JP2009095514A - Submucosal swelling forming gas injection device and endoscope using the same - Google Patents
Submucosal swelling forming gas injection device and endoscope using the same Download PDFInfo
- Publication number
- JP2009095514A JP2009095514A JP2007270891A JP2007270891A JP2009095514A JP 2009095514 A JP2009095514 A JP 2009095514A JP 2007270891 A JP2007270891 A JP 2007270891A JP 2007270891 A JP2007270891 A JP 2007270891A JP 2009095514 A JP2009095514 A JP 2009095514A
- Authority
- JP
- Japan
- Prior art keywords
- gas
- submucosal
- bulge
- forming
- injection device
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Granted
Links
- 238000002347 injection Methods 0.000 title claims abstract description 80
- 239000007924 injection Substances 0.000 title claims abstract description 80
- 230000008961 swelling Effects 0.000 title abstract 7
- 230000003902 lesion Effects 0.000 claims abstract description 34
- 210000001035 gastrointestinal tract Anatomy 0.000 claims abstract description 18
- 239000007789 gas Substances 0.000 claims description 164
- CURLTUGMZLYLDI-UHFFFAOYSA-N Carbon dioxide Chemical compound O=C=O CURLTUGMZLYLDI-UHFFFAOYSA-N 0.000 claims description 38
- 210000004876 tela submucosa Anatomy 0.000 claims description 20
- 229910002092 carbon dioxide Inorganic materials 0.000 claims description 19
- 239000001569 carbon dioxide Substances 0.000 claims description 19
- XKRFYHLGVUSROY-UHFFFAOYSA-N Argon Chemical compound [Ar] XKRFYHLGVUSROY-UHFFFAOYSA-N 0.000 claims description 10
- IJGRMHOSHXDMSA-UHFFFAOYSA-N Atomic nitrogen Chemical compound N#N IJGRMHOSHXDMSA-UHFFFAOYSA-N 0.000 claims description 8
- 229910001873 dinitrogen Inorganic materials 0.000 claims description 8
- 230000015572 biosynthetic process Effects 0.000 claims description 7
- 238000003780 insertion Methods 0.000 claims description 7
- 230000037431 insertion Effects 0.000 claims description 7
- 229910052786 argon Inorganic materials 0.000 claims description 5
- 238000004806 packaging method and process Methods 0.000 claims 1
- 239000000243 solution Substances 0.000 abstract description 9
- 238000000034 method Methods 0.000 description 12
- 210000004204 blood vessel Anatomy 0.000 description 11
- 238000011282 treatment Methods 0.000 description 10
- 239000002504 physiological saline solution Substances 0.000 description 9
- 230000008901 benefit Effects 0.000 description 5
- 210000002784 stomach Anatomy 0.000 description 5
- GQPLMRYTRLFLPF-UHFFFAOYSA-N Nitrous Oxide Chemical compound [O-][N+]#N GQPLMRYTRLFLPF-UHFFFAOYSA-N 0.000 description 4
- 238000001839 endoscopy Methods 0.000 description 4
- 230000000699 topical effect Effects 0.000 description 4
- 206010040844 Skin exfoliation Diseases 0.000 description 3
- FAPWRFPIFSIZLT-UHFFFAOYSA-M Sodium chloride Chemical compound [Na+].[Cl-] FAPWRFPIFSIZLT-UHFFFAOYSA-M 0.000 description 3
- 238000002583 angiography Methods 0.000 description 3
- 230000000052 comparative effect Effects 0.000 description 3
- 230000002496 gastric effect Effects 0.000 description 3
- 210000002429 large intestine Anatomy 0.000 description 3
- 239000011780 sodium chloride Substances 0.000 description 3
- 229920002385 Sodium hyaluronate Polymers 0.000 description 2
- 239000007864 aqueous solution Substances 0.000 description 2
- 238000012333 histopathological diagnosis Methods 0.000 description 2
- 229940010747 sodium hyaluronate Drugs 0.000 description 2
- YWIVKILSMZOHHF-QJZPQSOGSA-N sodium;(2s,3s,4s,5r,6r)-6-[(2s,3r,4r,5s,6r)-3-acetamido-2-[(2s,3s,4r,5r,6r)-6-[(2r,3r,4r,5s,6r)-3-acetamido-2,5-dihydroxy-6-(hydroxymethyl)oxan-4-yl]oxy-2-carboxy-4,5-dihydroxyoxan-3-yl]oxy-5-hydroxy-6-(hydroxymethyl)oxan-4-yl]oxy-3,4,5-trihydroxyoxane-2- Chemical compound [Na+].CC(=O)N[C@H]1[C@H](O)O[C@H](CO)[C@@H](O)[C@@H]1O[C@H]1[C@H](O)[C@@H](O)[C@H](O[C@H]2[C@@H]([C@@H](O[C@H]3[C@@H]([C@@H](O)[C@H](O)[C@H](O3)C(O)=O)O)[C@H](O)[C@@H](CO)O2)NC(C)=O)[C@@H](C(O)=O)O1 YWIVKILSMZOHHF-QJZPQSOGSA-N 0.000 description 2
- 208000002699 Digestive System Neoplasms Diseases 0.000 description 1
- 238000012323 Endoscopic submucosal dissection Methods 0.000 description 1
- 238000012276 Endovascular treatment Methods 0.000 description 1
- 206010028980 Neoplasm Diseases 0.000 description 1
- 238000013130 cardiovascular surgery Methods 0.000 description 1
- 239000002872 contrast media Substances 0.000 description 1
- 238000005553 drilling Methods 0.000 description 1
- 238000009297 electrocoagulation Methods 0.000 description 1
- 230000010102 embolization Effects 0.000 description 1
- 238000012326 endoscopic mucosal resection Methods 0.000 description 1
- 238000012143 endoscopic resection Methods 0.000 description 1
- 210000003238 esophagus Anatomy 0.000 description 1
- 239000012530 fluid Substances 0.000 description 1
- 230000000968 intestinal effect Effects 0.000 description 1
- 206010022694 intestinal perforation Diseases 0.000 description 1
- 239000000644 isotonic solution Substances 0.000 description 1
- 210000000867 larynx Anatomy 0.000 description 1
- 239000007788 liquid Substances 0.000 description 1
- 201000011591 microinvasive gastric cancer Diseases 0.000 description 1
- 210000004877 mucosa Anatomy 0.000 description 1
- 210000003205 muscle Anatomy 0.000 description 1
- 239000001272 nitrous oxide Substances 0.000 description 1
- 235000013842 nitrous oxide Nutrition 0.000 description 1
- 210000000056 organ Anatomy 0.000 description 1
- 238000010827 pathological analysis Methods 0.000 description 1
- 238000002271 resection Methods 0.000 description 1
- 210000000813 small intestine Anatomy 0.000 description 1
Abstract
Description
本発明は、消化管の病変部を内視鏡的に切除する際に病変部全体を膨隆させるための装置及びそれを用いた内視鏡に関する。 The present invention relates to an apparatus for bulging an entire lesioned part when the lesioned part of the digestive tract is endoscopically removed, and an endoscope using the same.
消化管腫瘍に対する内視鏡的粘膜切除術（Ｅｎｄｏｓｃｏｐｉｃ ｍｕｃｏｓａｌ ｒｅｓｅｃｔｉｏｎ；以下「ＥＭＲ」と略記することがある）は、広く普及している（非特許文献１）。これは、内視鏡下で粘膜下層に局注針を介して局注液を注入することにより、病変全体を隆起させ（粘膜下膨隆形成）、スネアで絞扼（スネアリング）後、高周波電流を用いて病変を切除する方法である。粘膜下膨隆を形成することによりスネアリングを容易にすることができ、また、病変と筋層との距離を十分に保つことにより偶発症である腸管穿孔を予防することができる。ＥＭＲでは、局注液として生理食塩水が一般的に使用されてきたが、等張液のため粘膜下膨隆持続時間が短く、局注後からスネアリングまでを手早く進める必要があり、スネアリング自体も難しくなる場合があった。そのため、生理食塩水に代わる様々な局注液の臨床応用が考案されてきたが（特許文献１、非特許文献２、３及び４）、一括で切除できる病変の大きさに制限があり改善が望まれていた。 Endoscopic mucosal resection (hereinafter sometimes abbreviated as “EMR”) for gastrointestinal tumors is widely spread (Non-patent Document 1). This is because the entire lesion is raised (submucosal bulge formation) by injecting a local injection solution through the local injection needle into the submucosal layer under an endoscope, and strangling (snarling) with a snare, followed by a high-frequency current This is a method for excision of lesions. By forming a submucosal bulge, snare can be facilitated, and by maintaining a sufficient distance between the lesion and the muscle layer, accidental intestinal perforation can be prevented. In EMR, physiological saline has been generally used as a topical injection solution, but because of the isotonic solution, the submucosal bulge duration is short, and it is necessary to proceed quickly after the topical injection to snare. It could also be difficult. Therefore, clinical application of various topical injection solutions to replace physiological saline has been devised (Patent Document 1, Non-Patent Documents 2, 3 and 4), but there is a limitation on the size of lesions that can be excised in a lump, and improvement is possible. It was desired.
上記ＥＭＲにおける技術的な制限を改善した手法として、内視鏡的粘膜下層剥離術（Ｅｎｄｏｓｃｏｐｉｃ ｓｕｂｍｕｃｏｓａｌ ｄｉｓｓｅｃｔｉｏｎ；以下「ＥＳＤ」と略記することがある）が考案され、早期胃癌の治療選択の一つとして確立されてきている（非特許文献５）。内視鏡的切除法に求められることは、病理組織学的診断と遺残・再発の面から可能な限り病変を一括切除することである。粘膜下膨隆を形成後に、高周波メスにて直接病変周囲粘膜を切開するとともに粘膜下層を剥離して病変を切除していくこの方法により、腫瘍径が大きな病変でも高い一括切除率が得られるとされている。ＥＳＤは手技自体の難易度が高く、熟練を要するとされている。したがって、腸壁の厚みが薄い大腸のＥＳＤでは、局注液として粘膜下膨隆持続時間が長いヒアルロン酸ナトリウム水溶液の使用が必須であった（非特許文献６及び７）。しかしながら、形成された粘膜下膨隆の隆起がそれほど高くない場合には穿孔の危険性があり、また、ヒアルロン酸ナトリウム水溶液は他の局注液に比べて高価であり、改善が望まれていた。 Endoscopic submucosal dissection (hereinafter sometimes abbreviated as “ESD”) has been devised as a technique for improving the technical limitations in the EMR, and is one of the treatment options for early gastric cancer. It has been established (Non-Patent Document 5). What is required for endoscopic resection is to remove as much of the lesion as possible from the viewpoint of histopathological diagnosis and residual / relapse. After the formation of submucosal bulges, this method of incising the mucosa surrounding the lesion directly with a high-frequency knife and excising the lesion by peeling the submucosal layer is said to provide a high resection rate even for lesions with a large tumor diameter. ing. ESD has a high degree of difficulty in the technique itself and is said to require skill. Therefore, in the large intestine ESD where the intestinal wall is thin, it is essential to use a sodium hyaluronate aqueous solution having a long submucosal bulge duration as a local injection (Non-patent Documents 6 and 7). However, when the bulge of the formed submucosal bulge is not so high, there is a risk of perforation, and the sodium hyaluronate aqueous solution is more expensive than other topical injection solutions, and improvement has been desired.
また、特許文献２には、消化管の病変部を内視鏡的に切除するために粘膜下層内に先端部が挿入されて粘膜下層を剥離する粘膜下層剥離処置具であって、管路が軸方向に延びて設けられ基端側に前記管路と連通された注入口が設けられた処置具本体と、前記管路の先端側に配設され、前記注入口から供給された流体によって膨張可能な膨張部とを備え、前記処置具本体の先端近傍に、柔軟限界と硬質限界との間の外力が加わった際に湾曲変形する柔軟部が設けられていることを特徴とする粘膜下層剥離処置具について記載されている。これによれば、粘膜下層剥離処置具を粘膜下層に挿入する際、誤って強い力で挿入したとしても、柔軟部が湾曲して挿入の際の力を逃がすことができるため、粘膜下層剥離処置具の挿入による穿孔のおそれを低減できるとされている。更にこのことにより、術者の技量に左右されることなく、簡便な方法で粘膜下層剥離処置具の粘膜下層への挿入を実現することができると報告されている。しかしながら、盲目的に粘膜下層に処置具を潜り込ませるため、穿孔の危険性が高く実用化が困難であり改善が望まれていた。 Further, Patent Document 2 discloses a submucosal stripping treatment instrument in which a distal end portion is inserted into the submucosa layer to exfoliate the lesion of the digestive tract endoscopically, and the submucosal layer is peeled off. A treatment instrument main body provided with an injection port that extends in the axial direction and communicates with the pipe line on the proximal end side, and is disposed on the distal end side of the pipe line and is expanded by the fluid supplied from the injection port An inflatable portion, and a flexible portion that deforms when an external force between the soft limit and the hard limit is applied to the vicinity of the distal end of the treatment instrument body. The treatment tool is described. According to this, even when the submucosal layer peeling treatment instrument is inserted into the submucosal layer, even if it is mistakenly inserted with a strong force, the flexible portion can bend and the force at the time of insertion can be released. It is said that the risk of drilling due to the insertion of the tool can be reduced. Further, it has been reported that the insertion of the submucosal layer peeling treatment tool into the submucosa can be realized by a simple method without depending on the skill of the operator. However, since the treatment tool is buried in the submucosa blindly, there is a high risk of perforation and it is difficult to put it to practical use, and an improvement has been desired.
一方、非特許文献８には、血管造影及び血管造影による血管内治療の際に陰性造影剤として炭酸ガスを用いたことが記載されている。これによれば、シリンジ内に注入された炭酸ガスを血管内に注入することにより、炭酸ガスによる血管造影下での血管内治療が可能であるとされている。しかしながら、消化管における内視鏡の操作において炭酸ガスを使用することについては記載されていない。 On the other hand, Non-Patent Document 8 describes that carbon dioxide was used as a negative contrast agent in angiography and endovascular treatment by angiography. According to this, by injecting carbon dioxide gas injected into the syringe into the blood vessel, intravascular treatment under angiography with carbon dioxide gas is possible. However, there is no description about using carbon dioxide in the operation of an endoscope in the digestive tract.
本発明は上記課題を解決するためになされたものであり、消化管の病変部を内視鏡的に切除する際に病変部全体を膨隆させて粘膜下層を剥離させることができ、しかも隆起が高く安定した粘膜下膨隆を形成することのできる装置を提供することを目的とするものである。 The present invention has been made to solve the above-mentioned problems, and when the lesioned part of the digestive tract is endoscopically excised, the entire lesioned part can be bulged and the submucosal layer can be peeled off. It is an object of the present invention to provide a device capable of forming a highly stable submucosal bulge.
上記課題は、消化管の病変部を内視鏡的に切除する際に粘膜下層にガスを注入して病変部全体を膨隆させるための粘膜下膨隆形成用ガス注入装置であって、ガス供給手段と、穿刺手段と、ガス供給手段と穿刺手段とを接続するフレキシブルチューブを備えたことを特徴とする粘膜下膨隆形成用ガス注入装置を提供することによって解決される。 An object of the present invention is to provide a gas injection device for forming a submucosal bulge for injecting gas into the submucosal layer and bulging the entire lesion when endoscopically removing a lesion in the digestive tract, comprising a gas supply means And a gas injection device for forming a submucosal bulge characterized by comprising a puncture means and a flexible tube connecting the gas supply means and the puncture means.
このとき、注入されるガスが炭酸ガス、窒素ガス、アルゴンガスから選択される少なくとも１種のガスであることが好適であり、注入されるガスが炭酸ガスであることがより好適である。ガス供給手段が、ガスが圧縮されたボンベ及び減圧弁を有することが好適であり、ガス供給手段が、更にガス流量制御手段を備えたことがより好適であり、ガス流量が５０ｍｌ／ｓ以下であることが好適である。また、ガス供給手段が、ガスが封入された注射器であることが好適であり、フレキシブルチューブの粘膜下層挿入側の先端部に注入針が設けられてなり、注入針が長手方向に移動することによって、フレキシブルチューブによる注入針の保護が可能であることも好適である。また、上記粘膜下膨隆形成用ガス注入装置が装着された内視鏡が本発明の好適な実施態様である。 At this time, the injected gas is preferably at least one gas selected from carbon dioxide gas, nitrogen gas, and argon gas, and the injected gas is more preferably carbon dioxide gas. It is preferable that the gas supply means includes a cylinder in which gas is compressed and a pressure reducing valve, and it is more preferable that the gas supply means further includes a gas flow rate control means, and the gas flow rate is 50 ml / s or less. Preferably it is. The gas supply means is preferably a syringe filled with gas, and an injection needle is provided at the distal end of the flexible tube on the submucosal layer insertion side, and the injection needle moves in the longitudinal direction. It is also preferable that the injection needle can be protected by a flexible tube. An endoscope equipped with the submucosal bulging gas injection device is a preferred embodiment of the present invention.
更に上記課題は、消化管の病変部を内視鏡的に切除する際に病変部全体を膨隆させるための粘膜下膨隆形成用ガス注入キットであって、ガス供給装置と、一端に注入針が設けられかつ他端がガス供給手段と接続可能なフレキシブルチューブとからなることを特徴とする粘膜下膨隆形成用ガス注入キットを提供することによって解決される。 Furthermore, the above-mentioned problem is a gas injection kit for forming a submucosal bulge for bulging the entire lesion when endoscopically resecting the lesion in the digestive tract, comprising a gas supply device and an injection needle at one end. The problem is solved by providing a gas injection kit for forming a submucosal bulge, characterized in that it is provided with a flexible tube which can be connected to the gas supply means at the other end.
また、上記課題は、消化管の病変部を内視鏡的に切除する際に病変部全体を膨隆させるために用いられるガス供給装置であって、ガスが圧縮されたボンベ及び減圧弁を有することを特徴とするガス供給装置を提供することによって解決される。 In addition, the above-mentioned problem is a gas supply device used to bulge the entire lesion when endoscopically removing the lesion in the digestive tract, and has a gas cylinder and a pressure reducing valve. This is solved by providing a gas supply device characterized by the following.
更に、上記課題は、消化管の病変部を内視鏡的に切除する際に病変部全体を膨隆させるために用いられるガス供給装置であって、ガスが充填された注射器であることを特徴とするガス供給装置を提供することによっても解決される。 Furthermore, the above-mentioned problem is a gas supply device used for bulging the entire lesioned part when endoscopically removing the lesioned part of the digestive tract, which is a syringe filled with gas. This can also be solved by providing a gas supply device.
また、上記ガス供給装置が、ガス供給装置に充填されたガスと同一のガスが充填された容器に封入されたことを特徴とする包装体であることも本発明の好適な実施態様である。 It is also a preferred embodiment of the present invention that the gas supply device is a package that is sealed in a container filled with the same gas as the gas filled in the gas supply device.
本発明の粘膜下層膨隆形成用ガス注入装置によれば、粘膜下層にガスが注入されて、隆起が高く安定した粘膜下膨隆が形成される。このようにして、病変部全体を膨隆させることができるため、病変部を容易で確実かつ安全に一括切除することができる。更に、隆起の高い粘膜下膨隆の形成により粘膜下層に存在する血管が損傷されることなく露出されて粘膜下層の剥離が起こるため、血管を傷つけることなく病変部を一括切除することができる。したがって、ＥＭＲやＥＳＤに好適に用いられる。 According to the gas injection device for forming a submucosal bulge of the present invention, gas is injected into the submucosal layer to form a stable submucosal bulge with a high bulge. In this way, since the entire lesioned part can be bulged, the lesioned part can be easily, reliably and safely collectively excised. In addition, the formation of highly bulged submucosal bulges exposes the blood vessels existing in the submucosal layer without damaging them, and the submucosal layer is peeled off, so that the lesion can be excised without damaging the blood vessels. Therefore, it is suitably used for EMR and ESD.
本発明の装置は、消化管の病変部を内視鏡的に切除する際に粘膜下層にガスを注入して病変部全体を膨隆させるための粘膜下膨隆形成用ガス注入装置であって、ガス供給手段と、穿刺手段と、ガス供給手段と穿刺手段とを接続するフレキシブルチューブを備えたものである。 The apparatus of the present invention is a gas injection device for forming a submucosal bulge for inflating the entire lesion by injecting gas into the submucosa when the lesion of the digestive tract is endoscopically excised. A supply means, a puncture means, and a flexible tube for connecting the gas supply means and the puncture means are provided.
本発明の粘膜下膨隆形成用ガス注入装置を用いることにより、従来の生理食塩水等の局注液を注入する場合と異なり、粘膜下層にガスを注入することができる。粘膜下層にガスが注入されることにより、生理食塩水等の局注液を注入して形成された粘膜下膨隆と比べて、隆起が高く持続時間が長い粘膜下膨隆が形成される。したがって、病変部を容易で確実かつ安全に一括切除することができる。更に、粘膜下膨隆が形成される際に粘膜下層に存在する比較的太い血管が損傷されることなく露出されて粘膜下層が剥離されるため、病変部を一括切除する際に血管を損傷することがなく手技全体の安全性が保たれる利点を有する。また、生理食塩水等の局注液を注入する場合と比べて、本発明の装置を用いて粘膜下層にガスを注入する場合には、注入抵抗が小さいため操作性が良好である利点も有する。 By using the gas injection device for forming a submucosal bulge according to the present invention, it is possible to inject gas into the submucosal layer, unlike the case of injecting a local injection solution such as conventional saline. By injecting gas into the submucosal layer, a submucosal bulge having a high bulge and a long duration is formed as compared with a submucosal bulge formed by injecting a local injection solution such as physiological saline. Therefore, the lesioned part can be easily, reliably and safely removed at once. Furthermore, when a submucosal bulge is formed, a relatively thick blood vessel existing in the submucosa is exposed without being damaged, and the submucosa is peeled off. There is an advantage that the safety of the entire procedure is maintained. In addition, when injecting gas into the submucosal layer using the apparatus of the present invention, compared with injecting a local injection solution such as physiological saline, there is an advantage that the operability is good because the injection resistance is small. .
本発明において、消化管とは、食物を消化・吸収するための器官であって、食道、胃、小腸及び大腸等の消化管に咽・喉頭を加えたものの総称をいう。これらの中でも特に大腸は内壁の厚みが薄いため、膨隆形成が不十分であったり膨隆持続時間が短い場合にはＥＳＤにより穿孔が生じるおそれがあり、本発明の粘膜下膨隆形成用ガス注入装置を採用する利点が大きい。 In the present invention, the digestive tract refers to an organ for digesting and absorbing food, and is a general term for a digestive tract such as the esophagus, stomach, small intestine, and large intestine to which a throat and larynx are added. Among these, especially in the large intestine, since the inner wall is thin, there is a possibility that perforation may occur due to ESD when the bulge formation is insufficient or the bulge duration is short, and the gas injection device for submucosal bulge formation according to the present invention is used. The advantage to adopt is great.
本発明において、粘膜下層に注入されるガスは特に限定されず、炭酸ガス、窒素ガス、アルゴンガス、亜酸化窒素ガス（笑気ガス）等が挙げられる。中でも人体に対する安全性を考慮すると、注入されるガスが炭酸ガス、窒素ガス、アルゴンガスから選択される少なくとも１種のガスであることが好ましい。更に人体に対する安全性及び液体への溶解性が高く、特に血管内での塞栓が起こりにくい観点から、注入されるガスが炭酸ガスであることがより好ましい。 In the present invention, the gas injected into the submucosa layer is not particularly limited, and examples thereof include carbon dioxide gas, nitrogen gas, argon gas, and nitrous oxide gas (laughing gas). In consideration of safety to the human body, it is preferable that the injected gas is at least one gas selected from carbon dioxide gas, nitrogen gas, and argon gas. Furthermore, it is more preferable that the injected gas is carbon dioxide from the viewpoint of high safety to the human body and high solubility in a liquid, and in particular, embolization in blood vessels is unlikely to occur.
本発明の粘膜下層膨隆形成用ガス注入装置は、ガス供給手段を備えていることを特徴とする。ガス供給手段としては、一定量のガスを粘膜下層に注入できるのであれば特に限定されない。本発明では、ガス供給手段が、ガスが圧縮されたボンベ及び減圧弁を有することが好ましく、特に、減圧弁を有することで粘膜下層に一定量以上ガスが急激に注入されるのを防ぐことができる。ここで、ガスが圧縮されたボンベは、カートリッジ式のボンベであることが取り扱い性の観点から好ましく、特に、内視鏡への装着が可能なカートリッジ式のボンベであることがより好ましい。 The gas injection device for forming a submucosal bulge according to the present invention is characterized by comprising a gas supply means. The gas supply means is not particularly limited as long as a certain amount of gas can be injected into the submucosa. In the present invention, it is preferable that the gas supply means has a cylinder in which the gas is compressed and a pressure reducing valve, and in particular, by having the pressure reducing valve, it is possible to prevent the gas from being rapidly injected into the submucosa below a certain amount. it can. Here, the gas-compressed cylinder is preferably a cartridge-type cylinder from the viewpoint of handleability, and more preferably a cartridge-type cylinder that can be attached to an endoscope.
本発明において、ガス供給手段が、更にガス流量制御手段を備えたものであることが好ましい。このように、ガス流量制御手段を備えていることにより、病変部の大きさや部位に応じて粘膜下膨隆の大きさを適宜調節することができる。ここで、粘膜下層に注入されるガスの総量は、病変部の大きさや部位に応じて粘膜下膨隆の大きさも異なるため特に限定されないが、通常、３〜１００ｍｌ以下である。 In the present invention, it is preferable that the gas supply means further includes a gas flow rate control means. Thus, by providing the gas flow rate control means, the size of the submucosal bulge can be appropriately adjusted according to the size and site of the lesion. Here, the total amount of gas injected into the submucosal layer is not particularly limited because the size of the submucosal bulge varies depending on the size and site of the lesion, but is usually 3 to 100 ml or less.
本発明において、粘膜下層にガスを注入する際のガス流量（単位時間当たりのガスの注入量）については特に限定されないが、５０ｍｌ／ｓ以下であることが好ましい。ガス流量が５０ｍｌ／ｓを超える場合、粘膜下層に急激にガスが注入されて適切な粘膜下膨隆の形成が困難となるおそれがあり、ガス流量は、３０ｍｌ／ｓ以下であることがより好ましく、２０ｍｌ／ｓ以下であることが更に好ましく、１５ｍｌ／ｓ以下であることが特に好ましい。一方、ガス流量は通常１ｍｌ／ｓ以上である。 In the present invention, the gas flow rate (gas injection amount per unit time) when injecting gas into the submucosa layer is not particularly limited, but is preferably 50 ml / s or less. When the gas flow rate exceeds 50 ml / s, gas may be rapidly injected into the submucosa and it may be difficult to form an appropriate submucosal bulge, and the gas flow rate is more preferably 30 ml / s or less, It is more preferably 20 ml / s or less, and particularly preferably 15 ml / s or less. On the other hand, the gas flow rate is usually 1 ml / s or more.
また、本発明において、病変部の大きさや部位により粘膜下膨隆を形成させるために必要なガスの注入量は異なるが、粘膜下層に注入されるガスの１回の注入量が１００ｍｌ以下であることが好ましい。１回の注入量が１００ｍｌを超える場合、過大な粘膜下膨隆が形成されるため、その後の操作を行うためのスペースが確保できなくなるおそれがあり、１回の注入量は５０ｍｌ以下であることがより好ましい。本発明において、粘膜下層にガスを注入する回数については特に限定されず、１回で注入してもよいし、複数回で注入してもよい。 In the present invention, the amount of gas injected to form submucosal bulges differs depending on the size and site of the lesion, but the amount of gas injected into the submucosa is 100 ml or less. Is preferred. If the injection volume per injection exceeds 100 ml, an excessive submucosal bulge is formed, and there is a risk that a space for subsequent operations may not be secured, and the injection volume per injection may be 50 ml or less. More preferred. In the present invention, the number of times of injecting the gas into the submucosa layer is not particularly limited, and it may be injected once or a plurality of times.
本発明において、ガス供給手段が、ガスが封入された注射器であることも好ましい。ガスが封入された注射器を用いて粘膜下層にガスを注入する方法としては特に限定されず、注射器を手動で操作してガスを注入してもよいし、注射器にガス流量の制御が可能な機械的手段が更に備えられていてもよい。粘膜下層にガスを注入する際のガス流量については特に限定されず、上述のように、ガスが圧縮されたボンベを用いた場合と同様のガス流量であることが好ましい。また、生理食塩水等の局注液を粘膜下層に注入する場合と比べて、本発明の装置を用いて粘膜下層にガスを注入する際の注入抵抗が小さいため、操作性が良好である利点を有する。 In the present invention, it is also preferable that the gas supply means is a syringe filled with gas. There is no particular limitation on the method of injecting gas into the submucosal layer using a syringe in which gas is sealed, and the gas may be injected by manually operating the syringe, or the gas flow rate can be controlled in the syringe. An additional means may be further provided. The gas flow rate at the time of injecting the gas into the submucosal layer is not particularly limited, and as described above, the gas flow rate is preferably the same as that when a gas compressed cylinder is used. In addition, compared with the case where a local injection solution such as physiological saline is injected into the submucosa, the injection resistance when injecting gas into the submucosa using the apparatus of the present invention is small, so that the operability is good. Have
本発明において、ガスが封入された注射器であるガス供給装置が、注射器に充填されたガスと同一のガスが充填された容器に封入された包装体であることが好ましい。このことにより、注射器に充填されたガス以外のガスが注射器内に混入されるのを防止することができる。また、包装体を開封してすぐに使用することができるため取り扱い性が良好である。 In this invention, it is preferable that the gas supply apparatus which is a syringe with which gas was enclosed is a package body enclosed with the container filled with the same gas as the gas with which the syringe was filled. Thereby, it is possible to prevent gas other than the gas filled in the syringe from being mixed into the syringe. In addition, since the package can be used immediately after opening, the handleability is good.
本発明の粘膜下膨隆形成用ガス注入装置は、穿刺手段を備えている。穿刺手段を備えていることにより目的とする箇所に膨隆を形成させることができるとともに、粘膜下層にガスを注入するためのガス供給路を確保することができる。穿刺する方法としては特に限定されないが、粘膜下層に穿刺してそこからガスを注入するためには、注射針のような中空針であることが好ましい。本発明の粘膜下膨隆形成用ガス注入装置は、上記穿刺手段に加え、ガス供給手段と穿刺手段とを接続するフレキシブルチューブを備えたことを特徴とする。このように、ガス供給手段と穿刺手段とがフレキシブルチューブにより接続されているため、穿刺された箇所から粘膜下層にガスが注入され、粘膜下膨隆が形成される。用いられるフレキシブルチューブとしては、医療用に用いられるカテーテルのような中空のフレキシブルチューブであれば特に限定されない。用いられるフレキシブルチューブの長さや太さとしては、内視鏡に装着して使用可能な長さや太さであれば特に限定されず、フレキシブルチューブの長さは１〜４ｍであることが好ましい。また、フレキシブルチューブの外径は、１〜３．５ｍｍであることが好ましい。 The gas injection device for forming a submucosal bulge according to the present invention includes a puncturing means. By providing the puncture means, a bulge can be formed at a target location, and a gas supply path for injecting gas into the submucosal layer can be secured. The puncturing method is not particularly limited, but in order to puncture the submucosal layer and inject gas from there, a hollow needle such as an injection needle is preferable. The gas injection device for forming a submucosal bulge according to the present invention is characterized by comprising a flexible tube for connecting the gas supply means and the puncture means in addition to the puncture means. Thus, since the gas supply means and the puncture means are connected by the flexible tube, gas is injected from the punctured portion into the submucosal layer to form a submucosal bulge. The flexible tube used is not particularly limited as long as it is a hollow flexible tube such as a catheter used for medical purposes. The length and thickness of the flexible tube used are not particularly limited as long as the length and thickness can be used by being attached to an endoscope, and the length of the flexible tube is preferably 1 to 4 m. The outer diameter of the flexible tube is preferably 1 to 3.5 mm.
本発明では、フレキシブルチューブの粘膜下層挿入側の先端部に注入針が設けられてなり、注入針が長手方向に移動することによって、フレキシブルチューブによる注入針の保護が可能であることが好ましい。このように、フレキシブルチューブによる注入針の保護が可能である構成を採用することで、目的とする粘膜下層以外のところに誤って注入針が穿刺されるのを防止することができるため好ましく、更に、注入針が長手方向に移動可能であるため、任意のタイミングで注入針を粘膜下層に穿刺することができる。注入針を長手方向に移動させる方法としては特に限定されないが、フレキシブルチューブの注入針が設けられていない側の端部において注入針の移動操作が可能であることが好ましい。具体的には、フレキシブルチューブが、外層チューブと内層チューブとからなる二層積層構造を有するフレキシブルチューブであって、内層チューブの粘膜下層挿入側の先端部に注入針が設けられてなり、内層チューブが外層チューブ内で長手方向に移動することによって、注入針の移動操作が可能となる実施態様であることが好ましい。 In the present invention, it is preferable that an injection needle is provided at the distal end portion of the flexible tube on the submucosal layer insertion side, and the injection needle can be protected by the flexible tube by moving in the longitudinal direction. In this way, by adopting a configuration capable of protecting the injection needle with a flexible tube, it is possible to prevent the injection needle from being accidentally punctured outside the target submucosal layer. Since the injection needle is movable in the longitudinal direction, the injection needle can be punctured into the submucosa at an arbitrary timing. The method of moving the injection needle in the longitudinal direction is not particularly limited, but it is preferable that the injection needle can be moved at the end of the flexible tube where the injection needle is not provided. Specifically, the flexible tube is a flexible tube having a two-layer laminated structure including an outer layer tube and an inner layer tube, and an injection needle is provided at the distal end portion of the inner layer tube on the mucosal layer insertion side. It is preferable that the injection needle can be moved by moving in the longitudinal direction in the outer tube.
本発明の粘膜下膨隆形成用ガス注入装置の好適な実施態様は、粘膜下膨隆形成用ガス注入装置が装着された内視鏡である。このように、本発明の粘膜下膨隆形成用ガス注入装置を内視鏡に装着することによって、内視鏡の操作をしながら手元で注入針の移動操作を行うことができるとともに、粘膜下層に注入針を穿刺し、そのままガスを注入して粘膜下膨隆を形成させることができる。 A preferred embodiment of the gas injection device for forming a submucosal bulge of the present invention is an endoscope equipped with a gas injection device for forming a submucosal bulge. As described above, by attaching the gas injection device for forming the submucosal bulge of the present invention to the endoscope, the injection needle can be moved by hand while operating the endoscope, and the submucosa A submucosal bulge can be formed by puncturing the injection needle and injecting the gas as it is.
また、上記粘膜下膨隆形成用ガス注入装置は、ガス供給手段と、穿刺手段と、ガス供給手段と穿刺手段とを接続するフレキシブルチューブを備えたことを特徴とするが、ガス供給装置と、一端に注入針が設けられかつ他端がガス供給手段と接続可能なフレキシブルチューブとを現場で組み立てて使用するような実施態様であってもよい。すなわち、消化管の病変部を内視鏡的に切除する際に病変部全体を膨隆させるための粘膜下膨隆形成用ガス注入キットであって、ガス供給装置と、一端に注入針が設けられかつ他端がガス供給手段と接続可能なフレキシブルチューブとからなることを特徴とする粘膜下膨隆形成用ガス注入キットであることも本発明の実施態様の一つである。 The submucosal bulge-forming gas injection device includes a gas supply unit, a puncture unit, and a flexible tube that connects the gas supply unit and the puncture unit. In another embodiment, a flexible tube having an injection needle provided at the other end and connectable to the gas supply means at the other end is assembled and used in the field. That is, a gas injection kit for forming a submucosal bulge for bulging an entire lesion when endoscopically removing a lesion in the digestive tract, comprising a gas supply device, an injection needle at one end, and Another embodiment of the present invention is a gas injection kit for forming a submucosal bulge characterized by comprising a flexible tube connectable to the gas supply means at the other end.
本発明の粘膜下膨隆形成用ガス注入装置を用いることにより、粘膜下層にガスが注入されて隆起が高く安定した粘膜下膨隆が形成される。このように、病変部全体を膨隆させることができるため、病変部を容易で確実かつ安全に一括切除することができる。病変部が一括切除されることにより、詳細な病理組織学的診断が可能となるとともに、遺残や局所再発を防止することができる利点を有する。 By using the gas injection device for forming a submucosal bulge according to the present invention, gas is injected into the submucosal layer to form a stable submucosal bulge with a high bulge. In this way, since the entire lesioned part can be bulged, the lesioned part can be easily, reliably and safely collectively excised. By excising the lesion part at once, there is an advantage that detailed histopathological diagnosis can be performed, and a remnant and local recurrence can be prevented.
以下、実施例を用いて本発明を更に具体的に説明する。 Hereinafter, the present invention will be described more specifically with reference to examples.
実施例１
炭酸ガスが圧縮されたボンベから炭酸ガスを５０ｍｌの注射器内へ注入した。次いで、２４Ｇの注射針を炭酸ガスが封入された注射器に炭酸ガス以外のガスが注射器内に混入しないように装着した。豚の切除胃の粘膜下層に対してガス流量約１０ｍｌ／ｓで炭酸ガスを局注して粘膜下膨隆を形成させた。図１で示されるように半球状の大きな粘膜下膨隆が形成された。ＥＳＤの手技に準じて粘膜下膨隆の周囲を切開したところ、粘膜下層が部分的にすでに剥離されていることが確認された。このとき、図４に示されるように粘膜下層に存在している比較的太い血管が破れることなく露出されていた。また、図５に示されるように粘膜下膨隆の形成により粘膜下層の部分的剥離が進んでいた。
Example 1
Carbon dioxide was injected into a 50 ml syringe from a cylinder compressed with carbon dioxide. Next, a 24G injection needle was attached to a syringe in which carbon dioxide gas was sealed so that no gas other than carbon dioxide was mixed into the syringe. A submucosal bulge was formed by locally injecting carbon dioxide gas at a gas flow rate of about 10 ml / s into the submucosal layer of the resected stomach of a pig. A large hemispherical submucosal bulge was formed as shown in FIG. An incision was made around the submucosal bulge according to the ESD procedure, and it was confirmed that the submucosal layer had already been partially detached. At this time, as shown in FIG. 4, a relatively thick blood vessel present in the submucosa layer was exposed without being broken. In addition, as shown in FIG. 5, partial detachment of the submucosal layer progressed due to the formation of submucosal bulges.
実施例２
窒素ガスを注射器内に封入した以外は実施例１と同様にして豚の切除胃の粘膜下層に対してガス流量約１０ｍｌ／ｓで窒素ガスを局注して粘膜下膨隆を形成させた。図２に示されるように半球状の大きな粘膜下膨隆が形成された。
Example 2
A submucosal bulge was formed by locally injecting nitrogen gas at a gas flow rate of about 10 ml / s into the submucosal layer of the resected stomach of a pig in the same manner as in Example 1 except that nitrogen gas was sealed in the syringe. As shown in FIG. 2, a large hemispherical submucosal bulge was formed.
実施例３
アルゴンガスを注射器内に封入した以外は実施例１と同様にして豚の切除胃の粘膜下層に対してガス流量約１０ｍｌ／ｓで窒素ガスを局注して粘膜下膨隆を形成させた。実施例１及び２と同様に半球状の大きな粘膜下膨隆が形成された。
Example 3
A submucosal bulge was formed by locally injecting nitrogen gas at a gas flow rate of about 10 ml / s into the submucosal layer of the resected stomach of a pig in the same manner as in Example 1 except that argon gas was sealed in the syringe. A hemispherical large submucosal bulge was formed as in Examples 1 and 2.
比較例１
生理食塩水を注射器内に注入した以外は実施例１と同様にして豚の切除胃の粘膜下層に対して流量約５ｍｌ／ｓで生理食塩水を局注して粘膜下膨隆を形成させた。図３に示されるように大きな粘膜下膨隆は形成されず、半球状の緩やかな傾斜の粘膜下膨隆が形成された。ＥＳＤの手技に準じて膨隆の周囲を切開したところ、粘膜下層の剥離は認められず、血管の露出もなかった。
Comparative Example 1
A submucosal bulge was formed by locally injecting saline at a flow rate of about 5 ml / s into the submucosal layer of the resected stomach of a pig in the same manner as in Example 1 except that physiological saline was injected into the syringe. As shown in FIG. 3, a large submucosal bulge was not formed, but a hemispherically gently inclined submucosal bulge was formed. When an incision was made around the bulge according to the ESD procedure, no submucosal detachment was observed and no blood vessels were exposed.
実施例１〜３の結果から分かるように、形成された粘膜下膨隆の隆起が高く、粘膜下層の一部が剥離されていた。粘膜下層に存在している比較的太い血管は損傷されることなく露出されており、露出された血管に対して電気凝固による血管処理を速やかに行うことにより、手技全体の安全性が保たれることが分かる。これに対し、生理食塩水を局注して粘膜下膨隆を形成させた比較例１では、得られた粘膜下膨隆の傾斜が緩やかであり、粘膜下層の剥離は認められず、血管の露出もなかった。また、生理食塩水を追加で局注しても粘膜下膨隆の隆起が高くならなかったことを本発明者は確認している。以上のことから、粘膜下層へガスを局注することにより安全かつ容易に病変の一括切除が得られることから、詳細な病理診断が可能となり、遺残や局所再発が極めて少なくなることが期待され、更に患者に恩恵を施すことができる。また、生理食塩水により形成された粘膜下膨隆の持続時間と比べて、ガスにより形成された粘膜下膨隆は安定して持続していたため、安全で確実かつ迅速に病変の一括切除が可能であることが分かった。 As can be seen from the results of Examples 1 to 3, the formed submucosal bulge was high and a part of the submucosal layer was peeled off. The relatively thick blood vessels present in the submucosa are exposed without being damaged, and the safety of the entire procedure is maintained by promptly performing blood vessel treatment by electrocoagulation on the exposed blood vessels. I understand that. In contrast, in Comparative Example 1 in which physiological saline was locally injected to form submucosal bulges, the obtained submucosal bulges had a gentle slope, no submucosal detachment was observed, and blood vessels were also exposed. There wasn't. In addition, the present inventor has confirmed that the submucosal bulge did not increase even when additional saline was locally administered. Based on the above, it is possible to safely and easily collectively remove lesions by locally injecting gas into the submucosal layer, so that detailed pathological diagnosis is possible, and residual and local recurrence are expected to be extremely small. , And can even benefit the patient. Compared with the duration of the submucosal bulge formed with physiological saline, the submucosal bulge formed with the gas was stable and stable, enabling safe, reliable and quick bulk excision of lesions I understood that.
Claims (13)
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP2007270891A JP5257970B2 (en) | 2007-10-18 | 2007-10-18 | Gas injection device for forming submucosal bulge and endoscope using the same |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP2007270891A JP5257970B2 (en) | 2007-10-18 | 2007-10-18 | Gas injection device for forming submucosal bulge and endoscope using the same |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| JP2009095514A true JP2009095514A (en) | 2009-05-07 |
| JP5257970B2 JP5257970B2 (en) | 2013-08-07 |
Family
ID=40699084
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP2007270891A Expired - Fee Related JP5257970B2 (en) | 2007-10-18 | 2007-10-18 | Gas injection device for forming submucosal bulge and endoscope using the same |
Country Status (1)
| Country | Link |
|---|---|
| JP (1) | JP5257970B2 (en) |
Citations (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| JP2005007161A (en) * | 2003-05-23 | 2005-01-13 | Yukinobu Takimoto | Emr treatment device and emr apparatus |
| WO2006051593A1 (en) * | 2004-11-11 | 2006-05-18 | Olympus Corporation | Living body tissue collecting device |
| JP2006333943A (en) * | 2005-05-31 | 2006-12-14 | Olympus Medical Systems Corp | Treatment device for submucosal dissection and its system |
| JP2007075518A (en) * | 2005-09-16 | 2007-03-29 | Olympus Medical Systems Corp | Air supplying apparatus, and surgery system provided with the same |
-
2007
- 2007-10-18 JP JP2007270891A patent/JP5257970B2/en not_active Expired - Fee Related
Patent Citations (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| JP2005007161A (en) * | 2003-05-23 | 2005-01-13 | Yukinobu Takimoto | Emr treatment device and emr apparatus |
| WO2006051593A1 (en) * | 2004-11-11 | 2006-05-18 | Olympus Corporation | Living body tissue collecting device |
| JP2006333943A (en) * | 2005-05-31 | 2006-12-14 | Olympus Medical Systems Corp | Treatment device for submucosal dissection and its system |
| JP2007075518A (en) * | 2005-09-16 | 2007-03-29 | Olympus Medical Systems Corp | Air supplying apparatus, and surgery system provided with the same |
Also Published As
| Publication number | Publication date |
|---|---|
| JP5257970B2 (en) | 2013-08-07 |
Similar Documents
| Publication | Publication Date | Title |
|---|---|---|
| US20230414247A1 (en) | Methods and systems for performing submucosal medical procedures | |
| US8929988B2 (en) | Methods and systems for submucosal implantation of a device for diagnosis and treatment of a body | |
| US8491472B2 (en) | Methods and systems for submucosal implantation of a device for diagnosis and treatment with a therapeutic agent | |
| US7721742B2 (en) | Methods for diagnostic and therapeutic interventions in the peritoneal cavity | |
| AU2007238753B2 (en) | Apparatus and methods for endoscopic resection of tissue | |
| Moyer et al. | A self-approximating transluminal access technique for potential use in NOTES: an ex vivo porcine model (with video) | |
| US20110172491A1 (en) | Detachable balloon catheter | |
| US20120239061A1 (en) | Endoscopic full thickness gastric reduction apparatus and method | |
| JP2009183516A (en) | Treatment tool for esd | |
| JP4761921B2 (en) | Endoscope injection for endoscope | |
| JP2010104527A (en) | Closed lumen producing aid for endoscope or the like and endoscope apparatus | |
| Moyer et al. | Transgastric organ resection solely with the prototype R-scope and the self-approximating transluminal access technique | |
| JP5311314B2 (en) | Guide tube system for pneumoperitoneum and intracavity access path formation | |
| JP5257970B2 (en) | Gas injection device for forming submucosal bulge and endoscope using the same | |
| von Delius et al. | Percutaneously assisted endoscopic surgery using a new PEG-minitrocar for advanced endoscopic submucosal dissection (with videos) | |
| JP4525931B2 (en) | Backflow prevention device and method for mounting the same | |
| Elmunzer et al. | Hydroperitoneum-facilitated EUS-guided peritoneal entry and closure of alternate access sites for NOTES | |
| Tat et al. | Principles of Intramural Surgery | |
| JP2000271217A (en) | Endoscopic drug solution injection needle | |
| CN109381229B (en) | Suture needle with suture thread for digestive endoscopy operation | |
| Budihal et al. | PTH-078 Snare tip anchor polypectomy: a useful technique to achieve EN-BLOC resection | |
| CN109381231B (en) | Suture needle release and recovery device for digestive endoscopic surgery | |
| JP2004283620A (en) | Endoscope type drug solution infusion needle | |
| Choi | Endoscopic Resection of | |
| KR200416420Y1 (en) | Apparatus for inserting ballon for treatment of obesity using endoscope |
Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| A621 | Written request for application examination |
Free format text: JAPANESE INTERMEDIATE CODE: A621 Effective date: 20101013 |
|
| A977 | Report on retrieval |
Free format text: JAPANESE INTERMEDIATE CODE: A971007 Effective date: 20120719 |
|
| A131 | Notification of reasons for refusal |
Free format text: JAPANESE INTERMEDIATE CODE: A131 Effective date: 20120731 |
|
| A521 | Request for written amendment filed |
Free format text: JAPANESE INTERMEDIATE CODE: A523 Effective date: 20120927 |
|
| RD03 | Notification of appointment of power of attorney |
Free format text: JAPANESE INTERMEDIATE CODE: A7423 Effective date: 20120927 |
|
| A521 | Request for written amendment filed |
Free format text: JAPANESE INTERMEDIATE CODE: A821 Effective date: 20120927 |
|
| TRDD | Decision of grant or rejection written | ||
| A01 | Written decision to grant a patent or to grant a registration (utility model) |
Free format text: JAPANESE INTERMEDIATE CODE: A01 Effective date: 20130326 |
|
| A61 | First payment of annual fees (during grant procedure) |
Free format text: JAPANESE INTERMEDIATE CODE: A61 Effective date: 20130418 |
|
| FPAY | Renewal fee payment (event date is renewal date of database) |
Free format text: PAYMENT UNTIL: 20160502 Year of fee payment: 3 |
|
| R150 | Certificate of patent or registration of utility model |
Ref document number: 5257970 Country of ref document: JP Free format text: JAPANESE INTERMEDIATE CODE: R150 Free format text: JAPANESE INTERMEDIATE CODE: R150 |
|
| R250 | Receipt of annual fees |
Free format text: JAPANESE INTERMEDIATE CODE: R250 |
|
| R250 | Receipt of annual fees |
Free format text: JAPANESE INTERMEDIATE CODE: R250 |
|
| R250 | Receipt of annual fees |
Free format text: JAPANESE INTERMEDIATE CODE: R250 |
|
| S111 | Request for change of ownership or part of ownership |
Free format text: JAPANESE INTERMEDIATE CODE: R313113 |
|
| R350 | Written notification of registration of transfer |
Free format text: JAPANESE INTERMEDIATE CODE: R350 |
|
| R250 | Receipt of annual fees |
Free format text: JAPANESE INTERMEDIATE CODE: R250 |
|
| R250 | Receipt of annual fees |
Free format text: JAPANESE INTERMEDIATE CODE: R250 |
|
| R250 | Receipt of annual fees |
Free format text: JAPANESE INTERMEDIATE CODE: R250 |
|
| R250 | Receipt of annual fees |
Free format text: JAPANESE INTERMEDIATE CODE: R250 |
|
| LAPS | Cancellation because of no payment of annual fees |