JP2627285B2 - Hysteroscope for flexible tissue sampling - Google Patents

Description

Description: TECHNICAL FIELD The present invention relates to a soft tissue sample collecting endoscope for collecting a soft tissue sample such as placental villi or endometrium as a biopsy sample.

(Prior Art) In a biopsy such as a histological test, a sample is collected while observing an affected part or a collection site with an endoscope.

However, since the forceps used conventionally are open in a scissors shape, such as double-opening and single-opening, the forceps are used in a narrow portion where the forceps cannot be opened widely, or in a portion where the movement of the forceps adversely affects an affected part or a sampling site. However, the size of the forceps was limited to a small one, and the amount that could be collected was also limited. Analysis that requires a large amount of sample for this purpose, such as DN performed by collecting placental villi for early diagnosis of fetal genetic diseases and chromosomal abnormalities
In A-analysis and chromosome analysis, forceps had to be inserted into the collection site many times, which was not only inconvenient, but also shortened the collection time and could not reduce the effect on the body. In particular, in the case of a flexible endoscope in which the entire insertion portion of the endoscope is flexible, the forceps made of a rigid material cannot be increased in order not to hinder the flexibility of the insertion portion. It was big.

On the other hand, soft tissue (soft tissue) such as villi of the placenta
In order to collect the sample, it is considered that a sample can be collected without mechanically resecting or grasping the affected part like a conventional forceps. Therefore, a non-scissor-like forceps is desired. Was.

(Object of the Invention) The present invention has been made in view of such circumstances,
An object of the present invention is to provide a soft tissue sample collection uterus endoscope that allows a large amount of biopsy soft tissue samples to be collected without directly damaging the vicinity of the collection site while directly observing a narrow biopsy sample collection site with an endoscope. .

(Constitution of the Invention) An object of the present invention is to provide an optical fiber that connects an eyepiece provided at a base and an objective lens at a tip, an insertion port provided at a base, and a projection at a tip. , A perfusion solution inlet provided in the vicinity of the base of the cable introduction passage for supplying liquid to the distal end of the cable introduction passage, and a cable introduction passage longer than the entire length of the cable introduction passage. A cable rotatably and slidably fitted therein, and a screw attached to the end of the cable, the screw having a groove for sampling and having an ultrasonic reflecting member sealed at least at the end. The soft tissue sample collecting uterus is characterized in that the screw is rotated to collect a soft tissue sample in the groove of the screw.

That is, in the present invention, instead of using forceps that open and close like scissors, a screw member is provided at the end of the cable, and this spiral member is rotated and advanced toward the sample collection site, and the groove of the screw member or the cable is inserted. The sample is taken into the cable introduction path.

(Embodiment) FIG. 1 is a view showing a flexible hysteroscope according to an embodiment of the present invention, FIG. 2 is an end view taken along the line II-II, and FIGS. FIG. 5 is an explanatory view of use.

In these figures, reference numeral 1 denotes a hysteroscope, which is an endoscope for collecting a sample. From the base 2 of this hysteroscope 1
The insertion portion 8 that reaches the distal end portion 7 via the soft portion 3, the hard portion 4, the second soft portion 5, and the curved portion 6 extends. 1st and 2nd flexible part
3,5 are flexible and bend according to the insertion site of the internal organ. The bending portion 6 is bent by remote control of an operation lever 9 provided on the base 2. Inside the insertion portion 8, the base 2
An optical fiber 11 for communicating an eyepiece 10 provided at the end with an objective lens (not shown) at the distal end 7, light guides 12 and 12 for guiding illumination light to the distal end 7, and provided at the base 2. Insertion port 1
An introduction path 15 that communicates with the projecting opening 14 of the distal end portion 7 is provided therein (FIG. 2).

Reference numeral 16 denotes a cable, which is formed of a flexible material such as a synthetic resin or a piano wire, and is fitted into the cable introduction path 15 so as to be slidable in the longitudinal direction and rotatable in the circumferential direction.

At the end of this cable 16, as shown in FIGS.
A helical screw 17 is provided. This screw
Reference numeral 17 is formed of a flexible material such as polyethylene, Teflon, or silicon, and a metal wire (ultrasonic reflection member) (not shown) is sealed at least at its tip. Due to the presence of the metal wire serving as the ultrasonic reflecting member, the position of the screw 17 protruding from the projecting port 14 can be monitored from outside the body by an ultrasonic diagnostic imaging apparatus. Further, since the metal wire is buried in the screw 17 so as not to be exposed, the metal wire does not damage the tissue even when the tip of the screw 17 hits the biopsy sample collection site.

A knob 18 is attached to the end of the cable 16 on the insertion port 13 side, and a male screw 19 is formed on the cable 16 at a portion in front of the knob 18. On the other hand, the cable inlet 15
An adapter 20 having a through hole communicating with the connector 20 is detachably attached via a socket 21. A female screw 22 is formed in the through hole of the adapter 20, and the female screw 22 and the male screw 19 are screwed together in a liquid-tight manner.

This cable 16 is longer than the entire length of the cable introduction path 15,
When this is made to penetrate deep into the cable introduction path 15, the tip of the cable 16 projects from the projecting opening 14 (see FIG. 4).

The male screw 19 of the cable 16 is marked with a scale of about 1 cm in colors of about 5 cm.
When the screw 17 is inserted and the tip of the screw 17 is
The scale at the upper end position of the adapter 20 is 0 cm. With this scale, it is possible to set the length of the tip portion of the screw 17 that protrudes from the protrusion 14.

Reference numeral 23 denotes an irrigation liquid inlet provided in the middle of the vicinity of the base of the cable introduction path 15, and sends perfusion liquid to the distal end portion 7 via the cable introduction path 15.

The outer diameter of the insertion section 8 of the hysteroscope 1 thus configured is 4 m.
m (corresponding to No. 1 Hegar cervical dilator) and can be inserted into the uterus without dilating the cervix. In the present embodiment, the inner diameter of the cable introduction path 15 is 2.0 mm, the outer diameter of the cable 16 is 1.6 mm, the diameters of the optical fiber 11 and the light guides 12 and 12 are each 0.6 mm, and the outer diameter of the insertion portion 8 is 3.7 mm. .

 Next, a method of using this embodiment will be described.

First, the cable 16 is inserted into the introduction path 15 from the insertion port 13 via the adapter 20, and the scale of the cable 16 at the upper end position of the adapter 20 is 0 cm so that the tip of the screw 17 reaches the position of the protrusion port 14. (See FIG. 3).

Next, as shown in FIG. 5, the insertion portion 8 of the hysteroscope is inserted into the uterus from the cervix while monitoring with the ultrasonic diagnostic imaging apparatus 24. At this time, since the physiological saline is supplied to the distal end portion 7 of the hysteroscope through the perfusate inlet 23 and the gap between the cable introduction path 15 and the cable 16, the objective lens at the distal end is not fogged. The view is secured. The operating lever 9 is operated to bend the bending section 6 of the insertion section 8 appropriately, and the tip 7 of the hysteroscope 1 is guided to the observation / biopsy sample collection site.

The ultrasound image diagnostic apparatus 24 monitors that the tip 7 of the hysteroscope has reached the base 25, and when the presence of villi is confirmed by observation from the eyepiece 10, as shown in FIG.
Then, the cable 16 is screwed into the adapter 20 for a predetermined scale (for example, 2 cm), and the screw 17 of the cable 16 is protruded from the opening 14 at the tip of the hysteroscope into the villous tissue while rotating. The soft villous tissue can be caught in the screw groove by the rotation and advancement of the screw. Protruding screw
The tip 17 can be detected by the ultrasonic diagnostic imaging device 24 due to the presence of the metal which is the ultrasonic reflecting material. After confirming that the tip of screw 17 is at the desired position, remove socket 21 and
Pull out the cable 16 from the insertion slot 13 together with the cable 20. The placental villi adhering to the pulled-out screw 17 are collected and subjected to a subsequent inspection.

As described above, the endoscope of the present invention does not cut or hold the sample collection site, and therefore does not damage the vicinity of the sample site. Further, since it does not open and close like scissors like a conventional forceps, a sample can be collected even in a narrow portion, and even a small screw member can collect a large amount of sample at a time.

In the present embodiment, the adapter 20 which is detachable from the insertion port 13 in a liquid-tight manner is used, but the present invention does not need to use such an adapter 20. However, when the adapter 20 is not used, it is necessary to provide a liquid-tight seal between the inlet 13 and the inlet 23 so that the physiological saline injected from the perfusate inlet 23 does not flow backward from the inlet 13. However, while the sample is scraped off from the screw 17 when passing through the seal portion, there is a loss, whereas if the adapter 20 is used, such a seal is unnecessary and the sample collection loss is eliminated.

In addition, as shown in FIG.
May be liquid-tightly sealed both when the cable 16 is introduced and when it is not introduced by a soft member 27 that seals the center hole of the cap 26 so that it can be opened and closed. When such a cap with a seal is used, even when the cable 16 is not introduced, the physiological saline can be perfused and fed into the hysteroscope insertion section 8 without getting wet from the insertion port 13, so that the insertion section 8 at the stenosis site can be used. Insertion becomes easy.

Further, as shown in FIG. 7, the cable 16 is not inserted directly into the cable introduction path 15 but is inserted freely into the outer cable 28 so as to be rotatable and slidable. 15 may be inserted. In this case, since the sample can be collected in the outer cable 28,
The sample collection loss can be prevented without using the adapter 20 as in the previous embodiment. Further, the cap with seal shown in FIG. 6 may be used together.

In this embodiment, the present invention is applied to a flexible hysteroscope. However, the present invention is not limited to this, and the endoscope in which the entire endoscope insertion portion is flexible and the entire insertion portion are incompatible. It can also be applied to flexible rigid endoscopes.

(Effect of the Invention) As described above, according to the present invention, instead of using forceps that open and close like scissors, a screw member is provided at the tip of the cable, and the screw member is rotated and advanced toward the sample collection site to collect a sample. Thus, even in a narrow biopsy sample collection site, a large amount of soft tissue samples for biopsy can be collected without directly damaging the area around the collection site while directly observing the endoscope.

[Brief description of the drawings]

FIG. 1 is a diagram showing a flexible hysteroscope according to one embodiment of the present invention,
Fig. 2 is an end view taken along the line II-II, Figs. 3 and 4 are cross-sectional views of main parts of a base and a tip part, Fig. 5 is an explanatory view of use, and Fig. 6 is a main part of a base in another embodiment. FIG. 7 is a sectional view of a main part of a distal end portion in still another embodiment. 1 ... Endoscope, 10 ... Eyepiece, 11 ... Optical fiber, 12 ... Light guide, 13 ... Cable insertion port, 14 ... Cable outlet, 15 ... Cable introduction path, 16 ... Cable, 17: Screw with a groove for sampling, 20: Adapter, 23: Perfusion liquid inlet, 24: Ultrasound diagnostic imaging device.

Claims (3)

(57) [Claims] 1. An optical fiber for connecting an eyepiece provided at a base and an objective lens at a distal end, a cable introduction path communicating between an insertion opening provided at the base and a projecting opening at the distal end, and An irrigation liquid inlet that is provided in the vicinity of the base of the cable introduction path and feeds liquid to the tip of the cable introduction path, and is longer than the entire length of the cable introduction path and rotatably and slidably fits in the cable introduction path. An inserted cable, and a screw attached to the end of the cable, the screw having a groove for sampling and having an ultrasonic reflecting member sealed at least at the end thereof, and rotating the screw. A soft tissue sample collecting uterus endoscope, wherein a soft tissue sample is collected by a screw groove. 2. An external thread is formed on the outer periphery of the projecting end of the insertion port of the cable, and an adapter formed with a female thread to be screwed with the external thread of the cable is attached to the insertion port in a liquid-tight and detachable manner. 2. The endoscopic endoscope for collecting soft tissue according to claim 1, wherein the endoscope is provided. 3. The cable according to claim 1, wherein said cable is rotatably and slidably inserted into said outer cable and inserted into said cable introduction path together with said outer cable. 2. A uterine endoscope for sampling a soft tissue according to claim 1.