JP2001120569A - Marking device for endoscope - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a marking device for an endoscope which can easily hold a marking member and insert it in an in-vivo tissue, easily retain a marker in the tissue, simplify the total device, and reduce the diameter of a portion to be inserted in-vivo. SOLUTION: A radiation non-permeable ball 5 retained in the in-vivo tissue is stored in a marking member storage part 6 in a hollow sheath part 2 which is flexible over the whole length, a locking part 11 to lock the ball 5 to a tip part of the sheath part 2 in a pushing manner, and the ball 5 is pushed outside from the locking part 11 by a pusher 12 inserted in the sheath part 2 in an attachable/detachable manner.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a marking device for an endoscope for performing an operation of placing a radiopaque marking member in a living tissue.

[0002]

2. Description of the Related Art In general, there has been known a technique for marking a target site such as a lesion site in a living tissue in a body at the time of treatment or examination of the living tissue in the body and specifying the position thereof. For example, Japanese Unexamined Patent Publication No. Hei 10-508504 discloses a marker indwelling device including a marker which is indwelled at a target site such as a lesion site in a living tissue in a body and which performs a marking operation. It is shown.

[0003] Japanese Patent Application Laid-Open No. H11-199234 discloses a radiotherapy apparatus that irradiates a target site (fixed position) such as a lesion site in a living tissue using a marker placed in the living tissue in the body. ing.

[0004]

[Problems to be Solved by the Invention]
The device disclosed in Japanese Patent Publication No. 04-2004 is a marker insertion device for inserting a marker into a body mainly percutaneously. Therefore, when this marker insertion device is used with a flexible endoscope, there are the following problems.

(1) Since the sheath of the marker insertion device is not flexible enough to be inserted into the channel of the flexible endoscope, it can be used by being inserted into the forceps channel of the flexible endoscope. difficult.

(2) Since the marker is introduced into the body in a state where the marker is held at the distal end of the sheath tube of the marker insertion device, the living body in the body is actually provided without a guide sheath for guiding the marker. It is difficult to lead inside the organization. When such a guide sheath is provided, the outer diameter of a portion of the marker insertion device to be inserted into the body becomes large, so that the marker insertion device can be inserted into a thin lumen such as a forceps channel of a flexible endoscope. difficult. Therefore, there is a problem that it is difficult to insert and use the forceps channel of the flexible endoscope.

Japanese Patent Application Laid-Open No. H11-199234 discloses a technique in which a marker for performing this type of radiation treatment is provided at the tip of an injection needle and inserted into the body. There is a problem that it is difficult to guide a marker to be performed into a living tissue in a body using an endoscope.

The present invention has been made in view of the above circumstances, and has as its object to facilitate the operation of holding a marking member and inserting it into a living tissue, and to facilitate the operation of placing a marker in the tissue. It is an object of the present invention to provide an endoscope marking device which can simplify the configuration of the entire device and reduce the diameter of a portion to be inserted into the body.

[0009]

SUMMARY OF THE INVENTION The present invention contains a hollow sheath having flexibility over its entire length and a radiopaque marking member formed in the sheath and placed in living tissue. A marking member accommodating portion, a locking portion provided at a distal end portion of the sheath, and locking the marking member so as to be able to be pushed out; And a pusher for pushing out from the outside to the outside. In the present invention, in the state where the radiopaque marking member to be placed in the living tissue at the time of use of the endoscope marking device is housed in the marking member housing portion in the hollow sheath having flexibility,
The marking member is pushed out and locked by a locking portion at the distal end of the sheath. In this state, the marking member is pushed out from the locking portion to the outside by a pusher inserted removably into the sheath. Thereby, when treating a lesion of the bronchial peripheral part by a stereotactic radiotherapy device, for example, by placing a spherical gold marking using an endoscope, it is possible to perform a safe radiotherapy. It was done.

[0010]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS A first embodiment of the present invention will be described below with reference to FIGS. FIG. 1 (A)
1 shows the entire endoscope marking device 1 of the present embodiment. The marking device 1 of the present embodiment is provided with an elongated sheath portion 2. As shown in FIGS. 1C and 1D, the main body of the sheath portion 2 is formed by a hollow resin tube 3 having flexibility. Further, a base 4 is connected to the base end side of the tube 3.

In the distal end portion of the sheath 2, FIG.
As shown in (C), a marking member housing portion 6 for housing a ball 5 which is a radiopaque marking member to be placed in a living tissue is formed. In the present embodiment, a spherical ball 5 made of a radiopaque material such as gold or platinum is used as a marking member for indwelling in a living body.

The distal end of the sheath 2 is formed with a tapered portion 7. The inner diameter of the small diameter portion on the distal end side of the tapered portion 7 is set to be smaller than the outer diameter of the ball 5. As a result, the ball 5 in the marking member housing portion 6 is disposed so as to be held at the tip end side of the tapered portion 7. Further, a sharp needle-like portion 8 which is notched obliquely is formed at the tip of the tapered portion 7 as shown in FIGS. 1 (A) and 1 (C). The distal end opening 9 of the sheath 2 is formed in the needle-like portion 8.

Further, a slit 10 is formed in the peripheral portion of the distal end opening 9 of the sheath portion 2 so as to extend on the tapered portion 7 along the center line direction of the sheath portion 2 as shown in FIG. Have been. The slit 10 allows the peripheral portion of the distal end opening 9 to be elastically deformable by the slit 10 into an expanded shape that enlarges the inner diameter of the distal end opening 9.

Here, the slit 10 is held in a non-deformed shape which does not expand in a normal state where no external force is applied from the ball 5 side in the marking member housing portion 6. In this state, the ball 5 in the marking member housing portion 6 is held in a state where the ball 5 is abutted against the peripheral portion of the distal end opening 9 of the sheath portion 2 and locked. Further, when a pressing force is applied to the peripheral portion of the distal end opening 9 of the sheath portion 2 from the ball 5 side in the marking member containing portion 6, the peripheral portion of the distal end opening portion 9 of the sheath portion 2 is caused by this pressing force. Elastically deformed into an expanded shape that pushes the slit 10 open,
The inner diameter of the distal end opening 9 is enlarged so that the ball 5 can be pushed outward. As a result, a locking portion 11 for locking the ball 5 in the marking member housing portion 6 so as to be able to be pushed out is formed at the distal end portion of the sheath portion 2.

A substantially rod-shaped pusher 12 for pushing the ball 5 in the marking member housing portion 6 from the engagement portion 11 to the outside is inserted into the sheath portion 2 so as to be insertable and removable. The pusher 12 is provided with a long metal coil 13 disposed on the distal end side and an operation rod 14 disposed on the proximal end side of the sheath 2. The distal end of the operating rod 14 is connected and fixed to the proximal end of the coil 13 via a connecting member 15.

Further, the operating rod 14 of the pusher 12
The base end side extends outward from the opening 16 on the base end side of the sheath portion 2. A knob 1 for facilitating the operation of the pusher 12 is provided at the base end of the operation rod 14.
7 are connected.

Next, the operation of the above configuration will be described.
When using the marking device 1 for an endoscope of the present embodiment, the ball 5 is housed in the marking member housing portion 6 of the sheath portion 2 of the marking device 1 in advance. Then, sheath part 2
Is set with the pusher 12 inserted therein. At this time, the ball 5 is held without applying a pressing force from the pusher 12 to the ball 5. Thereby, the sheath portion 2
Of the ball 5 in the marking member housing 6
It is held in a normal non-deformed shape with no external force applied from the side. Therefore, in this state, the ball 5 in the marking member housing portion 6 is held in a state where the ball 5 is abutted against the locking portion 11 at the peripheral portion of the distal end opening 9 of the sheath portion 2 and locked.

In this state, the sheath 2 of the marking device 1 is inserted into the body through a forceps channel of an endoscope (not shown). Here, after the distal end portion of the sheath portion 2 is made to protrude from the distal end of the endoscope, the needle portion 8 is punctured at a target lesion site.

Subsequently, the pusher 12 is pushed in. As a result, the ball 5 in the marking member accommodation portion 6
A pressing force is applied to the peripheral portion of the distal end opening 9 of the sheath 2 from the side. By this pressing force, the peripheral portion of the distal end opening 9 of the sheath portion 2 is elastically deformed into an expanded shape that pushes the slit 10 open, the inner diameter of the distal end opening 9 is enlarged, and the ball 5 is pushed to the outside. . Thereby, the ball 5 is fixed to the locking portion 11 at the peripheral portion of the distal end opening 9 of the sheath portion 2.
, The ball 5 is pushed outward, and the ball 5 is placed in the lesion site.

Therefore, the above configuration has the following effects. That is, in the present embodiment, the marking member accommodating portion 6 is provided in the flexible hollow sheath portion 2, and the radiopaque member indwelled in the living tissue when the endoscope marking device 1 is used. In a state where the ball 5 is accommodated in the marking member accommodating portion 6, the ball 5 is ejectably engaged with the engaging portion 11 at the distal end of the sheath portion 2. In this state, the ball 5 is pushed out from the locking portion 11 to the outside by a pusher 12 which is inserted into and removed from the sheath portion 2. This facilitates the operation of holding the ball 5 of the marking member and inserting it into the living tissue, and also facilitates the operation of placing the ball 5 in the living tissue.

Furthermore, the configuration of the entire endoscope marking device 1 is simplified, and the diameter of the portion to be inserted into the body can be reduced. Further, the use of an endoscope allows the ball 5 to be placed deep inside the internal organ, so that stereotactic radiation therapy can be performed on a lesion site deep inside the body. Here, by placing the ball 5 of the marking member at a lesion site such as cancer, stereotactic radiotherapy can be performed safely. Therefore, without irradiating biological tissue other than the target biological tissue, such as a lesion site, safely,
In addition, there is an effect that radiation can be strongly radiated to a lesion site with high precision.

Further, since the operation of placing the ball 5 of the marking member at a lesion site such as cancer can be performed endoscopically, the ball 5 of the marking member is placed deep within the organ and in the entire reach of the endoscope. And the effect of treatment can be broadened.

FIGS. 2A and 2B show a second embodiment of the present invention.
1 shows an embodiment of the present invention. In the present embodiment, the configuration of the pusher 12 of the endoscope marking device 1 of the first embodiment (see FIGS. 1A to 1D) is changed as follows.

That is, in the present embodiment, the coil 13 of the pusher 12 of the first embodiment is connected to the metal wire 2.
1 and the operation rod 14 is changed to an operation pipe 22. In the present embodiment, the proximal end of the metal wire 21 is fitted to the distal end of the operation pipe 22 in a press-fitted state. Further, the operation pipe 22
A knob 23 for facilitating the operation of the pusher 12 is connected to the base end of the knob.

The rest of the configuration is the same as that of the endoscope marking device 1 of the first embodiment.
The same portions as those of the endoscope marking device 1 of the first embodiment are denoted by the same reference numerals, and description thereof will be omitted.

In this embodiment, the ball 5 of the radiopaque marking member is inserted into the living tissue by using the endoscope by the same operation as the endoscope marking device 1 of the first embodiment. Then, the ball 5 can be placed in the lesion site deep inside the body organ.

Therefore, in this embodiment, the same effect as that of the endoscope marking device 1 of the first embodiment can be obtained. In this embodiment, in particular, by using the wire 21 for the pusher 12, Further marking device 1
There is an effect that the flexibility of the sheath portion 2 can be improved.

FIGS. 3A to 3D show a third embodiment of the present invention.
1 shows an embodiment of the present invention. FIG. 3A shows the entire endoscope marking device 31 of the present embodiment. In the marking device 31 of the present embodiment, an elongated sheath portion 32 is provided. As shown in FIGS. 3 (C) and 3 (D), the main body of the sheath portion 32 is made of a resin-made resin body having flexibility and two lumens (lumens) 33 and 34.
It is formed by a lumen tube 35. Here, one first lumen 3 of the two-lumen tube 35
3 has a larger diameter than the other second lumen 34.

Further, at the base end side of the tube 35, as shown in FIG. 3 (A), a branch portion 38 is formed which is branched into two introduction conduits 36 and 37. The first lumen 33 is connected to one of the introduction pipes 36, and the other introduction pipe 3 is connected to the other.
The second lumens 34 are connected to each other.

As shown in FIG. 3 (C), a ball 39 which is a radiopaque marking member to be indwelled in a living tissue is provided in the large-diameter first lumen 33 at the distal end of the sheath portion 32. Marking member housing section 40 for housing
Are formed.

Further, a tapered portion 41 is formed at the distal end of the sheath portion 32. The inner diameter of the small diameter portion on the distal end side of the tapered portion 41 is set to be smaller than the outer diameter of the ball 39. Thus, the ball 39 in the marking member housing portion 40 is arranged so as to be held at the tip end side of the tapered portion 41. Further, a sharp needle-shaped portion 42 which is notched obliquely is formed at the tip of the tapered portion 41 as shown in FIGS. 3 (A) and 3 (C). Then, the first lumen 3 is attached to the needle-like portion 42.
A distal end opening 43 of the sheath portion 32 communicating with the third portion 3 is formed.

As shown in FIG. 3B, a slit 4 extending on the tapered portion 41 along the center line direction of the sheath portion 32 is formed at the peripheral portion of the distal end opening portion 43 of the sheath portion 32.
4 is formed on the first lumen 33 side. And
The slit 44 allows the peripheral portion of the distal end opening 43 of the sheath portion 32 to be elastically deformable into an expanded shape that enlarges the inner diameter of the distal end opening 43.

Here, the slit 44 is held in a non-deformed shape which does not expand in a normal state where no external force is applied from the ball 39 side in the marking member accommodating portion 40. In this state, the ball 39 in the marking member accommodating portion 40 is held in a state where the ball 39 is abutted against the peripheral portion of the distal end opening 43 of the sheath portion 32 and locked. Further, the ball 39 in the marking member housing portion 40
When a pressing force is applied to the peripheral portion of the distal end opening 43 of the sheath portion 32 from the side, the pressing force is applied to the sheath portion 3 by the pressing force.
The peripheral edge portion of the second end opening 43 is elastically deformed into an expanded shape that pushes and spreads the slit 44, so that the inner diameter of the end opening 43 can be enlarged and the ball 39 can be pushed to the outside. As a result, a locking portion 45 for locking the ball 39 in the marking member housing portion 40 so as to be able to be pushed out is formed at the distal end portion of the sheath portion 32.

The first lumen 33 of the sheath portion 32
A substantially rod-shaped pusher 46 that pushes the ball 39 in the marking member accommodating portion 40 from the engaging portion 45 to the outside is inserted in the inside of the inside of the inside of the inside of the. The pusher 46 has a long metal wire 4 disposed on the tip side.
7 and an operating rod 48 connected to and fixed to the base end of the wire 47. The proximal end side of the operation rod 48 extends outward from the opening of the sheath portion 32 on the proximal end side of the introduction conduit 36. A knob 4 for facilitating the operation of the pusher 46 is provided at the base end of the operating rod 48.
9 are connected.

A plurality of second slits 50 for bending the sheath 32 are formed on the outer peripheral surface of the sheath 32 on the side of the second lumen 34 as shown in FIG. 3C.

Further, the second lumen 3 of the sheath portion 32
An angle operating member 51 is inserted into the inside of the tube 4 from the side of the introduction conduit 37 to control the bending of the sheath portion 32. The angle operating member 51 includes an angle wire 5
2 and the angle wire 5 at the tip of the second lumen 34.
2 and a fixing member 53 for fixing the angle wire 5
2 and a control rod 54 connected to the base end of the control rod 2
And a knob 55 that is connected to the base end of the base member and facilitates the bending operation.

At the tip of the second lumen 34, a filler for preventing contamination such as silicon for filling a dead space surrounded by the second lumen 34 and the fixing member 53 of the angle operating member 51. 56 are filled.

Next, the operation of the above configuration will be described.
When the endoscope marking device 31 of the present embodiment is used, the first end of the sheath 32 of the marking device 31 is used in advance.
The ball 39 is accommodated in the marking member accommodating portion 40 of the lumen 33. Subsequently, the pusher 46 is set in a state where the pusher 46 is inserted inside the sheath portion 32. At this time, the ball 39 is held without applying a pressing force from the pusher 46 to the ball 39. Thereby, the slit 44 of the sheath portion 32 is held in a normal non-deformed shape in which no external force is applied from the ball 39 side in the marking member housing portion 40. Therefore, in this state, the marking member housing 4
The ball 39 in the inner portion 0 is held in a state where the ball 39 is abutted against the locking portion 45 at the peripheral portion of the distal opening 43 of the sheath portion 32 and locked.

In this state, the sheath 32 of the marking device 31 is inserted into the body through a forceps channel of an endoscope (not shown). At this time, the sheath portion 32 can be freely bent by operating the angle operation member 51. That is, by pulling the angle wire 52 of the angle operating member 51 in the state of FIG. 3C, the sheath portion 32 can be bent downward in FIG. 3C. Then, after the distal end portion of the sheath portion 32 is projected from the distal end of the endoscope, the needle portion 42 is punctured at a target lesion site.

Subsequently, the pusher 46 is pushed in. Thereby, a pressing force is applied to the peripheral portion of the distal end opening 43 of the sheath portion 32 from the ball 39 side in the marking member housing portion 40. By this pressing force, the peripheral portion of the distal end opening 43 of the sheath portion 32 is elastically deformed into an expanded shape that pushes the slit 44 open, the inner diameter of the distal end opening 43 is enlarged, and the ball 39 is extruded to the outside. . Thereby, the ball 39 is moved to the distal end opening 43 of the sheath portion 32.
Is pushed out from the locking portion 45 at the peripheral portion of the rim, and the ball 39 is placed in the lesion.

Therefore, the above configuration has the following effects. That is, in this embodiment, the ball 39 of the radiopaque marking member is inserted into the living tissue using the endoscope by the same operation as the endoscope marking device 1 of the first embodiment, and the body The ball 39 can be placed in the lesion site deep in the organ. for that reason,
The same effect as in the first embodiment can be obtained.

Further, in this embodiment, particularly, the sheath portion 32 of the marking device 31 is formed by a two-lumen tube 35, and the sheath portion 3 is provided inside the second lumen 34.
Since the angle operating member 51 is inserted to control the bending of the marking device 31, the angle operation of the sheath portion 32 is performed by the angle operating member 51, and thus the marking device 31 is operated.
The operation of guiding the sheath portion 32 to a target position can be easily performed. Therefore, there is an effect that the operation of inserting the sheath portion 32 of the marking device 31 into the body can be facilitated.

Further, the present invention is not limited to the above-described embodiment, and it goes without saying that various modifications can be made without departing from the spirit of the present invention. Next, other characteristic technical matters of the present application will be additionally described as follows. (Additional Item 1) A hollow sheath having a needle-like tip and having flexibility over the entire length, a radiopaque marking member disposed in the sheath and placed in the tissue, and marking Equipped with a pusher for holding the member,
Endoscope marking device.

(Supplementary Item 2) The sheath distal portion is formed to be tapered so that the outer diameter is smaller than the base end portion, the sheath distal end portion has a sharp pointed end, and furthermore, the marking member is used to remove the tissue from inside the sheath. The marking device for an endoscope according to claim 1, wherein a slit is provided on a taper at a distal end portion of the sheath in order to easily push the sheath inward.

(Supplementary Note 3) The sheath is made of a flexible resin, the marking member is made of a metal such as gold, platinum, palladium, and tungsten, which is excellent in radiopacity and biocompatibility, and the pusher is made of a flexible material. Item 1 or 2 made of a wire or a metal coil having a property
Endoscope marking device.

(Additional Item 4) The additional items 1, 2, wherein the sheath is formed of a flexible tube having a plurality of lumens, and at least one of the lumens is provided with a wire for controlling the bending of the sheath. Or 3.

(Appendix 5) In order to bend the sheath,
Additional item 1 in which a plurality of circumferential slits are provided at a sheath distal portion.

(Prior Art of Supplementary Items 1 to 5) Japanese Patent Application Laid-Open No. 10-508504 discloses a prior art of a marker placement device. Japanese Patent Application Laid-Open No. H11-199234 discloses a radiation treatment for irradiating a fixed position using a marker.

(Problems to be Solved by Additional Items 1 to 5)
In the device disclosed in Japanese Patent Publication No. Hei 10-508504, a marker is mainly inserted percutaneously,
Use of this with a flexible endoscope has the following problems.

(1) The sheath is not flexible enough to be inserted into the channel of the flexible endoscope. (2) Since the marker is held at the distal portion of the tube and placed in the tissue, it is difficult to actually insert the marker into the tissue without a guide sheath for guiding the marker. In the embodiment in which the guide sheath is provided, the outer diameter becomes large and cannot be used in a thin lumen such as a channel of a flexible endoscope. (3) In JP-A-11-199234, there is no apparatus for introducing a marker for performing this type of radiation therapy into the body using an endoscope.

(Purposes of Additional Items 1 to 5) (1) By forming a needle at the distal end of the sheath, the sheath becomes a guide member for inserting the marking member into the tissue and a member for holding the marking member. A structure can be provided, and a thinner device can be provided. (2) The distal end of the sheath is tapered to form a needle at the distal end, thereby facilitating insertion into the tissue. By providing a slit, the marker can be easily placed in the tissue. .

(Effects of Additional Items 1 to 5) When a stereotactic radiotherapy device is used to treat a lesion in the bronchial region,
For example, safe radiation therapy can be performed by placing a spherical gold marking using an endoscope.

(Effects of Additional Items 1 to 5) As described above, according to the present invention, stereotactic radiotherapy can be safely performed by placing a marker in a lesion such as cancer. In addition, since it can be performed endoscopically, the marker can be placed deep inside the organ and in the entire reach of the endoscope, and the range to which the treatment can be applied is widened.

[0054]

According to the present invention, a radiopaque marking member to be placed in a living tissue is accommodated in a marking member accommodating portion in a hollow sheath having flexibility over the entire length. Since a locking portion is provided at the distal end of the sheath to lock the marking member so that the marking member can be pushed out, and the marking member is pushed out from the locking portion to the outside by a pusher which is inserted into and removed from the sheath. In addition to facilitating the operation of holding the marking member and inserting the marker into the living tissue, the operation of placing the marker in the tissue can be facilitated, and the configuration of the entire device is simplified, and the portion to be inserted into the body Can be reduced in diameter.

[Brief description of the drawings]

FIG. 1 shows a first embodiment of the present invention;
(A) is a side view of the entire endoscope marking device, (B)
Is a plan view showing a locking portion at the distal end of the sheath portion of the marking device, (C) is a longitudinal sectional view showing a marking member accommodating portion inside the distal end portion of the sheath portion, and (D) is a longitudinal sectional view of the sheath portion of the marking device. FIG. 3 is a longitudinal sectional view showing a base end side.

FIG. 2 shows a second embodiment of the present invention.
(A) is a longitudinal sectional view showing a marking member accommodating portion inside a distal end portion of a sheath portion of the marking device, and (B) is a longitudinal sectional view showing a proximal end side of the sheath portion of the marking device.

FIG. 3 shows a third embodiment of the present invention;
(A) is a side view of the entire endoscope marking device, (B)
Is a plan view showing a locking portion at a distal end portion of a sheath portion of the marking device, (C) is a longitudinal sectional view showing a marking member housing portion inside the distal end portion of the sheath portion, and (D) is a 3D- view of (C). 3D
Line sectional view.

[Explanation of symbols]

 2, 32 Sheath part 5, 39 Ball (marking member) 6, 40 Marking member housing part 11, 45 Locking part 12, 46 Pusher

Claims (1)

[Claims] 1. A hollow sheath having flexibility over its entire length, a marking member housing portion formed in the sheath and housing a radiopaque marking member to be placed in a living tissue, A locking portion provided at a distal end portion of the sheath for locking the marking member so that the marking member can be pushed out; and a pushing member that is inserted into the sheath so that it can be inserted and removed, and pushes the marking member outward from the locking portion. A marking device for an endoscope, comprising a pusher.