JPH11332880A - Puncture treatment apparatus - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a puncture treatment apparatus which achieves a coagulation treatment or prostatomegaly accurately. SOLUTION: This apparatus is provided with an inserting part 5 insertable into a biomedical lumen, a first electrode 11 insertable into a channel 8 for insertion formed at the inserting part 5 and a second electrode 16 arranged on the outer circumference of the tip of the inserting part 5. The first electrode 16 is guided out free to advance or retract at a specified angle to the axis center of the inserting part 5 from the vicinity of the second electrode 16 at the tip of the inserting part 5 and electric energization is made between the first electrode 11 and the second electrode 16 to accomplish a treatment of the prostatomegaly.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a puncture treatment device for puncturing an enlarged prostate tissue with an electrode and applying a high-frequency current to coagulate and treat the prostate tissue.

[0002]

2. Description of the Related Art Conventionally, this type of apparatus has been disclosed in Japanese Patent No.
As disclosed in Japanese Patent No. 647557, a probe in which a high-frequency electrode is incorporated in an insulating sleeve is pierced into the prostate, and the application of high-frequency power is stopped according to the impedance value of prostate tissue.
As shown in No. 3311, there is known a coagulation treatment apparatus in which a coagulation electrode provided at a distal end of a catheter has a needle type structure capable of moving back and forth into a lumen of the catheter.

[0003]

[Patent Document 2]
The treatment device disclosed in Japanese Patent Laid-Open Publication No. H10-15064 is a so-called monopolar type comprising a treatment electrode for puncturing the prostate and a neutral electrode for collecting high-frequency current, and is concentrated around the electrode for puncturing the prostate. The current causes the tissue to coagulate. According to such a monopolar method, there is a risk of causing unintended burns on the tissue, and the current path flowing from the electrode piercing the prostate to the neutral electrode becomes longer,
It has been difficult to accurately measure the impedance of only the coagulated tissue site and properly control the applied high frequency power.

On the other hand, in the treatment apparatus disclosed in US Pat. No. 5,403,311, a so-called bipolar type in which a high frequency is supplied between a puncture-type coagulation electrode and a distal end of a catheter is disclosed. In this configuration, coagulation treatment can be performed by puncturing the coagulation electrode at the tip vertically into the inner wall of something like the digestive tract, but in the urethra like the prostate, the coagulation electrode is directed in the prostate direction relative to the catheter insertion direction Prostate hyperplasia cannot be treated for coagulation because there is no means to do so. The present invention has been made in view of the above circumstances, and an object of the present invention is to provide a puncture treatment device capable of reliably performing treatment such as prostatic hypertrophy.

[0005]

In order to solve the above-mentioned problems, the present invention provides an insertion part which can be inserted into a living body lumen, a first electrode which can be inserted through a lumen formed in the insertion part, and A puncture treatment device having a second electrode disposed on the outer periphery of the distal end of the insertion portion, further comprising a predetermined angle from the vicinity of the second electrode at the distal end of the insertion portion with respect to the axial center of the insertion portion. A means is provided for guiding the first electrode forward and backward. The first electrode having a predetermined angle from the vicinity of the second electrode at the distal end of the insertion portion with respect to the axial center of the insertion portion.
The electrodes are led out and punctured into a living tissue, and a current is applied to a tissue site between the first electrode and the second electrode to perform treatment such as prostatic hypertrophy.

[0006]

DESCRIPTION OF THE PREFERRED EMBODIMENTS <First Embodiment> A first embodiment of the present invention will be described with reference to FIG. (Structure) In FIG. 1, 1 is a bladder of a living body, 2 is a urethra, 3 is an enlarged prostate, and 4 is an electrode probe of a puncture treatment apparatus according to this embodiment. The electrode probe 4 has an insertion section 5 that can be inserted into the urethra (living body lumen) 2, and an operation section 6 is provided at a proximal end of the insertion section 5. A finger hook 7 is formed on the operation unit 6. The insertion portion 5 is formed with an insertion channel (lumen) 8 penetrating a central portion along the longitudinal direction. The insertion channel 8 is capable of inserting an insulating tube 12 formed of an electrically insulating material that covers a current-carrying wire (lead wire) of the first electrode 11. When the insulating tube 12 is inserted into the insertion channel 8, at least the proximal end is formed to have a length protruding out of the operation unit 6. An operating member 13 for moving the insulating tube 12 forward and backward is connected to the proximal end of the insulating tube 12. Further, the first electrode 11 is provided to be exposed at the tip of the insulating tube 12, and the exposed portion forms a puncture needle electrode portion.

The distal end of the insertion section 5 is oriented in such a manner that the distal end portion of the insulating tube 12 protruding from the insertion channel 8 is guided out of the insertion direction into the urethra 2, that is, with respect to the axis center of the insertion section 5. A deflecting unit 15 for guiding in an angled lateral direction is provided. Here, the distal end portion of the insulating tube 12 is led out slightly diagonally to puncture the needle-shaped first electrode 11 into the tissue of the prostatic enlargement 3.

A second electrode 16 having a larger surface area than the first electrode 11 is provided on the outer periphery of the distal end of the insertion section 5. The second electrode 16 is formed of a thin-film cylindrical conductive member attached over the entire periphery of the distal end of the insertion section 5.

A first lead wire 17 is connected to the first electrode 11, and a second lead wire 1 is connected to the second electrode 16.
8 are connected. Each of the lead wires 17 and 18 is electrically connected to a high frequency power supply 20 while being insulated from each other. In addition, the urethra 2 is provided around the proximal end of the insertion portion 5.
There is provided an index 21 for confirming the length of insertion into the device.

(Operation) First, the position of the prostatic hyperplasia 3 is observed using, for example, an ultrasonic probe (not shown) inserted into the anus, and the length of the insertion portion 5 to be inserted into the urethra 2 is measured in advance. Next, the insertion section 5 is inserted into the urethra 2. The length of the insertion portion 5 is determined based on the above-described index 2
Determine 1 together. Subsequently, the operating member 13 is operated to slide the insulating tube 12 provided with the first electrode 11 that is a puncture electrode, and the deflection unit 15 advances the distal end of the insulating tube 12 to the side. Electrode 11
Is punctured to the central position of the prostatic enlargement 3 (see FIG. 1). When the high-frequency power supply 20 is output in this state, the high-frequency current flows from the minute first electrode 11 to the second electrode 16 having a relatively large area at the position of the urethra in the vicinity. The extremely small tip portion of the one electrode 11 locally generates heat, and a treatment for coagulating the prostatic hypertrophy 3 is performed. Further, the puncture position of the first electrode 11 is changed, and the coagulation treatment is performed again. Do this several times in a row.

(Effect) The second electrode 16 is provided with a relatively large area on the outer peripheral portion of the distal end of the insertion portion 5, and a current is locally supplied to a portion located between the first electrode 11 and the second electrode 16. In addition, it is possible to efficiently generate heat at the distal end portion of the first electrode 11, and to safely perform local coagulation treatment.

Further, the second electrode 16 is positioned in advance at the position of the enlarged prostate part 3, and the first electrode 16 is
By puncturing the electrode 11, the prostatic enlargement 3 can be cauterized over a relatively wide area even with a single puncture. If the first electrode 11 is re-punctured several times into the prostatic hyperplasia 3, the prostatic hyperplasia 3 can be cauterized over a wider area. In addition, by arranging the second electrode 16 on the outer periphery of the insertion section 5, a relatively large area can be obtained. As a result, current is concentrated on the first electrode 11, and the prostatic hyperplasia 3 is efficiently formed. Can be cauterized.

<Second Embodiment> A second embodiment of the present invention will be described with reference to FIG. (Configuration) This embodiment is a modification of the above-described first embodiment, and differs only in the structure of the second electrode 16 and the deflecting unit 15 that deflects and leads the first electrode 11. The rest of the configuration is the same as that of the above-described first embodiment, and the description thereof will be omitted.

That is, the outer periphery of the distal end of the insertion portion 5
An electrode 16 is provided. A side hole 22 is formed in a part of the outer peripheral surface of the second electrode 16, which is located on a part of the outer peripheral surface, at a distal end peripheral wall of the insertion portion 5, which is connected to the insertion channel 8 and is directed sideways. The side hole 22 guides the distal end of the insulating tube 12 introduced into the insertion channel 8 and at the same time, sets the direction in which the distal end of the insulating tube 12 extends to a predetermined angle with respect to the direction of insertion into the urethra 2. The deflecting unit 15 guides and deflects to the side. The second electrode 16
Has a larger electrode surface area than that of the first embodiment. A side hole 22 through which the first electrode 11 passes is provided at an intermediate position of the second electrode 16.

(Operation) The positioning method and the energizing method of the insertion portion 5 are the same as those in the first embodiment described above.
The description is omitted.

(Effect) Since the position of the side hole 22 from which the distal end of the insulating tube 12 extends is in the middle of the area of the second electrode 16, the surface area of the second electrode 16 is larger than that of the first embodiment. In addition, since the first electrode 11 can be located near the center of the region of the second electrode 16, even if the output of the high-frequency power supply 20 is increased, it is possible to safely and efficiently treat.

<Third Embodiment> A third embodiment of the present invention will be described with reference to FIG. (Configuration) This embodiment is a modification of the above-described second embodiment, and differs only in the insertion positioning means of the insertion portion 5.
Other configurations are the same as those of the above-described second embodiment.
A description thereof will be omitted.

A balloon 23 made of rubber such as latex is mounted on the tip of the insertion section 5. A conduit 24 communicating with the balloon 23 is provided inside the insertion portion 5, and a fluid such as air is sent into the balloon 23 through the conduit 24 so that the balloon 23 can be expanded. I have. Further, the conduit 24 is connected to the insertion portion 5.
Is connected to a cock 25 provided in the operation unit 6 at the hand side. Fluid supply means 26 such as a syringe is connected to the cock 25. (Operation) First, the insertion portion 5 is inserted into the urethra 2 without expanding the balloon 23. Then, the insertion section 5 is inserted until the distal end thereof is located in the bladder 1. In this state, the fluid supply means 26 is operated to operate the balloon 23.
To expand the balloon 23. In this state,
When the insertion portion 5 is pulled back, as shown in FIG.
Abuts on the neck of the bladder 1. Therefore, the insertion portion 5 is positioned with respect to the prostatic enlargement 3. After that, coagulation treatment is performed as in the second embodiment.

(Effect) By using the balloon 23, the first electrode 11, which is a puncture electrode, can be easily positioned with respect to the prostatic hyperplasia 3. Others are second
The same effects as in the embodiment can be obtained. In the first to third embodiments described above, the case where the first electrode 11 is one is described. However, the first electrode 11 may be composed of a plurality of electrodes.

<Fourth Embodiment> A fourth embodiment of the present invention will be described with reference to FIG. (Configuration) This embodiment is different from the first embodiment in the configuration of the high-frequency power supply 20, and the other configuration is the same as that of the above-described first embodiment.

The high-frequency power supply 20 according to the present embodiment has an output circuit 31, and the output circuit 31 has lead wires 17 and 18.
The first electrode 11 and the second electrode 16 are connected via.
Further, the high frequency power supply 20 is provided with a voltage sensor 32 and a current sensor 33 for measuring a voltage value and a current value on the output side of the output circuit 31. The voltage sensor 32 and the current sensor 33 are connected to an impedance measuring circuit 34, and the impedance measuring circuit 34 is connected to a control circuit 35. The control circuit 35 is connected to the output circuit 31 and also to a display 36 for notifying the coagulation state based on the measured value of the impedance by light or sound.

(Operation) In the present embodiment, first, the insertion portion 5 is inserted into the urethra 2 to a predetermined position, and at the stage of performing coagulation treatment by high frequency, the first electrode 11 based on the voltage value and current value of high frequency output is The tissue impedance between the second electrodes 16 is measured by the impedance measuring circuit 34.
When the measured value or the change amount of the impedance reaches a predetermined value, the control circuit 35 sends a signal indicating completion of coagulation to the display 36. The display 36 notifies the operator of the completion of coagulation by light or sound based on the signal. Further, the control circuit 35 may send a signal to the output circuit when the predetermined impedance value or the amount of impedance change has been reached, so that the high-frequency output is automatically stopped or the output is reduced.

Based on the notification of completion of the coagulation, the surgeon removes the first electrode 11, changes the puncturing position, punctures another position, and performs coagulation. By performing this several times, a wide range of coagulation treatment is performed.

(Effect) By measuring the impedance, a wide range of coagulation treatment can be performed more accurately. In addition, since the local impedance of the tissue by the bipolar is measured, the coagulation state can be accurately monitored.

<Fifth Embodiment> A fifth embodiment of the present invention will be described with reference to FIGS. (Configuration) This embodiment is a modification of the above-described fourth embodiment. In the present embodiment, the first electrode 1 in the fourth embodiment is used.
The configuration of the high-frequency power supply 20 is different from that of the first embodiment, and the other configuration is the same as that of the fourth embodiment.

The tip of the first electrode 11 as a puncture electrode is formed in a snare wire shape, and the first electrode 11 is pushed and pulled by an electrode shape operation section 38 provided on the operation member 13 as shown in FIG.
5 can be changed from the needle-like state to the loop-shaped state 11a shown in FIG. For example, by pulling a part of the root of the first electrode 11 from the distal end of the insulating tube 12 through a current-carrying wire 39 which is inserted into the insulating tube 12 so as to be able to advance and retreat, the first electrode 11 is in a closed needle state. . Insulating tube 1
By extending a portion of the root of the first electrode 11 from the tip of the second electrode 2, the first electrode 11 is developed by its own elastic force and spreads in a loop. Further, a foot switch 41 is connected to the control circuit 35 of the high frequency power supply 20, and by operating the foot switch 41, an incision output and a coagulation output can be selected.

Here, load characteristics of the incision and coagulation output of the high-frequency power supply 20 will be described with reference to FIG. In general, the solidification output characteristic of the bipolar is such that the output decreases as solidification proceeds and exceeds the rated load, as indicated by a solid line 42 in FIG. Here, as shown by the broken line 43, if the output characteristic is set to maintain a high output even in a high impedance region, it becomes possible to incise the tissue even in the bipolar.

(Operation) The coagulation operation is selected by the foot switch 41 when the tip of the first electrode 11 has a single needle shape as shown in FIG. Then, as shown in FIG. 7, the coagulation progresses with the elapse of time, and at the coagulation completion time point 44 when the impedance value or the amount of change in the impedance reaches a predetermined value, the operator is notified that coagulation is completed. Alternatively, the coagulation output may be automatically stopped at the coagulation completion time point 44 or the output may be reduced.

Here, the surgeon operates the electrode shape operating section 38 to deform the tip of the first electrode 11 into the loop-shaped state 11a, and at the same time, performs the operation of selecting the incision output of the foot switch 41. Thus, the coagulated prostatic enlargement 3 can be incised without causing bleeding. By repeating such coagulation and incision operations several times, the tissue is incised and fragmented. The fragmented tissue is recovered.

(Effects) According to the present embodiment, not only coagulation of the enlarged prostate tissue but also incision and collection of the tissue can enhance the therapeutic effect.

<Sixth Embodiment> A sixth embodiment of the present invention will be described with reference to FIGS. (Structure) As shown in FIG. 8, the treatment apparatus for prostatic hypertrophy according to the present embodiment has a high-frequency oscillator 51 for supplying high-frequency energy, a catheter 52 as an insertion probe that can be inserted into the urethra 2, and this catheter. An insertion needle probe 53 that can be inserted into the internal passage of 52 and a catheter operation unit 54 that operates the insertion needle probe 53 are provided.

As shown in FIG. 9, the insertion needle probe 53 has an insulating sleeve 56 of an electrically insulating tube having a notch 55 having a needle-like tip. A puncture needle 57 is inserted into the insulating sleeve 56. The distal end portion of the insertion needle 57 protruding from the distal end of the insulating sleeve 56 is a high-frequency energizing electrode portion 58, and the distal end of the insertion needle 57 has a blunt shape, for example, a spherical shape larger in diameter than the electrode portion 58. Are electrically insulating portions 59.

The catheter operating section 54 is provided with a switch 60 for controlling on / off of energization from the high-frequency oscillator 51 to the high-frequency energizing electrode section 58. The high frequency oscillator 51 has a counter electrode connecting cable 61.
The counter electrode plate 62 is connected via the. The counter electrode plate 62 is installed in close contact with the outer surface of the living body, and receives a return current from the high-frequency electrode 58. The high frequency oscillator 51 includes a switch 6 of the catheter operation unit 54.
A foot switch 63 that can perform on / off operations of high-frequency power supply other than 0 is connected.

As shown in FIG. 9, a hole 65 opened sideways is formed in the peripheral wall portion of the distal end of the catheter 52 through the internal passage of the catheter 52. The distal end portion of the insertion needle 53 is drawn out to the side, and the insulating sleeve 56 of the insertion needle catheter 53 is further separated.
The tip portion of the puncture needle 57 can be protruded or retracted from the tip of the needle. That is, the catheter 52
At a predetermined angle with respect to the axial center of
The leading end of the insulating sleeve 56 in which is inserted and incorporated can be led out freely.

As shown in FIG. 8, the catheter operating section 54 has a high-frequency energizing section advance / retreat operating lever 66 capable of operating the high-frequency energizing electrode section 58 of the insertion needle 57 and an insulating sleeve of the insertion needle 57. An insulating sleeve advance / retreat operating lever 67 that can advance / retreat the 56 and a switch 60 described above are provided.

(Operation) In the present embodiment, the distal end of the catheter 52 is made to approach the prostatic enlargement 3 using the urethra 2. First, as shown in FIG. 9A, the notch 55 of the insulating sleeve 56 is pushed by pushing the operating lever 67 of the catheter operating section 54 toward the tissue to be destroyed or the target tissue to be treated. Push, Figure 9
As shown in (b), the tip of the insertion needle 57 is inserted into the prostatic enlargement 3. After the insertion needle 57 is once inserted into the prostatic enlargement section 3, the high-frequency power supply section advance / retreat lever 66 of the catheter operation section 54 is pushed, and the high-frequency power is applied from the distal end of the insulating sleeve 56 as shown in FIG. The electrode section for use 58 is pushed to the prostatic enlargement section 3 to determine the energization range.

Since the high-frequency electrode section 58 is surrounded by the insulating sleeve 56, it is possible to prevent the tissue outside the treatment range from being exposed to the high-frequency current. The amount of exposure of the electrode portion 58 can be set by adjusting the position of the insulating sleeve 56 in the longitudinal direction by pressing the insulating sleeve advance / retreat lever 67. Then, it is possible to select only the target tissue portion and to energize. After this setting, a treatment such as coagulation is performed by energizing.

By pressing the high-frequency energizing section advance / retreat operating lever 66 of the catheter operation section 54 and pushing the high-frequency energizing electrode section 58 inside the prostatic enlargement section 3, the electrically insulating section 59 having a blunt tip is formed. Prostate enlargement 3
In this case, the surgeon can know the state in which the tip has hit by touching the hand, and the surgeon stops pushing the high-frequency energizing electrode portion 58 any further, which is safe.

(Effect) In this embodiment, since the insulating sleeve 56 is inserted into the prostatic enlargement 3 by the presence of the blunt electric insulating portion 59 at the tip of the high-frequency electrode section 58, the high-frequency electrode section 58 can be safely advanced. Further, the insulating sleeve 56 and the high-frequency energizing electrode 58
Can be independently advanced and retracted, and therefore, after the high-frequency energizing electrode portion 58 is inserted into the prostatic enlargement 3, the energizing portion of the high-frequency energizing electrode portion 58 can be controlled.
For this reason, it is possible to perform the energization treatment only on the target tissue or over a wide range.

<Seventh Embodiment> A seventh embodiment of the present invention will be described with reference to FIGS. (Configuration) This embodiment shows an example of a forceps for puncture and coagulation. As shown in FIG. 10, the forceps 71 includes a treatment section 73 at the distal end of an elongated and flexible insertion section 72.
An operation unit 7 for operating the treatment unit 73 is provided at the proximal end of the hand 2.
4 are provided.

As shown in FIG. 11, the insertion section 72 is formed in a sheath shape by a flexible coil 76 covered with an electric insulating material 75. The treatment section 73 has a cover member 77 attached to the tip of the coil 76.
The cover member 77 has a slit 78 extending along the longitudinal direction of the insertion portion 72 and penetrating at the tip. A pivot pin 79 is provided on the left and right end portions of the cover member 77, and the needle electrode 80 has a sharp tip.
Is pivotally supported. Needle electrode 80 is slit 7
8 and is pivotally mounted on a pivot pin 79. The middle part of the needle electrode 80 is the coil 7
The distal end of an operation wire 81 extending to the hand side through the inside 6 is connected to a connected connecting member 82 via a link plate 83. As shown in FIG.
A slit 84 for accommodating the needle electrode 80 is formed.

The operating section 74 is provided with a fixed handle 86 and a slider 87, and the proximal end of the operating wire 81 extending to the proximal side through the coil 76 is fixed to the slider 87. Further, the operation wire 81 is connected to the slider 87.
Are connected to a high frequency power supply (not shown) by a cable 88 provided so as to be led out of the power supply.

(Operation) As shown in FIGS. 10 and 11,
The needle electrode 80 is opened in a direction away from the central axis of the cover member 77 by advancing the connection member 82 by the slider 87 via the operation wire 81.

In use, the treatment section 73 is advanced transurethrally into the bladder 1 with the needle electrode 80 closed and the needle electrode 80 is opened as described above, and then the forceps 7
When the whole 1 is retracted, the needle electrode 80 punctures the prostatic enlargement 3 as shown in FIG. In a state where the needle electrode 80 is punctured in the prostatic enlargement part 3, the needle electrode 8 is
When a high-frequency current is supplied to the prostatic enlargement 3 through 0,
The enlarged prostate is coagulated and dissected.

(Effect) Since the insertion section 72 is flexible, it is easy to insert the insertion section 72 transurethrally. Since the puncture is performed with the rigid needle electrode 80 while pulling the insertion portion 72, the force is transmitted reliably, and the coagulation / incision treatment for the prostatic enlargement 3 can be performed easily and reliably.

Although one needle electrode 80 is used in this embodiment, another needle electrode 80 can be added at a position symmetric with respect to the central axis. <Eighth Embodiment> An eighth embodiment of the present invention will be described with reference to FIG. (Configuration) The apparatus for treating benign prostatic hyperplasia according to the present embodiment comprises:
High frequency oscillator 91 for supplying high frequency energy
An insertion needle probe 95 having an electrode portion 92 for high-frequency current conduction at the tip, inserted through an insulating sleeve 93 made of an electrically insulating tube, and having an insertion needle 94 at the tip, and an insertion needle probe 95 A catheter 97 having an insertion portion lumen 96 through which the catheter operates, and a catheter operation unit 99 having a switch 98 for controlling on / off of energization are provided. The distal end of the insulating sleeve 93 of the insertion needle probe 95 forms an insertion needle 94 as a notch 100 having a needle shape. The distal end of the puncture needle 94 protruding from the distal end of the insulating sleeve 93 is a high-frequency energizing electrode portion 92, and the distal end of the puncture needle 94 is connected to the above-described electrically insulating portion 103 having a dull shape as described above. Has become.

The catheter operating section 99 includes a high-frequency energizing section advancing / retracting operation lever 105 capable of advancing and retracting the puncture needle 94 of the puncture needle probe 95, and an insulating sleeve capable of advancing / retracting the insulating sleeve 93 of the puncture needle probe 95. Forward / backward operation lever 1
06 is provided.

A counter electrode 112 is connected to the high frequency oscillator 91 via a counter electrode connection cable 111. The return electrode plate 112 is brought into close contact with the outer surface of the living body, and receives a return current from the high-frequency electrode section 92. The high-frequency oscillator 91 has a switch 98 of the catheter operation unit 99.
In addition to the above, a foot switch 113 capable of performing an on / off operation of high-frequency power supply is connected.

(Function) In this apparatus for treating benign prostatic hyperplasia,
The distal end of the catheter 97 is made to approach the enlarged prostate part 3 using the urethra 2 and the insulating sleeve advance / retreat operating lever 106 of the catheter operating part 99 is pushed to insulate the tissue to be destroyed or the target tissue to be treated. Sleeve 9
3, the notch 100 is pushed forward, and the insertion needle 94 is inserted into the prostatic hypertrophy 3. Insertion needle 94 is enlarged prostate 3
After that, the high-frequency energizing section advance / retreat operation lever 105 of the catheter operating section 99 is pushed to push the high-frequency energizing electrode section 92 to the prostatic hypertrophy section 3 to determine the energizing range. Then, a treatment such as coagulation is performed by energization.

(Effect) In the present embodiment, since the blunt electric insulating portion 103 is provided at the tip of the high-frequency energizing electrode portion 92, after the insulating sleeve 93 is inserted into the prostatic enlargement portion 3, the high-frequency energizing electrode 3 is formed. The part 92 can be advanced with confidence. In addition, since the insulating sleeve 93 and the high-frequency power supply electrode 92 can be independently advanced and retracted, the high-frequency power supply electrode 92 is inserted into the prostatic enlargement 3 and then the high-frequency power supply electrode 92 is turned on. Can be controlled. For this reason, it is possible to perform the energization treatment only on the target tissue or over a wide range.

[Supplementary Notes] (First Group) A puncture treatment device including an insertion portion that can be inserted into a living body lumen, a first electrode that can be inserted into a lumen formed in the insertion portion, and a second electrode that is disposed on the outer periphery of the distal end of the insertion portion A puncture treatment apparatus comprising means for leading the first electrode forward and backward at a predetermined angle from the vicinity of the second electrode at the tip of the insertion section with respect to the axial center of the insertion section. . 2. 2. The puncture treatment apparatus according to claim 1, wherein a balloon is provided at the distal end of the insertion section, and a channel for sending a fluid to the balloon is provided at the insertion section. 3. 2. The high-frequency power supply connected to the electrode for puncture treatment according to claim 1, further comprising means for detecting a coagulation state of the tissue. 4. 4. The puncture treatment device according to claim 3, wherein the high-frequency power supply device is provided with an incision output and a coagulation output means.

(Second Group) A device for performing prostate treatment surrounding the bladder and urethral wall, having a proximal end and a distal end, and a passage extending from the proximal end to the distal end, such as to be introduced into the urethra. An elongate probe member sized, at least one needle disposed in the passage extending from the proximal end to the distal end of the elongate probe member, and attached to the proximal end of the elongate probe member. In a treatment apparatus having an operation section and a means for advancing a needle into the tissue of the prostate by the operation section, the needle includes a high-frequency power supply section having an insulating section attached to a tip thereof; An electric insulating sleeve is provided coaxially with the energizing section, and the operating section is configured to independently advance and retreat the high-frequency energizing section and the electric insulating sleeve, and to the high-frequency energizing section. High frequency energy Which is characterized in that it comprises a switch for imparting ghee. 2. At the same time as providing an insulated portion with a blunt shape at the tip of the high-frequency energizing part, the high-frequency energizing part and the insulating sleeve are each independently constituted by an insertion needle formed of an insulating sleeve having a needle-like tip. Because you can move forward and backward,
After the tip of the electrode penetrates into the prostate due to the needle shape of the insulating sleeve, it is possible to advance only the high-frequency power supply unit and set the range of the part where power supply is actually performed. A catheter and treatment device for treating hypertrophy.

(Two groups of conventional techniques and problems) Treatment of benign prostatic hyperplasia is performed by applying controlled heat to the tissue, which is the proliferative part. When the electrode part advances in the enlarged part, it may be pushed out of the prostate and may damage or heat other tissues. Therefore, great care must be taken to push the high-frequency energized part into the prostate, and it is difficult to make the energized part large, and effective treatment cannot be performed. Conventionally, as a treatment apparatus for this type of prostatic hypertrophy, for example, US Pat. No. 5,549,644 and US Pat. No. 5,554,110 are known. US Pat. No. 5,549,644 comprises a guide tube slidable within a sheath and a needle electrode covered with an insulating sleeve slidable within the guide tube. Also,
U.S. Pat. No. 5,554,110 includes a guide housing having a passageway, a sharpened electrode, and a stylet comprising an insulating sleeve. In USP 5,549,644 and US Pat. No. 5,554,110, the tip of the high-frequency power supply section is sharp, so when pushing the electrode inside the prostate, an incorrect operation may cause the electrode to protrude from the prostate, It is conceivable that heating and energization may occur at the same time as other tissues are damaged, and the electrode could not be pushed safely and easily. In the above-mentioned second group, the high-frequency power supply section can be safely pushed in the prostate to obtain a large power supply range, and the target treatment tissue can be effectively heated.

(Third group) An insertion portion to be inserted into the lumen, a needle electrode having at least one sharply energizable portion disposed at the distal end of the insertion portion so as to be pivotable, and provided at a proximal end of the insertion portion for rotating the needle electrode In the forceps having a high-frequency power supply comprising an operating unit, a sharp portion of the needle electrode is attached to a hand side. 2. 2. The forceps according to claim 1, wherein the needle electrode is positioned between a first position where the sharp portion is stored in the insertion portion and a second position where the sharp portion protrudes laterally with respect to the insertion portion. Characterized by being movable. 3. 3. The forceps according to item 1 or 2, wherein the insertion portion has flexibility.

(Third group of prior art and problems) One of conventional methods for electrically coagulating and incising tissue under an endoscope is disclosed in Japanese Patent Application Laid-Open No. Hei 7-265329 and US Pat. No. 5,554,11.
A device using a puncture electrode as shown in No. 0 is known. In the treatment device disclosed in Japanese Patent Application Laid-Open No. 7-265329, a conductive needle, which can be advanced and retracted in a flexible tube, is punctured into tissue, and a high-frequency current is applied to the puncture portion. Coagulation and incision of nearby tissue. Further, in the treatment device disclosed in US Pat. No. 5,554,110, a needle electrode is disposed in a channel (see FIG. 2) that opens laterally at a distal end portion of a rigid sheath, and can be advanced and retracted. It is intended to make a puncture or incision into the tissue of the side wall of the lumen. JP 7
In the treatment tool disclosed in -265329, since the electrode is oriented only in the axial direction, it is difficult to puncture and treat the electrode on the side of a narrow lumen such as the prostate. U
SP 5,554,110 protrudes to the side of the electrode so that it can easily approach narrow sides of the lumen, such as the prostate. However, since the electrode has a meandering conduit as shown in FIG. 2, at least a part of the electrode requires flexibility. In addition, USP 5,554,1
The electrode shown in No. 10 punctures the needle part by pressing the needle part against the tissue to perform a treatment. Even if such a flexible object is pushed, the force is easily absorbed by the flexible part, and it may not be transmitted to the tip without fail. Therefore, it cannot be said that puncturing and treatment can be performed easily. The third group is made in view of such a point, and reliably transmits the force for puncturing to the needle electrode at the distal end of the treatment tool, and can easily approach the side of the lumen, and the puncturing can be performed. Easy to do treatment (especially for lateral tissues)
However, an object of the present invention is to provide a treatment tool that can be easily and reliably performed.

(Fourth group) An insertion portion that can be inserted into a living body lumen, a high-frequency power supply portion that can be inserted into the insertion portion lumen, and an insulating sleeve that is coaxially disposed with respect to the high-frequency power supply portion, wherein the high-frequency power supply portion and the insulation sleeve are A puncture treatment electrode, wherein the electrode moves forward and backward at a predetermined angle from the distal end of the insertion shaft. 2. 2. The puncture treatment electrode according to claim 1, wherein an insulating portion is attached to a tip of the high-frequency current applying portion. 3. 2. The puncture treatment electrode according to claim 1, wherein an operation unit attached to a proximal end of the insertion unit has means for respectively operating the high-frequency power supply unit and the insulating sleeve. 4. 4. The puncture treatment electrode according to claim 3, further comprising a switch for applying high-frequency energy to the high-frequency power supply unit.

[0057]

As described above, according to the present invention, since damage such as burns is reduced and the puncture direction of the electrode advances and retreats at a predetermined angle, coagulation treatment such as enlargement of the prostate is reliably and reliably performed. It can be performed efficiently.

[Brief description of the drawings]

FIG. 1 is an explanatory diagram of a puncture treatment device according to a first embodiment.

FIG. 2 is an explanatory diagram of a puncture treatment device according to a second embodiment.

FIG. 3 is an explanatory view of a puncture treatment device according to a third embodiment.

FIG. 4 is an explanatory diagram of a puncture treatment device according to a fourth embodiment.

FIG. 5 is an explanatory view of a puncture treatment device according to a fifth embodiment.

FIG. 6 is an explanatory diagram of solidification characteristics.

FIG. 7 is an explanatory diagram of solidification characteristics.

FIG. 8 is an explanatory diagram of a treatment device for benign prostatic hyperplasia according to a sixth embodiment.

FIG. 9 is an explanatory diagram of the operation of the prostatic hypertrophy treatment apparatus according to the sixth embodiment.

FIG. 10 is an explanatory view of a puncture coagulation forceps according to a seventh embodiment.

FIG. 11 is a longitudinal sectional view of a treatment section of a forceps for puncture and coagulation according to a seventh embodiment.

FIG. 12 is an explanatory view of the operation of the treatment section of the forceps for puncture and coagulation according to the seventh embodiment.

FIG. 13 is an explanatory diagram of a treatment device for benign prostatic hyperplasia according to the eighth embodiment.

[Explanation of symbols]

DESCRIPTION OF SYMBOLS 1 ... living body's bladder, 2 ... urethra, 3 ... prostatic enlargement part, 4 ... electrode probe, 5 ... insertion part, 6 ... operation part, 8 ... insertion channel (lumen), 11 ... first electrode, 12 ... insulation Tube, 15: deflecting unit, 16: Second electrode.

 ──────────────────────────────────────────────────続 き Continued on the front page (72) Inventor Masatoshi Tomura 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Industrial Co., Ltd. (72) Inventor Hideto Yoshimine 2-43 Hatagaya, Shibuya-ku, Tokyo No. 2 Inside Olympus Optical Kogyo Co., Ltd. (72) Masahide Oyama 2-43-2 Hatagaya, Shibuya-ku, Tokyo 2nd Inside Olympus Optical Kogyo Co., Ltd. (72) Takahiro Ogasaka 2-43 Hatagaya, Shibuya-ku, Tokyo No. 2 Inside Olympus Optical Co., Ltd. (72) Inventor Kazuya Hijii 2-43-2 Hatagaya, Shibuya-ku, Tokyo (72) Inventor Akio Nakata 2-chome Hatagaya, Shibuya-ku, Tokyo 43-2 Olympus Optical Co., Ltd. (72) Inventor Takeaki Nakamura 2-43-2 Hatagaya, Shibuya-ku, Tokyo Ori Path Optical Industry Co., Ltd. in

Claims (1)

[Claims] 1. An insertion portion that can be inserted into a living body lumen, a first electrode that can be inserted into a lumen formed in the insertion portion, and a second electrode that is disposed on the outer periphery of the distal end of the insertion portion. A puncture treatment device, characterized in that a means is provided for leading and retracting the first electrode at a predetermined angle with respect to the axial center of the insertion portion from the vicinity of the second electrode at the distal end of the insertion portion. Puncture treatment device.