JP2000033071A - Endoscope therapeutic device - Google Patents
Endoscope therapeutic deviceInfo
- Publication number
- JP2000033071A JP2000033071A JP10203479A JP20347998A JP2000033071A JP 2000033071 A JP2000033071 A JP 2000033071A JP 10203479 A JP10203479 A JP 10203479A JP 20347998 A JP20347998 A JP 20347998A JP 2000033071 A JP2000033071 A JP 2000033071A
- Authority
- JP
- Japan
- Prior art keywords
- endoscope
- treatment
- tool
- tube
- body cavity
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Granted
Links
Abstract
PROBLEM TO BE SOLVED: To provide an endoscope therapeutic device which is capable of adequately and easily guiding an endoscope and a therapeutic means or the therapeutic means to a lesion section and is capable of surely executing the therapy of the lesion section when the endoscope and the therapeutic means are introduced into a patient. SOLUTION: This endoscope therapeutic device has an endoscope 1 having an insertion implement part 7 and executes the therapy of the intra-coeliac section by a treatment implement 4 to be used in combination with this endoscope 1. The device described above has a regulating means for regulating the relative distance between both of the insertion part 21 for at least either of the treatment implement 4 to be inserted in juxtaposition on the outer side of the insertion part 7 of the endoscope 1 and an insertion implement 2 for guiding to the desired position the insertion part 7 of the endoscope 1 near the front end of the insertion part 7 of the endoscope 1. This regulating means is disposed in at least either of the insertion part 7 of the endoscope 1 and the insertion part 21 of the insertion implement 2.
Description
【０００１】[0001]
【発明の属する技術分野】本発明は、挿入部を有した内
視鏡及びこれに付随する器具により体腔内の病変部位を
治療する内視鏡治療装置に関する。BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an endoscope having an insertion portion and an endoscope treatment apparatus for treating a lesion site in a body cavity by using an accessory.
【０００２】[0002]
【従来の技術】挿入部を有する内視鏡及びこれに付随す
る処置具により体腔内の病変部位を処置する治療が従来
より行われている。特に、複数の管路を有した挿入案内
具を体腔内に挿入し、各管路に内視鏡と処置具とを個別
に挿通して内視鏡と処置具とを異なる方向から病変部位
に誘導して治療を行う技術に関しては特開昭５４−１３
６７８０号公報に開示されている。2. Description of the Related Art A treatment for treating a lesion in a body cavity with an endoscope having an insertion portion and a treatment tool attached to the endoscope has been conventionally performed. In particular, an insertion guide having a plurality of conduits is inserted into a body cavity, an endoscope and a treatment tool are individually inserted into each conduit, and the endoscope and the treatment tool are inserted into a lesion site from different directions. Japanese Patent Application Laid-Open No. 54-13 / 1979 discloses a technique for performing treatment by induction.
It is disclosed in Japanese Patent No. 6780.
【０００３】[0003]
【発明が解決しようとする課題】（従来技術の問題点）
前述の公報に記載の従来技術によると、体腔内に挿入さ
れる、複数の管路が形成された挿入案内具により内視鏡
と処置具との相対位置が定められて、内視鏡と処置具と
の病変部位への誘導が行われる。しかし、挿入案内具に
形成された複数の管路を通じて内視鏡と処置具とが体腔
内に導入されるため、内視鏡と処置具との相対位置が狭
い範囲に制限されやすい。その結果、例えば胃内におけ
る病変部位の所在位置によっては内視鏡と処置具との相
対位置が不適切な関係となり、適切な治療、例えば病変
部位の切除などを確実に行えないという不具合が生じる
虞があった。[Problems to be Solved by the Invention]
According to the prior art described in the above-mentioned publication, the relative position between the endoscope and the treatment tool is determined by the insertion guide that is inserted into the body cavity and has a plurality of conduits, and the endoscope and the treatment are performed. The device is guided to the lesion site. However, since the endoscope and the treatment tool are introduced into the body cavity through a plurality of conduits formed in the insertion guide, the relative position between the endoscope and the treatment tool is likely to be limited to a narrow range. As a result, for example, depending on the location of the lesion site in the stomach, the relative position between the endoscope and the treatment tool becomes an inappropriate relationship, and there occurs a problem that appropriate treatment, for example, resection of the lesion site cannot be reliably performed. There was a fear.
【０００４】（目的）本発明は、上記問題点に着目して
なされたもので、その目的とすることは、患者に対して
内視鏡と治療手段を導入したとき、内視鏡と治療手段も
しくは治療手段を適切かつ容易に病変部位へ誘導するこ
とができ、病変部位の治療を確実に行えるようにした内
視鏡治療装置を提供することにある。(Object) The present invention has been made in view of the above-mentioned problems, and an object of the present invention is to introduce an endoscope and treatment means into a patient when the endoscope and treatment means are introduced into a patient. Another object of the present invention is to provide an endoscopic treatment apparatus that can appropriately and easily guide a treatment means to a lesion site, and can reliably treat a lesion site.
【０００５】[0005]
【課題を解決するための手段および作用】本発明は、挿
入部を有した内視鏡を備え、その内視鏡に組み合わせて
使用する処置具により体腔内部位の治療を行う内視鏡治
療装置において、上記内視鏡の挿入部の外側に並置して
挿入される処置具を構成する治療手段及び上記治療手段
を所望の位置に誘導するための挿入具の少なくとも一方
の挿入部と、上記内視鏡の挿入部との両者間の、上記内
視鏡の挿入部の先端近傍における相対距離を調整する調
整手段を有し、上記調整手段は上記内視鏡の挿入部およ
び上記挿入具の挿入部の少なくともいずれか一つに設け
たことを特徴とするものである。このような内視鏡治療
装置によれば、観察手段となる内視鏡の挿入部と、例え
ば異なる処置機能を有する、もしくは複数の処置機能を
有する処置手段の挿入部を病変部位に対して異なる方向
よりそれぞれ誘導して病変部位の治療を容易かつ確実に
行うことができる。SUMMARY OF THE INVENTION The present invention provides an endoscope treatment apparatus provided with an endoscope having an insertion portion, and for treating a site in a body cavity with a treatment tool used in combination with the endoscope. In the above, the treatment means constituting a treatment tool inserted side by side outside the insertion portion of the endoscope, and at least one insertion portion of an insertion tool for guiding the treatment means to a desired position, Adjusting means for adjusting a relative distance between the insertion part of the endoscope and the vicinity of the distal end of the insertion part of the endoscope, wherein the adjustment means inserts the insertion part of the endoscope and the insertion of the insertion tool; It is characterized by being provided in at least one of the sections. According to such an endoscope treatment apparatus, the insertion portion of the endoscope serving as the observation device and the insertion portion of the treatment device having a different treatment function or having a plurality of treatment functions are different from the lesion site. It is possible to easily and surely treat the lesion site by guiding from the respective directions.
【０００６】[0006]
【発明の実施の形態】［第１の実施形態］図１乃至図１
２を参照して本発明の第１の実施形態を説明する。 （構成）図１および図２は内視鏡治療装置を示す斜視図
であって、図１はその各器具の先端側部分を示し、図２
はその各器具の手元側部分を示している。内視鏡治療装
置は内視鏡１と、２つの処置具誘導挿入具２と、処置具
３，４と、上記内視鏡１と２つの処置具誘導挿入具をそ
れぞれ個別に体腔内に誘導するための３つのチューブ部
を備えた導入ガイド体としてのオーバーチューブ５を備
えている。DESCRIPTION OF THE PREFERRED EMBODIMENTS [First Embodiment] FIGS. 1 to 1
A first embodiment of the present invention will be described with reference to FIG. (Structure) FIGS. 1 and 2 are perspective views showing an endoscope treatment apparatus. FIG. 1 shows a distal end portion of each instrument.
Indicates a hand side portion of each device. The endoscope treatment apparatus individually guides the endoscope 1, the two treatment tool guiding / inserting tools 2, the treatment tools 3 and 4, and the endoscope 1 and the two treatment tool guiding / inserting tools into the body cavity. An overtube 5 is provided as an introduction guide body having three tube sections for performing the operation.
【０００７】上記内視鏡１は軟性の挿入部７と手元操作
部８を有してなり、手元操作部８には図示しない光源装
置とビデオプロセッサーに接続されるユニバーサルコー
ド９が連結されている。内視鏡１の本体には観察光学
系、照明光学系及びチャンネル管路などが内蔵されてい
る。また、挿入部７は先端部１０とこれに隣接した湾曲
部１１とこの湾曲部１１の手元側に接続された可撓管１
２とによって構成される。挿入部７の先端部１０には観
察光学系の観察窓１３、照明光学系の照明窓１４及びチ
ャンネル管路の先端開口部１５が形成されている。先端
部１０に隣接して挿入部５の先端側途中部分に設けられ
た湾曲部１１は手元操作部８に設けたアングルノブ１６
による操作によって湾曲させられる。手元操作部８には
送気、送水、吸引、または後述するバルーンへの流体の
給排等の切換え操作を行う各種の操作用ボタン１７や各
種スイッチの操作用ボタン１８が設けられている。[0007] The endoscope 1 has a flexible insertion section 7 and a hand operation section 8, and a light source device (not shown) and a universal cord 9 connected to a video processor are connected to the hand operation section 8. . The main body of the endoscope 1 incorporates an observation optical system, an illumination optical system, a channel, and the like. The insertion portion 7 includes a distal end portion 10, a curved portion 11 adjacent to the distal end portion 10, and a flexible tube 1 connected to a proximal side of the curved portion 11.
And 2. An observation window 13 of an observation optical system, an illumination window 14 of an illumination optical system, and a front end opening 15 of a channel are formed at a front end portion 10 of the insertion portion 7. The bending portion 11 provided in the middle of the distal end side of the insertion portion 5 adjacent to the distal end portion 10 is provided with an angle knob 16 provided on the hand operation portion 8.
Is curved. The hand operation unit 8 is provided with various operation buttons 17 and operation buttons 18 of various switches for performing a switching operation such as air supply, water supply, suction, or supply and discharge of a fluid to and from a balloon described later.
【０００８】また、手元操作部８には上記チャンネル管
路に通じる処置具挿入口部１９が設けられている。そし
て、処置具挿入口部１９から処置具３を挿入し、上記チ
ャンネル管路に通じて先端開口部１５から処置具３を突
き出せるようになっている。この内視鏡１は図示は省略
したが観察レンズを洗浄、そして、送気が行えるノズル
を含め、従来より用いられている内視鏡のものと同様な
構造が組み込まれている。[0008] The hand operating section 8 is provided with a treatment instrument insertion port 19 communicating with the channel. Then, the treatment tool 3 is inserted from the treatment tool insertion port 19, and the treatment tool 3 can protrude from the distal end opening 15 through the channel. Although not shown, the endoscope 1 has a structure similar to that of a conventionally used endoscope, including a nozzle capable of cleaning an observation lens and supplying air.
【０００９】また、内視鏡１の挿入部７にはその挿入部
７の先端近傍における他の器具との相対的な距離を調整
する調整手段としてのバルーン２０が設けられている。
このバルーン２０の具体的な構成については後述する。The insertion section 7 of the endoscope 1 is provided with a balloon 20 as adjustment means for adjusting a relative distance between the insertion section 7 and another instrument near the distal end of the insertion section 7.
The specific configuration of the balloon 20 will be described later.
【００１０】上記処置具誘導挿入具２は図１及び図２で
示すように、軟性の挿入部２１と手元操作部２２を有す
る。挿入部２１には図４で示す如く、上記処置具４を挿
通するチャンネル管路２３が形成されている。チャンネ
ル管路２３は手元操作部２２に設けた処置具挿入口部２
４から挿入部２１の先端部２５の先端面に開口した先端
開口部２６にわたり形成されている。そして、処置具４
の挿入部２７を処置具挿入口部２４から上記チャンネル
管路２３に挿入し、上記チャンネル管路２３を通じて先
端開口部２６から突き出せるようになっている。As shown in FIGS. 1 and 2, the treatment tool guiding insert 2 has a soft insertion portion 21 and a hand operation portion 22. As shown in FIG. 4, a channel duct 23 through which the treatment tool 4 is inserted is formed in the insertion portion 21. The channel conduit 23 is provided for the treatment instrument insertion port 2 provided in the hand operation unit 22.
4 to a distal end opening 26 opened at the distal end surface of the distal end 25 of the insertion portion 21. And treatment tool 4
The insertion portion 27 is inserted into the channel 23 through the treatment tool insertion port 24 and can be projected from the distal end opening 26 through the channel 23.
【００１１】上記処置具誘導挿入具２の挿入部２１は可
撓管２８とこの先端に接続される湾曲部２９とこの先端
に接続される上記先端部２５とにより構成されている。
湾曲部２９は一般的な内視鏡のものと同様、手元操作部
２２に設けたアングルノブ３０により挿入部２１内に挿
通配置した操作ワイヤ３１を押し引きすることによって
湾曲可能なものである。なお、ここでの処置具誘導挿入
具２はその挿入部２１に上記処置具４を手元側から挿通
できるチャンネル管路２３のみが主に形成されており、
観察光学系、照明光学系、他のチャンネル管路等は設け
られていない。このため、処置具誘導挿入具２の挿入部
２１は内視鏡１の挿入部７よりも外径が細く形成されて
いる。The insertion portion 21 of the treatment instrument guiding insertion tool 2 comprises a flexible tube 28, a curved portion 29 connected to the distal end, and the distal end portion 25 connected to the distal end.
The bending portion 29 can be bent by pushing and pulling an operation wire 31 inserted and arranged in the insertion portion 21 by an angle knob 30 provided on the hand operation portion 22, as in a general endoscope. Note that the treatment tool guiding insertion tool 2 here is mainly formed with only a channel duct 23 through which the treatment tool 4 can be inserted from the hand side in the insertion portion 21.
No observation optical system, illumination optical system, and other channel conduits are provided. For this reason, the outer diameter of the insertion portion 21 of the treatment tool guide insertion tool 2 is smaller than that of the insertion portion 7 of the endoscope 1.
【００１２】また、処置具誘導挿入具２の挿入部２１は
そのチャンネル管路２３もしくは内視鏡１のチャンネル
管路に高周波電流を用いる処置具を使用することがある
ために、その挿入部２１の先端部２５の少なくとも外装
部分が樹脂製の電気的絶縁部材からなり、高周波処置具
に使用される高周波電流から上記挿入部２１を電気的に
絶縁遮断する構造となっている。Since the insertion portion 21 of the treatment tool guiding insertion tool 2 may use a treatment tool using a high-frequency current in its channel 23 or the channel of the endoscope 1, the insertion portion 21 may be used. At least the exterior portion of the distal end portion 25 is made of an electrically insulating member made of resin, and has a structure in which the insertion portion 21 is electrically insulated from high-frequency current used in the high-frequency treatment instrument.
【００１３】上記内視鏡治療装置における各器具の手元
側部分が図２で示されるが、これらの手元側部分は患者
体腔外にて術者が操作する部分であり、これらを実際に
使用するときには図３で示すように、内視鏡１の手元操
作部８と２つの処置具誘導挿入具２の手元操作部２２は
いずれも操作部架台３３に保持される。操作部架台３３
は支柱３４により支持されている。FIG. 2 shows a proximal portion of each instrument in the endoscope treatment apparatus. These proximal portions are portions operated by an operator outside the body cavity of the patient, and these are actually used. Sometimes, as shown in FIG. 3, both the hand operation unit 8 of the endoscope 1 and the hand operation units 22 of the two treatment instrument guide insertion tools 2 are held by the operation unit base 33. Operation unit base 33
Is supported by the support 34.
【００１４】上記オーバーチューブ５は図１及び図２に
示す如く、内視鏡１の挿入部７を挿通する第１のチュー
ブ３５と、２本の処置具誘導挿入具２の挿入部２１をそ
れぞれ挿通する第２のチューブ３６及び第３のチューブ
３７の計３本のチューブ部分を有する。As shown in FIGS. 1 and 2, the overtube 5 includes a first tube 35 through which the insertion section 7 of the endoscope 1 is inserted, and an insertion section 21 of the two treatment tool guiding insertion tools 2, respectively. It has a total of three tube portions of a second tube 36 and a third tube 37 to be inserted.
【００１５】これらのチューブ３５，３６，３７はいず
れも柔軟な素材、例えばウレタン樹脂や多孔質フッ素樹
脂などにより作られたチューブ部材で形成されている。
図５および図６で示す如く、これらのチューブ３５，３
６，３７は患者体腔内に挿入する先端側部分のみが結束
されている。つまり、最も径が大きな第１のチューブ３
５の先端部外周面に第２のチューブ３６の先端部と第３
のチューブ３７の先端部を接合して結束されている。第
２のチューブ３６の先端と第３のチューブ３７の先端の
各部分はそれぞれのチューブ軸方向に対して鋭角となる
後方へ斜めに傾斜した傾斜端面３８を形成している。Each of the tubes 35, 36, 37 is formed of a tube material made of a flexible material, for example, urethane resin or porous fluororesin.
As shown in FIGS. 5 and 6, these tubes 35, 3
In Nos. 6 and 37, only the distal end portion to be inserted into the patient's body cavity is bound. That is, the first tube 3 having the largest diameter
The tip of the second tube 36 and the third
Of the tubes 37 are joined and bound. Each part of the distal end of the second tube 36 and the distal end of the third tube 37 forms an inclined end surface 38 that is inclined rearward at an acute angle with respect to the tube axis direction.
【００１６】第２のチューブ３６の先端と第３のチュー
ブ３７の先端には第１のチューブ３５の先端部外周面に
接合するように延出した舌片４１が形成されている。そ
して、この第２のチューブ３６の舌片４１と第３のチュ
ーブ３７の舌片４１を第１のチューブ３５の先端部外周
面に接合した状態で、舌片４１を糸４２で巻き付け、そ
れらを固定的に結束する。舌片４１および糸４２の外表
面には接着剤４３が塗布され、仕上げられている。ま
た、図６に示す如く、第１のチューブ３５の先端部内腔
には金属製もしくは硬質な樹脂製のリング状の口金部材
４４が嵌込み挿入され、これにより結束部を補強して結
束強度を高めている。A tongue piece 41 is formed at the distal end of the second tube 36 and the distal end of the third tube 37 so as to be joined to the outer peripheral surface of the distal end of the first tube 35. Then, in a state where the tongue piece 41 of the second tube 36 and the tongue piece 41 of the third tube 37 are joined to the outer peripheral surface of the distal end portion of the first tube 35, the tongue piece 41 is wound with a thread 42, and they are wound. Bind tightly. An adhesive 43 is applied to the outer surfaces of the tongue piece 41 and the thread 42 and finished. As shown in FIG. 6, a ring-shaped base member 44 made of metal or hard resin is inserted and inserted into the inner cavity of the distal end of the first tube 35, thereby reinforcing the binding portion and increasing the binding strength. Is increasing.
【００１７】また、図５で示す如く、オーバーチューブ
５における患者体腔外側に位置する３本のチューブ３
５，３６，３７の手元側部分はいずれもフリーな状態で
独立している。これらのチューブ３５，３６，３７の手
元端にはそれぞれ口金３９が設けられている。As shown in FIG. 5, three tubes 3 located outside the patient's body cavity in the overtube 5 are provided.
The hand-side portions 5, 36 and 37 are all free and independent. A base 39 is provided at the proximal end of each of the tubes 35, 36, 37.
【００１８】一方、図１で示す如く、上記内視鏡１の挿
入部７における湾曲部１１の後方位置には手元操作部８
での操作にて膨脹・収縮が可能となるバルーン２０が装
着され、このバルーン２０を膨脹させることによって内
視鏡１の挿入部７に近接しようとする例えば処置具誘導
挿入具２の挿入部２１を適宜離れさせる調整手段を構成
する。そして、このバルーン２０の膨らみ度合いに応じ
て、各挿入部７，２１の先端近傍における相対距離を調
整（制御）することができる。On the other hand, as shown in FIG. 1, a hand operating section 8 is located at a position behind the bending section 11 in the insertion section 7 of the endoscope 1.
The balloon 20 which can be inflated and deflated by the above operation is mounted, and the balloon 20 is inflated to approach the insertion section 7 of the endoscope 1. Is formed as appropriate. The relative distance in the vicinity of the distal end of each of the insertion sections 7 and 21 can be adjusted (controlled) in accordance with the degree of inflation of the balloon 20.
【００１９】上記バルーン２０は挿入部７の内部に配置
されたチューブ（図示せず）に接続され、このチューブ
を通じて生理食塩水等の流体の供給がなされ、またはそ
の流体の排出がなされるように構成されている。バルー
ン２０に対する流体の給排の制御は、例えば内視鏡１の
手元操作部８に設けられたバルーン操作用ボタン１７の
１つのものを操作することにより行う。そして、バルー
ン２０は送り込まれる流体によって膨張し、その流体を
排出することにより収縮すると共に挿入部７の外径の程
度まで細く収縮する。The balloon 20 is connected to a tube (not shown) disposed inside the insertion portion 7 so that a fluid such as a physiological saline solution is supplied or discharged through the tube. It is configured. The control of supply and discharge of the fluid to and from the balloon 20 is performed, for example, by operating one of the balloon operation buttons 17 provided on the hand operation unit 8 of the endoscope 1. The balloon 20 is inflated by the fluid to be sent, contracts by discharging the fluid, and contracts to the extent of the outer diameter of the insertion portion 7.
【００２０】尚、本実施形態では調整手段としてバルー
ン２０によるものの例を挙げたが、本発明はこれに限ら
ない。例えば図７で示す如く、内視鏡１の挿入部７の外
表面部に多数のワイヤー４５を配設し、これらのワイヤ
ー４５を全体的に籠状に膨らませたり収縮させたりする
ようにしたものであってもよい。この場合、各ワイヤー
４５は挿入部７の長手軸方向に沿って平行ではなく、斜
めの配置、例えば螺旋状に配置されている。このように
ワイヤー４５を斜めの配置とすると、各ワイヤー４５で
処置具誘導挿入具２の挿入部２１などを受け支える上で
望ましい。In the present embodiment, an example using the balloon 20 as the adjusting means has been described, but the present invention is not limited to this. For example, as shown in FIG. 7, a large number of wires 45 are arranged on the outer surface of the insertion section 7 of the endoscope 1, and these wires 45 are expanded or contracted as a whole in a cage shape. It may be. In this case, the wires 45 are not parallel to each other along the longitudinal axis direction of the insertion section 7 but are arranged obliquely, for example, spirally. It is desirable that the wires 45 be arranged obliquely as described above in order to support the insertion portion 21 of the treatment instrument guiding / inserting tool 2 with each wire 45.
【００２１】また、多数のワイヤー４５を膨らませたり
収縮させたりする手段として各ワイヤー４５の先端を挿
入部７の外表面部に固定し、各ワイヤー４５の後端側部
分を挿入部７内に引き込み、および挿入部７の外に繰り
出せるようにし、手元操作部８での操作にて各ワイヤー
４５を一緒に進退操作するようにすることが考えられ
る。そして、上記バルーン２０の場合と同様に手元側か
らの操作によって各ワイヤー４５が挿入部７の外周面か
ら離れるように変形して全体として籠状に膨らみ、その
程度により処置具誘導挿入具２の挿入部７との相対距離
を調整する。As a means for expanding or contracting a large number of wires 45, the tip of each wire 45 is fixed to the outer surface of the insertion portion 7, and the rear end portion of each wire 45 is drawn into the insertion portion 7. It is conceivable that the wire 45 can be extended out of the insertion section 7 and the wires 45 can be moved forward and backward together by the operation of the hand operation section 8. Then, similarly to the case of the balloon 20, each wire 45 is deformed away from the outer peripheral surface of the insertion portion 7 by the operation from the hand side and swells in a cage shape as a whole. Adjust the relative distance to the insertion section 7.
【００２２】また、挿入部７の外周面からワイヤー４５
が離れるように変形させる方式としては各ワイヤー４５
の後端側を先端側へ押し出すものの他に各ワイヤー４５
を挿入部７の外周面に螺旋状の巻き付けた状態から各ワ
イヤー４５をほぐすように戻して膨らませるようにした
ものであってもよい。Further, the wire 45 extends from the outer peripheral surface of the insertion portion 7.
Each wire 45
In addition to pushing out the rear end side to the front end side, each wire 45
The wire 45 may be returned from the spirally wound state around the outer peripheral surface of the insertion portion 7 so as to be loosened and expanded.
【００２３】ここで、内視鏡１のチャンネル管路に挿通
される第１の処置具３は高周波電流による生体組織の切
開及び出血の凝固止血が行える高周波メス４６であり、
各処置具誘導挿入具２のチャンネル管路に挿通される第
２の処置具４はいずれも生体組織の把持を行う把持鉗子
４７とする。The first treatment instrument 3 inserted into the channel of the endoscope 1 is a high-frequency knife 46 capable of incising a living tissue and coagulating and stopping bleeding by high-frequency current,
Each of the second treatment tools 4 inserted into the channel of each treatment tool guide insertion tool 2 is a grasping forceps 47 for grasping a living tissue.
【００２４】（作用）本実施形態の内視鏡治療装置の使
用方法について説明する。まず内視鏡１の挿入部７にオ
ーバーチューブ５における第１のチューブ３５を被嵌し
ておき、この状態で、通常の内視鏡検査の要領で内視鏡
１の挿入部７を患者の体腔内へ挿入する。内視鏡１の挿
入部７が体腔内まで挿入されたらその内視鏡１の挿入部
７をガイドとして、予め手元側に退避させて置いたオー
バーチューブ５の全体を体腔内に挿入していく。その
際、内視鏡１の挿入部７が挿通されている第１のチュー
ブ３５以外となる第２チューブ３６及び第３のチューブ
３７の先端はチューブ軸方向に対して鋭角となる斜めに
傾斜する傾斜端面３８を形成していることから挿入時に
おける粘膜などへの擦過による影響を少なくすることが
できる。このため、極力生体にダメージを与えることな
くオーバーチューブ５の全体を挿入することが可能であ
る。(Operation) A method of using the endoscopic treatment apparatus according to the present embodiment will be described. First, the first tube 35 of the overtube 5 is fitted to the insertion section 7 of the endoscope 1 and, in this state, the insertion section 7 of the endoscope 1 is inserted into the patient in the manner of a normal endoscopy. Insert into body cavity. When the insertion section 7 of the endoscope 1 is inserted into the body cavity, the entirety of the overtube 5 that has been previously retracted and placed on the hand side is inserted into the body cavity using the insertion section 7 of the endoscope 1 as a guide. . At this time, the distal ends of the second tube 36 and the third tube 37 other than the first tube 35 into which the insertion section 7 of the endoscope 1 is inserted are inclined at an acute angle to the tube axis direction. Since the inclined end surface 38 is formed, the influence of rubbing on the mucous membrane or the like during insertion can be reduced. Therefore, it is possible to insert the entire overtube 5 without damaging the living body as much as possible.
【００２５】次に、オーバーチューブ５における第２の
チューブ３６及び第３のチューブ３７に処置具誘導挿入
具２の挿入部２１を挿入していき、上記処置具誘導挿入
具２の挿入部２１を上記内視鏡１の観察下で、上記内視
鏡１の挿入部７と共に体腔内の病変部位に誘導する。そ
して、内視鏡１の操作部８、及び処置具誘導挿入具２の
手元操作部２２を図３に示すように操作部架台３３にそ
れぞれ設置し、内視鏡１、及び処置具誘導挿入具２のチ
ャンネル管路２３に処置具３，４の挿入部２７を挿通し
ていく。この状態で、術者は図８に示す内視鏡画像４０
を観察しながら体腔内の治療を行う。Next, the insertion portion 21 of the treatment instrument guiding insertion tool 2 is inserted into the second tube 36 and the third tube 37 of the overtube 5, and the insertion section 21 of the treatment tool guiding insertion tool 2 is inserted. Under the observation of the endoscope 1, together with the insertion section 7 of the endoscope 1, it is guided to a lesion site in a body cavity. Then, the operation unit 8 of the endoscope 1 and the hand operation unit 22 of the treatment instrument guide insertion tool 2 are installed on the operation unit frame 33 as shown in FIG. 3, and the endoscope 1 and the treatment tool guide insertion tool are respectively installed. The insertion portions 27 of the treatment tools 3 and 4 are inserted into the channel channels 23 of the second. In this state, the operator operates the endoscope image 40 shown in FIG.
Observe the body cavity while treating.
【００２６】この体腔内における治療を行う場合、図１
２で示す如く、第２のチューブ３６または第３のチュー
ブ３７の先端から内視鏡１の挿入部７と略並行に処置具
誘導挿入具２を突き出し、さらに、処置具誘導挿入具２
の先端から把持鉗子４７を突き出す。そして、把持鉗子
４７によって生体組織４８を把持し、その生体組織４８
の部分を持ち上げる。さらに内視鏡１のチャンネル管路
に挿入した先端がフック型を呈する高周波メス４６を用
いて、引き上げられた生体組織４８の根元部分を切開す
る。フック型高周波メス４６により病変部位を含む生体
組織４８を切除する場合、病変部位の周囲に２ケ所に個
別に切開を加える。When performing treatment in the body cavity, FIG.
As shown by 2, the treatment tool guiding insertion tool 2 projects from the distal end of the second tube 36 or the third tube 37 substantially in parallel with the insertion section 7 of the endoscope 1, and further, the treatment tool guiding tool 2
The grasping forceps 47 is protruded from the tip of the gripper. Then, the living tissue 48 is grasped by the grasping forceps 47, and the living tissue 48 is grasped.
Lift the part. Further, a root portion of the pulled-up living tissue 48 is incised by using a high-frequency scalpel 46 having a hook-shaped tip inserted into a channel of the endoscope 1. When the living tissue 48 including the lesion is cut by the hook-type high-frequency knife 46, two incisions are separately made around the lesion.
【００２７】この際、図８では図示しないが、図１で示
す如く内視鏡１の挿入部７に装着されるバルーン２０を
膨らませることによりそのバルーン２０により上記内視
鏡１の挿入部７より離れた位置に処置具誘導挿入具２の
挿入部２１を移動させて両者の相対的な距離を確保し、
把持鉗子４７により病変部位の生体組織４８を把持する
操作が適切な方向から行えるように調整する。また、高
周波メス４６での生体組織４８の切開を２ケ所に行った
後、図９に示すように２本の処置具誘導挿入具２を用
い、一つの切開部にガイドワイヤー４９を挿入し、それ
を体腔臓器の外側を経て他方の切開部より体腔内に戻
し、把持鉗子４７で掴み取る作業を行う。このことで、
図１０に示すように目的とする組織部位の全層を２本の
処置具誘導挿入具２によって広範囲に持ち上げることが
可能となり、持ち上げた組織部分を内視鏡１のチャンネ
ル管路に挿通する鋏鉗子５０により切離していく。尚、
生体組織４８が切離した後は、図１１に示すように内視
鏡１のチャンネル管路に挿通する縫合針５１とそれに挿
通する縫合糸５２と、組織を把持する把持鉗子４７と、
それを挿通する処置具誘導挿入具２、そして上記縫合糸
５２を受け取る持針鉗子５３と、それを挿通する処置具
誘導挿入具２により切開部を縫合していく。このときの
状況は図１２で示す内視鏡観察画像により観察できる。At this time, although not shown in FIG. 8, the balloon 20 mounted on the insertion portion 7 of the endoscope 1 is inflated as shown in FIG. By moving the insertion portion 21 of the treatment instrument guiding insertion tool 2 to a more distant position, a relative distance between the two is secured,
It is adjusted so that the operation of gripping the living tissue 48 at the lesion site by the gripping forceps 47 can be performed from an appropriate direction. After the incision of the living tissue 48 with the high-frequency knife 46 is performed at two locations, the guide wire 49 is inserted into one incision using two treatment instrument guiding inserts 2 as shown in FIG. It is returned to the body cavity from the other incision via the outside of the body cavity organ, and the work of grasping with the grasping forceps 47 is performed. With this,
As shown in FIG. 10, all the layers of the target tissue site can be lifted over a wide range by the two treatment tool guide insertion tools 2, and the scissors for inserting the lifted tissue portion into the channel of the endoscope 1 are provided. The cutting is performed by the forceps 50. still,
After the living tissue 48 is cut off, as shown in FIG. 11, a suture needle 51 inserted into the channel of the endoscope 1 and a suture 52 inserted therethrough, a grasping forceps 47 for grasping the tissue,
The incision is sewn up by the treatment tool guiding insert 2 that passes through the needle, the needle-holding forceps 53 that receives the suture 52, and the treatment tool guiding insert 2 that passes through it. The situation at this time can be observed by the endoscope observation image shown in FIG.
【００２８】以上のいずれの作業においても内視鏡１の
挿入部７に装着されるバルーン２０の膨脹収縮を調整す
ることにより内視鏡１の挿入部７と処置具誘導挿入具２
の挿入部２１または処置具の挿入部との相対距離を適切
に制御し、例えば把持鉗子４７による生体組織４８の把
持や、組織切開部の牽引を適切に行うことが可能とな
る。In any of the above operations, by adjusting the inflation and contraction of the balloon 20 mounted on the insertion section 7 of the endoscope 1, the insertion section 7 of the endoscope 1 and the treatment tool guiding insertion tool 2 are adjusted.
By appropriately controlling the relative distance between the insertion portion 21 and the insertion portion of the treatment tool, for example, it is possible to appropriately grasp the living tissue 48 with the grasping forceps 47 and tow the tissue incision portion.
【００２９】（効果）以上説明した如く本実施形態の構
成及びその使用と作用によれば、体腔内の治療を内視鏡
１を用いて行うに当たって患者に対して適切に処置する
ことができ、かつ術者による容易かつ確実な操作による
治療作業が可能となる。(Effects) As described above, according to the configuration of the present embodiment and its use and operation, it is possible to appropriately treat a patient when performing treatment in a body cavity using the endoscope 1, In addition, the operator can perform a treatment operation by an easy and reliable operation.
【００３０】尚、本実施形態では処置具誘導挿入具２と
それに挿通される把持鉗子４７による体腔内の生体組織
把持とその持ち上げ、そのときの内視鏡１のチャンネル
管路から突出するフック型の高周波メス４６による切
開、２本の処置具誘導挿入具２内に挿通されるガイドワ
イヤー４９による広範囲にわたる組織の持ち上げと、そ
の部分の鋏鉗子５０による切離、さらには同じく処置具
誘導挿入具２に挿通される把持鉗子４７と持針鉗子５
３、及び内視鏡１のチャンネル管路から突出させる縫合
針５１とその中に挿通する縫合糸５２による切開部の縫
合を記したが、これらの他にも、内視鏡１と処置具誘導
挿入具２による体腔内の治療はさまざまに考えられ、そ
の適用例について以降に記す。In this embodiment, a living tissue in the body cavity is grasped and lifted by the treatment instrument guiding / inserting tool 2 and the grasping forceps 47 inserted therethrough, and the hook type projecting from the channel of the endoscope 1 at that time. Using a high-frequency scalpel 46, lifting of a wide range of tissue by a guide wire 49 inserted into the two treatment tool guide insertion tools 2, and cutting off that portion with scissors forceps 50, and also a treatment tool guide insertion tool Grasping forceps 47 and needle holding forceps 5 inserted through
3 and the suturing of the incision by the suturing needle 51 protruding from the channel of the endoscope 1 and the suture thread 52 inserted therein. Various treatments in the body cavity by the insertion tool 2 are conceivable, and examples of the application will be described below.
【００３１】［第２の実施形態］図１３のものでは処置
具誘導挿入具２に挿通する把持鉗子４７により、切除の
目的とする生体組織４８を把持して挙上し、持ち上げら
れた生体組織４８に対して内視鏡１のチャンネル管路に
挿通される鋏鉗子５０により切離していくことを示す。
ここでは処置具誘導挿入具２を２本ではなく、１本だけ
の利用とし、内視鏡１の挿入部７の先端部分の誘導と上
記処置具誘導挿入具２の誘導により、比較的小さい面積
の病変部位におけるその周囲を切離していく。このこと
により比較的小さい病変部位に対してより簡便に治療を
行うことができる。[Second Embodiment] In the apparatus shown in FIG. 13, a living tissue 48 to be resected is grasped and lifted by a grasping forceps 47 inserted through the treatment instrument guiding / inserting tool 2, and the living tissue lifted. 48 indicates that cutting is performed by the scissors forceps 50 inserted into the channel of the endoscope 1.
Here, only one treatment tool guiding insert 2 is used instead of two, and a relatively small area is obtained by guiding the distal end portion of the insertion portion 7 of the endoscope 1 and guiding the treatment tool guiding insert 2. The surrounding area of the lesion site is cut away. Thus, a relatively small lesion can be treated more easily.
【００３２】［第３の実施形態］図１４で示す第３の実
施形態は前述した第２の実施形態の場合と同様に比較的
小さい病変部に対して行うことを想定するが、ここでは
周囲の切離を、先端が導電性の高い金属からなる針状高
周波メス４６を用いることにより病変粘膜のみの局所的
切離が行うようにしたものである。[Third Embodiment] The third embodiment shown in FIG. 14 is assumed to be performed on a relatively small lesion as in the case of the above-described second embodiment. Is performed by using a needle-shaped high-frequency scalpel 46 whose tip is made of a highly conductive metal so that only the affected mucosa can be locally separated.
【００３３】［第４の実施形態］図１５乃至図１６を参
照して第４の実施形態を説明する。図１５に示すように
病変部位を取り囲むのに十分な開口を有するスネア５５
を内視鏡１のチャンネル管路を通じて導入し、病変部位
に配置しておき、そのループ内に位置する病変部位に処
置具誘導挿入具２のチャンネル管路に挿通する糸もしく
はワイヤー付きクリップ５６を複数固定する。そして図
１６に示すように上記クリップ５６に付く糸もしくはワ
イヤー５７を牽引し、病変部位を十分に挙上させて、最
初に配設したスネア５５による緊縛と高周波電流の通電
により、その病変部位を全層に切除させる。このこと
は、多数のクリップ５６の牽引によることから前述の実
施形態での把持鉗子４７による挙上に比べ、広範囲の生
体組織の切除が可能となる。[Fourth Embodiment] A fourth embodiment will be described with reference to FIGS. As shown in FIG. 15, a snare 55 having an opening sufficient to surround the lesion site
Is introduced through the channel line of the endoscope 1 and is arranged at the lesion site, and a thread or a wire-attached clip 56 inserted into the channel line of the treatment instrument guiding / inserting tool 2 is inserted into the lesion site located in the loop. Fix several. Then, as shown in FIG. 16, the thread or wire 57 attached to the clip 56 is pulled, the lesion site is sufficiently lifted, and the lesion site is first tightened by the snare 55 and the high-frequency current is applied. All layers are excised. This is because a large number of clips 56 are towed, so that a wide range of living tissue can be resected as compared with the lifting by the grasping forceps 47 in the above-described embodiment.
【００３４】尚、ここでは大きい開口のループを有する
スネア５５による切除を示したが、このクリップ５６に
よる挙上と、前述した実施形態にて示した高周波メス４
６あるいは鋏鉗子５０により行う切離にも有効である。Although the cutting by the snare 55 having the loop with the large opening is shown here, the lifting by the clip 56 and the high-frequency knife 4 shown in the above-described embodiment are performed.
6 or the scissors forceps 50 are also effective.
【００３５】［第５の実施形態］図１７乃至図１８を参
照して第５の実施形態を説明する。この実施形態では生
体組織を切除した後に体腔内壁に生じる開口部分を縫縮
させる場合について述べる。図１７において示す如く、
先端のループ部を切り離すことができる留置スネア５８
を内視鏡１のチャンネル管路から体腔内に突き出し、そ
のループワイヤ部５９を緊縛後に切除された後に生じる
開口部分に配設する。次に、そのループワイヤ部５９の
上方から処置具誘導挿入具２を用いてクリップ６０を上
記留置スネア５８のループワイヤ部５９と生体組織開口
部周辺の組織とを共に把持しながら複数固定する。その
後、クリップ６０が固定された留置スネア５８のループ
ワイヤ部５９を緊縛していく。このとき、スネアのルー
プワイヤ部５９と共にクリップ６０に固定されている生
体組織の開口部は留置スネア５８の緊縛に伴って閉塞し
ていく。そして留置スネア５８のループワイヤ部５９が
完全に緊縛されたらそのループワイヤ部５９を手元側か
ら切り離し、図１８に示すように開口部の縫縮が終了す
る。[Fifth Embodiment] A fifth embodiment will be described with reference to FIGS. In this embodiment, a case will be described in which an opening portion formed in an inner wall of a body cavity after a living tissue is cut is contracted. As shown in FIG.
Detention snare 58 that can cut off the loop at the tip
Is projected from the channel of the endoscope 1 into the body cavity, and the loop wire portion 59 is disposed in the opening formed after the resection after the binding. Next, a plurality of clips 60 are fixed from above the loop wire portion 59 while grasping the loop wire portion 59 of the indwelling snare 58 and the tissue around the living tissue opening together using the treatment instrument guiding insert 2. Thereafter, the loop wire portion 59 of the indwelling snare 58 to which the clip 60 is fixed is tightened. At this time, the opening of the living tissue fixed to the clip 60 together with the loop wire portion 59 of the snare is closed with the binding of the indwelling snare 58. Then, when the loop wire portion 59 of the indwelling snare 58 is completely tightened, the loop wire portion 59 is cut off from the hand side, and as shown in FIG. 18, the sewing of the opening is completed.
【００３６】尚、詳細な図示は省略するが、この縫縮さ
れた組織の接合部分に別のクリップで固定し、あるいは
接合部に接着剤を塗布するなどの処置を施す場合も考え
られる。Although not shown in detail, it is also conceivable to perform a treatment such as fixing the joint portion of the sewn tissue with another clip, or applying an adhesive to the joint portion.
【００３７】［第６の実施形態］図１９を参照して第６
の実施形態を説明する。この実施形態では切離された部
分に対して、内視鏡１のチャンネル管路に挿通される長
い把持鉗子６１で接合するように把持し、図１９に示す
ように接合部分にクリップ６２を処置具誘導挿入具２を
用いて固定する。[Sixth Embodiment] Referring to FIG.
An embodiment will be described. In this embodiment, the detached portion is grasped so as to be joined by long grasping forceps 61 inserted into the channel of the endoscope 1, and a clip 62 is treated at the joined portion as shown in FIG. It is fixed using the tool guiding insert 2.
【００３８】以上の各実施形態では上記に説明した複数
本の挿入具を体腔内に挿入し、体腔内における切開、切
除、そして縫縮、縫合等の技術を、食道、胃、十二指腸
などの上部消化管に適用することで示してきたが、これ
らは下部消化管、つまり大腸においても同様の作用とそ
の効果が期待できる。さらにこれらの他に、特にオーバ
ーチューブの適用として、図２０および図２１に示すよ
うに十二指腸６３から十二指腸乳頭部６４を経由して胆
道６５内に処置具誘導挿入具２を挿入し、上記胆道６５
内の処置具誘導挿入具２で操作される処置具６６と、さ
らに十二指腸６３まで追加して挿入される内視鏡６７も
しくはそのチャンネル管路に挿通される処置具６８とで
バイパスを形成する治療なども行えることが考えられ
る。In each of the above embodiments, a plurality of the insertion tools described above are inserted into a body cavity, and techniques such as incision, resection, sewn and suturing in the body cavity are applied to the upper part of the esophagus, stomach, duodenum and the like. Although they have been shown to be applied to the gastrointestinal tract, they can be expected to have similar effects and effects in the lower gastrointestinal tract, that is, the large intestine. In addition to these, particularly as an application of an overtube, the treatment instrument guiding insertion tool 2 is inserted into the biliary tract 65 from the duodenum 63 via the duodenal papilla 64 as shown in FIGS.
A treatment in which a bypass is formed by a treatment tool 66 operated by the treatment tool guide insertion tool 2 and an endoscope 67 additionally inserted up to the duodenum 63 or a treatment tool 68 inserted through a channel of the endoscope 67. It is conceivable that this can be done.
【００３９】＜付記＞ （Ａ群） １．挿入部を有した内視鏡を備え、その内視鏡に組み合
わせて使用する処置具により体腔内部位の治療を行う内
視鏡治療装置において、上記内視鏡の挿入部の外側に並
置して挿入される処置具を構成する治療手段及び上記治
療手段を所望の位置に誘導するための挿入具の少なくと
も一方の挿入部と、上記内視鏡の挿入部との両者間の、
上記内視鏡の挿入部の先端近傍における相対距離を調整
する調整手段を有し、上記調整手段は上記内視鏡の挿入
部および上記挿入具の挿入部の少なくともいずれか一つ
に設けたことを特徴とするもの。<Supplementary Note> (Group A) An endoscope treatment device that includes an endoscope having an insertion portion and treats an internal body cavity with a treatment tool used in combination with the endoscope, wherein the treatment device is arranged side by side outside the insertion portion of the endoscope. At least one of the insertion section of the treatment means constituting the treatment tool to be inserted and the insertion tool for guiding the treatment means to a desired position, between both the insertion section of the endoscope,
Adjusting means for adjusting a relative distance in the vicinity of the distal end of the insertion portion of the endoscope, wherein the adjustment means is provided on at least one of the insertion portion of the endoscope and the insertion portion of the insertion tool; What is characterized by.
【００４０】２．上記第１項に記載の内視鏡治療装置に
おいて、上記調整手段が内視鏡および治療手段の少なく
とも一方の手元側において操作可能であるバルーンであ
ることを特徴とするもの。 ３．上記第１項に記載の内視鏡治療装置において、上記
調整手段が内視鏡および治療手段の少なくとも一方の手
元側において操作可能であるワイヤー部材であることを
特徴とするもの。 ４．上記第１項に記載の内視鏡治療装置において、上記
挿入具は、軟性の挿入部とその手元側に接続される操作
部を有し、上記操作部から上記挿入部の先端にわたって
その内部に処置具を挿通することができるチャンネル管
路を備えると共に、上記挿入部の先端には挿入部先端の
方向を所望の向きに変えることができる湾曲機構が備わ
ることを特徴とするもの。 ５．上記第４項に記載の内視鏡治療装置において、上記
挿入具はその挿入部全長において、その外表面が電気的
絶縁素材で被覆されていることを特徴とするもの。2. 2. The endoscopic treatment apparatus according to claim 1, wherein the adjusting means is a balloon operable on at least one hand side of the endoscope and the treatment means. 3. 2. The endoscope treatment apparatus according to claim 1, wherein the adjustment means is a wire member operable on at least one hand side of the endoscope and the treatment means. 4. 2. The endoscope treatment apparatus according to claim 1, wherein the insertion tool has a flexible insertion portion and an operation portion connected to a proximal side of the insertion portion, and extends from the operation portion to a distal end of the insertion portion. In addition to a channel conduit through which a treatment tool can be inserted, a distal end of the insertion section is provided with a bending mechanism that can change the direction of the insertion section distal end to a desired direction. 5. 5. The endoscopic treatment device according to claim 4, wherein the outer surface of the insertion tool is covered with an electrically insulating material over the entire length of the insertion portion.
【００４１】（Ｂ群） １．軟性の挿入部を有する内視鏡と、上記内視鏡の挿入
部と並行して挿入される少なくとも一つ以上の治療手段
とからなる体腔内の治療装置において、上記内視鏡の挿
入部と上記治療手段の挿入部とを独立に挿通し得る管路
を有するオーバーチューブを備え、上記オーバーチュー
ブは複数の可撓性を有するチューブ体を束ねた形態であ
り、かつそれらチューブ体同士は少なくともいずれか一
方の端部で互いに接合されていることを特徴とするも
の。 ２．上記第１項に記載のオーバーチューブにおいて、上
記チューブ体は多孔質フッ素樹脂からなるチューブより
なることを特徴とするもの。 ３．上記第１項に記載のオーバーチューブにおいて、上
記オーバーチューブの先端における複数のチューブ体の
接合が、少なくとも一つのチューブ体の先端内腔に硬質
の口金が挿入され、上記口金が挿入される部分のチュー
ブ外周に、他のチューブ体と共に糸巻き固定されること
を特徴とするもの。 ４．上記第３項に記載のオーバーチューブにおいて、上
記オーバーチューブは内視鏡の挿入部が挿通される第１
の管路を形成するチューブ体と、治療手段が挿通される
第２もしくは第３のチューブ体とで構成され、上記第２
のチューブ体もしくは第３のチューブ体の上記第１のチ
ューブ体と接合される先端部の端縁が、チューブ軸方向
に対して略斜めに形成されることを特徴とするもの。(Group B) An endoscope having a flexible insertion portion, and a treatment device for a body cavity comprising at least one or more treatment means inserted in parallel with the insertion portion of the endoscope, wherein the insertion portion of the endoscope, An overtube having a channel that can be inserted independently with the insertion portion of the treatment means is provided, and the overtube is in a form in which a plurality of flexible tube bodies are bundled, and the tube bodies are at least any one of them. Characterized by being joined to each other at one end. 2. 2. The overtube according to claim 1, wherein the tube body is a tube made of a porous fluororesin. 3. 2. The overtube according to claim 1, wherein a plurality of tube bodies at the distal end of the overtube are joined by inserting a hard die into a distal end lumen of at least one of the tube bodies, and a portion into which the die is inserted. A thread fixed to the outer periphery of a tube together with another tube body. 4. 4. The overtube according to item 3, wherein the overtube is a first tube through which an insertion portion of an endoscope is inserted.
And a second or third tube body through which the treatment means is inserted.
An end edge of a distal end portion of the tube body or the third tube body joined to the first tube body is formed substantially obliquely with respect to the tube axis direction.
【００４２】[0042]
【発明の効果】以上説明したように本発明によれば、体
腔内の病変部位に対して内視鏡と治療手段を容易かつ確
実に誘導して病変部位の治療を確実に行うことができ
る。As described above, according to the present invention, it is possible to easily and reliably guide the endoscope and the treatment means to the lesion site in the body cavity, and to reliably treat the lesion site.
【図面の簡単な説明】[Brief description of the drawings]
【図１】第１の実施形態に係る内視鏡治療装置の先端側
部分の斜視図。FIG. 1 is a perspective view of a distal end portion of an endoscope treatment apparatus according to a first embodiment.
【図２】上記内視鏡治療装置の手元側部分の斜視図。FIG. 2 is a perspective view of a proximal portion of the endoscope treatment apparatus.
【図３】上記内視鏡治療装置の使用中における手元側部
分を保持する状態の斜視図。FIG. 3 is a perspective view of a state where a hand side portion is held during use of the endoscopic treatment device.
【図４】上記内視鏡治療装置の処置具誘導挿入具の先端
付近部分の縦断面図。FIG. 4 is a vertical cross-sectional view of a portion near a distal end of a treatment instrument guiding insert of the endoscope treatment apparatus.
【図５】上記内視鏡治療装置のオーバーチューブの斜視
図。FIG. 5 is a perspective view of an overtube of the endoscope treatment apparatus.
【図６】上記内視鏡治療装置のオーバーチューブの先端
付近部分の縦断面図。FIG. 6 is a longitudinal sectional view of a portion near a distal end of an overtube of the endoscope treatment apparatus.
【図７】上記内視鏡治療装置の変形例を示すその先端側
部分の斜視図。FIG. 7 is a perspective view of a distal portion of a modification of the endoscope treatment apparatus.
【図８】上記内視鏡治療装置を用いて体腔内部位の治療
を行う手順の斜視図。FIG. 8 is a perspective view of a procedure for performing treatment of a site in a body cavity using the endoscope treatment apparatus.
【図９】上記内視鏡治療装置を用いて体腔内部位の治療
を行う手順の斜視図。FIG. 9 is a perspective view of a procedure for performing treatment of a site in a body cavity using the endoscope treatment apparatus.
【図１０】上記内視鏡治療装置を用いて体腔内部位の治
療を行う手順の斜視図。FIG. 10 is a perspective view of a procedure for performing treatment of a site in a body cavity using the endoscope treatment apparatus.
【図１１】上記内視鏡治療装置を用いて体腔内部位の治
療を行う手順の斜視図。FIG. 11 is a perspective view of a procedure for treating a site in a body cavity using the endoscope treatment apparatus.
【図１２】上記内視鏡治療装置を用いて体腔内部位の治
療を行っている状況を示す内視鏡観察画像の説明図。FIG. 12 is an explanatory diagram of an endoscope observation image showing a state in which a treatment of a site in a body cavity is being performed using the endoscope treatment device.
【図１３】第２の実施形態に係る内視鏡治療装置を用い
て体腔内部位の治療を行う状況の斜視図。FIG. 13 is a perspective view of a state in which a treatment is performed on a site in a body cavity using the endoscope treatment apparatus according to the second embodiment.
【図１４】第３の実施形態に係る内視鏡治療装置を用い
て体腔内部位の治療を行う状況の斜視図。FIG. 14 is a perspective view of a state in which a treatment is performed on a site in a body cavity using the endoscope treatment apparatus according to the third embodiment.
【図１５】第４の実施形態に係る内視鏡治療装置を用い
て体腔内部位の治療を行う状況の斜視図。FIG. 15 is a perspective view of a state in which a treatment is performed on a body cavity using the endoscope treatment apparatus according to the fourth embodiment.
【図１６】同じく第４の実施形態に係る内視鏡治療装置
を用いて体腔内部位の治療を行う状況の斜視図。FIG. 16 is a perspective view showing a state in which a treatment is performed on a site in a body cavity using the endoscopic treatment device according to the fourth embodiment.
【図１７】第５の実施形態に係る内視鏡治療装置を用い
て体腔内部位の治療を行う状況の斜視図。FIG. 17 is a perspective view of a state in which a treatment is performed on a site in a body cavity using the endoscope treatment apparatus according to the fifth embodiment.
【図１８】同じく第５の実施形態に係る内視鏡治療装置
を用いて体腔内部位の治療を行う状況の斜視図。FIG. 18 is a perspective view showing a state in which a treatment is performed on a site in a body cavity using the endoscopic treatment device according to the fifth embodiment.
【図１９】第６の実施形態に係る内視鏡治療装置を用い
て体腔内部位の治療を行う状況の斜視図。FIG. 19 is a perspective view of a state in which a treatment is performed on a site in a body cavity using the endoscope treatment apparatus according to the sixth embodiment.
【図２０】内視鏡治療装置の他の適用例の説明図。FIG. 20 is an explanatory diagram of another application example of the endoscope treatment device.
【図２１】同じく内視鏡治療装置の他の適用例の説明
図。FIG. 21 is an explanatory view of another application example of the endoscopic treatment device.
１…内視鏡 ２…処置具誘導挿入具 ３…処置具 ４…処置具 ５…オーバーチューブ ７…内視鏡の挿入部 ２１…処置具誘導挿入具の挿入部 ２０…バルーン ４５…ワイヤー DESCRIPTION OF SYMBOLS 1 ... Endoscope 2 ... Treatment tool guidance insertion tool 3 ... Treatment tool 4 ... Treatment tool 5 ... Overtube 7 ... Endoscope insertion part 21 ... Treatment tool guidance insertion tool insertion part 20 ... Balloon 45 ... Wire
───────────────────────────────────────────────────── フロントページの続き (72)発明者 関根 竜太 東京都渋谷区幡ヶ谷２丁目43番２号 オリ ンパス光学工業株式会社内 Ｆターム(参考） 2H040 BA00 DA03 DA11 DA16 DA17 DA51 DA54 DA56 GA02 4C060 GG22 GG24 GG32 KK03 KK06 KK09 KK14 KK17 4C061 AA01 BB02 CC06 DD03 FF21 FF36 FF43 GG15 HH57 ────────────────────────────────────────────────── ─── Continued on the front page (72) Inventor Ryuta Sekine 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Industrial Co., Ltd. F-term (reference) 2H040 BA00 DA03 DA11 DA16 DA17 DA51 DA54 DA56 GA02 4C060 GG22 GG24 GG32 KK03 KK06 KK09 KK14 KK17 4C061 AA01 BB02 CC06 DD03 FF21 FF36 FF43 GG15 HH57
Claims (1)
に組み合わせて使用する処置具により体腔内部位の治療
を行う内視鏡治療装置において、 上記内視鏡の挿入部の外側に並置して挿入される処置具
を構成する治療手段及び上記治療手段を所望の位置に誘
導するための挿入具の少なくとも一方の挿入部と、上記
内視鏡の挿入部との両者間の、上記内視鏡の挿入部の先
端近傍における相対距離を調整する調整手段を有し、上
記調整手段は上記内視鏡の挿入部および上記挿入具の挿
入部の少なくともいずれか一つに設けたことを特徴とす
る内視鏡治療装置。1. An endoscope treatment apparatus comprising an endoscope having an insertion portion, wherein an endoscopic treatment device for treating a region in a body cavity with a treatment tool used in combination with the endoscope, wherein: Between both the treatment means constituting the treatment tool inserted side by side on the outside and at least one insertion part of the insertion tool for guiding the treatment means to a desired position, and the insertion part of the endoscope Adjusting means for adjusting a relative distance in the vicinity of the distal end of the insertion section of the endoscope, wherein the adjustment means is provided on at least one of the insertion section of the endoscope and the insertion section of the insertion tool. An endoscopic treatment apparatus characterized by the above-mentioned.
Priority Applications (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP20347998A JP3806518B2 (en) | 1998-07-17 | 1998-07-17 | Endoscopic treatment device |
| US09/354,011 US6352503B1 (en) | 1998-07-17 | 1999-07-15 | Endoscopic surgery apparatus |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP20347998A JP3806518B2 (en) | 1998-07-17 | 1998-07-17 | Endoscopic treatment device |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| JP2000033071A true JP2000033071A (en) | 2000-02-02 |
| JP3806518B2 JP3806518B2 (en) | 2006-08-09 |
Family
ID=16474836
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP20347998A Expired - Fee Related JP3806518B2 (en) | 1998-07-17 | 1998-07-17 | Endoscopic treatment device |
Country Status (1)
| Country | Link |
|---|---|
| JP (1) | JP3806518B2 (en) |
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