed at the tip.
[0043]
On the other hand, the second electrode unit 82 includes a second electrode 83 which is a return electrode in which a hard metal member located at the tip is formed in a loop shape, and the position of the second electrode 83 relative to the insertion axis of the scope 3. A second electrode support portion 87 formed of a hard metal member that constitutes a support portion that holds the relationship so as to fix the relationship, and a bifurcated arm member 88 that holds the base end of the second electrode support portion 87 and has a rigid through hole. And an elongated metal pipe 89 having the bifurcated arm member 88 disposed at the tip.
[0044]
The configuration of the first electrode unit 81 is the same as the electrode unit of the above-described embodiment. Instead of configuring the first electrode support portion 84 with an elastic member or providing the first electrode support portion 84 with an elastic portion, The structure which provides the 1st electrode 80 with an elastic member, or provided the elastic part in the 1st electrode 80 may be sufficient.
[0045]
The operation of the reject scope 6A configured as described above will be described.
The insertion portion 21 constituting the sheath 2 of the reject scope 6A of the present embodiment is inserted from the urethra. Then, while observing the inside of the urethra through the eyepiece 33 of the scope 3 disposed in the sheath 2, the distal end opening 25 of the distal end member 24 is disposed in the vicinity of the lesioned portion, and thereafter, the electrode is passed through the distal end opening 25. The units 81 and 82 are projected to bring the electrodes 80 and 83 into contact with the lesion. At this time, even if there is an uneven part or a step part in the body tissue, the first electrode support part 84 has elasticity in the first electrode unit 81, so that the second electrode 83 is passed through the eyepiece part 33 to the affected part. As a result, the positional relationship of the first electrode 80 with respect to the scope insertion axis changes, and the electrodes 80 and 83 are in uniform contact with the stepped portion of the lesion.
[0046]
Next, energization is started after the positional relationship between the electrodes 80 and 83 and the lesioned part is confirmed through the eyepiece 33. As a result, a current flows from the first electrode 80 to the second electrode 83.
[0047]
In this state, the thumb ring 56 is appropriately operated to move the electrodes 80 and 83 in parallel with the scope insertion axis. Then, the position of the electrodes 80, 83 indicated by the solid line from the position indicated by the broken line while excising the lesion corresponding to the elastic force of the electrode support 42, the weight of the electrodes 80, 83, and the operation of the thumb ring 56. Move to and take action.
[0048]
Then, after the treatment is completed, the surface layer state of the lesion is observed with the scope 3, and when the treatment is completed, the reject scope 6 is removed from the urethra and the procedure is finished.
[0049]
As described above, in the bipolar reject scope having two electrodes, at least a part of the first electrode or the first electrode support portion constituting the first electrode unit having the first electrode located on the distal end side has elasticity. By forming a member with elasticity, or by providing an elastic member on at least a part of the first electrode or the first electrode support portion, the positional relationship of the first electrode with respect to the scope insertion axis can be changed, and a pair of The treatment can be performed while the electrode is reliably brought into contact with the treatment site.
[0050]
This prevents electrical loss of the current flowing from the first electrode to the second electrode, and allows the treatment with a pair of electrodes to be performed reliably and smoothly.
[0051]
It should be noted that the present invention is not limited to the embodiments described above, and various modifications can be made without departing from the spirit of the invention.
[0052]
[Appendix]
According to the embodiment of the present invention described in detail above, the following configuration can be obtained.
[0053]
(1) an elongated hollow sheath inserted into a body cavity;
A scope that is placed in this sheath and observes inside the body cavity,
An electrode unit that is disposed in the sheath and has at least one electrode that excises or coagulates tissue in a body cavity using a high-frequency ablation current, and an electrode support that supports the electrode;
In a reject scope device comprising an operation unit for operating this electrode unit,
A rejectscope device in which at least a part of an electrode or an electrode support portion constituting the electrode unit has elasticity.
[0054]
(2) The rejectscope device according to appendix 1, wherein the electrode support portion of the electrode unit has elasticity.
[0055]
(3) The rejectscope device according to appendix 2, wherein at least a part of the electrode support portion is made of an elastic metal member.
[0056]
(4) The rejectscope device according to appendix 2, wherein at least a part of the electrode support portion is made of a coil member having elasticity.
[0057]
(5) The rejectscope device according to appendix 1, wherein at least a part of the electrodes of the electrode unit has elasticity.
[0058]
(6) The rejectscope device according to appendix 5, wherein the electrode of the electrode unit is a coil member having elasticity formed in a loop shape.
[0059]
(7) The rejectscope device according to appendix 1, wherein the electrode unit has a pair of electrode units electrically insulated from each other.
[0060]
(8) The pair of electrode units includes a first electrode unit in which the first electrode is located on the distal end side, and a second electrode unit in which the second electrode is located on the proximal end side from the first electrode,
The rejectscope apparatus according to appendix 7, wherein at least a part of the first electrode or the first electrode support portion constituting the first electrode unit has elasticity.
[0061]
(9) The rejectscope device according to appendix 8, wherein the first electrode support portion of the first electrode unit has elasticity.
[0062]
(10) The rejectscope device according to appendix 9, wherein at least a part of the first electrode support portion is made of an elastic metal member.
[0063]
(11) The rejectscope device according to appendix 9, wherein at least a part of the first electrode support portion is made of a coil member having elasticity.
[0064]
(12) The rejectscope device according to appendix 8, wherein at least a part of the first electrode of the first electrode unit has elasticity.
[0065]
(13) The reject scope device according to appendix 12, wherein the first electrode is an elastic coil member formed in a loop shape.
[0066]
【The invention's effect】
As described above, according to the present invention, a reject scope apparatus that can effectively treat a lesion located on the front of the scope or the like by changing the positional relationship between the electrode to be treated and the scope insertion axis. Can be provided.
[Brief description of the drawings]
FIG. 1 to FIG. 3 relate to an embodiment of the present invention, FIG. 1 is an explanatory view showing a reject scope device, FIG. 2 is an explanatory view showing a configuration of an electrode unit, and FIG. FIG. 4 is a diagram illustrating another configuration of the electrode unit. FIG. 5 is a diagram illustrating another configuration of the electrode unit. FIG. 6 is a diagram illustrating the operation of the electrode unit shown in FIG. FIGS. 7 and 8 relate to an embodiment of a reject scope including a pair of electrodes that can be treated smoothly without an electrical loss, and FIG. 7 shows an embodiment of a reject scope having a plurality of electrode portions. FIG. 8 is a diagram for explaining the configuration. FIG. 8 is a diagram for explaining the action of the reject scope shown in FIG. 7.
DESCRIPTION OF SYMBOLS 1 ... Rejectoscope apparatus 3 ... Scope 4 ... Electrode unit 6 ... Rejectoscope 7 ... High frequency power supply device 41 ... Treatment electrode 42 ... Electrode support part

Claims (1)

An elongated hollow sheath inserted into the body cavity;
A scope that is inserted into the sheath with a predetermined insertion axis to observe the inside of the body cavity;
An electrode unit inserted into the sheath together with the scope, and having an electrode formed in a loop shape that excises or coagulates tissue in the body cavity using a high-frequency current, and an electrode support part that supports the electrode, ,
Provided in at least a part of the electrode or electrode support portion that constitutes the electrode unit, and changes the positional relationship of the electrode with respect to the insertion axis of the scope to form a loop shape with respect to the lesioned portion facing the scope An elastic member having elasticity for disposing the electrode at a desired site ;
A reject scope device comprising:

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