JP2015134098A - Snare for endoscope - Google Patents

Snare for endoscope Download PDF

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JP2015134098A
JP2015134098A JP2014007056A JP2014007056A JP2015134098A JP 2015134098 A JP2015134098 A JP 2015134098A JP 2014007056 A JP2014007056 A JP 2014007056A JP 2014007056 A JP2014007056 A JP 2014007056A JP 2015134098 A JP2015134098 A JP 2015134098A
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snare
wire
flexible tube
endoscope
sheath
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橋本　真一
Shinichi Hashimoto
真一 橋本
功 坂井田
Isao Sakaida
功 坂井田
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Yamaguchi University NUC
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Abstract

PROBLEM TO BE SOLVED: To provide a thin snare for an endoscope excellent in operability which enables a gripped capsule endoscope to smoothly pass through a pyloric ring.SOLUTION: A snare for an endoscope includes: an operation wire 2; a snare wire 3 connected to the tip of the operation wire 2; and a thread 5, one end of which is fixed to the most leading end part of the snare wire 3 when the snare wire is inserted into a snare sheath 6, the thread 5 being at least longer than the length of the snare sheath 6. One end of the thread may be fixed to the tip part of the snare wire 3, and the other end may be fixed to the wall surface in the vicinity of the tip of the snare sheath 6.

Description

この発明は、カプセル内視鏡の胃内への長時間の停滞を防ぐために、内視鏡を用いてカプセル内視鏡を把持し、速やかに十二指腸へ移送するためのスネアに関するものである。   The present invention relates to a snare for holding a capsule endoscope using an endoscope and quickly transferring it to the duodenum in order to prevent the capsule endoscope from staying in the stomach for a long time.

侵襲性の非常に低いカプセル内視鏡を用いて、胃、十二指腸、小腸又は大腸の内部を撮影し、読影する技術がイスラエルにおいて開発され、日本においても２００３年から臨床試験が開始され、２００７年に保険承認されている。
しかし、カプセル内視鏡の移動は蠕動に依存しているため、患者によって通過速度に大きなばらつきがあるが、小腸や大腸の検査を完遂するためにはバッテリーの持続時間内にカプセル内視鏡を大腸や直腸まで到達させる必要がある。この到達時間を早くするためには、胃の通過時間短縮が非常に重要であることが、これまでの研究によって明らかとなっている。 A technique for imaging and interpreting the inside of the stomach, duodenum, small intestine or large intestine using a capsule endoscope that has a very low invasiveness has been developed in Israel, and clinical trials have started in Japan since 2003. Has been approved for insurance.
However, since the movement of the capsule endoscope depends on peristalsis, the passage speed varies greatly depending on the patient, but in order to complete the examination of the small intestine and large intestine, the capsule endoscope must be moved within the battery duration. It is necessary to reach the large intestine and rectum. Previous studies have shown that shortening the transit time of the stomach is very important for speeding up this arrival time.

そこで、カプセル内視鏡の胃内への長時間の停滞を防ぐために、内視鏡を用いてカプセル内視鏡を把持し十二指腸へ移送する各種の内視鏡用処置具が開発されている。
例えば、特許文献１（特許第４６６５６７１号公報、特に段落００４３〜００４５及び図４を参照）には、内視鏡の挿入部の先端部に円筒状のフードを装着し、鉗子口から吸引を行ってカプセル型内視鏡をフードの先端部に吸着保持させることが記載されている。
また、特許文献２（特開２００７−８９８１３号公報、特に段落００５３〜００５５及び図７を参照）には、フード部材を挿入部の先端部に装着した後、フード部材の先端部を体腔内の医療用カプセルに接近させ、フード部材の内部に医療用カプセルの少なくとも一部が入るように挿入部を操作し、バルーンに流体を供給すると、フード部材の先端部の内周面と膨張したバルーンによって医療用カプセルを保持できることが記載されている。 Therefore, in order to prevent the capsule endoscope from staying in the stomach for a long time, various types of endoscopic treatment tools have been developed that use the endoscope to hold the capsule endoscope and transfer it to the duodenum.
For example, in Patent Document 1 (Japanese Patent No. 4665671, particularly refer to paragraphs 0043 to 0045 and FIG. 4), a cylindrical hood is attached to the distal end portion of the insertion portion of the endoscope, and suction is performed from the forceps opening. It is described that the capsule endoscope is sucked and held at the tip of the hood.
Further, in Patent Document 2 (Japanese Patent Laid-Open No. 2007-89813, particularly refer to paragraphs 0053 to 0055 and FIG. 7), after the hood member is attached to the distal end portion of the insertion portion, the distal end portion of the hood member is placed in the body cavity. When the insertion portion is operated so that at least a part of the medical capsule enters the inside of the hood member and fluid is supplied to the balloon, the inner peripheral surface of the distal end portion of the hood member and the inflated balloon are used. It describes that it can hold medical capsules.

特許第４６６５６７１号公報Japanese Patent No. 4665671 特開２００７−８９８１３号公報JP 2007-89813 A

しかし、特許文献１及び２記載の技術ともに、長さ２６ｍｍ、直径１１ｍｍ程度あるカプセル内視鏡をフード内に挿入して保持するため、先端部に太いフードを装着した経口内視鏡を用いることとなる。そうすると、患者の苦痛が大きく咽頭の麻酔も必要となるので、侵襲性が低いというカプセル内視鏡の長所が削がれてしまう。
また、カプセル内視鏡内服前に咽頭の麻酔を行うと、カプセル内視鏡を気管へ誤嚥する可能性があることから麻酔は内服後となり、カプセル内視鏡を内服してからカプセル内視鏡の把持及び移送までに時間がかかってしまうという問題がある。
さらに、いずれもカプセル内視鏡を把持するための専用装置を用いているため、装置を使いこなすのに時間がかかるという問題や、使用方法を習得するために特別な研修や訓練が必要といった問題もある。
なお、従来利用されている処置具を流用してカプセル内視鏡を把持することも考えられるが、色々な処置具を用いて実際に移送を試みた結果、ポリープ切除用として普及しているスネア以外ではカプセル内視鏡の把持が困難であった。
そして、スネアでカプセル内視鏡を把持した場合には、スネアシースの軸とカプセル内視鏡の長軸とがほぼ直交するため、胃の出口である狭い幽門輪を通過させることが困難であった。 However, both of the techniques described in Patent Documents 1 and 2 use a capsule endoscope having a length of about 26 mm and a diameter of about 11 mm to be inserted and held in the hood. It becomes. In this case, the patient suffers greatly and the pharyngeal anesthesia is required, so that the advantage of the capsule endoscope that the invasiveness is low is removed.
In addition, if the pharynx is anesthetized before taking the capsule endoscope, there is a possibility of aspiration of the capsule endoscope into the trachea. There is a problem that it takes time to hold and transfer the mirror.
In addition, since each uses a dedicated device for grasping the capsule endoscope, there are problems that it takes time to master the device and that special training and training are required to learn how to use it. is there.
Although it is conceivable to hold the capsule endoscope by diverting a conventionally used treatment tool, as a result of actual transfer using various treatment tools, a snare that is widely used for polypectomy In other cases, it was difficult to hold the capsule endoscope.
When the capsule endoscope is gripped by the snare, the axis of the snare sheath and the long axis of the capsule endoscope are almost perpendicular to each other, so that it is difficult to pass the narrow pylorus ring that is the exit of the stomach. .

本発明は、これらの課題を解消するため、次に挙げる事項を目的としてなされたものである。
（１）カプセル内視鏡を把持するための処置具を細くすることにより、細い経口内視鏡や経鼻内視鏡を用いることができ、カプセル内視鏡を把持し十二指腸へ移送するに際しての侵襲性を小さくする。
（２）経鼻内視鏡を用いてカプセル内視鏡を把持し十二指腸へ移送することにより、鼻腔のみの麻酔で済み、カプセル内視鏡の内服と経鼻内視鏡の挿入をほぼ同時に施行できるので、カプセル内視鏡を内服してからカプセル内視鏡の把持及び移送までにかかる時間を短縮する。
（３）カプセル内視鏡を把持するための処置具にスネアを利用しつつ、把持したカプセル内視鏡の長軸を経口内視鏡や経鼻内視鏡の軸にある程度沿わせられるようにすることにより、セッティングや操作がし易く、かつ、把持したカプセル内視鏡が幽門輪をスムーズに通過できるようにする。 In order to solve these problems, the present invention has been made for the following purposes.
(1) By thinning the treatment tool for grasping the capsule endoscope, a thin oral endoscope or transnasal endoscope can be used. When the capsule endoscope is grasped and transferred to the duodenum Reduce invasiveness.
(2) Grasping the capsule endoscope using a transnasal endoscope and transferring it to the duodenum allows only anesthesia of the nasal cavity, and the capsule endoscope and the transnasal endoscope are inserted almost simultaneously. As a result, the time taken from taking the capsule endoscope to grasping and transferring the capsule endoscope can be shortened.
(3) While using a snare as a treatment tool for grasping the capsule endoscope, the long axis of the grasped capsule endoscope can be aligned with the axis of the oral endoscope or transnasal endoscope to some extent. Thus, setting and operation are easy, and the grasped capsule endoscope can smoothly pass through the pyloric ring.

請求項１に係る発明は、内視鏡の可撓管又は該可撓管に挿入されるスネアシースに挿通可能であり、前記可撓管の基端側で操作して前記可撓管の軸線方向に進退させることにより、前記可撓管又は前記スネアシースの先端から突出した部分がループとなる内視鏡用スネアであって、操作ワイヤと、該操作ワイヤの先端に連結されたスネアワイヤと、前記スネアワイヤを前記可撓管又は前記スネアシースの先端から突出させた状態において、前記ループの面が前記可撓管又は前記スネアシースの軸の延長線に対して±４５度〜１３５度の範囲でいずれかの角度をなすように変形させるスネアワイヤ変形手段を備えていることを特徴とする。
なお、「±４５度〜１３５度の範囲」は、一方向へ４５度〜１３５度又はその逆方向へ４５度〜１３５度の角度範囲を意味する。 The invention according to claim 1 can be inserted into a flexible tube of an endoscope or a snare sheath inserted into the flexible tube, and is operated on a proximal end side of the flexible tube to be axially connected to the flexible tube. A portion of the flexible tube or the snare sheath that protrudes from the tip of the snare sheath into a loop. The operation wire, the snare wire connected to the tip of the operation wire, and the snare wire Is projected from the distal end of the flexible tube or the snare sheath, and the surface of the loop is at any angle within a range of ± 45 degrees to 135 degrees with respect to the extension line of the axis of the flexible tube or the snare sheath And a snare wire deforming means for deforming so as to form.
“Range of ± 45 degrees to 135 degrees” means an angle range of 45 degrees to 135 degrees in one direction or 45 degrees to 135 degrees in the opposite direction.

請求項２に係る発明は、請求項１に記載の内視鏡用スネアにおいて、前記スネアワイヤ変形手段は、前記スネアワイヤを前記可撓管又は前記スネアシースに挿通したとき、該スネアワイヤの最も先端となる部分に一端が固定された、少なくとも前記可撓管又は前記スネアシースの長さより長い糸であることを特徴とする。   The invention according to claim 2 is the endoscopic snare according to claim 1, wherein the snare wire deforming means is a portion that becomes the most distal end of the snare wire when the snare wire is inserted into the flexible tube or the snare sheath. One end of the thread is longer than the length of the flexible tube or the snare sheath.

請求項３に係る発明は、請求項１に記載の内視鏡用スネアにおいて、前記スネアワイヤ変形手段は、前記スネアワイヤを前記可撓管又は前記スネアシースに挿通したとき、該スネアワイヤの最も先端となる部分に一端が固定されているとともに、前記可撓管又は前記スネアシースの先端付近の壁面に他端が固定された糸であることを特徴とする。   The invention according to claim 3 is the endoscopic snare according to claim 1, wherein the snare wire deforming means is a portion that becomes the most distal end of the snare wire when the snare wire is inserted into the flexible tube or the snare sheath. One end is fixed to the flexible tube or the snare sheath, and the other end is fixed to the wall surface in the vicinity of the tip of the snare sheath.

請求項４に係る発明は、請求項２又は３に記載の内視鏡用スネアにおいて、前記最も先端となる部分に突起又は凹部を備えていることを特徴とする。   The invention according to claim 4 is characterized in that in the endoscope snare according to claim 2 or 3, a projection or a recess is provided in the most distal end portion.

請求項５に係る発明は、請求項１に記載の内視鏡用スネアにおいて、前記スネアワイヤ変形手段は、前記スネアワイヤの一部に設けた形状記憶合金と、少なくとも前記形状記憶合金の温度を制御する温度制御手段であることを特徴とする。   The invention according to claim 5 is the endoscopic snare according to claim 1, wherein the snare wire deforming means controls the shape memory alloy provided in a part of the snare wire and at least the temperature of the shape memory alloy. It is a temperature control means.

請求項１に係る発明の内視鏡用スネアによれば、細い経口内視鏡や経鼻内視鏡を用いてカプセル内視鏡を把持し、幽門輪をスムーズに通過させて十二指腸へ移送できるので、侵襲性を小さくすることができる。
そして、経鼻内視鏡を用いた場合には、鼻腔のみの麻酔で済み、カプセル内視鏡の内服と経鼻内視鏡の挿入をほぼ同時に施行できるので、カプセル内視鏡を内服してからカプセル内視鏡の把持及び移送までにかかる時間をより短縮することができる。
また、ポリープ切除用として普及しているスネアを利用しているので、医師や看護師がその取り扱いに慣れ易く、セッティングや操作がし易いという効果もある。
さらに、ループの面が可撓管又はスネアシースの軸の延長線に対して±４５度〜１３５度の範囲でいずれかの角度をなすように変形させることができるので、把持したカプセル内視鏡をスムーズに幽門輪へ送り込むことができるだけでなく、カプセル内視鏡の長軸方向やポリープの突出方向から可撓管の先端を近接させつつ、スムーズにスネアワイヤのループをカプセル内視鏡の中央部やポリープの基端部に到達させることができる。なぜなら、内視鏡においては可撓管の先端部に撮像部が設けられ、可撓管の先端方向を観察しながら処置することが多いため、可撓管を先端方向へ移動させながら処置具を所望の位置に誘導する方が、医師にとって操作性が良いからである。 According to the endoscopic snare of the invention according to claim 1, the capsule endoscope can be grasped using a thin oral endoscope or a transnasal endoscope, and can be smoothly passed through the pylorus and transferred to the duodenum. Therefore, invasiveness can be reduced.
When using a nasal endoscope, only anesthesia of the nasal cavity is required, and the capsule endoscope and the nasal endoscope can be inserted almost simultaneously. It is possible to further reduce the time required for grasping and transferring the capsule endoscope.
In addition, since a snare that is widely used for polypectomy is used, doctors and nurses can easily get used to the handling, and can be easily set and operated.
Furthermore, since the loop surface can be deformed so as to make any angle within the range of ± 45 degrees to 135 degrees with respect to the extension line of the flexible tube or the snare sheath, the grasped capsule endoscope Not only can it be smoothly fed into the pyloric ring, but also the snare wire loop can be smoothly inserted into the center of the capsule endoscope while the tip of the flexible tube is brought close to the long axis direction of the capsule endoscope or the protruding direction of the polyp. The base end of the polyp can be reached. This is because in an endoscope, an imaging unit is provided at the distal end of the flexible tube, and treatment is often performed while observing the distal end direction of the flexible tube. This is because it is easier for the doctor to guide to the desired position.

請求項２に係る発明の内視鏡用スネアによれば、請求項１に係る発明の効果に加え、ループの面と可撓管又はスネアシースの軸線との角度を操作によって変化させることができるので、把持したカプセル内視鏡の幽門輪への送り込みやカプセル内視鏡中央部又はポリープ基端部の把持をよりスムーズに行うことができる。   According to the endoscopic snare of the invention according to claim 2, in addition to the effect of the invention of claim 1, the angle between the surface of the loop and the axis of the flexible tube or the snare sheath can be changed by operation. In addition, it is possible to smoothly feed the grasped capsule endoscope to the pyloric ring and grasp the capsule endoscope central portion or the polyp base end portion more smoothly.

請求項３に係る発明の内視鏡用スネアによれば、請求項１に係る発明の効果に加え、糸を固定する構成以外は通常のスネアと同様なので、内視鏡用スネアの可撓管への挿通を通常のスネアと全く同様に行うことができる。
また、請求項２に係る発明と比べて糸を操作する手間なくスネアワイヤを変形させることができる。
なお、請求項２に係る発明の内視鏡用スネアと異なり、ループの面と可撓管又はスネアシースの軸線との角度を操作によって変化させることはできないが、カプセル内視鏡やポリープの直径は予め計測できるので、その直径に合った膨らみとなるようにスネアワイヤを突出させた時に、ループの面が可撓管又はスネアシースの軸の延長線に対して±４５度〜１３５度の範囲でいずれかの角度をなすように糸の長さを調整しておけば良い。
例えば、カプセル内視鏡を把持した状態で９０度の角度をなすようにする場合、カプセル内視鏡の直径をＲ、可撓管又はスネアシースの先端から糸を固定する点までの長さをＬとした時、Ｒ×Ｒ＋Ｌ×Ｌの平方根の長さに調整しておけば良い。 According to the endoscopic snare of the invention according to claim 3, in addition to the effect of the invention of claim 1, the flexible snare for the endoscope snare is the same as the normal snare except for the configuration for fixing the thread. Can be inserted in exactly the same way as a normal snare.
Moreover, compared with the invention which concerns on Claim 2, a snare wire can be deform | transformed without the effort which operates a thread | yarn.
Unlike the endoscope snare according to claim 2, the angle between the loop surface and the axis of the flexible tube or snare sheath cannot be changed by operation, but the diameter of the capsule endoscope or polyp is Since it can be measured in advance, when the snare wire is projected so that it swells to match its diameter, the loop surface is either within the range of ± 45 degrees to 135 degrees with respect to the extension line of the axis of the flexible tube or snare sheath The thread length should be adjusted to make the angle of.
For example, when the capsule endoscope is held at an angle of 90 degrees, the diameter of the capsule endoscope is R, and the length from the tip of the flexible tube or snare sheath to the point where the thread is fixed is L. Then, the length of the square root of R × R + L × L may be adjusted.

請求項４に係る発明の内視鏡用スネアによれば、請求項２又は３に係る発明の効果に加え、スネアワイヤの最も先端となる部分に糸を固定しやすく、固定位置から糸がずれにくいという効果を奏することができる。   According to the endoscopic snare of the invention according to claim 4, in addition to the effect of the invention according to claim 2 or 3, it is easy to fix the yarn to the most tip portion of the snare wire, and the yarn is not easily displaced from the fixing position. The effect that can be produced.

請求項５に係る発明の内視鏡用スネアによれば、請求項１に係る発明の効果に加え、形状記憶合金の温度制御のみによってループの面と可撓管又はスネアシースの軸線との角度を随時に変化させることができる。   According to the snare for an endoscope of the invention according to claim 5, in addition to the effect of the invention of claim 1, the angle between the surface of the loop and the axis of the flexible tube or the snare sheath is controlled only by temperature control of the shape memory alloy. It can be changed at any time.

実施例１に係る内視鏡用スネアのループをカプセル内視鏡の中央部に位置させた状態を示す図。The figure which shows the state which located the loop of the snare for endoscopes which concerns on Example 1 in the center part of the capsule endoscope. 実施例１に係る内視鏡用スネアによってカプセル内視鏡の中央部を把持した状態を示す図。The figure which shows the state which hold | gripped the center part of the capsule endoscope with the snare for endoscopes which concerns on Example 1. FIG. 胃の内部における図１の状態を示す図。The figure which shows the state of FIG. 1 in the inside of a stomach. 胃の内部における図２の状態を示す図。The figure which shows the state of FIG. 2 in the inside of a stomach. 実施例２に係る内視鏡用スネアをスネアシースにセットした状態を示す図。The figure which shows the state which set the snare for endoscopes concerning Example 2 to the snare sheath. 実施例２に係る内視鏡用スネアのループをカプセル内視鏡の長軸方向から近接させた状態を示す図。The figure which shows the state which made the loop of the snare for endoscopes based on Example 2 approach from the major axis direction of the capsule endoscope. 実施例２に係る内視鏡用スネアによってカプセル内視鏡の中央部を把持した状態を示す図。The figure which shows the state which hold | gripped the center part of the capsule endoscope with the snare for endoscopes concerning Example 2. FIG.

以下、実施例によって本発明の実施形態を説明する。   Hereinafter, embodiments of the present invention will be described by way of examples.

図１は、実施例１に係る内視鏡用スネアのループをカプセル内視鏡１の中央部に位置させた状態を示す図である。
実施例１の内視鏡用スネアは、操作ワイヤ２と、操作ワイヤ２の先端に連結されたスネアワイヤ３と、スネアワイヤ３をスネアシース６に挿通したとき、スネアワイヤ３の最も先端となる部分に設けられた突起４と、その突起に固定された糸５からなっている。 FIG. 1 is a diagram illustrating a state in which the loop of the endoscope snare according to the first embodiment is positioned at the center of the capsule endoscope 1.
The snare for an endoscope according to the first embodiment is provided at the most distal end portion of the snare wire 3 when the operation wire 2, the snare wire 3 connected to the distal end of the operation wire 2, and the snare wire 3 are inserted through the snare sheath 6. A projection 4 and a thread 5 fixed to the projection 4.

実施例１の内視鏡用スネアを使用する際には、以下の手順で行う。
（１）スネアシース６に操作ワイヤ２とスネアワイヤ３を挿通した後、スネアワイヤ３の先端部にある突起４に糸５を固定する。
（２）患者にカプセル内視鏡１を服用させる。
（３）可撓管７を患者の口又は鼻から体内に挿入して先端部を胃８の内部に到達させる。
（４）可撓管７の先端部に設けられている撮像部及び照明部（図示せず）を用いて送信される胃８の内部画像を観察しながら可撓管７を操作し、服用させたカプセル内視鏡１を探し出す。
（５）可撓管７の基端部側に設けられている鉗子挿入部（図示せず）からスネアシース６を先端側から糸５とともに挿入し、可撓管７の先端から若干突出した状態とする。
（６）可撓管７の基端部側で操作ワイヤ２を操作してスネアワイヤ３をスネアシース６の先端から突出させ、略楕円形状のループを形成し、必要に応じて可撓管７の基端部側で糸５を引っ張り、ループを適宜の角度に曲げる。
（７）可撓管７を操作してループをカプセル内視鏡１の中央部に位置させる（図１及び３の状態）。
（８）可撓管７の基端部側で操作ワイヤ２を操作してスネアワイヤ３を引き込み、カプセル内視鏡１の中央部を把持する。
（９）可撓管７の基端部側で糸５を引っ張り、把持したカプセル内視鏡１の長軸をスネアシース６の軸に沿わせる（図２の状態）。
（１０）可撓管７を操作してカプセル内視鏡１及びスネアシース６の先端を幽門輪９に移動させる（図４の状態）。
（１１）幽門輪９を通過した後、可撓管７の基端部側で操作ワイヤ２を操作しスネアワイヤ３を押し出してループを緩め、カプセル内視鏡１を解放する。 When using the endoscope snare of Example 1, the following procedure is used.
(1) After the operation wire 2 and the snare wire 3 are inserted through the snare sheath 6, the thread 5 is fixed to the protrusion 4 at the tip of the snare wire 3.
(2) Have the patient take the capsule endoscope 1.
(3) The flexible tube 7 is inserted into the body from the patient's mouth or nose, and the distal end portion reaches the inside of the stomach 8.
(4) The flexible tube 7 is operated and taken while observing the internal image of the stomach 8 transmitted using an imaging unit and an illumination unit (not shown) provided at the distal end of the flexible tube 7. The capsule endoscope 1 is searched.
(5) A state in which the snare sheath 6 is inserted together with the thread 5 from the distal end side from a forceps insertion portion (not shown) provided on the proximal end side of the flexible tube 7 and slightly protrudes from the distal end of the flexible tube 7 To do.
(6) The operation wire 2 is operated on the proximal end side of the flexible tube 7 so that the snare wire 3 protrudes from the distal end of the snare sheath 6 to form a substantially elliptical loop, and if necessary, the base of the flexible tube 7 The yarn 5 is pulled on the end side, and the loop is bent to an appropriate angle.
(7) The flexible tube 7 is operated to position the loop at the center of the capsule endoscope 1 (the state shown in FIGS. 1 and 3).
(8) The operation wire 2 is operated on the proximal end side of the flexible tube 7 to retract the snare wire 3 and grip the center portion of the capsule endoscope 1.
(9) The thread 5 is pulled on the proximal end side of the flexible tube 7, and the long axis of the grasped capsule endoscope 1 is aligned with the axis of the snare sheath 6 (state shown in FIG. 2).
(10) The flexible tube 7 is operated to move the tips of the capsule endoscope 1 and the snare sheath 6 to the pyloric ring 9 (state shown in FIG. 4).
(11) After passing through the pyloric ring 9, the operation wire 2 is operated on the proximal end side of the flexible tube 7 to push out the snare wire 3 to loosen the loop and release the capsule endoscope 1.

図５は、実施例２に係る内視鏡用スネアをスネアシース６にセットした状態を示す図であり、図６は、実施例２に係る内視鏡用スネアのループをカプセル内視鏡１の長軸方向から近接させた状態を示す図である。なお、実施例１と全く同じ構成で良い部分については共通の番号を使用した。
実施例２の内視鏡用スネアは、操作ワイヤ２と、操作ワイヤ２の先端に連結されたスネアワイヤ３と、スネアワイヤ３をスネアシース６に挿通したときスネアワイヤ３の最も先端となる部分に設けられた突起４と、その突起４に一端が固定されているとともにスネアシース６の先端から２〜５ｃｍ程度基端側壁面の固定部１１に他端が固定された糸１０からなっている。 FIG. 5 is a diagram illustrating a state in which the endoscope snare according to the second embodiment is set on the snare sheath 6. FIG. 6 illustrates the loop of the endoscope snare according to the second embodiment of the capsule endoscope 1. It is a figure which shows the state made to adjoin from the long axis direction. In addition, the same number was used about the part which may be the completely same structure as Example 1. FIG.
The snare for the endoscope according to the second embodiment is provided on the operation wire 2, the snare wire 3 connected to the distal end of the operation wire 2, and the portion that becomes the most distal end of the snare wire 3 when the snare wire 3 is inserted into the snare sheath 6. The protrusion 4 is composed of a thread 10 having one end fixed to the protrusion 4 and the other end fixed to the fixing portion 11 on the proximal side wall surface about 2 to 5 cm from the distal end of the snare sheath 6.

実施例２の内視鏡用スネアを使用する際には、以下の手順で行う。
（１）スネアシース６に操作ワイヤ２とスネアワイヤ３を挿通した後、糸１０の一端は突起４に固定し他端はスネアシース６の固定部１１に固定する（図５の状態）。
（２）患者にカプセル内視鏡１を服用させる。
（３）可撓管７を患者の口又は鼻から体内に挿入して先端部を胃８の内部に到達させる。
（４）可撓管７の先端部に設けられている撮像部及び照明部（図示せず）を用いて送信される胃８の内部画像を観察しながら可撓管７を操作し、服用させたカプセル内視鏡１を探し出す。
（５）可撓管７の基端部側に設けられている鉗子挿入部（図示せず）からスネアシース６を先端側から糸１０とともに挿入し、可撓管７の先端から若干突出した状態とする。
（６）可撓管７の基端部側で操作ワイヤ２を操作してスネアワイヤ３をスネアシース６の先端から突出させ、略楕円形状のループを形成する。ループは大きくなるにつれて糸１０に引っ張られ、カプセル内視鏡１の直径より若干大きくなった時点でスネアシース６の軸にほぼ直交する状態となる（図６の状態）。
（７）可撓管７を操作してループをカプセル内視鏡１の中央部に位置させる。
（８）可撓管７の基端部側で操作ワイヤ２を操作してスネアワイヤ３を引き込み、カプセル内視鏡１の中央部を把持する（図７の状態）。
（９）可撓管７を操作してカプセル内視鏡１及びスネアシース６の先端を幽門輪９に移動させる（図４と同様の状態）。
（１０）幽門輪９を通過した後、可撓管７の基端部側で操作ワイヤ２を操作しスネアワイヤ３を押し出してループを緩め、カプセル内視鏡１を解放する。 When using the endoscope snare of the second embodiment, the following procedure is used.
(1) After the operation wire 2 and the snare wire 3 are inserted into the snare sheath 6, one end of the thread 10 is fixed to the protrusion 4 and the other end is fixed to the fixing portion 11 of the snare sheath 6 (state shown in FIG. 5).
(2) Have the patient take the capsule endoscope 1.
(3) The flexible tube 7 is inserted into the body from the patient's mouth or nose, and the distal end portion reaches the inside of the stomach 8.
(4) The flexible tube 7 is operated and taken while observing the internal image of the stomach 8 transmitted using an imaging unit and an illumination unit (not shown) provided at the distal end of the flexible tube 7. The capsule endoscope 1 is searched.
(5) A state in which the snare sheath 6 is inserted from the distal end side together with the thread 10 from a forceps insertion portion (not shown) provided on the proximal end side of the flexible tube 7 and slightly protrudes from the distal end of the flexible tube 7 To do.
(6) The operation wire 2 is operated on the proximal end side of the flexible tube 7 so that the snare wire 3 protrudes from the tip of the snare sheath 6 to form a substantially elliptical loop. As the loop becomes larger, it is pulled by the thread 10 and when it becomes slightly larger than the diameter of the capsule endoscope 1, it becomes almost perpendicular to the axis of the snare sheath 6 (state shown in FIG. 6).
(7) The flexible tube 7 is operated to position the loop at the center of the capsule endoscope 1.
(8) The operation wire 2 is operated on the proximal end side of the flexible tube 7 to draw the snare wire 3 and grip the central portion of the capsule endoscope 1 (state shown in FIG. 7).
(9) The flexible tube 7 is operated to move the tips of the capsule endoscope 1 and the snare sheath 6 to the pylorus ring 9 (the same state as FIG. 4).
(10) After passing through the pylorus 9, the operation wire 2 is operated on the proximal end side of the flexible tube 7 to push out the snare wire 3 to loosen the loop and release the capsule endoscope 1.

実施例１、２の内視鏡用スネアに関する変形例を列記する。
（１）実施例１、２においては、操作ワイヤ２とスネアワイヤ３を挿通したスネアシース６を鉗子挿入部から挿入したが、専用の内視鏡であれば、操作ワイヤ２、スネアワイヤ３及び糸５（実施例２においては糸１０）を直接可撓管７に挿通することも可能である。
なお、実施例２においてそうした場合、糸１０の他端は可撓管７の壁面に設けた固定部に固定することとなる。
（２）実施例１、２においては、ループの面とスネアシース６の軸の延長線がなす角度を、カプセル内視鏡１を把持した状態でほぼ９０度となるようにしているが、同角度は４５度〜１３５度、好ましくは６０度〜１２０度、さらに好ましくは７５度〜１０５度の範囲でいずれかの角度であれば、カプセル内視鏡１の十二指腸への送り込みや把持をスムーズに行うことができる。
また、図２、図６、図７においては、スネアワイヤ３が下側に変形しているが、上側に変形しても同様に操作できるので、上側に変形した場合を、本明細書においてはループの面とスネアシース６の軸の延長線がなす角度に、マイナスを付して記載することとする。
そして、スネアワイヤ３はカプセル内視鏡１を把持する目的以外にも使用できるので、ループの面とスネアシース６の軸の延長線がなす角度は、スネアワイヤ３をスネアシース６の先端から突出させた状態において、±４５度〜１３５度、好ましくは±６０度〜１２０度、さらに好ましくは±７５度〜１０５度の範囲でいずれかの角度であれば、カプセル内視鏡１の十二指腸への送り込みや把持、さらにはポリープ切除等をスムーズに行うことができる。
（３）実施例１、２においては、スネアワイヤ３をスネアシース６に挿通したとき最も先端となる部分に突起４を設けているが、スネアワイヤ３の当該部分の一部又は全周に凹部を設けても良い。
（４）実施例１、２においては、スネアワイヤ３の先端となる部分に糸を固定し、糸を引っ張ることでスネアワイヤ３を変形させているが、スネアワイヤ３を適当な時点で変形させるスネアワイヤ変形手段を備えていれば良い。
例えば、スネアワイヤ３が適当な大きさのループを形成した時にスネアシース６の先端に当たる部分を形状記憶合金とし、少なくとも形状記憶合金部分の温度を熱伝導、電気的な加温素子、電気的な冷却素子等の温度制御手段を用いて変化させることにより、随時にスネアワイヤ３を変形させることができる。
（５）実施例２の使用手順においては、スネアシース６に操作ワイヤ２とスネアワイヤ３を挿通した後、糸１０の一端は突起４に固定し他端はスネアシース６の固定部１１に固定しているが、糸１０の一端又は他端を、スネアシース６に操作ワイヤ２とスネアワイヤ３を挿通する前に予め固定しておいても良い。 The modification regarding the snare for endoscopes of Examples 1 and 2 is listed.
(1) In the first and second embodiments, the snare sheath 6 through which the operation wire 2 and the snare wire 3 are inserted is inserted from the forceps insertion portion. However, if the endoscope is a dedicated endoscope, the operation wire 2, the snare wire 3 and the thread 5 ( In the second embodiment, the thread 10) can be directly inserted into the flexible tube 7.
In the second embodiment, the other end of the yarn 10 is fixed to a fixing portion provided on the wall surface of the flexible tube 7.
(2) In Embodiments 1 and 2, the angle formed by the loop surface and the extension line of the snare sheath 6 is set to approximately 90 degrees in the state where the capsule endoscope 1 is gripped. Is any angle in the range of 45 to 135 degrees, preferably 60 to 120 degrees, more preferably 75 to 105 degrees, and the capsule endoscope 1 is smoothly fed into the duodenum and grasped. be able to.
2, 6, and 7, the snare wire 3 is deformed downward, but it can be operated in the same manner even when deformed upward. The angle formed by the extension line of the surface of the snare sheath 6 and the axis of the snare sheath 6 is described with a minus sign.
Since the snare wire 3 can be used for purposes other than the purpose of grasping the capsule endoscope 1, the angle formed between the loop surface and the axis of the snare sheath 6 is determined in a state where the snare wire 3 protrudes from the tip of the snare sheath 6. If it is any angle in the range of ± 45 degrees to 135 degrees, preferably ± 60 degrees to 120 degrees, more preferably ± 75 degrees to 105 degrees, feeding or grasping the duodenum of the capsule endoscope 1; Furthermore, polypectomy can be performed smoothly.
(3) In the first and second embodiments, the protrusion 4 is provided at the most distal portion when the snare wire 3 is inserted through the snare sheath 6, but a concave portion is provided on a part or the entire periphery of the snare wire 3. Also good.
(4) In the first and second embodiments, the snare wire 3 is deformed by fixing the yarn to the tip portion of the snare wire 3 and deforming the snare wire 3 by pulling the yarn. As long as it has.
For example, when the snare wire 3 forms a loop of an appropriate size, the portion that contacts the tip of the snare sheath 6 is a shape memory alloy, and at least the temperature of the shape memory alloy portion is thermally conductive, an electrical heating element, an electrical cooling element The snare wire 3 can be deformed at any time by changing the temperature control means such as the above.
(5) In the usage procedure of Example 2, after the operation wire 2 and the snare wire 3 are inserted through the snare sheath 6, one end of the thread 10 is fixed to the protrusion 4 and the other end is fixed to the fixing portion 11 of the snare sheath 6. However, one end or the other end of the yarn 10 may be fixed in advance before the operation wire 2 and the snare wire 3 are inserted into the snare sheath 6.

１ カプセル内視鏡 ２ 操作ワイヤ ３ スネアワイヤ
４ 突起 ５、１０ 糸 ６ スネアシース ７ 可撓管
８ 胃 ９ 幽門輪 １１ 固定部 DESCRIPTION OF SYMBOLS 1 Capsule endoscope 2 Operation wire 3 Snare wire 4 Protrusion 5, 10 Thread 6 Snare sheath 7 Flexible tube 8 Stomach 9 Pyloric ring 11 Fixing part

Claims (5)

内視鏡の可撓管又は該可撓管に挿入されるスネアシースに挿通可能であり、前記可撓管の基端側で操作して前記可撓管の軸線方向に進退させることにより、前記可撓管又は前記スネアシースの先端から突出した部分がループとなる内視鏡用スネアであって、
操作ワイヤと、
該操作ワイヤの先端に連結されたスネアワイヤと、
前記スネアワイヤを前記可撓管又は前記スネアシースの先端から突出させた状態において、前記ループの面が前記可撓管又は前記スネアシースの軸の延長線に対して±４５度〜１３５度の範囲でいずれかの角度をなすように変形させるスネアワイヤ変形手段を備えている
ことを特徴とする内視鏡用スネア。 The flexible tube of the endoscope or a snare sheath inserted in the flexible tube can be inserted, and the flexible tube can be operated by moving it in the axial direction of the flexible tube by operating on the proximal end side of the flexible tube. An endoscope snare in which a portion protruding from the distal end of the flexible tube or the snare sheath becomes a loop,
An operation wire;
A snare wire connected to the tip of the operation wire;
In a state where the snare wire is protruded from the distal end of the flexible tube or the snare sheath, the surface of the loop is in a range of ± 45 degrees to 135 degrees with respect to an extension line of the shaft of the flexible tube or the snare sheath. A snare for an endoscope characterized by comprising a snare wire deforming means for deforming to make an angle of. 前記スネアワイヤ変形手段は、前記スネアワイヤを前記可撓管又は前記スネアシースに挿通したとき、該スネアワイヤの最も先端となる部分に一端が固定された、少なくとも前記可撓管又は前記スネアシースの長さより長い糸であることを特徴とする。
請求項１に記載の内視鏡用スネア。 When the snare wire is inserted into the flexible tube or the snare sheath, one end of the snare wire is fixed to the most distal end of the snare wire, and the snare wire deforming means is at least longer than the length of the flexible tube or the snare sheath. It is characterized by being.
The endoscope snare according to claim 1. 前記スネアワイヤ変形手段は、前記スネアワイヤを前記可撓管又は前記スネアシースに挿通したとき、該スネアワイヤの最も先端となる部分に一端が固定されているとともに、前記可撓管又は前記スネアシースの先端付近の壁面に他端が固定された糸であることを特徴とする
請求項１に記載の内視鏡用スネア。 The snare wire deforming means is configured such that when the snare wire is inserted into the flexible tube or the snare sheath, one end is fixed to a portion that becomes the most distal end of the snare wire, and the wall surface near the distal end of the flexible tube or the snare sheath The endoscope snare according to claim 1, wherein the other end is a thread fixed to the endoscope. 前記最も先端となる部分に突起又は凹部を備えていることを特徴とする
請求項２又は３に記載の内視鏡用スネア。 The endoscopic snare according to claim 2, wherein a projection or a recess is provided in the most distal portion. 前記スネアワイヤ変形手段は、前記スネアワイヤの一部に設けた形状記憶合金と、少なくとも前記形状記憶合金の温度を制御する温度制御手段であることを特徴とする
請求項１に記載の内視鏡用スネア。 2. The snare for an endoscope according to claim 1, wherein the snare wire deforming means is a shape memory alloy provided in a part of the snare wire and a temperature control means for controlling a temperature of at least the shape memory alloy. .
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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2018217000A1 (en) * 2017-05-24 2018-11-29 고려대학교 산학협력단 Device for changing mouth/nose position of nasobiliary drainage tube
KR20180128842A (en) * 2017-05-24 2018-12-04 고려대학교 산학협력단 Apparatus for repositioning a nasobiliary catheter from mouth to nostril
CN114145836A (en) * 2021-12-01 2022-03-08 复旦大学附属中山医院 Three-coil sleeve device applied under digestive endoscopy

Citations (16)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPS5252464Y2 (en) * 1975-01-31 1977-11-29
JPS5751516U (en) * 1980-09-09 1982-03-25
JPS63255051A (en) * 1987-04-14 1988-10-21 オリンパス光学工業株式会社 Treatment apparatus for endoscope
JPH0277245A (en) * 1988-05-19 1990-03-16 Olympus Optical Co Ltd Shape-memory action body
JPH06502354A (en) * 1990-10-09 1994-03-17 メッドトロニック・インコーポレイテッド A device or apparatus for manipulating a target object
US5738683A (en) * 1994-07-16 1998-04-14 Osypka; Peter Mapping and ablation catheter
JPH10234743A (en) * 1997-02-27 1998-09-08 Olympus Optical Co Ltd High-frequency excision tool
JPH10509338A (en) * 1994-10-07 1998-09-14 イーピー テクノロジーズ，インコーポレイテッド Flexible structure for supporting electrode elements
US20030109874A1 (en) * 2001-12-07 2003-06-12 Dennis William G. Surgical snare with steering tether and method of using same
JP2004525711A (en) * 2001-04-12 2004-08-26 ボストン サイエンティフィック リミテッド Cryogenic balloon for atrial ablation
US20050043743A1 (en) * 2001-12-07 2005-02-24 Dennis William G. Automatically deforming surgical snare
JP2006223640A (en) * 2005-02-18 2006-08-31 Olympus Corp Treatment device for endoscope
JP2009537280A (en) * 2006-05-19 2009-10-29 コンメッド エンドスコーピック テクノロジーズ インコーポレーテッド Mobile medical device
US20110112434A1 (en) * 2009-11-06 2011-05-12 Ethicon Endo-Surgery, Inc. Kits and procedures for natural orifice translumenal endoscopic surgery
JP2012500054A (en) * 2008-08-14 2012-01-05 ウィルソン−クック・メディカル・インコーポレーテッド Apparatus and method for retrieving an object from a body vessel
JP2013534447A (en) * 2010-07-02 2013-09-05 ユニバーシティ・オブ・ユタ・リサーチ・ファウンデイション Steerable surgical snare and method of use

Patent Citations (16)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPS5252464Y2 (en) * 1975-01-31 1977-11-29
JPS5751516U (en) * 1980-09-09 1982-03-25
JPS63255051A (en) * 1987-04-14 1988-10-21 オリンパス光学工業株式会社 Treatment apparatus for endoscope
JPH0277245A (en) * 1988-05-19 1990-03-16 Olympus Optical Co Ltd Shape-memory action body
JPH06502354A (en) * 1990-10-09 1994-03-17 メッドトロニック・インコーポレイテッド A device or apparatus for manipulating a target object
US5738683A (en) * 1994-07-16 1998-04-14 Osypka; Peter Mapping and ablation catheter
JPH10509338A (en) * 1994-10-07 1998-09-14 イーピー テクノロジーズ，インコーポレイテッド Flexible structure for supporting electrode elements
JPH10234743A (en) * 1997-02-27 1998-09-08 Olympus Optical Co Ltd High-frequency excision tool
JP2004525711A (en) * 2001-04-12 2004-08-26 ボストン サイエンティフィック リミテッド Cryogenic balloon for atrial ablation
US20030109874A1 (en) * 2001-12-07 2003-06-12 Dennis William G. Surgical snare with steering tether and method of using same
US20050043743A1 (en) * 2001-12-07 2005-02-24 Dennis William G. Automatically deforming surgical snare
JP2006223640A (en) * 2005-02-18 2006-08-31 Olympus Corp Treatment device for endoscope
JP2009537280A (en) * 2006-05-19 2009-10-29 コンメッド エンドスコーピック テクノロジーズ インコーポレーテッド Mobile medical device
JP2012500054A (en) * 2008-08-14 2012-01-05 ウィルソン−クック・メディカル・インコーポレーテッド Apparatus and method for retrieving an object from a body vessel
US20110112434A1 (en) * 2009-11-06 2011-05-12 Ethicon Endo-Surgery, Inc. Kits and procedures for natural orifice translumenal endoscopic surgery
JP2013534447A (en) * 2010-07-02 2013-09-05 ユニバーシティ・オブ・ユタ・リサーチ・ファウンデイション Steerable surgical snare and method of use

Cited By (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2018217000A1 (en) * 2017-05-24 2018-11-29 고려대학교 산학협력단 Device for changing mouth/nose position of nasobiliary drainage tube
KR20180128842A (en) * 2017-05-24 2018-12-04 고려대학교 산학협력단 Apparatus for repositioning a nasobiliary catheter from mouth to nostril
KR102131399B1 (en) 2017-05-24 2020-07-08 고려대학교산학협력단 Apparatus for repositioning a nasobiliary catheter from mouth to nostril
CN114145836A (en) * 2021-12-01 2022-03-08 复旦大学附属中山医院 Three-coil sleeve device applied under digestive endoscopy
CN114145836B (en) * 2021-12-01 2024-03-22 复旦大学附属中山医院 Three-wire snare for use under a digestive endoscope

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