JPH1057391A - Instrument for electrical operation - Google Patents

Abstract

PROBLEM TO BE SOLVED: To prevent current density from rising up in a part of a filament supplying electricity to a conductive filament by coating an insulating membrane on around the outer of respective proximal part of a pair of conductive filaments to be applied through a distal end of a catheter free to slide front and rear keeping isolation each other. SOLUTION: Instrument for electrical operation 10 is equipped with a catheter 16 having processed a lumen 14 inside, and a pair of conductive filaments 18, 20 are applied through a distal end 15 of the catheter 16 free to slide front and rear. Distal end of the conductive filaments 18, 20 are put fixed to an insulating spacer 22 using adhesive agent so as to keep isolation each other. Filaments 18, 20 are trained to form a loop(snare) 24 by themselves when extended out coming forward from the distal end 15 of the catheter 16. Around the outer of the filaments 18, 20 in a range from their distal ends to a distance La is coated with a distal end side insulating membrane 36.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an electrosurgical treatment instrument, and more particularly, to an instrument used in resection surgery of a polyp (elevated tumor-like lesion) and the like. During energization of the striatum, an increase in current density in part of the striatum (occurrence of overcrowding current) is prevented, and current is uniformly applied to tissues such as polyps to be resected. The present invention relates to a dipole type electrosurgical treatment instrument.

[0002]

2. Description of the Related Art An electrosurgical treatment instrument is an electrosurgical instrument that uses high-frequency electric energy, and electrically cuts a living tissue without giving an electric shock to a living body to reduce bleeding during the operation. Has been widely used in recent years. The electrosurgical treatment instrument utilizes the action of high-frequency electrical energy between an electrode provided at the distal end of the surgical treatment instrument and the living tissue, and includes a monopolar electrosurgical treatment instrument and a dipolar electric instrument. There are surgical treatment instruments.

[0003] The monopole type electrosurgical treatment instrument has an advantage of being excellent in a cutting force of a living tissue and having little bleeding upon cutting, but requires a high power of about 100 W, so that a living body to be cut can be cut. It has a wide tissue range and is not suitable for cutting the details of living tissue. On the contrary,
Dipolar electrosurgical treatment instruments can operate with low power requirements and the range of living tissue to be cut is small,
Suitable for cutting the details of living tissue.

[0004] A dipole type electrosurgical treatment instrument has a first conductive filament and a second conductive filament slidable in the longitudinal direction in a lumen of a tube, and uses an insulating spacer. In this method, a loop is formed by connecting the tip of the first conductive filament to the tip of the second conductive filament (Japanese Patent Laid-Open Nos. 2-291850 and 4-2418).
53, JP-A-4-325151, etc.).

In such a dipole electrosurgical treatment instrument, the conductive strip near the insulating spacer that strikes the first conductive strip and the second conductive strip has a small polyp resection capability. When the polyp is resected, the tissue may be left uncut.

FIG. 5A is a perspective view of a conventional dipole electrosurgical treatment instrument. In this figure, a first conductive filament 1 and a second conductive filament 2 are exposed from the distal end of the tube 3 and are connected by an insulating spacer 4 to form a loop 5.
Is formed. FIGS. 5B and 5C show FIG.
It is explanatory drawing which shows the state of the treatment using the treatment instrument for dipole electrosurgery of (a). At the time of treatment, the exposed portion is enlarged from the distal end of the tube at the tip of the conductive striated body by operating the conductive striated body operation unit, and a large loop is formed. Next, as shown in FIG. 5 (b), the loop 5 is arranged around the polyp 6, and the conductive filaments 1 and 2 are slid in the direction of being housed in the tube lumen 3, and the loop is reduced to reduce the polyp. By tightening around and activating the high-frequency current generator, the polyp 6 is cut off with electrical energy.

[0007]

However, in this dipole electrosurgical treatment instrument, the distal end portions of the conductive filaments 1 and 2 near the insulating spacer 4 (the filaments 1 and 2 are closest to each other). (Part), the current density increased (generation of dense current) during energization, and there was a risk of spark generation.
For this reason, carbonized tissue (burnt char, etc.) adheres to the distal end portions of the striatum 1 and 2 as electrodes, and as a result, non-uniformity of current supply (insufficient) occurs, as shown in FIG. In addition, there was a possibility that uncut portions 7 may occur.

Further, when the spark is generated, there is a possibility that the durability of the adhesive used for fixing the insulating spacer 4 to the filaments 1 and 2 or the durability of the insulating spacer 4 itself may be deteriorated.

The present invention has been made in view of such circumstances, and prevents an increase in current density (occurrence of a dense current) in a part of a striated body during energization of the conductive striated body. An object of the present invention is to provide a dipole-type electrosurgical treatment instrument which is capable of uniformly supplying current to a tissue such as a certain polyp and has excellent durability which does not cause a residue of a living tissue.

[0010]

To achieve the above object, an electrosurgical treatment instrument according to a first aspect of the present invention comprises:
An electrosurgical treatment instrument having a catheter tube that can be inserted into the body, and a pair of conductive filaments that are attached to the catheter tube so as to be able to move forward and backward from the distal end thereof and that are held in an insulated state from each other. In addition, an insulating film is attached to an outer peripheral surface of a portion of the pair of conductive filaments that are close to each other.

An electrosurgical treatment instrument according to a second aspect of the present invention is provided with a catheter tube which can be inserted into a body, and which is mounted so as to be movable forward and backward from a distal end of the catheter tube, and is insulated from each other. An electrosurgical treatment instrument having a pair of held conductive filaments, wherein an insulating film is coated on at least a distal end outer peripheral surface of one of the pair of conductive filaments. It is characterized by being worn.

It is preferable that the area where the insulating film is formed is a portion where the pair of conductive filaments is closest to each other. It is preferably in the range of 2 to 10 mm from the distal end of the body.

Although the insulating film is not particularly limited,
For example, a fluorine resin, a polyimide resin, a ceramic, or the like is used. Examples of the ceramic include metal oxides, metal nitrides, and metal carbides. It is preferable that the insulating film is a film to which the tissue after the energization hardly adheres or that the adhered material is easily peeled off. From such a viewpoint, it is preferable that the film is a slippery film.

The thickness of the insulating film is not particularly limited.
It is preferably about 5 to 50 μm. The method of forming the insulating film is as follows.
Although not particularly limited, baking, spraying,
An immersion method and the like can be exemplified.

In the present invention, the term “insulating film” means a film having a resistance value higher than that of the conductive striatum, and a current is applied between the striatum with a polyp or the like interposed therebetween. Is a film having conductivity enough to flow. From such a viewpoint, the insulating film does not necessarily need to be present over the entire outer peripheral surface of the striatum, and the insulating film portion may be scattered in an island shape or formed in a stripe or stripe shape. In some cases, a large number of openings (exposed portions on the surface of the linear body) may be formed in the insulating film. By forming the insulating film in this way, the insulating portion and the conductive portion are mixed on the outer peripheral surface of the linear body, and by adjusting the ratio thereof, the demand for the insulating property and the demand for the conductive property can be improved. And balance.

As a method for mixing the insulating portion and the conductive portion on the outer periphery of the linear body, for example, a low-adhesion polymer such as a fluororesin is baked on the linear body, and then the laser is spotted. There is a method of irradiating a large number of holes, evaporating the polymer in the irradiated portion, and opening many pores. There is also a method in which a pretreatment is performed on a surface portion of a striatum on which an insulating film is to be formed, and selective powder coating is performed, thereby forming an insulating film scattered. Further, there is a method in which, after forming an insulating film, the film is partially removed by polishing. Furthermore, CVD, PVD,
By depositing a low-adhesion substance by ion implantation or the like, an insulating film can be formed interspersed.

In the present invention, in order to hold the pair of conductive filaments insulated from each other, the distal ends of the filaments are connected by an insulating spacer, and the filaments are connected to the catheter tube. It is preferable that the tip is formed so as to form a loop when it is moved forward and protruded from the distal end.

In the electrosurgical treatment instrument according to the present invention, the current density tends to increase between the portions where both the striata are closest to each other during energization of the conductive striatum during surgery. Since the insulating film is coated, the current density does not increase as compared with other portions. As a result, it is possible to prevent sparking at this portion and to uniformly apply current to a tissue such as a polyp to be resected. Therefore, it is possible to prevent the carbonized tissue (burned charred) from adhering to the conductive striatum, and almost no remaining of the living tissue is generated. Further, since no spark is generated, there is little deterioration of a spacer or an adhesive for maintaining the striated body in an insulating state, and the durability is improved.

[0019]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Hereinafter, an electrosurgical treatment instrument according to the present invention will be described in detail based on an embodiment shown in the drawings.

First Embodiment FIG. 1 is a schematic perspective view of an electrosurgical treatment instrument according to an embodiment of the present invention, and FIG. 2 is a schematic perspective view showing a use state of the embodiment.

As shown in FIG. 1, an electrosurgical treatment instrument 10 according to this embodiment is an instrument called a so-called bipolar snare, and has a catheter tube 16 having a lumen 14 formed therein. Distal end 15 of tube 16
A pair of conductive filaments 1 so that they can move forward and backward
8, 20 are attached. The distal ends of the conductive filaments 18 and 20 are fixed to an insulating spacer 22 with an adhesive or the like, and are held so as to be insulated from each other. Further, when the filaments 18 and 20 move forward from the distal end 15 of the catheter tube 16 and protrude, the filaments 18 and 20 form a loop (snare) 24 with the filaments 18 and 20. It has a habit to do it.

The insulating spacer 22 is not particularly limited, but is made of an electric insulating material having appropriate strength, heat resistance and workability. Examples of such an electrically insulating material include ceramics such as alumina and zirconia, and heat-resistant plastics such as polybenzimidazole and polyethersulfone.

The shape and size of the spacer 22 are not particularly limited, and a spacer having a circular or elliptical cross section can be selected according to the outer diameter of the conductive filaments 18 and 20. The cross-sectional diameter of the spacer (diameter for a circle, long axis for an ellipse) is usually 0.5 to 5 mm, preferably 1 to 3 mm, and its axial length is usually 0.1 mm.
It is 5-5 mm, preferably 1-3 mm.

The material of the catheter tube 16 is not particularly limited as long as it is an electrically insulating material. Polyethylene, polypropylene, polyvinyl chloride, polyurethane, polyamide, polyester, polycarbonate, polyether sulfone,
Plastics such as fluororesin can be used, and a material having an appropriate elastic modulus can be selected according to the purpose. The outer diameter of the catheter tube 16 is not particularly limited, but is preferably, for example, 1.5 to 3.0 mm. The thickness of the catheter tube 16 is not particularly limited,
It is about 0.1 to 0.5 mm.

The conductive filaments 18 and 20 are wire electrodes, and the material thereof is not particularly limited as long as it is a conductive material.
For example, gold, silver, platinum, nickel, iron, aluminum,
Examples thereof include simple metals such as tin and zinc, and alloys such as stainless steel and nichrome. Conductive filament 1
The structure of 8, 20 may be either a single wire or a stranded wire, and the stranded wire includes a single wire and a coil surrounding the core wire.

The outer diameter of the conductive filaments 18, 20 can be arbitrarily selected depending on the surgical site, but is usually 0.1 mm.
の も の 1 mm, preferably 0.2-0.6 mm can be used.

One of the conductive filaments 18, 20 is connected to the lumen 1 as needed inside the catheter tube 16 in order to prevent a short circuit therebetween.
4 can be axially movably inserted into a resin tube 26 provided separately. The resin tube 26 is preferably fixed in the lumen 14 so as not to move in the axial direction. However, the resin tube 26 may move in the lumen 14 in the axial direction together with the striated body 20. The material of the resin tube 26 is not particularly limited, and examples thereof include a fluororesin such as polyethylene, polypropylene, and polytetrafluoroethylene. The other striated body 18 of the conductive striated body is axially movable in the lumen 14 of the catheter tube 16.

The means for holding the conductive filaments 18 and 20 in the lumen 14 of the catheter tube 16 in an insulated state so as to be movable in the axial direction is not limited to the above-mentioned means, but may be various means. Can be adopted. For example, the two filaments 18, 20 may be inserted into a resin tube disposed in the lumen 14, respectively, or the filament 1 may be inserted into each lumen of the resin tube having two lumens.
8, 20 may be inserted. Alternatively, an insulating film may be provided on each of the outer peripheral surfaces of the two filaments.

As shown in FIG. 1, the proximal end 28 of the catheter tube 16 is connected to an operating base 30, and the proximal ends of the conductive filaments 18, 20 are connected to the operating base 30. On the other hand, it is connected to an operation handle 32 mounted to be movable in the axial direction. By operating the operation handle 32, the striatum 1
8 and 20 can be moved axially within the catheter tube 16 to advance and project the striatum 18, 20 from the distal end 15 of the catheter tube 16, or retract it into the lumen 14 by retracting. It is possible.

The striatum 18, 20 is connected to the catheter tube 1
The structure for moving in the axial direction within 6 is not particularly limited, but includes an operating handle 32 that can move in the axial direction and a moving member that moves in the axial direction in conjunction with this, as shown in FIG. Or a moving member that moves in the axial direction in conjunction with the turning of the turning member. In the electrosurgical treatment instrument 10 of the present embodiment, the proximal ends of the filaments 18 and 20 are further connected through a cord 34 to a high-frequency current generator (not shown).

In the present embodiment, as shown in FIG. 1, the distal ends of the striated bodies 18 and 20 are formed so as to form a loop 24 while being exposed from the distal end of the catheter tube 16. I have. In the present embodiment, the striatum 18, 2
0 in the range of La from the distal end,
Is formed with a distal-end-side insulating film 36 on the outer peripheral surface thereof. The formation length La of the distal end side insulating film 36 is preferably about 2 to 10 mm.

The distal end side insulating film 36 is
8 and 20 are formed only at the distal ends, and behind them (on the proximal end side), there is no conductive film, or a conductive region 3 where only a thin insulating film is formed.
8 are formed. The length Lb of the conductive region 38 is 5-6.
0 mm is preferred. A proximal-end-side insulating film 40 is formed on the outer peripheral surfaces of the linear bodies 18 and 20 located behind (the proximal-end side) of the conductive region 38.

The distal-end-side insulating film 36 and the proximal-end-side insulating film 40 are not particularly limited. For example, a fluororesin, a polyimide resin, a ceramic or the like is used. Examples of the ceramic include metal oxides, metal nitrides, and metal carbides. It is preferable that the insulating films 36 and 40 are films to which a tissue after energization hardly adheres or that adhered matter is easily peeled off. From such a viewpoint, it is preferable that the film is a slippery film. The insulating films 36 and 40 may be the same type of insulating film, or may be different types of insulating films. From the viewpoint of reduction in manufacturing cost, it is preferable that the insulating films are of the same type. When different types of insulating films are selected, it is preferable to select such that the resistance value of the proximal end side insulating film 40 is higher. This is to prevent short-circuiting of the filaments 18 and 20 on the proximal end side.

The thickness of the insulating films 36 and 40 is not particularly limited, but is preferably about 5 to 50 μm. The thickness of the distal-end-side insulating film 36 and the proximal-end-side insulating film 40 may be changed. To change the thickness, the thickness of the proximal end side insulating film 40 is increased. This is to prevent short-circuiting of the filaments 18 and 20 on the proximal end side.

The method for forming the insulating films 36 and 40 is not particularly limited, and examples thereof include a baking method, a spraying method, and a dipping method. At that time, the conductive region 3
The portion 8 is preferably masked. Alternatively, the conductive region 38 may be formed by removing the insulating film in the portion of the conductive region 38 in a later step.

Although the distal end side insulating film 36 is an insulating film, as shown in FIG. 2, a current flows between the filaments 18 and 20 with a polyp or the like interposed therebetween. It is a film having conductivity. The higher insulation at the distal end portions of the striatum 18, 20 than the conductive region 38 suppresses the increase in current density due to the proximity of the distal end portions, and reduces the base of the polyp 42. This is for uniformly energizing around the surrounding loop 24.

Since the distal-end-side insulating film 36 requires a certain degree of insulating property and a degree of conductivity necessary for performing electric treatment, the insulating film portion may be scattered in an island shape. And
It may be formed in a stripe or stripe shape, or in a case where a large number of openings (exposed portions on the surface of the linear body) are formed in the insulating film. By forming the insulating film in this way, the insulating portions and the conductive portions are mixed on the outer peripheral surfaces of the linear bodies 18 and 20, and by adjusting the ratio thereof, the demand for the insulating property and the conductive Can be balanced with sexual demands.

At the time of performing a treatment using the dipole type electrosurgical treatment instrument 10 of the present embodiment, first, the catheter tube 16 is used.
The operating handle 32 is manipulated to move the distal end of the catheter tube close to the polyp and the lumen 1 of the catheter tube 16 is moved.
The filaments 18 and 20 are drawn into 4. In this state, the distal end of the catheter tube 16 is introduced into a body cavity, for example, through a channel of an endoscope.

The distal end of the catheter tube 16 is
Is located near the body, the operating handle 32 located outside the body
To operate the striatum 1 from the distal end 15 of the catheter tube 16.
8 and 20, and as shown in FIG.
At 20, a large loop 24 is formed.

Next, as shown in FIG.
The distal end of the catheter tube 16 is manipulated so that the base of the polyp 42 enters the inside thereof, and then the operating handle 32 is manipulated to draw the striatum 18, 20 into the catheter tube 16 in the axial direction. 24 is reduced and the base of the polyp 42 is tightened. After that, by starting the high-frequency current generator, a high-frequency current flows between the striatum 18 and the striatum 20, and the affected part is excised with electric energy.

At this time, in the present embodiment, the two striata 18,
Although the current density tends to increase between the distal end portions 20 closest to each other, the current density does not increase as compared with other portions because the insulating film 36 is coated on this portion. . As a result, it is possible to prevent sparking at this portion and to uniformly apply power to the tissue such as the polyp 42 to be resected. Therefore, the carbonized structure (burnt scorch) on the conductive filaments 18 and 20
Can also be prevented from being attached, and the living tissue is hardly left uncut. Further, since no spark is generated, the spacers 22 and the adhesive for maintaining the filaments 18 and 20 in an insulated state are hardly deteriorated, and the durability is improved.

Second Embodiment As shown in FIG. 3, an electrosurgical treatment instrument 10a according to the present embodiment has a predetermined length L on the distal end side of the striatum 18,20.
The insulating film 36 is formed only on the portion a, and no insulating film is formed on the other portions. Further, in the present embodiment, compared to the embodiment shown in FIG.
For forming a loop 24a at the distal end of the striatum 1
8, 20 have different habits. Loop 24,
The way of forming a habit for forming 24a is not limited to these embodiments, and can be variously modified. Other configurations are the same as those of the first embodiment.

The treatment instrument 10a of this embodiment has the same function as the treatment instrument 10 of the above embodiment.

Third Embodiment As shown in FIG. 4, an electrosurgical treatment instrument 10b according to the present embodiment has an insulating film 44 formed on only one of the striated bodies 18 over the entire length thereof, and the other striated body. No insulating film is formed on the body 20. Further, in the present embodiment, as compared with the embodiment shown in FIG. 1, the way of forming the loops 18, 20 for forming the loop 24 a at the distal ends of the filaments 18, 20 is different. doing. Other configurations are the same as those of the first embodiment.

The treatment instrument 10b of this embodiment has the same function as the treatment instrument 10 of the above embodiment.

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

[0047]

As described above, according to the electrosurgical treatment instrument according to the present invention, during energization of the conductive striatum during surgery, current is applied between the portions where both striata are closest. Although the density is about to increase, the current density does not increase as compared with other parts because the insulating film is coated on this part. As a result, it is possible to prevent sparking at this portion and to uniformly apply current to a tissue such as a polyp to be resected. Therefore, it is possible to prevent the carbonized tissue (burned charred) from adhering to the conductive striatum, and almost no remaining of the living tissue is generated. Further, since no spark is generated, there is little deterioration of a spacer or an adhesive for maintaining the striated body in an insulating state, and the durability is improved.

[Brief description of the drawings]

FIG. 1 is a schematic perspective view of an electrosurgical treatment instrument according to an embodiment of the present invention.

FIG. 2 is a schematic perspective view showing a use state of the embodiment.

FIG. 3 is a schematic perspective view of an electrosurgical treatment instrument according to another embodiment of the present invention.

FIG. 4 is a schematic perspective view of an electrosurgical treatment instrument according to still another embodiment of the present invention.

5 (a), 5 (b) and 5 (c) are perspective views showing a state of use of an electrosurgical treatment instrument according to a conventional example.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 10 ... Electrosurgical treatment instrument 14 ... Lumen 16 ... Catheter tube 18,20 ... Conducting filament 22 ... Insulating spacer 24 ... Loop 36,40 ... Insulating film 38 ... Conductive area 42 ... Polyp

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[Procedure amendment]

[Submission date] April 23, 1997

[Procedure amendment 2]

[Document name to be amended] Statement

[Correction target item name] Name of invention

[Correction method] Change

[Correction contents]

[Title of the Invention] Electrosurgical treatment instrument

Claims (2)

[Claims] 1. An electric apparatus comprising: a catheter tube that can be inserted into a body; and a pair of conductive filaments that are mounted so as to be able to move forward and backward from a distal end of the catheter tube and that are held in an insulated state from each other. Surgical treatment instrument, wherein the outer peripheral surface of the mutually adjacent portion of the pair of conductive filaments,
An electrosurgical treatment instrument with an insulating film attached. 2. An electric apparatus comprising: a catheter tube insertable into a body; and a pair of conductive filaments mounted to be movable forward and backward from a distal end of the catheter tube and held in a mutually insulated state. An electrosurgical treatment instrument, comprising an insulating film adhered to at least a distal end outer peripheral surface of one of the pair of conductive filaments.