JP2000166936A - Endoscopic treatment instrument - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an endoscopic treatment instrument, by which an object capable of being created from the inside of an organ by means of endoscope is extended and also even a wide range of lesion part on a wall in the deep part of a celom or the deeply infiltrated lesion part especially difficult to be treated in a conventional manner is easily treated. SOLUTION: A treatment endoscope 23 and treatment tool units 35 and 37 are inserted to the inner hole of a tool introducing guide tube 21 to be inserted to the celom so as to be freely retrogressing possible, the horizontal cross section shapes of the endoscope 23 and the units are provided with an arc part with a diameter being a little smaller than that of the inner hole of the guide tube and the endoscope 23 and the units are assembled and inserted to the tool introducing guide tube. In this case, the horizontal cross section shape of the whole assembled body is constituted to be the one having the diameter being a little smaller than that of the inner hole of the guide tube. Then the treatment endoscope and the treatment tool units are inserted to the guide tube and used.

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 for transendoscopically treating a lesion in a body cavity.

[0002]

2. Description of the Related Art When treating a lesion formed on the inner wall of a body cavity of a gastrointestinal organ such as the stomach or the large intestine, a method of transendoscopic treatment is considered first. In this method, an endoscope is inserted into a body cavity, a surgical treatment tool is inserted into the body cavity through a treatment tool insertion channel of the endoscope, and a surgical operation is performed from the body cavity.

[0003] However, when performing this endoscopic surgical operation, the lesion is often uncontrollable if the lesion is large or if the lesion is deeply infiltrated into the wall. In such a case, the procedure shifts to surgery to be performed from outside the body cavity,
Laparoscopic or open surgery will be performed.

[0004] By the way, as shown in FIG. 11, an insertion portion 1 of an endoscope used in a conventional endoscopic surgery is as follows.
The distal end portion 4 is connected to the distal end of the flexible tube portion 2 via a curved tube 3. A treatment instrument insertion channel 5 is formed in the insertion portion 1 over the entire length. Tip 4
A distal end of the treatment instrument insertion channel 5 has an opening at the distal end surface thereof, and an observation window 6 and an illumination window 7 are arranged alongside the opening.

When treating a lesion 9 on the inner wall of the stomach 8, a grasping forceps 11 and a high-frequency snare dissector 12 are first introduced through the treatment tool insertion channel 5 of the insertion portion 1 inserted into the stomach 8. Then, the lesion 9 is surgically treated under the endoscope from the inside of the stomach 8.

[0006]

However, since the insertion portion 1 of the endoscope is soft, the stomach 8 is inflated.
Even if the user tries to hold the insertion portion 1 in a state where the insertion portion 1 is floated in the air, the distal end portion 4 fluctuates, resulting in an unstable state. Therefore, a method is adopted in which the insertion section 1 is pushed along the inner wall surface of the stomach, and the distal end portion 4 is brought close to the lesion 9 while positioning and holding the insertion section 1 on the stomach wall, thereby performing a treatment operation. For this reason, the part of the lesion 9 is viewed from the side along the wall of the stomach. As a result, it is difficult to grasp the entire image of the lesion 9, so that the treatment operation of the lesion 9 is difficult. Was. In addition, since the observation system and the treatment system are close to each other, if the distal end 4 of the endoscope is separated from the lesion 9 in order to observe the entire lesion 9, the distal end of the treatment tool becomes farther,
Inconveniences such as the distal end of the treatment tool fluctuating and the lesion 9 not being able to be grasped occur. Conversely, if the distal end of the insertion section 1 is brought close to the lesion 9 in order to prevent the treatment instrument from swaying, the angle of view becomes narrow, so that only a part of the lesion 9 can be seen.

In addition, since the treatment tool used here is used only by being inserted into the treatment tool insertion channel 5 provided in the endoscope, the entire treatment tool needs to be thin. As a result, the treatment tool loses its waist. For this reason,
Inability to treat large areas of tumor, large polyps, etc.

Therefore, it may be considered that the observation endoscope and the treatment tool may be inserted separately into the body cavity. However, in such a case, a treatment operation may be performed such that the treatment tool is deviated from the visual field range of the endoscope. The serious inconvenience of not being able to do so occurs.

In order to prevent the treatment instrument from being separated from the endoscope by using a guide tube such as an overtube or a sliding tube, two guide tubes are inserted into one guide tube. As a result, a so-called pig nose state occurs, and a thick guide tube having an inner diameter equal to or larger than the circumscribed circle of the outer diameter of the endoscope and the outer diameter of the treatment tool is required. But,
Actually, the inner diameter of the body cavity is naturally limited, so that the outer diameter of the guide tube cannot be increased, and the endoscope and the treatment tool can only be used with a smaller outer diameter. The inconvenience that treatment capacity is reduced occurs. In particular, it becomes difficult to treat a large lesion 9 requiring a major operation or a lesion 9 that has deeply infiltrated.

On the other hand, as shown in FIG. 12, which will be described later, two treatment tools are inserted through one treatment tool insertion channel 18.
For example, when the grasping forceps 11 and the high-frequency snare dissector 12 are introduced and protruded into the body cavity, the distance between the two treatment tools protruding from the distal end portion 4 of the endoscope becomes narrower, and the distal end portion of the endoscope becomes narrower. It will be very difficult to treat the lesion 9 located in front of 4.

[0011] As shown in FIG. 11, the endoscope is provided with two treatment instrument insertion channels 5, and the two treatment instruments are individually inserted through the separate channels 5. Since the distance between the two channels 5 provided at the distal end portion 4 of the endoscope is originally narrow, there is essentially no change in the distance between the protruding treatment tools being narrowed, and particularly a large lesion requiring a large-scale operation. It is difficult to treat a lesion 9 or a deeply infiltrated lesion 9.

Further, if it is attempted to treat the lesion 9 by inserting a treatment tool into the treatment tool insertion channels 5 and 18 of the endoscope, it is inevitable that a narrow area between the lesion 9 and the distal end portion 4 will be formed. As a result of the treatment tool being protruded, the treatment tool obstructs the visual field of the lesion 9 to be observed. Moreover, the illumination light emitted from the two illumination windows 7 hits the surface of the treatment tool and shines, making it difficult to see the lesion 9. Conversely 1
When one illumination light is emitted from the two illumination windows 7, a shadow of the treatment tool is formed, and the image on the shadow side becomes difficult to see.

FIG. 12 shows a lesion 9 formed on the inner wall of the intestinal tract 15.
In this case, the endoscope used in this case has a direct observation direction, and the insertion section 1 has one treatment instrument insertion channel 18 having a large diameter. Even in this case, it is difficult to view the lesion 9 from the front, and it is difficult to perform the treatment. In addition, one treatment instrument insertion channel 18
In order to penetrate a plurality of treatment tools through the through hole, it is necessary to reduce the distal end of each treatment tool, and also to make the sheath portion behind the treatment tool thin. For this reason, the lower back is generally weak, and particularly a large lesion 9 requiring a large-scale operation is required.
It becomes difficult to treat the lesion 9 that has infiltrated deeply.

In Japanese Patent Application No. 53-43875, a treatment tool insertion channel and a distal end portion of a flexible optical viewing tube are biased outwardly of the insertion guiding main tube of the insertion guide main tube of the endoscope. In this document, a means for providing treatment is provided to improve treatment performance.

However, Japanese Patent Application No. 53-4387.
In the case of No. 5, the large-sized treatment tool close to the outer diameter of the insertion portion of the endoscope cannot be passed. In addition, the handle portion of the treatment tool passing through the forceps insertion channel of the endoscope is thin or soft, and cannot transmit a large force for treatment to the distal end. Was enough.

In Japanese Utility Model Laid-Open Publication No. Sho 51-149985, a guideway is provided on the outer wall of an endoscope, an outer tube is inserted into the body through the guideway, and a suture device is inserted into the outer tube. Something like that has been proposed. However, in the case of Japanese Utility Model Application Laid-Open No. 51-149985,
Since the endoscope and the outer tube are connected by a taxiway,
The outer shape was thick and complicated, and the insertability of the endoscope was poor.

The present invention has been made in view of the above circumstances, and an object of the present invention is to expand an object which can be treated from the inside of an organ by an endoscope, and perform laparoscopic surgery or open surgery. In addition to avoiding treatment from outside the organ as much as possible, it is also possible to easily perform treatment of lesions in a large range of the deep wall of the body cavity or lesions that have deeply infiltrated, which was particularly difficult in the past, and as a result It is to reduce the burden and risk such as the length of hospital stay and cost of patients, pain, scars and spread of cancer cells.

[0018]

SUMMARY OF THE INVENTION An endoscopic treatment apparatus according to the present invention comprises a guide tube for guiding an instrument inserted into a body cavity;
At least one treatment endoscope which is inserted into the inner hole of the instrument guiding guide tube so as to be able to advance and retreat, and at least one treatment instrument unit which is inserted and retractable into the inner hole of the instrument guiding guide tube. The endoscope and at least one of the treatment tool units has an arc shape having a cross section whose outer shape is slightly smaller than the size of the inner hole of the guide tube for instrument guidance, When the endoscope and the treatment instrument unit are combined and put into the instrument guiding guide tube, the longest dimension of the combined overall cross section is slightly smaller than the diameter of the inner hole of the instrument guiding guide tube. It is characterized by having been constituted so that it may have a shape.

Therefore, when using the endoscopic treatment apparatus of the present invention, for example, the instrument guiding guide tube is fitted on the outer periphery of the endoscope insertion portion previously inserted into the body cavity, and thereafter, the device is inserted into the body cavity. The endoscope insertion portion is inserted, and subsequently, an instrument guiding guide tube is inserted into the body cavity along the endoscope insertion portion. Next, the endoscope is once pulled out, and an operation is performed by inserting the following treatment endoscope and treatment instrument unit.

[0020]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS [First Embodiment] A first embodiment of the present invention will be described with reference to FIG.

(Construction) In FIG. 1, reference numeral 21 denotes a guide tube for guiding an instrument which is formed in a substantially cylindrical shape. The guide tube 21 for guiding an instrument is fitted on the outer periphery of an insertion portion of an endoscope (not shown). It is guided into the body cavity using the insertion portion of the endoscope as a guide. The instrument guiding guide tube 21 is formed of a flexible and long tubular member. A hard reinforcing tube 22 is attached to the tip of the guide tube 21 for guiding the instrument. The inner and outer diameters of the guide tube 21 for guiding the instrument including the reinforcing tube 22 are formed to be equal over the entire length.

In the inner hole of the guide tube 21 for guiding the instrument, one endoscope 23 dedicated to treatment (hereinafter referred to as a treatment endoscope) specially made for the purpose of observing a treatment operation, and 2 The treatment tool guide tubes 24 are inserted independently of each other. These three instruments are inserted or arranged together or individually in the instrument guiding guide tube 21 so as to be able to advance and retreat. In addition, the outer shapes (also referred to as cross-sectional shapes) of the cross-sections of the three devices are such that the total cross-sectional shape is substantially circular, and the straight portions of the devices are close to each other (including the case where they come into contact with each other). It is configured to be combined in a closely packed filled relationship. Then, the outer shape of the cross section of at least one of the three instruments has an arc portion having a diameter slightly smaller than the size of the inner hole of the instrument guiding guide tube 21, and the three instruments are combined to form the above. When inserted into the guide tube 21 for guiding the instrument, the longest dimension of the combined overall cross section is configured to have a shape slightly smaller than the diameter of the inner hole of the guide tube 21 for guiding the device.

The insertion portion 25 of the treatment endoscope 23 includes a distal end portion 26, a curved portion 27, and a flexible tube portion 28. The cross section of the insertion portion 25 is formed in a semicircular shape over substantially the entire length thereof. Have been. The radius of the arc portion in the cross-sectional shape of the insertion portion 25 is formed to be slightly smaller than the radius of the inner hole of the instrument guiding guide tube 21, and the insertion portion 25 is a semicircle of the inner hole of the instrument guiding guide tube 21. Are arranged almost densely in the area of
It is inserted back and forth freely.

An observation means and an illuminating means are incorporated in the distal end portion 26 of the treatment endoscope 23 in the same manner as a general endoscope (both are not shown). , And an illumination lens 30 of the illumination means.

Each guide tube 24 is formed of a flexible and long tubular member having a sectoral cross section of 1/4 of a circle over its entire length. A hard reinforcing tube 24a is attached to the tip of 24. The treatment tool guide tube 24 has the same inner and outer diameters over substantially the entire length including the reinforcing tube 24a. The radius of the arc portion in the cross-sectional shape of each treatment instrument guide tube 24 is slightly smaller than the radius of the inner hole of the instrument guiding guide tube 21. Then, by combining the two treatment instrument guide tubes 24, the overall cross-sectional shape of the combination becomes substantially semicircular, and they are arranged almost densely in the semicircular region of the inner hole of the instrument guiding guide tube 21. In addition, they are inserted into the instrument guiding guide tube 21 as a whole and individually so as to be able to move back and forth.

As described above, one treatment endoscope 23 and two treatment instrument guide tubes 24 arranged in the inner hole of the instrument guiding guide tube 21 are the sum of the three treatment endoscopes. The cross-sectional shape is substantially circular, and the inner straight portions that are joined to each other are closely and relatively closely combined so that they can be entirely and individually arranged in the guide tube 21 for guiding the instrument. Has become.

Each of the treatment instrument guide tubes 24 includes a bending portion 31 having a bending function of bending in two directions in the left-right direction or four directions in the up-down and left-right directions.
The distal end of the treatment instrument guide tube 24 can be moved up, down, left, and right, and the direction of the distal end of the treatment instrument guide tube 24 can be changed by being forcibly bent by an operation on the hand side. Has become.

The curved portion 31 of the treatment instrument guide tube 24 may be configured by combining a plurality of curved portions to obtain various deviations or deflections. For example, if the proximal portion is curved so as to spread left and right, and the distal portion is curved inward, it is convenient in treating the lesion 39 as shown in FIG.

The treatment tools such as grasping forceps 32 and high-frequency snare dissector 36 necessary for treatment and the like are individually inserted into each treatment tool guide tube 24. In this embodiment,
Inserting the grasping forceps 32 into the treatment instrument guide tube 24 on the left side
One treatment tool unit (treatment device) 35 is configured, and another treatment tool unit (treatment device) 37 is configured by inserting the high-frequency snare incision tool 36 into the treatment tool guide tube 24 on the right side.

Each of the above-mentioned treatment instrument units is provided with a grasping forceps 32.
And a single treatment tool such as the high-frequency snare cutting tool 36.

(Operation / Effect) A case will be described in which an endoscopic surgical operation for excision of a lesion 39 formed on the inner wall of the stomach 38 using the endoscopic treatment apparatus of the first embodiment will be described.
First, a relatively large-diameter, not-shown, for example, a flexible endoscope is inserted into the stomach 38, and the guide tube 21 for guiding the instrument, which is provided in advance at the insertion portion of the endoscope, is inserted into the flexible endoscope. While sliding along the insertion portion, the patient is guided until the distal end portion is near the lesion 39. After that, the guide tube 2 for guiding the instrument
Withdrawing only the endoscope while maintaining the posture after insertion of 1.

Next, 1 is set so that the plane portions match each other.
The treatment endoscope 23 and the two treatment instrument guide tubes 24 are bundled in a cylindrical shape, and these are inserted together into the inner hole of the instrument guide guide tube 21. Then, the distal end portions of the treatment endoscope 23 and the treatment tool guide tube 24 are projected from the distal end opening of the instrument guiding guide tube 21. Thereafter, the grasping forceps 32 is inserted through the treatment instrument guide tube 24 on the right side, and the high-frequency snare cutting tool 36 is inserted into the treatment instrument guide tube 24 on the left side.

Next, as shown in FIG. 1, the grasping forceps 32 and the high-frequency snare incision tool 36 inserted into the right treatment tool guide tube 24 and the left treatment tool guide tube 24 are advanced and retreated. By using the bending function of the tool guide tube 24 and appropriately bending the bending portion 31 of the guide tube 24,
The positioning operation of the distal ends of the grasping forceps 32 and the high-frequency snare cutting tool 36 is performed.

By performing such an operation, the lesion 3
9, a loop portion of the snare wire 36a of the high-frequency snare incision tool 36 is hooked, and the grasping forceps 32 is used to hold the lesion 3
While grasping and raising the 9, the root of the lesion 39 is narrowed down with the snare wire 36 a of the high-frequency snare cutting tool 36, and the lesion 39 is cut off by applying high frequency to the snare wire 36 a.

At this time, the operation can be performed while observing the condition of the lesion 39 and the positions and movements of the grasping forceps 32 and the high-frequency snare dissecting tool 36 by the treatment endoscope 23 independent of the treatment tool units 35 and 37. Therefore, the treatment operation is easy and the treatment can be performed quickly.

As described above, since the observing function and the bending function of the treatment endoscope 23 and the treatment function and the bending function of the treatment instrument units 35 and 37 are independent, the distal end of the treatment endoscope 23 is provided. The portion 26 can be positioned obliquely above the lesion 39. In addition, by observing the movement, position, and the like of the lesion 39 and the treatment instrument units 35 and 37, it is possible to reliably grasp the entire image of the treatment operation. In addition, since the position of each device is stably held by the device guiding guide tube 21, the treatment of the lesion 39 can be performed reliably and quickly.

Needless to say, the positions of the treatment instrument units 35 and 37 can be freely selected and do not unnecessarily come close to each other, so that the observation field of view of the treatment endoscope 23 is not obstructed. In addition, since the visual field to be observed can be minimized from entering the shadows of the treatment instrument units 35 and 37, it is possible to observe with a clear image.

Further, since the guide tube 24 of the treatment tool units 35 and 37 also has a bending function, the two treatment tools can be used with a sufficient distance therebetween. Therefore,
The operability is good, and it is possible to easily cope with a large lesion 39 or a deeply infiltrated lesion 39 which is a particularly large operation.

Further, since the treatment tool can be moved in the left and right directions, the present invention can be applied to various treatments such as extending the body wall in the lateral direction and incising the extended portion with an electric knife.

[Second Embodiment] A second embodiment of the present invention will be described with reference to FIG.

(Construction) In the present embodiment, the distal end portion 26 of the treatment endoscope 23 inserted into the guide tube 21 for guiding the instrument is provided.
Has a circular cross-sectional shape, while the cross-sectional shapes of the curved portion 27 and the flexible tube portion 28 of the insertion portion 25 are semicircular only on the upper side. The curved portion 27 and the flexible tube portion 28 of the insertion portion 25 have a shape in which the lower half thereof has been cut off, and the space after the cut-out has a space portion into which one treatment instrument guide tube 24 described later is fitted. A space 41 is formed.

On the distal end surface of the distal end portion 26 of the treatment endoscope 23, in addition to the observation lens 29 of the observation means and the illumination lens 30 of the illumination means, the distal end of an insertion channel (treatment instrument insertion conduit) 42 is provided. It is open. The insertion channel 42 is formed over the entire length of the insertion portion 25. Here, the observation lens 29 is disposed at a relatively lower portion on the distal end surface of the distal end portion 26, and the illumination lens 3
0 is located on the left and right in the vicinity. Further, the distal end opening of the insertion channel 42 is disposed at a relatively upper position. That is, the insertion channel 4
The second tip opening is located above the observation lens 29 and the storage space 41.

The treatment instrument guide tube 24 is formed of a flexible and long tubular member having a semicircular sector cross section over its entire length. It is configured in a shape that fits and fits in the storage space 41. In other words, the total cross-sectional shape when the treatment tool guide tube 24 is inserted and stored in the storage space 41 so as to embrace it becomes substantially circular, and the instruments are densely arranged in a state where the straight portions of both tools are in contact with each other. In this regard, the two instruments are combined so as to be collectively inserted into the instrument guiding guide tube 21 and can be inserted together.

The treatment instrument guide tube 24 has a semi-circular cross-sectional shape, and the semi-circular shape and the cross-sectional shape of the curved portion 27 and the flexible tube portion 28 of the treatment endoscope 23. Each instrument has a cross-sectional shape obtained by combining an arc and a straight line so that the cross-sectional shape including the semicircle is substantially circular, and the total circular outer diameter is smaller than the inner diameter of the instrument guiding guide tube 21. It consists of.

In addition, the treatment instrument guide tube 24 is the first tube described above.
As in the embodiment, a bending portion 31 having a bending function is provided, and the bending portion 31 is forcibly bent by an operation on the hand side.

(Operation) In the present embodiment, the treatment instrument guide tube 24 is combined into a storage space 41 for one treatment endoscope 23 so as to be embraced, and both instruments are used for instrument guidance. It is designed to be inserted into the guide tube 21 collectively.

Therefore, the guide tube 21 for guiding the instrument is introduced into the body cavity in the same manner as described in the first embodiment, and the endoscope 23 for treatment and the guide tube 24 for the treatment tool are introduced from the distal end of the guide tube 21 for instrument. The distal end portion is protruded, and the treatment instrument guide tube 24
Is bent downward, detached from the storage space 41, and advanced forward.

As shown in FIG. 2, the grasping forceps 32 is inserted through the insertion channel 42 of the treatment endoscope 23, and the scissors forceps 44 is inserted through the treatment instrument guide tube 24.
A procedure for removing the lesion 39 is performed.

The grasping forceps 32 is inserted through the insertion channel 42 of the treatment endoscope 23, and the high-frequency snare dissecting tool 36 is inserted through the treatment instrument guide tube 24 as described in the first embodiment. High-frequency ablation of the lesion 39 can also be performed.

(Effect) In this embodiment, the guide tube 2 for the treatment tool is used.
When inserting the treatment endoscope 23 and the treatment instrument guide tube 24 into the rear end 4, the distal ends are not divided, so that despite the insertion of a plurality of instruments, the plurality of instruments are unlikely to fall apart. In addition, it is easy to insert a plurality of instruments into the instrument guiding guide tube 21 with little hooking or insertion resistance.

Since only one treatment tool guide tube 24 is used, the occupied space can be increased.
The internal space of the guide tube 24 can be made larger than that of the first embodiment. Therefore, a large treatment tool can be inserted and used.

In the first embodiment, the treatment operation is mainly performed from the horizontal direction. However, in the present embodiment, the treatment operation can be performed from the vertical direction, so that the mucous membrane with the tumor is pulled up by the grasping forceps 32. It is easy to perform such a procedure as to make it protrude greatly and then peel off with scissors forceps 44.

Further, since the distal end portion 26 of the treatment endoscope 23 can be made large, a large observation optical system and an illumination optical system can be incorporated, and their abilities can be easily enhanced.

Third Embodiment A third embodiment of the present invention will be described with reference to FIG.

(Structure) In this embodiment, the insertion portion 25 of the treatment endoscope 23 inserted into the guide tube 21 for guiding the instrument is provided.
Is a semicircle having a cross-sectional shape including the tip portion 26 only on the upper side. Further, the cross-sectional shape of the treatment instrument guide tube 24 having the bending function is a semicircular shape of only the lower side similarly to the above-described second embodiment, and the insertion portion 25 and the straight portion of the treatment instrument guide tube 24 are formed. The total cross-sectional shape when joined together is substantially circular, and the instrument is configured to be able to be inserted into the treatment instrument guide tube 24 in a combined state in which the flat portions of both instruments are joined.

The lower surface of the distal end portion 26 of the insertion portion 25 of the treatment endoscope 23 (the portion facing the boundary surface with the treatment instrument guide tube 24) is provided with an observation lens 29 of an observation means and an illumination means. The illumination lens 30 is arranged in front and rear, and the treatment endoscope 23 is of a side-view type that performs side-view observation and side-view illumination.

An image pickup means such as a solid-state image pickup device (not shown) is provided inside the observation lens 29, and a tip of a light guide fiber (not shown) is provided inside the illumination lens 30. The light guide fiber receives light from a light source device (not shown) from its proximal end, and transmits the light to a laterally directed illumination lens 30 to illuminate the body cavity.

An outlet 42a of an insertion channel 42 is formed on the lower surface of the distal end portion 26 of the insertion portion 25 of the treatment endoscope 23, and a treatment tool raising table 43 for bending the treatment tool is provided at the outlet 42a. Provided. Treatment instrument elevator 4
Numeral 3 is pivotally attached to the tip portion 26 so as to be rotatable within a predetermined angle range. Usually, the treatment instrument raising table 43 is in a posture in which it falls down and is stored in the outlet 42a. However, when the raising operation lever provided on the operation unit (not shown) of the treatment endoscope 23 is rotated, Interlocking raising wire (not shown)
To get up. Other configurations are the same as those of the first embodiment or the second embodiment described above.

(Operation) As in the previous examples, the guide tube 21 for guiding the instrument is inserted into the body cavity in advance using an endoscope (not shown) so that the distal end comes near the lesion 39. I do. The guide tube 24 for guiding the instrument for treatment is arranged so that the insertion portion 25 of the treatment endoscope 23 and the guide tube 24 for treatment instrument are tied together and the distal end is located behind the observation lens 29 of the endoscope 23 for treatment. Shift 21 In this state, both the insertion portion 25 of the treatment endoscope 23 and the treatment tool guide tube 24 are guided together by the treatment endoscope 23 while observing the inner wall of the guide tube 21 for treatment. It is inserted into the tube 21.

The distal end 2 of the insertion section 25 of the treatment endoscope 23
6 protrudes from the distal end of the instrument guiding guide tube 21, the body cavity wall is seen by the treatment endoscope 23, and it is confirmed that the distal end portion 26 protrudes from the distal end of the instrument guiding guide tube 21. While bending the bending portion 27 of the mirror 23, the insertion portion 25 is appropriately rotated to observe the lesion 39 from directly above. At this time, the treatment instrument guide tube 24 is also rotated together with the insertion portion 25.

Next, the high-frequency snare incision tool 36 is inserted through the treatment instrument guide tube 24, and the treatment instrument guide tube 24 is bent or moved forward and backward.
The loop wire 36 a of the high-frequency snare incision tool 36 is hung on the lesion 39 while moving back and forth as appropriate. Subsequently, a treatment tool, for example, a grasping forceps 32 is inserted into the insertion channel 42 of the treatment endoscope 23, and the distal end protrudes into the body cavity from the outlet 42a. Further, the raising section 43 is appropriately raised, and while pressing the sheath distal end portion of the grasping forceps 32 so as to bend to the side, the grasping forceps 32 is used to grasp the lesion 39, and the lesion 3
Pull 9 up. Thereafter, the high-frequency snare cutting tool 36
Of the lesion 3
9 is excised.

(Effect) Since the treatment endoscope 23 is of a side-view type for observing the side, the lesion 39
Can be observed from directly above, and it can be easily understood that the loop wire 36a of the high-frequency snare cutting tool 36 comes around the lesion 39. In addition, both the operation of grasping the lesion 39, the operation of pulling up the lesion 39, and the operation of tightening the loop wire 36a can be reliably performed while observing, and the reliability of the treatment can be improved. Further, since the two treatment tools can be operated independently, there is little re-execution due to failure.

In the present embodiment, the observation direction of the treatment endoscope 23 is set at 90 degrees with respect to the longitudinal axis of the endoscope 23. Or, it may be a front perspective. Various types of treatment tools may be used in combination, such as a clip, an electric scalpel, and a T-shaped tag, which are pulled up and cut by a laser probe. Further, as in the case of the above-described first embodiment, two treatment instrument guide tubes 24 may be used.

[Fourth Embodiment] A fourth embodiment of the present invention will be described with reference to FIG. (Structure) In the present embodiment, instead of the treatment instrument guide tube 24, a suction tube 51 having a bending function and provided with a transparent and flexible urethane resin cap 50 whose tip is obliquely cut is used. It is an example of a treatment tool unit. Further, the treatment endoscope 23 has a substantially circular outer shape in the cross section at the distal end portion 26, and has a crescent-shaped outer shape in the bending portion 27 and the flexible tube portion. A storage groove 52 was formed. The suction tube 51 is fitted and housed in the housing groove 52.

The lower end portion of the distal end portion 26 of the treatment endoscope 23 located on the side where the housing groove 52 is disposed is provided with the observation lens 29 of the observation means and the illumination lens 3 of the illumination means.
0 are arranged side by side in the front-rear direction, thereby constituting a side-view type endoscope for performing side-view observation and side-view illumination as in the case of the above-described third embodiment.

An outlet 42a of the insertion channel 42 is formed on the lower surface of the distal end portion 26.
As in the case of the third embodiment described above, a treatment tool raising base 43 for adjusting the protruding direction of the treatment tool is provided. A cleaning nozzle 53 for cleaning the outer surface of the observation lens 29 by spraying cleaning water or air is further provided on the distal end portion 26. Further, the light source of the illumination means in this embodiment is a white LED built in the distal end portion 26.

(Operation) First, as described above, the guide tube 21 for guiding the instrument is inserted into the body cavity and placed in the body cavity using the endoscope insertion portion (not shown) so that the tip comes near the lesion 39. . Next, the suction tube 51 is fitted into the storage groove 52 of the treatment endoscope 23 to hold the two together to hold the two instruments together. Both of the suction tubes 51 are inserted into the guide tube 21 for guiding the instrument, and are guided to a position where the distal end portion is located near the lesion 39 in the body cavity.

Then, when the curved portion 27 of the treatment endoscope 23 is guided to the vicinity of the lesion 39, the suction tube 51 is moved.
And separates the suction tube 51 from the treatment endoscope 23. For example, in the case of a lesion 39 such as a varicose vein, if the lesion 39 is captured in the visual field, the lesion 3
The loop wire 55 of the loop indwelling device 54 inserted through the insertion channel 42 around the periphery 9 is pressed and positioned. Thereafter, the distal end portion of the suction cap 50 is put on the lesion 39.

Then, the switch of the suction pump is turned on, and the lesion 39 is sucked into the suction cap 50. When the lesion 39 has been sufficiently sucked into the suction cap 50, the loop wire 55 disposed around the lesion 39 is squeezed, and then the loop wire 55 is cut off to bundle the lesion 39. Then, the loop wire 55 is released and left as it is.

(Effect) According to the present embodiment, a large lesion 39 can be sufficiently lifted as compared with the case where the lesion 39 is pulled up by grasping forceps or a clip. Also,
Since the force for sucking the lesion 39 into the suction cap 50 can be sufficiently increased, when tightening the lesion 39,
Alternatively, when the lesion 39 is pulled up, there is no problem that the treatment tool is pulled into the lesion 39 side. In addition, by controlling the suction force, a wide range of lesions 39
An accurate treatment is possible even for a deep or deep lesion 39.

In the present embodiment, the storage groove 52 having a crescent cross section is formed from the curved portion 27 of the treatment endoscope 23 to the hand side.
Similarly to the distal end portion 26, the cross-sectional shape may be circular and the concave groove portion 52 for storage may be formed from the portion of the flexible tube portion 28 following the rear end of the curved portion 27.

The cross-sectional shape of the suction tube 51 is not limited to a circular shape, but may be a semicircle, a fan shape, a crescent shape, or the like, which is combined with the cross-sectional shape of the other endoscope 23 for treatment. Occasionally, the shape may be substantially circular.

Further, the cross-sectional shape of the distal end portion 26 of the treatment endoscope 23 is not limited to a circular shape, but may be a semicircular shape as in the third embodiment shown in FIG. But it is good.

The lesion 39 may be ablated and cut off using the high-frequency snare incision tool 36 as described above instead of the loop indwelling tool 54. When a submucosal tumor or a depressed lesion is to be treated, a syringe is inserted in advance using the treatment endoscope 23, saline is injected below the lesion 39, and the lesion is injected from the muscle layer. The portion 39 may be peeled off, and the lesion 39 may be raised. In addition, when the lesion 39 is difficult to distinguish, the lesion 39 may be treated with a mark.

[Fifth Embodiment] A fifth embodiment of the present invention will be described with reference to FIG.

(Structure) In this embodiment, as a means for pulling up the lesion 39 in the body cavity, a second treatment endoscope 60 is used instead of the suction tube 51 of the fourth embodiment.
This is combined with the treatment endoscope 23 of the above-described fourth embodiment as one treatment instrument unit.

This second medical treatment endoscope 60 has a distal end portion 6.
1 and an insertion portion 63 having a curved portion 62. The distal end surface of the distal end portion 61 is provided with an observation lens 64 of an observation means and an illumination lens 65 of an illumination means.
Is provided with an image guide fiber as observation means, and a portion behind the illumination lens 65 is provided with a light guide fiber as illumination means. The distal end face of the distal end portion 61 has an opening at the distal end of the insertion channel 66 so that the treatment tool can be protruded. That is, the second treatment endoscope 60 also constitutes a direct-viewing endoscope similar to the treatment endoscope 23 in the second embodiment.

(Operation) While observing the lesion 39 in the body cavity from directly above with the treatment endoscope 23, the second treatment endoscope 6
At 0, various treatments can be performed using both treatment endoscopes 23 and 60 while observing the lesion 39 from the lateral direction.

For example, the loop wire 55 of the loop indwelling device 54 introduced through the insertion channel 42 of the treatment endoscope 23 is placed around the lesion 39, and the insertion channel 66 of the second treatment endoscope 60 is placed. T inserted through
The L-shaped tag 67 is penetrated through the wall of the lesion 39, the lesion 39 is pulled up, the lesion 39 is ligated with the loop wire 55 of the loop indwelling device 54, and then the loop wire 55 is released to release the loop. The indwelling device 54 is indwelled.

(Effect) As described above, since the second treatment endoscope 60 is used as a lifting tool while observing the lesion 39 with the two treatment endoscopes 23 and 60, the treatment is easy.

Of course, the treatment method is the opposite combination,
That is, it may be lifted on the treatment endoscope 23 side and ligated and placed on the second treatment endoscope 60 side.
Further, depending on the treatment site, the observation direction of the treatment endoscope 23 may not be lateral but may be a direct view, and the second treatment endoscope 60 may be provided with no illumination means. In some cases, it can be covered by the lighting means. The second treatment endoscope 60 may be an electronic endoscope using a solid-state imaging device as the observation means. These cross-sectional shapes are not limited to the above shapes.

[Sixth Embodiment] A sixth embodiment of the present invention will be described with reference to FIG.

(Configuration) In the present embodiment, the treatment endoscope 23
The cross-sectional shape of the insertion portion 25 is substantially semicircular, and the distal end surface of the distal end portion 26 is cut obliquely at 45 degrees. The observation direction of the treatment endoscope 23 is 45 degrees.
It is a perspective type with a diagonal degree. The two illumination lenses 30 and 1
An outlet of one observation lens 29 and one treatment instrument insertion channel (treatment instrument insertion channel) 42 is provided. The illumination lens 30 is connected to an illumination light transmitting unit composed of a light guide fiber bundle. Further, inside the outlet at the tip of the insertion channel 42, a treatment instrument raising table 43 is provided.
Are arranged.

In this embodiment, the treatment endoscope 2 is used.
An automatic suturing device 70 having a bending function, which is paired with the automatic suturing device 3, is provided. The insertion portion 71 of the automatic suturing device 70 is paired with the substantially semicircular cross-sectional shape of the insertion portion 25 of the treatment endoscope 23. A guide tube 2 having a substantially semicircular cross-sectional shape, and
1 are inserted together. That is,
When the insertion portion 25 of the treatment endoscope 23 and the insertion portion 71 of the automatic suture device 70 are combined, the total cross-sectional shape is substantially circular, and the inner straight portions to be joined are close to each other and relatively dense. And can be arranged to be able to move forward and backward in the guide tube 21 for guiding the instrument. Then
When the insertion section 25 of the treatment endoscope 23 and the insertion section 71 of the automatic suturing device 70 are combined, the outer diameter of the total circular cross-sectional shape is slightly smaller than the inner diameter of the inner hole of the instrument guiding guide tube 21. It is formed small.

A suturing portion 73 having a pair of openable and closable jaws 72 is provided at the distal end of the insertion portion 71 of the automatic suturing device 70. The pair of jaws 72 have a staple 74 attached to the inside thereof, and the pair of jaws 72 are closed to sandwich the tissue portion so that the tissue portion is sewn with the staple 74. By closing the pair of jaws 72, the jaws 72 can be inserted and arranged in the instrument guiding guide tube 21 together with the insertion portion 25 of the treatment endoscope 23 so as to be able to advance and retreat.

(Operation) When observing the inside of the body cavity obliquely from above with the treatment endoscope 23, when the lesion 39 is captured in the visual field, the grasping forceps 32 are inserted through the insertion channel 42, and the grasping forceps 32 are used. The lesion 39 is grasped. On this occasion,
The treatment tool raising table 43 is raised and lowered and rotated as necessary to adjust the gripping position by the gripping forceps 32. When the grasping forceps 32 grasps the lesion 39, the grasping forceps 32 is pulled to near the distal end portion 26 of the treatment endoscope 23, and in this state, the bending portion 27 of the treatment endoscope 23 is curved to thereby obtain the lesion 39. Lift.

At this time, the pair of jaws 72 of the suturing portion 73 of the automatic suturing device 71 are opened, and the root of the lesion 39 is positioned between them. Thereafter, the lesion 39 is sandwiched between the pair of jaws 72 and sewn with staples 74.

(Effect) In the present embodiment, since the entire image of the lesion 39 can be captured from obliquely above, the lesion 39
The operation of suturing the root of the stomach is easy. In addition, since the automatic suturing device 70 is inserted directly into the instrument guiding guide tube 21 without the intervention of the treatment tool guiding tube 24 as described above, a relatively large automatic suturing device 70 may be used. Can be. Further, the automatic suturing device 70 is usually a treatment tool with a bending function formed in an irregular large cross-sectional shape. However, since the automatic suturing device 70 is inserted directly into the guide tube 21 for guiding the device, there is enough room. Can be used. As a result, the treatment range can be expanded.

Although the distal end surface of the insertion section 25 of the treatment endoscope 23 is cut obliquely at 45 degrees, the cut angle is not limited to 45 degrees. Also, instead of the automatic suturing device 70, an ultrasonic vibration incision tool, a high frequency incision scissors forceps, the high frequency wire incision tool described above, or FIG.
The use of a high-frequency incision tool as described in (1) above makes it easier to resect a wider range of mucous membrane. Further, the suturing direction of the suturing device is not limited to the above example parallel to the axis, and may be a direction perpendicular to the axis.

[Seventh Embodiment] A seventh embodiment of the present invention will be described with reference to FIG.

(Structure) In the treatment endoscope 23 of this embodiment, only the distal end portion 26 has a circular cross section having a relatively large diameter. The observation lens 29 of the observation optical system and the illumination lens 30 of the illumination optical system are provided on the side portions of the distal end portion 26.
The observation lens 29 and the illumination lens 3 are provided.
0 is covered with a cylindrical transparent cover 75 made of acrylic resin.

A thin tube 76 having a curved portion 27 and a flexible tube portion 28 is connected to the distal end portion 26 of the treatment endoscope 23. The thin tube 76 has a diameter smaller than the diameter of the distal end portion 26, and its distal end is displaced from the central axis of the distal end portion 26, and is located on the upper peripheral surface of the distal end portion 26 so as to be completely shifted upward.
6 is connected to the rear end.

Further, a treatment instrument guide tube 80 having a bending function as described above is arranged in a region other than the thin tube 76 from the rear end of the distal end portion 26 of the treatment endoscope 23. The thin tube 7 is provided on the upper peripheral surface of the treatment instrument guide tube 80.
6 is formed long along the longitudinal direction of the guide tube 80 for a treatment tool, and the outer shape of the cross section of the portion including the groove 81 is a so-called broad bean-like shape. It has become.

When the treatment endoscope 23 and the treatment instrument guide tube 80 are densely combined with each other by disposing the thin tube 76 in the concave groove portion 81, the total cross-sectional shape becomes substantially circular.
Both are disposed in the treatment guide tube 80 so as to be able to advance and retreat. In the treatment instrument guide tube 80, two treatment instrument insertion channels 82, which also have a broad bean-shaped cross section, are provided.
Are provided through.

(Operation) The treatment instrument guide tube 8 is placed in a region avoiding the thin tube 76 from the rear end of the distal end portion 26 of the treatment endoscope 23.
Combine the two, tying them together. Then, both are inserted into the guide tube 21 for guiding the instrument and guided into the body cavity. When the distal ends of both protrude into the body cavity from the distal end of the guide pipe 21 for guiding the instrument, the guide pipe 8
The zero bending portion 83 is bent and separated from the treatment endoscope 23.

Then, as shown in FIG. 7, the treatment endoscope 2
While observing the lesion 39 from directly above by 3, the lesion 39 is treated with a pair of treatment tools inserted through the two treatment tool insertion channels 82 of the treatment tool guide tube 80. For example, the lesion 39 is cut off by the high-frequency snare dissecting tool 36 while the lesion 39 is pinched and pulled up by the grasping forceps 32.

(Effect) The distal end portion 26 of the treatment endoscope 23 has a circular cross section with a large diameter, and the thin tube 76 having the curved portion 27 and the flexible tube portion 28 has a smaller diameter. Since the main body of the observation optical system and the illumination optical system is incorporated in the distal end portion 26 and other members are incorporated in the thin tube 76, the structure of the thin tube 76 can be particularly simplified. In addition, since the cross-sectional shape of the portion of the thin tube 76 is circular, disturbing movement such as deviation when the thin tube 76 is curved does not occur.

Although the description has been given of the case where only one treatment instrument guide tube 80 is used in the present embodiment, the distal end portion 26 of the treatment endoscope 23 is formed by using two treatment instrument guide tubes 80. May be arranged behind the. In this case, one treatment instrument insertion channel 82 may be formed in each treatment instrument guide tube 80. Further, the combination of the treatment tools to be used is not limited to this example, and for example, various combinations as described above can be considered.

[Eighth Embodiment] An eighth embodiment of the present invention will be described with reference to FIG.

(Structure) This embodiment is similar to the first embodiment described above, except that the instrument having the treatment function includes a grasping forceps 85 having a bending function and a treatment instrument having a bending function. It is a treatment tool inserted into the guide tube 86, for example, a high-frequency treatment tool 87. The cross-sectional shape of the sheath 88 of the grasping forceps 85 is a sector shape with a sharp angle near the center, and the cross-sectional shape of the treatment instrument guide tube 86 is a sector shape with an angle near the center at an obtuse angle. Yes, above 2
When the two angles are combined, the angle becomes 180 degrees, and the cross-sectional shape of the sum of the two is approximately a semicircle.

On the other hand, the transverse cross-sectional shape of the treatment endoscope 23 is substantially semicircular, and when this semicircle and the semicircle on the treatment function side are combined, it becomes substantially circular, and the outer diameter of the circular shape is It is formed to be slightly smaller than the inner diameter of the instrument guiding guide tube 21 through which the treatment function member is inserted. That is, when the grasping forceps 85, the treatment instrument guide tube 86, and the treatment endoscope 23 are joined together and assembled, they can be assembled so that they can be inserted into the inner hole of the instrument guide guide tube 21. It is configured.

(Operation) Unlike the first embodiment, the treatment operation is performed by a combination of a treatment tool having a sheath 88 with an irregular cross-sectional shape and a treatment tool inserted through the guide pipe 86 for the treatment tool.

(Effect) According to the present embodiment, it is possible to perform treatment using a large treatment tool as compared with the case of using a treatment tool using the guide tube for the treatment tool. Therefore, treatment of a large polyp or the like can be easily performed.

The total cross-sectional shape of the members having the treatment function when they are tied together, and the cross-sectional shape of the instrument guiding guide tube 21 through which these members are inserted are not true circles but non-circular shapes such as ellipses. (Deformed).

[Ninth Embodiment] A ninth embodiment of the present invention will be described with reference to FIG.

(Structure) The present embodiment is different from the previous embodiments in that a simple illuminating means is incorporated in a part of the wall of the guide tube 21 for guiding the instrument. The illumination lens 90 of this illumination means is provided on the distal end surface of the guide tube 21 for guiding the instrument. In addition, a battery comprising a light guide fiber as a lighting means, a small halogen lamp, and a battery is built in the wall of the guide tube 21 for guiding the instrument. Further, the cross-sectional shapes of the treatment endoscope 23 and the treatment instrument guide tube 24 having a bending function are each semicircular.

(Operation / Effect) With this configuration,
The illuminating means of the guide tube 21 for guiding the instrument whose distal end is introduced near the lesion 39 in the body cavity along the insertion portion of the endoscope can be illuminated to illuminate the lesion 39. Further, the treatment endoscope 23 and the treatment instrument guide tube 24 having a bending function are tied together and inserted into the instrument guiding guide tube 21, and inserted through the insertion channel 42 provided in the treatment endoscope 23. The body cavity wall including the lesion 39 is pulled up by the grasping forceps 32 and sutured by the automatic suture instrument 70. In addition, various treatment tools can be inserted through the treatment endoscope 23 and the treatment tool guide tube 24 to perform various treatments.

Further, since the illumination means is incorporated in the guide tube 21 for guiding the instrument, the number of light guides of the illumination means of the treatment endoscope 23 can be reduced, and the outside of the treatment endoscope 23 can be reduced. The diameter can be reduced. This makes it possible to increase the thickness of the treatment tool guide tube 24 used indirectly and relatively simultaneously, so that a large treatment tool, an automatic suturing device, or an ultrasonic vibration heat cautery cutter can be used. Can be used.

In the present embodiment, the lighting means may be constituted by embedding a light guide in the entire wall of the guide tube 21 for guiding the instrument or incorporating a white LED at the tip. If the illuminating light amount of the illuminating means is increased, the treatment endoscope 23 may be only an observation means, and thereby the treatment endoscope 23 and the treatment instrument guide tube 24 can be further reduced in diameter and the treatment instrument can be inserted therethrough. The diameter of the channel can be increased.

[Tenth Embodiment] A tenth embodiment of the present invention will be described with reference to FIG.

(Configuration) In this embodiment, the distal end portion 2 of the treatment endoscope 23 used by being inserted into the instrument guiding guide tube 21 is used.
The cylindrical part 9 has an outer diameter smaller than the outer diameter of the shell shape by cutting off the rear part at an angle of 45 degrees from the middle of the tip of the shell shape.
1 is formed so that the center is brought to one side.
The maximum outer diameter of the distal end portion 26 is slightly smaller than the inner diameter of the guide tube 21 for guiding the instrument, and the cylindrical portion 91 is configured to enter the outer region of the maximum outer diameter. The observation lens 29 of the observation means and the illumination lens 30 of the illumination means are disposed obliquely rearward on a crescent-shaped step surface 92 formed at the difference between the two outer diameters.

A high frequency resect treatment instrument 94 having a bending function and having a sheath 93 having a cross section close to the crescent shape of the step is arranged at the recessed position facing the step. The high-frequency rescue treatment tool 94 includes a sheath 93
An arc-shaped high-frequency wire 95 is provided at the tip of the wire so as to be able to advance and retreat. Further, the tip portion 26 is made of an insulating material such as a synthetic resin.

(Function) The high-frequency resect treatment tool 94 is tied to the treatment endoscope 23 and inserted together into the instrument guiding guide tube 21 for use. For example, the guide tube 2 for guiding the instrument to the esophagus 96 using an endoscope (not shown).
Then, the treatment endoscope 23 and the high-frequency resect treatment tool 94 are tied together and inserted together into the instrument guiding guide tube 21 to protrude into the body cavity to thereby cause the lesion 3
Check 9 After confirming the lesion 39, the treatment endoscope 2
While observing the posterior view at 3, the lesion 39 (e.g., Barrett's epithelium or tumor) generated at the cardia 98 at the boundary between the esophagus 96 and the stomach 97 is pulled up while energizing an arc-shaped high-frequency wire 95 while conducting electricity. The tissue at the lesion 39 is scraped off.

(Effect) Originally, it was difficult to observe the cardia 98 because it was narrow, and the lesion 39 was apt to be overlooked. In addition, although diseases of the mucous membrane on the inner surface of the cardia 98, such as reflux esophagitis and Barrett's epithelium, are increasing, it has been difficult to observe / treat the disease. Conventionally, the distal end of the endoscope was inserted into the stomach 97, and the distal end of the endoscope was observed while looking up from the stomach 97 side of the cardia 98 with a curvature of 180 degrees or more. Only the side can be seen, and the endoscope insertion part becomes an obstacle for performing the procedure. If the curvature is 180 degrees or more, the distal end portion 26 fluctuates, so that the treatment tool cannot catch the lesion 39 as intended.

Further, the observation direction is forward from the esophagus 96 side,
When an observation / treatment is performed using a so-called direct-viewing endoscope, the observation is performed while pushing and expanding the cardia 98 because the cardia 98 is closed. Since the inner wall and the tip are in close contact, it becomes a so-called red ball state, so that only a narrow range of observations can be made.
Even near the cardia 98, the inner wall is viewed and treated from the side, so the lesion 39 cannot be reliably captured.
The treatment was difficult. Observation is easy with a perspective or side-view type endoscope.However, the forceps raising base provided at the exit of the treatment tool insertion channel of the endoscope is operated to move the treatment tool in the observation direction. As a result, the treatment tool did not move so as to scrape off the lesion 39 along the inner wall. Moreover, since the treatment tool that can be inserted through the treatment tool insertion channel is thin and has no waist, it has been difficult to sufficiently grasp the inner wall.

However, in the present embodiment, the observation direction is set to a rear oblique view like never before, and the distal end portion 2 of the treatment endoscope 23 is set.
By pushing and expanding the cardia 98 using the guide tube 6 and the instrument guiding guide tube 21, it is possible to observe and treat the esophagus 96 side from the stomach 97 side of the cardia 98 at a time, which has been difficult to observe and treat. Further, by gradually performing the treatment while simultaneously pulling the treatment instrument and the treatment endoscope 23, the treatment can be surely performed while observing the lesion 39 near.

Since the treatment instrument and the treatment endoscope 23 are independent, the distal end of the treatment endoscope 23 is fixed, and the treatment instrument is bent while observing the lesion 39 at a fixed point. Can be pulled along the inner wall of the

In the case of Barrett's epithelium, the treatment involves scraping the entire circumference. However, when the treatment tool is passed through the treatment tool insertion channel of the endoscope, the sheath is thin and the hips are weak,
Since the tip cannot be enlarged, the area to be treated is reduced, and it is necessary to repeat the treatment many times to treat the entire circumference, which is troublesome. However, in this embodiment, the treatment tool, particularly the high-frequency wire 95, can be lengthened,
The number of treatments for the entire circumference can be reduced.

In addition to this, observation / treatment of a similarly narrowed pyloric part is also possible. A stenosis of the duodenum may be considered.

The angle of the rear oblique view may be 30 degrees or 60 degrees by changing the cut angle of the step surface 92 or the optical system in this embodiment. Also,
The distal end of the instrument guiding guide tube 21 may be cut obliquely, and the shorter side may be used for a treatment operation. Furthermore, in addition to the above-mentioned treatment tools, an argon plasma laser, a high-frequency ablation tool using a roller, or the like may be used.

Furthermore, since the treatment endoscope inserted into the instrument guiding guide tube 21 has a large solid-state image sensor and is suitable for an endoscope having excellent observation capability, the distal end portion incorporating the solid-state image sensor is required. The cross section may have a large circular cross section, and the curved portion and the insertion section may have a small non-circular cross section.

Further, in the above-described embodiment, the overall cross-sectional shape of the combination of the inner hole of the device guiding guide tube and the device to be inserted therein is substantially circular. However, the present invention is not limited to this, and the present invention is not limited to this. It may be circular or of other shapes.

In order to smoothly advance and retreat the treatment endoscope and the treatment unit individually, each of the treatment endoscope and the treatment unit may be made of a material having excellent sliding properties, or an outer surface may be coated with a sliding property. Further, a similar coating may be applied to the inner surface of the guide tube into which the treatment endoscope and the treatment unit instrument are inserted.

<Supplementary Notes> A guide tube for guiding the instrument inserted into the body cavity, at least one treatment endoscope which is inserted into the inner hole of the guide tube for guiding the instrument so as to be able to advance and retreat, and advance / retreat to an inner hole of the guide tube for guiding the instrument. At least one treatment instrument unit freely inserted, wherein the outer shape of the cross section of at least one of the endoscope and the treatment instrument unit is a diameter of an inner hole of the instrument guiding guide tube. When the endoscope and the treatment tool unit are combined into the guide tube for guiding the instrument, the outer shape of the combined overall cross section is slightly smaller than that for guiding the instrument. An endoscopic treatment apparatus characterized in that the guide tube has a shape slightly smaller than a diameter of an inner hole of a guide tube.

[0125] 2. 2. The endoscopic treatment device according to claim 1, further comprising a second endoscope for guiding the instrument guiding guide tube into a body cavity. 3. At least one of the endoscope and the treatment tool unit has a non-circular cross-sectional shape with a part of an arc, and the diameter of this arc is slightly smaller than the radius of the inner hole of the guide tube for guiding the instrument. An endoscope treatment apparatus characterized in that the overall cross-sectional shape when the endoscope and the treatment instrument unit are combined is substantially circular when the endoscope and the treatment instrument unit are combined so that the arc portion is located outside.

4. 4. The endoscopic treatment according to claim 3, wherein the non-circular shape of a part of the cross-sectional shape of at least one of the endoscope and the treatment tool unit is a combination of a circular arc and another curve. apparatus. 5. 4. The endoscopic treatment apparatus according to claim 3, wherein the non-circular shape is a substantially fan shape obtained by combining an arc and a straight line.

6. The cross-sectional shape of both the endoscope and the treatment tool unit is substantially semicircular, and the overall cross-sectional shape when the endoscope and the treatment tool unit are combined is substantially circular. Endoscopic treatment device. 7. 2. The endoscope treatment device according to claim 1, wherein the cross-sectional shapes of the endoscope and the treatment tool unit are both substantially fan-shaped. 8. 2. The endoscopic treatment apparatus according to claim 1, wherein the treatment tool unit has a bending function.

9. 2. The endoscopic treatment apparatus according to claim 1, wherein the treatment instrument unit has a treatment instrument guide tube having a bending function. 10. 2. The endoscopic treatment apparatus according to claim 1, wherein the treatment instrument unit comprises at least two or more treatment instrument units. 11. 2. The endoscope treatment apparatus according to claim 1, wherein a bending function is provided on at least a part of the treatment instrument guide tube.

12. 2. The endoscopic treatment apparatus according to claim 1, wherein at least one of the treatment instrument units is a treatment instrument and the other is a treatment instrument insertion guide tube. 13. 2. The endoscope treatment device according to claim 1, wherein the endoscope includes a treatment instrument insertion conduit. 14． 2. The endoscopic treatment apparatus according to claim 1, wherein the treatment instrument guide tube has at least one treatment instrument insertion conduit.

15. 2. The endoscopic treatment apparatus according to claim 1, wherein the guide tube for guiding the instrument has lighting means. 16. The inner surface of the guide tube for guiding the instrument, the outer surface of the treatment tool unit at the portion inserted into the guide tube for guiding the device, and the outer surface of the second endoscope inserted into the guide tube for guiding the device are lubricated. 2. The endoscope treatment apparatus according to claim 1, wherein 17． 2. The endoscopic treatment according to claim 1, wherein the distal end of the guide tube for guiding the instrument and the distal end of the endoscope inserted into the guide tube for guiding the instrument are formed in an obliquely cut shape. apparatus.

18. 2. The endoscope treatment apparatus according to claim 1, wherein the observation direction of the endoscope inserted into the guide tube for guiding the instrument is a side view. 19. 3. The endoscopic treatment apparatus according to claim 2, wherein the observation direction of the endoscope inserted into the instrument guiding guide tube is a rear oblique view. 20. 3. The endoscopic treatment apparatus according to claim 2, wherein the observation direction of the endoscope inserted through the instrument guiding guide tube is a front perspective. 21. The endoscope inserted into the instrument guiding guide tube includes a treatment tool insertion channel, and the endoscope has a treatment tool elevating means at a distal end opening of the treatment tool insertion channel at a distal end portion of the endoscope. 3. The endoscopic treatment apparatus according to claim 2, wherein:

[0132]

As described above, according to the present invention, at least one endoscope and at least one treatment instrument unit are inserted into a guide tube for guiding an instrument near a lesion in a body cavity. Since it can be used, treatment is easier than in the conventional case. In other words, the treatment endoscope and treatment tool unit are independent and can be operated separately, so that a wide range of lesions can be observed from a distance and treated with a large treatment tool if necessary. It is. The use of a large-sized treatment tool has the advantages that a large lesion can be resected at once, and a wide lesion or a deeply infiltrated lesion can be resected in a small number of times in a short time. If not a partial resection, a specimen with a small cut surface is obtained, and pathological examination of the resected specimen is facilitated. In addition, spread of metastases can be prevented in the case of tumors such as cancer with little bleeding.

Further, by configuring the guide tube for guiding the instrument, the treatment endoscope to be inserted therethrough and the various treatment tool units in various forms, a wider range of lesions can be obtained in the body cavity than before. It is possible to easily and quickly perform an appropriate operation while observing the entire treatment situation.

Further, in the present invention, since at least one of the instruments has a cross-sectional shape other than a circular shape and a plurality of instruments are combined, it is possible to make both instruments as thin as possible.

Further, if the end of the guide tube for guiding the instrument is held near the lesion, a portion of the endoscope which can be approached only from the side by a direct-viewing endoscope until now can be used, for example. By making the observation direction of the inserted endoscope sideways, the approach from above the lesion can be performed, and the treatment can be easily performed.

[Brief description of the drawings]

FIG. 1 is a perspective view showing a use state of an endoscope treatment apparatus according to a first embodiment.

FIG. 2 is a perspective view showing a use state of the endoscope treatment apparatus according to the second embodiment.

FIG. 3 is a perspective view showing a use state of an endoscope treatment apparatus according to a third embodiment.

FIG. 4 is a perspective view showing a state of use of an endoscope treatment apparatus according to a fourth embodiment.

FIG. 5 is a perspective view showing a state of use of an endoscope treatment apparatus according to a fifth embodiment.

FIG. 6 is a perspective view showing a state of use of an endoscope treatment apparatus according to a sixth embodiment.

FIG. 7 is a perspective view showing a state of use of an endoscope treatment apparatus according to a seventh embodiment.

FIG. 8 is a perspective view showing a state of use of an endoscope treatment apparatus according to an eighth embodiment.

FIG. 9 is a perspective view showing a state of use of the endoscope treatment apparatus according to the ninth embodiment.

FIG. 10 is a perspective view showing a state of use of the endoscope treatment apparatus according to the tenth embodiment.

FIG. 11 is a perspective view showing a use state of a conventional endoscope treatment apparatus.

FIG. 12 is a perspective view showing a use state of a conventional endoscope treatment apparatus.

[Explanation of symbols]

21 ... guide tube for instrument guidance, 23 ... endoscope for treatment, 24 ...
Guide tube for treatment instrument, 39: lesion, 32: grasping forceps, 36
... High-frequency snare incisor, 35 ... Treatment tool unit, 37 ...
Treatment instrument unit, 38: stomach, 39: lesion.

Claims (1)

[Claims] 1. An instrument guiding guide tube inserted into a body cavity, at least one treatment endoscope inserted into an inner hole of the instrument guiding guide tube so as to be able to advance and retreat, and the instrument guiding guide tube. At least one treatment tool unit inserted into the inner hole of the endoscope and at least one of the endoscope and the treatment tool unit. The arcuate part having a diameter slightly smaller than the size of the inner hole of the endoscope, and the longest dimension of the combined overall cross section when the endoscope and the treatment instrument unit are combined into the instrument guiding guide tube. Is configured to have a shape slightly smaller than a diameter of an inner hole of the guide tube for guiding the instrument.