JP5992355B2 - Endoscopic high-frequency treatment instrument - Google Patents

Description

  The present invention relates to a high-frequency treatment instrument for an endoscope that performs treatment such as hemostasis using a high-frequency current using an endoscope.

  For example, a bipolar hemostatic forceps as an endoscopic high-frequency treatment instrument opens and closes a pair of high-frequency electrodes (cups) arranged at the distal end of a sheath that is passed through an endoscopic treatment instrument guide tube. A device used to perform hemostasis by cauterizing and coagulating the tissue in the vicinity of the grasping part by operating with the operation part provided and passing a high-frequency current while grasping a living tissue such as a blood vessel with the high-frequency electrode. is there. The electrode needs to be able to rotate around the axis of the sheath for positioning with respect to the target biological tissue, and two wires are required for reciprocation to supply a high-frequency current to the electrode.

  As such a bipolar hemostatic forceps, for example, as described in Patent Document 1, one of a pair of high-frequency electrodes is used as a fixed electrode, and the other is rotatably supported as a movable electrode. It is known that only one electrode is opened and closed by connecting the slider with a wire and sliding the slider.

  For example, in Patent Document 2, each of the pair of electrodes is pivotally supported so that both of the pair of electrodes can be opened and closed, and a pair of wires is provided between each electrode and the slider of the operation unit. By connecting and sliding the slider, both the pair of electrodes are rotated to open and close. The high-frequency current is supplied to the electrodes via the pair of wires, and each wire is inserted into a pair of guide holes formed in a multi-lumen tube inserted into the sheath, and rotation around the axis of the electrode sheath is performed. This is done by rotating the multi-lumen tube within the sheath.

  As a technique not using a multi-lumen tube, as described in Patent Documents 3 and 4, one of a pair of electric wires (wires) for supplying a high-frequency current to an electrode is used as a torque wire with high rotational transmission, and the torque By rotating the wire within the sheath, the electrode is rotated around the axis of the sheath.

JP 2009-119083 A JP 2007-215896 A JP 2009-142513 A JP 2010-68981 A

  By the way, in order to enable the electrode to rotate around the sheath axis, if the electrode support member that supports the electrode is supported at the distal end of the sheath so as to be rotatable around the sheath axis, high-frequency current is generated along with the rotation around the sheath axis of the electrode. There is a case where the electric wire constituting the circuit for supplying the wire is twisted, and the rotability and responsiveness (followability of the electrode rotation with respect to the rotation operation in the operation unit) are hindered, and the operability is deteriorated. In order to avoid this, it is conceivable to employ a configuration in which the metals are slidably face-to-face in the rotating portion of the electrode support member with respect to the sheath. However, there is a possibility that the reliability of energization and the stability of rotation cannot be sufficiently ensured by simply bringing the metals into contact with each other.

  The present invention has been made in view of such a point, and in an endoscopic high-frequency treatment instrument having an electrode that rotates around a sheath axis, the reliability of energization of the electrode can be sufficiently ensured. An object is to provide a high-frequency treatment instrument for endoscope.

  An endoscopic high-frequency treatment instrument according to the present invention is provided along an axial direction of the outer sheath in a state in which the outer sheath, the operation portion provided at the proximal end of the outer sheath, and the outer sheath are electrically insulated from each other. The outer sheath is electrically connected to the first conductive wire and the second conductive wire, respectively, and the distal end of the second conductive wire, and the annular surface faces the axial direction of the outer sheath. An annular ring-shaped conductive ring member attached to the distal end of the ring member, and an electrode support portion. The ring member is rotatable relative to the ring member and is axially movable with respect to the outer sheath. An insulating electrode support member fixed so as to be prohibited from relative movement, and electrically connected to the distal end of the first conductive wire, and supported by the electrode support portion of the electrode support member. The first electrode and the first electrode A second electrode supported by the electrode support portion of the electrode support member and electrically connected to the second electrode and attached to the electrode support member while being electrically insulated from the electrode The return electrode is provided with a conductive elastic member that includes a return electrode and is slidably pressed against the inner peripheral surface of the ring member.

  In the endoscope high-frequency treatment instrument of the present invention, the elastic member can be formed of a leaf spring.

  In the endoscope high-frequency treatment instrument of the present invention, the return electrode further includes a substantially annular and conductive washer electrode portion, and the annular surface of the washer electrode portion faces the annular surface of the ring member. Thus, it can be configured to be slidably pressed.

  The endoscopic high-frequency treatment instrument of the present invention includes a substantially cylindrical conductive fixing member attached to a distal end of the outer sheath, and the electrode support member protrudes toward the proximal end side. And the ring member is rotatably fitted in the annular groove, and the washer electrode portion is inserted in the neck portion in the state where the neck portion is inserted. The electrode support member is fixed to the fixing member by inserting the neck portion loosely fitted to the ring member into the fixing member and fixing the ring member to the fixing member. It can be configured to be rotatably mounted around.

  In the endoscopic high-frequency treatment instrument of the present invention, the ring member can be formed by inserting a pair of substantially semicircular C-ring members from the outside into the annular groove and fixing opposite ends thereof. .

  In the endoscope high-frequency treatment instrument of the present invention, an insulating inner sheath inserted through the outer sheath, and a conductive conductive member inserted through the inner sheath that transmits a rotational operation force and a slide operation force by the operation unit. A drive wire, a lock member made up of a lock metal member and a lock insulating member attached to the distal end of the drive wire, one end of the drive wire being attached to the lock metal member and the other end being attached to the first electrode A conductive first wire member for conducting the drive wire and the first electrode; a second wire member having one end attached to the hook insulation member and the other end attached to the second electrode; and the outer sheath And the inner sheath, and the distal end thereof is electrically connected to the fixing member. In said the member first line member, said constitutes a first conductive line, wherein between the fixing member and the outer sheath wire, it is possible to configure the second conductive line.

  In the endoscope high-frequency treatment tool of the present invention, the electrode support member has a pair of opposing arm portions protruding toward the distal end side, and the first electrode and the second electrode are It can comprise so that it may be rotatably supported by the said arm part of an electrode supporting member, respectively.

  In the endoscope high-frequency treatment instrument of the present invention, the electrode support member has a through hole reaching one of the arm portions to the bearing portion of the second electrode, and the return electrode is formed on the washer electrode portion. It can have a pin portion that is erected, is exposed at the bearing portion of the second electrode through the through hole, and is electrically in contact with the second electrode.

  In the endoscope high-frequency treatment instrument of the present invention, the return electrode electrically connected to the second electrode is provided with the conductive elastic member slidably pressed against the inner peripheral surface of the ring member. The two electrodes are electrically connected to the second conductive line through a pressure contact portion between the elastic member and the ring member. Since the elastic member is elastically pressed against the ring member, stable conduction can be ensured regardless of the rotation position of the electrode support member. Therefore, it is possible to ensure sufficient reliability of energization to the electrodes. In the endoscope high-frequency treatment instrument of the present invention, since the elastic member is configured to slide on the inner peripheral surface of the ring member, the conduction between the elastic member and the ring member is affected by the surrounding environment. In addition to being less likely to be disturbed, the structure can be made compact.

It is a top view which shows the whole structure of the high frequency treatment tool for endoscopes of embodiment of this invention. It is sectional drawing along the AA line of FIG. It is a perspective view which shows the structure of the operation part of the high frequency treatment tool for endoscopes of embodiment of this invention. It is a cutting perspective view showing composition of an operation part of a high frequency treatment instrument for endoscopes of an embodiment of the present invention. It is sectional drawing which shows the structure of the operation part of the high frequency treatment tool for endoscopes of embodiment of this invention. It is a top view which shows the structure of the distal end vicinity of the high frequency treatment tool for endoscopes of embodiment of this invention. It is a side view which shows the structure of the distal end vicinity of the high frequency treatment tool for endoscopes of embodiment of this invention. It is a back view which shows the structure of the distal end vicinity of the high frequency treatment tool for endoscopes of embodiment of this invention. It is sectional drawing which shows the structure of the distal end vicinity of the high frequency treatment tool for endoscopes of embodiment of this invention. It is sectional drawing which shows the structure of the connection part vicinity of the sheath part and forceps part of the high frequency treatment tool for endoscopes of embodiment of this invention. It is a top view which shows the structure of the connection part vicinity of the electrode and drive wire of the high frequency treatment tool for endoscopes of embodiment of this invention. It is a perspective view which shows the structure of the distal end vicinity of the drive wire of the high frequency treatment tool for endoscopes of embodiment of this invention. It is a perspective view which shows the structure of the leaf | plate spring electrode of the high frequency treatment tool for endoscopes of embodiment of this invention. It is a disassembled perspective view which shows the rotation mechanism around the sheath axis line of the high frequency treatment tool for endoscopes of embodiment of this invention. It is a reverse view which shows the rotation mechanism around the sheath axis line of the high frequency treatment tool for endoscopes of embodiment of this invention, and has shown the state which attached the return electrode to the resin wax. It is a reverse view which shows the rotation mechanism around the sheath axis line of the high frequency treatment tool for endoscopes of embodiment of this invention, and has shown the state which attached the return electrode and the ring member to the resin wax. It is a back view which shows the rotation mechanism around the sheath axis line of the high frequency treatment tool for endoscopes of embodiment of this invention, and has shown the state which attached the resin wax which attached the return electrode and the ring member to the fixed metal. It is a perspective view which shows the structure of the electrode of the high frequency treatment tool for endoscopes of embodiment of this invention. It is a perspective view which shows the structure of the electrode of the high frequency treatment tool for endoscopes of embodiment of this invention. It is a perspective view which shows the structure of the insulation spacer of the high frequency treatment tool for endoscopes of embodiment of this invention. It is a top view which shows the structure of the forceps part of the high frequency treatment tool for endoscopes of embodiment of this invention. It is sectional drawing which shows the structure of the forceps part of the high frequency treatment tool for endoscopes of embodiment of this invention.

  Hereinafter, a bipolar hemostatic forceps as a high-frequency endoscopic treatment tool according to an embodiment of the present invention will be specifically described with reference to the drawings. However, the present invention is not limited to the bipolar hemostatic forceps, but can be applied to a bipolar knife including a pair of high-frequency electrodes that can be opened and closed.

  As shown in FIG. 1, the bipolar hemostatic forceps according to the present embodiment is configured by roughly including a sheath portion 1, an operation portion 2, and a forceps portion 3. An operation portion 2 is provided at the proximal end of the sheath portion 1, and a forceps portion 3 is provided at the distal end of the sheath portion 1.

  The operation unit 2 includes a base 21 and a slider 22 slidably attached to the base 21, and the forceps unit 3 includes a pair of high-frequency electrodes (a first electrode 31a and a second electrode 31b) provided to be openable and closable. A cup 31 is provided. In the operation unit 2, the cup 31 can be opened by sliding the slider 22 toward the distal end side (lower side in FIG. 1) with respect to the base 21, and conversely, the slider 22 is moved to the base end side with respect to the base 21. The cup 31 can be closed by sliding it upward (in FIG. 1). The operation unit 2 includes a pair of electric wires (cables) 24a and 24b and a plug 24 provided at the tip thereof. These electric wires 24a and 24b are connected to a high-frequency power supply device (not shown) via the plug 24. It is electrically connected and is supplied with a high-frequency current. As will be described in detail later, the electric wire 24a is electrically connected to the electrode 31a, and the electric wire 24b is electrically connected to the electrode 31b.

  As shown in FIG. 2, the sheath portion 1 includes a tubular outer sheath 11, a tubular inner sheath 12, a drive wire 13, and an outer sheath inner wire 14. The outer sheath 11 is made of a flexible hollow tube, and in this embodiment, a tube made of an insulating resin is used. The inner sheath 12 is formed of a flexible hollow tube, and in this embodiment, a tube formed of an insulating resin is used. The resin material forming the outer sheath 11 and the inner sheath 12 is not particularly limited as long as it is an electrically insulating material, and includes polyethylene, polypropylene, polyvinyl chloride, polyurethane, polyamide, polyester, polycarbonate, polyethersulfone, fluororesin, and the like. Can be used.

  The drive wire 13 is inserted into the inner sheath 12, and the inner sheath 12 is inserted into the outer sheath 11. The drive wire 13 can rotate and slide (slide movement in the direction along the axial direction) around its axis within the inner sheath 12.

  The drive wire 13 is made of a flexible and conductive wire (torque wire), and the drive wire 13 can be a single wire made of metal such as stainless steel. However, a wire rope or a wire tube may be used as the drive wire 13. Here, the wire rope is a rope made of a stranded wire formed by spirally twisting a plurality of wires made of a metal wire such as stainless steel. Moreover, a wire tube is a tube which consists of a hollow strand wire formed by twisting a plurality of wires made of metal wires such as stainless steel in a spiral shape so as to be hollow. The drive wire 13 is a power transmission member for transmitting a sliding force for opening and closing the cup 31 and a rotational force for rotating the cup 31 around a sheath axis for adjusting its posture. Although the details will be described later, the proximal end of the drive wire 13 is electrically connected to the electric wire 24a of the operation unit 2, and the distal end is one electrode (first electrode) 31a constituting the cup 31. Is electrically connected.

  Between the outer sheath 11 and the inner sheath 12, an outer sheath inner wire 14 made of a metal such as stainless steel having conductivity is inserted. Although the details will be described later, the proximal end of the outer sheath inner wire 14 is electrically connected to the wire 24b of the operation portion 2, and the distal end is the other electrode (second electrode) constituting the cup 31. ) 31b is electrically connected.

  As shown in FIGS. 3 to 5, the operation unit 2 is configured to include a base 21, a slider 22, and a tip cap 23. The base 21 has a ring portion 21a and a guide portion 21b having a guide groove. The slider 22 is attached to be slidable back and forth along the guide portion 21 b of the base 21. A tip cap 23 is attached to the tip (distal end) of the base 21. The base 21, the slider 22 and the tip cap 23 are mainly formed from an insulating resin.

  The distal end cap 23 has a substantially cylindrical space inside the distal end portion side, and the outer sheath 11, the inner sheath 12, the drive wire 13, and the outer sheath are inserted through a through portion formed at the distal end of the distal end cap 23. The proximal end of the sheath part 1 provided with the inner wire 14 is inserted. A substantially cylindrical sleeve pipe 25 made of a conductive metal such as stainless steel is attached in the substantially cylindrical space in the tip cap 23, and the SK pipe 26 rotates in the sleeve pipe 25. Interpolated as possible. The SK pipe 26 is made of a conductive metal such as stainless steel, and has a thin-walled and small-diameter tip tube portion 26a on the distal end side.

  The outer sheath 11 is attached to the SK pipe 26 in a state where the distal end cylindrical portion 26a of the SK pipe 26 is inserted inside the proximal end. The inner sheath 12 is inserted so that the vicinity of the proximal end thereof reaches a proximal end of a through hole formed in the longitudinal direction of the SK pipe 26. The drive wire 13 further extends through the through hole of the SK pipe 26, and its proximal end is fixed to a sleeve 27 provided on the slider 22 with a screw 28. The proximal end of the outer sheath inner wire 14 inserted through the portion between the outer sheath 11 and the inner sheath 12 is electrically connected to the tip of the tip tube portion 26a of the SK pipe 26 by laser welding, brazing, or the like. It is connected.

  On the distal end 25a side of the sleeve pipe 25, a coil spring 29 is inserted. The coil spring 29 is made of a conductive material such as stainless steel. The distal end 29a of the coil spring 29 is welded and fixed to the distal end 25a of the sleeve pipe 25 by laser welding or the like. Therefore, the coil spring 29 is electrically connected to the sleeve pipe 25 at least at this fixed portion. The proximal end 29b of the coil spring 29 is in pressure contact with the stepped surface (stepped portion) 26b on the proximal end side of the distal end cylindrical portion 26a of the SK pipe 26 by its own urging force in a state compressed to an appropriate load. doing. The proximal end 29b of the coil spring 29 is an end turn to ensure sufficient contact (conduction) with the step surface 26b. Note that the distal end 29a of the coil spring 29 may also be an end turn. With this configuration, the SK pipe 26 electrically connected to the outer sheath inner wire 14 at the tip 26c of the tip tube portion 26a does not interfere with rotation with respect to the sleeve pipe 25, and at least the coil pipe 29 and the sleeve pipe 25. The conduction state can always be maintained.

  The length, diameter, wire diameter, number of turns, pitch, spring constant, compression length, etc. of the coil spring 29 do not inhibit the rotation of the SK pipe 26 in the sleeve pipe 25 and are always in conductive contact with the SK pipe 26. As appropriate, it is selected. Specifically, the specifications of the coil spring 29 are selected so that the load is about 0.05 to 1 N in the assembled state (the state compressed by a predetermined amount). If the load is less than 0.05N, conduction may become unstable, and if the load exceeds 1N, smooth rotation may be hindered.

  Although not shown, the proximal end of the drive wire 13 is electrically connected to the electric wire 24 a at a fixing portion by a screw 28 with the sleeve 27 of the slider 22. Further, the sleeve pipe 25 is electrically connected to the electric wire 24b. Therefore, the outer sheath inner electric wire 14 is electrically connected to the electric wire 24b via the SK pipe 26, the coil spring 29 and the sleeve pipe 25. .

  With such a configuration, the slider 22 is slid back and forth (up and down in FIG. 1) with respect to the base 21 in the operation unit 2, and the drive wire 13 can be slid in the axial direction within the sheath portion 1. By rotating the operation portion 2 with respect to the sheath portion 1 (outer sheath 11), the drive wire 13 can be rotated around the axis within the sheath portion 1.

  The coil spring 29 is provided because there is a clearance (gap) between the sleeve pipe 25 and the SK pipe 26 so as not to hinder the rotation. This is to prevent the occurrence of defects and further improve the reliability of conduction.

  As shown in FIGS. 6 to 12, the forceps portion 3 includes a cup 31 including a first electrode 31 a and a second electrode 31 b that are a pair of high-frequency electrodes, a resin wax (electrode support member) 32, and a return electrode 33. , A ring member 34, a fixing bracket (fixing member) 35, and the like. The return electrode 33 has a conductive wire (pin portion) 33b, a washer electrode (slip ring portion) 33c, and a leaf spring electrode 38.

  As shown in FIG. 14 to FIG. 17, the resin wafer 32 is configured by standing up a pair of arm portions 32 a and 32 b facing each other at a base end portion having a substantially cylindrical neck portion 32 c. . An annular groove 32d that is recessed from the outside is formed in the neck 32c of the resin wax 32. Through holes 32e and 32f are formed in the vicinity of the tip portions of the pair of arm portions 32a and 32b, respectively.

  As best shown in FIG. 14, the return electrode 33 is a substantially annular washer electrode (slip ring part) 33 c formed from a conductive metal such as stainless steel, and is erected on this. A single conductive wire (pin portion) 33b is provided.

  The return electrode 33 has a neck portion 32c of the resin casing 32 inserted into a hole inside the washer electrode 33c so that the core conductor 33b is inserted along the through hole 32g formed in the arm section 32b of the resin casing 32. It is attached to the resin casing 32 integrally.

  Further, the return electrode 33 further includes a leaf spring electrode 38, and the leaf spring electrode 38, as best shown in FIG. 13 and FIG. 14, is a substantially annular leaf spring washer portion 38a. A plurality of leaf spring portions (elastic members) 38b are integrally provided upright and arranged on the inner peripheral surface so as to protrude. The leaf spring washer portion 38a is formed with a cutout portion 38c into which the conductive wire 33b is inserted. The leaf spring electrode 38 is made of a metal such as stainless steel having elasticity and conductivity. However, the material for forming the leaf spring electrode 38 is not necessarily a metal, and a conductive polymer or the like may be used.

  The plate spring electrode 38 can be formed by, for example, pressing a thin plate material made of stainless steel having a plate thickness of 0.05 mm. In the present embodiment, four leaf spring portions 38b are arranged equally on the inner peripheral surface of the leaf spring washer portion 38a (that is, in a positional relationship of 90 degrees), but the number is limited to four. For example, the number can be eight. Although it is not always necessary to arrange a plurality of the leaf spring portions 38b equally on the inner peripheral surface of the leaf spring washer portion 38a, it is preferable that the plurality of leaf spring portions 38b be equally arranged from the viewpoint of achieving stable rotation. . As will be described in detail later, the leaf spring portion 38 b is slidably pressed against the inner peripheral surface of the ring member 34 to ensure the reliability of conduction between the return electrode 33 and the ring member 34.

  As shown in FIGS. 14 to 17, the ring member 34 includes a pair of substantially semi-annular C rings (C ring portions) 34 a and 34 a made of a conductive metal such as stainless steel. The pair of C-rings 34a and 34a are inserted into the annular groove 32d formed in the neck portion 32c of the resin wax 32 so as to be sandwiched from both sides, and both opposite end portions thereof are fixed by laser welding or the like, thereby the neck portion. The ring member 34 is loosely fitted in the gap 32c with a slight clearance (clearance), and the ring member 34 can be freely rotated with respect to the resin casing 32 while being attached to the annular groove 32d of the resin casing 32. As the plate thickness of the ring member 34 (C rings 34a, 34a), for example, a thickness of about 0.1 mm can be used.

  In addition, as the ring member 34, a substantially annular single C-ring formed so that both opposite ends face each other with a slight gap is fitted into the annular groove 32d of the neck portion 32c while being elastically deformed. Can be adopted. However, there may be a step in the gap between the opposite ends, or the shape of the inner peripheral surface may not be an accurate circle, which may hinder continuity and rotation. Therefore, as described above, the configuration in which the pair of C-rings 34a and 34a are inserted so as to be sandwiched from both sides, and both opposite end portions of both are fixed by laser welding or the like, the inner peripheral surface is more accurate. Since it can be made circular, it is advantageous from the viewpoints of conductivity and rotation.

  As shown in FIGS. 9 and 14 to 17, the fixing bracket 35 is a substantially cylindrical member formed of a conductive metal such as stainless steel. The distal end of the inner sheath 12 is inserted and fixed to the inside of the fixing fitting 35 (see FIGS. 9 and 10). The fixing fitting 35 is inserted inward from the distal end of the outer sheath 11, and is adhered and fixed to the outer sheath 11 (see FIGS. 9 and 10). Further, the distal end of the outer sheath inner wire 14 wired in the portion between the outer sheath 11 and the inner sheath 12 is electrically connected to the proximal end side of the fixing bracket 35 ( (See FIG. 10).

  As shown in FIG. 14, the resin casing 32, the return electrode 33 (including the leaf spring electrode 38, the core conductor 33b, and the washer electrode 33c), the ring member 34 (C rings 34a and 34a), and the fixing bracket 35 are disassembled. First, the conductive wire 33b is inserted or fitted into the notch 38c of the leaf spring electrode 38, and the leaf spring portion 38b is inserted inside the washer electrode 33c so as to protrude beyond the washer electrode 33c. The leaf spring washer portion 38a is disposed so as to face and abut against the washer electrode 33c, and laser welding or the like is performed at a plurality of locations in the corresponding contact portion to integrally fix the leaf spring electrode 38 to the washer electrode 33c. Thereafter, as shown in FIG. 15, the return conductor 33b of the return electrode 33 is inserted into the through hole 32g of the arm portion 32b of the resin casing 32, and the leaf spring electrode 38 and the washer electrode 33c are fixed integrally. The return electrode 33 thus formed is attached to the resin casing 32.

  Next, as shown in FIG. 16, a pair of C-rings 34a and 34a are inserted into the annular groove 32d formed in the neck 32c of the resin wax 32 so as to be sandwiched from both sides. By being fixed by laser welding or the like, the neck portion 32c is loosely fitted. In this state, the washer portion 33 c of the return electrode 33 is slidably in contact with the ring member 34, and the outer surfaces of the plurality of leaf spring portions 38 b of the leaf spring electrode 38 of the return electrode 33 are the inner periphery of the ring member 34. It is slidably pressed on the surface.

  After that, as shown in FIG. 17, the neck 32 c is inserted into the fixing bracket 35 and the resin member 32 to which the return electrode 33 and the ring member 34 are attached, and the ring member 34 is attached to the fixing member 35. In this state, the ring member 34 is fixed to the fixing bracket 35 by laser welding or the like to attach the resin pad 32 to which the return electrode 33 and the ring member 34 are attached to the fixing bracket 35.

  As a result, the resin casing 32 to which the return electrode 33 is integrally attached can be rotated around its axis with respect to the fixing bracket 35, and the fixing bracket 35 and the return electrode 33 are connected to the washer electrode 33c regardless of the rotational position. In addition to the contact surface of the ring member 34 and the contact surface of the ring spring 34 with the inner peripheral surface of the ring member 34, the electrically conductive state is maintained. Can be done.

  As shown in FIGS. 6 to 9, the first electrode 31 a and the second electrode 31 b constituting the cup 31 are arranged in a substantially X shape with each other, and at a crossing portion of each other, It is rotatably supported between the arm portions 32a and 32b. The first electrode 31a and the second electrode 31b are insulated from each other by an insulating spacer 36 made of an insulating resin.

  As shown in FIG. 18 and FIG. 19, the first electrode 31a and the second electrode 31b are formed in the direction along the rotation axis of the first electrode 31a and the second electrode 31b (hereinafter referred to as the horizontal). A plurality of (for example, three) crests 31d extending in a direction (which may be referred to as a direction) are formed in parallel in a direction substantially orthogonal to the horizontal direction (hereinafter may be referred to as a vertical direction) A tip convex tooth 31e is formed. A single front end longitudinal groove 31f is formed along the longitudinal direction in the central portion of the front end convex tooth 31e.

  The first electrode 31a and the second electrode 31b are formed with a through hole 31c at an intermediate portion thereof, and a through hole 31g for attaching the first line member 17a or the second line member 17b is formed on the rear end side. Is formed. In addition, a protrusion 31h is formed on one surface of the first electrode 31a (the surface that contacts the insulating spacer 36) (see FIG. 19). In addition, you may form the protrusion part 31h similar to the 1st electrode 31a also in the 2nd electrode 31b.

  The insulating spacer 36 has a substantially cylindrical shaft portion 36a having a through hole 36b in the center portion on one surface side (see FIGS. 9 and 20), and has a substantially cylindrical shape on the other surface side. It has the recessed part 36d depressed in the annular | circular shape with which the metal washer (washer member) 39 is fitted (refer FIG. 9).

  On one surface of the insulating spacer 36, as shown in FIG. 20, a guide groove 36c having a substantially arc shape is formed at a position substantially corresponding to the protruding portion 31h of the first electrode 31a. The guide groove 36c is for defining the rotation angle range of the first electrode 31a and thus the opening angle of the cup 31 by loosely fitting the projection 31h of the first electrode 31a (FIG. 21, FIG. (See FIG. 22). When the same protrusion as the protrusion 31h of the first electrode 31a is formed on the second electrode 31b, the same guide groove 36c as the corresponding guide groove 36c is formed on the other surface of the insulating spacer 36. A groove is provided.

  As shown in FIG. 9, the first electrode 31a is rotatably supported by the insulating spacer 36 by inserting the shaft portion 36a of the insulating spacer 36 into the through hole 31c. The second electrode 31 b is rotatably supported by the insulating spacer 36 by inserting a metal washer 39 into the through hole 31 c and fitting the metal washer 39 into the recess 36 d of the insulating spacer 36. A substantially cylindrical king pin 37 is inserted into the through hole 36 b of the insulating spacer 36 and the central through hole of the metal washer 39. The insulating spacer 36 is insulated by fitting and fixing the distal end portion of the shaft portion 36a to the through hole 32e of the arm portion 32a and the distal end portion of the metal washer 39 opposite to the insulating spacer 36 to the through hole 32f of the arm portion 32b. The first electrode 31a and the second electrode 31b that are rotatably supported by the spacer 36 are supported between the pair of arm portions 32a and 32b.

  As shown in FIG. 9, the distal end portion of the lead wire 33b of the return electrode 33 inserted through the through hole 32g formed in the arm portion 32b of the resin wax 32 is in the through hole 32f of the arm portion 32b. The protruding and exposed state where the tip of the metal washer 39 fitted in the through hole 32f of the arm portion 32b and the exposed portion near the tip of the lead wire 33b are electrically connected by laser welding or the like. The connection is fixed with. As a result, the second electrode 31b is kept electrically connected to the return electrode 33 via the metal washer 39, regardless of its rotation.

  As shown in FIGS. 10 to 12, the power transmission mechanism between the distal end of the drive wire 13 and the first electrode 31 a and the second electrode 31 b constituting the cup 31 includes An insulating member 15, a pair of straight lines 17a and 17b, and a pipe 18 are provided.

  The bush metal member 19 is a substantially cylindrical member formed of a conductive metal, and has a hole 19a for inserting the distal end of the drive wire 13 on the proximal end side thereof. The distal end of the drive wire 13 is inserted into 19a and connected and fixed in a state where it is electrically conducted by laser welding or the like.

  The jumpsuit insulating member 15 is a substantially columnar member formed of an insulating resin, and has a relatively large-diameter hole 15d on the proximal end side and a relatively long hole extending from the distal end side to the hole 15d. Has a small-diameter hole 15b. The jumpsuit insulating member 15 has a recessed portion 15a having a bottom surface 15c. The recessed portion 15a of the jumping insulating member 15 is a portion for arranging and fixing the straight line 17a, and the hole 15b of the jumping insulating member 15 is a hole for inserting and fixing the straight line 17b.

  The straight lines 17a and 17b are each formed from a single wire made of a conductive metal such as stainless steel. On the proximal end side of the straight line 17b, the pipe 18 is connected and fixed by laser welding or the like in a state of being inserted into the hole 15b of the jumper insulating member 15, and the portion where the pipe 18 is fixed is the hole of the jumper insulating member 15. 15d. The bush insulation member 15 is inserted into the bush metal member 19 from the distal end side, and is adhered and fixed to the bush metal member 19 with an adhesive. The proximal end side of the straight line 17a is disposed along the recessed portion 15a of the jumper insulating member 15, and the proximal metal member 19 is in a state where the proximal end surface of the straight line 17a is in contact with the bottom surface 15c of the recessed portion 15a. Are connected and fixed in an electrically conductive state by laser welding or the like. Thereby, the straight line 17a is electrically connected to the drive wire 13 via the metal metal member 19. On the other hand, since the straight insulating member 15 is interposed in the straight line 17b, the straight straight member 17b is insulated from the metallic metallic member 19. Note that the hole 15d of the bush insulation member 15 is filled by filling with an epoxy adhesive.

  As shown in FIG. 11, the distal end of the straight line 17a is attached to a hole 31g (see FIG. 18) formed near the proximal end of the first electrode 31a. The distal end is attached to a hole 31g (see FIG. 18) formed near the proximal end of the second electrode 31b. The straight line 17b is insulated and coated with a resin such as polytetrafluoroethylene (PTFE) except for a portion that is conductively connected to the second electrode 31b.

  When the slider 22 is slid to the distal end side with respect to the base 21, the drive wire 13 is slid to the distal end side, and the straight line 17 a and A sliding force is transmitted to the straight line 17b, the first electrode 31a is rotated in a direction away from the second electrode 31b via the straight line 17a, and the second electrode 31b is moved from the first electrode 31a via the straight line 17b. The cup 31 can be opened by being rotated in the direction of separation. At this time, as shown in FIG. 22, the opening angle of the cup 31 is defined by the protrusion 31h formed on the first electrode 31a and the guide groove 36c formed on the insulating spacer 36. The same opening angle can always be set.

  On the other hand, when the slider 22 is slid to the proximal end side with respect to the base 21, the drive wire 13 is slid to the proximal end side along with this, and the straight line 17a is passed through the jumper metal member 19 and the jumper insulating member 15. The sliding force is transmitted to the straight line 17b, the first electrode 31a is rotated in the direction approaching the second electrode 31b via the straight line 17a, and the second electrode 31b is turned to the first electrode via the straight line 17b. The cup 31 can be closed by being rotated in a direction close to 31a.

  When the operation portion 2 including the base 21 and the slider 22 is rotated around the axis of the sheath portion 1 (outer sheath 11), the drive wire 13 is rotated along with this, and the metal metal member 19 and the bush insulation member 15 are rotated. Rotational force (torque) is evenly transmitted to the first electrode 31a and the second electrode 31b via the straight line 17a and the straight line 17b, and the resin casing 32 rotates with respect to the fixing bracket 35, so that the cup 31 is desired. It can be adjusted to the posture (rotational position).

  As described above, the rotation operation force for rotating the electrode and the slide operation force for opening and closing the electrode by the operation unit 2 are transmitted via the drive wire 13 and the jumper member composed of at least the jumper metal member 19 and the jumper insulating member 15. Further, it is transmitted to the first electrode 31a via the straight line 17a and to the second electrode 31b via the straight line 17b.

  According to the above-described embodiment, the substantially annular leaf spring washer portion 38a disposed in contact with the surface on the distal end side of the washer electrode 33c of the return electrode 33, and the inner periphery of the leaf spring washer portion 38a. Since the leaf spring electrode 38 having the leaf spring portion 38b that is provided so as to protrude beyond the washer electrode 33c toward the distal end side and is elastically pressed slidably on the inner peripheral surface of the ring member 34 is provided. Regardless of the rotational position, the fixture (fixing member) 35 and the return electrode 33 are connected to the ring of the leaf spring portion 38b of the leaf spring electrode 38 in addition to the contact surface of the washer electrode 33c and the ring member 34. It is electrically connected via the pressure contact surface with respect to the inner peripheral surface of the member 34. Since the leaf spring portion 38b is elastically pressed against the ring member 34, stable conduction can be secured, and since the leaf spring portion 38b is pressed against the inner peripheral surface of the ring member 34, The possibility that the electrical connection between the spring portion 38b and the ring member 34 is hindered by the environment around the bipolar hemostatic forceps is reduced, and the structure of the bipolar hemostatic forceps can be made compact.

  In the above-described embodiment, the washer electrode 33c and the leaf spring electrode 38c integrally formed with the leaf spring washer portion 38a and the plurality of leaf spring portions 38b are configured as separate members, and these are fixed by welding. However, instead of this, the return electrode 33 is configured, but instead of this, a leaf spring portion similar to the leaf spring portion 38b may be integrally provided on the inner peripheral surface of the washer electrode 33c. If so, the number of parts and the number of assembly steps can be reduced.

  Further, according to the above-described embodiment, the first electrode 31a, which is one high-frequency electrode constituting the cup 31, is not shown in the figure via the straight line 17a, the jumper metal member 19, the drive wire 13, and the electric wire 24a. The second electrode 31b, which is electrically connected to one pole of the power supply device and is the other high-frequency electrode, is a metal washer 39, a return electrode 33, a ring member 34, a fixture 35, an outer sheath inner wire 14, a sleeve pipe 25, It is electrically connected to the other pole of the high-frequency power supply device (not shown) via the SK pipe 26 and the electric wire 24b. Transmission of power for opening and closing the cup 31 and rotation around its axis is performed by the drive wire 13, and the outer sheath inner wire 14 and the drive wire 13 are separated by the inner sheath 12. 14 does not interfere with the sliding or rotating operation of the drive wire 13. Accordingly, it is possible to improve the responsiveness of the rotating operation of the cup 31 (following performance of the electrode rotation with respect to the rotating operation in the operating portion) and the responsiveness of the sliding operation, and the change in the responsiveness due to the curved state of the sheath is reduced. High operability can be realized.

  Furthermore, a ring member 34 is rotatably loosely fitted in an annular groove 32d of the neck 32c at the base end of the resin wax 32, and the neck 32c into which the ring member 34 is loosely fitted is inserted into a fixing bracket 35, Since the ring member 34 is fixed to the fixing bracket 35, the resin casing 32 can be stably and rotatably supported on the fixing bracket 35.

  In the above-described embodiment, the conductive wire 33 b is not exposed to the outside through the inside of the arm portion 32 b (through hole 32 g), and the entire fixing bracket 35 is completely buried in the outer sheath 11. For this reason, it is possible to completely prevent the conductive wire 33b and the fixture 35 from touching the body tissue.

  Furthermore, as described with reference to FIG. 10, the bush insulation member 15 is bonded and fixed to the joint metal member 19, and the end surface of the straight line 17 a on the base end side is the bottom surface of the recess 15 a of the bush insulation member 15. Since the straight line 17a is welded and fixed to the metal metal member 19 in a state of being in contact with the cable 15c, the lock insulating member 15 is securely fixed to the metal metal member 19, and stable performance is realized over a long period of time. can do.

  Further, as best shown in FIG. 18, the gripping portions of the electrodes 31 a and 31 b are provided with a plurality of chevron teeth 31 d extending in the lateral direction, so that the longitudinal direction with the body tissue gripped is provided. In addition to being able to suppress slipping through, the tip longitudinal groove 31f is provided in the tip convex tooth 31e, so that slipping in the lateral direction with the body tissue gripped can also be suppressed, and stable gripping can be achieved. Can be realized.

  In addition, the conductive wire 33b of the return electrode 33 is electrically connected to the second electrode 31b via the metal washer 39, so that the rotation of the second electrode 31b accompanying the opening / closing of the cup 31 is not hindered. The electrical conduction state can be kept stable.

  The embodiment described above is described for facilitating the understanding of the present invention, and is not described for limiting the present invention. Therefore, each element disclosed in the embodiment described above is intended to include all design changes and equivalents belonging to the technical scope of the present invention.

1 ... sheath part,
11: outer sheath,
12 ... Inner sheath,
13 ... Drive wire,
14: Electric wire in outer sheath,
15 ... jumpsuit insulation member,
16 ... Tsunagi washer,
17a, 17b ... straight line,
18 ... pipe,
19 ... jumpsuit metal member,
2 ... operation part,
21 ... Base,
22 ... Slider,
23 ... tip cap,
24 ... Plug,
24a, 24b ... electric wires,
25 ... Sleeve pipe,
26 ... SK pipe,
29 ... Coil spring,
3 ... forceps part,
31 ... Cup,
31a, 31b ... electrodes,
32 ... resin wrap,
32a, 32b ... arm part,
32c ... neck,
32d ... annular groove,
32e ... through hole,
32g ... through hole 33 ... return electrode,
33b ... Waku wire 33c ... Washer electrode,
33d ... projection,
33e, 33f ... through hole,
34. Ring member,
34a ... C-ring,
35. Fixing bracket,
36 ... Insulating spacer,
37 ... Kingpin,
38 ... leaf spring electrode,
38a ... leaf spring washer,
38b ... leaf spring part,
38c ... notch,
39 ... Metal washer.

Claims (8)

An outer sheath,
An operating portion provided at a proximal end of the outer sheath;
A first conductive line and a second conductive line respectively provided along the axial direction of the outer sheath in a state of being electrically insulated from each other;
A substantially annular and electrically conductive material that is electrically connected to the distal end of the second conductive wire and is attached to the distal end of the outer sheath such that the annular surface faces the axial direction of the outer sheath. A ring member;
An insulative electrode support member having an electrode support portion, fixed relative to the ring member so as to be capable of relative rotation and prohibiting relative movement in the axial direction with respect to the outer sheath;
A first electrode electrically connected to a distal end of the first conductive wire and supported by the electrode support portion of the electrode support member;
A second electrode supported by the electrode support portion of the electrode support member in a state of being electrically insulated from the first electrode;
A return electrode electrically connected to the second electrode and attached to the electrode support member;
A high-frequency treatment instrument for an endoscope, wherein a conductive elastic member that is slidably pressed against an inner peripheral surface of the ring member is provided on the return electrode.   The high-frequency treatment instrument for endoscope according to claim 1, wherein the elastic member is configured by a leaf spring.   The return electrode further has a substantially annular and conductive washer electrode portion, and the annular surface of the washer electrode portion is slidably pressed against the annular surface of the ring member. The high-frequency treatment instrument for endoscope according to claim 1 or 2. A substantially cylindrical conductive fixing member attached to the distal end of the outer sheath;
The electrode support member has a substantially cylindrical neck having an annular groove protruding toward the proximal end side and recessed.
The ring member is rotatably fitted in the annular groove;
The washer electrode portion is attached to the electrode support member with the neck portion inserted,
The electrode support member can be rotated around the axis of the fixing member by inserting the neck portion into which the ring member is loosely fitted into the fixing member and fixing the ring member to the fixing member. The high-frequency treatment instrument for endoscope according to claim 3, wherein the high-frequency treatment tool for endoscope is attached to the endoscope.   5. The endoscope according to claim 4, wherein the ring member is formed by inserting a pair of substantially semicircular C ring members from the outside into the annular groove and fixing opposite ends thereof. High frequency treatment tool. An insulating inner sheath inserted through the outer sheath;
A conductive drive wire inserted through the inner sheath for transmitting a rotation operation force and a slide operation force by the operation unit;
A jumper member composed of a jumper metal member and a jumper insulation member attached to the distal end of the drive wire;
One end thereof is attached to the metallic metal member and the other end is attached to the first electrode, and a conductive first wire member that conducts the drive wire and the first electrode;
A second wire member having one end attached to the jumper insulating member and the other end attached to the second electrode;
An outer sheath inner wire inserted between the outer sheath and the inner sheath, the distal end of which is electrically connected to the fixing member;
The first conductive wire is constituted by the drive wire, the metal metal member and the first wire member,
The high-frequency treatment instrument for endoscope according to claim 4 or 5, wherein the second conductive wire is configured by the fixing member and the electric wire in the outer sheath. The electrode support member has a pair of opposing arm portions protruding toward the distal end side,
The endoscope for any one of claims 1 to 6, wherein the first electrode and the second electrode are rotatably supported by the arm portion of the electrode support member, respectively. High frequency treatment tool. The electrode support member has a through hole reaching the bearing portion of the second electrode on one inner side of the arm portion,
The return electrode has a pin portion that is erected on the washer electrode portion, penetrates the through hole, is exposed at the bearing portion of the second electrode, and is electrically in contact with the second electrode. The high-frequency treatment instrument for endoscope according to claim 7, wherein:

Images