CN104334097B - 组织切除装置 - Google Patents

组织切除装置 Download PDF

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CN104334097B
CN104334097B CN201380028616.3A CN201380028616A CN104334097B CN 104334097 B CN104334097 B CN 104334097B CN 201380028616 A CN201380028616 A CN 201380028616A CN 104334097 B CN104334097 B CN 104334097B
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sealing
tissue
pair
cutting tissue
slit
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CN104334097A (zh
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宫本学
万寿和夫
竹本昌太郎
高桥慎治
三日市高康
铃木聪子
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Olympus Corp
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/08—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by means of electrically-heated probes
    • A61B18/082—Probes or electrodes therefor
    • A61B18/085—Forceps, scissors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
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    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/361—Image-producing devices, e.g. surgical cameras

Abstract

组织切除装置包括：一对把持构件，其用于保持组织；以及盒，其以能够更换的方式安装于所述一对把持构件，所述盒包括：盒主体，其具有长度轴线和沿着所述长度轴线延伸的狭缝，该盒主体利用所述狭缝引导用于切断组织的切断构件，并且限定所述切断构件的移动范围；一对密封部，其以夹着所述狭缝的方式设于所述狭缝的两侧，并分别与所述狭缝平行地延伸；以及组织密封部，其设置在比所述狭缝靠顶端侧的位置且是设置在所述狭缝的延长线上。

Description

组织切除装置
技术领域
本发明涉及一种组织切除装置，更详细地说，涉及一种在整个厚度方向上切除管腔组织的一部分的、用于所谓的整层切除的组织切除装置。
本申请基于2012年11月20日在美国提出临时申请的美国特许出愿第61/728,507号要求优先权，并将其内容引用于此。
背景技术
以往，在胃癌等的治疗中，进行在胃壁的整个厚度方向上切除肿瘤及其周边组织。这种整层切除多通过剖腹手术或腹腔镜下手术来进行。
另外，在专利文献1中记载了一种具有一对钳构件的手术用缝合器。在一对钳构件的一者上安装有装填了缝针的盒，在另一者上安装有具有多个缝针袋的砧座构件。若在一对钳构件之间夹持组织并闭合钳构件，则能够利用缝针缝合组织，并且利用内置的刀具整层切开组织的一部分。
现有技术文献
专利文献
专利文献1：日本国特表2010－522035号公报
发明内容
发明要解决的问题
以往，整层切除是在剖腹手术下、腹腔镜手术下进行的，但是基于进一步减小患者的创伤、或者降低切除肿瘤时的复发风险的观点考虑，正在研究从口等自然开口来进行切除。
但是，在如专利文献1所记载的以往的组织切除装置中，由于只具有第一缝针列，因此若沿着第一拉入线进行缝合和切断，则位于切断构件的切断线的顶端侧(前方)且位于第一缝针列之间的组织未缝合，残留有成为孔那样的状态的部位。因此，在管腔组织的内压升高等的情况下，存在有虽是暂时的、但是产生了管腔组织的内容物有可能从该部位向外部漏出的状态这样的问题。
用于解决问题的方案
本发明的第一技术方案的组织切除装置包括：一对把持构件，其用于保持组织；以及盒，其以能够更换的方式安装于所述一对把持构件，所述盒包括：盒主体，其具有长度轴线和沿着所述长度轴线延伸的狭缝，该盒主体利用所述狭缝引导用于切断组织的切断构件，并且限定所述切断构件的移动范围；一对密封部，其以夹着所述狭缝的方式设于所述狭缝的两侧，并分别与所述狭缝平行地延伸；以及组织密封部，其设置在所述狭缝的顶端侧且是设置在所述狭缝的延长线上。
在本发明的第二技术方案的组织切除装置中，根据上述第一技术方案，也可以是，所述组织密封部对被保持在所述一对把持构件之间并且位于比所述狭缝靠顶端侧的位置的组织进行接合。
在本发明的第三技术方案的组织切除装置中，根据上述第一技术方案，也可以是，所述一对密封部延伸至比所述狭缝靠所述顶端侧的位置，所述组织密封部设于所述一对密封部之间。
在本发明的第四技术方案的组织切除装置中，根据上述第一技术方案，也可以是，所述一对密封部是由配置于所述盒主体内的多个缝针构成的一对缝针列。
在本发明的第五技术方案的组织切除装置中，根据上述第一技术方案，也可以是，所述组织密封部是在所述盒主体内配置于所述狭缝的所述顶端侧的密封缝针。
在本发明的第六技术方案的组织切除装置中，根据上述第一技术方案，也可以是，所述组织密封部是能够与被保持在所述一对把持构件之间并且位于比所述狭缝靠顶端侧的位置的组织相接触的一对电极。
在本发明的第七技术方案的组织切除装置中，根据上述第一技术方案，也可以是，所述组织密封部是能够与被保持在所述一对把持构件之间并且位于比所述狭缝靠顶端侧的位置的组织相接触的一对发热元件。
在本发明的第八技术方案的组织切除装置中，包括：插入部，其沿着长度轴线延伸；一对把持构件，其设于所述插入部的顶端，用于把持组织；切断构件，其通过沿着预定的移动线路进行移动来切断被保持在所述一对钳构件之间的管腔组织；一对密封部，其以夹着所述移动线路的方式设于所述移动线路的两侧，并分别与所述移动线路平行地延伸；以及组织密封部，其设置在所述移动线路的顶端侧且是设置在所述移动线路的延长线上。
在本发明的第九技术方案的组织切除装置中，根据上述第八技术方案，也可以是，所述组织密封部对被保持在所述一对把持构件之间并且位于比所述移动线路靠顶端侧的位置的组织进行接合。
在本发明的第十技术方案的组织切除装置中，根据上述第八技术方案，也可以是，所述一对密封部延伸至比所述移动线路靠所述顶端侧的位置，所述组织密封部设于所述一对密封部之间。
在本发明的第十一技术方案的组织切除装置中，根据上述第八技术方案，也可以是，所述一对密封部是由配置于所述移动线路的两侧的多个缝针构成的一对缝针列。
在本发明的第十二技术方案的组织切除装置中，根据上述第八技术方案，也可以是，所述组织密封部是配置于所述移动线路的所述顶端侧的密封缝针。
在本发明的第十三技术方案的组织切除装置中，根据上述第八技术方案，也可以是，所述组织密封部是能够与被保持在所述一对把持构件之间并且位于比所述移动线路靠顶端侧的位置的组织相接触的一对电极。
在本发明的第十四技术方案的组织切除装置中，根据上述第八技术方案，也可以是，所述组织密封部是能够与被保持在所述一对把持构件之间并且位于比所述移动线路靠顶端侧的位置的组织相接触的一对发热元件。
发明的效果
上述各个技术方案的组织切除装置由于在盒中配置有组织密封部，因此位于切断构件的切断线的顶端侧(前方)且位于一对密封部之间的组织被组织密封部可靠地缝合并密封。另外，在将组织拉入并把持在一对把持构件之间的较窄的间隙内的状态下，首先利用一对密封部和组织密封部缝合组织，在切断构件切断组织之后解除由一对把持构件进行的保持。因而，在使用了组织切除装置的一系列的手法操作中，能够完全不产生管腔组织的内容物有可能向外部漏出的状态地进行组织切除。
附图说明
图1是表示本发明的第一实施方式的组织切除装置的整体结构的图。
图2是表示该组织切除装置的使用时的一动作的图。
图3是表示从该组织切除装置的第二钳构件侧观察第一钳构件和盒看到的状态的局部放大图。
图4A是表示从盒射出缝针的结构的图。
图4B是表示盒内的驱动件的图。
图5是表示切除区域和把持点的图。
图6是表示该组织切除装置的使用时的一动作的图。
图7是表示该组织切除装置的使用时的一动作的图。
图8是表示该组织切除装置的使用时的一动作的图。
图9是表示该组织切除装置的使用时的一动作的图。
图10是表示该组织切除装置的使用时的一动作的图。
图11是表示该组织切除装置的使用时的一动作的图。
图12是表示使用以往的组织切除装置进行缝合和切断后的状态的图。
图13是表示该实施方式的变形例中的刀具的图。
图14是表示该实施方式的变形例中的第一钳构件和盒的顶端侧的局部放大图。
图15是表示本发明的第二实施方式的组织切除装置中的第一钳构件和盒的顶端侧的局部放大图。
图16是表示该组织切除装置中的电连接的图。
图17是表示该实施方式的变形例中的第一钳构件和盒的顶端侧的局部放大图。
具体实施方式
以下，参照图1～图14说明本发明的第一实施方式。
图1是表示本实施方式的组织切除装置1的整体结构的图。组织切除装置1具有设于顶端、并用于对对象组织进行处理的处理部10。另外，组织切除装置1还包括用于操作处理部10的第一操作部30、设于处理部10与第一操作部30之间的纵长的插入部40、贯穿于插入部40的观察部50、用于操作观察部50的第二操作部60以及用于操作处理部的第三操作部70。处理部10具有第一钳构件(第一把持构件)11和第二钳构件(第二把持构件)12作为能够开闭的一对钳构件，使用装填有缝针13A的盒13对组织进行缝合和切离。另外，处理部10的基本结构例如像上述专利文献1所记载的那样是公知的。
第一操作部30具有公知的结构，包括两个拨盘旋钮31、32和锁定杆33。拨盘旋钮31、32利用线等操作构件(未图示)与后述的弯曲部41相连接。在第三操作部70上设有用于开闭操作一对钳构件11、12的第一扳机34和用于进行缝合与切开操作的第二扳机35。
插入部40具有挠性，并形成为沿着长度轴线延伸的管状。在插入部40的顶端侧安装有处理部10，在插入部40的基端侧安装有第一操作部30。插入部40在顶端侧具有公知结构的弯曲部41，该弯曲部41具有多个节环或弯曲块等，通过操作第一操作部30的拨盘旋钮31、32，能够使弯曲部41弯曲。弯曲状态能够通过操作锁定杆33来进行固定。在插入部40的内腔内，以能够沿轴线方向进退的方式贯穿有操作构件。另外，在插入部40的基端侧设有钳子口42，能够将具有钳子部101的一般的内窥镜用处理器具100等插入钳子口42，并使其自第一钳构件11的基端侧突出。
观察部50以能够进退的方式贯穿于插入部40，在观察部50的顶端部具有包括LED等的照明部51和CCD等摄像部件52。另外，在顶端侧具有与弯曲部41相同结构的弯曲部53。观察部50的顶端部能够自设于插入部40的顶端侧的开口43突出没入。由此，例如，如图2所示，通过使观察部50的顶端部突出并使弯曲部53适当地弯曲，能够适当地观察被保持在处理部10的组织等。
第二操作部60与从插入部40的基端侧向外伸出的观察部50的基端相连接。在第二操作部60上设有与第一操作部30相同的拨盘旋钮61、按钮62等。第二操作部60能够进行弯曲部53的弯曲操作、照明部51和摄像部件52的操作等。由摄像部件52获取的影像信号通过通用线缆63发送到未图示的图像处理部，并显示于未图示的显示器等。作为观察部50和第二操作部60，能够通过适当地设定尺寸等而使用公知的内窥镜装置等。
图3是表示从第二钳构件12侧观察第一钳构件11和盒13看到的状态的局部放大图。盒13包括：盒主体14，其具有长度轴线和狭缝14A，该狭缝14A沿着长度轴线延伸，并且供用于切断组织的刀具(切断构件)20移动；一对第一缝针列(一对密封部)15，其在狭缝14A的宽度方向两侧分别与狭缝14A平行地延伸；以及第二缝针(组织密封部、密封缝针)16，其配置在狭缝14A的前方(比狭缝14A靠顶端侧的位置)并且配置在狭缝14A的延长线上。
在第一缝针列15中，多个缝针15A排列配置在盒主体14内，比狭缝14A延伸预定的长度、例如5毫米(mm)至顶端侧。第二缝针16配置在两列第一缝针列15之间。在图3中，示出了配置有两个第二缝针16的例子，但是所配置的个数并无特别限制，也可以是一个，亦可以是三个以上。作为第二缝针而配置的缝针既可以是与第一缝针列相同的缝针15A，也可以是与第一缝针列不同的缝针。
刀具20从盒13的内侧贯穿于狭缝14A，以朝向第二钳构件12突出的状态在狭缝14A内移动。刀具20为了能够整层切断被夹持在一对钳构件11、12之间的组织而在刀具20的突出端进入到设于后述的砧座构件的槽内的状态下沿着狭缝14A进行移动。为此所需的刀具20的刀刃长度比以折回状态保持的对象组织的两张的厚度长，并且比闭合状态的一对钳构件11、12之间的距离长。
图4A是表示从盒13中射出缝针的结构的图。在缝针15A的下方配置有由树脂等形成的驱动件17。在盒13内配置有楔子18，该楔子18在顶端侧具有斜面18A。若操作第二扳机35使楔子18前进，则楔子18向上方顶起与斜面18A相接触的驱动件17。其结果，缝针15A通过被驱动件17按压而自基端侧依次射出并贯穿组织，贯穿后的端部抵靠设于第二钳构件12的砧座构件21而折回。
驱动件17配置于两列第一缝针列15的各缝针，但是在比狭缝14A靠顶端侧的区域中，如图4B所示，配置有用于顶起两列第一缝针列15和第二缝针16的驱动件19。因而，若楔子18顶起驱动件19，则第一缝针列15的缝针15A与第二缝针16一起被顶起而射出。
接着，以整层切除胃(管腔组织)的恶性肿瘤(以下，简称作“肿瘤”。)的情况为例说明组织切除装置1的使用时的动作。
首先，手术者将组织切除装置1从患者的口等导入胃内，使用观察部50对肿瘤进行观察。然后，如图5所示，设定包围肿瘤Tm的大致的切除区域R。为了在组织切除时不损伤肿瘤Tm等，切除区域R优选设定为与肿瘤Tm之间的最短距离为5毫米(mm)以上。
接着，手术者使内窥镜用处理器具100自第一钳构件11突出，如图6所示，利用钳子部101从胃Sm的内侧把持胃壁的自肿瘤Tm离开的一点。由于这一点会成为实际上切除的区域的周缘的一部分，因此优选设定在与所设定的切除区域R的周缘部相当的位置，例如，能够选择距肿瘤Tm的中心30mm左右的部位。以后，将该把持的一点称作第一把持点P1。
接下来，手术者使把持着第一把持点P1的内窥镜用处理器具100后退，适当地操作第一扳机34，同时如图7所示，将胃壁组织ST的一部分拉入第一钳构件11与第二钳构件12之间的间隙内。在拉入时，利用观察部50对肿瘤Tm进行观察，注意使肿瘤Tm不接触一对钳构件来进行拉入。
胃壁组织ST被沿着自第一把持点P1延伸的两条第一拉入线L1拉入第一钳构件11与第二钳构件12之间。即，所拉入的胃壁组织ST以胃的外表面彼此接触的方式使胃的外表面向内侧弯折，以第一拉入线L1的一者与第一钳构件11相对、另一者与第二钳构件12相对的状态被逐渐拉入。一对钳构件的间隙呈较窄的狭缝状，其间隔成为胃壁组织的大致两张的厚度，因此与胃相邻的其他脏器等组织不会与胃壁组织一起被拉入一对钳构件之间。
如果将胃壁组织ST充分地拉入一对钳构件11、12之间，则手术者操作第二扳机35。由此，在盒13内，楔子18朝向顶端前进，并从基端侧依次顶起被配置于第一缝针列15的各个缝针15A的下方的驱动件17。其结果，缝针15A从基端侧朝向顶端侧依次抵靠被设于第二钳构件12的砧座构件21(参照图4A)，贯穿胃壁组织ST后的缝针15A的两端部折回。其结果，在第一拉入线L1的两侧，弯折的胃壁组织ST以在整个厚度方向上成为一体的方式被缝合。
进而，刀具20(参照图4A)稍微晚于楔子18朝向顶端前进，沿着大致第一拉入线L1切断位于缝合了胃壁组织ST的第一缝针列15的列之间的胃壁组织。其结果，如图8所示，胃壁的一部分被整层切断。在此，在刀具20的移动线路(实质上与狭缝14A相同)的延长线上的前方，位于第一缝针列15的列之间的胃壁组织被第二缝针16缝合为一体。
在沿着第一拉入线L1的切断和缝合结束之后，手术者向体腔外拔出组织切除装置1并将盒13更换为装填有缝针的新的盒，再次导入胃内。然后，如图9所示，将沿着第一拉入线L1的切断线的与第一把持点P1相反的一侧的端部作为第二把持点P2，并用内窥镜用处理器具100的钳子部101进行把持。
接着，手术者使内窥镜用处理器具100后退，如图10所示，将用钳子部101把持的胃壁组织ST沿着第二拉入线L2拉入一对钳构件11、12内。此时，以弯折为外表面彼此接触的胃壁组织的棱线rg通过一对钳构件11、12内的方式拉入胃壁组织ST。
之后，若以与上述相同的操作进行缝合和切断，则沿着第二拉入线L2对胃壁组织ST进行切断和缝合。进而，如图5所示，第一拉入线L1与第二拉入线L2形成闭合的四边形，因此如图11所示，包括肿瘤Tm在内的切除区域R内的胃壁组织ST被沿着第一拉入线L1和第二拉入线L2形成的切断线自胃Sm切离。这样的话，在胃Sm上不会残留有孔，胃壁组织ST的一部分被整层切除。
切除结束后，手术者拔出组织切除装置1，对切除的胃壁组织ST(切除片)进行回收并结束手法操作。此时，也可以用钳子部101把持切除片，同时进行组织切除装置1的拔出与切除片的回收。
如开头所说明的那样，以往，整层切除是在剖腹手术下、腹腔镜手术下进行的，但是基于进一步减小患者的创伤、或者降低切除肿瘤时的复发风险的观点考虑，正在研究从口等自然开口来进行切除。
但是，在如上述专利文献1所记载的以往的组织切除装置中，由于只具有第一缝针列，因此若沿着第一拉入线进行缝合和切断，则如图12所示，位于刀具的切断线的前方且位于第一缝针列之间的组织未缝合，残留有成为孔那样的状态的部位。因此，在管腔组织的内压升高等的情况下，存在有虽是暂时的、但是产生了管腔组织的内容物有可能从该部位向外部漏出的状态这样的问题。
根据本实施方式的组织切除装置1，由于在盒13内配置有作为组织密封部的第二缝针16，因此位于刀具20的切断线的前方且位于第一缝针列15之间的组织被第二缝针16可靠地缝合并密封。另外，在将组织拉入、把持在一对钳构件11、12之间的较窄的间隙内的状态下，首先利用第一缝针列15和第二缝针16缝合组织，在刀具切断组织之后解除由一对钳构件进行的保持。因而，在使用了组织切除装置1的一系列的手法操作中，能够完全不产生管腔组织的内容物有可能向外部漏出的状态地进行组织切除。
另外，由于在将组织拉入闭合的一对钳构件11、12之间的比较窄的狭缝状的间隙内之后进行缝合和切断，因此即使与胃等管腔组织相邻的其他脏器、组织等要被一起拉入，也在间隙的入口被阻止。因而，即使是无法目视确认管腔组织的外部的经自然开口的路径(日文：アプローチ)，也能够不误将这些脏器、组织等与管腔组织一起进行缝合或切断地进行手法操作。
在本实施方式中，说明了在比狭缝14A靠顶端侧的位置利用共同的驱动件射出第一缝针列的缝针与第二缝针的例子，但是用于射出缝针的结构并不限定于此。例如，也可以使顶起第二缝针的驱动件与第一缝针列的驱动件相独立。具体地说，如图13所示，也可以设为在刀具20的前方设置第二楔子23、并且用第二楔子23顶起用于顶起第二缝针16的驱动件22的结构。或者，也可以设为用第二楔子23顶起共同的驱动件19的结构，或者设为用第二楔子23顶起所有的驱动件的结构。
另外，在上述例子中，第一缝针列的缝针的方向与第二缝针的方向平行，但也可以像图14所示的变形例那样设置为第二缝针16A的长度方向与供刀具20移动的狭缝14A正交。如果这样设置的话，能够在更大的范围内接合狭缝的前方的组织，能够更可靠地进行组织切除。
接着，说明本发明的第二实施方式。本实施方式的组织切除装置71与第一实施方式的组织切除装置1的不同之处在于组织吻合部的结构。另外，在以后的说明中，对与已经说明的结构共同的结构，标注相同的附图标记并省略重复说明。
图15是表示组织切除装置71中的第一钳构件11和盒72的顶端侧的局部放大图。在狭缝14A的前方，取代第二缝针而设有线状或带状的第一电极73。在第一电极73的周围配置有绝缘体74，与处理部10的其他金属制部位绝缘。
如图16所示，在设于第二钳构件12的砧座构件75上，在与第一电极73对应的位置设有具有与第一电极73相同结构的第二电极76，第一电极73和第二电极76连接于高频电源77。通电的接通断开能够用操作部(未图示)来进行切换。
在使用组织切除装置71时，与第一实施方式相同地在使用第一缝针列15与刀具20对组织进行了缝合、切断之后，不打开一对钳构件11、12地从高频电源77向被夹持在第一电极73与第二电极76之间的组织通入高频电流。由此，第一电极73和第二电极76这一对电极作为所谓的双极(双极性)的电外科学器具(electrosurgical instrument)发挥作用。其结果，如日本国特开2009－247893等所记载的那样，接触第一电极73和第二电极76而被通电的组织的细胞内成分与细胞外成分均匀化(液体化)，在一对钳构件11、12之间，组织彼此相接合，由于未缝合组织的残存而产生的孔被密封。
在本实施方式的组织切除装置71中，也与第一实施方式相同地能够完全不产生管腔组织的内容物有可能向外部漏出的状态地进行组织切除。
另外，由于组织密封部由第一电极73和第二电极76构成，因此密封部位呈面状进行接合。其结果，能够进一步可靠地堵塞孔。
在本实施方式中，通过通电对相接触的组织进行密封的组织密封部的结构并不限定于上述双极的机构。例如，也可以设为取代第一电极73和第二电极76而将通过通电而自身发热的加热器等发热元件安装于盒和砧座构件、并从两侧对被夹在一对钳构件之间的组织进行加热的结构。根据该结构，这些发热元件作为所谓的热凝固处理器具发挥作用，因此通过适当地设定温度、加热时间，能够接合组织彼此。
另外，电极的形状也并不限于上述线状、带状等，也可以是图17所示的电极73A那样的袋状。
以上，说明了本发明的各个实施方式，但是本发明的保护范围并不限定于上述实施方式，在不脱离本发明的主旨的范围内能够改变构成元件的组合，或者对各个构成元件施加各种变更或进行削除。
例如，在上述实施方式中，说明了进行两次缝合和切断来切除组织的例子，但是缝合和切断的次数并不限于两次。例如，在因肿瘤较大等而设定了较大的切除区域的情况下，由于钳构件的大小的关系，有时两次无法完全切断。在这种情况下，若在以弯折的管腔组织的棱线不通过狭缝内的方式拉入管腔组织的一部分的状态下进行第2次缝合和切断，则在第2次缝合和切断后，切除的组织也未被切离。之后，根据需要重复相同的缝合和切断，最后通过使管腔组织的棱线通过狭缝内并进行缝合和切断，能够整层切除任意大小的区域。在此，在切除组织片的最后的缝合和切断中，由于在狭缝的前方不存在组织，因此也可以使用没有组织密封部的以往的盒。
此外，成为本发明的组织切除装置的对象的管腔组织并不限定于胃。例如，肠与胃相比，直径较小，但是通过适当地设定缝合器等所使用的器件的尺寸，从而即使在肠等中也能够适当地进行本发明的组织切除方法。
另外，组织切除的对象疾病并不限定于实施方式中说明的肿瘤，当然也能够应用于例如重度的溃疡等其他疾病等。
产业上的可利用性
根据上述各个实施方式，由于在盒内配置有组织密封部，因此位于切断构件的切断线的前方且位于一对密封部之间的组织被组织密封部可靠地缝合并密封。另外，在将组织拉入并把持在一对把持构件之间的较窄的间隙内的状态下，首先利用一对密封部和组织密封部缝合组织，在切断构件切断组织之后解除由一对把持构件进行的保持。因而，在使用了组织切除装置的一系列的手法操作中，能够完全不产生管腔组织的内容物有可能向外部漏出的状态地进行组织切除。
附图标记说明
1、71 组织切除装置；11 第一钳构件(第一把持构件)；12 第二钳构件(第二把持构件)；14 盒主体；14A 狭缝；15 一对第一缝针列(一对密封部)；16 第二缝针(组织密封部、密封缝针)；20 刀具(切断构件)。

Claims (15)

1.一种组织切除装置，其中，该组织切除装置包括：
一对把持构件，其用于保持组织；以及
盒，其以能够更换的方式安装于所述一对把持构件，
所述盒包括：
盒主体，其具有长度轴线；
狭缝，其沿着所述长度轴线延伸，该狭缝引导用于切断组织的切断构件，并且限定所述切断构件的在所述长度轴线的方向上的移动范围；
第1密封部，其以大于所述狭缝的宽度的间隔设于夹着所述狭缝的位置，并与所述狭缝平行地延伸；以及
第2密封部，其用于对所述组织进行接合，其设置在比所述狭缝的顶端靠所述盒主体的顶端侧的位置且是设置在所述狭缝的延长线上。
2.根据权利要求1所述的组织切除装置，其中，
所述第2密封部沿着与所述狭缝的长度轴线正交的方向延伸。
3.根据权利要求1所述的组织切除装置，其中，
所述第2密封部对被保持在所述一对把持构件之间并且位于比所述狭缝靠顶端侧的位置的组织进行接合。
4.根据权利要求1所述的组织切除装置，其中，
所述第1密封部延伸至比所述狭缝靠所述顶端侧的位置，
所述第2密封部设于所述第1密封部之间。
5.根据权利要求1所述的组织切除装置，其中，
所述第1密封部是由配置于所述盒主体内的多个缝针构成的一对缝针列。
6.根据权利要求1所述的组织切除装置，其中，
所述第2密封部是在所述盒主体内配置于所述狭缝的所述顶端侧的密封缝针。
7.根据权利要求1所述的组织切除装置，其中，
所述第2密封部是能够与被保持在所述一对把持构件之间并且位于比所述狭缝靠顶端侧的位置的组织相接触的一对电极。
8.根据权利要求1所述的组织切除装置，其中，
所述第2密封部是能够与被保持在所述一对把持构件之间并且位于比所述狭缝靠顶端侧的位置的组织相接触的一对发热元件。
9.一种组织切除装置，其中，该组织切除装置包括：
插入部，其沿着长度轴线延伸；
一对把持构件，其设于所述插入部的顶端，用于把持组织；
切断构件，其通过沿着预定的移动线路进行移动来切断被保持在所述一对把持构件之间的管腔组织；
第1密封部，其设于夹着所述移动线路的位置，并与所述移动线路平行地延伸；以及
第2密封部，其用于对所述组织进行接合，该第2密封部设置在比所述移动线路的顶端靠所述一对把持构件的顶端侧的位置且是设置在所述移动线路的延长线上。
10.根据权利要求9所述的组织切除装置，其中，
所述第2密封部对被保持在所述一对把持构件之间并且位于比所述移动线路靠顶端侧的位置的组织进行接合。
11.根据权利要求9所述的组织切除装置，其中，
所述第1密封部延伸至比所述移动线路靠顶端侧的位置，
所述第2密封部设于所述第1密封部之间。
12.根据权利要求9所述的组织切除装置，其中，
所述第1密封部是由配置于所述移动线路的两侧的多个缝针构成的一对缝针列。
13.根据权利要求9所述的组织切除装置，其中，
所述第2密封部是配置于所述移动线路的所述顶端侧的密封缝针。
14.根据权利要求9所述的组织切除装置，其中，
所述第2密封部是能够与被保持在所述一对把持构件之间并且位于比所述移动线路靠顶端侧的位置的组织相接触的一对电极。
15.根据权利要求9所述的组织切除装置，其中，
所述第2密封部是能够与被保持在所述一对把持构件之间并且位于比所述移动线路靠顶端侧的位置的组织相接触的一对发热元件。
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