JP2018102831A - Endoscope distal hood for photodynamic therapy - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an endoscope distal hood optimal for use in a photodynamic therapy (PDT).SOLUTION: An endoscope distal hood 1 is mounted on a distal end 21a of an endoscope 2. The hood 1 is composed of a substantially cylindrical member, the base end side of which is externally fitted around the distal end 21a of the endoscope 2, and the tip end of which includes an inclined edge part 12a inclined at 20-60° with respect to an axial center AX thereof.SELECTED DRAWING: Figure 3

Description

  The present invention relates to a tip hood attached to a tip portion of an endoscope.

  Recently, a photodynamic therapy (PDT), which is a local treatment using a photochemical reaction caused by a photosensitizing substance that accumulates in cancer and a laser beam, has attracted attention. This PDT is different from conventional treatment methods using physical destruction such as photocoagulation and evaporation by laser, and low energy laser light is applied to a photosensitive substance (PDT drug) that is selectively accumulated in cancer cells. Irradiation is a treatment method that generates excited oxygen due to intersystem crossing and kills cancer cells, and is expected as a minimally invasive treatment method with very little damage to normal tissues.

  When irradiating light to the affected area using a laser light probe as a light source endoscopically, for example, a tip hood is attached to the tip of the endoscope and the endoscope is inserted to the vicinity of the lesion. Then, a probe that emits a laser beam having an optimum wavelength according to the photosensitive substance to be used is inserted into the endoscope forceps channel (treatment instrument guide tube). The probe tip is directed to the lesion, and laser light is irradiated while holding the lesioned part (wall surface part to be treated with the luminal organ) or its vicinity at one end of the tip hood.

  As a general tip hood attached to the tip portion of an endoscope, one having a substantially cylindrical shape and a circular opening that opens in a plane substantially perpendicular to the axis at the tip is used ( Patent Document 1). However, in PDT, it has been clarified that the distance between the lesion and the light source and the irradiation angle of the light to the lesion affect the treatment results. When using a tip hood having a circular opening at the tip, these There is a problem that it is not easy to set the distance and the irradiation angle to the values intended by the operator.

JP 2007-20759 A

  The present invention has been made in view of such a situation, and an object thereof is to provide an endoscope tip hood suitable for use in photodynamic therapy.

In order to achieve the above object, an endoscope tip hood for photodynamic therapy according to the present invention comprises:
An endoscope tip hood composed of a substantially cylindrical member, which is attached to the tip of the endoscope when performing a photodynamic therapy endoscopically,
An endoscope mounting portion to be mounted on the distal end portion of the endoscope;
The endoscope mounting portion and a tip opening formed on the opposite side along the axis; and
The tip opening has an inclined edge portion inclined at 20 to 60 ° with respect to the axis.

  In this invention, it has the inclination edge part which inclines at 20-60 degrees with respect to the axial center in the front-end | tip part of a food | hood. For this reason, after selecting in advance a hood having an appropriate inclination angle and length in accordance with the irradiation angle and irradiation distance intended by the operator, the inclined edge of the hood has a lesion (the wall surface on which the luminal organ is to be treated). The distal end of the endoscope (for example, the distal end opening of the treatment instrument guide tube in which the probe for light emission is arranged) by adjusting the posture of the distal end of the endoscope so as to abut along the circumference of It is easy to set the position (angle and distance) of the part) with respect to the affected part as intended by the operator.

  An alignment mark portion may be provided at a position corresponding to the most protruding portion of the inclined edge portion on the inner surface of the substantially cylindrical member. With this configuration, when the distal end hood is attached to the distal end portion of the endoscope, the positioning of the distal end hood with respect to the distal end portion of the endoscope is easily performed using the landmark portion as a landmark. obtain.

  The substantially cylindrical member positioned at least on the distal end side with respect to the endoscope mounting portion may have a light shielding property. By comprising in this way, it can suppress that light leaks from the front-end | tip hood to the exterior.

  At least the inclined edge portion may have flexibility. By comprising in this way, the inclined edge part of a front-end | tip hood can be stuck to the circumference | surroundings of a lesioned part.

FIG. 1A is a perspective view of an endoscope distal end hood according to an embodiment of the present invention. FIG. 1B is a side sectional view of the endoscope front end hood shown in FIG. 1A. FIG. 2 is a perspective view showing the vicinity of the distal end portion of the endoscope to which the endoscope distal end hood shown in FIG. 1A is attached. FIG. 3 is a perspective view showing a state in which the endoscope tip hood shown in FIG. 1A is attached to the tip of the endoscope shown in FIG. FIG. 4 is a diagram schematically illustrating a state in which the distal end portion of the endoscope to which the endoscope distal end hood illustrated in FIG. 1A is attached is positioned with respect to a lesioned portion of a luminal organ and irradiated with laser light. It is. FIG. 5 is a perspective view of an endoscope distal end hood according to another embodiment of the present invention.

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

  An endoscope tip hood for photodynamic therapy according to an embodiment of the present invention is a tip portion of an endoscope when performing a photodynamic therapy (PDT) photoendoscopically. Used by attaching to. Hereinafter, a case where an esophageal lesion (cancer) as a luminal organ is treated by PDT will be described as an example.

  As shown in FIGS. 1A and 1B, the endoscope distal end hood 1 is formed of a substantially cylindrical member as a whole, and a distal end portion 21 of the endoscope 2 is disposed on the proximal end side thereof (see FIGS. 2 and 3). An endoscope mounting portion 11 that is externally fitted to the hood portion 12 is provided, and a hood portion 12 is provided on the distal end portion side.

  The hood part 12 has a tip opening part at the tip part, and the tip opening part has an inclined edge part 12 a that is inclined at a predetermined angle θ with respect to the axis AX of the tip hood 1. Then, the inclined edge 12a has an elliptical shape. That is, the tip opening has an elliptical inclined edge that is obtained by cutting a substantially cylindrical member at a plane oblique to the axis AX at a predetermined angle θ, and becomes an elliptical opening. Yes.

  A substantially linear concave groove (marking portion) 12b is formed on the inner surface of the hood portion 12 as a mark for aligning the position around the axis AX with the distal end portion of the endoscope 2. In the present embodiment, the hood portion 12 (the elliptical inclined edge portion 12a) is formed halfway along the axis AX direction from the most protruding portion.

  Note that the proximal end surface of the endoscope mounting portion 11 is a circular opening substantially orthogonal to the axis AX. The endoscope mounting part 11 is formed with a notch part 11a penetrating therethrough. The hood portion 12 is formed with a through-hole 13 penetrating inside and outside as a discharge port for preventing body fluid such as saliva and gastric juice from accumulating inside the hood portion 12 (see FIG. 1A).

  The inner diameter d of the endoscope mounting portion 11 is set in relation to the outer diameter of the distal end portion of the endoscope 2 to which the endoscope mounting portion 11 is mounted, and is preferably about φ4 to 12 mm. The inner diameter of the hood portion 12 is set slightly smaller than the inner diameter d of the endoscope mounting portion 11, and there is a step at the boundary position between the endoscope mounting portion 11 and the hood portion 12 on the inner peripheral side of the tip hood 1. Is formed. When the distal end portion of the endoscope is inserted into the endoscope mounting portion 11 and the edge of the distal end surface of the endoscope is abutted against this step, the distal end surface of the endoscope is used as the endoscope mounting portion in the distal end hood 1. 11 and the hood portion 12. Although the dimension (projection length from the distal end surface of the endoscope) L1 of the longitudinal direction (direction along the axis AX) of the hood portion 12 is set according to the distance between the lesion intended by the operator and the light source, etc. , Preferably in the range of 5-30 mm. The dimension L2 in the longitudinal direction (direction along the axis AX) of the endoscope mounting portion 11 is preferably set to about 2 to 20 mm.

  The predetermined angle θ with respect to the axis AX of the inclined edge portion 12a of the hood portion 12 can be set in a range of 20 to 60 °, and more preferably set in a range of 20 to 45 °. In this embodiment, as an example, θ = 30 ° is set. The predetermined angle θ may be set according to the light irradiation angle with respect to the lesion intended by the operator.

  The endoscope mounting portion 11 and the hood portion 12 may be integrally formed of the same material at the same time, or may be formed as separate members and then integrated with each other.

  The endoscope mounting part 11 and the hood part 12 can be made of a transparent or translucent material so that the inside thereof can be visually recognized. However, from the viewpoint of avoiding light irradiation to a place unintended by the operator due to light leakage. It is preferable that at least the hood portion 12 has light shielding properties. The endoscope mounting portion 11 may be made of a material that does not have light shielding properties, and the hood portion 12 may be made of a material that has light shielding properties. Further, the hood portion 12 is made of a material that does not have a light-shielding property, and is additionally provided with a light-shielding property by sticking a light-shielding tape or the like around it or by applying a light-shielding paint. You may do it.

  Further, it is preferable that at least the inclined edge portion 12a of the hood portion 12 has flexibility so as to be in close contact with the periphery of the lesioned portion of the luminal organ when it is brought into contact with the periphery of the lesioned portion. The entire hood portion 12 may be flexible. Further, the endoscope mounting portion 11 may have flexibility similar to the hood portion 12 on the condition that the function of securely fixing to the distal end portion of the endoscope is not impaired. In the present embodiment, it is assumed that the endoscope mounting portion 11 and the hood portion 12 are manufactured by integrally molding simultaneously using the same polymer material. As the polymer material constituting the endoscope mounting portion 11 and / or the hood portion 12, polycarbonate resin, polyacetal resin, silicone rubber, ethylene propylene rubber, various thermoplastic elastomers, and the like can be used.

  Next, an endoscope (electronic endoscope) to which an endoscope tip hood according to an embodiment of the present invention is attached will be outlined with reference to FIG. The endoscope 2 includes an insertion portion 21 made of a flexible tubular member having a distal end portion 21a inserted into the body (inside a luminal organ such as the esophagus) and a proximal end portion (not shown) disposed outside the body. And an operation unit (not shown) arranged at the proximal end of the insertion unit 21 and the like. The operation part is provided with an operation knob or the like for deflecting the distal end part 21a of the insertion part 21 and its vicinity.

  Although not shown in the drawing, the treatment instrument guide tube for inserting various endoscope treatment instruments (in this embodiment, a laser probe used as a light source for PDT) is omitted. As a forceps channel, a wiring channel through which electrical wiring to a CCD (imaging device) or the like provided at the distal end of the insertion portion 21 is inserted, a fiber channel through which an optical fiber for illumination (light guide) is inserted, gas Alternatively, a suction channel for sucking a liquid, a water supply channel for injecting a chemical solution, an air supply channel for sending air and the like are formed.

  The distal end portion 21a of the insertion portion 21 has a distal end opening 21b that is an outlet of the forceps channel, an imaging portion 21c having an objective lens and a CCD, and an illumination port 21d that emits illumination light from the distal end of the optical fiber inserted through the fiber channel. , 21d are provided. Although not shown, the distal end portion 21a of the insertion portion 21 is also provided with a suction channel, a water supply channel, and a suction port, a water supply port, and an air supply port corresponding to the air supply channel.

  Illumination light from a light source device (not shown) is sent through an optical fiber, emitted from the illumination ports 21d and 21d on the distal end surface of the insertion portion 21, and the lesioned portion of the luminal organ is illuminated, and imaged by the imaging unit 21c. The displayed image is displayed on a monitor (not shown).

  As shown in FIG. 3, the endoscope distal end hood 1 according to the present embodiment is attached to the distal end portion 21 a of the insertion portion 21 of the endoscope 2. The tip hood 1 is inserted by winding and affixing a sterilized elastic plastic tape (not shown) or the like in a state where the endoscope mounting portion 11 is externally fitted to the tip portion 21a of the insertion portion 21. It is fixed (attached) to the tip 21 a of the part 21.

  The laser probe 3 is inserted into the forceps channel from the operation part side of the endoscope 2 in order to irradiate the lesion part in the hollow organ with the laser light for PDT. The laser probe 3 includes a flexible tube having a distal end and a proximal end, an optical fiber (light guide) inserted through the tube, and a laser beam provided at the distal end of the tube and transmitted by the optical fiber. And a laser beam emitting section that emits light. The proximal end of the optical fiber is connected to a semiconductor laser generator not shown.

  The tip of the laser beam emitting portion of the laser probe 3 inserted into the forceps channel is disposed in the vicinity of the tip opening 21 b on the tip surface of the insertion portion 21. In a semiconductor laser generator not shown, laser light having a wavelength (for example, wavelength 633 nm) optimum for PDT is generated, and the laser light is emitted from the laser light emitting portion at the tip of the laser probe 3.

  Here, in order to carry out PDT, 633 nm is exemplified as the optimum wavelength of laser light for this, but the optimum wavelength is used in relation to the PDT agent (photosensitive substance) to be used.

  Next, the PDT using the endoscope tip hood 1 according to the present embodiment described above will be outlined.

  First, the endoscope distal end hood 1 according to the present embodiment is attached to the distal end 21 a of the insertion portion 21 of the endoscope 2. That is, the distal end portion 21 a of the insertion portion 21 of the endoscope 2 is inserted from the proximal end portion side of the endoscope mounting portion 11 of the distal end hood 1, and the endoscope mounting portion 11 is externally attached to the distal end portion 21 a of the insertion portion 21. Fit.

  When inserting the endoscope mounting portion 11 into the distal end portion 21a of the insertion portion 21, the endoscope distal end hood 1 is appropriately rotated relatively around the axis AX, and the groove 12b of the distal end hood 1 is inserted. The position in the rotational direction is adjusted so as to correspond to the distal end opening 21b of the forceps channel on the distal end surface of the portion 21. Thereafter, a plastic tape (not shown) is wound around a portion including a joint portion between the endoscope mounting portion 11 and the distal end portion 21a of the insertion portion 21, and the distal end hood 1 is fixed to the distal end portion 21a of the insertion portion 21. To do.

  The insertion part 21 of the endoscope 2 to which the tip hood 1 is attached is inserted from the mouth of a patient to whom a PDT drug has been administered in advance (oral administration, intravenous injection, etc.), and the image captured by the imaging part 21c is monitored. Meanwhile, the distal end portion 21a of the insertion portion 21 is inserted to the site (lesioned portion) where the esophagus is to be treated. Next, the laser probe 3 is inserted into the forceps channel, and the tip of the laser light emitting portion of the laser probe 3 is protruded from the tip opening 21b of the forceps channel on the tip surface of the insertion portion 21 by a predetermined protruding length b. (See FIG. 4). The position (protrusion length b) of the tip of the laser beam emitting portion of the laser probe 3 can be adjusted by, for example, the insertion length of the laser probe 3 with respect to the forceps channel of the endoscope.

  In this state, as shown in FIG. 4, the posture of the distal end portion 21 a of the insertion portion 21 is adjusted so that the elliptical inclined edge portion 12 a of the hood portion 12 follows the lesion portion 4 to be treated. The inclined edge portion 12 a of the portion 12 is brought into contact with the lesioned portion 4 so as to be in close contact with the entire lesioned portion 4. If necessary, the gas in the tip hood 1 may be sucked through the intake channel to enhance the adhesion of the inclined edge 12a to the periphery of the lesioned part 4.

  In this state, the laser beam L is emitted from the light emitting portion of the laser probe 3 for a predetermined time (for example, about 11 minutes). When a PDT drug selectively accumulated in cancer cells is irradiated with laser light, the cell destruction action (for example, generation of excited oxygen) of the PDT drug is exerted to kill the cancer cells. it can. When the lesioned part 4 is wider than the irradiation range of the laser light L, the range where the inclined edge 12a of the hood part 12 is in close contact is shifted along the inner wall surface of the lesioned part 4, and the same operation can be repeated. That's fine.

  In the above-described embodiment, the hood portion 12 of the endoscope distal end hood 1 has the inclined edge portion 12a that obliquely intersects with the axis AX at a predetermined angle θ (in this embodiment, θ = 30 °). . For this reason, by arranging the distal end portion 21a of the insertion portion 21 as described above (arranged as shown in FIG. 4), the optical axis of the laser light L emitted from the laser light emitting portion of the laser probe 3 and the lesioned portion. The angle (elevation angle) formed by the inner wall surface including 4 can be set to a substantially angle θ. Accordingly, by using the tip hood 1 with the angle θ selected according to the intended light irradiation angle, light irradiation at the intended irradiation angle can be easily performed. In addition, taking into account the position (protrusion length b) of the tip of the laser beam emitting portion of the laser probe 3 and the position of the tip opening 21b of the forceps channel of the endoscope 2, the dimension in the longitudinal direction of the hood portion 12 ( By using the tip hood 1 with the dimension L1) selected, the distance on the optical axis between the tip surface of the laser beam emitting portion of the laser probe 3 and the lesioned portion 4 is set to an intended distance a (for example, 17 mm). Can be set to Thus, an elliptical irradiation region having an intended size can be obtained according to the laser spot diameter of the laser probe 3 to be used.

  Further, according to the above-described embodiment, the tip hood 1 has the groove 12b as a mark portion for alignment at the inner surface of the hood portion 12 and corresponding to the most protruding portion of the inclined edge portion 12a. Therefore, when the distal end hood 1 is attached to the distal end portion 21a of the insertion portion 21 of the endoscope 2, the groove 12b is used as a mark, and the axis AX around the distal end portion 21a of the insertion portion 21 of the distal end hood 1 is used. Can be easily aligned.

  Furthermore, according to the above-described embodiment, the tip hood 1 has the light shielding property while the inclined edge portion 12a of the hood portion 12 obliquely intersects the axis AX at a predetermined angle θ. 4, the laser light L emitted from the laser light emitting portion of the laser probe 3 or the reflected light thereof can be prevented from leaking from the inside of the hood portion 12 to the outside. For this reason, it is possible to effectively prevent the laser light from being irradiated to a portion that is not intended to be irradiated.

  As shown in FIG. 1B, the inclined edge portion 12a of the hood portion 12 has a smooth shape such as an arc shape as shown by reference numeral 12c in FIG. This is preferable from the viewpoint of reducing the burden on the wall surface of the luminal organ when it is brought into contact with the luminal organ or when the insertion portion 21 of the endoscope 2 is inserted into the luminal organ.

  Further, since the hood portion 12 of the tip hood 1 has flexibility, as shown in FIG. 4, when the inclined edge portion 12 a of the hood portion 12 is brought into contact with the periphery of the lesioned portion 4, Since it is less likely to deform the periphery of the lesioned part 4 more than necessary, adverse effects on the lesioned part 4 can be reduced, and the distal end of the hood part 12 can be in close contact with the periphery of the lesioned part 4. It is possible to further suppress the leakage of laser light from the inside to the outside.

  In the above-described embodiment, the case where the substantially straight groove 12b is provided as an alignment mark around the axis AX between the distal end hood 1 and the distal end portion 21a of the endoscope 2 is illustrated. The alignment mark may be a substantially straight convex protrusion instead of the substantially straight groove 12b. Further, the alignment mark is not limited to the substantially linear groove 12b or the protrusion, but may be a concave or convex portion such as a circle or a triangle. Further, the alignment mark is not limited to the shape configured as described above, but may be a linear mark 12d drawn (applied) as shown in FIG. Also in this case, the mark as the mark is not limited to a straight line, and may be a circle or a triangle.

  In the above-described embodiment, the hood portion 12 having the inclined edge portion 12a obliquely intersecting with the axis AX is shaped like a substantially cylindrical member cut obliquely. It is good also as a shape which cut | disconnected the cylindrical member diagonally. Further, the hood portion 12 may have a cylindrical shape other than a cylinder.

  The embodiment described above is described for facilitating understanding of the present invention, and is not described for limiting the present invention. Therefore, each element disclosed in the above-described embodiment is intended to include all design changes and equivalents belonging to the technical scope of the present invention.

DESCRIPTION OF SYMBOLS 1 ... Endoscope hood 11 ... Endoscope mounting part 12 ... Hood part 12a ... Inclined edge part 12b ... Groove (marking part)
2 ... Endoscope 21 ... Insertion part 21a ... Tip part 3 ... Laser probe 4 ... Lesion part of luminal organ

Claims (4)

An endoscope tip hood composed of a substantially cylindrical member, which is attached to the tip of the endoscope when performing a photodynamic therapy endoscopically,
An endoscope mounting portion to be mounted on the distal end portion of the endoscope;
The endoscope mounting portion and a tip opening formed on the opposite side along the axis; and
An endoscope distal end hood for photodynamic therapy, wherein the distal end opening has an inclined edge portion inclined at 20 to 60 ° with respect to the axis.   2. The photodynamics according to claim 1, further comprising a mark portion for alignment at a position corresponding to the most protruding portion of the inclined edge portion on the inner surface of the substantially cylindrical member. Endoscope hood for treatment.   The endoscope distal end hood for photodynamic therapy according to claim 1 or 2, wherein at least the substantially cylindrical member positioned on the distal end side with respect to the endoscope mounting portion has a light shielding property.   The endoscope front hood for photodynamic therapy according to any one of claims 1 to 3, wherein at least the inclined edge portion has flexibility.

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