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WO2018025360A1 - Cathéter pour endoscope. - Google Patents

Cathéter pour endoscope. Download PDF

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Publication number
WO2018025360A1
WO2018025360A1 PCT/JP2016/072869 JP2016072869W WO2018025360A1 WO 2018025360 A1 WO2018025360 A1 WO 2018025360A1 JP 2016072869 W JP2016072869 W JP 2016072869W WO 2018025360 A1 WO2018025360 A1 WO 2018025360A1
Authority
WO
WIPO (PCT)
Prior art keywords
tube portion
energy
catheter
endoscope
hole
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/JP2016/072869
Other languages
English (en)
Japanese (ja)
Inventor
清一 中島
誠 保坂
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Yamashina Seiki Co Ltd
University of Osaka NUC
Original Assignee
Osaka University NUC
Yamashina Seiki Co Ltd
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Osaka University NUC, Yamashina Seiki Co Ltd filed Critical Osaka University NUC
Priority to PCT/JP2016/072869 priority Critical patent/WO2018025360A1/fr
Publication of WO2018025360A1 publication Critical patent/WO2018025360A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current

Definitions

  • the present invention relates to an endoscopic catheter having multiple functions such as washing, suction, incision, cauterization, coagulation, hemostasis, and smoke exhaustion.
  • an endoscope catheter having functions such as washing, suction, incision, cauterization, coagulation, hemostasis, and smoke exhaustion in a body cavity of a patient has been put to practical use (for example, Patent Document 1).
  • a hole is provided near the distal end of the distal end of the endoscope catheter, and there are a plurality of holes having a diameter smaller than the inner diameter of the catheter.
  • an energy element is further provided in the vicinity of the distal end of the catheter.
  • the electrode as the energy element is exposed from the tip. For this reason, for example, when a living tissue is coagulated and hemostatically generated by generating a high-frequency current from the electrode of the catheter, the high-frequency current diffuses in the living body from the tip electrode, and the living tissue in a range not intended by the operator There was a possibility of coagulation. In addition, in order to control the range of thermal damage, it may be required to coagulate by slightly pulling up the living tissue. However, in the above catheter, a portion where the tissue is thin is suitable for coagulation while being pressed. In some cases, it was difficult to solidify by pulling up.
  • the technology of the present disclosure has been made in view of the above circumstances, and the purpose thereof is a simple structure, such as cleaning, aspiration, incision, cauterization, coagulation, hemostasis, and smoke exhaustion in a patient's body cavity. It is providing the endoscope catheter which can exhibit these functions more efficiently while having many functions of these.
  • a hole is provided in the vicinity of the distal end of the tube portion, and an energy element is disposed on the proximal end side of the hole inside the tube portion.
  • this energy element has an energy generating part capable of generating predetermined energy in a cavity inside the pipe part.
  • the region on the hole side of the energy generating portion and the proximal end side of the energy generating portion in the pipe portion are communicated with each other by the communication path formed by including the surface of the energy generating portion in part.
  • the most characteristic feature is that cleaning, suction, smoke emission, and the like can be performed through this communication portion.
  • the endoscope catheter includes a hole provided near the distal end of the tube part, and an energy element provided on the proximal end side of the hole inside the tube part.
  • An endoscopic catheter wherein the energy element is disposed in a cavity inside the tube portion and is capable of generating a predetermined energy, and includes a surface of the energy generation portion and a hole and a tube. And a communication passage that allows the region on the proximal end side of the energy generating portion in the portion to communicate.
  • the energy generating part of the energy element after arranging the energy generating part of the energy element in the cavity inside the tube part of the catheter, it becomes possible to perform functions such as cleaning, suction, and smoke exhausting well through the communication path. . Then, it is possible to perform an efficient treatment such as sucking the living tissue from the hole and selectively cutting, cauterizing, coagulating, and hemostasing the sucked living tissue by the energy generated from the energy generating unit.
  • the communication path may be formed by the outer shape of the energy generating part and the inner wall of the pipe part.
  • the energy generating part has a cylindrical shape that is substantially the same diameter as the inner diameter of the tube part, and the communication path is formed by a groove provided on a side surface of the cylindrical energy generating part and an inner wall of the pipe part. May be.
  • the energy generated by the energy generating unit may include any of heat, a current having a predetermined frequency, an electromagnetic wave, a laser beam, and a sound wave.
  • the various electric currents, electromagnetic waves, and sound waves generated from the energy element can be used for treatment of living tissue.
  • the hole may be an opening at the distal end of the tube portion of the cavity inside the tube portion. According to this, it is possible to satisfactorily perform functions such as suction and traction by bringing the distal end of the catheter into contact with the living tissue as it is. Further, since the tube portion of the catheter generally has a cylindrical shape, the opening of the distal end is used as a hole rather than providing a hole on the side surface, thereby improving the adhesion with the living tissue at the time of suction. It becomes possible. As a result, the biological tissue can be sucked and pulled more efficiently.
  • the distal end of the energy generation unit is disposed at a proximal end side by a predetermined distance from the hole, and by sucking the gas or liquid in the tube unit from the region of the tube unit on the proximal end side of the energy generation unit, It is possible to suck the living tissue from the hole, and when sucking the living tissue from the hole, the sucked tissue can enter the inside of the tube part from the hole and come into contact with the distal end of the energy generating part. Good. According to this, it becomes possible to selectively and more reliably treat the living tissue that has been sucked and entered the inside of the tube portion by the energy generating portion.
  • the tube portion may be formed so as to be able to be inserted into a treatment instrument channel provided in a flexible endoscope or an endoscope overtube into which a flexible endoscope is inserted. Then, cooperation between the endoscopic catheter described above and the flexible endoscope or the endoscope overtube can be realized, and more efficient endoscopic treatment can be realized. Is possible.
  • the technology disclosed herein has a simple structure and has multiple functions such as cleaning, suction, incision, cauterization, coagulation, hemostasis, and smoke exhaustion in the body cavity of a patient, and more effectively exerts these functions.
  • An endoscopic catheter capable of this can be provided.
  • Open abdominal surgery is an operation performed by opening a patient's living body.
  • Fine (micro) surgery is an operation that requires a fine operation as performed under a microscope. Small tissues such as cranial nerves and microvessels are targeted for surgery.
  • Standard under the microscope is an operation using an endoscope.
  • the “endoscope” is a medical instrument that observes the inside of a living body with an optical system.
  • a “rigid endoscope” is an endoscope having a rigid structure in which lenses are attached to both ends of a cylinder. Examples of rigid scopes include cystoscopes, thoracoscopes, and laparoscopes.
  • the “soft mirror” is an endoscope having flexibility using a soft material. There are two types of flexible mirrors, one using an optical fiber as an optical system and the other using a CCD (Charged-Coupled Device). Examples of the flexible endoscope include a bronchoscope, an upper digestive tract endoscope, a small intestine endoscope, and a large intestine endoscope.
  • forceps that can coagulate or stop hemostasis of a living tissue using a high-frequency current may be used.
  • the forceps include “a type in which an electrode is pressed against a living tissue (knife electrode)” and “a type in which a living tissue is picked and gripped like tweezers (hemostatic forceps)”. Many of these have a monopolar structure, and forceps serve as one electrode, and an electric current flows between electrodes called a counter electrode that is in separate contact with the living body.
  • Examples of the endoscope catheter using the knife electrode described above include a treatment instrument that can discharge the cleaning liquid from the tip thereof.
  • the distal end of the tube portion is on the proximal end side of the electrode portion, and the knife portion protrudes from the opening at the distal end of the tube portion.
  • the opening and the living tissue are brought into contact with each other, it is difficult to improve the adhesion, and the living tissue cannot be suitably sucked or pulled.
  • the pressing force of the knife electrode against the living tissue is strong or the output of the high-frequency current is too high, the coagulation of the living tissue has progressed too much, and tissue perforation may occur after the treatment.
  • the high-frequency current diffuses into the living tissue, there is a possibility that the coagulation range is widened and thermal damage is caused even to a normal tissue.
  • the hemostatic forceps do not have a washing / suction function, and if the amount of bleeding is large, blood cannot be removed, so that it is difficult to identify the bleeding point and the hemostatic treatment cannot be performed. In this case, it is necessary to perform treatment while using both the jet function (discharging of the cleaning liquid) and the suction function of the endoscope, so that the operation of the hemostatic forceps becomes complicated.
  • a hemostatic forceps when a hemostatic forceps is used, high-frequency current is diffused in the living body, so that the coagulation range is widened, and there is a risk of heat damage even to normal tissue.
  • FIG. 1 shows a schematic configuration diagram of an endoscope catheter 1 according to an embodiment of the present invention as viewed from the side.
  • FIG. 2 shows a front view of the catheter 1.
  • FIG. 3 shows a perspective view of the catheter 1.
  • the end surface 10a side of the tube portion 10 of the catheter 1 is referred to as the distal end side of the catheter 1
  • the other end side (not shown) of the catheter 1 is referred to as the proximal end side of the catheter 1.
  • the catheter 1 has a small-diameter tube portion 10.
  • the tube part 10 is a hollow cylindrical member formed of a soft resin having flexibility, strength, low friction, insulation, and the like.
  • the material for forming the tube portion 10 include polyvinyl chloride, polyethylene, polyester, polyurethane, polyamide, silicone resin, PTFE, PFA, polypropylene, nylon, polyetheretherketone (PEEK), and POM. These materials may be used alone or in combination with other materials.
  • the length of the tube part 10 is 2000 to 2500 mm as an example.
  • the outer diameter of the pipe part 10 is 2.6 mm as an example.
  • the outer diameter of the tube portion 10 is not limited to this, and can be configured to be about 1 to 5 mm.
  • the catheter 1 can be inserted into a treatment instrument channel of a general endoscope or an endoscope overtube, and the distal end side of the catheter 1 can be inserted from the treatment instrument port at the distal end of the endoscope overtube.
  • the end face 10a can be protruded and used as an endoscopic treatment tool.
  • the end face 10a on the distal end side of the tube part 10 is open. Further, the electrode 20 is disposed in the cavity inside the tube portion 10 so as to be in contact with the inner wall 10b of the tube portion 10.
  • the electrode 20 corresponds to an example of the energy generation unit in the present embodiment.
  • the inner wall 10b of the pipe part 10 is shown with a dashed-two dotted line.
  • the electrode 20 has a columnar shape that is substantially the same diameter as the inner diameter of the tube portion 10, and is fitted to the tube portion 10 in a so-called simmering state.
  • the distance from the end surface 10a on the distal end side of the tube portion 10 to the surface 20b on the distal end side of the electrode 20 is 1.5 mm.
  • the electrode 20 is connected to the lead wire 40 on the proximal end side of the catheter 1.
  • the lead wire 40 extends to the proximal end of the catheter 1 (not shown) and is connected to an electrosurgical device (high frequency generator) (not shown).
  • the electrode 20 generates a high-frequency current by electric power supplied from the electrosurgical device via the lead wire 40.
  • a counter electrode plate (not shown) may be attached to the patient's body side. Thereby, various treatments for the patient's living tissue can be performed using the high-frequency current generated from the electrode 20.
  • the energy device in the present embodiment includes the electrode 20 and the lead wire 40.
  • a recess 30 extending from the distal end side to the proximal end side of the tube portion 10 is formed on the outer peripheral surface of the electrode 20.
  • the recessed part 30 is shown with a dotted line.
  • three recesses 30 are provided on the outer peripheral surface of the electrode 20 at intervals of about 120 degrees.
  • the number of the recessed parts 30 is not restricted to this. In this configuration, a space is formed between the recess 30 and the inner wall 10 b of the tube portion 10.
  • gas or fluid can be supplied from the proximal end side, pass through the flow channel 50, and discharged from the opening of the end surface 10 a on the distal end side of the tube part 10.
  • the opening of the end face 10a on the distal end side of the tube portion 10 corresponds to an example of a hole provided in the vicinity of the distal end of the tube portion in this embodiment.
  • the flow path 50 formed by the concave portion 30 of the electrode 20 and the inner wall 10b of the tube portion 10 corresponds to a communication path in this embodiment.
  • the recess 30 is provided so as to extend in parallel to the longitudinal direction of the tube portion 10, that is, the direction of the axis AX (indicated by the alternate long and short dash line in FIG. 1). It can also be provided so as to extend in a shape.
  • the posture of the tube unit 10 is controlled so that the end surface 10 a on the distal end side of the tube unit 10 faces the biological tissue in the body cavity of the patient, and the tube unit 10 is connected via the flow path 50.
  • sucking air from the distal end side to the proximal end side it is possible to adsorb biological tissue to the opening of the end face 10a.
  • the living tissue can be pulled by the tube portion 10 by using this adsorption force.
  • FIG. 4 shows an example of a state in which the biological tissue 100 is drawn into the tube portion 10 from the opening of the end surface 10a of the tube portion 10.
  • the living tissue 100 drawn into the tube portion 10 from the electrode 20 in the tube portion 10 is supplied.
  • a high-frequency current can be selectively supplied. Thereby, the biological tissue 100 is heated and solidified by the high frequency current.
  • the living tissue 100 drawn into the tube portion 10 is brought into contact with the electrode 20.
  • the high frequency current can be more intensively supplied to the part of the living tissue 100 that is in contact with the electrode 20, and the part can be solidified more reliably.
  • the biological tissue 100 is adsorbed in the tube unit 10 so that the electrode 20 and the bleeding point come into contact with each other.
  • the hemostasis of the living tissue 100 can be pinpointed by the flowing high-frequency current.
  • the living tissue 100 can be drawn into the space between the end surface 10a on the distal end side of the tube portion 10 and the electrode 20, and the coagulation and hemostasis can be selectively performed depending on the target location. Treatment can be performed. Further, unlike the conventional forceps, the electrode 20 is not exposed from the end face 10a on the distal end side of the tube portion 10, but is disposed in the tube portion 10, and the tube portion 10 is electrically insulated. Yes.
  • the range in which the high-frequency current flows from the electrode 20 to the living tissue 100 can be limited to the inside of the tube portion 10, and a stronger high-frequency current is supplied to the living tissue 100 drawn into the tube portion 10. can do.
  • the opening of the end face 10a on the distal end side of the tube portion 10 may stick to the living tissue 100 by inserting the catheter 1 in this embodiment into the body cavity of the patient and sucking it with a negative pressure of ⁇ 10 kPa or more. all right.
  • the suction negative pressure is further increased, the living tissue 100 attached to the opening of the end face 10 a on the distal end side of the tube portion 10 is drawn into the tube portion 10. It has been found that the amount of the living tissue 100 drawn into the tube portion 10 increases as the negative pressure increases. Further, it was found that the biological tissue 100 was in contact with the surface 20b on the distal end side of the electrode 20 in the tube portion 10 by suction with a negative pressure of ⁇ 30 kPa or more.
  • the living tissue 100 can be sufficiently pulled by the tube portion 10.
  • the biological tissue 100 can be coagulated by supplying power of 30 to 120 W to the electrode 20 and flowing high-frequency current from the electrode 20 to the biological tissue 100. It was.
  • the relationship between the negative pressure of the suction and the amount of drawing of the living tissue 100 into the tube portion 10 is merely an example, and the negative pressure depends on the thickness of the inner wall 10b of the tube portion 10 and the type and state of the living tissue 100. The pressure can be changed as appropriate.
  • the configuration of the endoscope catheter according to the present invention is not limited to that shown in the above embodiment, and is identical to the technical idea of the present invention.
  • the electrode 20 is fitted in the tube portion 10 in a squeeze state, but a gap is provided between the side surface of the electrode 20 and the inner wall 10b of the tube portion 10 to prevent gaps between the gaps and intermediate gaps.
  • the electrode 20 may be slidably disposed in the tube portion 10 in a state.
  • the electrode 20 and the flow path 50 can have various shapes.
  • FIG. 5 shows a front view of the catheter 1 as a modification of the above. In FIG. 5, the same components as those in the above embodiment are given the same reference numerals, and detailed description thereof is omitted.
  • the shape of the electrode 20 is a hexagonal column, and the cross section in a plane perpendicular to the axis AX is a hexagon.
  • the electrode 20 is disposed in the tube portion 10 so that the hexagonal apex of the cross section of the electrode 20 is substantially in contact with the inner wall 10 b of the tube portion 10 of the catheter 1. In this case, a space formed between the side surface 20 a of the electrode 20 and the inner wall 10 b becomes the flow path 50.
  • the electrode 20 is formed to have a cylindrical shape that is substantially the same diameter as the inner diameter of the tube portion 10, and the electrode 20 is further connected to the distal end of the electrode 20. It is good also as a structure which provides the flow path 60 penetrated from the side to the proximal end side.
  • the surface of the electrode includes not only the side surface of the electrode facing the inner wall of the catheter tube, but also the front surface of the electrode and the inner surface of the hole penetrating the electrode.
  • heat may be supplied to the living tissue by a heating element that generates heat when electric power is supplied instead of the electrode.
  • you may supply an ultrasonic wave and a shock wave to a biological tissue with the ultrasonic element which generate
  • electromagnetic waves may be supplied from the electrodes to the living tissue.
  • this electromagnetic wave it is possible to use electromagnetic waves of various frequencies and characteristics such as microwaves, radio waves, and laser light.
  • APC ArArgon Plasma Coagulation
  • the distance between the electrode 20 and the end face 10a on the distal end side of the tube portion 10 is adjusted by providing the electrode 20 in the tube portion 10 so as to be movable in the longitudinal direction of the tube portion 10. Then, the suction force when performing suction using the flow path 50 formed between the recess 30 of the power 20 and the inner wall 10b of the tube portion 10 and the traction force when the living tissue is adsorbed in the tube portion 10 are obtained. Can be adjusted. In addition, the contact state between the living tissue and the electrode 20 can be adjusted.
  • the opening in the end face 10a of the pipe portion 10 is used as a hole.
  • the structure of the hole is not limited to the above.
  • the end surface 10a of the tube portion 10 may be closed, and a hole may be separately provided on the side surface or end surface of the tube portion 10.
  • the diameter and number of holes can also be changed.
  • the shape of the tip of the tube portion 10 may be a tip shape different from the cylindrical shape, and a hole may be provided at any part of the tip shape.
  • the end surface 10a of the pipe part 10 does not need to be an end face perpendicular to the axis of the pipe part 10, and may be configured to have an inclination with respect to the axis of the pipe part 10.
  • the shape of the distal end of the tube portion 10 does not have to be a shape obtained by simply cutting a cylinder, and may be appropriately processed such as adding a taper or R to the tip.
  • the catheter 1 is formed using a soft resin.
  • the tube portion 10 of the catheter 1 is formed as a metallic tubular member, and an insulating member is disposed on the inner wall 10b of the tube portion 10 to form the electrode 20. It may be configured so that the high-frequency current generated from the gas does not diffuse outside the tube portion 10.
  • the catheter 1 of the present invention is useful for hemostasis treatment in the digestive tract cavity, and can be used for treatment in microsurgery and endoscopic surgery.
  • surgery in brain surgery or vascular surgery is assumed as the microsurgery.
  • the endoscopic surgery laparoscopic surgery, thoracoscopic surgery using a rigid endoscope, digestive endoscopic surgery using a flexible endoscope, bronchoscopic surgery, and the like are assumed.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Otolaryngology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Plasma & Fusion (AREA)
  • Physics & Mathematics (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)

Abstract

Le but de cette invention est de fournir un cathéter qui a une structure simple, tout en étant multifonctionnel, et qui peut adsorber, tirer, coaguler et former une hémostase d'un tissu vivant. Le cathéter pour endoscope a un trou, à proximité de l'extrémité distale du tube, et une source d'énergie à l'intérieur du tube à l'extrémité proximale du trou. La source d'énergie comprend une partie d'émission d'énergie, dans une cavité à l'intérieur du tube, qui peut émettre une énergie définie, et un trajet de communication. Ce dernier inclut une partie de la surface de la partie d'émission d'énergie, et facilite la communication entre le trou et une région à l'intérieur du tube a l'extrémité proximale de la partie d'émission d'énergie.
PCT/JP2016/072869 2016-08-03 2016-08-03 Cathéter pour endoscope. Ceased WO2018025360A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
PCT/JP2016/072869 WO2018025360A1 (fr) 2016-08-03 2016-08-03 Cathéter pour endoscope.

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/JP2016/072869 WO2018025360A1 (fr) 2016-08-03 2016-08-03 Cathéter pour endoscope.

Publications (1)

Publication Number Publication Date
WO2018025360A1 true WO2018025360A1 (fr) 2018-02-08

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PCT/JP2016/072869 Ceased WO2018025360A1 (fr) 2016-08-03 2016-08-03 Cathéter pour endoscope.

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2010046200A (ja) * 2008-08-20 2010-03-04 Fujinon Corp 高周波処置具
JP5033787B2 (ja) * 2005-04-11 2012-09-26 テルモ株式会社 層状組織の欠損の閉鎖をもたらすための方法および装置
JP2016150229A (ja) * 2015-02-19 2016-08-22 山科精器株式会社 内視鏡用カテーテル

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP5033787B2 (ja) * 2005-04-11 2012-09-26 テルモ株式会社 層状組織の欠損の閉鎖をもたらすための方法および装置
JP2010046200A (ja) * 2008-08-20 2010-03-04 Fujinon Corp 高周波処置具
JP2016150229A (ja) * 2015-02-19 2016-08-22 山科精器株式会社 内視鏡用カテーテル

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