Endoscopic treatment tools

Abstract

An endoscope treatment tool according to the present invention comprises: a sheath and a rod inserted into the sheath; a piezoelectric element provided at the periphery of the rod; a first flange connected to the rod; and a second flange connected to the rod. The piezoelectric element is sandwiched between the first flange disposed at a distal end side and the second flange disposed at a proximal end side.

Description

[Technical field]

[0001] The present invention relates to an endoscopic treatment tool. [Background technology]

[0002] Conventionally, in endoscopic treatments such as ESD (endoscopic submucosal dissection), endoscopic treatment tools for incision and dissection, such as high-frequency knives, have been used. Patent Document 1 describes a high-frequency knife that incises and dissects tissue using an electrode to which a high-frequency current is applied. [Prior art documents] [Patent documents]

[0003] [Patent Document 1] China Patent Application Publication No. 111202485 Summary of the Invention [Problem to be solved by the invention]

[0004] However, when using the conventional high-frequency knife described in Patent Document 1 and the like, blood vessels may stick to the high-frequency knife during treatment such as incision and dissection. In such cases, the high-frequency knife may damage the blood vessels as they are moved, causing bleeding.

[0005] In view of the above circumstances, an object of the present invention is to provide an endoscopic treatment tool that reduces bleeding during treatment such as incision and dissection. [Means for solving the problem]

[0006] In order to solve the above problems, the present invention proposes the following means. The endoscopic treatment tool according to a first aspect of the present invention includes a sheath, a rod inserted into the sheath, which is conductive and through which a high-frequency current is passed, before an ultrasonic oscillator provided around the rod; A metal rod for passing the high frequency current through the rod.and an operation wire, the ultrasonic oscillator has a piezoelectric element through which the rod passes, a first flange connected to the rod and disposed on a tip side of the piezoelectric element, and a second flange connected to the rod and disposed on a base end side of the piezoelectric element, the piezoelectric element is sandwiched between the first flange and the second flange, the piezoelectric element has a cylindrical piezoelectric body provided around the rod, a first electrode attached along an inner surface of the piezoelectric body, and a second electrode attached along an outer surface of the piezoelectric body, the rod passes through the ultrasonic oscillator, The tip of the rod has a monopolar electrode that outputs the high-frequency current, The rod has a base end protruding from the second flange and is connected to the operating wire. Effect of the Invention

[0007] According to the endoscopic treatment tool of the present invention, bleeding is less likely to occur during treatment such as incision and dissection. [Brief description of the drawings]

[0008] [Figure 1] 1 is an overall view of an endoscopic treatment system according to a first embodiment. [Diagram 2] 2 is an overall view showing a treatment tool of the endoscope treatment system. FIG. [Diagram 3] FIG. [Figure 4] 4 is a cross-sectional view of the distal end of the treatment tool. FIG. [Diagram 5] FIG. 2 is a perspective view of a piezoelectric element of the treatment tool. [Figure 6] FIG. 13 is a diagram showing a standing wave of vibration in the longitudinal direction. [Figure 7] 13 is a flowchart showing a procedure for using the treatment tool. [Figure 8] FIG. 13 is a perspective view showing a modified example of the ultrasonic oscillator of the treatment tool. [Figure 9] 13 is a cross-sectional view showing a modified example of the first flange of the treatment tool. FIG. [Figure 10] 11A and 11B are cross-sectional views showing modified examples of the path of the first flexible wiring. [Figure 11]FIG. 11 is a cross-sectional view showing a modified example of the second flange. [Figure 12] FIG. 4 is an overall view showing a treatment tool according to a second embodiment of the present invention. [Figure 13] FIG. [Figure 14] 4 is a cross-sectional view of the distal end of the treatment tool. FIG. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0009] First embodiment An endoscopic treatment system 300 according to a first embodiment of the present invention will be described with reference to Fig. 1 to Fig. 7. Fig. 1 is an overall view of the endoscopic treatment system 300 according to this embodiment.

[0010] [Endoscopic treatment system 300] 1, the endoscopic treatment system 300 includes an endoscope 200 and a treatment tool 100. The treatment tool 100 is inserted into the endoscope 200 when in use.

[0011] [Endoscope 200] The endoscope 200 is a known flexible endoscope, and includes an insertion section 202 that is inserted into the body from its tip, and an operation section 207 attached to the base end of the insertion section 202 .

[0012] The insertion section 202 has an imaging section 203, a bending section 204, and a flexible section 205. The imaging section 203, the bending section 204, and the flexible section 205 are arranged in this order from the tip of the insertion section 202. A channel 206 for inserting the treatment tool 100 is provided inside the insertion section 202. A tip opening 206a of the channel 206 is provided at the tip of the insertion section 202.

[0013] The imaging unit 203 includes an imaging element such as a CCD or a CMOS, and can capture an image of a site to be treated. The imaging unit 203 can capture an image of the rod 2 of the treatment tool 100 in a state in which the treatment tool 100 protrudes from the distal end opening 206a of the channel 206.

[0014] The bending section 204 bends in response to an operator's operation of the operating section 207. The flexible section 205 is a tubular section having flexibility.

[0015] The operation unit 207 is connected to the flexible portion 205. The operation unit 207 has a grip 208, an input unit 209, a proximal end opening 206b of the channel 206, and a universal cord 210. The grip 208 is a portion that is held by an operator. The input unit 209 accepts an operation input for bending the bending portion 204. The universal cord 210 outputs an image captured by the imaging unit 203 to the outside. The universal cord 210 is connected to a display device such as a liquid crystal display via an image processing device including a processor or the like.

[0016] [Treatment tool 100] FIG. 2 is an overall view showing the treatment tool 100. As shown in FIG. The treatment tool (endoscopic treatment tool) 100 includes a sheath 1, a rod 2, an ultrasonic oscillator 3, an operating wire 4, and an operating section 5. In the following description, in the longitudinal direction A of the treatment tool 100, the side that is inserted into the patient's body is referred to as the "distal side (A1)" and the operating section 5 side is referred to as the "base side (A2)."

[0017] The sheath 1 is a long member that is flexible and insulating and extends from a distal end 1a to a proximal end 1b. The sheath 1 has an outer diameter that allows it to be inserted into a channel 206 of an endoscope 200. As shown in FIG. 1, when the sheath 1 is inserted into the channel 206, the distal end 1a of the sheath 1 can protrude and retract from a distal end opening 206a of the channel 206.

[0018] FIG. 3 is a perspective view of the distal end of the treatment tool 100. As shown in FIG. The rod 2 is a generally round bar-shaped metallic member, and is provided so as to protrude from the tip 1a of the sheath 1. The rod 2 is conductive and a high-frequency current is passed through it. The rod 2 has a rod main body 20 and an electrode portion 21.

[0019] FIG. 4 is a cross-sectional view of the distal end of the treatment tool 100. As shown in FIG. The rod 2 penetrates the ultrasonic oscillator 3 along the longitudinal direction A. The central axis O2 of the rod 2 in the longitudinal direction A substantially coincides with the central axis O1 of the sheath 1 in the longitudinal direction A.

[0020] The rod body 20 is a round bar-shaped metal member. The operation wire 4 is attached to the base end of the rod body 20. The rod body 20 supplies a high-frequency current supplied from the operation wire 4 connected to the operation section 5 to the electrode section 21.

[0021] The electrode portion 21 is a disc-shaped conductive member provided at the tip of the rod body 20. In a front view seen from the direction along the longitudinal direction A, the outer periphery of the electrode portion 21 is formed concentrically with the outer periphery of the rod body 20. As shown in Fig. 4, the length L1 of the electrode portion 21 in the radial direction R perpendicular to the longitudinal direction A is longer than the length L2 of the rod body 20 in the radial direction R.

[0022] When a high-frequency current is supplied to the rod 2 from the manipulation wire 4, the electrode portion 21 and the protruding portion of the rod main body 20 function as a monopolar electrode that outputs the high-frequency current to the biological tissue.

[0023] The ultrasonic oscillator 3 is a member that oscillates ultrasonic waves and is provided around the rod 2 at the tip 1a of the sheath 1. The ultrasonic oscillator 3 is provided inside the sheath 1 and is in contact with the inner peripheral surface 1c of the sheath 1. The ultrasonic oscillator 3 has a piezoelectric element 30, a first flange 34, a second flange 35, a first insulating member 36, a second insulating member 37, a third insulating member 38, and a heat shrink tube 39.

[0024] FIG. 5 is a perspective view of the piezoelectric element 30. As shown in FIG. The piezoelectric element 30 is a passive element that utilizes the piezoelectric effect to convert voltage into force. The piezoelectric element 30 has a cylindrical shape with an internal cavity H. The piezoelectric element 30 has a piezoelectric body 31, a first electrode 32, and a second electrode 33.

[0025] The piezoelectric body 31 has a cylindrical shape and is made of, for example, ceramics or a single crystal material. As shown in Fig. 4, a first electrode 32 is attached to the piezoelectric body 31 along its inner surface 31i. A second electrode 33 is attached to the piezoelectric body 31 along its outer surface 31o.

[0026] The piezoelectric body 31 vibrates when an alternating current is applied from the first electrode 32 and the second electrode 33. The polarization direction of the piezoelectric body 31 is the radial direction R (thickness direction) connecting the inner surface 31i and the outer surface 31o. Since the polarization direction of the piezoelectric body 31 is the radial direction R connecting the inner surface 31i and the outer surface 31o, the piezoelectric body 31 vibrates in the radial direction R due to the piezoelectric effect.

[0027] 4, the rod 2 passes through a cavity H of the piezoelectric element 30. A first insulating member 36 is provided between the piezoelectric element 30 and the rod 2, so that the high-frequency current supplied to the rod 2 does not flow through the piezoelectric element 30. In addition, second insulating members 37 are provided on the tip and base end sides of the piezoelectric element 30.

[0028] As shown in Fig. 5, the first electrode 32 is connected to a first wire 32b via a first flexible wiring 32a. The first flexible wiring 32a is a flexible flat wiring board. The first wire 32b passes through the internal space 1s of the sheath 1 and extends to the operation unit 5, and is connected to an ultrasonic driving device (not shown). The surfaces of the first flexible wiring 32a and the first wire 32b are coated with an insulating coating.

[0029] The first electrode 32 and the first flexible wiring 32a may be integrally formed. This configuration reduces the number of processes for joining components, thereby improving assembly efficiency.

[0030] The second electrode 33 is connected to the second wire 33b via the second flexible wiring 33a. The second flexible wiring 33a is a flexible flat wiring board. The second wire 33b passes through the internal space 1s of the sheath 1 and extends to the operation unit 5, and is connected to an ultrasonic driving device (not shown). The surfaces of the second flexible wiring 33a and the second wire 33b are coated with an insulating coating.

[0031] The second electrode 33 and the second flexible wiring 33a may be integrally formed. This configuration reduces the number of parts joining steps, improving assembly efficiency.

[0032] 4, the first flange 34 is a cylindrical metal member, and is provided on the tip side of the piezoelectric element 30. The outer diameter (length in the radial direction R) of the first flange 34 is longer than the outer diameter (length in the radial direction R) L2 of the rod 2. The tip side of the first flange 34 is covered with a third insulating member 38. The first flange 34 is insulated from the piezoelectric element 30 by a second insulating member 37.

[0033] The first flange 34 is integrally formed with the rod 2. The first flange 34 and the rod 2 may be formed separately. In this case, the first flange 34 is attached to the rod 2 by bonding, screwing, press fitting, shrink fitting, or the like.

[0034] The second flange 35 is a cylindrical metal member, and is provided on the tip side of the piezoelectric element 30. The outer diameter (length in the radial direction R) of the second flange 35 is longer than the outer diameter (length in the radial direction R) L2 of the rod 2. The second flange 35 is insulated from the piezoelectric element 30 by a second insulating member 37.

[0035] The second flange 35 is attached by screwing into an external thread 20s provided on the outer periphery of the rod body 20. The second flange 35 may be attached to the rod 2 by bonding, press fitting, shrink fitting, or the like. The second flange 35 and the rod 2 may be formed integrally.

[0036] The second flange 35 has a through hole 35h formed therein, which penetrates in the longitudinal direction A. The first flexible wiring 32a passes through the through hole 35h and extends toward the base end. Meanwhile, the second flexible wiring 33a passes outside the second flange 35 and extends toward the base end. The first flexible wiring 32a and the second flexible wiring 33a are not electrically connected to the second flange 35 because their outer peripheries are insulatedly coated.

[0037] When vibrations occur in the radial direction R in the piezoelectric body 31 due to the piezoelectric effect, vibrations also occur in the longitudinal direction A due to the Poisson effect. The first flange 34 and the second flange 35 sandwich the piezoelectric element 30 via the second insulating member 37. The first flange 34 and the second flange 35 amplify the ultrasonic vibrations in the longitudinal direction A generated by the piezoelectric element 30.

[0038] FIG. 6 is a diagram showing a standing wave SW of vibration in the longitudinal direction A. In FIG. It is preferable that the frequency of the applied AC current and the dimensions of the piezoelectric element 30 are adjusted so that the tip end and the base end of the piezoelectric element 30 are located at the antinode SW1 (the portion with the largest amplitude) of the standing wave SW. By making these adjustments, the vibration in the longitudinal direction A can be further amplified.

[0039] It is preferable that the dimensions and material of the first flange 34 and the second flange 35 and the dimensions and material of the rod 2 are adjusted so that the tip end of the first flange 34 and the base end of the second flange 35 become nodes SW2 (portions with the smallest amplitude) of the standing wave SW. By making these adjustments, it is possible to further amplify the vibration in the longitudinal direction A. Note that the standing wave SW of the vibration in the longitudinal direction A is not limited to that shown in FIG. 6.

[0040] Since the first flange 34 is integrally formed with the rod 2, it can efficiently transmit the vibration in the longitudinal direction A transmitted from the piezoelectric element 30 to the rod 2. Even if the first flange 34 is formed separately from the rod 2, the first flange 34 can efficiently transmit the vibration in the longitudinal direction A to the rod 2, if the first flange 34 is made of the same material as the rod 2, for example.

[0041] From the viewpoint of transmitting vibration in the longitudinal direction A more toward the tip side than the base end side, it is desirable that the second flange 35 is a member having a smaller difference in acoustic impedance compared to the first flange 34.

[0042] 4, the heat shrink tube 39 is attached by heat shrinking to the outer periphery of the piezoelectric element 30, the first flange 34, and the second flange 35. Since the heat shrink tube 39 is in contact with the inner periphery 1c of the sheath 1, the piezoelectric element 30, the first flange 34, and the second flange 35 cannot slide back and forth inside the sheath 1.

[0043] The operation wire 4 is a metal wire, and is inserted through the internal space 1s of the sheath 1. The tip of the operation wire 4 is connected to the rod 2, and the base end of the operation wire 4 is connected to the operation section 5. The operation wire 4 has a coil wire 41 and an inner tube 42. The coil wire 41 is inserted through the inner tube 42. The inner tube 42 is flexible and insulating.

[0044] As shown in FIGS. 1 and 2, the operation unit 5 has an operation unit main body 51, a slider 52, and a power supply connector 53.

[0045] The tip end of the operation unit body 51 is connected to the base end 1b of the sheath 1. The operation unit body 51 has an internal space through which the operation wire 4 can be inserted. The operation wire 4 passes through the internal space of the sheath 1 and the internal space of the operation unit body 51 and extends to the slider 52.

[0046] The slider 52 is attached to the operation unit body 51 so as to be movable along the longitudinal direction A. The base end of the operation wire 4 is connected to the slider 52. When the surgeon advances or retreats the slider 52 relatively to the operation unit body 51, the operation wire 4 and the rod 2 advance or retreat. A power supply connector 53 is fixed to the slider 52.

[0047] The power supply connector 53 can be connected to a high-frequency power supply device (not shown), and is electrically and physically connected to the proximal end of the manipulation wire 4. The power supply connector 53 can supply a high-frequency current supplied from the high-frequency power supply device to the electrode portion 21 via the manipulation wire 4 and the rod 2.

[0048] [Method of using the endoscopic treatment system 300] Next, a procedure (a method of using the endoscopic treatment system 300) using the endoscopic treatment system 300 of this embodiment will be described. Specifically, an incision and dissection treatment of a lesion and a hemostatic treatment in an endoscopic treatment such as ESD (endoscopic submucosal dissection) will be described.

[0049] As a preparatory step, the surgeon identifies the lesion by a known method and bulges the lesion. Specifically, the surgeon inserts the insertion section 202 of the endoscope 200 into the digestive tract (e.g., the esophagus, stomach, duodenum, or large intestine) and identifies the lesion while observing an image obtained by the imaging section 203 of the endoscope. Next, the surgeon inserts a known submucosal local injection needle into the channel 206 of the insertion section 202 and injects a liquid for local injection (local injection liquid) through the submucosal local injection needle to bulge the lesion. After injecting the local injection liquid, the surgeon removes the submucosal local injection needle from the channel 206.

[0050] The surgeon inserts the treatment tool 100 into the channel 206, and causes the tip 1a of the sheath 1 to protrude from the tip opening 206a of the insertion section 202. The surgeon advances the slider 52 of the operation section 5 relatively to the operation section body 51, and causes the rod 2 to protrude.

[0051] FIG. 7 is a flowchart showing a procedure for using the treatment tool 100. In step S11, the surgeon operates the ultrasonic driving device to cause the piezoelectric element 30 to generate ultrasonic vibrations.

[0052] Next, in step S12, the surgeon operates the high-frequency power supply device to output a high-frequency current to the biological tissue from the rod 2. Since step S11 is performed before step S12, ultrasonic vibration is generated from the piezoelectric element 30 before the high-frequency current is output from the rod 2. Note that, if ultrasonic vibration is generated from the piezoelectric element 30 before the high-frequency current is output from the rod 2, the surgeon may perform steps S11 and S12 simultaneously, or may perform them in a reverse order.

[0053] In step S13, the surgeon performs incision and dissection procedures and hemostasis procedures. The surgeon advances the rod 2, and while high-frequency current is being applied, moves the electrode section 21 to incise the mucosa of the lesion. The surgeon also advances the rod 2, and while high-frequency current is being applied, lifts the mucosa of the incised lesion to expose the submucosa, and dissects the submucosa of the incised lesion.

[0054] When a high-frequency current is output from the rod 2 to incise and dissect a lesion, the rod 2 vibrates due to vibrations in the longitudinal direction A generated by the piezoelectric element 30. Therefore, living tissue is less likely to stick to the rod 2 that is being incised and dissected. As a result, bleeding caused by the rod 2 damaging blood vessels during incision and dissection can be suitably prevented.

[0055] If bleeding occurs during the incision and dissection procedure, the surgeon performs hemostasis procedures. The surgeon applies high-frequency current to the rod 2 to heat it. The surgeon cauterizes the bleeding site with the heated rod 2 to stop the bleeding.

[0056] When thermal energy is output from the rod 2 to cauterize the bleeding site and stop the bleeding, the rod 2 vibrates due to the vibration in the longitudinal direction A generated by the piezoelectric element 30. Therefore, biological tissue is less likely to stick to the rod 2 that stops the bleeding. As a result, further bleeding caused by damaging blood vessels when stopping the bleeding can be suitably prevented.

[0057] The surgeon continues the above-mentioned operations (treatments) as necessary, and finally excises the lesion, completing the ESD procedure.

[0058] In step S14, the surgeon operates the high-frequency power supply device to stop the output of high-frequency current from the rod 2.

[0059] In step S15, the surgeon operates the ultrasonic driving device to stop the output of ultrasonic vibration from the piezoelectric element 30. Since step S14 is performed before step S15, the output of ultrasonic vibration from the piezoelectric element 30 stops after the output of high-frequency current from the rod 2 stops. Note that, if the output of ultrasonic vibration from the piezoelectric element 30 stops after the output of high-frequency current from the rod 2 stops, the surgeon may perform steps S14 and S15 simultaneously, or may perform them in a reverse order.

[0060] If the procedure is performed according to the above flow, ultrasonic vibrations are always output from the piezoelectric element 30 when high-frequency current is output from the rod 2. When the surgeon performs treatment using the high-frequency current or thermal energy output from the rod 2, it is possible to suitably prevent blood vessels from being damaged and bleeding from occurring during the treatment.

[0061] The endoscopic treatment system 300 may further include a control device that controls the output and stop of high-frequency current and ultrasonic vibration as in the above flow. For example, the control device may control the output and stop of high-frequency current and ultrasonic vibration based on a single switch operation by the surgeon.

[0062] According to the treatment tool 100 of this embodiment, when treatment such as incision and dissection is performed with the rod 2, ultrasonic vibration of the rod 2 can prevent living tissue from sticking to the rod 2. Therefore, bleeding caused by the rod 2 damaging blood vessels during treatment such as incision and dissection can be preferably prevented.

[0063] According to the treatment tool 100 of this embodiment, the piezoelectric element 30 has the piezoelectric body 31, the first electrode 32, and the second electrode 33 arranged to overlap in the radial direction R. Therefore, compared to the case where these are arranged to overlap in the longitudinal direction A, the piezoelectric element 30 can be made thinner and more compact.

[0064] According to the treatment tool 100 of this embodiment, the ultrasonic vibration in the longitudinal direction A is smaller than that in the case where the piezoelectric body 31, the first electrode 32, and the second electrode 33 are arranged to overlap in the longitudinal direction A. However, the first flange 34 and the second flange 35 can amplify the ultrasonic vibration in the longitudinal direction A generated by the piezoelectric element 30 to a level sufficient for treatment.

[0065] Although the first embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment, and design modifications and the like that do not depart from the gist of the present invention are also included. Also, the components shown in the above embodiment and modified examples can be appropriately combined to form a configuration.

[0066] (Variation 1-1) In the above embodiment, the ultrasonic oscillator 3 has a cylindrical shape. However, the shape of the ultrasonic oscillator 3 is not limited to this. As long as the sheath 1 can be inserted into the channel 206 of the endoscope 200, the shape of the ultrasonic oscillator 3 is not limited. FIG. 8 is a perspective view showing an ultrasonic oscillator 3A, which is a modified example of the ultrasonic oscillator 3. The ultrasonic oscillator 3A differs from the ultrasonic oscillator 3 only in its shape. The ultrasonic oscillator 3A is formed in a cylindrical shape with a rectangular outer periphery when viewed from the front in the longitudinal direction A.

[0067] (Variation 1-2) In the above embodiment, the first flange 34 is a cylindrical member. However, the shape of the first flange 34 is not limited to this. Fig. 9 is a cross-sectional view showing a first flange 34A which is a modified example of the first flange 34. The first flange 34A has a tapered surface 34t on the tip side, the outer diameter of which decreases from the base end side toward the tip side. By adjusting the shape of the tapered surface 34t of the first flange 34A, the transformation ratio of the ultrasonic vibration in the longitudinal direction A can be optimized.

[0068] (Variation 1-3) In the above embodiment, the first flexible wiring 32a extends to the base end side through the through hole 35h formed in the second flange 35. However, the path of the first flexible wiring 32a is not limited to this. Fig. 10 is a cross-sectional view showing a modified example of the path of the first flexible wiring 32a. The first flexible wiring 32a shown in Fig. 10 does not pass through the second flange 35, but passes outside the second flange 35 while bending along the second flange 35, and extends to the base end side.

[0069] (Variation 1-4) In the above embodiment, the second flange 35 is formed with a through hole 35h through which the first flexible wiring 32a is inserted. However, the manner in which the first flexible wiring 32a passes through the second flange 35 is not limited to this. FIG. 11 is a cross-sectional view showing a second flange 35B which is a modified example of the second flange 35. The second flange 35B has a tip flange 35Ba and a base flange 35Bb. The tip flange 35Ba and the base flange 35Bb are cylindrical members made of metal. The tip flange 35Ba is disposed on the tip side of the base flange 35Bb. The base flange 35Bb is attached by being screwed into an external thread 20s provided on the outer periphery of the rod main body 20. The first flexible wiring 32a passes through the inside of the tip flange 35Ba. Furthermore, the first flexible wiring 32a passes through the outside of the base flange 35Bb while bending along the base flange 35Bb and extends to the base side.

[0070] Second Embodiment A treatment tool 100B according to a second embodiment of the present invention will be described with reference to Fig. 12 to Fig. 14. In the following description, the same components as those already described will be denoted by the same reference numerals, and duplicated description will be omitted.

[0071] [Treatment tool 100B] FIG. 12 is an overall view showing the treatment tool 100B. The treatment tool 100B is used as an endoscopic treatment system together with an endoscope 200, similar to the treatment tool 100 of the first embodiment. It includes a sheath 1, a rod 2B, an ultrasonic oscillator 3, an operation wire 4B, and an operation section 5B. In the following description, in the longitudinal direction A of the treatment tool 100B, the side inserted into the patient's body is referred to as the "distal side (A1)" and the operation section 5B side is referred to as the "base side (A2)."

[0072] FIG. 13 is a perspective view of the distal end of the treatment tool 100B. The rod 2B is a generally round bar-shaped metallic member, and is provided so as to protrude from the tip 1a of the sheath 1. The rod 2B has a rod main body 20B and an electrode portion 21B.

[0073] FIG. 14 is a cross-sectional view of the distal end of the treatment tool 100B. The rod body 20B and the electrode portion 21B are similar to the rod body 20 and the electrode portion 21 of the first embodiment, except that the rod body 20B and the electrode portion 21B have a first water supply pipe 22 extending along the longitudinal direction A. The first water supply pipe 22 communicates with a tip opening 22a formed in the electrode portion 21B.

[0074] The operation wire 4B is similar to the operation wire 4 of the first embodiment, except that a second water supply pipeline 43 is formed inside the coil wire 41. The second water supply pipeline 43 is connected to the base end of the first water supply pipeline 22.

[0075] The operation section 5B is similar to the operation section 5 of the first embodiment, except that a liquid supply port 54 is formed in the operation section body 51. The liquid supply port 54 is connected to the base end of the second water supply pipe 43. The liquid supplied from the liquid supply port 54 passes through the second water supply pipe 43 and the first water supply pipe 22 and is discharged from the tip opening 22a.

[0076] According to the treatment tool 100B of this embodiment, when performing treatment such as incision and dissection with the rod 2B, the rod 2B is vibrated, thereby preventing living tissue from sticking to the rod 2B. Therefore, bleeding caused by the rod 2B damaging blood vessels during treatment such as incision and dissection can be suitably prevented.

[0077] According to the treatment tool 100B of this embodiment, a lesion can be swollen by supplying a liquid for local injection (local injection liquid) from the liquid supply port 54. Without replacing another treatment tool with the channel 206 of the insertion section 202, the incision / removal treatment and the local injection treatment can be repeatedly performed.

[0078] Although the second embodiment of the present invention has been described above in detail with reference to the drawings, the specific configuration is not limited to this embodiment, and design modifications and the like that do not depart from the gist of the present invention are also included. Also, the components shown in the above embodiment and modified examples can be appropriately combined to form a configuration. [Industrial Applicability]

[0079] The present invention can be applied to an endoscopic treatment tool used for hemostasis treatment. [Explanation of symbols]

[0080] 300 Endoscopic treatment system 200 Endoscope 100, 100B Treatment tools (endoscopic treatment tools) 1,1B,1D sheath 2,2B Rod 20,20B Rod body 21,21B Electrode part 22 First water pipeline 22a Tip opening 3,3A Ultrasonic oscillator 30 Piezoelectric element 31 Piezoelectric 31i Inside 31o exterior 32 First electrode 32a First flexible wiring 32b First Wire 33 Second electrode 33a Second flexible wiring 33b Second Wire 34,34A First flange 35,35B Second flange 4,4B Operating wire 5,5B Operation section

Claims

1. A sheath, a rod that is inserted into the sheath and has electrical conductivity and through which a high-frequency current is passed; An ultrasonic oscillator provided around the rod; a metal operating wire for passing the high-frequency current through the rod; Equipped with The ultrasonic oscillator includes: a piezoelectric element through which the rod passes; A first flange connected to the rod and disposed on a tip side of the piezoelectric element; A second flange connected to the rod and disposed on a base end side of the piezoelectric element; having the piezoelectric element is sandwiched between the first flange and the second flange, The piezoelectric element is A cylindrical piezoelectric body provided around the rod; A first electrode attached along an inner surface of the piezoelectric body; A second electrode attached along an outer surface of the piezoelectric body; having The rod penetrates the ultrasonic oscillator, a tip end of the rod has a monopolar electrode that outputs the high-frequency current, and a base end of the rod protruding from the second flange is connected to the operation wire. Endoscopic treatment tools.

2. The piezoelectric element is formed in a cylindrical shape. The endoscopic treatment tool according to claim 1 .

3. The first flange is formed in a cylindrical shape, The second flange is formed in a cylindrical shape, The outer diameter of the first flange is greater than the outer diameter of the rod, The outer diameter of the second flange is greater than the outer diameter of the rod. The endoscopic treatment tool according to claim 1 .

4. The first flange is integrally formed with the rod. The endoscopic treatment tool according to claim 1 .

5. The first flange is attached to the rod. The endoscopic treatment tool according to claim 1 .

6. The second flange is integrally formed with the rod. The endoscopic treatment tool according to claim 1 .

7. The second flange is attached to the rod. The endoscopic treatment tool according to claim 1 .

8. The rod is conductive and is energized with the high-frequency current. The endoscopic treatment tool according to claim 1 .

9. The piezoelectric element is insulated from the rod by a first insulating member. The endoscopic treatment tool according to claim 1 .

10. The first flange and the second flange are insulated from the piezoelectric element by a second insulating member. The endoscopic treatment tool according to claim 1 .

11. The first flange has a tip side covered by a third insulating member. The endoscopic treatment tool according to claim 1 .

12. The rod has a water supply pipe extending along the longitudinal direction. The endoscopic treatment tool according to claim 1 .

13. The piezoelectric element is ultrasonically vibrated in the radial direction, and the ultrasonic vibration is transmitted to the rod in the longitudinal direction by utilizing the Poisson effect. The endoscopic treatment tool according to claim 1 .

14. The piezoelectric element is insulated from the rod by a first insulating member, The first insulating member is disposed between the first electrode of the piezoelectric element and the rod. The endoscopic treatment tool according to claim 1 .

15. When the high frequency current is output from the rod, ultrasonic vibration can be output from the piezoelectric element. The endoscopic treatment tool according to claim 1 .

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