JP2018102835A - Endoscope distal hood - 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 of an endoscope including a channel on which a light-emitting probe 3 is disposed forward/rearward movably in an axial center AX direction, and is composed of a substantially cylindrical member. The distal hood 1 includes: an endoscope mount part 11 to be mounted on the distal end of the endoscope; and a hood part 12 formed at an opposite side of the endoscope mount part 11, along the axial center AX. The hood part 12 includes a graduation part 13 representing a position in an advance direction of the probe 3 that advances from the channel, formed at an inner surface thereof.SELECTED DRAWING: Figure 1A

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 an affected area using a laser 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 having a circular opening at the tip is used (see Patent Document 1). However, in PDT, it has become clear that the length of the probe protruding from the distal end of the endoscope (probe protruding length) and the distance between the lesion and the probe (irradiation distance) affect the treatment results. When a general tip hood is used, there is a problem that it is not easy to adjust the probe protrusion length and irradiation distance to values intended by the operator and keep them constant during light irradiation.

JP 2013-248353 A

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

In order to achieve the above object, an endoscope tip hood according to the present invention includes:
A tip hood for an endoscope, which is attached to the tip of an endoscope having a channel in which a probe for emitting light is disposed so as to be able to advance and retreat in the axial direction, and is composed of a substantially cylindrical member,
An endoscope mounting portion mounted on a distal end portion of the endoscope;
A hood portion formed on the opposite side along the axis with the endoscope mounting portion;
A scale portion provided on an inner surface of the hood portion and indicating a position in the advancing direction of the probe advancing from the channel.

  When the distal end hood for an endoscope according to the present invention is attached to the distal end portion of the endoscope and the probe is inserted into the endoscope, the distal end of the probe advances from the channel of the endoscope in the endoscopic image. Part and the scale part are displayed. Therefore, the position (probe projection length) of the probe tip surface that advances from the endoscope channel can be easily confirmed, and the position of the probe tip surface in the axial direction relative to the tip portion of the hood portion is appropriately set. Can keep. For this reason, a part or all of the distal end portion of the hood portion is brought into contact with or near the lesioned portion (wall surface portion to be treated with the luminal organ), and the posture of the distal end portion of the endoscope is appropriately adjusted. Thus, it becomes easy to adjust the probe protrusion length and irradiation distance to values intended by the surgeon and keep them appropriately.

  It is preferable that the scale part includes a plurality of scale lines that are spaced apart in the axial direction. The graduation portion may be constituted by a single graduation line. However, by constituting the graduation portion by a plurality of graduation lines that are arranged apart from each other in the axial direction, it becomes easier to grasp the position of the tip surface of the probe.

FIG. 1A is a perspective view of a distal end hood for an endoscope according to an embodiment of the present invention. FIG. 1B is a cross-sectional view taken along line Ib-Ib 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. 3 is a side sectional view showing a state in which the endoscope distal end hood shown in FIG. 1A is attached to the distal end portion of the endoscope shown in FIG. FIG. 4A shows the position of the distal end of the endoscope to which the distal end hood for an endoscope shown in FIG. 1A is attached with respect to the lesioned portion of the luminal organ, and irradiates the laser beam from the probe inserted into the forceps channel. It is a figure which shows typically the state which carried out. FIG. 4B shows a probe inserted into a forceps channel by positioning the distal end portion of an endoscope to which a distal end hood for an endoscope according to another embodiment of the present invention is attached with respect to a lesioned portion of a luminal organ. It is a figure which shows typically the state which irradiated the laser beam. FIG. 5 is a diagram schematically illustrating an image captured by the imaging unit of the endoscope to which the endoscope front hood illustrated in FIG. 1A is attached.

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

First Embodiment An endoscope distal end hood according to an embodiment of the present invention is used by being attached to the distal end portion of an endoscope. This endoscopic tip hood can be suitably used for an endoscope used for a photodynamic therapy (PDT: Photo Dynamic Therapy). 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 distal end hood 1 for an endoscope is formed of a substantially cylindrical member as a whole, and a distal end portion 21 of the endoscope 2 (see FIGS. 2 and 3) on the base end side thereof. ), And has a hood portion 12 on the distal end side thereof.

  The hood portion 12 has a tip opening edge portion 12a at the tip, and in this embodiment, the tip opening edge portion 12a has a circular shape. That is, the tip opening edge portion 12a is a circular opening cut by a plane substantially orthogonal to the axis AX. In the present embodiment, the axis AX is an axis of a substantially cylindrical member, and the endoscope mounting portion 11 and the hood portion 12 are located on the opposite sides along the axis AX. The hood portion 12 is formed with a through-hole 12b 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. 3). Further, the inner surface of the hood portion 12 has a concave shape extending along the direction of the axis AX as a mark for aligning the position around the axis AX with the distal end of the endoscope 2 (see FIGS. 2 and 3). A groove, a mark, or the like may be formed.

  In the present embodiment, the position in the advancing direction of the laser probe 3 that advances from a distal end opening 21b (see FIG. 2) described later (from the distal end surface of the endoscope 2 on the distal end surface of the laser probe 3) The scale part 13 which shows the protrusion length) is formed. In this embodiment, the scale part 13 is comprised including the several scale line spaced apart and arrange | positioned in the axial center AX direction. The number of graduation lines 13 may be one or more, but in the present embodiment, the number of graduation lines 13 is three from the viewpoint of making it easier to grasp the protruding length of the laser probe 3.

  Each scale line of the scale portion 13 includes a portion corresponding to the tip opening 21b along the circumferential direction of the inner surface of the hood portion 12 in a state where the tip hood 1 is attached to the tip portion 21a of the endoscope 2. It is formed in an arc shape so as to extend on both sides. In the present embodiment, each graduation line of the graduation portion 13 has an arc shape along the inner surface of the hood portion 12, but may be formed over the entire circumference of the inner surface of the hood portion 12. The length of each scale line in the scale portion 13 in the arc direction is preferably larger than the outer diameter of the laser probe 3, and preferably 1.5 times or more the outer diameter of the laser probe 3.

  In the present embodiment, each scale line of the scale portion 13 is formed by a mark drawn on the inner surface of the hood portion 12 with a predetermined color paint. The color of the scale line can be easily identified in relation to the color of the inner surface of the hood unit 12 in the endoscopic image (the image captured by the imaging unit 21c of the endoscope 2 and displayed on the monitor). Color. The color of the graduation line is preferably a conspicuous color with respect to the color of the body tissue that is transparent and transparent when the color of the hood portion 12 is transparent, for example, black, blue, purple, green, yellow If the color of the hood portion 12 is black, it may be white, silver, gold, yellow, green, purple, etc. it can.

  Each scale line constituting the scale portion 13 does not have to be drawn by paint, but is formed in a bottomed groove, a groove penetrating inside or outside, or a convex ridge shape so that it can be identified in shape. It may be. The scale portion 13 may be formed by engraving or the like. Moreover, as the scale part 13, other than what is based on a single or several scale line, you may be comprised by the mark etc. of a single or several circle | round | yen, a triangle, etc.

  The inner diameter d1 of the endoscope attachment portion 11 is set in relation to the outer diameter of the distal end portion of the endoscope 2 to which the endoscope attachment portion 11 is attached, but is preferably about φ4 to 20 mm. The inner diameter d2 of the hood part 12 is set to a slightly smaller dimension (for example, a dimension smaller by 0.1 to 2 mm) than the inner diameter d1 of the endoscope mounting part 11, and the endoscope is mounted on the inner peripheral side of the tip hood 1. A step is formed at the boundary position between the portion 11 and the hood portion 12. When the distal end portion of the endoscope 2 is inserted into the endoscope mounting portion 11 and the edge of the distal end surface of the endoscope 2 is abutted against this step, the distal end surface of the endoscope 2 is viewed in the distal end hood 1. It can be located at the boundary between the mirror mounting portion 11 and the hood portion 12.

  The dimension (protrusion length from the distal end surface of the endoscope) L1 in the longitudinal direction (direction along the axis AX) L1 of the hood portion 12 shown in FIG. 1B is the protrusion of the probe 3 intended by the operator when performing PDT What is necessary is just to determine according to length and irradiation distance (distance from the front-end | tip of the probe 3 to a lesion | pathological lesion), Although it does not specifically limit, For example, it selects from the range of about 5-30 mm. The dimension L2 in the longitudinal direction (direction along the axis AX) of the endoscope mounting portion 11 is not particularly limited, but is set to, for example, about 2 to 20 mm.

  Between the front end surface of the endoscope mounting portion 11 (corresponding to the front end surface of the endoscope 2 inserted into the endoscope mounting portion 11) and the center graduation line of each graduation line constituting the graduation portion 13. The dimension L3 may be the same as the protruding length of the probe 3 intended by the operator, and is selected from a range of about 0.5 to 10 mm, for example. Although it does not specifically limit as a pitch (space | interval of the axial center AX direction) of each scale line which comprises the scale part 13, It can set to 0.1-1 mm.

  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. Further, a part of the endoscope mounting part 11 on the hood part 12 side and a part of the endoscope mounting part 11 on the opposite side to the hood part 12 are separate members, and the hood part 12 of the endoscope mounting part 11 is used. A part of the side may be integrally formed of the same material as the hood part 12 at the same time, and a part of the endoscope mounting part 11 opposite to the hood part 12 may be integrally formed therewith.

  The hood portion 12 may be made of a transparent or translucent material so that the inside thereof can be visually recognized, or may be made of a light-shielding material in order to suppress light leakage from the inside. . When the hood portion 12 is provided with light shielding properties, the hood portion 12 is made of a material that does not have light shielding properties, and an additional tape or the like having light shielding properties is applied around it, or a light shielding paint is applied. By applying, light shielding properties may be imparted.

  Moreover, the hood part 12 may have a part or all of the front end part side having flexibility. The endoscope mounting portion 11 may have flexibility similar to the hood portion 12 on the condition that the function of reliably 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 tool guide for inserting various endoscope treatment tools and the like (in this embodiment, the laser probe 3 used as a light source for PDT) is omitted. A forceps channel as a tube, a wiring channel through which electrical wiring or the like to a CCD (imaging device) 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, A suction channel for sucking a gas or a liquid, a water supply channel for injecting a chemical solution or the like, an air supply channel for sending air or 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 distal end hood 1 for an endoscope 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, an outline of the PDT using the endoscope distal end hood 1 according to the present embodiment described above will be given.

  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 the endoscope mounting portion 11 is inserted into the distal end portion 21 a of the insertion portion 21, the endoscope distal end hood 1 is appropriately rotated relatively around the axis AX, and each scale line of the scale portion 13 is obtained. The position in the rotational direction is adjusted so that the central portion (the central portion in the circumferential direction) or the vicinity thereof corresponds to the distal end opening 21b on the distal end surface of the insertion portion 21. In addition, when there exists a mark on the inner surface of the hood part 12, you may match the position of a rotation direction using this mark. 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 beam emitting portion of the laser probe 3 is projected (advanced) from the tip opening 21 b on the tip surface of the insertion portion 21.

  An endoscopic image in this state is schematically shown in FIG. In the endoscopic image shown in FIG. 5, the inner surface of the hood portion 12 and the scale portion 13 formed thereon are observed, and the lesioned portion 4 is observed inside the tip opening edge portion 12a.

  As the laser probe 3 advances from the distal end portion 21 a of the endoscope 2, the distal end portion of the laser light emitting portion of the laser probe 3 can be observed in the endoscopic image. For example, the position of the laser probe 3 in the advancing / retreating direction is adjusted so that the tip surface of the part substantially coincides with the center graduation line of each graduation line constituting the graduation part 13. In this state, the distal end surface of the laser light emitting portion of the laser probe 3 has a predetermined protruding length that is substantially the same length as the dimension L3 between the distal end surface of the endoscope mounting portion 11 and the center graduation line. Only b is projected (see FIGS. 1B and 4A).

  In this state, as shown in FIG. 4A, a portion of the distal end opening edge portion 12a of the hood portion 12 is abutted against a portion of the periphery of the lesioned portion 4 to be treated, and the posture of the distal end portion 21a of the insertion portion 21 is adjusted. Then, the distal end opening edge 12 a of the hood portion 12 is arranged in the vicinity of the lesioned portion 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, a portion that contacts the periphery of the lesioned part 4 of the distal end opening edge 12a of the hood part 12 is along the inner wall surface of the lesioned part 4. Just shift and repeat the same operation.

  In the embodiment described above, the scale portion 13 is provided at a predetermined position on the inner surface of the hood portion 12 of the endoscope distal end hood 1. Therefore, the tip hood 1 is attached to the tip portion 21a of the insertion portion 21 of the endoscope 2, the laser probe 3 is inserted into the forceps channel of the endoscope 2, and the laser beam emitting portion is advanced from the tip opening 21b. In the endoscopic image, the position of the tip surface of the laser probe 3 (probe protruding length) can be grasped by comparison with the scale portion 13. Thereby, the positional relationship in the axial center AX direction between the tip opening edge portion 12a and the tip surface of the laser beam emitting portion of the laser probe 3 can always be kept constant.

  For this reason, if the tip hood 1 having an appropriate dimension (L1) in the longitudinal direction of the hood portion 12 is selected and used in advance, the laser light L emitted from the laser light emitting portion of the laser probe 3 as shown in FIG. 4A. Is adjusted to an optimum angle θ (here, θ = 30 °), and one end opening edge portion 12a of the hood portion 12 is adjusted. The distance on the optical axis between the distal end surface of the laser beam emitting part of the laser probe 3 and the lesioned part 4 by bringing the part into contact with the lesioned part (wall surface part to be treated of the luminal organ) or the vicinity thereof a can be set to the intended distance (here 17 mm). 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. A tip hood 1 having a dimension (L3) between the tip surface of the endoscope mounting portion 11 and the center graduation line that is the same as the intended probe protrusion length (length b) is selected and used in advance. For example, it is easy to adjust the probe protrusion length to the intended length and maintain the length.

Second Embodiment Next, a modification of the above-described embodiment will be described with reference to FIG. 4B. In this modification, components that are substantially the same as those in the above-described embodiment will be denoted by the same reference numerals, description thereof will be partially omitted, and differences will be described.

  In this modification, as the hood portion 12, the tip opening edge portion 12 a has an elliptical inclined edge portion that is inclined at a predetermined angle θ with respect to the axis AX of the tip hood 1. That is, the tip opening edge portion 12a has an elliptical inclined edge portion obtained by cutting a substantially cylindrical member along a plane oblique to the axis AX at a predetermined angle θ, It has become. Although it does not specifically limit as inclination-angle (theta), Preferably it is 20-60 degrees.

  According to this modification, the hood part 12 has the tip opening edge part 12a which consists of the inclined edge part which inclines with the predetermined angle (theta) with respect to the axial center. For this reason, after using the tip hood 1 in which the length and the angle θ are selected according to the intended irradiation distance and angle, the tip opening edge portion 12a becomes the lesion portion 4 (the wall surface portion on which the luminal organ is to be treated). ) By adjusting the posture of the distal end portion of the endoscope 2 (insertion portion 21) so as to be in contact with each other around the periphery of the light source, the light irradiation distance (distance a) and the irradiation angle can be maintained at intended values in advance. It becomes easy. In addition, in order to make the front-end opening edge part 12a contact | abut along the periphery of the lesioned part 4, you may suck | inhale the gas in the front-end | tip hood 1 via an inhalation channel.

  In this modification, an alignment mark portion may be provided at a position corresponding to the most protruding portion of the tip opening edge portion 12a on the inner surface of the hood portion 12. With this configuration, when the distal end hood 1 is attached to the distal end portion of the endoscope, the positioning of the distal end hood around the axis with respect to the distal end portion of the endoscope can be easily performed using the landmark portion as a landmark. Can be done.

  In this modification, it is preferable that the hood part 12 has a light shielding property. By comprising in this way, it can suppress that light leaks from the inside of the food | hood part 12 to the exterior. That is, the laser light L emitted from the laser light emitting portion of the laser probe 3 or its reflected light can be prevented from leaking from 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. Further, at least the tip opening edge portion 12a may have flexibility. By configuring in this way, it is further easy to bring the tip opening edge 12a of the hood part into close contact with the periphery of the lesioned part 4.

  In the above-described embodiment, the hood portion 12 is a substantially cylindrical member. However, the hood portion 12 may be a substantially frustoconical cylindrical member that is widened or tapered. 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 for endoscope 11 ... Endoscope mounting part 12 ... Hood part 12a ... Edge opening edge part 13 ... Marking part 2 ... Endoscope 21 ... Insertion part 21a ... Tip part 3 ... Laser probe 4 ... Lumen Lesions of organs

Claims (2)

A tip hood for an endoscope, which is attached to the tip of an endoscope having a channel in which a probe for emitting light is disposed so as to be able to advance and retreat in the axial direction, and is composed of a substantially cylindrical member,
An endoscope mounting portion mounted on a distal end portion of the endoscope;
A hood portion formed on the opposite side along the axis with the endoscope mounting portion;
A tip hood for an endoscope, comprising: a scale portion provided on an inner surface of the hood portion and indicating a position in the advancing direction of the probe that advances from the channel.   The endoscope tip hood according to claim 1, wherein the scale portion includes a plurality of scale lines that are spaced apart in the axial direction.

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