JP2014171629A - Auxiliary tool for endoscope apparatus and endoscope apparatus using the same - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an auxiliary tool for an endoscope apparatus to be used along with a gripping tool with a thread that lifts a lesioned part to easily peel off a lower layer of the lesioned part when removing the lesioned part of early stomach cancer, etc., and an endoscope apparatus using the same.SOLUTION: An auxiliary tool 10A for an endoscope apparatus includes a cylindrical attachment part 11 to be removably attached to a leading end of an endoscope apparatus 15, and a guide tube 12 into which a forceps can be inserted. The guide tube 12 is fixed to the outer peripheral surface of the cylindrical attachment part 11, and a slit 14 of a predetermined length is formed in the guide tube 12, from the leading end toward the rear end, in the position except the part where the guide tube 12 is fixed to the outer peripheral surface of the cylindrical attachment part 11.

Description

  The present invention relates to an endoscopic device auxiliary tool used for endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and the like, and the same. Endoscopic devices for endoscopic devices for use with threaded grippers that make it easier to peel off the underlying layer of a lesioned part, especially when excising a lesioned part such as early gastric cancer The present invention relates to a tool and an endoscope apparatus using the same.

  Conventionally, resection of lesions such as early gastric cancer has been performed using an endoscope equipped with a sheath having a forceps opening or a removable sheath in the digestive tract such as the esophagus, stomach, small intestine, and large intestine. Yes. In this resection for early gastric cancer and the like, in addition to EMR, ESD that uses a high-frequency knife (IT knife, flex knife, hook knife, etc.) to exfoliate the lesioned mucosa in order to remove a large lesion is widely used. In ESD, for example, when removing a lesion such as early gastric cancer, physiological saline is injected between the submucosa and muscle layers to raise the lesion, and the submucosa is incised and detached using a snare or a high-frequency knife. However, the gastric wall perforation rate at which a hole is opened in the stomach by endoscopic surgery has decreased due to recent advances in treatment tools and technological improvements, but it is about 2-4%, so it is safe. The problem is to remove the lesion. For this reason,

  A typical excision method for a lesion such as early gastric cancer will be described with reference to FIG. 9A to 9D are perspective views for explaining the conventional method for resection of a lesion site in order, FIG. 9E is a cross-sectional view taken along line IXE-IXE in FIG. 9B, and FIG. 9F is an IXF- It is sectional drawing along the IXF line.

  First, as shown in FIG. 9A, markings 52 are provided at several places around the lesioned part 51 under the endoscope, and then, as shown in FIGS. A suitable amount of saline 55 or the like is locally injected between the muscle layer 54 and the muscle layer 54 (the submucosa) to raise the lesioned part 51. Thereafter, as shown in FIGS. 9C and 9F, an incision is made around the lesioned part 51 using an IT knife 56 or the like, and the lesioned part 51 and the muscular layer using other high-frequency knives or hook knives (not shown) as necessary. 54 is peeled off. Then, the excised lesion part 51 is captured using a tripod or a tripod, and the endoscope 51 is pulled out to collect the lesion part 51. On the other hand, in EMR, as shown in FIG. 9D, a metal ring (snare) 57 is used for staking and excision. In this case, treatment is performed by mutually replacing and inserting endoscope treatment tools such as a physiological saline injection tool, an IT knife, and a snare from one treatment tool guide channel of an endoscope (not shown).

  However, when the lesion is raised by locally injecting physiological saline as described above, the injected physiological saline diffuses into the submucosal layer over time, so that the artificially formed mucosal elevation gradually Go flat. Sufficient bulging of the lesion is necessary for incision and detachment of the lesion, and if the bulge of the lesion is not sufficient, the possibility of perforation of the muscle layer increases. Therefore, when excising the lesion, when the locally injected physiological saline diffuses and the mucosal bulge becomes flat, the saline is injected again locally, or hyaluronic acid with high water retention capacity is injected locally. It is also known to increase the distance between adjacent muscle layers or normal tissues using other means in combination.

  Here, the excision method of a lesion part disclosed in Patent Documents 1 and 2 below will be described with reference to FIGS. FIG. 10A is a front view of a conventional endoscope hood, and FIGS. 10B to 10E are diagrams for sequentially explaining a method of excising a lesion using the endoscope hood shown in FIG. 10A. . Further, FIGS. 11A to 11C are diagrams for sequentially explaining a method of excising a lesion using a conventional endoscope treatment tool.

  As shown in FIG. 10A, an endoscope hood 60 disclosed in Patent Document 1 below has a cylindrical mounting portion 62 that is detachably mounted on the outer peripheral surface of the distal end portion of the endoscope device 61. And a guide tube 63 through which the forceps attached to the outer peripheral surface of the mounting portion 62 can be inserted. As shown in FIGS. 10B to 10E, the endoscope hood 60 is marked around the lesioned portion 65 in the surface layer 64 of the digestive tract via a forceps channel (not shown) of the endoscope device 61. Next, the lesioned portion 65 is raised by locally injecting a drug such as physiological saline or sodium hyaluronate solution into the submucosal layer of the lesioned portion 65 through the forceps channel. Then, the entire circumference of the lesioned part 65 is incised by an incision knife 67a such as a hook knife inserted through the forceps channel to form a cut part 68.

  Next, as shown in FIG. 10C, the lesioned part 65 is grasped by the grasping forceps 69 inserted through the guide tube 63 and pulled toward the guide tube 63. In this way, the guide tube 63 is attached to the mounting portion 62 in a direction in which its axis intersects the axis of the endoscope device 61, so that the lesioned portion 65 is located at the distal end portion of the endoscope device 61. On the other hand, it is raised obliquely upward. As a result, a sufficient counter traction effect can be obtained for the portion to be peeled immediately under the lesioned portion 65, and a sufficient field of view can be secured for the endoscope apparatus 61. Therefore, next, as shown in FIG. 10D, the submucosal layer just under the lesion 65 is incised and peeled off by the IT knife 67b inserted through the forceps channel. If the exfoliation of the submucosal layer immediately below the lesioned part 65 has progressed, the grasping forceps 69 grips the further deeper part immediately below the lesioned part 65 and pulls it toward the guide tube 63, and repeats the operations of FIGS. 10C and 10D. . As a result, the workability at the time of incising and peeling the submucosal layer can be dramatically improved. Finally, as shown in FIG. it can.

  In addition, an endoscope treatment tool 70 disclosed in the following Patent Document 2 is configured by attaching a thread 72 to a well-known holding tool 71 for indwelling as shown in FIG. The lesioned part 75 is gripped by using a tool fixture (not shown) and contacting the lesioned part 75 via the forceps port 74 of the endoscope device 73. The endoscopic treatment instrument 70 lifts the lesioned part 75 by locally injecting a physiological saline 78 between the mucous membrane layer 76 and the muscle layer or normal tissue 77, and then grips it from the tip of the forceps port 74. The lesioned part 75 can be gripped by the pair of claws 71b of the gripper 71 by pressing the tool 71 against the lesioned part 75 and moving the presser ring 71a to close the pair of claws 71b. The gripping tool 71 is left in a state where the lesioned part 75 is gripped.

  By repeating such an operation a plurality of times, as shown in FIG. 11B, the lesioned part 75 is gripped by the plurality of grippers 71, and the tip inserted into the forceps port 74 of the endoscope apparatus 73 is bent. While using the flexible sheath 79 and pulling a plurality of threads 72 from the operation unit side, the lesioned part 75 can be lifted to increase the distance between the lesioned part 75 and the adjacent muscle layer or normal tissue 77. it can. For this reason, as shown in FIG. 11C, for example, an effect of facilitating excision of a lesion with an IT knife 80 or the like can be achieved.

JP 2010-273709 A JP 2007-143869 A

  When the endoscope hood 60 disclosed in Patent Document 1 is used, the lesioned portion 65 can be gripped by a strong force like the gripping forceps 69 through the guide tube 63 and a wide field of view can be secured. The effect which was able to be produced can be produced. However, in the endoscope hood 60, since the optimal length from the distal end of the guide tube 63 to the lesioned portion 65 is determined by the attachment angle of the distal end portion of the guide tube 63, there is play in the movement of the grasping forceps 69. In addition, there is a problem that the lesioned part 65 gripped during the operation of the endoscope treatment tool such as the IT knife by the operator also moves together.

  Further, according to the endoscope treatment tool 70 disclosed in Patent Document 2, the holding tool 71 for indwelling is operated from the endoscope operation unit by the thread 72, so that the operator can use an IT knife or the like. Even if the endoscopic device 73 moves during the operation of the endoscopic treatment tool, the movement of the endoscopic device 73 is difficult to be transmitted to the gripping tool 71, so that the grasped lesioned part 75 is difficult to move. doing. However, if the thread is pulled as it is, the lesioned part only approaches the endoscope apparatus and the field of view cannot be taken. Therefore, in order to make it easier to see the submucosal layer that is incised by efficiently raising the mucous membrane, a flexible sheath 79 is used. The thread 72 that is continuous from the forceps port 74 of the endoscope device 73 and that protrudes from the hole of the forceps port on the proximal side of the endoscope device 73 (the side closer to the operation unit of the endoscope device) Is inserted into the flexible sheath 79, tied to the tip of the guide wire, the guide wire is pulled out, the thread is introduced into the flexible sheath 79, and the flexible sheath 79 is inserted into the stomach from the forceps port 74. It was necessary to introduce it into the cavity. By this operation, by using the flexible sheath 79 like a fishing rod, the mucous membrane to be excised can be efficiently inverted and lifted to make it easier to see the submucosal layer to be incised.

on the other hand,
In addition, according to the endoscope treatment tool 70 disclosed in Patent Document 2,
Since the holding tool 71 for indwelling is operated from the endoscope operation unit by the thread 72, even if the endoscope apparatus 73 moves during the operation of the endoscope treatment tool such as an IT knife by the operator, Since the movement of the endoscope device 73 is difficult to be transmitted to the gripper 71, there is an advantage that the gripped lesioned part 75 is difficult to move. However, if the thread is pulled as it is, the lesion cannot be viewed just by moving closer to the endoscope. Therefore, in order to make it easier to see the submucosa to be incised by efficiently raising the mucosa, the flexible sheath 79 is used. Consecutive from the forceps port 74 of the endoscopic device 73, the thread 72 that has come out from the hole in the forceps port on the proximal side of the endoscopic device (the side close to the endoscope operation unit), and a guide wire is separately provided as a flexible sheath. The thread 72 is tied to the tip of the guide wire while being inserted into the guide 79, the guide wire is pulled out, the thread is introduced into the flexible sheath 79, and the flexible sheath 79 is introduced from the forceps port 74 into the stomach lumen. There was a need to do. By this operation, by using the flexible sheath 79 like a fishing rod, the mucosa to be excised can be efficiently reversed and lifted to make it easier to see the submucosal layer to be incised.

  On the other hand, in the case of using a plurality of gripping tools 71, a necessary number of sets of clips 71 tied with a thread 72 are attached to the edge of the mucous membrane to be excised, and then the same operation as described above is performed. For example, if there are three threaded clips, the three threaded clips are first fixed to the edge of the mucous membrane to be excised, and then the proximal side of the endoscope device (the side closer to the endoscope operation section). 3) are tied to the tip of the guide wire inserted into the flexible sheath 79, and the three threads 72 are passed through the flexible sheath 79 all at once. Thereafter, similarly, the flexible sheath 79 is introduced into the lumen of the stomach, and the mucous membrane to be excised is picked up. As described above, whether the clip with one set of threads or the clip with three sets of threads is complicated, preparations for binding an extremely fine thread after passing the guide wire through the flexible sheath 79 are complicated. Since a thin thread having a thickness of about 0.1 mm is used, it is troublesome to tie the guide wire without looseness.

  The present invention has been made to solve the above-described problems of the prior art, and the insertion operation of the grasping tool is simple, the lesioned part can be grasped reliably, and it is attached to the endoscope apparatus. Endoscopes for endoscopic devices that have a wide field of view and do not require an operation for tying ultra-fine threads, and the lesioned part that is gripped is difficult to move when operating an endoscopic treatment instrument such as an IT knife. An object of the present invention is to provide an endoscope apparatus using the same.

  In order to achieve the above object, an auxiliary device for an endoscope apparatus for use with the threaded gripping tool of the present invention includes a cylindrical mounting portion that is detachably mounted on the distal end of the endoscope, and insertion of forceps. An endoscope device auxiliary tool for use with a threaded gripper, wherein the guide tube is fixed to the outer peripheral surface of the cylindrical mounting portion, A slit is formed from the front end to the rear end side at a position excluding a portion fixed to the outer peripheral surface of the cylindrical mounting portion.

  An auxiliary device for an endoscope apparatus according to the present invention is for use with a gripping tool with a thread, and a cylindrical mounting portion that is detachably mounted on a distal end portion of an endoscope, and insertion of forceps. And a possible guide tube. In addition, the endoscope apparatus auxiliary tool in which the guide tube is fixed to the outer peripheral surface of the cylindrical mounting portion is known as, for example, an impact shooter (registered trademark). The endoscopic device auxiliary tool of the present invention is such a known endoscopic device auxiliary tool, except for a portion fixed to the outer peripheral surface of the cylindrical mounting portion of the guide tube as a guide tube. In the position, a slit is formed from the front end side toward the rear end side.

  As a result, a gripping tool such as a clip with a thread is inserted into the guide tube from the operation unit side of the endoscope apparatus by a known gripping tool mounting tool, and after gripping the lesioned part with the gripping tool, the gripping tool mounting tool is The rear end side of the slit formed in the guide tube with the gripper holding the lesioned part by pulling it out from the guide tube and operating the thread and the endoscope device from the operation unit side of the endoscope device Can be moved to. In this state, the lesioned part can be lifted by pulling the thread further forward, and the field of view of the distal end side of the endoscope apparatus is opened. Therefore, an incision tool such as an IT knife inserted into the endoscope apparatus It becomes easier to peel the lower layer of the lesion due to.

  In addition, when inserting a plurality of gripping parts, once the gripping tool fixture is pulled out of the guide tube, another gripping tool with a thread prepared in advance is attached to the gripping tool fixture, and again in the guide tube. Since it can be inserted, another gripping tool can be easily inserted in the vicinity of the lesioned part in a short time. Moreover, since the thread of the gripping tool previously gripped by the lesioned part can have play and can be positioned outside the field of view of the endoscope apparatus, the gripping of the lesioned part is again performed by another gripping tool. It can be done easily.

  In addition, the position of the slit formed in the guide tube of the auxiliary device for an endoscope apparatus of the present invention is arbitrary as long as it is a position excluding the portion fixed to the outer peripheral surface of the cylindrical mounting portion of the guide tube. However, if it is formed at a position opposite to the portion fixed to the outer peripheral surface of the cylindrical mounting portion of the guide tube, the thread can be easily inserted into the slit only by moving the endoscope device away from the thread. You can move. Further, in the endoscopic device auxiliary tool of the present invention, the slit is about 1 to 5 cm from the rear end of the cylindrical mounting portion in order to increase the height of the lesioned portion and facilitate various treatments. It is preferable that the length is provided. If this length is shorter than 1 cm, the height of the lesion will be reduced, and if it exceeds 5 cm, it will be difficult to apply force to the lesion, and the exposed thread that does not follow the endoscope will penetrate the mucous membrane. Since it may be damaged, it is not preferable.

  Moreover, in the endoscope apparatus auxiliary tool of the present invention, a tapered annular distal end portion may be provided on the distal end side of the cylindrical mounting portion. When a tapered annular tip is provided on the distal end side of the cylindrical mounting portion, the opening of the incision is enlarged and enlarged by inserting the tapered annular tip into the opening of the incision. As a result, the lesion can be easily submerged between the adjacent muscle layer or normal tissue.

  Moreover, in the auxiliary tool for an endoscope apparatus according to the present invention, the tapered hollow annular distal end portion includes a tapered semi-annular distal end portion divided into two, and one of the two divided tapered semi-annular distal end portions is Further, it is attached to the cylindrical mounting portion so as to be openable and closable, and a thread is connected to the front end side, and the thread may be extended to the rear end side in the guide tube.

  When such a configuration is adopted, in the loosened state, the configuration is the same as that of the tapered hollow annular tip, and one of the tapered semi-annular tips divided into two by pulling the yarn from the rear end side. Will be able to open. Therefore, according to the auxiliary device for an endoscope apparatus according to this aspect, the thread can be easily submerged between the muscle layer or the normal tissue adjacent to the lesioned part while the thread is loosened. By pulling, the lesion can be lifted more, and the field of view of the distal end side of the endoscope device is opened, so that the lower layer of the lesion is peeled off by an incision tool such as an IT knife inserted into the endoscope device. It becomes easier to do.

  Further, in the endoscope apparatus auxiliary tool of the present invention, the tapered hollow annular tip portion is composed of a tapered half-annular tip portion divided into two, and each of the two divided tapered semi-annular tip portions is The guide tube, which is attached to the cylindrical mounting portion so as to be openable and closable, has a thread connected to the distal end side, and is formed with slits, has two diameters on the side surface of the cylindrical mounting portion. The yarns may be provided at both ends in the direction, and the yarns may be individually passed through the two guide tubes and extended to the rear end side.

  When such a configuration is adopted, the configuration is the same as that of the tapered hollow annular tip when the yarn is loosened, and both the tapered semi-annular tip divided into two by pulling the yarn from the rear end side are provided. Will be able to open. Therefore, according to the auxiliary device for an endoscope apparatus according to this aspect, the thread can be easily submerged between the muscle layer or the normal tissue adjacent to the lesioned part while the thread is loosened. By pulling, the lesion can be lifted more, and the field of view of the distal end side of the endoscope device is opened, so that the lower layer of the lesion is peeled off by an incision tool such as an IT knife inserted into the endoscope device. It becomes easier to do.

  Further, in the endoscopic device auxiliary tool of the present invention, an adhesive tape is attached to the inner surface side where the slit of the guide tube is formed so as to close the slit, and the distal end side of the adhesive tape. The yarn may be bound to the yarn, and the yarn may be passed through the guide tube and extended to the rear end side.

  When such a configuration is adopted, the slit of the guide tube is closed with the adhesive tape from the back side when the yarn is loosened, and the adhesive tape can be peeled and removed by pulling the yarn. Therefore, according to the auxiliary device for an endoscope apparatus according to such an aspect, in a state where the thread is loosened, when the endoscope apparatus to which the auxiliary device for an endoscope apparatus is attached is inserted into the body cavity, the mucous membrane is formed in the slit. Since it is not pinched, it is difficult to damage the mucous membrane. If the adhesive tape is peeled off and then removed by pulling a thread, an endoscopic device auxiliary tool that can effectively use the function of the slit can be obtained.

In the endoscope apparatus assisting tool of the present invention, an adhesive tape is attached to the outer surface or inner surface of the rear end side of the slit on at least one of the inner surface and the outer surface where the slit of the guide tube is formed. The slit may be set to have a predetermined length by the adhesive tape.
If such a configuration is adopted, if only a guide tube with a certain long slit is prepared, the length of the slit can be set to a predetermined length by appropriately using an adhesive tape. Become economical.

  In addition, it is preferable that the tapered annular distal end portion in the endoscope apparatus auxiliary tool of the present invention is formed of a light-transmitting material. If the tapered annular tip is formed of a light-transmitting material, not only the tip of the endoscope device but also the surroundings can be illuminated, so the field of view of the endoscope device is widened and the endoscope device It becomes easier to peel off the lower layer of the lesioned part by an incision tool such as an IT knife inserted through the inside.

  Moreover, in the endoscope apparatus auxiliary tool of the present invention, the guide tube has an outer peripheral surface of the cylindrical mounting portion such that the distal end thereof is positioned on the rear end side with respect to the distal end of the cylindrical mounting portion. It is preferable to be fixed to. If the tip of the guide tube is located on the rear end side of the tip of the cylindrical mounting part, the thread can be moved into the slit more easily by simply moving the endoscope device away from the thread. become.

  Furthermore, in order to achieve the above object, an auxiliary device for an endoscope apparatus for use with the threaded gripping tool of the present invention comprises a cylindrical mounting portion that is detachably mounted on the distal end portion of the endoscope. A guide tube through which forceps can be inserted, wherein the guide tube is integrally coupled to a rear end of the cylindrical mounting portion by a belt-like member or a linear member. It is characterized by being.

  Since the auxiliary | assistant tool for endoscope apparatuses of this invention can set the distance between the front-end | tip of a guide tube and the rear end of a cylindrical mounting part to arbitrary length with a strip | belt-shaped member or a linear member, Insert a gripping tool such as a clip with a thread into the guide tube from the operation unit side of the apparatus with a known gripping tool fixture, and after grasping the lesioned part with the gripping tool, remove the gripping tool fixture from the guide tube, By operating the thread and the endoscope device from the operation unit side of the endoscope device, the lesioned portion can be lifted while the gripper grips the lesioned portion, and the visual field on the distal end side of the endoscope device Therefore, the lower layer of the lesioned part can be easily peeled off by an incision tool such as an IT knife inserted into the endoscope apparatus.

  In addition, when inserting a plurality of gripping parts, once the gripping tool fixture is pulled out of the guide tube, another gripping tool with a thread prepared in advance is attached to the gripping tool fixture, and again in the guide tube. Since it can be inserted, another gripping tool can be easily inserted in the vicinity of the lesioned part in a short time. Moreover, since the thread of the gripping tool previously gripped by the lesioned part can have play and can be positioned outside the field of view of the endoscope apparatus, the gripping of the lesioned part is again performed by another gripping tool. It can be done easily.

  In the endoscopic device assisting device of the present invention, the distance between the distal end of the guide tube and the rear end of the cylindrical mounting portion can be arbitrarily set according to the length of the belt-like member or the linear member. However, about 1 to 5 cm is preferable in order to increase the height of the lesioned portion and facilitate various treatments. If this distance is shorter than 1 cm, the height of the lesion will be reduced, and if it exceeds 5 cm, it will be difficult to apply force to the lesion, and the exposed thread that does not follow the endoscope will damage the mucous membrane. This is not preferable because there is a possibility. If there is no band-like member or linear member between the tip of the guide tube and the rear end of the cylindrical mounting portion, the cylindrical mounting portion and the guide tube are attached to the endoscope apparatus. Since the distance between the rear end of the cylindrical mounting portion and the tip of the guide tube varies, the usability of the operator varies.

  Assuming that a tapered annular tip is provided on the distal end side of the cylindrical mounting portion, this tapered annular tip can easily sink into the adjacent muscle layer or normal tissue. This makes it easier to increase the distance between the lesion and the adjacent muscle layer or normal tissue. In addition, when the tapered annular tip is made of a light-transmitting material, not only the tip side of the endoscope device but also the side surface can be illuminated. Makes it easier for a person to perform various operations.

  Furthermore, in order to achieve the above object, an endoscope apparatus provided with the endoscope apparatus auxiliary tool of the present invention includes the endoscope apparatus auxiliary tool described above and an endoscope apparatus. The cylindrical mounting portion of the endoscope device auxiliary tool is attached to the distal end of the endoscope device, and the guide tube is fixed to the outer peripheral surface of the endoscope device. And

  According to the endoscope apparatus provided with the auxiliary tool for an endoscope apparatus of the present invention, an endoscope apparatus that can exhibit the operational effects of the auxiliary tool for an endoscope apparatus is obtained.

1A is a front view of an auxiliary device for an endoscope apparatus according to Embodiment 1, FIG. 1B is a plan view of the same, and FIG. 1C is an attachment of the auxiliary device for an endoscope apparatus of FIG. 1A to the endoscope apparatus. It is a perspective view which shows a state. 2A is an exploded perspective view of a gripping tool used in the endoscope tool auxiliary tool of the present invention, FIG. 2B is a perspective view after the gripping tool of FIG. 2A is assembled, and FIG. 2C is a gripping tool of FIG. It is a partially expanded perspective view of the treatment tool mounting tool for using this. FIGS. 3A to 3D are diagrams for explaining in sequence the steps from incision of a lesioned portion to collection using the endoscope apparatus auxiliary tool of Embodiment 1 and the gripping tool of FIG. 2B. 4A is a front view of the auxiliary tool for an endoscope apparatus according to the second embodiment, FIG. 4B is a plan view of the same, and FIG. 4C is an endoscope apparatus to which the auxiliary tool for an endoscope apparatus according to the second embodiment is attached. It is a figure corresponding to FIG. 3C which shows the state inserted in the inside of the lesioned part which cut | disconnected the front-end | tip part. FIG. 5A is a front view of an auxiliary device for an endoscope apparatus according to Embodiment 3, FIG. 5B is a plan view of the same, and FIG. 5C is an attachment of the auxiliary device for an endoscope apparatus of FIG. 5A to the endoscope apparatus. It is a perspective view which shows a state. 6A is a front view of the auxiliary tool for an endoscope apparatus according to Embodiment 4, FIG. 6B is a plan view of the same, and FIG. 6C is a front view when the auxiliary tool for an endoscope apparatus of FIG. 6A is operated. FIG. 6D is a perspective view showing a state in which the distal end portion of the endoscope apparatus in which the endoscope apparatus auxiliary tool of FIG. 6A is attached to the endoscope apparatus is inserted into a lesioned part. FIG. 7A is a front view of an auxiliary tool for an endoscope apparatus according to a fifth embodiment, FIG. 7B is a plan view of the same, and FIG. 7C is a front view when the auxiliary tool for an endoscope apparatus of FIG. is there. FIG. 8A is a front view of an auxiliary tool for an endoscope apparatus according to Embodiment 6, FIG. 8B is a plan view of the same, and FIG. 8C is a front view in the middle of operation of the auxiliary tool for an endoscope apparatus of FIG. . FIG. 9A to FIG. 9D are perspective views for explaining the conventional method of resection of a lesion part by step, FIG. 9E is a sectional view taken along line IXE-IXE in FIG. 9B, and FIG. 9F is a line IXF-IXF in FIG. FIG. FIG. 10A is a front view of a conventional endoscope hood, and FIGS. 10B to 10E are diagrams for explaining a method of excising a lesion using the endoscope hood shown in FIG. 10A step by step. FIG. 11A to FIG. 11C are diagrams for explaining a method for excising a lesion using a conventional endoscope treatment tool in order.

  DESCRIPTION OF EMBODIMENTS Hereinafter, an endoscope apparatus auxiliary tool and an endoscope apparatus using the same according to the present invention will be described with reference to the drawings. An endoscope apparatus auxiliary tool and an endoscope apparatus using the same will be described below. The present invention is not intended to limit the present invention to these, and the present invention can be equally applied to various modifications without departing from the technical concept shown in the claims. Is. In addition, in each drawing used for the description in this specification, in order to make each member a size that can be recognized on the drawing, the scale is appropriately changed for each member. It is not displayed in proportion to the actual dimensions. In addition, the terms “front end side” and “rear end side” in this specification refer to the side where the insertion portion of the endoscope apparatus is present as the “front end side” with respect to the endoscope apparatus, The side where the part exists is used to mean the “rear end side”.

[Embodiment 1]
The assisting device for an endoscope apparatus according to the first embodiment will be described with reference to FIG. 1A is a front view of the endoscope apparatus auxiliary tool of Embodiment 1, FIG. 1B is a plan view, and FIG. 1C is a state in which the endoscope auxiliary tool of FIG. 1A is attached to the endoscope apparatus. FIG.

  The endoscope apparatus auxiliary tool 10 </ b> A according to the first embodiment includes a cylindrical mounting portion 11, a guide tube 12, and a treatment instrument insertion terminal 13. The cylindrical mounting portion 11 is formed of a relatively hard and transparent member such as polyvinyl chloride, polypropylene, polystyrene, or polycarbonate, and has an inner diameter that can be attached to the distal end side of the endoscope apparatus, for example, 5 to 5 The total length may be about 10 to 25 mm. When the cylindrical mounting portion 11 made of a transparent material is used, not only the distal end portion side but also the side surface of the endoscope device can be illuminated, so that the field of view of the endoscope device is widened and the operator can It becomes easy to perform various operations.

  Further, the guide tube 12 can be arbitrarily selected and used as long as it is made of a flexible resin that is usually used for medical purposes. It may be. The inner diameter of the guide tube 12 only needs to be such that the treatment instrument insertion tool to be used can be passed, and the length may be selected to the extent that it can extend to the operation unit of the endoscope apparatus.

  In the endoscope apparatus auxiliary tool 10A according to the first embodiment, the guide tube 12 is joined so that the distal end of the guide tube 12 coincides with the distal end of the cylindrical mounting portion 11, and a treatment instrument is inserted into the rear end of the guide tube 12. A terminal 13 is provided. The tip of the guide tube 12 does not necessarily have to be mounted at a position that coincides with the tip of the cylindrical mounting portion 11 as long as it is joined to the cylindrical mounting portion 11.

  A slit 14 is formed in the guide tube 12 over a predetermined length from the front end side to the rear end side of the guide tube 12. If the cylindrical mounting part 11 is attached to an endoscope apparatus, the length of the slit 14 will be sufficient if the end of the slit 14 is located on the rear end side of the distal end of the endoscope apparatus. The length L from the rear end of the cylindrical mounting portion 11 of the slit 14 is preferably about 1 to 5 cm. If the length L is too short, the details will be described later. However, if the length L is too long, the height of the lesioned part becomes small, and if it is too long, it becomes difficult to apply force to the lesioned part. The broken thread can damage the mucous membrane. The width of the slit 14 may be a width that allows a thread to be described later to pass freely, for example, 0.1 to 0.5 mm, but the thread can easily enter the slit 14 at the tip side. In order to be able to do so, it is preferable that the width is increased in a tapered shape toward the tip side.

  As shown in FIG. 1C, the endoscope apparatus auxiliary tool 10A according to the first embodiment is configured such that the rear end of the cylindrical mounting portion 11 is fitted into the distal end side of the endoscope apparatus 15, and the guide tube 12 is provided at a plurality of locations. It is used by being fixed by the tape 16. The tape 16 is preferably made of silicon rubber. Further, the treatment instrument insertion terminal 13 attached to the guide tube 12 may be positioned in the vicinity of the operation unit 15 a of the endoscope apparatus 15. In this way, the endoscope apparatus auxiliary tool 10A and the endoscope apparatus 15 are integrated, and can be used for excision of a lesion in a body cavity.

  Next, the configuration of the treatment tool and the treatment tool mounting tool for use with the above-described endoscope apparatus auxiliary tool 10A and the endoscope apparatus 15 will be described with reference to FIG. 2A is an exploded perspective view of the treatment instrument used in the auxiliary instrument for an endoscope apparatus of the present invention, FIG. 2B is a perspective view after the assembly of the treatment instrument of FIG. 2A, and FIG. 2C is the perspective view of FIG. It is a partially expanded perspective view of the treatment tool mounting tool for using the treatment tool.

  The treatment instrument 20 includes a pair of claws 21, a thread 22 a connected to a coupling portion 21 a of the pair of claws 21, a pressing ring 23, and a connecting plate 24. This treatment tool 20 is for grasping a lesioned part. For example, the surface of a clip (trade name: HX-600-090) commercially available from Olympus Optical Co., Ltd. is formed from silicon nitride by plasma CVD. What formed the insulating film used was used. As this insulating film, not only silicon nitride but also silicon oxide can be used, and a method for forming an insulating film made of silicon nitride or silicon oxide by the plasma CVD method is well-known and detailed. Description is omitted. In addition, it is preferable to use an extremely fine thread such as Tegs.

  Of the treatment tool 20, a pair of claw portions 21 coupled to each other by a coupling portion 21a, and a presser ring 23 movably provided around the pair of claw portions 21 and the coupling portion 21a are provided. A gripper 27 is configured. The pair of claw portions 21 have their tip portions bent toward each other's claw portions, and these bent tip portions can be opened and closed by operating the presser ring 23. That is, the pair of claws 21 are joined to each other after the intermediate portions in the length direction intersect and the rear end sides of the pair of portions are curved away from each other to form a joint portion 21a. The thread 22a is tied and inserted into the presser ring 23. The yarn 22a may be any material that has flexibility and strength, and suitably used are synthetic fibers such as nylon and polyvinylidene fluoride.

  The presser ring 23 and the pair of claw portions 21 are assembled so as to be movable relative to each other. When the presser ring 23 moves relatively toward the distal end portions of the pair of claw portions 21, the presser ring 23 is moved to the pair of claw portions. When the upper portions of the pair of claws 21 are covered, the tip portions of the pair of claw portions 21 are opened, and when the presser ring 23 covers the vicinity of the tip portions of the pair of claw portions 21, the tip portions are constrained from the outside. Thereby, the state which the front-end | tip part of a pair of nail | claw part 21 closed can be maintained. In this state, the coupling portion 21 a is exposed from the end portion of the presser ring 23.

  On the other hand, the coupling portion 21a of the pair of claw portions 21 is detachably fitted into a notch hole 25 provided at one end portion of the connecting plate 24 that is passed through the presser ring 23, and the treatment instrument 20 is attached. Is configured. The connecting plate 24 is longer than the presser ring 23, and when the coupling portion 21 a is located at the end in the presser ring 23, the engagement hole 26 provided at the end on the opposite side of the connecting plate 24 has a presser. It is exposed from the end of the ring 23. The thread 22 a connected to the coupling portion 21 a of the pair of claws 21 extends outside through the presser ring 23.

  The gripping tool 27 portion of the treatment tool 20 is gripped by the lesioned part as follows by using the treatment tool mounting tool 30 as shown in FIG. 2C. In FIG. 2C, the distal end portion of the left end of the treatment instrument mounting tool 30 is enlarged and displayed. The treatment instrument mounting tool 30 includes an insertion part 31 and an operation part 32. The distal end portion of the insertion portion 31 is provided with a fixing member 33 for holding the treatment instrument 20 and a pin 34 for coupling to the engagement hole 26 provided in the coupling plate 24 of the treatment instrument 20 at the distal end portion. The operation wire 35 is connected to the rear end portion of the insertion portion 31. The operation wire 35 is passed through the first flexible sheath 36 made of a coil sheath, and is connected to the slider 38 through the tube joint 37 of the operation portion 32. The slider 38 passes the operation wire 35 through the operation wire 35. The movement and rotation of the fixing member 33 can be controlled.

  The first flexible sheath 36 passes through the tube joint 37 and the slider 38 and is coupled to the ring 38a. Further, the outer side of the first flexible sheath 36 is covered with a second flexible sheath 39 made of a synthetic resin sheath, and the second flexible sheath 39 is a tube joint 37 of the operation portion 32. The tube joint 37 can control the movement and rotation of the second flexible sheath 39. The tube joint 37 is provided with a hole 37a for passing a thread.

  Next, an operation for attaching the treatment tool 20 and the thread 22a to the treatment tool attachment 30 will be described with reference to FIGS. First, the fixing member 33, the operation wire 35, and the first flexible sheath 36 are extracted from the tube joint 37 by simultaneously pulling out the slider 38 and the ring 38 a of the operation unit 32. Next, a thin elastic wire having a fine needle hole at the tip (not shown) is inserted from the hole 37a provided in the tube joint 37 and protrudes from the opening on the slider side of the tube joint 37. In this state, the thin elastic wire is fixed to the treatment instrument 20. After passing through one end of the thread 22a, the elastic wire is pulled out. Then, one end of the thread 22 a fixed to the treatment instrument 20 is pulled out from the hole 37 a provided in the tube joint 37.

  Thereafter, the engagement hole 26 provided at the end of the connecting plate 24 of the treatment instrument 20 is fitted to the pin 34 of the fixing member 33, and then the treatment instrument 20 is fixed when the treatment instrument 20 is pulled lightly toward the distal end side. It is fixed to the member 33. Next, when the slider 38 is moved to the ring 38 a side, the operation wire 35 and the fixing member 33 are drawn into the first flexible sheath 36, and the holding ring 23 of the treatment instrument 20 is moved to the first flexible sheath 36. The tip is fitted and fixed. In this state, the tip portions of the pair of claws 21 of the treatment instrument 20 are slightly closed. In this state, the fixing member 33 to which the treatment instrument 20 is fixed, the operation wire 35 and the first flexible sheath 36 are integrally inserted into the tube joint 37, and the tube joint 37 is separated from the slider 38. When moved in this manner, the treatment instrument 20 is inserted into the second flexible sheath 39 without being exposed from the tip of the second flexible sheath 39.

  Then, as shown in FIG. 1C, the treatment tool 20 is attached from the treatment tool insertion terminal 13 of the endoscope apparatus auxiliary tool 10A that is integrated with the endoscope apparatus 15 in advance and inserted into the body cavity. The insertion portion 31 of the treatment instrument mounting tool 30 is inserted into the guide tube 12 and protruded from the distal end side of the cylindrical mounting portion 11 of the auxiliary device 10A for the endoscope device, and into the visual field of the endoscope device 15. Guide to the vicinity of the lesion. When the tube joint 37 is pulled in the vicinity of the lesioned portion so that the tube joint 37 and the slider 38 are adjacent to each other, the second flexible tube 39 is pulled up and the treatment instrument 20 is exposed. At this time, the thread 22 a connected to the coupling portion 21 a of the pair of claws 21 in the treatment instrument 20 passes between the first flexible sheath 36 and the second flexible sheath 39 through the holding ring 23. , And extends to the outside through a thread hole 37 a provided in the tube joint 37 of the operation portion 32.

  Here, when the slider 38 is further slowly moved to the ring 38a side, the presser ring 23 of the treatment instrument 20 presses the action portion of the pair of claw portions 21, so that the distal end portions of the pair of claw portions 21 of the treatment instrument 20 are Open wide. In this state, when the distal ends of the pair of claws 21 of the treatment instrument 20 are pressed against the portion to be grasped of the lesioned part 41 (see FIG. 3) and the slider 38 is pulled slowly, the retainer ring 23 of the treatment instrument 20 is moved. Since the pressure is applied to the vicinity of the distal ends of the pair of claws 21, the distal ends of the pair of claws 21 bite into the lesion 41 and grip the lesion 41. At the same time, the coupling portion 21a and the cutout hole 25 of the coupling plate 24 are exposed, so that the coupling plate 24 can be detached from the coupling portion 21a of the pair of claws 21 by operating the operation portion 32, and the lesion portion 41 The gripping tool 27 consisting only of the pair of claw portions 21 and the presser ring 23 of the treatment tool 20 remains fixed.

  Then, by pulling out the tube joint 37, the slider 38, and the ring 38a at the same time, the fixing member 33, the operation wire 35, the first flexible sheath 36, and the second flexible sheath 39 holding the connecting plate 24 are removed. Pull out. Then, the thread 22a extending from the grasping tool 27 of the treatment instrument 20 passes through the guide tube 12 of the endoscope apparatus auxiliary tool 10A and extends to the outside from the treatment instrument insertion terminal 13.

  Hereinafter, with reference to FIG. 3, a method for picking up a lesioned part by lifting the lesioned part using a grasping tool will be described with reference to FIG. 3. 3A to 3D are diagrams for explaining the steps until the lesion is incised and collected using the gripping tool of Embodiment 1 in order.

  As described above, after the lesioned part 41 is gripped by the gripper 27, as in the conventional example shown in FIGS. The lesioned part 41 is raised by locally injecting a drug 44 such as physiological saline or sodium hyaluronate solution. The state at this time is shown in FIG. 3A. The lesioned part 41 may be gripped by the gripper 27 before the lesioned part 41 is raised.

  Next, the thread 22a is pulled by pulling the thread 22a from the operation section 15a (see FIG. 1) side of the endoscope apparatus 15, and simultaneously the operation section 15a of the endoscope apparatus 15 is operated, whereby the thread 22a is guided. The distal end side of the endoscope apparatus 15 is operated so as to enter the slit 14 formed in the tube 12. In this state, an angle θ> 0 between the center line on the distal end side of the endoscope device 15 and the thread 22a can be set, and the thread 22a is pulled more strongly, as shown in FIG. 3B. Furthermore, the lesioned part 41 can be lifted up via the gripper 27.

  In addition, what is necessary is just to repeat the above-mentioned operation, when the lesioned part 41 is large and needs to be lifted in several places. At this time, another treatment tool 20 may be attached to the extracted treatment tool attachment 30 and reused. However, a necessary number of treatment tool attachments 30 each having the treatment tool 20 attached to the fixing member 33 are prepared in advance. In addition, it is desirable to use a replacement because the treatment time can be shortened. In this way, the lesioned part 41 can be gripped by the plurality of grippers 27 through the slits 14 of one guide tube 12, and the plurality of threads 22 a extending from the plurality of grippers 27 can also be guided by the guide tube. It can be made the state extended from the 12 treatment tool insertion terminals 13 outside.

  In this state, when each thread 22a is pulled from the outside, the lesioned part 41 can be raised upward. Therefore, as shown in FIG. 3B, an incision tool 45 such as an IT knife or a snare is inserted from a forceps insertion opening (not shown) of the endoscope apparatus 15 in the same manner as in the conventional example, and the lesion 41 Incision and exfoliation of the lower layer.

  In addition, from the relationship between the position of the lesioned part 41 and the direction in which the thread 22a extends, it may be difficult to raise the lesioned part 41 in a desired direction even if the thread 22a is pulled from the outside. In this case, the lesioned part 41 can be raised in a desired direction by changing the strength of pulling the thread 22a while changing the angle θ between the center line on the distal end side of the endoscope device 15 and the thread 22a. As a result, it becomes easier to incise the lower layer of the lesioned part 41 with the incision tool 45.

  Further, after making an incision in the lower layer of the lesioned part 41, when the force for pulling the thread 22a is weakened and the cylindrical mounting part 11 of the endoscope apparatus auxiliary tool 10A is inserted into the incised part, as shown in FIG. 3C. Further, the lesioned part 41 can be placed on the cylindrical mounting part 11 of the endoscope apparatus auxiliary tool 10A. In this case, even if the lesioned part 41 can be further raised by the angle operation of the endoscope apparatus 15, and even if the pulling force of the thread 22a is weakened to cause play in the thread 22a, the endoscope apparatus Even if the incision tool 45 such as 15 or IT knife is moved, the position of the lesioned part 41 is in a stable state, so that the lower layer of the lesioned part 41 can be easily incised.

  When the lesioned part is raised using a plurality of gripping tools 27, the plurality of threads 22a connected to each gripping tool 27 are independent of each other from the treatment tool insertion terminal 13 of the guide tube 12. Therefore, in order to make each gripping tool 27 and the thread correspond to 1: 1, the holding ring 23 of each gripping tool 27 is displayed for identification, and the thread 22a is also connected thereto. It is preferable to enable corresponding identification. As the display for identification, appropriate means such as identification by different coloring, identification by different numbers and symbols, and the like can be used. In the case of identification by coloring, the coloration of the presser ring 23 and the coloration of the thread 22a can be made the same. In the case of numerical identification, the presser ring 23 is numbered and the thread 22a This can be done by putting a kocher with a corresponding number on the operator side.

  According to the endoscope apparatus auxiliary tool 10A of the first embodiment described above, the entire lesioned part 41 can be raised by a simple operation. Can be excised without any remaining part. Further, since the plurality of gripping tools 27 can be sequentially passed through the slits 14 formed in the guide tube 12 of one endoscope apparatus auxiliary tool 10A, the lesioned part 41 can be gripped, so that the guide tube 12 is thickened. There is no need to do so and the pain given to the patient can be reduced.

  As for the excised lesion part 41, as shown in FIG. 3D, the endoscopic device 15 to which the endoscope apparatus auxiliary tool 10A is attached and the thread 22a are simultaneously pulled out from the body cavity, thereby causing the lesion part 41. Can be taken out of the body. For this reason, according to the first embodiment, it is not necessary to separately capture the lesioned part 41 after the lesioned part 41 is excised, and not only the operation is simplified, but also the operation time can be shortened. It is possible to flexibly cope with the case where the value is large.

[Embodiment 2]
In the endoscope apparatus auxiliary tool 10A according to the first embodiment, an example in which a cylindrical mounting portion is used has been described. However, as is apparent from the description of FIG. In order to insert it, it is necessary to make a large incision in the lesion. In the endoscope apparatus auxiliary tool 10B of the second embodiment, the distal end portion is thinned so that the distal end portion of the endoscope apparatus auxiliary tool 10B is inserted into the incised portion even if the incised portion is small. In addition to facilitating, it is easier to raise the lesion.

  The configuration of the endoscope apparatus auxiliary tool 10B according to the second embodiment will be described with reference to FIG. 4A is a front view of the endoscope apparatus auxiliary tool of the second embodiment, FIG. 4B is a plan view of the same, and FIG. 4C is an endoscope with the endoscope apparatus auxiliary tool of the second embodiment attached thereto. It is a figure corresponding to FIG. 3C which shows the state inserted in the inside of the lesioned part which cut | disconnected the front-end | tip part of the mirror apparatus. 4A to 4C, the same reference numerals are used for the same components as those of the endoscope apparatus auxiliary tool 10A according to the first embodiment and the endoscope apparatus 15 to which the auxiliary tool 10A is attached. The detailed description is omitted.

  In the endoscope apparatus auxiliary tool 10B according to the second embodiment, the inner side of the first embodiment shown in FIGS. 1A and 2A except that the distal end side of the cylindrical mounting portion 11 includes a tapered annular distal end portion 11a. A configuration similar to that of the assisting device for endoscope apparatus 10A is provided. The tapered annular tip portion 11a may be separate from or integrated with the annular mounting portion 11, and is different even if it is made of the same material as the annular mounting portion 11. It may be made of a material. Further, if the tip of the cylindrical mounting portion 11 is provided with a tapered annular tip portion 11a, various processing liquids may accumulate inside, so the cylindrical mounting portion 11 and the tapered annular tip portion 11a. An opening for draining liquid may be provided at the boundary.

  Even when the endoscope apparatus auxiliary tool 10B according to the second embodiment is used, the guide tube 12 is first used in the same manner as when the endoscope apparatus auxiliary tool 10A according to the first embodiment shown in FIGS. 3A and 3B is used. Then, the gripping tool 27 to which the thread 22a is bound is fixed to the lesioned part 41, and the lesioned part 41 is appropriately raised by pulling the thread 22a from the rear end side. Next, a part of the lesioned part 41 is incised by an incision tool 45 such as an IT knife, and the tapered distal end part 11a of the endoscope apparatus auxiliary tool 10B of the second embodiment is inserted into the incision part.

  When the endoscopic apparatus auxiliary tool 10B having such a tapered annular tip portion 11a is used, the size of the incision of the lesioned portion 41 is smaller than the size of the cylindrical mounting 11 as shown in FIG. 4C. However, since the opening of the incision portion is enlarged by inserting the tapered annular tip portion 11a into the opening of the incision portion, the distal end side of the endoscope apparatus auxiliary tool 10B is placed inside the incision portion. This makes it easier to insert the lesion portion 41 and to raise the lesioned portion 41.

  The tapered annular tip portion 11a may be formed of a translucent material. If the tapered annular distal end portion 11a is formed of a translucent material, not only the distal end side of the endoscope device 15 but also the surroundings can be illuminated, so that the visual field of the endoscope device 15 is widened, It becomes easier to peel the lower layer of the lesioned part 41 by the incision tool 45 such as an IT knife inserted into the endoscope apparatus 15.

  In the endoscope apparatus auxiliary tool 10B according to the second embodiment, the distal end of the guide tube 12 is the same as the distal end of the cylindrical mounting portion 11 as in the case of the endoscope apparatus auxiliary tool 10A according to the first embodiment. Although the example which joined to the cylindrical mounting part 11 so that it may become the position of this was shown, you may join to the rear end side of the cylindrical mounting part 11. FIG. Further, although not shown, the tip of the guide tube 12 may be joined to the tapered annular tip portion 11a. With such a configuration, when the lesioned part 41 is gripped by the gripper 27, the gripper 27 can be easily positioned in the field of view of the endoscope apparatus 15, so that the operation becomes easy. Since the thread 22a can be moved to the rear side of the guide tube 12 through the slit 14 after the lesioned part 41 is gripped by the gripper 27, the endoscope apparatus auxiliary tool of the first embodiment is substantially provided. The same effect as in the case of 10A can be achieved.

[Embodiment 3]
In the endoscope apparatus auxiliary tools 10A and 10B according to the first and second embodiments, an example in which a slit having a predetermined length L is used on the distal end side of the guide tube 12 is shown, but the distal end side of the guide tube 12 is a cylindrical mounting portion. If it exists in the position further away from the rear end side of 11, the same effect can be produced. The configuration of the endoscope apparatus auxiliary tool 10C according to the third embodiment in which no slit is formed in the guide tube 12 will be described with reference to FIG. FIG. 5A is a front view of the endoscope apparatus auxiliary tool according to the third embodiment, FIG. 5B is a plan view of the same, and FIG. 5C is an endoscope apparatus auxiliary tool of FIG. 5A. It is a perspective view which shows the state attached. 5A to 5C, the same reference numerals are used for the same components as those of the endoscope apparatus auxiliary tool 10A of Embodiment 1 and the endoscope apparatus 15 to which the auxiliary tool 10A is attached. The detailed description is omitted.

  In the endoscope apparatus auxiliary tool 10C according to the third embodiment, the distal end side of the guide tube 12 is formed at a position further apart from the rear end side of the cylindrical mounting portion 11 by a predetermined distance L. It connects with the cylindrical mounting part 11 by the strip | belt-shaped member 14a. The band-shaped member 14a is formed so that the distal end of the guide tube 12 is between the rear end of the cylindrical mounting portion 11 when the endoscope apparatus auxiliary tool 10C of Embodiment 3 is attached to the distal end of the endoscope apparatus 15. The distance is provided so that the predetermined distance L can always be maintained. That is, even if the belt-like member 14a does not exist and the guide tube and the cylindrical mounting portion are separate, the distance between the tip of the guide tube and the rear end of the cylindrical mounting portion is a predetermined distance L. However, if the guide tube and the mounting part are attached to the endoscope device at the surgical site, the distance between the tip of the guide tube and the rear end of the cylindrical mounting part will vary. As a result, the operator's usability varies.

  Even in this case, the distance L between the distal end of the guide tube 12 and the rear end of the cylindrical mounting portion 11 can be arbitrarily set according to the length of the belt-like member 14a, but the lifting height of the lesioned portion is increased. In order to facilitate various treatments, about 1 to 5 cm is preferable. If this distance is shorter than 1 cm, the height of lifting the lesioned part becomes small, and if it exceeds 5 cm, it is difficult to apply force to the lesioned part, which is not preferable. The belt-like member 14 a is made of the same material as the cylindrical mounting portion 11, is made of the same material as the guide tube 12, or is made of a material different from the cylindrical mounting portion 11 and the guide tube 12. Can be used. Further, a linear member can be used instead of the belt-like member 14a.

  When the endoscope apparatus auxiliary tool 10C according to the third embodiment is fixed to the endoscope apparatus 15, as shown in FIG. 5C, the endoscope apparatus auxiliary tool 10A according to the first embodiment is used. Similarly, it is preferable that the guide tube 12 is fixed to the endoscope device 15 with the tape 16 and the belt-like member 14a is also fixed with the tape 16a. Further, in the endoscope apparatus auxiliary tool 10C of the third embodiment, as in the case of the endoscope apparatus auxiliary tool 10B of the second embodiment shown in FIG. A tapered annular tip can also be provided.

[Embodiment 4]
In the endoscope apparatus auxiliary tool 10B according to the second embodiment, the shape of the distal end portion of the endoscope apparatus auxiliary tool 10B is narrowed so that even if the incision portion is small, the endoscope apparatus auxiliary tool 10B has a small shape. While making it easy to insert the distal end portion into the incised portion, the lesioned portion is more easily raised. However, the bulge of the lesioned part is limited to the maximum diameter of the endoscope apparatus auxiliary tool 10B. Therefore, in the endoscope apparatus auxiliary tool 10D according to the fourth embodiment, a part of the tapered annular distal end portion can be opened by an operation from the rear end side of the endoscope apparatus so that the lesion is raised. It was designed to be larger.

  The configuration of the endoscope apparatus auxiliary tool 10D according to the fourth embodiment will be described with reference to FIG. 6A is a front view of the endoscopic device auxiliary tool of Embodiment 4, FIG. 6B is a plan view of the same, and FIG. 6C is a front view when the endoscopic device auxiliary tool of FIG. 6A is operated. FIG. 6D is a perspective view showing a state in which the distal end portion of the endoscope apparatus in which the endoscope apparatus auxiliary tool of FIG. 6A is attached to the endoscope apparatus is inserted into a lesioned part. 6A to 6D, the same reference numerals are given to the same components as those of the endoscope apparatus auxiliary tool 10B of Embodiment 2 shown in FIG. 4 and the endoscope apparatus 15 attached thereto. Detailed description thereof will be omitted.

  The auxiliary device for endoscope device 10D of the fourth embodiment includes tapered semi-annular tip portions 11b and 11c that are divided into two on the tip side of the cylindrical mounting portion 11, and the cylindrical mounting portion 11. A guide tube 12 having a slit 14 formed on the side surface is provided. These tapered semi-annular tip portions 11b and 11c divide the hollow truncated cone-like tip portion into two vertically from the tip side to the cylindrical mounting portion 11, and further, about one semi-annular tip portion 11b Has a configuration in which a part is integrally connected to the cylindrical mounting portion 11 and an incision is made between the semicircular tip portion 11 b and the cylindrical mounting portion 11. The other semi-annular tip portion 11c is all connected to the cylindrical mounting portion 11. Thereby, the front end side of one semi-annular front end portion 11 b can be opened and closed with respect to the cylindrical mounting portion 11.

  Two threads 22b are fixed to the tip of one semi-annular tip 11b. The two yarns 22b are bundled on the rear end side, passed through the guide tube 12 through the slit 14, and extend to the operation unit side through the treatment instrument insertion terminal 13. The tapered semi-annular tip portions 11b and 11c divided into two are closed when the thread 22b is loosened by the elastic force of the connecting portion between the cylindrical mounting portion 11 and substantially the embodiment. The configuration is the same as that of the endoscope apparatus auxiliary tool 10B.

  Therefore, also when using the endoscope apparatus 15 to which the endoscope apparatus auxiliary tool 10D of the fourth embodiment is attached, first, the endoscope apparatus auxiliary tool 10B of the second embodiment shown in FIG. 4C is used. As in the case of the case, the grasping tool 27 to which the thread 22a is bound through the guide tube 12 is fixed to the lesioned part 41, and the lesioned part 41 is appropriately raised by pulling the thread 22a from the rear end side. Next, a part of the lesion 41 is incised by an incision tool 45 such as an IT knife, and the tapered semicircular tip 11b of the endoscopic device auxiliary tool 10D attached to the endoscopic device 15 is attached to the incision. 11c is inserted. Then, even if the size of the incision of the lesioned portion 41 is smaller than the size of the annular mounting portion 11, the opening of the incised portion is opened by inserting the tapered semi-annular tip portions 11b and 11c into the opening of the incised portion. Since the diameter is increased and enlarged, the distal end side of the endoscope apparatus auxiliary tool 10B can be easily inserted into the incision portion.

  In this state, when the thread 22b is pulled from the rear end side, as shown in FIGS. 6C and 6D, the tip end side of one tapered semi-annular tip end portion 11b is lifted. The lesion 41 can be raised more greatly than in the case of the auxiliary tool 10B. Therefore, when the endoscope apparatus auxiliary tool 10D according to the fourth embodiment is used, an IT knife or the like inserted into the endoscope apparatus 15 is used as compared with the case where the endoscope apparatus auxiliary tool 10B according to the second embodiment is used. It becomes easier to peel the lower layer of the lesioned part 41 by the cutting tool 45.

  The tapered semi-annular tip portions 11b and 11c are preferably formed of a translucent material, and the tapered semi-annular tip portions 11b and 11c and the cylindrical mounting portion 11 are made of different materials. However, it is preferable to form the same material. Note that, in the endoscope apparatus auxiliary tool 10D of the fourth embodiment, the tip of the guide tube 12 is the same as the tip of the cylindrical mounting portion 11 as in the case of the endoscope apparatus auxiliary tool 10A of the first embodiment. Although the example which joined to the cylindrical mounting part 11 so that it may become the position of this was shown, you may join to the rear end side of the cylindrical mounting part 11. FIG.

[Embodiment 5]
In the endoscope apparatus auxiliary tool 10D according to the fourth embodiment, a part of the tapered annular distal end portion can be opened by an operation from the rear end side of the endoscope apparatus, and the bulge of the lesioned portion is increased. As described above, the endoscope apparatus auxiliary tool 10E according to the fifth embodiment can open both the pair of tapered annular tip portions 11b.

  The configuration of the endoscope apparatus auxiliary tool 10E according to the fifth embodiment will be described with reference to FIG. 7A is a front view of the endoscope apparatus auxiliary tool 10E of the fifth embodiment, FIG. 7B is a plan view of the same, and FIG. 7C is a case where the endoscope apparatus auxiliary tool 10E of FIG. 7A is operated. FIG. 7A to 7C, the same reference numerals are given to the same components as those of the endoscope apparatus auxiliary tool 10D of the fourth embodiment shown in FIG. 6, and the detailed description thereof will be omitted.

  The endoscope apparatus auxiliary tool 10E according to the fifth embodiment includes a pair of tapered semi-annular tip portions 11b that are divided into two on the tip side of the cylindrical mounting portion 11, and the cylindrical mounting portion 11 of the cylindrical mounting portion 11. Two guide tubes 12 each having a slit 14 formed on each side surface are provided at both ends in the diameter direction. The pair of tapered semi-annular tip portions 11b divide the tip portion of the hollow truncated cone shape vertically into the cylindrical mounting portion 11 from the tip side, and both are partly cylindrical mounting portions. As a state of being connected to the portion 11, a configuration in which a gap is formed between the pair of semi-annular tip portions 11 b and the cylindrical mounting portion 11 is provided. Thereby, the front end side of a pair of semi-annular front end portions 11 b can be opened and closed with respect to the mounting portion 11.

  Two threads 22b are fixed to the tips of the pair of semi-annular tips 11b. Each of the two yarns 22b is bundled on the rear end side, passes through the guide tube 12 through the slits 14 formed in the pair of guide tubes 12, and passes through the treatment instrument insertion terminal 13 to operate the operation unit. Extended to the side. The pair of tapered semi-annular tip portions 11b are closed to each other when the yarn 22b is loosened by the elastic force of the connecting portion between the pair of cylindrical semi-annular portions 11 and substantially within the second embodiment. It becomes the structure similar to the auxiliary tool 10B for endoscope apparatuses.

  Although not shown in the case of using the endoscope apparatus to which the endoscope apparatus auxiliary tool 10E of Embodiment 5 is attached, initially, the endoscope apparatus auxiliary tool of Embodiment 2 shown in FIG. 4C. As in the case of using 10B, a gripping tool to which a thread is bound through one guide tube 12 is fixed to the lesioned part, and the lesioned part is appropriately raised by pulling the thread from the rear end side. Next, a part of the lesion is incised by an incision tool such as an IT knife, and a pair of tapered semi-annular tip portions 11b of the endoscopic device auxiliary tool 10E attached to the endoscope device are inserted into the incision portion. To do. Then, even if the size of the incision of the lesioned part is smaller than the size of the cylindrical mounting part 11, the opening of the incised part is opened by inserting the pair of tapered semi-annular tip parts 11b into the opening of the incised part. Since the diameter is enlarged and enlarged, the distal end side of the endoscope apparatus auxiliary tool 10E can be easily inserted into the incision portion.

  In this state, when both the yarns 22b are pulled from the rear end portion side, the tip end side of the pair of tapered semi-annular tip portions 11b is lifted, so that it is even larger than in the case of the endoscope apparatus auxiliary tool 10D of the fourth embodiment. The lesion can be raised. Therefore, when the endoscope apparatus auxiliary tool 10E according to the fifth embodiment is used, compared to the case where the endoscope apparatus auxiliary tool 10D according to the fourth embodiment is used, an IT knife or the like inserted into the endoscope apparatus is used. It becomes easier to peel the lower layer of the lesioned part with the cutting tool.

[Embodiment 6]
As shown in FIG. 1, the guide tube 12 of the endoscope apparatus auxiliary tool 10 </ b> A according to the first embodiment is provided with a slit 14 on the distal end side, and the distal end side of the slit 14 is open. Therefore, when the endoscope apparatus 15 to which the endoscope apparatus auxiliary tool 10A is attached is inserted into the body cavity, the mucous membrane may be caught on the distal end side where the slit 14 is opened, and the mucous membrane may be damaged. The endoscope apparatus auxiliary tool 10F according to the sixth embodiment is configured such that the slit 14 is closed when inserted into a body cavity, so that the slit 14 can be opened in the vicinity of the lesion.

  The configuration of the endoscope apparatus auxiliary tool 10F of the sixth embodiment will be described with reference to FIG. 8A is a front view of the endoscope apparatus auxiliary tool 10F according to the sixth embodiment, FIG. 8B is a plan view of the same, and FIG. 8C is a front view when the thread of FIG. 8A is operated. 8A to 8C, the same reference numerals are given to the same components as those of the endoscope apparatus auxiliary tool 10A of the first embodiment shown in FIG. 1, and the detailed description thereof will be omitted.

  As shown in FIGS. 8A and 8B, the endoscope apparatus auxiliary tool 10 </ b> F of Embodiment 6 is an adhesive tape so as to close the slit 14 on the inner surface side of the slit 14 formed in the guide tube 12. 14b is affixed. One end of the thread 22c is fixed to the tip side of the adhesive tape 14b, and the other end of the thread 22c passes through the guide tube 12 and passes through the treatment instrument insertion terminal 13. Extended to the operation side.

  When the endoscope apparatus (not shown) to which the endoscope apparatus auxiliary tool 10F of Embodiment 6 in this state is attached is inserted into the body cavity, the mucous membrane is not sandwiched between the slits 14, and the mucosa is damaged. It is suppressed. In this state, when the endoscope apparatus is inserted to the vicinity of the lesioned part, when the thread 22c is pulled from the rear end side, as shown in FIG. 8C, the adhesive adhered to the inner surface side of the slit 14 The tape 14b is gradually peeled off. When the thread 22c is completely pulled out from the treatment instrument insertion terminal 13, the adhesive tape 14b can be completely removed outside the guide tube 12. Thereafter, a predetermined lesion can be excised in the same manner as in the case of the endoscope apparatus 15 to which the endoscope apparatus auxiliary tool 10A of the first embodiment is attached.

  The configuration of the sixth embodiment is not limited to the endoscope apparatus auxiliary tool 14A of the first embodiment, but also to the endoscope apparatus auxiliary tools 10B, 10D to 10F of the second and fourth to sixth embodiments. Is applicable.

[Modification]
The guide tube 12 of the endoscope apparatus auxiliary tool 10A according to the first embodiment is provided with a slit 14 on the distal end side. The length of the slit 14 is a predetermined length that is predetermined according to the application. For example, it is 1-5 cm. However, it is troublesome and expensive to prepare an auxiliary tool for an endoscope apparatus including a guide tube having a slit having a predetermined length according to the application. Although the illustration of the auxiliary device for the endoscope apparatus according to the modified example is omitted, an adhesive tape is applied to the outer surface side or inner surface side of the slit formed in the guide tube so as to block a part of the rear end side of the slit. Is.

  By adopting such a configuration, if you prepare an auxiliary tool for an endoscope apparatus in which the slit with the maximum length is formed in advance in the guide tube, attach the adhesive tape to the rear end of the guide tube so that it has a predetermined length. If it is attached to the outer surface or inner surface of the side, an auxiliary device for an endoscope apparatus having a target guide tube having a slit having a predetermined length can be obtained. The configuration of the modified example is not limited to the endoscope apparatus auxiliary tool 14A of the first embodiment, but also to the endoscope apparatus auxiliary tools 10B, 10D to 10F of the second and fourth to sixth embodiments. Is also applicable.

DESCRIPTION OF SYMBOLS 10A-10F ... Auxiliary tool for endoscope apparatuses 11 ... Mounting part 11a ... Annular tip part 11b, 11c ... Semi-annular tip part 12 ... Guide tube 13 ... Terminal for treatment tool insertion 14 ... Slit 14a ... Band-like member 14b ... With thread Adhesive tape 15 ... Endoscope device 15a ... Operation part 16, 16a ... Tape 20 ... Treatment tool 21 ... Claw part 21a ... Coupling part 22a-22c ... Thread 23 ... Ring 24 ... Connecting plate 25 ... Hole 26 ... Engagement hole 27 DESCRIPTION OF SYMBOLS ... Grasping tool 30 ... Treatment tool mounting tool 31 ... Insertion part 32 ... Operation part 33 ... Fixing member 34 ... Pin 35 ... Operation wire 36 ... First flexible sheath 37 ... Tube joint 37a ... Hole 38 ... Slider 38a ... Ring 39 ... Second flexible sheath 41 ... Lesions 42 ... Mucosal layer 43 ... Submucosal layer 44 ... Drug 45 ... Cutting tool

Claims (12)

A cylindrical mounting portion that is detachably mounted on the distal end of the endoscope;
A guide tube capable of inserting forceps;
An endoscopic device auxiliary tool for use with a threaded gripper, comprising:
The guide tube is fixed to the outer peripheral surface of the cylindrical mounting portion and from the front end to the rear end side at a position excluding a portion fixed to the outer peripheral surface of the cylindrical mounting portion. An assisting device for an endoscope apparatus, wherein a slit is formed.   The auxiliary device for an endoscope apparatus according to claim 1, wherein a tapered hollow annular distal end portion is provided on a distal end side of the cylindrical mounting portion. The tapered hollow annular tip is composed of a two-part tapered semi-annular tip, and one of the two divided tapered semi-annular tips is attached to the cylindrical mounting part so as to be openable and closable. And the thread is connected to the tip side,
The endoscope apparatus assisting tool according to claim 2, wherein the thread extends in the guide tube to a rear end side. The tapered hollow annular tip is composed of a tapered semi-annular tip divided into two parts, and each of the two divided tapered semi-annular tips is attached to the cylindrical mounting part so as to be openable and closable. And the thread is connected to the tip side,
Two guide tubes in which the slit is formed are provided at both ends in the diameter direction of the side surface of the cylindrical mounting portion,
The endoscope apparatus assisting device according to claim 2, wherein the yarns are individually passed through the two guide tubes and extended to the rear end side. On the inner surface side where the slit of the guide tube is formed, an adhesive tape is stuck so as to close the slit,
A thread is tied to the tip side of the adhesive tape,
The endoscope apparatus assisting tool according to any one of claims 1 to 4, wherein the thread is passed through a guide tube and extends to a rear end side. At least one of the inner surface and the outer surface where the slit of the guide tube is formed, an adhesive tape is attached to the outer surface or the inner surface on the rear end side of the slit,
The auxiliary device for an endoscope apparatus according to any one of claims 1 to 4, wherein the slit is set to have a predetermined length by the adhesive tape.   The auxiliary tool for an endoscope apparatus according to any one of claims 2 to 6, wherein the tapered annular distal end portion is formed of a translucent material.   The guide tube is fixed to the outer peripheral surface of the cylindrical mounting portion so that the tip is positioned at the rear end side of the tip of the cylindrical mounting portion. The auxiliary device for an endoscope apparatus according to any one of claims 7 to 9. A cylindrical mounting portion that is detachably mounted on the distal end of the endoscope;
A guide tube capable of inserting forceps;
An endoscopic device auxiliary tool for use with a threaded gripper, comprising:
The auxiliary device for an endoscope apparatus, wherein the guide tube is integrally coupled to a rear end of the cylindrical mounting portion by a band-shaped member or a linear member.   The endoscopic device assisting tool according to claim 9, wherein a tapered hollow annular distal end portion is provided on a distal end side of the cylindrical mounting portion.   The auxiliary tool for an endoscope apparatus according to claim 10, wherein the tapered annular tip portion is formed of a light-transmitting material. An endoscope apparatus auxiliary tool for use with the gripping tool with a thread according to any one of claims 1 to 11, and an endoscope apparatus,
The cylindrical mounting portion of the endoscope device auxiliary tool is attached to the distal end of the endoscope device, and the guide tube is fixed to the outer peripheral surface of the endoscope device. An endoscope apparatus comprising the featured auxiliary tool for an endoscope apparatus.

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