JP2005073798A - Puncture needle device for endoscope - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To realize a puncture needle device for an endoscope which facilitates a collection of a specimen of a sufficient amount for a diagnosis for a pathological confirmation. <P>SOLUTION: The puncture needle device 1 is equipped with a coil sheath 12 which is inserted in and removed from an insertion channel for endo-therapy accessories of the endoscope, a long puncture needle which is inserted in the coil sheath 12, punctures a site to be tested in a body cavity by freely moving forward and backward, and is formed into a tube shape to obtain a biological tissue, a main body 13 of an auxiliary device which is provided on the proximal end side of the coil sheath 12 for operating the backward and forward movements of the puncture needle, and a protruding mechanism provided on the main body 13 for protruding the puncture needle. The puncture needle device 1 has a slanting blade surface which becomes sharper toward the distal end on the outer peripheral surface and the inner peripheral surface, or at least one of them on the distal end part of the puncture needle. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

  The present invention relates to an endoscope puncture needle device that is inserted into a treatment instrument insertion channel of an endoscope, punctures a subject part in a body cavity, and collects a living tissue.

  In recent years, pathological diagnosis has been widely performed in the medical diagnosis field. This pathological definite diagnosis is a diagnostic method performed by collecting a specimen under observation of an ultrasonic tomogram using an ultrasonic diagnostic apparatus, for example. In this diagnosis method, an ultrasonic tomogram is used as a guide to guide a long puncture needle to a subject portion through a treatment instrument insertion channel of an endoscope and puncture the specimen, thereby collecting the specimen.

  In order to perform such a pathological definite diagnosis, as described in, for example, Japanese Patent Application Laid-Open No. 2001-37765 and Japanese Patent Application Laid-Open No. 8-150145, an endoscope that can be fixed to a treatment instrument insertion channel entrance of an endoscope. A puncture needle device for a mirror has been proposed.

  Here, in general, the cutting edge shape of a conventional puncture needle used in the above-described puncture needle device for an endoscope has the same structure as the cutting edge shape of a normal injection needle as shown in FIGS. 24 (a) and 24 (b). It has become. That is, the conventional puncture needle 100 cuts the tip of an ultrathin tube, and forms at least one blade surface 100a at the cut tip. Here, FIG. 24A is a cross-sectional view showing the tip of the puncture needle 100 with the inner needle (stylet) 101 protruding, and FIG. 24B shows the tip of the conventional puncture needle 100. It is a perspective view shown.

  However, in general, an injection needle is originally intended to be inserted into a living tissue. As described above, the conventional puncture needle formed in the same structure as the shape of the cutting edge of the injection needle has a structure in which the living tissue is actively taken into the inside because the cutting edge inserts while cutting the living tissue. Absent. For this reason, the conventional puncture needle may not be collected in the state of the subject part, for example, when the living tissue is hard, or only a very small amount is collected even if the sample is collected. There wasn't. In addition, when performing a suction biopsy in which the inside of the needle is subjected to negative pressure with a syringe or the like and sucks the tissue, there is a disadvantage that the biological tissue is collected in pieces.

As another conventional puncture needle device for an endoscope, for example, as described in Japanese Patent Application Laid-Open No. 10-216134, a notch is formed in a side portion of an inner needle that is inserted and retracted through the puncture needle. An apparatus having a configuration in which is formed is proposed.
In the endoscope puncture needle device described in Japanese Patent Laid-Open No. 10-216134, the puncture needle is moved forward by causing the inner needle to protrude and sandwiching the living tissue of the subject portion into the notch. By storing the inner needle, the living tissue is cut and the sample is collected.

However, although the puncture needle device for endoscope described in the above-mentioned Japanese Patent Application Laid-Open No. 10-216134 is capable of collecting a sample long, in order to ensure the mechanical strength of the cutout portion, The depth is limited, and a specimen with sufficient thickness cannot be collected.
Therefore, in the biopsy using the conventional endoscopic puncture needle device, if the sample amount collected is insufficient for performing pathological diagnosis, it is repeated until a sufficient amount is collected. A biopsy had to be performed and was cumbersome.

  In general, there are two types of diagnostic methods for collected specimens: cytology and histology. In cytodiagnosis, each cell is diagnosed and diagnosed. For this reason, in cytodiagnosis, it is difficult to determine whether a specimen is benign or malignant, and it is difficult to obtain information up to the pathological diagnosis.

On the other hand, histological diagnosis is a method of diagnosing by diagnosing one lump with a collection of living tissues as a whole, so that information sufficient to perform pathological definitive diagnosis can be easily obtained.
Therefore, when performing pathological confirmation diagnosis, it is desirable to collect the sample as a certain amount of tissue-like mass as the amount of the sample that can be histologically diagnosed.
JP 2001-37765 A JP-A-8-150145 JP-A-10-216134

  The problem to be solved is that it has been difficult for a conventional endoscope puncture needle device to collect a sufficient amount of sample for pathological confirmation diagnosis.

The puncture needle device for an endoscope according to claim 1 of the present invention includes a sheath that can be inserted into and removed from a treatment instrument insertion channel of an endoscope, and a subject portion in a body cavity that is inserted into the sheath and can be moved forward and backward. A long puncture needle formed in a tubular shape to puncture the body tissue and to collect a living tissue; an operation portion provided on the proximal end side of the sheath for operating the advancement and retraction of the puncture needle; provided in the operation portion; A protrusion mechanism for causing the needle to protrude, and at least one of an outer peripheral surface and an inner peripheral surface of the distal end portion of the puncture needle is formed with an inclined blade surface that is sharp toward the distal end. Yes.
The invention according to claim 2 of the present invention is the endoscope puncture needle device according to claim 1, further comprising an inner needle that is inserted through the puncture needle and is movable forward and backward. When the inner needle is projected from the tip of the puncture needle, at least one of the outer peripheral surface and the inner peripheral surface of the tip of the puncture needle has a blade surface formed in a slope shape that is sharp toward the tip. It is characterized in that a substantially continuous slope is formed with the needle.

  The puncture needle device for endoscope of the present invention has an advantage that it is possible to easily collect a sufficient amount of sample for performing pathological confirmation diagnosis.

  Embodiments of the present invention will be described below with reference to the drawings.

  FIGS. 1 to 16 relate to the first embodiment of the present invention, and FIG. 1 is an explanatory view showing a state in which the endoscope puncture needle device of the first embodiment is attached to the treatment instrument insertion port of the endoscope. 2 is an external view of the puncture needle device for endoscope of FIG. 1, FIG. 3 is a cross-sectional view of the puncture needle device for endoscope of FIG. 2, FIG. 4 is an external view showing the coil sheath of FIG. 3 is an explanatory view showing the puncture needle part of FIG. 3, FIG. 6 is a cross-sectional explanatory view showing the switch part of FIG. 3, FIG. 7 is an explanatory view showing the distal end side of the puncture needle of FIG. 7B is a cross-sectional view of FIG. 7A, FIG. 8 is an explanatory view showing the operation of the first half side of the puncture needle device for an endoscope, and FIG. FIG. 8B is a cross-sectional view showing a puncture preparation state in which the tip of the puncture needle is accommodated in the coil sheath, and FIG. 8B is a diagram illustrating a state in which the third slide portion is advanced to the maximum extent. FIG. 8C is a cross-sectional view showing a state where the inner needle has been removed, and FIG. 9 is an explanatory view showing the operation of the second half side of the puncture needle device for endoscope. 9A is a cross-sectional view showing a state in which the adjustment cylinder is rotated to set the protruding length, and FIG. 9B shows a state in which the tip of the puncture needle protrudes at a high speed by setting the protruding length. FIG. 9C is a cross-sectional view, and FIG. 9C is a cross-sectional view showing a state in which the third slide portion is pulled to the maximum proximal side when the puncture needle device is removed from the treatment instrument insertion channel of the endoscope. FIG. 11 is an explanatory view showing a puncture preparation state in which the tip of the puncture needle is housed in the coil sheath, and FIG. 11 shows a state when the tip of the puncture needle is protruded from the tip of the coil sheath and advanced to the front of the subject part. FIG. 12 shows the tip of the puncture needle portion inserted into the subject portion and led into the target lesion portion. FIG. 13 is an explanatory view showing a state when the tip of the puncture needle portion reaches the target lesion portion and the inner needle is removed, and FIG. 14 is a diagram showing the state where the puncture needle portion is targeted by operating the switch portion. FIG. 15 is an explanatory view showing a state when deeply inserted into the lesioned part, FIG. 15 is an explanatory view showing a state when the tip of the puncture needle part is removed from the target lesioned part with the sample taken in, and FIG. FIG. 16A is an explanatory view showing a modified example of the puncture needle, FIG. 16A is a cross-sectional view showing the modified example of the puncture needle, and FIG. 16B is a plan view of the puncture needle of FIG. FIG.

As shown in FIG. 1, an endoscope puncture needle device (hereinafter simply referred to as a puncture needle device) 1 according to the present embodiment is passed through an ultrasonic endoscope or a treatment instrument insertion channel (not shown) of the endoscope 2. It is guided into the body cavity.
The endoscope 2 includes an elongated insertion portion 3 to be inserted into a body cavity, an operation portion 4 provided at the rear end of the insertion portion 3, and an eyepiece portion 5 disposed at the rear end of the operation portion 4. And a universal cord 6 having a connector 7 connected to a light source device (not shown). The illustrated endoscope 2 is an optical endoscope. However, by attaching a television camera head to the eyepiece 5 of the endoscope, the endoscope optical image is photoelectrically converted and not illustrated. It is also used to obtain an endoscopic image by connecting to a camera control unit (hereinafter referred to as CCU). In addition, as an endoscope used in the present embodiment, as an electronic endoscope, an imaging optical system and an imaging device are built in the distal end portion of the insertion portion, and a signal line extends from the operation portion to the end of the universal cord. Of course, an endoscope that can be connected to the CCU via the provided connector to obtain an endoscopic image may be used.

  On the front end side of the operation section 4 of the endoscope, a treatment instrument insertion port 8 for inserting a treatment instrument such as the puncture needle device 1 is provided. The treatment instrument insertion port 8 communicates with a treatment instrument insertion channel (not shown). The treatment instrument insertion channel is disposed in the insertion portion 3 and opens to the treatment instrument outlet 9a formed in the insertion portion distal end portion 3a. Therefore, the puncture needle device 1 can project the distal puncture needle portion 11 from the treatment instrument outlet 9a by being inserted into the treatment instrument insertion channel from the treatment instrument insertion port 8. ing.

  As shown in FIG. 2, the puncture needle device 1 includes a puncture needle portion 11 (see FIG. 5) for puncturing a subject portion in a body cavity, and the puncture needle portion 11 is inserted to insert a treatment instrument of the endoscope. A coil sheath 12 (see FIG. 4) to be inserted into a body cavity via a general channel, and the coil sheath 12 is disposed inside, and the puncture needle portion 11 inserted from the rear end side is inserted through the coil sheath 12. It is mainly comprised by the auxiliary instrument main body 13 as an operation part which provided the protrusion mechanism for making the puncture needle part 11 protrude to the front end side.

  The auxiliary instrument body 13 includes a projecting mechanism for projecting the puncture needle unit 11, and a hollow fixed tube 21 including a fixing unit 21a detachably attached to the treatment instrument insertion port 8 of the endoscope 2. A hollow first slide portion 22 which is inserted inside the fixed tube 21 so as to be movable in the longitudinal direction, an adjustment tube 23 for adjusting the protrusion length of the protrusion mechanism of the puncture needle portion 11, and the first tube A hollow second slide portion 25 (see FIG. 3) that is provided in the slide portion 22 so as to be capable of advancing and retreating and having a finger hook portion 24 on the rear end side, and a pipe that is inserted into the second slide portion 25 so as to be capable of advancing and retreating And a third slide portion 28 having a hollow structure provided with a pipe cap 27 fixed to the base end side of the pipe portion 26.

Next, the internal structure of the auxiliary instrument body 13 will be described with reference to FIG.
A groove 31 is provided on one side surface of the fixed cylinder 21 in the longitudinal direction, and a first fixing screw 32 is screwed into the vicinity of the tip of the first slide portion 22 through the groove 31. A male screw portion 33 is provided on the outer periphery on the proximal end side of the first slide portion 22. A female screw of the adjusting cylinder 23 is screwed into the male screw portion 33. Near the center of the first slide portion 22, a switch portion 34 for projecting the puncture needle portion 11 is provided.

  The adjustment cylinder 23 has a flat adjustment cylinder bottom portion 36 which is open at the front end side so as to be screwable with the male screw portion 33 and has a hole through which the small diameter portion 35 constituting the second slide portion 25 is formed at the rear end side. have. The adjustment cylinder 23 is provided with a coil spring 37 as an urging member for urging the second slide portion 25 toward the distal end side with respect to the first slide portion 22.

  The adjustment cylinder 23 is moved back and forth by rotating with respect to the first slide portion 22, and is movable to the proximal end side until the adjustment cylinder bottom portion 36 contacts the damper 38 of the finger hook portion 24. The adjustment cylinder 23 defines a protrusion length 39 (a length by which the puncture needle portion 11 protrudes by the urging force of the coil spring 37) 39 by a distance between the adjustment cylinder bottom 36 and the damper 38. ing. In the state shown in FIG. 8A described later, the adjustment cylinder 23 is located on the most distal side, so that the protrusion length 39 is the maximum protrusion length 40.

  The second slide portion 25 includes a large-diameter portion 41, the small-diameter portion 35, and the finger hanging portion 24 in order from the tip side. The large diameter portion 41 and the small diameter portion 35 are inserted into the first slide portion 22. The large-diameter portion 41 has an outer diameter that is slightly smaller than the inner diameter of the first slide portion 22. The small-diameter portion 35 is a pipe-like member having an outer diameter thinner than the inner diameter of the coil spring 37, and the pipe portion 26 of the third slide portion 28 is inserted therein.

  The coil spring 37 is inserted inside the first slide portion 22 outside the small diameter portion 35 of the second slide portion 25. The proximal end side of the coil spring 37 is fixed to the proximal end side of the first slide portion 22, and the distal end side is fixed to the proximal end side of the large diameter portion 41 of the second slide portion 25. The coil spring 37 is a compression spring and always urges the second slide portion 25 toward the distal end side with respect to the first slide portion 22 as described above.

  The finger hanging portion 24 is provided with a disk-shaped damper fixing plate 42 on the distal end side and a disk-shaped finger hanging plate 43 on the proximal end side. In the vicinity of the center of the finger hook 24, the second fixing screw 44 is screwed perpendicularly to the longitudinal axis. A ring-shaped damper 38 made of a shock-absorbing material such as rubber is fixed to the front end side of the damper fixing plate 42. An annular groove 45 is formed in a part of the inner diameter of the finger hook 24, and an elastic ring 46 made of a material such as rubber is fitted therein. The inner diameter of the elastic ring 46 is slightly smaller than the outer diameter of the pipe portion 26 of the third slide portion 28.

  A scale 47 (see FIG. 2) is formed on the outer periphery of the small-diameter portion 35 of the second slide portion 25 so that the tip-side surface of the damper 38 is zero toward the tip side. The scale 47 indicates the protrusion length 39 defined between the damper 38 and the adjustment cylinder bottom 36.

  Two click grooves, which are annular grooves, are formed on the outer surface of the pipe portion 26. The first end groove is the first click groove 48 and the second end groove is the second click groove 49, respectively. ing. The first click groove 48 and the second click groove 49 are grooves that generate a slight locking force when the elastic ring 46 is fitted, and further make the operator feel a click.

  The second click groove 49 is formed on the tip side of the first click groove 48. The distance between the first click groove 48 and the second click groove 49 is not less than the maximum protrusion length 40. Further, the base end of the pipe base 27 of the third slide portion 28 is a male thread luer base 50.

It is possible to provide a puncture needle retraction index (not shown) composed of a colored ring on the surface of the pipe portion 26 of the third slide portion 28, so that the third slide portion 28 is completely It is pulled at the base end side, and is provided at a position where it is visible only when the second click groove 49 is in a clicked state. (In FIG. 2, since the third slide portion is located on the more distal end side, the third slide portion is located inside the second slide portion 25 and cannot be visually recognized.)
From this puncture needle retraction index, the operator can indirectly recognize that the puncture needle portion 11 is housed in the coil sheath 12, and after confirming this puncture needle retraction index, the operator By extracting, it is possible to prevent the treatment instrument insertion channel of the endoscope 2 from being perforated by the puncture needle portion 11 at the time of extraction.

Next, the coil sheath 12 that is detachably fixed to the first slide portion 22 of the auxiliary instrument body 13 will be described with reference to FIG.
The coil sheath 12 includes a coil sheath insertion part 51, a coil sheath base end part 52, and a coil sheath base part 53.

  The coil sheath insertion portion 51 has the same length as the treatment instrument insertion channel of the endoscope 2 and is configured by a flexible metal coil. The coil sheath insertion portion 51 has an inner diameter larger than the outer diameter of the puncture needle portion 11 and an outer diameter smaller than the treatment instrument insertion channel of the endoscope 2, and the treatment instrument of the endoscope 2. It can be inserted into and removed from the insertion channel. The coil sheath insertion portion 51 penetrates the fixed tube 21 and protrudes toward the distal end side in a state where the coil sheath insertion portion 51 is attached to and combined with the coil sheath base portion 53.

  The coil sheath base 53 is detachably screwed to the tip of the first slide part 22 of the auxiliary instrument body 13. The coil sheath base end portion 52 is connected to the base end side of the coil sheath base portion 53. The coil sheath base end portion 52 is composed of a coil similar to the coil sheath insertion portion 51 and is inserted halfway through the third slide portion 28 of the auxiliary instrument body 13.

Next, with reference to FIG. 5, the puncture needle unit 11 for puncturing a subject portion in a body cavity will be described.
The puncture needle portion 11 is detachably attached to the luer base 50 provided in the pipe base 27 of the auxiliary instrument body 13. The puncture needle portion 11 is inserted into the coil sheath 12 and punctures a subject portion in a body cavity so as to freely advance and retreat, and is a long puncture needle (endoscopic puncture needle) formed in a tubular shape for collecting a living tissue. 55 and a puncture needle base 56 fixed to the puncture needle 55.

  The puncture needle 55 is configured such that an inner needle (stylet) 57 is inserted through the puncture needle 55 so as to freely advance and retract. An inner needle cap 58 is fixed to the inner needle 57. The puncture needle base 56 and the inner needle base 58 are detachably combined. When the inner needle 57 is inserted through the puncture needle 55, the distal end of the inner needle 57 is the distal end of the puncture needle 55. It protrudes to the tip side.

Next, the structure of the switch part 34 provided on the first slide part 22 of the auxiliary instrument body 13 will be described with reference to FIG.
As shown in FIG. 6, the switch seat 61 of the switch portion 34 is provided on the upper side of the notch portion 62 formed near the center of the first slide portion 22. In the switch unit 34, a safety ring 63 as a safety device and a button 64 as a switch mechanism are assembled to the switch seat 61.

  The safety ring 63 is a ring-shaped member and is assembled to the switch seat 61 so as to be rotatable about an axis perpendicular to the longitudinal axis. On the cylindrical surface of the safety ring 63, lock indexes 65, which are pin-shaped members, are radially penetrated and fixed. The lock indicator 65 protrudes from the inner surface and the outer surface of the safety ring 63.

  The button 64 is incorporated inside the safety ring 63 and includes a button head 66, a shaft 67, and a pusher 68. The button head 66 is a tubular member having the same diameter as the inner diameter of the safety ring 63. The shaft 67 is a rod-shaped member coaxial with the button head 66 and penetrates the switch seat 61 freely. The pusher 68 is fixed to the other end of the shaft 67 and has a size that can be inserted into the notch 62.

  A switch spring 69 is incorporated between the switch seat 61 of the shaft 67 and the button head 66. The button 64 is always urged upward in the figure by the switch spring 69. On the lower surface of the button head 66, a switch groove 71 is formed as a recess into which the lock index 65 can enter.

  The lock index 65 and the switch groove 71 are in a positional relationship shifted by approximately 180 degrees, and unless the safety ring 63 is rotated around the shaft 67 so that the lock index 65 matches the switch groove 71, Since the bottom portion of the button head 66 and the lock indicator 65 are in contact with each other, the button 64 cannot be pressed.

  When the safety ring 63 is rotated from this state until the lock index 65 is rotated to the same position as the switch groove 71, the switch portion 34 is connected to the lock index 65 and the switch groove 71. When the positions match, the button 64 can be pushed down. That is, the switch part 34 can be in a restriction release state that allows the puncture needle part 11 to protrude.

  The large-diameter portion 41 of the second slide portion 25 is partially cut away, and a latch 72 as a locking mechanism that temporarily locks the urging force of the coil spring 37 is incorporated. A swing shaft 73 perpendicular to the longitudinal axis passes through the base end side of the latch 72. The latch 72 is supported so as to be swingable about the swing shaft 73. By the swinging of the swinging shaft 73, the front end side of the latch 72 takes a state of being accommodated in the outer diameter of the large diameter portion 41 of the second slide portion 25 and a state of protruding from the large diameter portion 41. To get. A leaf spring 74 is attached to the front end side of the latch 72, and one end thereof urges the front end side of the latch 72 to protrude from the large diameter portion 41.

  As shown in FIG. 6, the latch 72 has a distal end engaged with the notch 62 of the first slide portion 22 and is biased toward the distal end by the coil spring 37. 25 is preventing it from moving forward. As described above, the switch portion 34 rotates the safety ring 63 around the shaft 67 to release the restriction, and pushes down the button head 66 so that the pusher 68 enters the notch portion 62. When the latch 72 latched to the notch 62 is pushed down, the latching between the notch 62 and the latch 72 is released. Thereby, the switch part 34 releases the urging force of the coil spring 37 that urges the second slide part 25 toward the distal end side.

  The puncture needle unit 11 projects at a high speed by the length of the projection length 39 set as will be described later, as the second slide unit 25 advances at a high speed by the projection length 39 set in advance. The lesion is inserted.

  Here, the conventional puncture needle has a structure in which the cutting edge shape is the same as that of a normal injection needle, and the cutting edge is inserted while cutting the living tissue, so that the living tissue is actively taken into the structure. is not. For this reason, the conventional puncture needle is in a very small amount even when the state of the subject part, for example, when the living tissue is hard, the specimen is not collected inside, or the specimen is collected.

Therefore, in this embodiment, the puncture needle 55 is configured by forming an inclined blade surface that is sharp toward the tip on the outer peripheral surface of the tip.
That is, as shown in FIGS. 7A and 7B, the puncture needle 55 is formed by cutting the tip of the ultrathin tube obliquely with respect to the longitudinal axis direction to form a tip portion. A sloped blade surface 81 that is sharp toward the tip is formed on the entire circumference. Note that the puncture needle 55 shown in FIGS. 7A and 7B shows a state in which the inner needle 57 is protruded from the distal end side.

The puncture needle 55 is formed such that the blade surface 81 forms a substantially continuous slope with the inner needle 57 when the inner needle 57 is protruded from the distal end portion.
Accordingly, the puncture needle 55 can be smoothly and deeply inserted into the subject part manually with relatively little resistance with the inner needle 57 even when the inner needle 57 is inserted, for example, at a deep part of the subject part. It is possible to pierce the existing target lesion.

  Furthermore, the puncture needle 55 can be used as a target lesion portion without taking in unnecessary biological tissue on the puncture route by causing the puncture needle portion 11 to protrude by the above-described operation after the inner needle 57 is removed. This specimen can be taken in as a tissue-like mass and cut out from surrounding tissues.

The operation of the puncture needle device 1 configured as described above will be described with reference to FIGS.
First, the distal end portion 3a of the endoscope insertion portion 3 is inserted and positioned near the target site.
Next, in the state where the tip of the puncture needle portion 11 is accommodated in the coil sheath 12 as shown in FIG. 10, the coil sheath 12 is inserted into the treatment instrument insertion channel of the endoscope 2, and the fixing portion 21a is inserted into the treatment instrument. It is fixed to the mouth 8. At this time, the distal end of the puncture needle portion 11 is accommodated in the coil sheath 12 so as to be slightly proximal to the distal end of the coil sheath 12 inserted into the distal end portion 3 a of the endoscope insertion portion 3.

At this time, as shown in FIG. 8A, the first fixing screw 32 is in a tightened state, and the adjustment cylinder 23 is located on the most distal side as described above. For this reason, the protrusion length 39 of the puncture needle portion 11 is the maximum protrusion length 40.
Further, the first click groove 48 is in a state of being fitted into the elastic ring 46. The front end side of the latch 72 is locked to the notch portion 62 of the first slide portion 22, and prevents the second slide portion 25 urged toward the front end side by the urging force of the coil spring 37 from moving forward. doing.

Next, when the first fixing screw 32 is loosened and the first slide portion 22 is moved forward, the first slide portion 22 is moved forward by being guided by the groove 31 of the fixed cylinder 21.
Then, under the observation of the optical field of view of the endoscope 2 or the ultrasonic image, the distal end of the coil sheath 12 is advanced to the vicinity of the subject part 90. Then, the first slide portion 22 is fixed again by tightening the first fixing screw 32.

  Next, the second fixing screw 44 is loosened so that the third slide portion 28 can advance and retreat with respect to the second slide portion 25. Then, the third slide portion 28 is advanced while holding the pipe cap 27. The third slide portion 28 is locked with a light locking force by the elastic ring 46 and the first click groove 48, but can be easily released manually and moved forward.

  Then, as shown in FIG. 8B, the puncture needle portion 11 moves forward, and the distal end of the puncture needle portion 11 protrudes from the distal end of the coil sheath 12. In addition, in FIG.8 (b), the auxiliary instrument main body 13 has shown the state which advanced the 3rd slide part 28 to the maximum. By this operation, the puncture needle unit 11 is advanced to the front of the subject unit 90 as shown in FIG. 11 under the observation of an ultrasonic image obtained by an ultrasonic observation apparatus (not shown), and the object to be examined is shown in FIG. The sample portion 90 is inserted and guided into the target lesion. At this time, the puncture needle unit 11 allows the puncture needle 55 and the inner needle 57 to be manually and smoothly inserted deeply into the subject portion without relatively resistance.

When the tip of the puncture needle 11 reaches the target lesion, the inner needle base 58 is removed from the puncture needle base 56 as shown in FIG. 8C, and the inner needle 57 is removed as shown in FIG.
Next, the distance at which the specimen is to be collected, that is, the distance at which the specimen is to be projected by the coil spring 37 is measured. The operator sets the projection length 39 by rotating the adjustment cylinder 23 shown in FIG. 9A to a desired position while reading the scale 47 according to the measured distance.

Next, the second fixing screw 44 is tightened to keep the third slide portion 28 from moving forward and backward with respect to the second slide portion 25. This is to prevent the third slide portion 28 from retreating when protruding by the coil spring 37.
Next, the operator operates the switch unit 34 to automatically project the puncture needle unit 11 by the projecting mechanism. Here, by further aspirating, the specimen (tissue) is easily taken into the puncture needle 55. For this reason, suction may be performed by connecting a suction device (not shown) to the puncture needle base 56.

  The switch 34 is rotated until the safety ring 63 is turned from the restricted state described with reference to FIG. 6 until the lock index 65 is in the same position as the switch groove 71. Since the lock index 65 also protrudes from the outer surface of the safety ring 63, the position of the lock index 65 can be grasped visually and tactilely by the operator. When the positions of the lock index 65 and the switch groove 71 coincide with each other, the button 64 can be pushed down.

Here, when the button head 66 of the switch part 34 is pushed down, the notch 62 and the latch 72 are unlocked.
Then, as shown in FIG. 9B, the second slide portion 25 urged toward the distal end side by the urging force of the coil spring 37 advances at a high speed by the protruding length 39. At this time, the damper 38 absorbs an impact when the third slide portion 28 collides with the adjustment cylinder 23.

  At this time, the third slide portion 28 is fixed to the second slide portion 25 by the second fixing screw 44, and the puncture needle portion 11 is further fixed to the third slide portion 28. For this reason, while the 2nd slide part 25 advances at high speed only by the protrusion length 39, the 3rd slide part 28 also advances at high speed only by the protrusion length 39, the puncture needle part 11 also advances at high speed simultaneously. That is, when the button head 66 of the button 64 is pressed, the tip of the puncture needle portion 11 protrudes at a high speed by the set protrusion length 39.

  Then, the puncture needle part 11 is deeply inserted into the target lesion part as shown in FIG. Then, as described with reference to FIGS. 7A and 7B, the puncture needle 55 can take in the specimen of the target lesion site as a certain amount of tissue and cut it from the surrounding tissue.

Then, the second fixing screw 44 is loosened, and the third slide portion 28 is pulled to the maximum extent on the base end side as shown in FIG. Then, as shown in FIG. 15, the tip of the puncture needle unit 11 is removed from the target lesioned part with the sample still taken in. The puncture needle unit 11 is accommodated in the coil sheath 12. Next, the engagement of the fixing portion 21a is released, and the puncture needle device 1 is removed from the treatment instrument insertion channel of the endoscope.
As a result, the puncture needle device 1 of the present embodiment can collect a sufficient amount of specimen at one time for performing pathological confirmation diagnosis, and the operation time can be shortened.

The puncture needle may have a tip as shown in FIGS. 16 (a) and 16 (b).
As shown in FIGS. 16 (a) and 16 (b), the puncture needle 55B cuts the tip of the microtubule perpendicularly to the longitudinal axis direction to form the tip, and the entire circumference of the outer peripheral surface of this tip An inclined blade surface 81b that is sharpened toward the tip is formed.

  As a result, the puncture needle 55B according to the present modification obtains substantially the same effect as that of the first embodiment, and the inclination formed with the inner needle 57 is further continuous, so that the puncture needle 55B smoothly enters the target lesion. Can be inserted. Furthermore, since the tip of the puncture needle 55B of this modification is vertical, the tissue does not escape and more specimens can be taken.

  The puncture needle of this example has a sloped blade surface that is sharp toward the tip, but is formed on the entire circumference of the tip, but may be formed on a substantially half circumference of the tip, It may be formed intermittently along the circumference of the tip portion, or may be formed on the entire circumference leaving a part of the tip portion (this point is a second operation to be performed later). The same applies to the examples and variations.)

  FIGS. 17 to 23 relate to a second embodiment of the present invention, FIG. 17 is a cross-sectional view showing the puncture needle of the second embodiment, and FIG. 18 shows a state when the puncture needle is guided before the target lesion site. FIG. 19 is an explanatory diagram showing a state when the target lesion is drawn into the puncture needle by performing suction, and FIG. 20 is when the puncture needle is deeply inserted into the target lesion by operating the switch unit. FIG. 21 is an explanatory view showing a state when the tip of the puncture needle is removed from the target lesion while the specimen is taken in, and FIG. 22 is an explanatory view showing a modification of the puncture needle. 22 (a) is a cross-sectional view of a puncture needle of a first modification, FIG. 22 (b) is a cross-sectional view of a puncture needle of a second modification, and FIG. 22 (c) is a puncture of a third modification. 23 is an explanatory view showing a further modification of the puncture needle, and FIG. 23 (a) is a sectional view of the puncture needle of the fourth modification. Figure, FIG. 23 (b) is a sectional view of the puncture needle of the fifth modification.

  In the first embodiment described above, a sloped blade surface that is sharp toward the tip is formed on the entire circumference of the outer peripheral surface with respect to the tip of the puncture needle. An inclined blade surface that is sharp toward the tip is formed on the entire circumference of the inner peripheral surface with respect to the tip of the puncture needle. Since the other configuration is the same as that of the first embodiment, the description thereof will be omitted, and the same components will be described with the same reference numerals.

  That is, as shown in FIG. 17, in the puncture needle device of the second embodiment, the tip of the microtubule is cut perpendicularly to the longitudinal axis direction (or may be cut obliquely as a modification). A puncture needle 55C is formed and formed with an inclined blade surface 81c that is sharp toward the tip on the entire circumference of the inner peripheral surface of the tip.

  With this configuration, when the puncture needle 55C is inserted into the subject portion 90, the specimen of the target lesion portion can be cut out by the blade surface 81c and taken in as a certain tissue-like lump. Since the other configuration is almost the same as that of the first embodiment, the description thereof is omitted.

  The operation of the puncture needle device of the second embodiment configured as described above will be described with reference to FIGS. Note that the puncture needle device of the second embodiment is used when the target lesion is present in the subject part 90 near the body surface.

For this reason, the puncture needle device of the second embodiment does not require the inner needle 57 from the beginning, and the inner needle base 58 is removed from the puncture needle base 56 in FIGS. 57 is used in the removed state. The other operations of the puncture needle device of the second embodiment are substantially the same as those of FIGS. 8 and 9 of the first embodiment until the puncture needle portion 11 is guided to the front of the subject portion 90 as shown in FIG. This is the same (however, the inner needle base 58 is removed from the puncture needle base 56 and the inner needle 57 is removed), and the description is omitted.
Next, the operator measures and sets a predetermined distance from which the sample is to be collected from the tip of the puncture needle unit 11. And an operator operates the switch part 34 and makes the puncture needle part 11 protrude automatically by a protrusion mechanism.

Here, by further aspirating, the specimen (tissue) is easily taken into the puncture needle 55C. Therefore, suction is performed by connecting a suction device (not shown) to the puncture needle base 56. As shown in FIG. 19, the puncture needle 55C of the puncture needle portion 11 draws a part of the target lesion portion inside by the suction.
And if the switch part 34 is operated, the puncture needle part 11 will protrude only the length of the set protrusion length 39 at high speed. Then, the puncture needle 55C of the puncture needle unit 11 is deeply inserted into the target lesion as shown in FIG. 20, and the sample is taken into the tissue as a certain amount of tissue and cut out from the surrounding tissue.

  Next, when the third slide portion 28 is pulled to the proximal end to the maximum extent, as shown in FIG. 21, the tip of the puncture needle 55C of the puncture needle portion 11 is removed from the target lesion portion with the sample taken in. And accommodated in the coil sheath 12. Then, the puncture needle device is removed from the treatment instrument insertion channel of the endoscope.

  Thereby, in the puncture needle device of the second embodiment, since the blade surface 81c of the puncture needle 55C is formed on the inner peripheral surface of the distal end portion, the specimen (tissue) cut out by insertion of the puncture needle 55C is The effect that it becomes easy to be taken in more actively inside can be acquired.

In addition, you may form the said puncture needle in the front-end | tip shape as shown to Fig.22 (a)-(c).
A puncture needle 55D shown in FIG. 22A is configured by forming a step portion 81d for holding and holding a tissue on the inner peripheral surface of the puncture needle 55C of the second embodiment. With this configuration, after the puncture needle 55D is inserted into the target site, the sample entering the inside is hooked by the step portion 81d and cut out, so that it is easier to cut from the surrounding tissue, and the cut sample (tissue) Is difficult to drop off. Therefore, the puncture needle 55D can further enhance the effect of cutting and collecting from the surrounding tissue with respect to the sample taken in, and the sample collection property is further improved.

  A puncture needle 55E shown in FIG. 22 (b) is formed by displacing (biasing) the blade surface 81e with respect to the puncture needle 55C of the second embodiment. With this configuration, the puncture needle 55E can further enhance the effect of cutting from the surrounding tissue with respect to the sample taken inside, as with the puncture needle 55D, and the sample collection performance is further improved.

  Furthermore, the puncture needle 55F shown in FIG. 22 (c) is configured by forming a sloped blade surface 81b that sharpens toward the tip on both inner peripheral surfaces and outer peripheral surfaces of the tip portion. . With this configuration, the puncture needle 55F can further enhance the effect of insertion into the subject portion, and the insertion property is improved.

Furthermore, the puncture needle may be formed in the shape of the tip as shown in FIGS. 23 (a) and 23 (b).
The puncture needle 55G shown in FIG. 23 (a) cuts the tip of the microtubule in a curved shape with respect to the longitudinal axis direction to form the tip, and the tip is formed on the entire circumference of the inner peripheral surface of the tip. An inclined blade surface 81g that is sharpened toward the surface is formed. With this configuration, the puncture needle 55G can be inserted into a punching punch when the specimen is relatively hard or fibrous, thereby further enhancing the insertion effect on the subject portion. Will improve.

  Further, the puncture needle 55H shown in FIG. 23 (b) is configured by forming an inclined blade surface 81h near the center of the outer peripheral surface of the puncture needle 55G. With this configuration, the puncture needle 55H can further enhance the effect of puncturing the subject portion with respect to the puncture needle 55G, and the piercing property is improved.

  The present invention is not limited to the above-described embodiments, and various modifications can be made without departing from the spirit of the invention.

[Appendix]
(Additional item 1)
A sheath that can be inserted into and removed from the treatment instrument insertion channel of the endoscope;
A long puncture needle formed into a tubular shape that penetrates the sheath and punctures a subject part in a body cavity so as to freely advance and retract, and collects a biological tissue;
An operating portion that is provided on the proximal end side of the sheath and operates to advance and retract the puncture needle;
A projecting mechanism for projecting the puncture needle, provided in the operation unit;
Comprising
A puncture needle device for an endoscope, wherein a sloped blade surface that is sharp toward the tip is formed on at least one of an outer peripheral surface and an inner peripheral surface of the tip portion of the puncture needle.

(Appendix 2)
The puncture needle has a slanted blade surface that is sharpened toward the tip, formed on at least one of the outer peripheral surface, the inner peripheral surface, and the inner and outer peripheral surfaces of the tip portion. Endoscopic puncture needle device.

(Additional Item 3)
It has an inner needle that is inserted through the puncture needle and can freely advance and retreat,
The puncture needle is formed in an inclined surface that is sharp toward the tip on at least one of the outer peripheral surface and the inner peripheral surface of the tip portion of the puncture needle when the inner needle is protruded from the tip portion of the puncture needle. The puncture needle device for an endoscope according to appendix 1, wherein the blade surface forms a substantially continuous slope with the inner needle.

(Appendix 4)
The puncture needle has a beveled blade surface that sharpens toward the tip on at least one of the outer peripheral surface, inner peripheral surface, and inner and outer peripheral surfaces of the tip portion on the entire circumference, substantially half circumference, and circumference of the tip portion. The puncture needle device for an endoscope according to appendix 1, wherein the puncture needle device for an endoscope is formed intermittently along the entire circumference or with a part of the circumference.

(Appendix 5)
The puncture needle cuts the tip of the ultrathin tube obliquely with respect to the longitudinal axis direction to form a tip portion, and sharpens toward the tip on at least one of the outer peripheral surface, inner peripheral surface, and inner and outer peripheral surfaces of the tip portion. The puncture needle device for an endoscope according to appendix 1, wherein a slanted blade surface is formed.

(Appendix 6)
The puncture needle is formed by cutting the tip of an ultrathin tube perpendicularly to the longitudinal direction to form a tip, and sharpens toward the tip on at least one of the outer peripheral surface, inner peripheral surface, and inner and outer peripheral surfaces of the tip. The puncture needle device for an endoscope according to appendix 1, wherein a slanted blade surface is formed.

(Appendix 7)
The puncture needle is formed by cutting the distal end of the ultrathin tube in a curved shape from the distal end side with respect to the longitudinal axis direction to form a distal end portion. The puncture needle device for an endoscope according to appendix 1, wherein a sloped blade surface that is sharpened toward the top is formed.

(Appendix 8)
The puncture needle is formed by offsetting (displacement) a slanted blade surface that is sharp toward the tip on at least one of the outer peripheral surface, inner peripheral surface, and inner and outer peripheral surfaces of the tip portion of the puncture needle. The puncture needle device for an endoscope according to Additional Item 1, wherein the puncture needle device is for endoscope.

(Appendix 9)
The puncture needle is formed by cutting the distal end of the ultrathin tube in a curved shape from the distal end side with respect to the longitudinal axis direction to form a distal end portion. The puncture needle device for an endoscope according to appendix 1, wherein an inclined blade surface that is sharpened toward the center is formed, and further, the blade surface is formed in the vicinity of the center of the curved portion.

(Appendix 10)
The puncture needle device for an endoscope according to appendix 1, wherein the puncture needle has a holding step portion formed on the inner peripheral surface for hooking and cutting a living tissue that has entered the puncture needle.

(Appendix 11)
A sheath that can be inserted into and removed from the treatment instrument insertion channel of the endoscope;
A puncture needle that is inserted through the sheath and can be advanced and retracted;
An inner needle that can be inserted through the puncture needle and can be advanced and retracted;
An operation unit that is located on the proximal end side of the sheath and operates to advance and retract the puncture needle and the inner needle;
In an endoscope puncture needle device having
An endoscope for an endoscope characterized in that an inclined blade surface is formed on almost the entire outer peripheral surface or inner peripheral surface of the distal end portion of the puncture needle, and a projection mechanism for the puncture needle is provided in the operation portion. Puncture needle device.

(Appendix 12)
A long endoscope puncture formed into a tubular shape that is inserted into a sheath that can be inserted into and removed from a treatment instrument insertion channel of an endoscope, and punctures a subject part in a body cavity so as to advance and retreat, and collect a living tissue. A needle,
A puncture needle for an endoscope, wherein a sloped blade surface that is sharp toward the tip is formed on at least one of the outer peripheral surface, inner peripheral surface, and inner and outer peripheral surfaces of the tip.

It is explanatory drawing which shows the state in which the puncture needle apparatus for endoscopes of 1st Example is attached to the treatment tool insertion port of an endoscope. It is an external view of the puncture needle device for endoscopes of FIG. It is sectional drawing of the puncture needle apparatus for endoscopes of FIG. It is an external view which shows the coil sheath of FIG. It is explanatory drawing which shows the puncture needle part of FIG. It is explanatory drawing which shows the switch part of FIG. It is explanatory drawing which shows the front end side of the puncture needle of FIG. It is explanatory drawing which shows operation | movement of the front half side of the puncture needle apparatus for endoscopes. It is explanatory drawing which shows operation | movement of the second half side of the puncture needle apparatus for endoscopes. It is explanatory drawing which shows the puncture preparation state in which the front-end | tip of the puncture needle part is accommodated in the coil sheath. It is explanatory drawing which shows the state at the time of making the front-end | tip of a puncture needle part protrude from a coil sheath front-end | tip, and to advance ahead of the subject part. It is explanatory drawing which shows the state at the time of inserting the front-end | tip of a puncture needle part into a subject part, and guide | inducing into the target lesion part. It is explanatory drawing which shows the state when the front-end | tip of a puncture needle part arrives at the inside of a target lesion part, and extracted the inner needle. It is explanatory drawing which shows the state at the time of operating a switch part and inserting the puncture needle part deeply in the target lesion part. It is explanatory drawing which shows the state at the time of extracting from the inside of a target lesion part in the state in which the front-end | tip of the puncture needle part took in the sample. It is explanatory drawing which shows the modification of a puncture needle. It is sectional drawing which shows the puncture needle of 2nd Example. It is explanatory drawing which shows the state at the time of guiding the puncture needle part before the target lesion part. It is explanatory drawing which shows the state at the time of performing suction and drawing the target lesion part into the inside of a puncture needle. It is explanatory drawing which shows the state at the time of operating a switch part and inserting the puncture needle part deeply in the target lesion part. It is explanatory drawing which shows the state at the time of being extracted from the inside of a target lesion part in the state in which the front-end | tip of the puncture needle part has taken in the sample. It is explanatory drawing which shows the modification of a puncture needle. It is explanatory drawing which shows the modification of the further puncture needle. It is explanatory drawing which shows the conventional puncture needle.

Explanation of symbols

1 Puncture needle device (Puncture needle device for endoscope)
2 Endoscope 3 Insertion section 8 Treatment instrument insertion port (treatment instrument insertion channel inlet)
9a Treatment instrument outlet 11 Puncture needle part 12 Coil sheath 13 Auxiliary instrument body 21 Fixed cylinder 21a Fixed part 22 First slide part 23 Adjustment cylinder 25 Second slide part 28 Third slide part 32 First fixing screw 34 Switch part 37 Coil spring 44 Second fixing screw 55 Puncture needle (Puncture needle for endoscope)
56 Puncture needle base 57 Inner needle 58 Inner needle base 81 Blade surface

Attorney Susumu Ito

Claims (2)

A sheath that can be inserted into and removed from the treatment instrument insertion channel of the endoscope;
A long puncture needle formed into a tubular shape that penetrates the sheath and punctures a subject part in a body cavity so as to freely advance and retract, and collects a biological tissue;
An operating portion that is provided on the proximal end side of the sheath and operates to advance and retract the puncture needle;
A projecting mechanism for projecting the puncture needle, provided in the operation unit;
Comprising
A puncture needle device for an endoscope, wherein a sloped blade surface that is sharp toward the tip is formed on at least one of an outer peripheral surface and an inner peripheral surface of the tip portion of the puncture needle. It has an inner needle that is inserted through the puncture needle and can freely advance and retreat,
The puncture needle is formed in an inclined surface that is sharp toward the tip on at least one of the outer peripheral surface and the inner peripheral surface of the tip portion of the puncture needle when the inner needle is protruded from the tip portion of the puncture needle. The puncture needle device for an endoscope according to claim 1, wherein a blade surface forms a substantially continuous slope together with the inner needle.

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