JP2000037348A - Endoscope for treatment - Google Patents

Abstract

PROBLEM TO BE SOLVED: To easily treat the tissue part of an affected part or the like over a wide range by using an endoscope provided with at least two channels for passing through a treatment tool. SOLUTION: This endoscope 1 is provided with at least two channels 21 and 22 for passing through the treatment tool. In this case, the tip opening parts 23 and 24 of at least one or more of the plural channels 21 and 22 are provided with forceps electing table 27 for controlling the projecting direction of a treatment tool projecting therefrom, and the table 7 is fixed so as to erect the treatment tool in the direction of being away from the parts 23 and 24 of the other channel 21 and 22.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a treatment endoscope having two or more channels through which a treatment tool is inserted.

[0002]

2. Description of the Related Art In recent years, a technique of endoscopically treating a lesion generated in an organ by inserting an insertion portion of an endoscope into the organ has been widely performed. For example, early cancers formed on the inner wall of the stomach are treated by EMR (endoscopic mucosal resection) without laparotomy.

[0003] When performing an operation for removing a wide range of tissue portions, it is preferable to use an endoscope having two or more forceps channels. In this case, while pulling up the mucous membrane of the lesion with a grasping forceps or the like inserted through one forceps channel, a snare wire of a high-frequency snare inserted through the other forceps channel is hung on the tissue surrounding the lesion, and the periphery of the lesion is wrapped. A relatively wide area of the tissue is excised in order to bind and resect the mucosal tissue.

[0004]

However, in the above-mentioned conventional endoscopic surgery, the cutting area is determined by the direction of the high-frequency snare protruding from the endoscope and the opening diameter of the distal end hood of the endoscope insertion portion. Therefore, in order to resect a tissue part over a wider range, the operation of resecting the affected part is performed several times. When resecting a tissue portion over a wide range, the operation becomes complicated and much time is required. In the case of this type of transendoscopic operation, it is necessary to check the cut end face of the cut tissue in order to check the residual cancer tissue immediately after the operation. However, when the excision is performed in a plurality of parts, it is very difficult to confirm the excision. Furthermore, it is difficult to perform full-thickness resection including the intrinsic muscle layer in transendoscopic surgery using a conventional endoscope.

[0005] When an affected part is resected endoscopically, a two-channel endoscope is used and an electric scalpel inserted through the other forceps channel while grasping the affected part with a grasping forceps inserted from one forceps channel. It is also conceivable to resect the affected area. However, in this case, since each treatment tool protrudes from the distal end opening of each forceps channel in a substantially parallel state, the distal end of the electric scalpel is applied to the affected part while grasping the affected part with grasping forceps, for example, over a wide range. It is very difficult to remove the affected part.
Also, in an endoscope having a forceps raising mechanism, the direction in which the forceps are raised is a direction approaching the other forceps channel side. It is not suitable for resection over a wide area. As described above, with the conventional endoscope, it is difficult to resect a living tissue in a wide range and deeply, for example, all layers including the proper muscle layer.

The present invention has been made in view of the above-mentioned problems, and an object of the present invention is to easily form a tissue portion such as an affected area over a wide area by using a device having at least two channels through which a treatment tool is inserted. It is an object of the present invention to provide a medical treatment endoscope capable of performing medical treatment.

[0007]

SUMMARY OF THE INVENTION The present invention provides at least two
In a treatment endoscope having at least one treatment instrument insertion channel, a raising mechanism for controlling a projecting direction of a treatment instrument protruding from the distal end opening of at least one of the plurality of channels is provided. The raising mechanism has a function of raising the treatment tool in a direction away from the distal end opening of another channel.

According to the present invention, it is possible to easily treat a tissue portion such as an affected area over a wide area by using two or more treatment tools and moving the distal ends of the treatment tools in directions away from each other. Become. For example, by moving the distal end of the grasping forceps by the raising mechanism while gripping the living tissue with the grasping forceps inserted through the channel having the raising mechanism, the living tissue can be pulled in a direction to open the cut surface. This makes it easy for an electric scalpel or the like inserted into another channel to easily approach the cut surface. In particular, in the case of a flexible living tissue, it is easier to cut when working while applying a certain amount of tension.

[0009]

[First Embodiment] FIGS. 1 to 6
A first embodiment of the present invention will be described with reference to FIG. (Structure) FIG. 1 is a perspective view conceptually showing a use state of the first embodiment. In the first embodiment, a soft insertion portion 2 of an endoscope 1 having two channels is orally inserted into a body cavity of a patient 3, and an operation such as excision of an affected part is performed in the body cavity. Things. The doctor inserts the insertion section 2 of the endoscope 1 to the target affected part, fixes the endoscope holder 4 on the hand operation section 5 of the endoscope 1, and inserts the treatment tool into the channel of the endoscope 1. For example, the affected part is excised while operating the grasping forceps 6 and the electric scalpel 7 on the hand side. The electric scalpel 7 is connected to an electric scalpel drive unit (not shown), and a high frequency is supplied by an on / off operation of a foot switch (not shown) to cut and coagulate a living tissue.

The insertion section 2 of the endoscope 1 comprises a distal end portion 10, a curved portion 11 adjacent to the distal end portion 10, and a flexible tube 12 connected to the proximal side of the curved portion 11. As shown in FIG. 2, the tip portion 10 has a tip block (body member) 8,
The tip block 8 is covered with a tip cover 9 made of resin such as polysulfone. As shown in FIGS. 2 and 3, the distal end portion 10 has an observation window (image guide lens) 13 of an observation optical system including various lenses and a CCD, an illumination window (light guide lens) 14 of an illumination optical system, and the above observation. A tip nozzle unit 15 that opens toward the window 13 to wash dirt on the observation window 13 by supplying air and water, a sub-water supply channel opening 16 for supplying clean water and the like into the body cavity, and 2.
The tip openings 23 for the channels 21 and 22
24 are formed. Each tip opening 23, 24 is shown in FIG.
As shown by, they are located below the observation window 13 on the distal end surface of the distal end portion 10 and are arranged side by side. That is, the tip openings 23 and 24 of the channels 21 and 22 are provided corresponding to the lower region of the endoscope visual field observed in a normal state.

On the other hand, a light guide cable 35 is connected to the hand operation section 5 of the endoscope 1. An angle knob 36 that is operated to bend the bending portion 11 of the insertion portion 2 is provided on the hand operation portion 5. The hand operation section 5 is provided with two treatment tool insertion ports 37 that are respectively connected to the two channels 21 and 22 side by side. The operation unit 5 is provided with various operation buttons (not shown) for performing switching operations such as air supply, water supply, and suction, and an operation box 39 for various switches.

As shown in FIG. 2, the first channel 21 and the second channel 22 are independently and separately formed in the insertion portion 2, and are formed in parallel along the center of the long axis of the insertion portion 2. It is arranged. The distal end opening 23 of the first channel 21 is linearly opened with the same diameter along the center of the long axis, but is opposite to the first channel 21 in the distal opening 24 of the second channel 22. Is formed on the inner surface portion of which is inclined in a direction in which the distal end is away from the first channel 21.

A forceps raising base housing recess 26 is formed in an inner surface portion of the second channel 22 at the distal end opening 24 which is located on the first channel 21 side. A forceps raising table 27 is stored in the forceps raising table storage recess 26. The forceps raising stand 27 is pivotally attached at its proximal end to a pivot pin 28 attached to and fixed to the distal end block 8, and the distal end portion pivots about the pivot pin 28 so as to be freely raised and lowered. Attached to. Further, a forceps raising wire 29 is provided on a side wall portion of a tip portion of the forceps raising table 27.
The distal end of the treatment tool protruding from the distal end opening 24 of the second channel 22 is pulled up by the forceps raising base 27 by pulling the forceps raising wire 29. A raising mechanism is configured to move away from a falling position parallel to the first channel 21 in a direction away from the first channel 21. That is, the raising mechanism has a function of bending the distal end of the treatment instrument introduced through the second channel 22 in a direction away from the distal end of the treatment instrument introduced through the first channel 21.

The forceps raising wire 29 is guided to the hand operation unit 5 through a guide tube 30 provided in the insertion unit 2 and is connected to a pulling mechanism (not shown) provided in the hand operation unit 5.

(Operation) The insertion section 2 of the endoscope 1 is introduced into a body cavity, and the operation section 5 at hand of the endoscope 1 is fixed to the endoscope holder 4. Next, a treatment tool to be used is inserted into each of the channels 21 and 22 from the treatment tool insertion opening 37 of the hand operation unit 5 and the distal end of the treatment tool is inserted into the channels 21 and 22.
Protrude into the body cavity from the distal end openings 23 and 24 of the body. For example, the electric knife 7 is inserted into the first channel 21 and the second
The grasping forceps 6 is inserted into the channel 22 of. The grasping forceps 6 and the electric scalpel 7 are guided in parallel along the long axis center direction of the insertion section 2, and their distal ends are usually kept as they are.
Project in parallel along the long axis center direction.

Then, as shown in FIG. 4, while grasping the affected part 33 with the grasping forceps 6, the surrounding living tissue portion is incised with the electric scalpel 7. FIG. 6 shows a visual field image by the endoscope 1 at the time of this procedure. When the living tissue portion is incised with the electric scalpel 7, the affected part 33 is grasped by the grasping forceps 6, and the affected part 33 is grasped.
Is held, the electric scalpel 7 can be accurately and easily pressed against the surrounding living tissue portion. In this pressed state, a mixed high frequency for incision and tissue coagulation is applied to the electric scalpel 7 to incise the living tissue portion around the diseased part 33.

When the incision is made to some extent, the cut surface of the living tissue becomes difficult to see. At this time, the grasping forceps 6 is moved in the direction of the arrow in FIGS. 5 and 6 by raising the forceps raising table 27. Then, the affected part 33 is pulled to the right in FIG.
The cut surface of the incised part is greatly opened. Then, the operator continues to press the electric scalpel 7 again to incise the living tissue around the affected part 33. Thus, the affected part 33 can be resected by one continuous operation.

Since normal living tissue is flexible, cutting off while pressing a hard rod-shaped object like the electric scalpel 7 causes the living tissue to escape. Therefore, the grasping forceps 6
By performing the incision work while pulling the affected part with a certain amount of tension, the electric scalpel 7 can be reliably pressed, and the incision work of the living tissue becomes easy.

(Effect) In general, when incising a soft living tissue such as a living tissue, it is easier to work while fixing the affected part 33 without moving the living tissue. In the case of this embodiment, the grasping forceps 6 is inserted into one of the plurality of channels, and
Since the incision is made by the electric scalpel 7 inserted through the other channel while holding and fixing the 3, the cutting operation is easy. Further, the direction in which the grasping forceps 6 is raised by the forceps raising table 27 of the raising mechanism is away from the electric scalpel 7 of the other treatment tool, that is, the distal end portions of both treatment tools are separated from each other. Work can be performed while opening the incision around the. For this reason, it became possible to incise the living tissue deeper than in the conventional method. Further, by performing the work while separating the incised portion of the affected part 33, the work is performed while applying a certain amount of tension to the incised portion, so that the incision becomes easier.

In the first embodiment, an electric scalpel is selected and used as a method for resecting an affected part. However, in addition to the electric scalpel, a treatment tool such as scissors forceps for mechanically resecting tissue or a laser. -An ultrasonic treatment device may be used.

[Second Embodiment] A second embodiment of the present invention will be described with reference to FIGS. (Structure) The endoscope 1 in the present embodiment has a first channel 4
1 of the second channel 42 and 3 of the third channel 43
And a first channel 41 and a third channel 4 with a second channel 42 interposed therebetween.
3 are provided. As described above, a forceps raising mechanism having a forceps raising base for moving the treatment tool inserted therethrough in a direction away from the second channel 42 at the distal end openings of the first channel 41 and the third channel 43. Is provided.

Each of the forceps raising tables provided in the first channel 41 and the third channel 43 can be independently operated by a forceps raising lever provided in a hand operation unit. Other configurations are the same as those of the above-described first embodiment.

(Operation) As shown in FIG. 7, the first channel 41 of the insertion section 2 of the endoscope 1 is inserted into the body cavity.
The first grasping forceps 45 is inserted into the second channel 4
An electric knife 46 is inserted into 2, and a second grasping forceps 47 is inserted into the third channel 43. Then, the first grasping forceps 45 and the second grasping forceps 47 grasp the living tissue portion 48. In this state, the first gripping forceps 45 and the second
The electric scalpel 46 is made to protrude into a region located between the grasping forceps 47, and the living tissue portion 48 is incised by high frequency while the tip thereof is pressed against the living tissue portion 48. Subsequently, the forceps raising tables provided in the first channel 41 and the third channel 43 are raised, and the first gripping forceps 45 and the second gripping forceps 4 are raised.
Move the tips of 7 in opposite directions so as to move away from each other. At this time, by operating each forceps raising mechanism independently, the tip of the electric scalpel 46 is adjusted so as to hit the incision portion of the living tissue portion 48. Subsequently, the electric scalpel 46 is again projected to make an incision in the living tissue portion 48.

(Effect) In order to perform an operation such as incision while grasping the living tissue portion 48 with the two grasping forceps 45 and 47,
The incision of the living tissue portion 48 can be performed more reliably and easily than in the case of fixing the living tissue portion 48 with a single grasping forceps as in the first embodiment. In addition, by independently adjusting the raised state of the grasping forceps 45 and 47, the target incision site of the living tissue portion 48 can be easily brought to the vicinity of the distal end of the electric knife 46.

In the present embodiment, the movements of the forceps raising mechanisms are moved independently of each other. However, the two forceps raising mechanisms are moved in conjunction with one forceps raising lever.
The two grasping forceps 45, 47 may be moved in a direction away from each other. In the case of this method, since it is not necessary to operate each of the plurality of forceps raising levers, work by one operator becomes easy. Further, as shown in FIG. 9, a detachable external channel tube (tubular member) 49 is provided in the insertion portion 2 of the endoscope 1 shown in the first embodiment, and thereby the first channel 41 or the third channel Channel 43 may be formed. In this case, the channel tube 49 extends along the insertion section 2 of the endoscope 1.
Preferably, the channel tube 49 is detachably attached to the insertion section 2 of the endoscope 1.

[Other Endoscope System for Treatment Part 1] As shown in FIGS. 10 to 15, this endoscope system for treatment includes a normal endoscope 51 and a tube-like treatment tool insertion tool 52. Things. The treatment tool insertion tool 52 does not have an optical system such as an image guide and a light guide provided in a normal endoscope or an air / water supply pipe system, and its insertion portion 53 is provided with only a channel 54 through which a treatment tool is inserted. Have been. Other parts have the same structure as a normal endoscope. The insertion portion 53 of the treatment tool insertion tool 52 is formed with a distal end portion 56 in which the distal end opening of the channel 54 opens and a curved portion 57. The curved portion is operated by a hand-side operation portion (not shown). 57 is curved.

The insertion section 58 of the normal endoscope 51 is provided with one channel 59.
The indwellable snare 61 is inserted through the body cavity. The indwelling snare 61 includes a sheath 62 and a snare wire 63.
Can be removed from the tip of the

Then, the insertion section 58 of the endoscope 51 and the insertion section 53 of the treatment tool insertion tool 52 are introduced into the body cavity. At this time, the forceps insertion tool 52 is inserted into the body cavity along the insertion section 58 of the endoscope 51. Thereafter, the indwelling snare 61 is introduced into the body cavity through the channel 59 of the endoscope 51, and the clip device or the grasping forceps 64 is introduced into the body cavity through the channel 54 of the treatment instrument insertion tool 52.

Therefore, as shown in FIG. 10, the affected part 65 is surrounded by the snare wire 63 of the indwellable snare 61. The snare wire 63 thus arranged is gripped together with the living tissue portion by a plurality of clips 66 supplied by a clip device or gripping forceps 64. That is, each clip 6
Numeral 6 simultaneously clips the snare wire 63 and the living tissue portion and fixes them.

Next, as shown in FIG.
A grasping forceps 68 having a large tip grasping portion 67 is inserted into the second channel 54, and the affected part 65 is grasped by the grasping forceps 68. Pull out to the side. Then, as shown in FIG. 11, the affected part 65 is grasped and raised including the intrinsic muscle layer. That is, as shown in FIG. 13, the portion of the diseased part 65 which was a flat part is raised, and in this raised state, the indwelling snare 61 is placed.
The snare wire 63 is squeezed to bind the root of the raised portion. Then, as shown in FIG. 14, the snare wire 63 of the indwelling snare 61 can bind all layers including the proper muscle layer. In this state, the channel 5 of the endoscope 51
9, the electric scalpel 69 is exchanged and passed.
Then, as shown in FIGS. 12 and 15, the surrounding tissue portion of the affected part 65 is incised and the affected part 65 is excised.

According to the present method, in performing full-thickness resection including the intrinsic muscle layer, all the layers including the intrinsic muscle layer can be tied up by the indwelling snare 61 in advance.
No hole is made in the body cavity after resection.

Usually, the inside of the abdominal cavity, which is the outer surface between the inner surface and the outer surface of the luminal organ in the body cavity, is sterile. On the other hand, some bacteria are often present on the inner surface, as represented by the large intestine. Therefore, when a puncture is caused in a luminal organ, bacteria are dispersed in a sterile abdominal cavity, causing peritonitis or the like. According to the present method, there is no danger.

Although the forceps insertion tool used in the present method is inserted along the endoscope, at least a part thereof may be fixed to the endoscope insertion portion. Since the positional relationship between the endoscope and the forceps insertion tool is uniquely determined, the forceps inserted from the forceps insertion tool come within a certain range on the endoscope image, thereby improving workability. . As a fixing method, it is conceivable to use a heat-shrinkable tube or the like to avoid the curved portion of the endoscope and the forceps insertion tool.

[Other Endoscope System for Treatment, Part 2] This endoscope system for treatment raises all layers of the affected part without using forceps. This method will be described with reference to FIGS. First, as shown in FIG. 16, an injection needle-shaped needle 72 is placed on a living tissue 71 such as a muscle layer near the affected area to be raised.
Puncture. Subsequently, as shown in FIG. 17, the tip locking portion 73 inserts the T-shaped protruding jig 74 into the living tissue portion 71 by passing through the needle body 72. The distal end locking portion 73 of the protruding jig 74 is folded substantially linearly in the needle body 72, but recovers to a T-shape when protruding from the distal end of the needle body 72. Subsequently, as shown in FIG. 18, the needle body 72 is pulled out while leaving the raised jig 74. As shown in FIG. 19, when the protruding jig 74 is pulled, since the distal locking portion 73 is T-shaped, the distal locking portion 73 is hooked on the living tissue portion 71 and raises the affected part including the intrinsic muscle layer. Can be done. In this state, the affected part is removed by making an incision with an electric knife 75 or the like.

[Another Endoscope System for Treatment Part 3] FIGS. 20 to 22 show another example of the treatment instrument insertion tool. Although the forceps insertion tool 52 here does not have a built-in component such as an optical system or an air supply / water supply pipe system other than the channel 54 similarly to the forceps insertion tool described above, 5
6 is provided on the side surface. An elevating mechanism having a forceps elevating base 81 for elevating the treatment tool inserted into the channel 54 is provided at the distal end opening 55 of the channel 54.

FIG. 21 shows a situation in which a normal endoscope 51 and the forceps insertion tool 52 are used in combination.
The forceps insertion tool 52 bends the bending portion 57 of the insertion portion 53 and uses the forceps raising table 81 to sandwich the diseased portion 82 therebetween and grasp the diseased portion 82 from the opposite side of the endoscope 51 with the grasping forceps 83. To grip. Then, the affected part 82 is cut off by the electric scalpel 84 inserted into the channel 59 of the endoscope 51. According to this method, the affected part 82 is grasped by the grasping forceps 83 from the opposite side of the endoscope 51 with the affected part 82 interposed therebetween, so that the field of view of the endoscope 51 is not obstructed by the grasping forceps 83.

FIG. 22 shows a scene in which the affected part 82 is resected from the side opposite to the direction in which the endoscope 51 is inserted. First, the affected part 8 is grasped by the grasping forceps 83 using the forceps insertion tool 52.
2 is gripped and the affected part 82 is raised. The endoscope 51 is inverted inside the lumen, and the affected part 82 is excised by the electric scalpel 84 from the side opposite to the insertion direction of the endoscope 51.

FIGS. 23 to 26 show, for example, the Barrett's esophagus and the like using the treatment endoscope 1 having two channels as in the first embodiment.
This is an example in the case of treating reflux esophagitis.

First, as shown in FIG. 23, while holding the insertion portion 2 of the endoscope 1 inserted into the stomach in a substantially linear state, a large grasping forceps 86 is inserted into one channel 21 and the other channel is inserted. Insert a large clip device 87 into 22,
The distal ends of the gripping forceps 86 and the clip device 87 are made to protrude from the distal end of the insertion section 2 of the endoscope 1.

Subsequently, as shown in FIG. 24, the bending portion 11 of the insertion portion 2 of the endoscope 1 is bent, and the distal end portion 10 of the insertion portion 2 is inverted in the stomach so as to look up at the cardia of the stomach. Then, the user grasps the cardia and the stomach tissue with the large grasping forceps 86. Subsequently, as shown in FIG. 25, the grasped tissue portions of both the esophagus and the stomach are clip-fixed with a large clip device 87. By repeating this, as shown in FIG.
An artificial valve is formed between the esophagus and the stomach to prevent reflux of gastric juice.

[Other Endoscope System for Treatment No. 5] This endoscope system for treatment relates to a procedure performed using a side-view type endoscope. The method will be described with reference to FIGS.

FIG. 27 is a longitudinal sectional view of the vicinity of the distal end of the insertion section 90 of a side-view type endoscope having two or more channels. As shown in FIG. 27, a first channel 91 and a second channel 92 are provided in the insertion section 90, and both of these channels 91 and 92 are provided in a hand operation section of an endoscope (not shown). It is formed independently from the forceps insertion port provided to the distal end portion 93 of the insertion portion 90, and communicates with distal end openings 96 and 97 formed in a distal end block (body member) 94 of the distal end portion 93, respectively. In addition, each of the channels 91 and 92 is provided with an insertion section 9
It is arranged up and down on a vertical plane along the direction of the central axis 0.

The front end block 94 of the front end 93 is provided with various lenses (not shown), a CCD / light guide cable, an air / water supply line, a front end nozzle unit, and the like. The tip block 94 is covered with a tip cover 98 made of resin such as polysulfone.

A forceps erecting base 101 is provided in the distal end opening 96 of the first channel 91, and this forceps erecting base 101 is provided.
Is fixed so as to be rotatable around a pin 102 fixed to the end block 94, and a forceps raising wire 103 is connected and fixed to an end opposite to the fixing pin 102. The forceps raising wire 103 is connected to a pulling mechanism provided in a not-shown operation unit. Then, the pulling mechanism is operated by the forceps raising lever, and the forceps raising wire 103 is pulled to raise the forceps raising table 101. Thereby, the grasping forceps 105 inserted into the first channel 91 moves in the direction of the arrow in FIG. When the forceps raising wire 103 is returned, the forceps raising table 101 falls down, and the grasping forceps 105 are
Move in the opposite direction of the middle arrow.

The distal end opening 97 of the second channel 92 is formed at the distal end of the insertion portion 90 at an angle of less than 90 ° with respect to the center axis direction of the insertion portion 90. . Then, the electric scalpel 106 inserted through the second channel 92 is inserted and removed at an angle of less than 90 ° with respect to the center axis direction of the insertion portion 90.

FIG. 28 shows the use state of the endoscope. The affected part is grasped by the grasping forceps 105 protruding from the first channel 91 of the endoscope in which the insertion section 90 is inserted into the body cavity, and
The affected part 107 is excised with the electric scalpel 106 protruding from the channel 92. The incision is opened by adjusting the raised state of the grasping forceps 105, and the incision is made with the electric knife 107 while applying tension.

Further, the grasping forceps 105 is inserted through the second channel 92, and the electric knife 1 is inserted through the first channel 91.
07 may be inserted to perform a surgical procedure. In this case, the approach can be performed by the electric knife 107 from the opposite side of the insertion direction of the endoscope, which is relatively difficult to approach.

By approaching the affected part with a side-viewing type endoscope in this way, it is possible to perform treatment while viewing the affected part in a site where it is difficult to see the frontal view with a direct-viewing type endoscope. In addition, since the resection is performed while being held by the holding forceps, the incision can be easily performed because the incision can be performed with an electric scalpel or the like while firmly fixing the soft living tissue.

[Other treatment endoscope method 6] In this treatment endoscope method, a distal end cap 112 is provided at a distal end portion 111 of the endoscope in a procedure performed using a side-view type endoscope. It is a thing. The method will be described with reference to FIGS.

FIG. 30 shows a state in which a distal end cap 112 is attached to a distal end portion 111 of the insertion section 90 of the above-described side-view type endoscope. The tip cap 112 is made of a transparent material such as polycarbonate having a rubber portion 113 for fixing the tip cap 112 to the rigid portion of the tip portion 111 and an opening 114 in the side view direction of the tip portion 111 as shown in FIG. And a hard transparent cap portion 115.

FIGS. 32 to 34 show examples of how to use the endoscope with the tip cap 112 attached. With the insertion portion 90 inserted into the body cavity, the high-frequency snare 121 is inserted through the second channel, and the snare wire 122 of the high-frequency snare 121 is projected from the opening at the distal end. The snare wire 122 expands within the tip cap 112. In this state, the opening 114 of the tip cap 112 is pressed against the affected part 123 and the first channel 91 is pressed.
The snare wire 122 is pulled in, the snare wire 122 is pulled in, the affected portion 123 is tightened by the snare wire 122, and the high frequency is supplied to the snare wire 122 to apply the high frequency to the affected portion 123.
Cut off.

According to this method, compared to the conventional side-view type endoscope, this endoscope is provided with a channel having a distal end opening along the axial direction of the insertion portion.
A procedure using a tip cap can be easily performed with a side-viewing type endoscope.

<Supplementary Notes> In a treatment endoscope having at least two or more treatment tool insertion channels, a raising control for controlling a projecting direction of a treatment tool protruding from a distal end opening of a channel of at least one of a plurality of channels. An endoscope for treatment, wherein a mechanism is provided, and the elevating mechanism is set so that a direction for elevating the treatment tool is away from a treatment tool protruding from a distal end opening of another channel. 2. 2. The medical treatment endoscope according to claim 1, wherein two channels are built into an insertion portion of the endoscope. 3. 3. The medical treatment endoscope according to claim 2, wherein the two channels are provided corresponding to positions below the endoscope field of view observed in a normal state. 4. 3. The medical treatment endoscope according to claim 2, wherein the two channels are provided one each in the left-right direction of the endoscope visual field observed in a normal state.

5. 2. The treatment endoscope according to claim 1, further comprising a tubular member in which a channel through which a treatment tool is inserted is formed, and the tubular member being detachably attached along an insertion portion of the endoscope. The means is provided on the tubular member. 6. In the medical treatment endoscope according to the above item 5, the tubular member attached to the insertion portion of the endoscope is defined so as to be attached to the opposite side to the operation direction of the forceps raising mechanism provided in the endoscope. That are characterized by 7. 7. The medical treatment endoscope according to claim 6, wherein the distal end of the tubular member attached to the insertion portion of the endoscope is provided with means for bending the distal end of the tubular member in a predetermined direction. What to do. 8. 2. The medical treatment endoscope according to claim 1, wherein three channels are incorporated in an insertion portion of the endoscope.

9. 9. The medical treatment endoscope according to claim 8, wherein all three channels are provided below an endoscope visual field observed in a normal state. 10. 9. The endoscope for treatment according to the item 8, wherein at least two of the three channels are provided one each in the left and right direction of the endoscope field of view observed in a normal state. What to do. 11. Item 9. The treatment endoscope according to Item 8, wherein the operating direction of raising the forceps is such that the protruding direction of the inserted treatment tool is moved right and left away from each other.

[0056]

As described above, according to the present invention, an elevating mechanism for controlling the protruding direction of a treatment tool protruding from the distal end opening of at least one of a plurality of channels is provided. The mechanism can be controlled so that the direction in which the treatment tool rises is away from the treatment tool protruding from the opening at the tip of another channel. Can be easily performed.

[Brief description of the drawings]

FIG. 1 is an exemplary perspective view conceptually showing a usage state of a first embodiment;

FIG. 2 is a vertical cross-sectional view near the distal end of the insertion section of the endoscope according to the first embodiment.

FIG. 3 is a front elevational view of a distal end portion of the insertion section of the endoscope according to the first embodiment.

FIG. 4 is an explanatory diagram of a usage state of the endoscope according to the first embodiment.

FIG. 5 is an explanatory diagram of a usage state of the endoscope according to the first embodiment.

FIG. 6 is a view of a visual field image by the endoscope in a use state of the endoscope according to the first embodiment.

FIG. 7 is an explanatory diagram of a usage state of the endoscope according to the second embodiment.

FIG. 8 is an explanatory diagram of the usage state of the endoscope according to the second embodiment.

FIG. 9 is an explanatory diagram of a usage state of a modification of the endoscope according to the second embodiment.

FIG. 10 is an explanatory diagram of a use state by another treatment endoscope.

FIG. 11 is an explanatory diagram of a use situation by the treatment endoscope.

FIG. 12 is an explanatory diagram of a use state by the treatment endoscope.

FIG. 13 is an explanatory diagram of a treatment state of a living tissue by the treatment endoscope.

FIG. 14 is an explanatory diagram of a treatment state of a living tissue by the treatment endoscope.

FIG. 15 is an explanatory diagram of a treatment state of a living tissue by the treatment endoscope.

FIG. 16 is an explanatory diagram of a treatment state of a living tissue with still another treatment endoscope.

FIG. 17 is an explanatory diagram of a treatment state of a living tissue by the treatment endoscope.

FIG. 18 is an explanatory diagram of a treatment state of a living tissue by the treatment endoscope.

FIG. 19 is an explanatory diagram of a treatment state of a living tissue by the treatment endoscope.

FIG. 20 is a perspective view of another example of the treatment tool insertion tool.

FIG. 21 is an explanatory diagram of a treatment state of a living tissue by the treatment tool insertion tool.

FIG. 22 is an explanatory view of a treatment state of a living tissue by the treatment tool insertion tool.

FIG. 23 is an explanatory view of a state of use by still another treatment endoscope.

FIG. 24 is an explanatory diagram of a treatment state of a living tissue by the treatment endoscope.

FIG. 25 is an explanatory diagram of a treatment state of a living tissue by the treatment endoscope.

FIG. 26 is an explanatory diagram of a treatment state of a living tissue by the treatment endoscope.

FIG. 27 is a longitudinal sectional view of a distal end portion of still another treatment endoscope.

FIG. 28 is an explanatory diagram of a treatment state of a living tissue by the treatment endoscope.

FIG. 29 is an explanatory diagram of a treatment state of a living tissue by the treatment endoscope.

FIG. 30 is a perspective view of a distal end portion of still another treatment endoscope.

FIG. 31 is a perspective view showing the distal end portion of the treatment endoscope with a part of a distal end cap cut away.

FIG. 32 is an explanatory view of a treatment state of a living tissue by the treatment endoscope.

FIG. 33 is an explanatory diagram of a treatment state of a living tissue by the treatment endoscope.

FIG. 34 is an explanatory diagram of a treatment state of a living tissue by the treatment endoscope.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Endoscope 2 ... Insertion part 6 ... Grasping forceps 7 ... Electric scalpel 21 ... 1st channel 22 ... 2nd channel 23 ... 1st channel tip opening 24 ... 2nd channel tip opening 26 … Forceps raising table storage recess 27… forceps raising table 29… forceps raising wire

 ────────────────────────────────────────────────── ─── Continuing on the front page (72) Inventor Keiichi Arai 2-43-2 Hatagaya, Shibuya-ku, Tokyo F-term in Olympus Optical Co., Ltd. (reference) 2H040 DA03 DA12 DA17 DA18 DA51 DA56 4C060 GG23 GG24 GG32 JJ12 KK03 KK04 KK06 KK09 KK16 4C061 AA01 BB02 CC06 DD03 FF43 GG15 HH24 HH25

Claims (1)

[Claims] 1. A treatment endoscope having at least two or more treatment instrument insertion channels, the direction in which a treatment instrument protrudes from a distal end opening of at least one of the plurality of channels. An endoscope for treatment, comprising: a raising mechanism for controlling a treatment tool, wherein the raising mechanism has a function of raising the treatment tool in a direction away from a distal end opening of another channel.