JP2001321389A - Operating tool for endoscope - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an operating tool for an endoscope capable of easily incising a part around the mucous membrane of a lesion part and cutting-off a wide range of the mucous membrane at one stroke. SOLUTION: This operating tool for the endoscope is provided with an incision instrument holding part 43 of elongated shape at a part of a guide tube 3. An incision instrument lead-in part 45 of tapered shape is provided at the tip of the incision instrument holding part 43. A high frequency incision instrument having a high frequency wire 47 provided at a specified distance from the inner surface of the holding part 43 is provided form the rear of the incision instrument lead-in part 45 toward the inner direction of the guide tube 3, and a current is supplied to the high frequency wire 47 of the high frequency incision instrument.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an endoscope treatment apparatus used in combination with an endoscope and used for excision of mucous membrane or the like.

[0002]

2. Description of the Related Art Heretofore, a method of excision of a wide area of a mucous membrane in an affected area in a body cavity has been performed by injecting physiological saline or the like into a lower layer of the mucous membrane in the affected area and bulging a tissue at a boundary between the mucous membrane and a muscle layer. Inflate to separate the mucous membrane and the muscle layer,
The mucous membrane is sucked from the hood (cap) attached to the end of the insertion section of the endoscope or the tip of the overtube placed over the insertion section of the endoscope, and the high-frequency snare previously attached to the tip of these instruments is removed. By squeezing and removing a part of the mucous membrane and repeating the partial resection of the mucous membrane continuously, the resection range is widened and the entire mucous membrane in the affected area is removed.

[0003] In addition, as a method of collectively removing mucous membranes in an affected area, a portion of a bulge is incised, and grasping forceps introduced through a treatment instrument insertion channel (channel) of an endoscope is used.
The high-energy incision such as a high-frequency incision instrument or a laser scalpel introduced through the treatment instrument insertion conduit of the endoscope while allowing the incised mucous membrane to be picked up or turned over so that the border tissue can be observed with the endoscope. In some cases, a tool was applied to the tissue to make an incision.

[0004]

However, in the former method, the range in which the partial resection is performed is considerably narrow, and in order to resection a wide area of the mucous membrane, it is necessary to repeat the partial resection many times. take time. In addition, since a part of the mucous membrane is cut off by squeezing a high-frequency snare, the range of the sucked mucous membrane changes depending on the volume of the sucked mucous membrane. In addition, in the endoscope image after suctioning the mucous membrane, the distal end position of the hood or the like to which the high-frequency snare is applied cannot be observed with the endoscope, so that it is difficult to confirm the range to be resected and to control it accurately. Further, it is difficult to efficiently remove the part that is adjacent to the part that has been partially removed so as to be continuous.

[0005] On the other hand, in the latter method, the range in which the mucosa can be cut off by a single scalpel movement is limited to the area where the incision tool is applied. And the trouble was troublesome. Also, when incising the tissue of the submucosal layer, smoke and water vapor are generated, making it difficult to observe the location where the incision is made with the smoke and water vapor. In addition, smoke and water vapor must be removed by a suction operation, and the treatment time becomes longer.

In addition, in order to cut only the tissue of the submucosal layer in a narrow area between the muscular layer and the mucosa, it is necessary to carefully position the tip of the incision tool under observation with an endoscope. Must perform complicated operations coordinating the bending operation of the endoscope, the raising operation of the forceps, and the reciprocating operation of the incision tool, and these operations are complicated and require nerves. Had to stay focused.

Also, since the mucous membrane is turned over, it is difficult to know how far the submucosal layer should be cut, and it is necessary to return the mucous membrane to its original position and check the affected part, which is cumbersome and troublesome. . In order to solve this point, there is a method of making an incision in the mucous membrane around the affected area in advance.However, only the mucous membrane is incised with an incision-type incision tool such as a needle-shaped high-frequency knife or laser knife. As described above, as in the above-described incision at the boundary portion, it was a task that required a high degree of skill and consumed the nerve.

[0008] Therefore, in an unpublished application of Japanese Patent Application No. 11-64774, an endoscopic treatment apparatus in which a high-frequency incision device is attached to the tip of a hood and a high-frequency treatment device thereof have been devised. Since only the length can be incised, it is necessary to repeat the partial incision carefully and repeatedly to make a long incision.In addition, to incise only the mucous membrane, finely adjust the suction operation of the endoscope and put the mucous membrane in the hood It is not easy to precisely control the height of the pumping water.

SUMMARY OF THE INVENTION The present invention has been made in view of the above-mentioned problems, and it is an object of the present invention to make it easier to incise the mucous membrane of an affected area and to exfoliate a wide range of mucosa at a time. It is an object of the present invention to provide an endoscope treatment apparatus capable of performing the operation.

[0010]

According to the present invention, there is provided an endoscopic treatment apparatus which is used in combination with an endoscope and is used for incising tissue in a body cavity. A tubular body made of a transparent and heat-resistant electrical insulator placed in the vicinity of the tip of the tube, and an elongated shape made of a material with excellent heat resistance and electrical insulation provided protruding from a part of the tubular body An incision tool holding portion, and a tapered incision device introduction portion provided at the tip of the incision device holding portion,
A high-frequency incision tool having an incision portion provided at a predetermined distance from the inner surface of the incision device holding portion toward the inside of the tubular body from behind the incision device introduction portion, and an incision portion of the high-frequency incision device And a high-frequency power supply device.

The tubular body may be a hood mounted on the end of the endoscope or a guide tube mounted on an insertion portion of the endoscope.

[0012] Before the mucous membrane of the disease is exfoliated and resected with a high-frequency incision device, an incision is made in advance around the mucous membrane of the affected part.

An example of the operation will be described with reference to the case where the tubular body is a hood. The high-frequency incision tool is applied to the tissue at the boundary between the mucous membrane and the muscular layer, which has been swollen in a jelly form by absorbing physiological saline or the like. From the small incision made by using a high-frequency scalpel or the like, penetrate the incision introducer and apply a high-frequency power to the mucous membrane while applying a treatment incision such as a high-frequency wire to the end and back surfaces of the mucous membrane. Make an incision.

If the high-frequency incision device is arranged in a circumferential shape, the mucous membrane of the luminal organ can be incised in an arc shape or a ring shape.
If it is arranged in the axial direction, it is possible to make an incision not only in the luminal organ but also in the direction in which the endoscope advances and retreats.

The tip of the hood is cut obliquely and has a sharp edge, and an incision is made in advance around the lesion using the high-frequency incision tool described above.
The edge can be made to penetrate the boundary between the mucous membrane and the muscular layer, and the endoscope can be moved forward, so that the mucous membrane can be exfoliated.

At this time, if the sharp edge is made of a soft material, it can absorb physiological saline or the like and can incis only the jelly-like relatively soft boundary tissue.

Further, since the sharp edge portion is introduced into the body cavity through the guide tube, the mucous membrane is not damaged by the sharp edge at the time of insertion.

[0018]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS [First Embodiment] An endoscopic treatment apparatus according to the present embodiment will be described with reference to FIGS.

(Structure) FIG. 1 is a perspective view schematically showing a use state of an endoscope treatment apparatus according to this embodiment. The endoscope treatment apparatus includes a guide tube 3 including an outer tube (outer jacket) 1 and an inner tube 2. The inner cylinder 2 is inserted into the outer cylinder 1 so as to slide, advance, retreat and rotate. The flexible insertion portion 11 of the endoscope 10 is inserted into the inner cylinder 2. With the insertion portion 11 of the endoscope 10 inserted into the guide tube 3, the inner cylinder 2 and the insertion portion 11 can slide, advance, retreat, and rotate.

The operation section 12 of the endoscope 10 has an entrance 13 for a treatment instrument insertion passage (channel). An exit 15 of the treatment instrument insertion passage is formed at a distal end surface of the distal end portion 14 of the insertion portion 11. An observation window 16, an illumination window 17, a nozzle 18, and the like are additionally provided on the distal end surface of the distal end portion 14. Here, the endoscope 10 constitutes a direct-viewing endoscope, but may be a perspective endoscope as long as it can observe the front.

At the base end of the outer tube 1 in the guide tube 3, a large-diameter base 5 serving also as a grip portion is provided. In addition, inner cylinder 2
Is provided with a large-diameter base 6 also serving as a gripping part. The base 5 and the base 6 are provided with an airtight seal configured to ensure airtightness with the mating partner while preventing rotation / retreat of the mating partner.

FIG. 2 shows a base 5 incorporating the hermetic seal.
3 shows the structure of the base 6. Describing these structures, the rear end portion of the tube member 21 forming the outer cylinder 1 is fitted to a tapered portion 23 provided at the front end portion of the main body 22 in the base 5, and is pressed by the tightening screw ring 24. It is connected to the base 5 in an airtight state. A flange 25 is formed at the rear end of the main body 22 of the base 5, and a ring-shaped rubber seal 26 is hermetically attached to the flange 25. The diameter of the center hole of the rubber seal 26 is slightly smaller than the outer diameter of the inner cylinder 2 inserted therethrough. Therefore, the rubber seal 26 keeps the space between the rubber seal 26 and the inner cylinder 2 to be inserted airtight.

Similarly, the tube material 27 forming the inner cylinder 2
The rear end portion is fitted to a tapered portion 29 provided at the tip of the main body 28 of the base 6, pressed by a tightening screw ring 30 and connected to the base 6 in an airtight state. Further, two ring-shaped rubber sheet seals 31 are fastened and fixed to the rear end of the main body 28 of the base 6 by set screw rings 32. The inner diameter of each sheet seal 31 is formed slightly smaller than the outer diameter of the insertion section 11 of the endoscope 10 inserted therein. For this reason, each sheet seal 31 keeps airtight between the insertion portion 11 of the endoscope 10 to be inserted.

The body 28 of the base 6 for the inner cylinder 2
Has two holes formed in front of the seat seal 31. One hole has a high-frequency cable 33
Through which a cable base 34 with a flange is attached. A rubber stopper 36 having a slit at the center is detachably mounted on the flange 35 of the base 34 in a detachable and airtight manner.

The other hole is provided with a flanged tube base 37 having a tapered flange with a thin tip. The base 37 connects a reflux tube 38, and a reflux device (not shown) is connected to the rear end of the tube 38.

The material of the outer cylinder 1 of the guide tube 3 is made of porous polytetrafluoroethylene, and is flexible and excellent in slipperiness. The length of the outer cylinder 1 is shorter than the length of the inner cylinder 2 of the guide tube 3, and the inner diameter of the outer cylinder 1 is slightly larger than the outer diameter of the inner cylinder 2.
The outer diameter of the outer cylinder 1 is usually 18 mm or less so that it can be orally inserted into the esophagus under local anesthesia. The thickness of the outer cylinder 1 is about 1 mm. The material of the inner tube 2 of the guide tube 3 is a fluoroelastomer resin, and the inner tube 2 is transparent, flexible, and excellent in heat resistance and electrical insulation.

As shown in FIG. 1, the inner tube 2 of the guide tube 3
Is cut diagonally, and the tip edge is formed as a sharp edge 41.

A U-shaped side opening 42 is formed at one side of the inner cylinder 2 at a position behind the distal end thereof, as viewed from the side. The incision tool holding portion 43 protrudes from the one side edge (side) of the side opening 42 toward the center of the side opening 42 at the same curvature integrally with the peripheral portion of the inner cylinder 2. . That is, the incision tool holder 43
Is a band-like member that protrudes in a lateral direction (circumferential direction) from a wall on one side of the side opening 42 and curves. The distal end of the cutting tool holder 43 forms a tapering cutting tool introducing portion 45. The incision instrument introduction part 45 here is gradually thinner and thinner toward the tip end, and the tip end side is formed round.

The length of the incision device introduction portion 45 is approximately 2 mm in a circumferential shape from the front end. A conductive high-frequency wire 47 that generates heat by a high-frequency current is stretched straight from the back of the incision device introduction portion 45 to the base of the incision device holding portion 43 at a position where the insertion portion 11 of the endoscope 10 can be inserted. I have. The relationship is such that the incision holder 43 is a bow and the high-frequency wire 47 is a string. In the present embodiment, a high-frequency wire 47 is provided in the incision device holding portion 43 that forms the incision device introduction portion 45 at the distal end, and this is used as an incision portion to constitute a high-frequency incision device capable of incising tissue. I have.

The rear end of the high-frequency wire 47 is connected to the high-frequency cable 33 for supplying a high-frequency current. The high-frequency cable 33 is covered with an electrically insulating resin. Then, the high-frequency cable 33 passes through the inner cylinder 2 in the axial direction from the cutting tool holding portion 43, and exits from the cable base 34 of the rear base 6, and is guided to a high-frequency power supply device (not shown). And is connected to the high-frequency power supply device.

(Method of Use) Next, a method of using the endoscope treatment apparatus according to the present embodiment will be described with reference to FIGS.

Insertion section 1 of endoscope 10 into a body cavity such as the esophagus
1 and then, using the insertion portion 11 as a guide,
The guide tube 3 covering the insertion portion 11 is inserted into the body cavity, or the guide tube 3 and the insertion portion 11 are inserted into the body cavity together with the guide tube 3 covered. In any case, at this time, the inner tube 2 of the guide tube 3 is drawn into the outer tube 1.

Next, a long injection needle introduced through the treatment instrument insertion passage of the endoscope 10 is punctured into the mucous membrane 51 of the affected area such as Barrett's esophagus to be resected, and the submucosal layer between the mucous membrane 51 and the muscular layer 52 is punctured. A physiological saline mixed with a hemostatic agent and a stain is injected over the entire circumference. Then, the boundary tissue 53 between the mucous membrane 51 and the muscle layer 52 absorbs the injection solution and swells in a jelly-like manner, so that the space between the mucous membrane 51 and the muscle layer 52 is sufficiently separated.

Thereafter, a hole is made in a part of the mucous membrane 51 with an electric scalpel or the like inserted into the treatment instrument insertion passage of the endoscope 10, and the mucous membrane 51 is sucked into the side opening 42 by the suction operation of the endoscope 10. Then, the inner tube 2 is advanced and retracted and rotated to align the position of the introduction portion 45 of the incision device holding portion 43 with the hole formed in the mucous membrane 51, and the inner tube 2 is turned counterclockwise to move the incision device introduction portion 45. Mucous membrane 51
To the boundary tissue 53 of the muscle layer 52.

In this manner, the incision device introduction section 4 is placed under the mucous membrane 51.
5, the inner cylinder 2 is further rotated, and the high-frequency wire 4
When 7 has entered under the mucous membrane 51 by about half, the suction is stopped, air is supplied, and the back of the mucous membrane 51 is brought into close contact with the high-frequency wire 47.

Subsequently, the foot switch of the high-frequency power supply is depressed to energize. The mucous membrane 51 is cut by the heat generated in the high-frequency wire 47 (see FIG. 3). During this energization, water vapor and smoke are generated, so that the air supply and suction operations by the endoscope 10 are repeated to remove them. Alternatively, the recirculation device interlocked with the high-frequency power supply device is started, and air supply and suction are repeated through the tube 38 from between the insertion portion 11 of the endoscope 10 and the inner cylinder 2 to remove smoke and the like. To secure the field of view. By repeating these series of operations,
The mucous membrane 51 is cut in a ring shape over the entire circumference.

Next, a ring-shaped incision is similarly made at another position, which is separated in the front-rear direction. In order to match the positions of the cutting start and the cutting end in each incision, the incision is made through the transparent inner tube 2 and the exposed muscle layer portion is observed, while the inner tube 2 is moved forward and backward to adjust the position.

Next, as shown in FIG. 4, the cut end of the entire circumference is sucked into the tip of the inner cylinder 3 to be depressed, and then the cut end is cut by a high-frequency gripping forceps 55 capable of supplying a high-frequency current. Close and push forward.

Subsequently, the sharp edge 41 of the inner cylinder 3 is
1 and the boundary tissue 53 are slowly inserted, and the inner cylinder 2 is advanced while rotating slowly. Thereby, the boundary tissue 53 is cut, and the mucous membrane 51 is peeled between the muscle layers 52. When bleeding occurs on the way, the distal end of the high-frequency grasping forceps 55 is pressed against the bleeding point to supply a coagulation current to stop the bleeding.

When the fibrous structure remains so as not to be cut at the edge 41 of the inner cylinder 2, the fibrous tissue is picked up by the high frequency grasping forceps 55 and cut off. In this case, since the stump gripped by the high-frequency grasping forceps 55 has been released, the stump is again sucked, grasped by the high-frequency grasping forceps 55, and pushed forward.

By repeating these operations, the exfoliation is advanced so that the tube of the mucous membrane 51 including the affected part is turned upside down, and when it reaches the other ring-shaped incision, the mucous membrane is naturally turned upside down into a cylindrical shape all around. It is resected in the state that it was.

(Effect) By the way, since the outer tube 1 of the guide tube 3 is made of tetrafluoroethylene and has excellent slipperiness, the forward / backward / rotation of the inner tube 2 is easy. Also, since the inner cylinder 2 is made of a fluorine-based elastomer resin and has excellent heat resistance,
Does not melt or deform.

Since the inner tube 2 is transparent, the incised portion is projected on the endoscope image through the inner tube, so that the start and end of the ring-shaped incision can be easily adjusted. The incision tool holding portion 43 is an insulator integral with the inner cylinder 2, and since the high-frequency incision wire 47 is not located at the incision device introduction portion 45, the back side of the mucous membrane 51 is not cauterized, and the incision device introduction portion 45 is not used.
The portion of the line has no high-frequency wire 47 and is tapered and thin and round, so it is easy to penetrate under the mucous membrane, and serves as a guiding role for infiltrating the high-frequency wire 47 under the mucous membrane. It helps to make continuous incisions.

Since the high-frequency wire 47 is arranged separately inside the cutting tool holder 43 in contact with the muscle layer 52, heat generated by energization is hardly transmitted, and the muscle layer 52 is not heated.

Further, the various airtight seals provided at the rear end of the guide tube 3 do not cause the leaked air to leak into the body cavity and do not suck the outside air during the suction operation. In addition, by applying jelly for lubrication to the rubber seal portion, rotation / advance / retreat of the insertion portion 11 of the endoscope 10 and the inner cylinder 2 can be performed while maintaining airtightness.

At the time of the ring-shaped incision, the incision tool is sunk under the mucous membrane, so that the endoscopic image shows the mucous membrane 51 riding on the high-frequency wire 47 and that the high-frequency wire 47 is not on the muscle layer side. Since it can be confirmed, the operator can proceed with ease.

After the incision, the incision device introduction portion 45 at the distal end of the incision device holding portion 43 remains under the mucous membrane, so that the incision device does not come off and continuous incision is facilitated.

Further, at the time of peeling, two ring-shaped incisions are made in advance and then sharply cut with the sharp edge 41 of the inner cylinder 2 to thereby be able to peel in a short time and not to be tired.

At this time, since the sharp edge 41 is made of a relatively soft material, it absorbs physiological saline or the like and incises only a jelly-shaped relatively soft boundary tissue.

In addition, since the mucous membrane 51 is turned over,
Since the portion to be peeled can be reliably observed as an endoscope image around the hood-shaped tip, the peeling can be advanced with ease.

Further, since the peeling is performed without using a high energy device, the field of view cannot be secured due to the generation of smoke or water vapor as in the prior art, and the peeling operation is not interrupted.

Further, even when there is bleeding from the detached portion, the detached portion can be immediately determined, and the bleeding can be immediately stopped using the coagulation / hemostatic treatment device or the like through the treatment device insertion port.

Since the sharp edge 41 is introduced into the body cavity through the outer tube 1, the mucous membrane is not damaged by the sharp edge during insertion.

(Modification) Since the organ to which the present invention is applied is not limited to the esophagus, the inner and outer diameters and length of the guide tube 3 are not limited to the numerical values of the first embodiment. Alternatively, the inner tube 2 of the guide tube 3 may be made into two parts, and the tip portion may be made of a transparent material having excellent heat resistance and electrical insulation, and the rear portion may be made of another flexible material. The size and shape of the side opening 42 need not be limited to those of the first embodiment. In the first embodiment, the curvature of the incision holder 43 is the same as the curvature of the inner cylinder 2, but the endoscope 1
A small curvature may be used as long as it does not hinder insertion of the zero insertion portion 11. The length of the incision tool holding portion 43 and the length of the incision device introduction portion 45 are not limited to those of the first embodiment. The shape of the high-frequency wire 47 may also be changed to a shape such as an arc as long as it does not hinder the insertion of the insertion portion 11 of the endoscope 10.

Further, the shape of the sharp edge 41 formed on the inner cylinder 2 of the guide tube 3 for exfoliating the tissue is not limited to that of the first embodiment. Therefore, examples of various sharp edges 41 are shown in FIG.
Shown in

In the example shown in FIG. 5 (a), the tip of the inner cylinder 2 is cut at a right angle, and the edge is sharply cut all around to form a sharp edge 41. According to such a sharp edge 41, when the mucous membrane is resected at once on the entire circumference, it can be peeled off all over at once.

In the example shown in FIG. 5B, the lower end of the inner cylinder 2 is cut obliquely and the upper half is cut at a right angle. And a sharp edge 41 is formed in the lower half circumference. In this example, since the sharp edge 41 is formed in the lower half circumference, the tissue is easily peeled off. Also, since the upper half circumference is formed at a right angle, the lower half circumference is less likely to be deformed.

In the example shown in FIG. 5C, the tip of the inner cylinder 2 is cut into an arc shape, and the sharp edge 41 is formed in a circular shape. Since the sharp edge 41 is formed more sharply than before, the tissue is easily peeled off and the sharpness is good, so that the fiber tissue can be easily cut.

In the example shown in FIG. 5D, the tip of the inner cylinder 2 is formed in a closed hood shape, and the rear edge of the side opening 42 is formed as a sharp edge 41. According to this, since the distal end portion of the inner cylinder 2 is closed, the mucous membrane 51 can be sucked into only the side opening 42 by suction, so that even in an organ such as the stomach that is not a luminal organ, an incision is made in advance around the affected part. By doing so, peeling is possible.

In the example shown in FIG. 5 (e), the leading edge of the inner cylinder 2 is a right angle, and a sharp edge 41 having a saw blade shape is formed on the right angled leading edge in the vertical direction. The effect of this is that due to the rotation, the remaining fibrous tissue can be cut without being completely cut by peeling.

[Second Embodiment] An endoscopic treatment apparatus according to the present embodiment will be described with reference to FIG. The same components as those in the first embodiment are given the same numbers.

(Structure) In this embodiment, the inner tube 2 of the first embodiment described above is not provided. Instead, the inner tube 2 has a detachable inner diameter at the distal end portion 14 of the endoscope 10, and is flexible, transparent, and heat-resistant. An excellent resin cylindrical hood 60 is provided as a tubular body. The hood 60 is provided with a sharp edge 41, a side opening 42, an incision holder 43, a high-frequency wire 47, and the like, as in the first embodiment.

The guide tube 3 here is not of an inner / outer double tube structure but is single, and the center hole diameter of the rubber seal of the mouthpiece at the rear end is slightly smaller than the outer diameter of the insertion portion 11 of the endoscope 10. The high-frequency cable 33 is connected to the insertion section 11 of the endoscope.
Are taped at several places so as to pass between the guide tube 3.

Further, the insertion section 11 of the endoscope 10 can be advanced / retracted / rotated with respect to the guide tube 3.

(How to Use / Function) The method of use of the present embodiment is the same as that of the above-described first embodiment, but the hood 60 acts similarly to the first embodiment instead of the inner cylinder 2 in the first embodiment. Further, since the hood 60 moves forward / backward / rotates, an external force is applied. However, since the hood 60 is tightly attached to the distal end portion 14 of the endoscope 10, it does not fall off. Since the high-frequency cable 33 of the high-frequency wire 47 is electrically insulated, no current flows to the patient. If the high-frequency cable 33 is fixed to the insertion portion 11 of the endoscope 10 with a tape, it will not be wound even by a rotating operation such as incision.

(Effect) In the present embodiment, since the hood 60 is used, unlike the inner cylinder 2, the insertion portion 11 of the endoscope 10 does not have to be inserted. Therefore, the high-frequency wire 47 is greatly extended inward. It is possible to make the shape of a circular arc long, and the length of one incision can be lengthened, so that the time required to make a ring-shaped incision can be reduced.

Since there is no portion corresponding to the inner cylinder 2,
When the endoscope 10 having the insertion portion 11 having the same outer diameter as that of the first embodiment is used, the outer diameter of the guide tube 3 can be made smaller than that of the first embodiment, so that the patient's pain can be reduced.

When the endoscope 10 having a thick treatment instrument insertion conduit is combined with the thick insertion portion 11 using the guide tube 3 having the same thickness as the outer cylinder 1 of the first embodiment, a large end is required. Since the forceps having the same can be used, the cutting of the fibrous tissue is facilitated.

In addition, the smoke generated at the time of high-frequency incision can be easily sucked. It is also possible to use an endoscope having two forceps insertion passages and having a forceps raising mechanism at one of the outlets (see the endoscope shown in FIG. 8). In this combination, the position of the tip of the forceps is easily controlled by the forceps raising mechanism, and the two forceps can be used at the same time, so that the cutting of the fibrous tissue, the hemostasis, and the position control of the mucous membrane are facilitated.

As the high-frequency wire 47 is repeatedly cut, soot-like dirt adheres and cannot be cut. Therefore, the high-frequency wire 47 needs to be replaced. However, since the hood 60 is cheaper than the guide tube 2, it is economical to replace. Burden is low.

[Third Embodiment] An endoscope treatment apparatus according to the present embodiment will be described with reference to FIGS.

(Structure) The structure of the present embodiment is an example in which the hood 60 is used similarly to the case of the second embodiment, but the side opening 42 formed in the hood 60 extends in the obliquely forward lower half of the hood 60. Is widely formed. Further, the incision tool holding portion 43 is provided with the side opening 4 along the axial direction of the hood 60.
2 protrudes from the rear end to near the center.

The incision tool holding portion 43 is formed in a hollow pipe shape, and the incision device introduction portion 45 formed by the distal end portion of the incision tool holding portion 43 is formed in a shell shape. I have.

Further, the incision device introduction portion 4 of the incision device holding portion 43
5 is provided with a hole 61 at the center thereof.
A thin and long circular slit 62 is opened along the axial center of the upper side surface facing inward.

The high-frequency wire 47 protrudes toward the inside of the hood 60 in a semicircular shape from the slit 62 of the cutting tool holder 43. The distal end portion of the high-frequency wire 47 is bent into a hairpin shape inside the cutting tool holder 43. The hairpin section 63 is slidably housed in the cutting tool holding section 43. The maximum diameter of the semicircular portion of the high-frequency wire 47 protruding from the slit 62 is shorter than the length of the slit 62. When the semicircular portion is located forward, the hairpin portion 63 at the tip protrudes from the hole 61 with the same length as the thickness of the mucous membrane 51, and the mucous membrane 51 of the tissue sucked into the hood 60 through the side opening 42. Only functions as a high-frequency knife to incise.

On the other hand, a high-frequency cable 33 is connected to the rear end of the high-frequency wire 47, and the connection end of the high-frequency cable 33 is bent into a crank shape or an S-shape to enter the treatment instrument insertion passage 64 of the endoscope 10. It is led. The high-frequency cable 33 is thickly covered with a hard resin PFA or the like, and has such a rigidity that an operation force by a push-pull operation near the entrance of the treatment instrument insertion passage of the endoscope 10 is transmitted to the high-frequency wire 47. That is, the high-frequency cable 33 also serves as an operation wire for moving the high-frequency wire 47 back and forth.

Then, by moving the high-frequency cable 33 back and forth, the semicircular portion of the high-frequency wire 47 protruding from the slit 62 of the cutting tool holder 43 moves back and forth along the slit 62. The high-frequency wire 47
Is restricted by the length of the slit 62 in the front-rear direction. The high-frequency wire 47 functions as a high-frequency knife that moves and incises the tissue mucous membrane 51 taken into the inside of the hood 60 from the side opening 42.

(Usage Method) The purpose of using the hood 60 of the present embodiment is to cut the mucous membrane 51 along the axial direction of the insertion section 11 of the endoscope 10. Affected part 71 to be resected
After a swelling is formed by local injection of physiological saline or the like under the mucous membrane of the endoscope, the mucous membrane 51 is sucked into the side opening 42, and then the operator is in the vicinity of the entrance 13 of the treatment instrument insertion passage of the endoscope 10. Then, the high-frequency cable 33 is pinched and pushed forward, and the hairpin 63 is projected from the hole 61 of the incision holder 43 and energized to make a small incision only on the mucous membrane 51.

Next, the high-frequency cable 33 is pulled in the vicinity of the entrance 13 of the treatment instrument insertion passage, the semi-circular high-frequency wire 47 is moved backward, and the hairpin 63 is housed in the incision instrument holder 43. Then, the incision device introduction part 45 is sunk under the mucous membrane.

Here, if the size of the incision is not enough and the incision device introduction part 45 does not go under the mucous membrane, the hairpin 63 is again protruded and pierced into the previously opened small incision, and the endoscope is inserted. While performing the bending operation and the rotation operation of 10, the electric power is supplied to widen the incision portion.

Next, the insertion operation of the endoscope 10, the suction operation and the air supply operation are performed, and the semicircular portion of the high-frequency wire 47 is connected to the mucous membrane 5.
1 and a high-frequency wire 47 is energized with a high frequency to make a longitudinal incision 44 b in the mucous membrane 51. Another similar longitudinal incision 44b is added across the affected part 71,
An incision is made in two parallel lines.

The next step will be described with reference to FIG. The endoscope 10 used here has two treatment tool insertion passage outlets 15, and one insertion passage outlet 15a is provided with a forceps raising mechanism 19 such as a forceps raising base.

The hood 60 at the tip is the same as that in the second embodiment described above, and is used to make two incisions 74a in the circumferential direction so as to leave a slight space around the affected part 71. Thus, a square incision line 74 is formed.

Subsequently, the stump is pinched with the high-frequency grasping forceps 55, the forceps raising table 19 of the forceps raising mechanism 19 is raised, the high-frequency grasping forceps 55 are pushed in, the mucous membrane 51 is turned over, and the tip of the hood 60 is The endoscope 10 is rotated while a sharp edge 41 is applied to the boundary tissue 53 and the incision is observed, and the endoscope 10 is swung in an arc shape, and the mucous membrane 51 of the affected part 71 is partially peeled off in a square. I do.

(Operation / Effect) Here, the high-frequency cable 3
Since 3 is hard, a semicircular portion of the high-frequency wire 47 can be easily advanced and retracted by a push-pull operation near the entrance 13 of the treatment instrument insertion passage. The protruding length of the hairpin portion 63 is regulated by the front end of the slit 62 abutting on the front side of the semicircular high-frequency wire 47, so that the protruding length does not excessively exceed the thickness of the mucous membrane 51. .

Further, since the swollen mucous membrane 51 is thinly stretched, the mucous membrane 51 can be cut sufficiently by the projection amount of the thickness of the mucous membrane 51. Since the hairpin portion 63 is housed under the mucous membrane in the incision tool holding portion 43, even if electricity is supplied during mucosal incision, the hairpin portion 63 does not hit the back side of the mucous membrane 51 and does not touch the muscle layer 52. That is, it is electrically insulated. Due to the slit 62, the semicircular high-frequency wire 47 always faces the center of the axis, and does not hit the muscle layer 52. When the high-frequency wire 47 is sunk under the mucous membrane, the high-frequency wire 4
Since the mucous membrane 51 is lifted along 7, the moment of incision of the mucous membrane 51 is displayed as an endoscopic image.

When the diseased part 71 is present not in the entire circumference but in a part thereof, a partial resection can be easily performed by incising the periphery of the diseased part 71 in advance. Therefore, it is possible to resect a half of the esophagus, for example, over a wider area than in the case of the conventional partial resection method, in which the mucous membrane 51 is suctioned at the tip of the hood or the guide tube and squeezed with a snare. Becomes The mucous membrane 51 can be easily and widely resected in a short time, rather than by raising or turning over the mucous membrane 51 and incising the submucosal layer little by little with the tip of the dissecting instrument.

In addition, even if the mucosa of the luminal organ is peripheral, resection of the entire perimeter at a time will cause a great invasion, burden the patient with pain, and reduce the risk of stenosis. Because there is a gap, we will make a partial excision after a short period of time. In such a case, according to this example, partial excision can be easily performed, which is effective.

Further, in the case of the conventional partial resection in which the mucous membrane is suctioned at the tip of the cap or the guide tube and squeezed with a snare, and the resection is performed, it is possible to directly observe which part is to be incised by an endoscopic image. Although not possible, it can be observed in the present embodiment. In addition, in these procedures for partial resection in an elliptical shape, when making a planned partial resection, if the overlapping part between the adjacent parts is enlarged, the part will be deeply resected. Since it cannot be removed, a time-consuming and careful overlapping operation is required. However, in the case of the present example, since a rectangular incision can be made, planned partial resection is reliable and easy. Since the mucous membrane can be easily reconstructed after the resection, an effect of increasing the accuracy of the pathological test result can be expected.

[Fourth Embodiment] An endoscope treatment apparatus according to this embodiment will be described with reference to FIG. The same components as those in the above-described embodiment are given the same numbers.

(Structure) In the endoscope treatment apparatus of the present embodiment, as shown in FIG. 9, a hood 60 that can be detachably attached to the distal end portion 14 of the endoscope 10 is provided. Food 6
Numeral 0 is made of a transparent and flexible polyurethane resin, and its tip is a shell type. The side opening 42 of the hood 60 is largely open over approximately ／ of the circumference of the hood 60, and two incision tool holders 43 are integrally formed with the hood 60,
They are provided in parallel in the axial direction. The two cutting tool holders 43 have a circumferential angle of about 90 degrees therebetween.

[0092] Located between the two cutting tool holders 43,
The edge of the side opening 42 has a sharp edge 41
However, it is formed diagonally like a guillotine blade. The sharp edge 41 is formed of the same material integrally with the hood 60. However, the positions of the incision device introduction portions 45 in the two incision device holding portions 43 are slightly shifted in the axial direction.

A high-frequency wire 47 is formed in an arc shape toward the center of the hood 60 along the inner edge of the incision tool holding portion 43 from the back of the incision device introduction portion 45 at the front end of the incision device holding portion 43. It is attached to protrude. The edge of the sharp edge 41 is the high-frequency wire 4.
It is located in the middle of 7.

The high-frequency cable 33 is connected behind the high-frequency wire 47. The high-frequency cable 33 has a bifurcated end, and each end is connected to a high-frequency wire 47. The high-frequency wire 47 is fitted into a groove 68 formed on the outer wall of the hood 60 and is adhered so as not to protrude from the outer surface of the hood 60.

(Usage Method) When using the endoscopic treatment apparatus of the present embodiment, first, a physiological saline solution or the like is injected under the mucosa by the above-described method using the injection needle, and the mucous membrane 51 of the affected part 71 is muscularized. Float with respect to layer 52. Thereafter, the distal end 1 of the endoscope 10
The hood 60 previously mounted on the hood 4 is rotated in the circumferential direction in the same manner as the above-described second embodiment. At about 90 degrees, make two circumferential incisions in the near and far side.

After that, the hood 60 is replaced with the one shown in the present embodiment, the portion of the previously formed circumferential incision line 72a is sucked into the side opening 42, and is fitted to both ends thereof.
The distal end portion 14 of the endoscope 10 is adjusted while adjusting the air supply and suction operations.
To the front, the two incision tool holders 43 are pierced from the incision tool introduction part 45 at the tip thereof, and further forward, the mucosa 5
1 is set to evenly ride on the two high-frequency wires 47, and high-frequency current is applied to both high-frequency wires 47 to cut out the mucous membrane 51.

At this time, since smoke and water vapor are emitted, the air supply and suction operations of the endoscope 10 are quickly repeated to remove the smoke and water vapor.

At the incised portion, the high-frequency wire 47 is further pushed together with the incision holder 43, and at the same time, the sharp edge 41 is made to penetrate into the border tissue 53 and pushed, and the border is cut to detach the mucous membrane 51 and the muscular layer 52. I do. In order to easily observe the detached portion, the stump is gripped by the gripping forceps 55, and the mucous membrane 51 is turned over, as shown in FIG. In this way, the vertical incision and the peeling are simultaneously advanced to the depth of the incision line 74 at the back, which has been previously incised.
Thereby, the mucous membrane 51 can be peeled off in a square.

(Effect) In the present embodiment, the two high-frequency wires 47 move in parallel in the axial direction because they are at equal intervals. , So that the sharp edge 41
There is no uncut portion between the peeling due to the incision and the axial incision line.

Further, since the positions of the incision tool introduction portions 45 in the two incision tool holding portions 43 are slightly shifted, insertion resistance is reduced. Since the sharp edge 41 is oblique,
Peeling resistance is further reduced.

Since the two longitudinal incisions and the peeling of the mucous membrane 51 are performed almost simultaneously, the peeling process can be performed in a short time. Incision one by one makes it difficult to make parallel incisions, and it becomes more difficult to make them longer, but with such a hood 60, parallel and long incisions and peelings can be easily made.

Furthermore, since the incision device introduction portion 45 is not sharp and made of a flexible material, even if it is inserted into the boundary tissue and hits the muscle layer 52, it is not damaged.

(Modification) In the present embodiment, two high-frequency wires 47 are provided as cutting tools, but the interval between them is not limited to 90 degrees, but may be any angle as required. Further, instead of the hood 60, the guide tube 3 as in the first embodiment may be provided. Further, the sharp edge 41 may be formed in an arc shape, or may be sharpened at the center like an inverted letter. In addition, the shape of the high-frequency wire 47 may be a slope. The protruding direction is not limited to the axial direction, and if the hood 60 and a part of the guide tube 3 are protruded circumferentially, two incisions can be formed circumferentially on the mucous membrane.

[Fifth Embodiment] An endoscopic treatment apparatus according to the present embodiment will be described with reference to FIG. The same components as those in the above-described embodiment are given the same numbers.

In the present embodiment, the high-frequency wire 47 extends in the axial direction.
It is an example of a high-frequency incision tool section provided with. That is, a notch 81 that opens forward is provided at the tip of a transparent and flexible resin tubular body (for example, an inner tube or a hood) 80, and a rear wall (side) of the notch 81 extends forward. Is provided in a state where the band-shaped cutting tool holding portion 43 is left uncut. That is, the incision tool holding portion 43 is disposed at the center of the notch 81 so as to protrude forward.

The slit groove 8 is provided at the center of the cutting tool holder 43.
2 is formed to extend to the rear of the incision instrument introduction portion 45. A high-frequency wire 47 is provided at the tip of the slit groove 82.
Are fixed, and the high-frequency wire 47 is housed in the slit groove 82. The high-frequency wire 47 is preliminarily bent in an arc shape.

At the rear end of the high-frequency wire 47, a hard high-frequency cable 33 in which a heat-shrinkable tube made of Teflon (registered trademark) is covered on an electrically insulating coat is connected. The high-frequency cable 33 is slidably housed in a cable insertion pipe 86 provided in a cable groove 85 formed integrally with the tubular body 80.

The width of the slit groove 82 is slightly larger than the outer diameter of the high-frequency wire 47, so that storage and display can be smoothly repeated. The bending tendency of the high-frequency wire 47 is a tubular body 80.
Because it is oriented in the direction of the central axis, it appears in that direction.

(How to use) If only different points from the above are described, the mucous membrane 51 is picked up by a grasping forceps inserted through the treatment instrument insertion passage of the endoscope, and the incision instrument holding portion is previously cut into a small incision. 43, the high-frequency cable 33 is pulled, and the high-frequency wire 47 is inserted under the mucous membrane to the vicinity of the base of the incision tool holding portion 43 housed in the slit groove 82. Then, the high-frequency cable 33 is pushed in, the high-frequency wire 47 is exposed in an arc shape, and while energized, the mucous membrane 51 is incised from the back side of the mucous membrane 51 and pushed to a desired position.

(Effect) Since the high-frequency wire 47 is housed in the incision tool holding portion 43, the high-frequency wire 47 does not hinder the insertion of the incision device holding portion 43 under the mucous membrane, and is inserted long to the vicinity of the base. it can. Accordingly, the high-frequency wire 47 can be sunk under the mucous membrane for a longer time, and the incision can be made longer, and as a result, the time for incision in the axial direction can be shortened.

Further, since the distal end of the tubular body 80 is open, it is difficult for smoke and water vapor at the time of incision to stay in the tubular body 80.
Securing the field of view becomes easier.

Further, since the high-frequency cable 33 is housed at a predetermined position, the treatment operation and the field of view are not hindered. Moreover, the notch 81 opened forward rather than the side opening widens the field of view seen by the endoscope 10.

(Modification) The cutting angle of the tip is not necessarily a right angle, but may be cut obliquely to facilitate insertion and suction.

[Sixth Embodiment] An endoscope treatment apparatus according to the present embodiment will be described with reference to FIG. The same components as those in the above-described embodiment are given the same numbers.

(Structure) The embodiment in this embodiment shows another example of the high-frequency incision tool used for incision in the circumferential direction. That is, at the front open end of a transparent and flexible resin tubular body, for example, a hood 90, a T-shaped incision tool holder 43 is formed so as to protrude forward. A piece 91 extending in both circumferential directions is formed in a T-shape at the tip of the incision tool holding portion 43. The front edge of the T-shaped piece 91 is formed as a sharp edge 41 for tissue incision.

The horizontal line piece 91 of the cutting tool holder 43 is formed to be curved in parallel with the peripheral surface of the hood 90. A high-frequency wire 47 is provided on the inner surface of the arc-shaped T-shaped piece portion 91 so as to extend in a chord shape facing inward.

The two ends of the high-frequency wire 47 are provided slightly away from the end of the piece 91, and the distal end portions of the piece 91 form the incision implement introduction portions 45, respectively.

(How to use) The difference from the conventional method is that when the entire circumference is cut, the clockwise or counterclockwise rotation is used.
Rotate to make an incision, reverse the rotation, reverse the tip, insert the leading end introduction part on the opposite side of the T-shape, rotate it 180 degrees in the opposite direction to the beginning, make an incision, and make it 360 degrees A continuous incision is possible.

(Operation / Effect) By the suction operation of the endoscope,
The dissector can be sunk under the mucous membrane in either direction of rotation against the raised mucous membrane. Also, 360
Since there is no need to turn the hood 90, the rotation operation becomes easier.

As the high-frequency wire 47 cuts the mucous membrane, blood and tissue may be scorched and difficult to cut, but in the case of an arcuate wire, half of the wire is cut in half. It is difficult to cut as compared to incising the entire circumference with. In the luminal organs such as the esophagus, the organ is twisted to a certain extent because the incision tool is rotated, but compared to rotating 360 degrees in the same direction,
Since the rotation is a half turn, the burden on the patient can be reduced. Since the contact area between the mucous membrane and the outer surface of the hood is small, the rotation resistance is small, and the rotation is easy, the surgeon can not hold on. Since the length of the hood can be reduced as compared with the side opening, the rotation resistance can be reduced, and the rotation operation can be easily performed. Further, the portion of the hood occupying the endoscope image is reduced, so that the inside of the body cavity can be easily seen. The hood is less likely to be in the way, and the treatment operation with the treatment tool becomes easier.

(Modification) The T-shaped incision holder 43 may be provided in the side opening or the notch as described above. Further, the shape of the wire is not limited to a circular arc, and the T-shape may be rotated by 90 degrees and the high-frequency wire 47 may be disposed in the axial direction as in the embodiment shown in FIG. Further, the incision tool holding part is L
The cutting tool may be shaped like a letter 360 and rotated 360 degrees.

(Modification) The shape of the portion of the high-frequency wire 47 protruding from the cutting tool holder 43 may be a parabola, a part of an ellipse, a half of an ellipse, or a slope. FIG. 12 shows these examples.

In FIG. 12A, the protruding portion of the high-frequency wire 47 is formed in a shape in which a linear slope 65 rises up suddenly. The steep rise of the linear slope 65 makes it easy for the high-frequency wire 47 to hit the back of the mucous membrane, making it easy to make an incision.

FIG. 12B shows a shape in which the protruding portion of the high-frequency wire 47 forms a gentle curved slope 66. Since the slope 66 has a gentle curved shape, the high-frequency wire 47 is unlikely to hinder the incision tool from entering the submucosa, and the incision tool can be smoothly inserted under the mucous membrane. As the mucous membrane covers it, it cuts longer.

In the one shown in FIG. 12 (c), the protruding portion of the high-frequency wire 47 forms a back-fin shaped wire portion 67,
The incision tool holder 43 is provided. Since the mucous membrane hits the arc portion having a small curvature on the introduction portion 45 side of the dorsal fin-shaped wire portion 67, the mucous membrane is cut not at the back of the mucous membrane but at the end of the mucous membrane, and the high-frequency wire 47 is sunk under the mucous membrane. Since there is no need, there is little resistance, the rotating operation is easy, and the incision point is easy to observe.

(Modification) The arrangement of the wires in each example is not limited to the circumferential cutting tool, but may be arranged in the axial direction.

The present invention is not limited to the above embodiment. According to the above description, each item listed in the following supplementary notes and those obtained by arbitrarily combining those items can be obtained.

[Supplementary Notes] Supplementary Notes 1. In an endoscope treatment apparatus used in combination with an endoscope, a sharp edge for mucosal exfoliation is provided on a part of a transparent and flexible tubular body disposed near the distal end of the endoscope. An endoscope treatment device characterized by being provided.

Appendix 2 The transparent and flexible tubular body comprises an inner cylinder of a double guide tube, one end of which is rotatably and retractably and air-tightly connected, wherein the inner cylinder is shorter than the outer cylinder. thing.

Appendix 3 The incision tool holding part according to claim 1 is provided in a part of the tubular body so as to be integral with or separate from the tubular body so as to protrude in the circumferential direction, and has a curvature equal to or smaller than that of the tubular body. Features that are.

Appendix 4 2. The incision device holding part according to claim 1, wherein the cutting tool holding part is provided integrally with or separately from the tubular body so as to protrude in the axial direction.

Appendix 5 2. The incision device holding part according to claim 1, wherein the incision tool holding part is provided so as to protrude from a side wall provided in a part of the tubular body.

Appendix 6 2. The cutting tool holder according to claim 1, wherein the cutting tool holder is provided so as to protrude from a notch wall provided at a distal end of the tubular body.

Appendix 7 2. The cutting tool holder according to claim 1, wherein the cutting tool holder is provided so as to protrude from a distal end of the tubular body.

Appendix 8 The incision device holding part of the first aspect is configured such that at least two or more high-frequency energizing wires disposed on a portion of the tubular body and protruding in the axial direction are disposed on these supporting parts. Characterized by that.

Appendix 9 The high-frequency incision tool according to claim 1, the incision tool holding portion made of a hollow insulating material, the incision device introduction portion provided at the tip of the incision device holding portion, and between the introduction portion rear and the support portion base. A slit provided toward the inside of the tubular body, and a high-frequency conducting wire which is disposed inside the support portion hollow so that it can be exposed and housed from the slit, and supplies a current to the wire, and also performs an operation for storing and storing the wire. Characterized by a cable that also serves as a high-frequency power supply.

Appendix 10 3. The hood according to claim 2, wherein a tip of the hood is closed in a shell shape.

Supplementary Note 11. 3. The hood according to claim 2, wherein a minimum outer diameter of the hood is substantially the same as or smaller than an outer diameter of an endoscope distal end portion to be combined.

Supplementary Note 12. The sharp edge of appendix 1 is formed integrally with the tubular body.

Supplementary Note 13. The sharp edge of Appendix 1 is provided on at least a part of the distal end of the tubular body.

Supplementary Note 14. The sharp edge of the appendix 1 is provided on at least a part of an inner wall of a side opening provided in the tubular body.

Appendix 15 The sharp edge of Appendix 1 is provided on at least a part of a notched wall provided on a part of a distal end of the tubular body.

Supplementary Note 16. The sharp edge according to the appendix 1, wherein the sharp edge is provided on at least a part of the incision tool holding portion provided at the tip of the tubular body.

Supplementary Note 17. The shape of the incision tool holding part of Claim 1 is T-shaped, and the high frequency incision wire is provided in the center of the T-shaped horizontal line.

Appendix 18. The shape of the incision tool holding part of Claim 1 is L-shape, and the high frequency incision wire is provided in the L-shaped horizontal line.

Supplementary Note 19. The guide tube according to claim 3 is characterized in that a predetermined length of the distal end is made of a material which is transparent and has excellent electric insulation and heat resistance, and the rear portion is made of another material.

Appendix 20. The hood according to claim 2, wherein a predetermined length of the distal end is made of a material which is transparent and has excellent electrical insulation and heat resistance, and a mounting portion with the endoscope distal end is made of an elastic material.

Appendix 21. 3. The position of the high-frequency wire according to claim 2, wherein when the hood is attached to the endoscope, the position of the high-frequency wire is substantially a focal position of an endoscope image.

[0149]

As described above, according to the present invention, it is possible to inject, for example, physiological saline or the like, and easily and incision the periphery of the affected part of the mucous membrane separated from the mucous membrane and the muscular layer in a short time. Can be. In addition, the separation of the mucous membrane including the affected part can be easily shortened.

Since there is little time for careful operation, the operator does not need to use his / her concentration power more than before and is not tired. Shorter times also reduce patient fatigue.

[0151] Since a technique requiring skill as in the conventional technique is not required, the apparatus and technique can be used by many operators without taking much time for training.

The incision prior to mucosal dissection can be made while grasping the positional relationship between the incision tool and the mucous membrane firmly, and then directly observing the incision of the mucous membrane with an endoscopic image. Can be.

[0153] Mucosal exfoliation is physically inexpensive, and is less expensive because it does not use high energy as compared to exfoliation while incising the boundary with a high-frequency knife or laser beam. Also, unlike high frequency or laser, no smoke or water vapor is generated, and the separation can be performed without interruption, so that the operator does not need to be irritated.

[Brief description of the drawings]

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

FIG. 2 is a longitudinal sectional view of the vicinity of a hand of the endoscope treatment apparatus according to the first embodiment.

FIG. 3 is an explanatory diagram of a treatment state by the endoscope treatment device according to the first embodiment, which is indicated by an endoscope image.

FIG. 4 is an explanatory diagram of a treatment state of the endoscopic treatment device according to the first embodiment.

FIGS. 5 (a), (b), (c), (d) and (e) are explanatory views showing different examples of the shape of a sharp edge formed on the inner cylinder of the guide tube.

FIG. 6 is a perspective view of the vicinity of the distal end of the endoscope treatment device according to the second embodiment.

FIG. 7A is a vertical cross-sectional view of the vicinity of a distal end of an endoscope treatment device according to a third embodiment, and FIG. 7B is a perspective view of the dissecting device.

FIG. 8 is an explanatory diagram of a use state of the endoscope treatment apparatus according to the third embodiment.

FIG. 9 is a perspective view of the vicinity of the distal end of the endoscope treatment device according to the fourth embodiment.

FIG. 10 is a perspective view of the vicinity of the distal end of an endoscope treatment device according to a fifth embodiment.

FIG. 11 is a perspective view of a portion near a distal end of an endoscope treatment apparatus according to a sixth embodiment.

FIGS. 12 (a), (b) and (c) are explanatory views showing modified examples of different cutting tools.

[Explanation of symbols]

DESCRIPTION OF SYMBOLS 1 ... Outer cylinder, 2 ... Inner cylinder, 3 ... Guide tube, 10 ... Endoscope, 11
... Endoscope insertion part, 12 ... Endoscope operation part, 41 ... Sharp edge of inner cylinder, 42 ... Side opening, 43 ... Incision tool holding part, 45
... Incision implement introduction part, 47 ... High frequency wire, 33 ... High frequency cable.

Claims (3)

[Claims] 1. An endoscope treatment apparatus used in combination with an endoscope and used for incising tissue in a body cavity, comprising: a transparent and heat-resistant electric insulation disposed near a distal end portion of the endoscope. A tubular body made of a body, an elongated cutting tool holder made of a material having excellent heat resistance and electrical insulation provided protruding from a part of the tubular body, and provided at a tip of the cutting tool holder. A tapered incision instrument introduction portion, and an incision portion provided at a predetermined distance from the inner surface of the incision instrument holding portion toward the inside of the tubular body from the rear of the incision instrument introduction portion. An endoscope treatment device comprising: a high-frequency incision tool; a cable for supplying a current to an incision portion of the high-frequency incision tool; and a high-frequency power supply device. 2. The endoscope treatment apparatus according to claim 1, wherein the tubular body is formed of a hood detachably attached to an endoscope end portion. 3. The endoscope treatment apparatus according to claim 1, wherein the tubular body is formed of a guide tube fitted into an insertion portion of the endoscope and inserted into a body cavity.