WO2016042849A1

WO2016042849A1 - Biopsy system

Info

Publication number: WO2016042849A1
Application number: PCT/JP2015/065309
Authority: WO
Inventors: 大史江藤; 克次上道; 雄次坂本
Original assignee: オリンパス株式会社
Priority date: 2014-09-16
Filing date: 2015-05-27
Publication date: 2016-03-24
Also published as: CN206007283U

Abstract

In this biopsy system, when the distal end of a sheath (7) is located within the visual field of an optical imaging mechanism, the open surface of a needle tube (3) is located proximal to a sloped section (107a) and the position of the needle tube (3) is fixed with respect to an ultrasonic endoscope (100) by a fixing mechanism (50) so that the direction of the slant of the open surface and the direction of the slant of the sloped section (107a) coincide.

Description

Biopsy system

The present invention relates to a biopsy system.
This application claims priority based on Japanese Patent Application No. 2014-187420 filed in Japan on September 16, 2014, the contents of which are incorporated herein by reference.

Conventionally, an inspection method called biopsy, in which a small amount of body tissue is collected and observed with a microscope, is known. When collecting deep tissue such as organs, it is difficult to observe with an optical endoscope, so an ultrasonic tomographic image of the organ is obtained with an ultrasonic endoscope, etc. A tissue may be collected by inserting a biopsy needle.

For example, Patent Document 1 discloses a treatment instrument device including a needle tube used for biopsy and an outer sheath through which the needle tube is inserted. The needle tube of the treatment instrument device disclosed in Patent Document 1 can be fixed in the rotational direction with respect to the sheath.
Patent Document 2 discloses that the rotation of the treatment instrument relative to the treatment instrument channel is regulated at the distal end of the treatment instrument channel of the endoscope.
Patent Document 3 discloses an example of the structure of a treatment instrument channel in an ultrasonic endoscope.

Japanese Unexamined Patent Publication No. 2006-288615 Japanese Unexamined Patent Publication No. 2010-154895 Japanese Unexamined Patent Publication No. 2007-236684

In the techniques disclosed in Patent Documents 1 to 3, the rotation direction of the needle tube relative to the treatment instrument channel cannot be simply fixed in a state where the needle tube of the treatment instrument is accommodated in the treatment instrument channel of the ultrasonic endoscope. . For this reason, for example, when the needle tube accommodated in the sheath curved by the treatment instrument channel of the endoscope is advanced and retracted in the sheath, the sharp tip of the needle tube and the sheath may interfere with each other. Conceivable.

The present invention has been made in view of the above-described circumstances, and an object thereof is to provide a biopsy system in which interference between the distal end of a needle tube housed in a curved sheath and the sheath does not easily occur. is there.

A first aspect of the present invention includes a treatment tool for performing treatment on a living body, an optical imaging mechanism for performing observation, and an endoscope having a channel for inserting the treatment tool, The treatment instrument is provided at a distal portion of the channel of the endoscope, and a slope portion that is inclined so as to bend the treatment instrument in a direction inclined with respect to a center line of the endoscope; A sheath that can be inserted into the channel; a needle tube that is inserted into the sheath so as to be able to advance and retreat in the sheath; and a surface that is formed at a distal end of the needle tube and is inclined with respect to the long axis of the needle tube. An opening surface and a fixing mechanism that restricts rotation of the needle tube disposed in the channel around the long axis of the needle tube and fixes the direction of the tip of the needle tube in a predetermined direction with respect to the slope portion And comprising In a state where the distal end of the slope is located within the field of view of the optical imaging mechanism, the opening surface is located proximal to the slope portion, and the tilting direction of the opening surface is determined by the fixing mechanism. In the biopsy system, a position of the needle tube with respect to the endoscope is fixed so that an inclination direction of the slope portion matches.

According to a second aspect of the present invention, in the first aspect, the endoscope has an active bending portion capable of bending operation, the optical imaging mechanism and The treatment instrument may include an operation unit that is fixed to the sheath and moves the needle tube forward and backward with respect to the sheath. When the distal end of the needle tube is moved proximally by the operation unit to the limit in a positional relationship in which the distal end of the needle protrudes from the distal end of the channel and is optically observable by the optical imaging mechanism Furthermore, it may be located inside the hard part and located proximal to the slope part.

According to a third aspect of the present invention, in the second aspect, the fixing mechanism is configured such that the endoscope and the needle tube are centered on a long axis of the needle tube at a proximal opening in the channel. The treatment instrument may be fixed to the endoscope so as not to perform relative rotation.

According to a fourth aspect of the present invention, in the third aspect, the sheath may be a coil sheath.

According to a fifth aspect of the present invention, in the fourth aspect, the channel includes the slope portion, a channel tube extending along a center line of the insertion portion of the endoscope, the channel tube and the slope. And the coil sheath may be deformed following the bent shape of the angle portion when the coil sheath is positioned inside the angle portion. In the angle portion, the constituting wire may be closer to the wire closer to the tip of the needle tube than the wire far from the tip of the needle tube in the radial cross section of the coil sheath. .

According to the above embodiments, interference between the tip of the needle tube housed in the curved sheath and the sheath is unlikely to occur.

1 is an overall view of a biopsy system including an endoscope treatment tool according to an embodiment of the present invention. It is sectional drawing of the front-end | tip part of the ultrasonic endoscope which is an endoscope of the biopsy system of the embodiment. It is sectional drawing of the front-end | tip part of the treatment tool for endoscopes. It is sectional drawing which shows the state in which the treatment tool for endoscopes was attached to the ultrasonic endoscope. It is a fragmentary sectional view showing the treatment tool for endoscopes. It is a figure which shows the operation part of the treatment tool for endoscopes. It is a perspective view which shows the attachment state of the treatment tool for endoscopes, and the ultrasonic endoscope. It is explanatory drawing which shows the effect | action of the biopsy system. It is explanatory drawing which shows the effect | action of the biopsy system. It is explanatory drawing which shows the effect | action of the biopsy system.

An embodiment of the present invention will be described. FIG. 1 is a diagram illustrating a schematic configuration of a biopsy system 150 according to the present embodiment including the treatment tool 1 and the ultrasonic endoscope 100. FIG. 2 is a cross-sectional view of the distal end portion of the ultrasonic endoscope 100 that is an endoscope of the biopsy system 150.
The biopsy system 150 according to the present embodiment is a medical device that can be used for biopsy for collecting tissue in the body. The biopsy system 150 includes an ultrasonic endoscope 100 and an endoscope treatment tool 1 (hereinafter simply referred to as “treatment tool”).

As shown in FIG. 1, the ultrasonic endoscope 100 includes an insertion portion 101 that is inserted into the body from the distal end, an operation portion 109 that is attached to the proximal end of the insertion portion 101, and one end at the side of the operation portion 109. Is connected to the other end of the universal cord 112 via the branch cable 112a, and the optical observation unit is connected to the other end of the universal cord 112 via the branch cable 112b. 114 and an ultrasonic observation unit 115 connected to the other end of the universal cord 112 via a branch cable 112c.

The insertion portion 101 is provided with a hard portion 102, a bending portion 105, and a flexible tube portion 106 arranged in this order from the distal end side.

The hard part 102 includes an optical imaging mechanism 103 for performing optical observation and an ultrasonic scanning mechanism 104 for performing ultrasonic observation.

The optical imaging mechanism 103 controls an imaging optical system whose field of view is directed obliquely forward of the hard portion 102, an image sensor such as a CCD or CMOS that detects an image of a subject incident through the imaging optical system, and the operation of the image sensor. Various configurations (not shown) such as a CPU to perform are provided.

The ultrasonic scanning mechanism (probe) 104 includes an ultrasonic transducer (not shown) that emits and receives ultrasonic waves. The ultrasonic scanning mechanism 104 receives the reflected wave reflected by the ultrasonic wave emitted from the ultrasonic vibrator when it hits the observation target, and observes the signal based on the ultrasonic wave received by the ultrasonic vibrator. Output to the unit 115. The ultrasonic scanning mechanism 104 of the present embodiment is used to acquire an ultrasonic image of a tissue that is a biopsy target, and to acquire an ultrasonic image of the needle tube 3 in the course of a biopsy procedure.

The bending portion 105 is formed in a cylindrical shape. When the angle wire (not shown) that is fixed to the distal end 105a (see FIG. 4) of the bending portion 105 and extends to the operation portion 109 is pulled by the operation portion 109, the bending portion 105 is bent in a predetermined direction. That is, the bending portion 105 is an active bending portion. The bending portion 105 of this embodiment can be bent in two directions along the ultrasonic scanning direction.
In the present embodiment, for example, an endoscope having a thin outer diameter that can be bent in two directions is used for respiratory treatment. However, for example, when performing digestive organ treatment, the outer diameter is used. However, an endoscope that can be bent in four directions with a high degree of freedom of operation may be used.

The flexible tube portion 106 is a cylindrical member that is formed flexibly so that the rigid portion 102 can be guided to a desired position in the lumen tissue or the body cavity.
Inside each of the bending portion 105 and the flexible tube portion 106, a channel 107 and a conduit (not shown) for performing air supply / water supply and suction are provided.

The channel 107 shown in FIGS. 1 and 2 is a cylindrical portion for inserting the treatment instrument 1.
One end of the channel 107 is opened in the vicinity of the distal end portion of the hard portion 102, and the other end of the channel 107 is opened on the side surface on the distal end side of the operation portion 109. A base end cap 108 formed in a flange shape is fixed to the other end of the channel 107. The treatment tool 1 used together with the ultrasonic endoscope 100 can be fixed to the proximal end cap 108.

As shown in FIG. 2, the channel 107 includes a slope portion 107a inclined with respect to the axis C1 of the insertion portion 101 in the hard portion 102, and an angle tube 107b (angle portion) connected to the base end of the slope portion 107a. And a channel tube 107c connected to the proximal end of the angle tube 107b.

The slope portion 107a is provided in the hard portion 102 by forming a through hole in the hard portion 102 with a straight line inclined with respect to the axis C1 of the insertion portion 101 as a center line. The center line C2 of the through hole formed in the slope portion 107a is at a position included in the scanning surface (substantially the same as the curved surface described above) of the ultrasonic scanning mechanism 104. For this reason, when the treatment instrument 1 is inserted through the slope portion 107a, the slope portion 107a can guide the needle tube 3 of the treatment instrument 1 to the above-described scanning plane.
The inclination angle of the center line C2 of the slope portion 107a with respect to the axis C1 of the insertion portion 101 may be set as appropriate corresponding to the site to be treated. In the present embodiment, the center line C2 of the slope portion 107a is inclined with respect to the axis C1 of the insertion portion 101 at an angle of 26 degrees, for example.

The angle tube 107b is bent or bent at a predetermined angle in order to change the direction of the distal end of the treatment instrument 1 guided from the channel tube 107c to the slope portion 107a in a direction along the center line C2 of the slope portion 107a. It is a curved tube. The angle tube 107b connects the slope portion 107a and the channel tube 107c. In the present embodiment, the angle tube 107b has an arc shape bent with a constant curvature.

The channel tube 107c is opened toward the distal end side of the insertion portion 101 in a direction parallel to the direction of the axis C1 of the insertion portion 101 in the vicinity of the proximal end of the hard portion 102, and substantially parallel to the axis C1 of the insertion portion 101. It extends to the base end side of the insertion portion 101 and is fixed to the base end cap 108.

The operation unit 109 shown in FIG. 1 has an outer surface formed so that an operator who uses the ultrasonic endoscope 100 can hold it in his / her hand, and pulls the angle wire to cause the bending unit 105 to bend. A bending operation mechanism 110 and a plurality of switches 111 for supplying air, supplying water, or sucking through a pipeline.

The light source device 113 is a device for emitting illumination light for imaging by the optical imaging mechanism 103.

The optical observation unit 114 is configured to display an image captured by the image sensor of the optical imaging mechanism 103 on the monitor 116.

The ultrasonic observation unit 115 receives a signal output from the ultrasonic scanning mechanism 104, generates an image based on the signal, and displays the image on the monitor 116.

Next, the configuration of the treatment instrument 1 will be described. FIG. 3 is a cross-sectional view of the distal end portion of the treatment instrument 1. FIG. 4 is a cross-sectional view showing a state in which the treatment instrument 1 is attached to the ultrasonic endoscope 100. FIG. 5 is a partial cross-sectional view showing the treatment instrument 1. FIG. 6 is a diagram showing the operation unit 8 of the treatment instrument 1.

As shown in FIGS. 1 and 3, the treatment instrument 1 includes an insertion body 2 to be inserted into the body, an operation section (treatment instrument operation section) 8 for operating the insertion body 2, and a stylet (core metal). 27.

The insert 2 is a long member that can be attached to the channel 107 so as to protrude from the distal end of the insertion portion 101 of the ultrasonic endoscope 100. The insert 2 includes a needle tube 3 and a cylindrical sheath 7 into which the needle tube 3 is inserted.

The needle tube 3 is a cylindrical member that has a distal end and a proximal end, and is advanced and retracted by the operation unit 8.
The material of the needle tube 3 is preferably a material that has flexibility and elasticity that can be easily restored to a linear state even when bent by an external force. For example, as the material of the needle tube 3, an alloy material such as a stainless alloy, a nickel titanium alloy, or a cobalt chromium alloy can be employed.

At the tip of the needle tube 3, an opening 31 is formed for sharpening the tissue to puncture the needle tube 3 and sucking the tissue inside the needle tube 3.
The opening 31 provided at the distal end of the needle tube 3 is formed in an opening surface 31a generated by obliquely cutting off the distal end of the tubular member forming the needle tube with respect to its own axis X1, so that it can be inserted into a living tissue. It is sharply formed. The specific shape of the opening 31 may be appropriately selected from various known shapes in consideration of the target tissue and the like.

3 is made of a flexible tubular member. The sheath 7 is formed as a cylindrical coil sheath by winding a wire made of metal or the like in a coil shape. The strands constituting the sheath 7 are appropriately selected by paying attention to the bendability and restoring force of the sheath 7 such as a shape memory alloy or a superelastic alloy as a material and a circular shape or a rectangular shape as a shape. The sheath 7 may have the above-described coil sheath and a resin coating that covers the outer surface of the coil sheath. The above-described covering of the sheath 7 may be appropriately disposed on the outer surface of the above-described coil sheath in consideration of slidability with respect to the channel 107, ease of bending of the insertion body 2, restoring force, and the like.

The sheath 7 extends from the tip of the operation unit 8 as shown in FIG. The base end of the sheath 7 is fixed to the operation unit 8.

As shown in FIGS. 5 and 6, the operation unit 8 includes an operation main body 9, a sheath adjuster 18 provided on the distal end side of the operation main body 9, a fixing mechanism 50 disposed on the sheath adjuster 18, and the operation main body 9. Needle slider 23 provided on the proximal end side.

The operation body 9 is made of, for example, ABS resin and has a lumen through which the needle tube 3 and the sheath 7 can be inserted. The distal end side of the operation body 9 is inserted into a sheath adjuster 18 formed in a tubular shape. The proximal end side of the operation body 9 is inserted into a needle slider 23 formed in a tubular shape. The operation main body 9 and the sheath adjuster 18, and the operation main body 9 and the needle slider 23 are engaged with each other by a groove or a projection (not shown) formed on the outer peripheral surface, so that relative rotation around the axis is suppressed, and the axial direction Is slidable.

The fixing screw 54 is attached to the sheath adjuster 18. The fixing screw 54 passes through the sheath adjuster 18 and is fitted in a screw hole (not shown) provided in the operation main body 9. When the fixing screw 54 is tightened with respect to the operation main body 9, the sheath adjuster 18 is pressed against the operation main body 9, and the sheath adjuster 18 and the operation main body 9 can be fixed in a non-slidable manner. By changing the positional relationship between the sheath adjuster 18 and the operation main body 9, the protruding length of the sheath 7 from the channel 107 when the operation unit 8 is fixed to the ultrasonic endoscope 100 can be adjusted. The protrusion length can be fixed by the screw 54.

As shown in FIG. 1, the axis of the fixing screw 54 is preferably arranged so as to be directed to the axis of the operation unit 109 housed in the holder 52. Thereby, since the fixing screw 54 is not biased left and right when the operation unit 8 is positioned in the front, it can be easily operated regardless of the operator's dominant hand. As long as the axis of the fixing screw 54 is directed toward the axis of the operation unit 109 accommodated in the holder 52, substantially the same effect can be obtained even if the fixing screw 54 is attached to the opposite side of FIG.

The outer peripheral surface of the distal end portion of the sheath adjuster 18 is provided with irregularities so that the operator can easily grasp it.

The fixing mechanism 50 is provided in the operation unit 8 in order to fix the operation unit 8 to the ultrasonic endoscope 100 in a predetermined positional relationship.
The fixing mechanism 50 includes a slide lock 51 for attaching and detaching the sheath adjuster 18 to the proximal end base 108 of the ultrasonic endoscope 100, and a pair of

wall portions

52a and 52b that abut on the operation unit 109 of the ultrasonic endoscope 100. And a support pipe 53 protruding from the tip of the sheath adjuster 18.
The slide lock 51 is slidable in a direction perpendicular to the axis of the operation unit 8, and engages with the base end cap 108 by this sliding movement. When the slide lock 51 is engaged with the base end cap 108, the operation unit 8 is fixed to the ultrasonic endoscope 100.

The holder 52 is disposed on the distal end side of the slide lock 51 and is fixed to the sheath adjuster 18. The pair of

wall portions

52a and 52b of the holder 52 are substantially parallel, and the distance is set to a value that allows the distal end side of the operation unit 109 of the ultrasonic endoscope 100 to be accommodated without rattling.

The holder 52 and the slide lock 51 restrict the rotation of the needle tube 3 about the long axis (center line) of the needle tube 3 with respect to the channel 107. That is, first, the slide adjuster 18 is engaged with the base end base 108 with the slide lock 51 engaged with the base end base 108 while the pair of

wall portions

52 a and 52 b constituting the holder 52 are in contact with the operation unit 109. It becomes a fixed state.

Here, the operation main body 9 and the sheath adjuster 18 and the operation main body 9 and the needle slider 23 are prevented from rotating relative to each other around the axis line by engaging grooves (not shown) or projections formed on the outer peripheral surface with each other. However, it can slide in the axial direction. Therefore, when the sheath adjuster 18 is fixed to the base end cap 108, the sheath 7 and the needle tube 3 disposed in the channel 107 are both restrained from relative rotation around the center line of the channel 107. Has been.

In addition, since the sheath 7 and the needle tube 3 try to eliminate twist by the restoring force of the sheath 7 and the needle tube 3, the sheath adjuster 18 is fixed at the proximal end base 108 at the distal portion of the channel 107. In this state, the angle tube 107b and the slope portion 107a are oriented in a predetermined direction.
In the present embodiment, the predetermined direction is a direction in which the opening surface 31a of the needle tube 3 is inclined toward the outside of the arc of the angle tube 107b. In other words, in the radial cross section of the sheath 7, the tip of the needle tube 3 is in a position close to the inside of the arc in the sheath 7 curved in the angle tube 107b. That is, the tip of the needle tube 3 in the predetermined direction is aligned with the strand of the sheath 7 curved in the angle tube 107b when the needle tube 3 is operated to the distal side of the sheath 7 by the operation unit 8. It is guided to the slope portion 107a without touching.

In the present embodiment, the setting of the orientation of the opening surface 31a of the needle tube 3 with respect to the ultrasonic endoscope 100 is the same as that of the needle tube 3 when the flexible tube 106 in the insertion portion 101 of the ultrasonic endoscope 100 is in a straight state. The positional relationship with the channel 107 is set as described above. That is, in this embodiment, the twist of the flexible tube portion 106 according to the flexibility of the flexible tube portion 106 is not considered in the setting of the orientation of the opening surface 31a. This is because in the ultrasonic endoscope 100 according to the present embodiment and other general flexible endoscopes, the amount of bending deformation of the insertion portion that is twisted around the center line is not so large. This is because the rotational follow-up performance of a treatment instrument or the like is sufficiently high.

When the ultrasonic endoscope 100 is assumed to be used in such a posture that the flexible tube 106 is extremely twisted around its center line, the twist of the flexible tube 106 is taken into consideration. The direction of the opening surface 31a may be set.

The support pipe 53 shown in FIG. 5 is a hard pipe made of, for example, stainless steel. The distal end portion of the support pipe 53 is inserted into the channel 107 when the treatment instrument 1 is attached to the ultrasonic endoscope 100. The support pipe 53 is inserted into the operation body 9. The base end of the support pipe 53 is located closer to the base end side (for example, position P1 shown in FIG. 6) than the tip end of the needle slider 23 in a state where the needle slider 23 is most advanced with respect to the operation body 9. The sheath 7 is inserted into the support pipe 53, and the base end portion protrudes from the base end of the support pipe 53 and is fixed to the operation body 9 by adhesion or the like.

The needle slider 23 is fixed to the proximal end of the needle tube 3. Further, the needle slider 23 is connected to the operation main body 9 so as to be movable with respect to the operation main body 9.
Since the proximal end side of the needle tube 3 protrudes from the proximal end of the sheath 7 and is fixed to the needle slider 23, the needle tube 3 is moved from the distal end of the sheath 7 by sliding the needle slider 23 with respect to the operation body 9. Can be plunged. A stopper 61 is movably attached to the operation main body 9 at the distal end side of the needle slider 23. The stopper 61 has a fixing screw 62 and can be fixed to the operation body 9 by tightening the fixing screw 62. As shown in FIG. 1, the axis of the fixing screw 62 is preferably arranged so as to be directed to the axis of the operation unit 109 housed in the holder 52. Thereby, since the fixing screw 62 is not biased left and right when the operation unit 8 is positioned in front, it can be easily operated regardless of the operator's dominant hand. As long as the axis of the fixing screw 62 is directed toward the axis of the operation unit 109 that is accommodated in the holder 52, substantially the same effect can be obtained even if the fixing screw 62 is attached facing the opposite side to FIG.

The fixing screw 62 may be directed in the same direction as the fixing screw 54 described above, or may be directed in directions opposite to each other.

As shown in FIG. 5, the needle slider 23 can only move forward with respect to the operation main body 9 to a position where it comes into contact with the stopper 61. Therefore, by adjusting the fixing position of the stopper 61 with respect to the operation main body 9, The maximum protruding length from can be adjusted. In the present embodiment, the operation stroke length L2 of the needle tube 3 by the needle slider 23 is at least 40 mm.

The state where the needle slider 23 is at the position where the needle slider 23 has moved to the limit on the proximal end side of the operation body 9 is the initial state before the treatment tool 1 is used. In the initial state, the tip of the needle tube 3 is in the sheath 7. Further, in a positional relationship (see FIG. 4) in which the sheath 7 is attached to the channel 107 of the ultrasonic endoscope 100 and the distal end portion of the sheath 7 can be optically observed by the ultrasonic endoscope 100 (see FIG. 4), The tip is located closer to the tip than the tip 105 a of the bending portion 105.

In the present embodiment, in the initial state, the needle tube 3 and the sheath 7 are arranged in the channel tube 107c over the entire area of the bending portion 105. For this reason, the content of the channel tube 107c in the whole area of the bending part 105 is uniform hardness, and the difference in hardness which changes the bending performance of the bending part 105 partially does not arise.

The position of the tip of the needle tube 3 with respect to the sheath 7 in the initial state varies depending on the influence of the expansion or contraction of the sheath 7 and the extension or contraction of the needle tube 3. Variations in the position of the distal end of the needle tube 3 with respect to the sheath 7 are affected by temperature, humidity, the attachment state of the ultrasonic endoscope 100 to the channel 107, the amount of operating force applied to the treatment instrument 1, and the like.

For example, when the sheath 7 and the needle tube 3 are formed of different materials, the expansion coefficient corresponding to the temperature change is different between the sheath 7 and the needle tube 3, so that the needle slider 23 is provided on the proximal end side of the operation body 9. Even in the initial state where the needle slider 23 is at the position where the needle has moved to the limit, the position of the needle tube 3 with respect to the sheath 7 varies depending on the temperature.

Further, in the process of inserting the insertion body 2 into the channel 107 (see FIG. 4), the sheath 7 may meander to the center line of the needle tube 3 due to the compressive force in the center line direction. In a state where the distal end of the insertion body 2 is guided to the distal end of the channel 107, the distal end of the needle tube 3 is located closer to the distal end of the sheath 7 than in a state where the insertion body 2 is not inserted into the channel 107. .

In the present embodiment, considering the temperature, humidity, the state of attachment of the ultrasonic endoscope 100 to the channel 107, and the amount of operation force applied to the treatment tool 1, the initial state is assumed in the environment assumed as the procedure using the treatment tool 1. Then, as shown in FIG. 5, it is set so that the tip of the needle tube 3 is always in the sheath 7.

The amount of movement of the needle slider 23 relative to the operation body 9 substantially corresponds to the amount of movement of the tip of the needle tube 3 relative to the sheath 7 (see FIG. 5). That is, when the needle slider 23 moves the needle tube 3 relative to the sheath 7, the movement amount (relative stroke length L1) of the needle tube 3 with respect to the sheath 7 is changed to the actual movement amount (operation stroke length L2) of the needle slider 23. ) Plus the expansion or contraction of the needle tube 3. The expansion or contraction of the needle tube 3 depends on the elasticity (elasticity) of the needle tube 3 itself, the magnitude of the frictional resistance between the needle tube 3 and the sheath 7, the meandering state of the sheath 7 in the channel 107, and the needle tube 3 in the sheath 7. Affected by the meandering state.

When the needle slider 23 is at the position where the needle slider 23 has moved to the limit on the distal end side of the operation body 9, the distal end of the needle tube 3 protrudes from the distal end of the sheath 7. The protruding length of the needle tube 3 when the needle slider 23 is at the position where the needle slider 23 has moved to the limit on the distal end side of the operation body 9 is shorter than the operation stroke length L2 of the needle slider 23, but may be at least 40 mm. preferable. The protruding length of the needle tube 3 when the needle slider 23 is at the position where the needle slider 23 has moved to the limit on the distal end side of the operation body 9 may be less than 40 mm.

An opening 23 a is provided at the proximal end portion of the needle slider 23, and the stylet 27 can be inserted into the needle tube 3 from the proximal end of the needle tube 3.
A knob 27 a attached to the proximal end portion of the stylet 27 can be attached to the opening 23 a. A screw thread for attaching the knob 27a may be provided in the opening 23a. Further, a known syringe or the like can be connected to the opening 23a, and an object in the needle tube 3 can be sucked. The outer peripheral surface of the distal end portion of the needle slider 23 is provided with irregularities so that the operator can easily grasp it.

The stylet 27 shown in FIGS. 3 and 5 has a knob 27a that can be attached to the opening 23a of the needle slider 23, and a core 27b fixed to the knob 27a.
The core 27 b has a cross-sectional shape corresponding to the inner surface shape of the needle tube 3. In the present embodiment, the core 27b has a circular cross section.

An operation when the biopsy system 150 having the above configuration is used will be described. FIG. 7 is a perspective view showing a state in which the treatment instrument 1 and the ultrasonic endoscope 100 are attached. 8 to 10 are explanatory diagrams showing the operation of the biopsy system 150. FIG.
Hereinafter, a biopsy procedure in which a lesion located in the deep part of the lung is used as a target tissue and the needle tube 3 of the treatment instrument 1 is inserted and the cells of the lesion are collected through the needle tube 3 will be described as an example.

First, the operator inserts the insertion portion 101 of the ultrasonic endoscope 100 shown in FIG. 1 into the body, observes with the optical imaging mechanism 103, and appropriately inserts the insertion portion 101 to the vicinity of the target tissue while curving the bending portion 105. Introduce the tip. After the introduction, the surgeon determines a site to perform a biopsy based on the observation results by the optical imaging mechanism 103 and the ultrasonic scanning mechanism 104.

Next, the surgeon inserts the insertion body 2 of the treatment instrument 1 from the distal end side into the channel 107 from the proximal end cap 108 provided in the operation unit 109 of the ultrasonic endoscope 100. Furthermore, as shown in FIG. 7, the surgeon enters the distal end side of the operation unit 109 between the pair of

wall portions

52 a and 52 b of the holder 52, and then slide slide 51 provided in the operation unit 8 of the treatment instrument 1. Is engaged with the base end cap 108. Thereby, the operation unit 8 of the treatment instrument 1 is fixed to the ultrasonic endoscope 100 so as not to rotate with respect to the operation unit 109.

The needle tube 3 guided in the channel 107 along the curved flexible tube portion 106 is protected so that the tip of the needle tube 3 does not break through the sheath 7. Further, due to the frictional resistance between the inner surface of the channel 107 and the outermost surface of the insert 2, the sheath 7 may accumulate shrinkage and meander due to compression as the insert 2 is pushed into the channel 107. In this case, the distal end of the sheath 7 moves toward the proximal end relative to the needle tube 3. In this case as well, the distal end of the needle tube 3 is protected by the sheath 7.

At this time, the treatment instrument 1 is in the initial state described above. The distal portion of the sheath 7 is guided from the channel tube 107c to the slope portion 107a through the angle tube 107b. At this time, the tip of the needle tube 3 is located between the proximal end of the angle tube 107 b and the distal end of the bending portion 105. In the present embodiment, the tip of the needle tube 3 is in the hard portion 102.

When the sheath 7 is deformed following the curved shape of the angle tube 107b, some of the strands constituting the sheath 7 are separated from each other. That is, in the curved shape of the sheath 7, the strands are opened outside the arc, and the strands are maintained in close contact with each other inside the arc. In the region where the strands are open in the outer portion of the arc in the curved shape of the sheath 7, there is no gap that allows the tip of the needle tube 3 to go out of the sheath 7 through the gap between the strands. Further, the proximal end portion of the opening surface 31a can come into contact with the wire corresponding to the outer portion of the arc in the curved shape of the sheath 7. That is, the sharp part which is the tip part of the opening surface 31 a is in a floating state with respect to the strand of the sheath 7.

For this reason, when the needle tube 3 is moved with respect to the sheath 7 along the center line of the sheath 7, the strands of the sheath 7 are bent so that the needle tube 3 is curved and guided to the slope portion 107 a. The needle tube 3 can be guided through the opening surface 31a. For this reason, the tip of the needle tube 3 does not come into contact with the wire constituting the sheath 7 and does not touch the inner surface of the channel 107, and moves forward and backward in a curved region from the angle tube 107b to the slope portion 107a. Is possible.

Next, the operator loosens the fixing screw 54 and observes the sheath 7 and the inside of the body with the optical imaging mechanism 103 and the ultrasonic scanning mechanism 104, and moves the sheath adjuster 18 and the operation body 9 relative to each other as shown in FIG. The amount of protrusion of the sheath 7 from the distal end of the insertion portion 101 of the ultrasonic endoscope 100 is adjusted to an appropriate amount. After the adjustment, the operator tightens the fixing screw 54 to fix the protrusion amount.

In the biopsy system 150 of the present embodiment, in the state where the distal end of the sheath 7 is located within the field of view of the optical imaging mechanism 103, the opening surface 31a of the needle tube 3 is located proximal to the slope portion 107a. At the same time, the position of the needle tube 3 with respect to the ultrasonic endoscope 100 is fixed by the fixing mechanism 50 so that the inclination direction of the opening surface 31a coincides with the inclination direction of the slope portion 107a.
The opening surface 31a of the needle tube 3 may be positioned on the slope portion 107a.

Even after the amount of protrusion of the sheath 7 is adjusted, the tip of the needle tube 3 is in the sheath 7. Further, the tip of the needle tube 3 is located at any position in the channel 107 between the curved portion 105 and the angle tube 107b, in the angle tube 107b, or in the slope portion 107a.

Next, based on the observation result by the ultrasonic scanning mechanism 104, the stopper 61 is moved in consideration of the distance to the target tissue T to be biopsied and fixed to the operation main body 9 at a desired position, and the maximum of the needle tube 3 is obtained. Adjust the protrusion length.

Next, as shown in FIG. 8, the surgeon advances the needle slider 23 toward the distal end side of the operation unit 8. Then, as shown in FIG. 9, the needle tube 3 protrudes from the sheath 7. When the operator advances the needle slider 23 toward the distal end side of the operation unit 8 with the distal end of the needle tube 3 between the curved portion 105 and the angle tube 107 b, the distal end of the needle tube 3 constitutes the sheath 7. As it passes through the angle tube 107b while being guided by the wire to be moved, its direction is changed to the direction of the center line of the slope portion 107a and reaches the slope portion 107a (see FIG. 4).

Even when the tip of the needle tube 3 is moved to the tip side starting from the angle tube 107b, and when the tip of the needle tube 3 is moved to the tip side starting from the slope portion 107a, the tip of the needle tube 3 is also as described above. Is projected from the distal end of the sheath 7 while being guided by the strands of the sheath 7.

When the operator advances the needle slider 23 toward the distal end side of the operation unit 8, as shown in FIG. 10, the distal end of the needle tube 3 is punctured into the tissue and is pushed forward to the target tissue T to be biopsied. At this time, the needle tube 3 exposed to the outside from the surface of the tissue can be observed by the optical imaging mechanism 103, and the tip side portion of the needle tube 3 inserted into the tissue is observed by the ultrasonic scanning mechanism 104. Can do.

The surgeon can observe an ultrasonic image based on the ultrasonic wave received by the ultrasonic scanning mechanism 104 with the ultrasonic observation unit 115 shown in FIG. With reference to the image of the needle tube 3 clearly displayed on the ultrasonic observation unit 115, the operator causes the tip of the needle tube 3 to reach the target tissue T on which biopsy is performed.

Next, the surgeon pushes out the tissue that has not entered into the needle tube 3 and is not subjected to biopsy with the stylet 27, and pulls out the stylet 27 from the insert 2 and the operation unit 8. Thereby, a through hole extending from the distal end of the needle tube 3 to the proximal end of the needle slider 23 is generated. The surgeon connects a syringe or the like to the proximal end of the needle slider 23 and sucks the inside of the needle tube 3, and sucks and collects cells of the target tissue T to be biopsied from the tip of the needle tube 3.

When a necessary amount of cells and the like have been collected, the needle slider 23 is retracted toward the proximal end side of the operation unit 8 and the distal end of the needle tube 3 is accommodated in the sheath 7. Thereby, the needle tube 3 comes out of the tissue. When the needle tube 3 is removed from the tissue, the slide lock 51 is removed from the proximal end cap 108 of the operation unit 109 of the ultrasonic endoscope 100, and the treatment instrument 1 is removed from the channel 107. Finally, the ultrasonic endoscope 100 is removed from the patient, and the series of treatments is completed.

As described above, in the present embodiment, the operation unit 8 of the treatment instrument 1 is fixed to the operation unit 109 of the ultrasonic endoscope 100 in the predetermined direction, so that The opening surface 31 a of the needle tube 3 comes into contact, and the tip of the needle tube 3 comes into contact with the strand of the sheath 7, or the tip of the needle tube 3 enters a gap portion separated by the curvature of the sheath 7 in the strand of the sheath 7. It is suppressed. That is, in the biopsy system 150 of the present embodiment, interference between the distal end of the needle tube 3 and the sheath 7 hardly occurs. For this reason, in this embodiment, the puncture property to the tissue is deteriorated due to the strand of the sheath 7 coming into contact with the distal end of the needle tube 3, or the treatment instrument 1 or the ultrasonic endoscope 100 is broken by the needle tube 3 breaking through the sheath 7. Is prevented from being damaged.

In addition, since the fixing mechanism 50 has a configuration for connecting the operation units (the operation unit 109 and the operation unit 8) of the ultrasonic endoscope 100 and the treatment instrument 1 to each other, the distal portion of the channel 107 And the opening 31a at the tip of the needle tube 3 can be easily positioned outside the body.

As mentioned above, although embodiment of this invention was explained in full detail with reference to drawings, the concrete structure is not restricted to this embodiment, The design change etc. of the range which does not deviate from the summary of this invention are included.
For example, instead of the curved or bent cylindrical angle tube 107b, a curved or bent through-hole (angle part) may be formed in the hard part 102 in the same manner as the angle tube 107b. In this case, the angle tube 107b is unnecessary.

According to the above embodiment, interference between the distal end of the needle tube housed in the curved sheath and the sheath is unlikely to occur.

1 treatment tool (endoscopic treatment tool)
DESCRIPTION OF SYMBOLS 2 Insert 3 Needle tube 31 Opening of needle tube 31a Opening surface 7 Sheath 8 Operation part 9 Operation main body 18 Sheath adjuster 23 Needle slider 27 Stylet (core metal)
27a Knob 27b Core 50 Fixing mechanism 51 Slide lock 52 Holder (fixing part)
52a, 52b A pair of wall parts 53 Support pipe 54 Fixing screw 61 Stopper 62 Fixing screw 100 Ultrasound endoscope 101 Insertion part 102 Hard part 103 Optical imaging mechanism 104 Ultrasonic scanning mechanism 105 Bending part 106 Flexible pipe part 107 Channel 107a Slope part 107b Angle tube (angle part)
107c Channel tube 108 Base end 109 Operation unit 110 Bending operation mechanism 111 Multiple switches 112 Universal code 113 Light source device 114 Optical observation unit 115 Ultrasound observation unit 116 Monitor 150 Biopsy system

Claims

A treatment tool for treating a living body;
An endoscope having an optical imaging mechanism for observation and a channel for inserting the treatment instrument;
With
The treatment tool is
A slope portion provided at a distal portion of the channel of the endoscope and inclined so as to bend the treatment instrument in a direction inclined with respect to a center line of the endoscope;
A sheath that can be inserted into the channel;
A needle tube inserted into the sheath so as to be able to advance and retreat in the sheath;
An opening formed at the tip of the needle tube and having a surface inclined with respect to the long axis of the needle tube;
A fixing mechanism that restricts rotation of the needle tube disposed in the channel around the long axis of the needle tube, and fixes the direction of the tip of the needle tube in a predetermined direction with respect to the slope portion;
With
In a state where the distal end of the sheath is located within the field of view of the optical imaging mechanism, the opening surface is located on the proximal side of the slope portion, and the fixing mechanism causes the opening surface to be inclined. A biopsy system in which the position of the needle tube with respect to the endoscope is fixed so that the inclination direction of the slope portion coincides with that of the slope portion.
The biopsy system according to claim 1,
The endoscope is
An active bending portion capable of bending operation;
A hard part provided with the optical imaging mechanism and the slope part on the distal side of the active bending part;
Have
The treatment instrument includes an operation unit that is fixed to the sheath and moves the needle tube forward and backward with respect to the sheath.
In a positional relationship where the distal end of the sheath protrudes from the distal end of the channel and is optically observable by the optical imaging mechanism, the tip of the needle tube is moved to the limit by the operation unit to the limit side. A biopsy system that is located inside the hard part and proximal to the slope part.
A biopsy system according to claim 2,
The fixing mechanism fixes the treatment instrument to the endoscope so that the endoscope and the needle tube do not rotate relative to each other about the long axis of the needle tube at the proximal opening of the channel. Biopsy system.
A biopsy system according to claim 3,
The biopsy system, wherein the sheath is a coil sheath.
A biopsy system according to claim 4,
The channel is
The slope portion;
A channel tube extending along the center line of the insertion portion of the endoscope;
An angle portion connecting the channel tube and the slope portion;
Have
When the coil sheath is located inside the angle portion, the coil sheath is deformed following the bent shape of the angle portion,
The strands constituting the coil sheath are formed in the angle portion so that the strands closer to the tip of the needle tube in the radial section of the coil sheath are denser than the strands farther from the tip of the needle tube. Inspection system.