JP2005204694A - Identifying system of lesion in digestive organ - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an identifying system of a lesion in the digestive organ capable of speedily and accurately identifying a lesion in excision of the lesion in the digestive organ without increasing a burden on a patient and improving reliability of the operation. <P>SOLUTION: This identifying system includes steps of: inserting an endoscope into the digestive organ and searching the lesion; mounting a clip on or near the searched lesion; drawing the endoscope out of the digestive organ with the mounted clip left as a mark of the lesion; applying light from an irradiation part outside the digestive organ; and identifying the clip mount part with an optical sensor. This identifying system is characterized in defining the identified clip mount part as the lesion of the digestive organ. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

  The present invention relates to a digestive organ lesion site identification system for identifying the position of a lesion site in a digestive organ from outside the digestive organ.

  In general, in excision of tumors in digestive organs such as stomach or large intestine, or other digestive organs that require excision, the position of the lesion is confirmed visually and tactilely from outside the digestive organs. If it is expected to be difficult to do, insert an endoscope into the digestive tract in advance before surgery and dye or marking clip in or near the lesion (hereinafter sometimes referred to as the vicinity of the lesion) A mark is made by using the mark, and a lesion site is visually or tactilely confirmed by using the mark at the time of surgery to determine a resection site.

  However, with this general method, it is often impossible to confirm the lesion site at the time of surgery. In such a case, the endoscope is inserted again to search for the lesion site, and the irradiation light from the tip of the endoscope is used. The resection site was determined by visual recognition from outside the digestive organs or by confirming the position of the clip by fluoroscopy.

  In the method of re-inserting the endoscope and visually confirming the irradiation light from the distal end of the endoscope, it is difficult to confirm clearly because it is viewed through the wall of the digestive organs, and the operation time becomes long. 10-40 minutes), the burden on the patient is greatly increased by the insertion of the endoscope and the extension of the operation time, the visual field during the operation is deteriorated (for example, when inserting the endoscope into the large intestine, In order to expand the field of view of the endoscope, the intestinal tract is expanded because gas is sent in, and the space between the intestinal wall and the intestine, which is a surgical field for laparoscopic surgery, is reduced.

  In the method of confirming the position of the clip by fluoroscopy, it is necessary to take measures so that the patient and the human body of the operator are not harmed by the X-ray, and the operation of the operator is restricted, so that prompt operation is hindered. There was a problem of becoming. Also, using an X-ray apparatus in a clean area where surgery is performed has been a problem from a hygiene viewpoint.

In the method of using dye as a marker, when the dye is injected into the digestive tract, the dye becomes invisible if the needle is pierced shallowly, and there is a high risk of causing peritonitis if the needle pierces deeply and penetrates the peritoneum ( In the colectomy, there was also a problem of causing peritonitis once every three times.
In order to improve the drawbacks of the above-mentioned general prior art, Patent Document 1 has the name “shining marking clip”. The clip attached near the lesion part of the digestive organ and a light emitter are combined to emit light from outside the digestive organ. Although a technique for confirming a lesion by looking at a clip is disclosed, it is difficult to confirm clearly because it is visually recognized through a digestive organ wall.

  Further, Patent Document 2 has the name “in-vivo position detection system”, and includes an endoscope inserted into the digestive organ, a treatment tool outside the digestive organ inserted into the space, and an endoscope and a treatment tool. A technique provided with a means (for example, a permanent magnet and a magnetic sensor) for detecting a relative position is disclosed. In this technique, just like the method of inserting an endoscope into the digestive organ immediately before the operation and visually observing the illumination light from the distal end of the endoscope, the operation time becomes longer and the burden on the patient is greatly increased. However, it is difficult to implement in practice.

  Further, Patent Document 3 discloses a technique for attaching a magnet in the vicinity of a digestive organ lesion and detecting a leakage magnetic field from the outside of the digestive organ using a magnetic sensor and confirming the lesion as a “digestive organ lesion identification system”. Although this uses the magnet attached to the clip at the time of implementation, the possibility of dropping cannot be denied.

Registered Utility Model No. 3027808 JP-A-6-285042 JP 2002-159508 A

  In view of the above situation, the present invention can identify a lesion site in digestive organ lesion excision quickly and accurately without increasing the burden on the patient, and improve the reliability of surgery. An object is to provide an organ lesion site identification system.

  In order to achieve the above object, the present invention includes a step of inserting an endoscope into a digestive organ to search for a lesion, a step of attaching a clip to the searched lesion or the vicinity thereof, and the clip to which the lesion is attached. The clip that includes the step of pulling out the endoscope from the digestive organ, leaving the mark as a marker, the step of irradiating light from the irradiation part outside the digestive organ, and the step of identifying the clip attachment site with an optical sensor. A digestive organ lesion site identification system characterized in that an attachment site is a digestive organ lesion site. The light to irradiate is light with high biological permeability, preferably near infrared light.

  Moreover, it is desirable that the irradiation unit and the optical sensor have a size and shape that can be integrated and applied to laparoscopic surgery.

  Furthermore, the present invention includes a data processing unit that processes a signal from the optical sensor, and the data processing unit has a function of visually displaying a signal detected by the optical sensor such as a numerical value and light, and the detected signal is previously stored. It is a digestive organ lesion identification system that has a function to warn by flashing of a buzzer or a lamp when a predetermined size is exceeded.

  According to the present invention, a clip previously attached in the vicinity of a lesion in the digestive tract is used as a mark, and during surgery, the light that is irradiated from outside the digestive tract and reflected by this clip is detected by the optical sensor. There is an effect that can be identified quickly and accurately.

  In addition to rapid and accurate identification, unlike X-ray fluoroscopy and the like, there is no need for a procedure that restricts the behavior of the operator, so that the operation time can be shortened. For this reason, the present invention makes it possible to insert an endoscope again, perform fluoroscopy, and inject a dye into the digestive organ, and has the effect of not increasing the burden on the patient.

  Furthermore, the ability to quickly and accurately identify lesions of the digestive organs, shorten the operation time, and minimize the extent of the excised lesions, including the psychological effects that occur to the surgeon, improves the reliability of the operation. Let

  The present invention uses a clip as a mark of a lesion in the digestive tract and detects light irradiated from outside the digestive tract and reflected by the clip using a photosensor. Prior to excision surgery, an endoscope is inserted into the digestive organ to search for a lesion, a clip is attached as a mark of the lesion near the searched lesion, and the endoscope is pulled out from the digestive organ. That is, before the operation, a clip as a mark is attached in the vicinity of the lesion in the digestive tract of the patient. The clip used as a mark may be inserted after looking for the lesioned part and inserted inside the endoscope while attached to the tip of the operation tube or the like, or may be inserted together with the endoscope first. Well, it does not limit the invention.

  At the time of surgery, the clip attachment position is identified by detecting the light irradiated from outside the digestive organs and reflected by the clip attached near the lesion in the digestive organs with a light sensor outside the digestive organs. Using the attachment position as the digestive organ lesion site, determine the resection site and perform surgery. The excision site is determined including the identified digestive organ lesion site and data such as the size of the lesion site confirmed at the time of insertion of the endoscope and the relative relationship between the lesion site and the magnet attachment unit.

  Confirmation of lesions in the digestive tract is more difficult with laparoscopic surgery than with open surgery. Therefore, it is desirable that the irradiation unit and the optical sensor have dimensions and shapes applicable to laparoscopic surgery.

  At the time of surgery, the surgeon uses a function of a data processing unit that processes a signal (a signal indicating the relative position of the clip and the optical sensor) detected by the optical sensor to reflect light from a clip attached in the vicinity of the lesion. The position of the clip can be searched while visually checking the relative position of the optical sensor with numerical values and light, etc., and a buzzer and a lamp flashing when the detected signal exceeds a predetermined size With this warning, the clip attachment site can be identified more quickly and accurately.

  Thus, according to the present invention, the clip previously attached in the vicinity of the lesioned part in the digestive organ is used as a mark, and the reflected light from this clip is detected from the outside of the digestive organ by the optical sensor during the operation. The site of organ lesion can be identified quickly and accurately.

  In addition to rapid and accurate identification, there is no need for a procedure that restricts the behavior of the operator, such as X-ray fluoroscopy, so that the operation time can be shortened.

  Thereby, the digestive organ lesion site identification system of the present invention does not require re-endoscopic insertion, X-ray fluoroscopy, injection of dye into the digestive organ, placement of a magnet in the digestive organ, and surgery. The time can be shortened and the extent of the excision lesion can be minimized, and the burden on the patient is not increased. Furthermore, the ability to quickly and accurately identify lesions of the digestive organs, shorten the operation time, and minimize the extent of the excision lesions, including the psychological effects that occur to the surgeon, improves the reliability of the operation. Let

  Hereinafter, an example of the present invention will be described based on an example of a system for identifying a tumor site of the large intestine.

  FIG. 1 is a schematic configuration diagram showing an example of a step of identifying a clip attachment site with an optical sensor from outside the digestive organs by the digestive organ lesion identification system of the present invention. Reference numeral 1 denotes a light detection probe which includes a light irradiation unit and a light sensor (not shown). 2 is a clip, 3 is a tumor part, 4 is a large intestine, 5 is an abdominal cavity, 6 is an abdominal wall, 7 is a laparoscope, 8 is a trocar, and 9 is a data processing part.

  FIG. 2 is a schematic configuration diagram showing an embodiment of a magnet attached to a lesioned part in the digestive organ or in the vicinity thereof by the digestive organ lesion site identification system of the present invention. In FIG. 2, the same symbols as those in FIG. In FIG. 2, 10 is an endoscope, and others are the same as in FIG.

  Next, the operation of this embodiment will be described.

  First, prior to the colectomy, a treatment is performed in which a clip as a mark is attached in the vicinity of the main part of the patient's large intestine.

  Specifically, first, the clip is connected to the operation tube, and the clip is pulled into the cladding tube (hereinafter, this state is collectively referred to as a clip or the like). This advance preparation is important in order to enable subsequent insertion of a clip or the like after searching for a tumor part with an endoscope. After preparing a permanent magnet or the like, an endoscope is inserted into the large intestine to search for a tumor part. After searching for a tumor part, the prepared clip or the like is inserted through the endoscope. Next, a permanent magnet is attached as a marker of the tumor part in the vicinity of the searched tumor part. FIG. 2 shows a state in which a clip is about to be attached in the vicinity of the tumor part. That is, FIG. 2 shows a state in which an operation tube or the like is slightly pushed out from a covering tube (not shown) in order to attach the clip 2 near the tumor part 3, and the clip 2 is connected and connected to the operation tube. It is inserted through the endoscope 10. The endoscope 10 is inserted into the large intestine 4.

  After the clip 2 is attached in the vicinity of the tumor part 3, the clip 2 is removed from the operation tube, the clip 2 is left in the vicinity of the tumor part 3, and the endoscope 10 is pulled out from the large intestine together with the operation tube and the like. This completes the attachment of the clip serving as a mark near the tumor site.

  In the operation, as shown in FIG. 1, the probe 1 incorporating a detection unit and a light sensor is inserted into the abdominal cavity 5 through the abdominal wall 6 through the introduction tube 8 such as trocar, and the abdominal cavity is introduced through the introduction tube 8 such as trocar. Under the observation of the laparoscope 7 inserted into 6, the clip 2 attachment position is identified while the reflected light from the clip is detected by the probe 1. At this time, the signal detected by the optical sensor is processed by the data processing unit 9, the relative position between the clip 2 and the optical sensor is visually displayed with a numerical value or light, and the detected signal is a predetermined magnitude. When the limit is exceeded, warnings such as blinking of buzzers and lamps are given. Thereby, the surgeon can identify the clip 2 attachment position more quickly and accurately.

  After identifying the clip 2 attachment position, the identified clip attachment position is taken as the colorectal tumor site, including data such as the size of the tumor part 3 and the relative relationship between the tumor part 3 and the clip 2 attachment part, and determining the resection site Perform surgery.

  According to the present invention, a clip previously attached near the tumor in the large intestine is used as a mark, and during surgery, the clip is irradiated with near infrared light from outside the large intestine, and the reflected light from the clip is detected by the optical sensor. The colon tumor site can be identified quickly and accurately. In addition to rapid and accurate identification, unlike X-ray fluoroscopy and the like, there is no need for a procedure that restricts the behavior of the surgeon, so the operation time is shortened. This eliminates the need for additional endoscope insertion, X-ray fluoroscopy, and dye injection into the digestive organs, and shortens the operation time and minimizes the excision range, increasing the burden on the patient. I will not let you. Furthermore, the ability to quickly and accurately identify a colorectal tumor site, shorten the operation time, and minimize the excision range, including psychological effects that occur to the surgeon, improves the reliability of the operation.

  As mentioned above, although the Example of this invention was shown, it is clear that a various change may be made in the form and detail, without deviating from the mind and range of this invention prescribed | regulated by the claim. .

  For example, in this embodiment, the clip is attached in the vicinity of the tumor part, but may be attached directly to the tumor part, and the attachment position of the clip does not limit the present invention at all.

  In this embodiment, the probe and the data processing unit are separated from each other. However, the probe may be integrated and does not limit the present invention.

  Furthermore, in the present embodiment, a clip or the like in which a clip is connected to an operation tube and pulled into a covering tube has been shown, but the function of being able to be inserted into a lesioned part through an endoscope, leaving the inserted clip and pulling out the other. The mechanism and structure of this detail do not limit the present invention.

  The digestive organ lesion identification system according to the present invention enables rapid and accurate identification of a digestive organ lesion site, shortens the operation time, and minimizes the range of the excision, so that a medical institution such as a hospital or an emergency center or a university It can be used as a surgical support system for digestive organ tumors in research institutions and educational institutions such as medical schools.

It is a schematic block diagram which shows the Example of the process of identifying a clip attachment site | part with the optical sensor from the outside of a digestive organ by the digestive organ lesion site identification system of this invention. It is a schematic block diagram which shows the Example of the process of attaching a clip to the lesion part in a digestive organ or its vicinity by the digestive organ lesion site identification system of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 ... Probe which incorporated the light irradiation part and the optical sensor 2 ... Metal marking clip 3 ... Tumor part 4 ... Large intestine 5 ... Abdominal cavity 6 ... Abdominal wall 7 ... Laparoscope 8 ... Trocar 9 ... Data processing part 10 ... Endoscope

Claims (5)

  A step of searching for a lesion by inserting an endoscope into the digestive organ, a step of attaching a clip to the searched lesion or in the vicinity thereof, and leaving the endoscope as a mark of the lesion in the digestive organ And a step of irradiating light from an irradiation part outside the digestive organ, and a step of identifying the clip attachment site with an optical sensor, wherein the identified clip attachment site is a digestive organ lesion site. Gastrointestinal lesion site identification system.   2. The digestive organ lesion site identification system according to claim 1, wherein the light to be irradiated is light having a high biological permeability.   3. The digestive organ lesion site identification system according to claim 2, wherein the light having a high biological permeability is near infrared light.   The digestive organ lesion site identification system according to any one of claims 1 to 3, wherein the irradiation unit and the optical sensor have a size and a shape that can be integrated and applied to laparoscopic surgery.   A data processing unit that processes a signal from the light projecting / receiving probe, the data processing unit visually displaying a signal detected by the light projecting / receiving probe with a numerical value or light, and the detected signal; The digestive organ lesion site identification system according to any one of claims 1 to 4, wherein the system has a function of warning by a buzzer or blinking of a lamp when the size exceeds a predetermined size. .