JP2000037347A - Endoscope treatment system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To prevent the deterioration of the function of an endoscope and to prevent a treatment tool from unstably moving in the limited internal space of a guide tube. SOLUTION: The shape of the cross section of at least one insertion part of the endoscope 1 and the curing tool, which are movably inserted freely forewords/backwards into the guide tube 3 to be introduced into a body cavity, is made flat. Consequently, the rigidity of the treatment tool is held without increasing the thickness of the tube 3, thereby the treatment tool never moves stably, the treatment function is never deteriorated and the treatment operation requiring large force is easily and surely executed.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an endoscopic treatment apparatus in which an endoscope and a treatment tool are inserted into a guide tube introduced into a body cavity to perform treatment.

[0002]

2. Description of the Related Art Japanese Unexamined Patent Publication No. Sho 54-136780 discloses a treatment instrument insertion channel for inserting a treatment instrument into an insertion guide main pipe of an endoscope, and an optical sight tube insertion for inserting a flexible optical sight tube. A passage channel is formed, and means for biasing the distal end of the optical sight tube to the outside of the main axis for insertion guide at the distal end of the optical sight tube insertion channel is provided to improve treatment performance. It is shown. In Japanese Utility Model Laid-Open Publication No. 51-149895, a guideway is provided outside the endoscope so that an outer tube can be inserted into a body cavity through the guideway and a suture device can be inserted into the outer tube. Are shown.

[0003]

However, in the former conventional example, a large-sized treatment instrument close to the outer diameter of the insertion portion of the endoscope cannot be passed, and the treatment instrument insertion channel of the endoscope cannot be passed. Even when the treatment tool is inserted through the treatment tool, the handle portion of the treatment tool is too thin or too soft to transmit a large force to the tip when performing a treatment, resulting in poor operability and impede treatment performance. There was something. In the latter conventional example, since the endoscope and the outer tube are connected by a guide path, the insertability of the endoscope is poor.

[0004] Some treatment tools for endoscopically treating a lesion on the inner wall of the body cavity cannot be inserted into the body cavity through a treatment tool insertion channel of the endoscope due to its function. In this case, a method of performing a treatment by inserting a treatment tool having a large diameter and an endoscope having a relatively small diameter into one guide tube can be considered.

However, when this method is used, there are the following problems as well as the following problems.
Both the handle of the conventional treatment instrument and the insertion portion of the endoscope have a circular cross-sectional shape, and the cross-sectional shape of the inner hole of the guide tube through which the handle is inserted is also circular. For this reason, when the handle of the treatment tool and the insertion portion of the endoscope are inserted into the guide tube at the same time, their cross-sectional shape becomes a so-called pig nose. In other words, the dead space generated between the circumscribed circle having two circular cross-sectional shapes of the handle of the treatment tool and the insertion portion of the endoscope and the circle of the inner hole of the guide tube becomes large.

[0006] In particular, unless the handle has a thick handle, the treatment tool loses rigidity and waist, so that the treatment portion at the distal end cannot be treated with a stronger force. Also, when the handle portion of the treatment tool does not have rigidity or waist, if an extra space is formed around the handle, the waist of the handle portion is easily deflected greatly, and in the case of a treatment tool whose tip side is heavy, The distal end portion fluctuates, and treatment operability is deteriorated.

Further, when an endoscope or a treatment tool is inserted into a body cavity of an organ such as the esophagus or the intestine by using a guide tube, the insertion property of the guide tube is ensured and the pain of the patient is not increased. Therefore, the outer diameter of the guide tube cannot be increased, and there is necessarily a limit to increasing the inner diameter of the guide tube. As a result, the operability is further deteriorated. I will.

[0008] Since the cross-sectional shape of the handle of the conventional treatment instrument and the insertion portion of the endoscope is circular, if the outer diameter of the handle of the treatment instrument and the insertion portion of the endoscope is increased, the handle and the endoscope are not enlarged. The cross-sectional area of the guide tube increases more than the cross-sectional area increase rate. For this reason, the guide tube cannot be made thicker and has its own limit. Accordingly, if the sheath is made thicker by giving priority to the treatment function of the treatment tool, the diameter of the insertion portion of the endoscope must be considerably reduced. For example, assuming an electronic endoscope, if the diameter of the insertion portion is small, a solid-state imaging device such as a CCD built in the insertion portion must be reduced, and the image performance deteriorates accordingly.
Further, the inner diameter of the forceps channel of the endoscope is reduced to, for example, 2 mm or less, and the treatment capability of the treatment tool inserted into the forceps channel of the endoscope is reduced. In the suction using the forceps channel, the suction capability is reduced. Will decrease.

Therefore, it is assumed that a cooperative work is performed in which the mucous membrane is pulled up by the grasping forceps inserted through the forceps channel of the endoscope and is sandwiched by a suture device provided with the endoscope in the guide tube. In order to use such a treatment tool, an endoscope having poor treatment ability and image quality is used. For this reason, the place to be treated cannot be observed sufficiently, or the above-mentioned collaborative work becomes difficult.

The present invention has been made in view of the above-mentioned problems, and an object thereof is to prevent a treatment tool from swaying in a guide tube and without lowering the function of an endoscope. It is an object of the present invention to provide an endoscope treatment apparatus capable of rationally incorporating a treatment tool and an endoscope into a limited guide tube.

[0011]

An endoscope treatment apparatus according to the present invention incorporates an endoscope and a treatment tool into a guide tube introduced into a body cavity, and includes at least one of the endoscope and the treatment tool. The cross-sectional shape of a portion located on the guide tube is configured to be flat. Therefore, it is possible to maintain the rigidity of the treatment tool without making the guide tube thicker, so that the treatment tool does not fluctuate and the treatment function is not reduced, and it is possible to easily and reliably perform a treatment operation requiring a large force. It is possible to do. In addition, the endoscope can be configured without deteriorating its function.

The specific examples of the endoscopic treatment apparatus and the specific procedures performed using the same are as follows. First, after the guide tube is fitted in advance outside the insertion portion of the endoscope, the endoscope is inserted into the body cavity, and then the guide tube is similarly inserted into the body cavity along the insertion portion of the endoscope. Insert
Thereafter, the endoscope is once pulled out. Next, another endoscope and a treatment tool having a large distal end are inserted into the guide tube, and the treatment is performed while observing the inside of the body cavity. At this time, since the cross section of one of the other endoscope and the treatment tool inserted into the guide tube is flat, it is not necessary to make the guide tube itself thick.

The distal end of the distal end of the treatment instrument is set at a value close to the outer diameter of the insertion portion of the endoscope to be inserted into the guide tube and slightly smaller than the inner diameter of the guide tube. The portion of the handle that transmits the force to the treatment means at the distal end portion of the treatment tool is thinner and flatter, and the insertion portion of the endoscope inserted into the guide tube together with the treatment tool Has an outer diameter that passes through a space in the guide tube other than the handle of the treatment tool.

The treatment instrument may be flattened to be integrated with the guide tube, or only the end of the endoscope may be enlarged, and the endoscope may be inserted into the guide tube prior to the treatment instrument. It is good. As another modification, instead of making the guide tube a general-purpose one as described above, the guide tube is specialized for a specific treatment, and a part of the distal end is provided with a large treatment tool such as an automatic suture device, The handle may be built into a part of the wall of the guide tube with a flat cross section. Further, as another modification, an endoscope dedicated to observation having a flat cross-sectional shape may be incorporated in a part of the guide tube.

The endoscope to be inserted later may be the same as the one used when inserting the guide tube. However, since the treatment can be performed using a treatment instrument with a large insertion space, the diameter of the forceps channel may be small. Instead, an endoscope having a large solid-state imaging device and excellent observation capability is suitable. Further, the outer diameter of the last-inserted endoscope may be the same as the outer diameter of the first-inserted endoscope, but it is preferable that the outer diameter be smaller in consideration of the degree of freedom of operation of the treatment tool.

The guide tube may have a plurality of conduits in order to facilitate the individual advance and retreat of each of the endoscope and the treatment tool. As described above, the guide tube, the endoscope incorporated therein, and the various treatment tools are separated or integrated, and are configured in various forms to be combined with each other in the body cavity. Can also be used while observing the treatment instrument at the large distal end.

[0017]

DESCRIPTION OF THE PREFERRED EMBODIMENTS (First Embodiment) FIGS. 1 to 3
A first embodiment of the present invention will be described with reference to FIG. The endoscopic treatment apparatus according to the first embodiment is configured by a combination for excision of a lesion that has occurred in the large intestine. That is, this endoscopic treatment apparatus includes a first endoscope 1, a second endoscope 2, a guide tube 3, a suturing device 26 as a treatment tool described later, and the like.

As shown in FIG. 1, the first endoscope 1 has an insertion portion 11 having an outer diameter slightly smaller than the inner diameter of the insertion tube 5 of the guide tube 3, and this insertion portion 11 is at hand. It is divided into a flexible tube portion 12, a curved tube portion 13, and a tip portion 14 in this order from the side. The distal end portion 14 of the first endoscope 1 has a built-in direct-viewing observation optical system. Further, the bending tube portion 13 is bent by the operation of the hand operation portion 15, and the tip portion 1 is bent.
The direction of 4 can be changed.

The guide tube 3 is formed of, for example, a flexible tube made of polyurethane. As will be described later, the distal end portion of the guide tube 3 is inserted to the vicinity of the splenic flexure of the large intestine by a procedure using the first endoscope 1,
The sigmoid colon is placed in the large intestine in a linearly regulated state.

As shown in FIG. 2, the second endoscope 2 has an insertion portion 16 having an outer diameter smaller than the inner diameter of the guide tube 3, and the insertion portion 16 is a flexible tube in order from the hand side. Part 1
7, a curved tube portion 18 and a tip portion 19 are formed separately. The distal end portion 19 of the second endoscope 2 is provided with an observation means 21, an illumination means 22, and a forceps channel port 23 toward the side. That is, the second endoscope 2 is of a side-view type. Also, in the case of the second endoscope 2,
The bending tube portion 18 is bent by the operation of the hand operation portion, and the direction of the distal end portion 19 can be changed. Although not shown, a forceps insertion channel is formed in the insertion portion 15 of the second endoscope 2, and a proximal end of the forceps insertion channel has a forceps insertion port (not shown) provided in a hand operation unit. The distal end of the forceps insertion channel is connected to the forceps channel opening 23 of the distal end portion 19. Then, a treatment tool, for example, the grasping forceps 25 is inserted through the forceps insertion channel, and the grasping forceps 25 can be inserted into the body cavity.

A second endoscope 2 and a suturing device 26 are inserted through the guide tube 3, and the second endoscope 2 and the suturing device 2 are inserted.
The distal end portion 6 projects from the distal end portion 30 of the guide tube 3. The suturing device 26 includes a suturing device distal end portion 31 and a portion of a handle 32 that incorporates a slide component for transmitting a force to the suturing device distal end portion 31. Are smaller than the inner diameter D of the guide tube 3, and can be inserted into the guide tube 3.

As shown in FIG. 3, the second endoscope 2
The cross-sectional shape of the portion of the insertion portion 16 is circular,
On the other hand, the cross-sectional shape of the handle 32 of the suture instrument 26 is flat. Then, the insertion section 1 of the second endoscope 2
In a crescent-shaped gap between the outer circumference of the guide tube 3 and the inner circumference of the guide tube 3, the longitudinal direction of the cross-sectional shape of the handle 32 is curved along the circumference of the insertion portion 16 of the second endoscope 2. It is arranged compactly.

Here, the maximum diameter d2 of the insertion portion 16 of the second endoscope 2 is smaller than the inner diameter D of the guide tube 3,
Moreover, the total length of the maximum diameter d2 of the insertion portion 16 and the short diameter d1 of the handle 32 of the suture device 26 is smaller than the inner diameter D of the guide tube 3. That is, each dimension is d1 + d
2 <D, and the second endoscope 2, the guide tube 3, and the suturing device 26 are combined in this relationship.

Next, a method of using the endoscope treatment apparatus having the above configuration will be described. First, the insertion section 1 of the first endoscope 1
The guide tube 3 is fitted on 1, and the guide tube 3 is positioned near the insertion portion 11. After the guide tube 3 is fitted over the insertion portion 11 of the first endoscope 1 in advance in this manner, the insertion portion 11 of the first endoscope 1 is inserted into the large intestine 35, and the distal end of the insertion portion 11 is inserted. The part 14 is inserted into the large intestine 35 near the splenic flexure. At this time, the bending tube section 13 may be bent by the operation of the hand operation section 15 and the distal end section 14 may be hooked on the spleen bending section 36 of the large intestine 35. Then, as shown in FIG. 1, the guide tube 3 retracted to the hand side is pushed in the direction of arrow 1 along the insertion portion 11 of the first endoscope 1, and inserted into the large intestine 35. , The tip portion 30 to the splenic bend portion 36
To be located near. As a result, the guide tube 3 is placed in a state where the portion of the S-shaped colon 37 of the large intestine 35 is contracted and regulated to a linear state (a state shown by a solid line in FIG. 1).

Thereafter, only the first endoscope 1 is pulled out, leaving the guide tube 3. Next, the suturing device 26 is inserted into the guide tube 3 and inserted until the distal end portion 31 of the suture device 26 comes out of the distal end portion 30 of the guide tube 3.
Under X-ray fluoroscopy, make sure that the distal end 31 of the suture instrument 26 does not go too far, or grasp the relationship between the handle 32 of the suture instrument 26 and the length of the guide tube 3, and determine their positional relationship. Note the insertion position.

Next, the insertion section 16 of the second endoscope 2 to be inserted later is inserted into the guide tube 3 so as to pass by the handle 32 of the suturing device 26, and as shown in FIG.
At least the curved tube portion 18 and the distal end portion 19 protrude from the distal end portion 30. Then, the second endoscope 2 which is inserted after this
Of the endoscope 2 by bending the bending tube portion 18 of the endoscope 2.
Over the lesion 38 of the large intestine 35. When the position of the lesioned part 38 is confirmed by the second endoscope 2, the grasping forceps 25 inserted through the forceps insertion channel of the second endoscope 2.
The center of the lesioned part 38 is picked up using and the lesioned part 38 is pulled up.

Next, while controlling the handle 32 of the suturing device 26, the picked-up lesion 3
The lesioned part 38 is sutured with the root of No. 8 interposed therebetween. Thereafter, by pulling out the second endoscope 2 and the suturing device 26 inserted later from the guide tube 3 and instead cutting the lesioned portion 38 with a treatment tool such as scissors forceps, the lesioned portion 38 can be cut off. Note that a treatment tool such as scissors forceps is introduced through the guide tube 3, but may be inserted through the forceps insertion channel without pulling out the second endoscope 2.

As described above, according to the endoscopic treatment apparatus of the first embodiment, it is possible to remove the lesion 38 while observing it with the second endoscope 2 from above. Is easy to perform, and a reliable and appropriate treatment can be easily performed.

(Second Embodiment) A second embodiment of the present invention will be described with reference to FIG. In the second embodiment, a modified example of the guide tube 3 of the endoscopic treatment device is shown. That is, the guide tube 3 is a storage part having an oval cross-sectional shape curved in an arc shape along the circumferential direction for storing a large ligating loop indwelling device 41 in a part of the wall portion of the distal end portion 30. An opening 42 is formed. This storage opening 4
Numeral 2 is formed in a fan shape whose tip side is widened. The storage port 42 communicates with a treatment instrument insertion passage 43 formed in the wall of the guide tube 3.

The loop indwelling device 41 has a sheath 44 forming a handle of the treatment tool and a ligating loop wire 45. The sheath 44 is inserted into the treatment tool insertion passage 43 of the guide tube 3. I have. Also, the loop wire 45
A rubber tube 46 is fitted to the root end of the wire, and the binding end of the loop wire 45 is hooked on a key (not shown) provided at the tip of the operation wire inserted into the sheath 44. By performing an operation of pulling the operation wire at the hand side, the rubber tube 46 is pushed by the distal end of the sheath 44 and can move on the loop wire 45.

As described above, since the guide tube 3 is configured, for example, the lesioned part 38 is observed with the second endoscope 2 which is inserted later, and the looped indwelling device 41 is taken out to raise the raised lesioned part 38 such as a polyp. The loop wire 45 is hung around the periphery of the patient, and the size of the loop wire 45 is reduced, so that the lesion 38
Can be tied. In addition, in addition to the loop indwelling device 41, a high-frequency snare or a treatment tool with a large clip inserted at the distal end of the sheath may be stored in the storage port 42.

As described above, since the treatment instrument storage port 42 is formed in the wall of the guide tube 3, a treatment instrument larger than that passing through the forceps insertion channel of the second endoscope 2 can be used. For this reason, a large lesion can be treated at a time to improve efficiency. Unlike the observation with the forceps channel of the endoscope, which is different from the observation of only the front of the lesion, the second endoscope 2 that is put in the rear can be moved forward and backward and bent to make the entire lesion or its back side an observation range. It is possible to confirm whether a loop or snare is involved in the lesion, and there is no failure.

(Third Embodiment) A third embodiment of the present invention will be described with reference to FIG. In the third embodiment, two or more insertion passages are formed in the guide tube 3 of the endoscopic treatment device. The guide tube 3 here has an insertion tube 51 for an endoscope through which the insertion portions 11 and 16 of the first and / or second endoscope 2 are inserted, and a treatment tool mainly through which a hard treatment tool is passed. The two insertion passages of the insertion passage 52 are formed so as to extend through the entire length of the guide tube 3. This 2
A partition partitioning the two insertion conduits 51 and 52 is formed of a single sheet of fluororesin 53 having good slipperiness and excellent strength, and this membrane 53 is formed integrally with the guide tube 3 by extrusion. . The film 53 is deformable, and is formed thinner and softer toward the center.
For this purpose, a treatment tool 55 having a relatively large tip portion 54
Even if it is, it can be inserted.

An example of the treatment tool 55 is an ultrasonic vibration coagulation cutter. In the case of an ultrasonic vibration coagulation cutter, the tip 54 is constituted by an ultrasonic probe 56 and a movable gripping member 57.

A guide tube 5 for the treatment tool of the guide tube 3
When the treatment tool 55 is inserted through the second device 2, the thin film 53 can be inserted while being deformed, so that it can be easily inserted.
In particular, even a treatment tool 55 having a large distal end portion 54 can be easily inserted. FIG. 5A shows a state in which the distal end portion 54 of the treatment tool 55 does not completely penetrate through the treatment tool insertion pipe 52, and FIG. 5B shows a state in which the distal end portion 54 of the treatment tool 55 has the treatment tool insertion tube. This shows a state in which treatment can be performed completely through the road 52.

After the treatment tool 55 having the large distal end 54 is inserted, the insertion section 16 of the second endoscope 2 to be inserted later is inserted into the insertion pipe 51 for the endoscope. At this time, the handle 58 portion of the treatment tool 55 is inserted into the adjacent treatment tool insertion pipe 52, but the thin film 53 other than the handle 58 portion naturally expands to return to its original shape even if expanded. Therefore, the cross-sectional shape of the second endoscope 2 does not hinder the insertion of the second endoscope 2 after being retracted and deformed into a U-shape.
The cross-sectional shape of the handle 58 is formed flat.

According to the above-described structure, the thin film 53 is deformed to allow the insertion of the handle 58 of the treatment tool 55 and to prevent the handle 58 from wobbling. . In addition, two insertion pipes 51, 5
Since the thin film 53 partitioning between the two endoscopes 2 can be used, the advancing and retreating operations of the treatment tool 55 and the second endoscope 2 can be performed independently without interfering with each other.
When the treatment instrument 55 is moved forward and backward, the second endoscope 2 in the rear insertion position
There is no problem due to interference such as moving the field of view.
In addition, since the thin film 53 has flexibility and slipperiness and is easily deformed, even a treatment tool 55 having a large distal end, such as a suture instrument, can be easily inserted.

Conversely, an endoscope having a small outer diameter is inserted into the treatment instrument insertion conduit 52, and a treatment instrument 55 having a larger tip is inserted into the endoscope insertion conduit 51. It is also possible.

In the guide tube 3 having the above-described structure, the two insertion pipes 51 and 52 are formed. However, the number of the insertion pipes is not limited to two, and a larger number of insertion pipes may be provided.
Further, a plurality of films 53 may be provided. In the example of the above configuration, the thin film 53 is formed integrally with the member of the guide tube 3, but may be formed separately. The material forming the guide tube 3 may be a mixture of a urethane-based elastomer and a solid lubricant or Teflon powder as a lubricant,
Also in this case, it is suitable because the film is slightly elongated. Ultra high molecular weight polyethylene is also suitable because of its excellent slipperiness.

(Fourth Embodiment) A fourth embodiment of the present invention will be described with reference to FIGS. The fourth embodiment shows a modification of the guide tube 3.
The guide tube 3 has a guide groove 61 for guiding the treatment tool formed on the outer surface of the wall portion over the entire length of the tube. The guide groove 61 has a rectangular cross-sectional shape, and is provided with a suturing device 62 as a treatment tool. A flat main body 63 is fitted so as to be able to advance and retreat. Further, the suturing device 62 has the main body 63 and a jaw 64 which is slidably mounted along the main body 63 and has a tip bent in a key shape. The living tissue is sandwiched between the living tissue and the living tissue.

At the distal end of the guide tube 3, a notch 66 having a round mouth and a rounded portion is provided at a portion facing the portion where the guide groove 61 is formed. The notch 66 allows the curved tube part 18 of the insertion part 16 of the second endoscope 2 to be inserted into the notch 66. Here, the second endoscope 2 is a direct-view endoscope.

With such a configuration, for example, when the bending tube portion 18 of the second endoscope 2 to be inserted is bent,
As shown in FIG. 7, the curved tube portion 18 enters the notch portion 66, retreats away from the lesioned portion 67, bends greatly, and can overlook the lesioned portion 67 from a distant position.

When the lesion 67 is to be treated, the lesion 6 is located between the receiving portion 65 of the suture device 62 and the jaw 64.
7 are positioned opposite to each other. Next, a lifting tool 69 having a T-shaped distal end portion 68 is inserted into the forceps channel of the second endoscope 2 and, as shown in FIG. The part 68 is protruded and driven into the lesion part 67 to be engaged therewith, and the lifting part 69 lifts the lesion part 67. Then, as shown in FIG. 7 (a), the lesion 67 is located between the receiving portion 65 of the suture device 62 and the jaw 64.
And the lesion 67 is sutured.

As described above, the tip 68 of the lifting tool 68
Is inserted into the lesion 67, the lesion 67 is pulled up, and the lesion 67 in the pulled-up state is sandwiched by the suturing device 62, and the surrounding body cavity wall of the lesion 67 is sewn in two layers. Thereafter, all layers of the wall of the lesion 67 are cut with a high-frequency knife or the like passing through the forceps channel of the second endoscope 2. Cut after suturing, less bleeding. In addition, a notch 66 is provided at the distal end of the guide tube 3 so that the endoscopes 1 and 2 can be easily advanced and retracted and bent. Since it can be observed from directly above, treatment is easy.

In the suturing device 62 in the above embodiment, the suturing direction is the direction intersecting with the long axis direction of the guide tube 3, but as shown in FIG. You may. Further, as shown in FIG. 8, the guide groove 61 may be provided on the inner surface side of the guide tube 3. Further, the shape of the cutout portion 66 may be made to widen as it goes to the tip of the tube.

(Fifth Embodiment) A fifth embodiment of the present invention will be described with reference to FIG. This fifth embodiment shows a modification of the guide tube 3. The guide tube 3 is formed of a multi-lumen tube made of FEP (tetrafluoroethylene-6-fluoropropylene resin), which is a kind of fluororesin. A central conduit 71 having a substantially elliptical cross-sectional shape, and two treatment-tool insertion conduits 72 such as broad beans having a substantially elliptical transverse cross-sectional shape are provided so as to sandwich the central conduit 71. I have.

As the treatment tool incorporated in the treatment tool insertion pipe 72, for example, a rigid treatment tool having a hard handle made of stainless steel is used. The rigid handle is formed flat so as to be movable along the longitudinal direction of the flat shape of the treatment instrument insertion tube 72. Further, the second endoscope 2 to be inserted later into the insertion pipe 21 for endoscope is of a direct-view type, and the distal end portion 19 of the insertion portion 16 has an observation means 73 and an illumination means 74. An observation window cleaning means 75 such as a cleaning nozzle is provided.

In the case of using the guide tube 3 configured as described above, for example, as shown in FIG. 9, the insertion portion 16 of the second endoscope 2 inserted later into the endoscope insertion conduit 71 of the guide tube 3. While observing the lesion 67 from a distance, the lesion 67 is excised using two rigid treatment tools, for example, grasping forceps 76 and a scalpel 77, which come out from both sides of the visual field. That is, the treatment is performed by moving the grasping forceps 76 and the scalpel 77 up, down, left, and right along the longitudinal direction of the treatment instrument insertion tube 72. For example, the lesioned part 67 is pulled and pulled up with the grasping forceps 76, and the root of the lesioned part 67 is incised with a scalpel 77.

If such a guide tube 3 is used,
Surgery is easy because the procedure can be performed in a situation of a procedure that the operator is accustomed to, such as laparoscopic surgery, that is, a situation in which two treatment tools come out from both sides of the field of view. In addition, since a treatment tool having a hard handle can be used, the force can be easily transmitted to the distal end, and efficient treatment can be performed.

If the treatment instrument is inserted using the forceps channel of the second endoscope 2 inserted later, three treatment instruments can be used in total. Can be spread out with grasping forceps and the center can be incised. The guide tube 3 is made of porous P
TFE (ethylene tetrafluoride resin) with improved flexibility may be used. If the guide tube 3 is flexible, the degree of freedom of the up, down, left, and right movements of the treatment tool used in combination therewith increases. Of course, the types of combinations of the treatment tools are not limited to the combinations described above.
The incision may be stitched together with a threaded needle using this method. Further, a combination of a high-frequency snare and grasping forceps, a clip and grasping forceps, a suturing device and a T-shaped lifting tool, and the like may be used.

(Sixth Embodiment) A sixth embodiment of the present invention will be described with reference to FIGS. The sixth embodiment shows a modification of the guide tube 3 in the fifth embodiment.

The guide tube 3 has been provided with a treatment instrument insertion conduit 72 having a flat cross-sectional shape, and the handle portion of the treatment tool inserted therethrough has a flat cross-sectional shape corresponding to it. However, in this embodiment, an endoscope 78 having a flat cross section is used, and the endoscope 78 is accommodated in a slide groove 79 formed outside the guide tube 3 so as to be able to advance and retreat. The distal end portion 80 of the endoscope 78 is formed to be relatively large, and its cross-sectional shape is a flat oval shape bent substantially at the curvature of the inner diameter of the guide tube 3.
Is attached so as to also serve as a part of the tip portion 30 of the nosepiece. Two white LEDs as illumination means at the tip 80
82, one solid-state imaging device (CCD) as observation means
83 are incorporated. The guide tube 3 is a semi-rigid material that can be deformed by bending the bending tube portion 13 of the first endoscope 1 inserted into the inner hole 81, for example.

Since the guide tube 3 is constructed as described above, for example, a flat endoscope 78 as a second endoscope is previously formed on a slide groove 79 formed on the outer wall of the guide tube 3.
Then, the first endoscope 1 is inserted into the stomach together with the guide tube 3. After that, after confirming the lesion position with the first endoscope 1 used for inserting the guide tube 3, the lesion portion 85 is grasped by the endoscope 78 this time. In other words, the lesion 85 is the guide tube 3
The semi-rigid guide tube 3 is deformed and adjusted using the curved portion 13 of the first endoscope 1 so as to be in front of.
Thereafter, the first endoscope 1 is removed from the guide tube 3.

Next, the guide tube 3 is slightly rotated or advanced or retracted, or the operation section of the endoscope 78 is pushed or pulled so that the lesion 85 has a distance which is the most easily treated. The lesion 85 is displayed on the monitor, and the endoscope 7 is displayed.
8 and the guide tube 3 are positioned.
8 and so on. Next, the lesion 85 is treated using a treatment tool 89 such as a rigid grasping forceps or scissors forceps whose handle portion is curved in an arc shape.

According to the guide tube 3 of this embodiment,
The guide tube 3 can be deformed into a free shape even after the insertion, and can be used even when the lesioned part 85 is not on the extension of the guide tube 3 during the insertion.

In the sixth embodiment, coils and wires are built in several places in the wall of the guide tube 3, and the coil is contracted by pulling the wires to harden the guide tube 3. You may be able to. In the case of such a guide tube 3, it is flexible until inserted into a body cavity, but the guide tube 3 can be hardened afterwards by performing an operation of pulling a wire, for example, after insertion into the esophagus,
The esophagus can be made substantially linear.
Further, the guide tube 3 may be hardened into an arcuate shape, or a predetermined length from the tip may be semi-hard, and the rear side may be gradually hardened. Also, the handle portion of the treatment tool may be semi-rigid so that it can be changed to a free shape by the force of a finger so that the shape can be freely changed depending on the position of the lesion, or it may be bent from near the tip Is also good. The viewing direction of the endoscope 78 is not limited to the direct viewing direction,
Depending on the position of the lesion, it may be viewed from the side or oblique. The types of treatment tools used in combination are not limited to the examples described above.

(Seventh Embodiment) A seventh embodiment of the present invention will be described with reference to FIG. In the seventh embodiment, the guide tube 3 has the same configuration as that of the third embodiment described above, but in this embodiment, the endoscope insertion conduit 51 and the treatment tool insertion conduit 52 are provided. Has been replaced.
In addition, the endoscope 90 has a unique shape in which the distal end portion 91 of the insertion portion is thicker than the other curved portions 92 and the flexible tube 93. Since the endoscope 90 is specialized only for observing a lesion, a CCD 95 as an observation means and a white LED 96 as an illumination means are arranged side by side at the distal end portion 91. The bending portion 92 and the flexible tube 9
Only the respective cables are built in the part 3. The cross-sectional shape of the distal end portion 92 is formed in an oblong flat shape.

As described above, since the insertion portion of the bending portion 92 and the flexible tube 93 is simple, thin, and flat, the endoscope 90 is automatically sewn after the endoscope 90 is inserted into the guide tube 3. A treatment tool such as a cutting device 97 can be inserted. That is, since the insertion portion of the endoscope 90 is thin, a treatment tool having a particularly large distal end can be inserted. Therefore, this is suitable for, for example, a stomach having a large space in a body cavity. As another modification, the cross-sectional shape of the handle portion of the treatment tool may be flat, or both may be flat together with the insertion portion of the endoscope.

(Eighth Embodiment) An eighth embodiment of the present invention will be described with reference to FIG. In the eighth embodiment, a curved tube portion 95 is formed in the guide tube 3. A section about 150 mm from the tip of the guide tube 3 contains a plurality of curved short tubes continuously riveted in two directions rotatably in the same manner as in a known endoscope. When it is pulled through the operation wire by the operation in the above, the curved tube portion 95 is configured to bend in two directions. The conduit of the guide tube 3 is divided into three as in the fifth embodiment.

Since the guide tube 3 is configured as described above, for example, as shown in FIG. 13A, a curved angle of 150 to 210 degrees is required such as the posterior wall of the stomach angle or the vicinity of the cardia.
In the case where there is a lesion 96 at the position of looking up,
The guide tube 3 can be used as a treatment tool such as a grasping forceps 76 or a guide for the second endoscope 2 to be inserted later.

As shown in FIG. 13 (b), a guide tube having a bending function is provided through two rigid treatment instrument insertion pipes.
The T-shaped lifting tool 69 of the stomach wall around the lesion 96 is driven into the stomach wall, the bending operation is performed to pull out the curved tube portion 95 while keeping it substantially straight, and the lesion 96 is moved to a position where it can be more easily treated. It is also possible to perform treatment using a hard treatment tool having a long bow-shaped handle as in the sixth embodiment shown in FIGS. 10 and 11 after being brought. Similarly, it can be used for a treatment in which the transverse colon is drawn to a position where it can be easily treated, for example, in a place having a curvature of 120 to 150 degrees like the descending colon and the transverse colon.

As described above, the bending tube portion 95 can be bent to guide the second endoscope 2 and the treatment tool inserted later, so that the treatment can be performed more easily than with the conventional endoscope. Since there is little fluctuation and the lesion 96 can be viewed from the front, the treatment can be easily performed. Although it is different from the conventional use of the guide tube 3, it has a diameter larger than that of the endoscope and is made rugged, so that a large lesion 96 can be pulled and pulled up, and if the endoscope is not curved, it must be treated. It can be brought to a place where it is easy to treat even a lesion site that does not need to be treated. It goes without saying that the adhesion site is cut from the outside by laparoscopic surgery, and that there is no large blood vessel or nerve at the place where the T-shaped pull-up device 69 is driven by laparoscope.

(Ninth Embodiment) A ninth embodiment of the present invention will be described with reference to FIG. In the ninth embodiment, a storage groove 101 having an elliptical cross-sectional shape curved in an arc shape along the circumferential direction is provided in a part of the guide tube 3,
The high-frequency incision tool 102 provided in the storage groove 101 is formed by bending the high-frequency wire 103 at a bending rate in the circumferential direction of the wall of the guide tube 3, and is built in the storage groove 101.

With such a configuration, a wide range of mucosal resection can be performed. For example, it is possible to insert the guide tube 3 into the esophagus 105, insert the distal end portion 30 to the vicinity of the cardia 106, and extensively remove the Barrett's epithelium 107 with the high-frequency wire 103.

Conventionally, only one point could be treated with a heat probe, so it was troublesome if the range of the Barrett's epithelium 107 was wide. However, according to the ninth embodiment,
It is easier because you can treat at once. Argon plasma lasers can perform a wide range of treatments, but are expensive, but high-frequency generators are inexpensive and often at hand.

In the ninth embodiment, a roller-type heater hemostatic device may be incorporated as a high-frequency treatment device. In addition, if a blade such as a sickle is bent and used, an inexpensive blade can be formed. Further, in the above example, the curved shape of the storage groove 101 and the incised portion of the incision tool are substantially the same, but the straight portion of the base of the incision tool is expanded outward to reduce the curvature of the curved shape of the incision tool. It is also possible to make the curvature larger than 101.

(Tenth Embodiment) A tenth embodiment of the present invention will be described with reference to FIG. In the tenth embodiment, the distal end surface of the distal end portion 30 of the guide tube 3 has a shape cut obliquely at approximately 45 degrees.
An automatic suturing device 111 and a cylindrical cutter 112 are provided inside the / 4 circumferential portion. Further, a treatment instrument insertion conduit 113 is provided at a position facing the automatic suturing device 111.

Therefore, for example, the guide tube 3 is inserted into the body cavity along the insertion section 11 of the first endoscope 1, and after confirming the lesion 38, the endoscope 1 is retracted, and the lesion 38 is retracted.
While observing, the suturing device side of the distal end portion 30 of the guide tube 3 is brought close to the lesioned portion 38, and the jaw 114 of the automatic suturing device 111 is protruded forward. Next, the T-shaped lifting tool 69 is driven into the wall of the lesioned part 38 from the treatment instrument insertion conduit 113 using a guide tube (not shown) having a bending function. Next, the guide tube 3 is fixed to a stand or the like so as not to rotate, and the body cavity wall is pulled up so as to cover the distal end portion 30 of the guide tube 3 as shown in FIG.
The body cavity wall is sewn between the body 11 and the jaw 114, and thereafter, the inner cylindrical cutter 112 is protruded to cut the lesion 38.

As described above, the wall of the body cavity can be securely grasped through the treatment instrument insertion channel 113 of the guide tube 3 and pulled so as to cover the distal end portion 30 of the guide tube 3 over a large area. As compared with the case where an endoscope is used, a large area of a wall can be removed at a time. Since the cylindrical cutter 112 is built in the guide tube 3 and can be observed and cut while covering the distal end portion of the guide tube 3 with the wall of the body cavity in a stretched state, it is easy to cut, efficient and safe. Also, it is suitable for removing a lesioned part such as an intestinal wall where there is a lot of slack. Since the treatment is performed inside, there is no spread of cancer cells into the abdominal cavity. Since the incision is made after sewing with the automatic suturing device 111, bleeding is small. The distal end of the guide tube 3 is cut obliquely, and the distal end of the treatment instrument insertion tube 113 is open at the distal end portion that protrudes sharply.
8 can be raised directly above.

The endoscope may be the same as the one used for inserting the guide tube, or may be one with improved observability by reducing the inner diameter of the forceps channel. Also,
In order to more reliably pull in the body wall, a plurality of treatment instrument insertion channels 113 may be provided at positions facing the suturing device 111. A large clip may be used instead of the suturing device 111. Of course, the range of the automatic suturing device 111 is not limited to the above-described １ ／ circumferential portion, and may be １ ／ or ／ circumferential, and can be sewn over a wider range.

Also, the cutting method is not limited to the cylindrical cutter, and the cutting may be performed while stopping the blood with a wire cutter using a high frequency as in the ninth embodiment. It can be treated safely. Moreover, a balloon for fixing the body cavity and the guide tube may be provided at least at one or more locations on the outer periphery of the guide tube.

The present invention is not limited to the above-described embodiment, but can be modified to other forms including those shown in the following supplementary notes. <Supplementary notes> Endoscope treatment having a substantially cylindrical guide tube guided into the body cavity by the insertion portion of the first endoscope, and a second endoscope and a treatment tool guided by the guide tube so as to be able to advance and retreat. An endoscope treatment apparatus, wherein a cross-sectional shape of a portion of at least one of the second endoscope and the treatment tool, which is located in the guide tube, is configured to be flat.

2. 2. The apparatus according to claim 1, wherein the guide tube and the treatment tool are separate bodies. 3. 2. The device according to claim 1, wherein the guide tube and the second endoscope are separate bodies. 4. 2. The device according to claim 1, wherein a part of the guide tube and the treatment tool are integrally formed. 5. 2. The device according to claim 1, wherein a part of the guide tube and the second endoscope are integrally formed. 6. A first guide groove having at least one or more flat cross-sectional shape provided in a part of the guide tube, and a treatment tool or a second endoscope housed in the guide groove so as to be able to advance and retreat therein. Items.

7. The first tube comprises at least one or more through-tubes having a flat cross-sectional shape provided in a part of the guide tube, and a treatment tool or a second endoscope which is inserted into the guide tube so as to be able to advance and retreat. Items. 8. A treatment tool or a second endoscope can be freely deformed into a predetermined shape at a boundary between at least one or more flat cross-sectional through pipes provided in a part of the guide tube by a force of insertion of a treatment tool or a second endoscope. 2. The device according to claim 1, wherein a special boundary wall is provided. 9. 2. The treatment instrument or the second endoscope according to claim 1, wherein a cross-sectional area of the distal end portion is larger than a cross-sectional area of a portion inside the guide tube. 10. 2. The device according to claim 1, wherein at least a part of the guide tube is provided with a bending function by remote control.

11. At least part of the guide tube,
2. The device according to claim 1, wherein a groove having a flat cross section for accommodating the distal end portion of the treatment tool is provided. 12. 2. The guide tube according to claim 1, wherein the end of the guide tube is cut obliquely. 13. 3. The guide tube according to claim 1, wherein a notch for receiving a treatment tool or a second endoscope is provided at least at a part of a distal end of the guide tube. 14． 2. The device according to claim 1, wherein at least a part of the guide tube is made semi-rigid so as to be deformable by a bending operation of the first endoscope or the second endoscope.

15. At least a part of the guide tube is
Item 1 wherein the flexibility is adjustable. 16. In at least one place on the outer circumference of the guide tube,
2. The device according to claim 1, wherein a balloon for fixing the body cavity and the guide tube is provided. 17． The treatment instrument having a flat cross-sectional shape in the guide tube is an automatic suturing device. 18. The treatment instrument having a flat cross section in the guide tube is an automatic ligating device. 19. 2. The treatment tool according to claim 1, wherein the treatment tool having a flat cross section in the guide tube is a high-frequency solidification cutting tool. 20. The treatment instrument having a flat cross-sectional shape in the guide tube is a loop-shaped ligature.

21. The treatment tool having a flat cross section in the guide tube is a scissors forceps.
Items. Twenty-two. 2. The treatment tool according to claim 1, wherein the treatment tool having a flat cross-sectional shape in the guide tube is an ultrasonic coagulation cutting tool. Twenty-third. 2. The treatment tool according to claim 1, wherein the treatment tool having a flat cross-sectional shape in the guide tube is a clip-shaped ligature. 24. 2. The treatment tool according to claim 1, wherein the treatment tool having a flat cross-sectional shape in the guide tube is an automatic suture cutting tool. 25. 2. The treatment tool according to claim 1, wherein the treatment tool having a flat cross section in the guide tube has a bending means near the distal end.

26. 2. The treatment tool according to claim 1, wherein the treatment tool having a flat cross-sectional shape in the guide tube is provided with a semi-rigid portion which can be deformed at least partially by the force of a finger. 27. The treatment instrument having a flat cross-sectional shape in the guide tube, wherein the hardness of the handle portion is adjustable. 28. 2. The treatment tool according to claim 1, wherein the treatment instrument having a flat cross-sectional shape in the guide tube has a handle portion coated with a coat mixed with a solid lubricant. 29. The treatment instrument having a flat cross-sectional shape in the guide tube, wherein a Teflon resin coat is applied to a handle portion thereof.

30. Item 1. The guide tube has a built-in cylindrical cutter. 31. 2. The guide tube according to claim 1, wherein the guide tube has a suction function. 32. Item 1. The guide tube is provided with an air supply function. 33. 2. The device according to claim 1, wherein a coat mixed with Teflon resin is applied to the outside of the insertion portion of the second endoscope.

According to the above-described embodiment and the supplementary items, a guide tube which conventionally had only a function of a guide for repeatedly inserting and removing an endoscope into and out of a body cavity, is provided with a treatment tool having a flat cross-sectional shape or an inner tube. By combining the endoscope, it is possible to effectively use the substantially straight shape of the guide tube and use a rigid treatment tool or the like, which allows the treatment performance to be increased through the forceps channel of the endoscope. The treatment of large lesions and deep lesions, such as large cancers and advanced cancers, which had to be performed externally, such as laparoscopic surgery or open surgery, has been significantly improved compared to Can be changed to a treatment from the inside as much as possible. In addition, by using a laparoscope to dissect adhesions and dissect lymph nodes, check the running of blood vessels and nerves, and use an ultrasonic probe to check the progress of cancer,
It is possible to perform a treatment that has not been possible with an endoscope, such as excision of the entire body cavity wall. As a result, it is possible to remove a wide range of tumors and remove all layers of the body cavity wall without using external treatments as much as possible, minimizing the length of hospital stay, costs, pain and scars, and greatly reducing the burden and risk of patients be able to.

[0081]

As described above, according to the present invention, it is possible to reduce the deterioration of the function of the endoscope in the limited inner space of the guide tube without wobbling of the treatment tool.

[Brief description of the drawings]

FIG. 1 is an explanatory diagram of a use state of an endoscope treatment device according to a first embodiment.

FIG. 2 is an explanatory diagram of a use state of the endoscopic treatment device according to the first embodiment.

FIG. 3 is a cross-sectional view of a guide tube of the endoscope treatment apparatus.

FIG. 4 is a perspective view of the vicinity of a distal end portion of the endoscope treatment device according to the second embodiment in use.

FIG. 5 is a perspective view of the vicinity of a distal end portion of the endoscopic treatment device according to the third embodiment in use.

FIG. 6 is a perspective view of the vicinity of a distal end in a use state of an endoscopic treatment device according to a fourth embodiment.

FIG. 7 is a cross-sectional view of the vicinity of the distal end of the endoscope treatment device according to the fourth embodiment in a use state.

FIG. 8 is a perspective view of an endoscope treatment apparatus according to a fourth embodiment in a used state near a distal end portion.

FIG. 9 is a perspective view of the endoscope treatment apparatus according to the fifth embodiment in the use state near the distal end.

FIG. 10 is a perspective view of an endoscope treatment device according to a sixth embodiment in use.

FIG. 11 is a perspective view of the use state of the vicinity of the distal end of the endoscopic treatment device according to the sixth embodiment.

FIG. 12A is a longitudinal sectional view showing the vicinity of the distal end of the endoscope treatment device according to the seventh embodiment in use, and FIG. 12B is a perspective view showing the vicinity of the distal end of the endoscope treatment device in use. FIG.

FIG. 13 is an explanatory diagram of a use state of the endoscope treatment device according to the eighth embodiment.

FIG. 14 is an explanatory diagram of a use state of the endoscopic treatment device according to the ninth embodiment.

FIG. 15 is an explanatory diagram of a use state of the endoscope treatment device according to the tenth embodiment.

[Explanation of symbols]

DESCRIPTION OF SYMBOLS 1 ... 1st endoscope, 2 ... 2nd endoscope, 3 ... Guide tube, 16 ... Insertion part of 2nd endoscope, 25 ... Grasping forceps, 2
6 ... suture device, 38 ... lesion.

Continued on the front page (72) Inventor Ryuta Sekine 2-43-2 Hatagaya, Shibuya-ku, Tokyo F-term in Olympus Optical Co., Ltd. (reference) 2H040 DA54 DA56 4C060 CC11 EE24 EE28 GG24 GG29 JJ12 KK03 KK04 KK10 KK12 4C061 AA01 AA02 AA04 BB02 BB04 CC06 DD03 GG15 GG24 HH56

Claims (1)

[Claims] An endoscope and a treatment tool are incorporated in a guide tube introduced into a body cavity, and a cross-sectional shape of at least one of the endoscope and the treatment tool located in the guide tube is configured to be flat. An endoscope treatment apparatus characterized by the above-mentioned.