JP3765730B2 - Continuous ligation device - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a ligation aid that is applied to ligation of the stomach and esophagus, internal hemorrhoids, and the like, and relates to a ligature that can be safely and reliably treated by a simple operation.
[0002]
[Prior art]
One method for treating gastroesophageal varices associated with cirrhosis or the like is an endoscopic varices ligation (hereinafter abbreviated as EVL) technique. EVL is a vein in which a varicose vein is sucked into a cylindrical shape attached to the distal end portion of an endoscope, and a rubber band ligature ring previously attached around the distal end of the cylindrical shape is made into a polyp shape by suction. It is a technique that is applied to the root part of the aneurysm and mechanically ligates the varicose vein by the contraction force of the rubber of the ligation ring to cause necrosis.
[0003]
Since varicose veins usually exist in multiple places, not only in one place, when ligating multiple varices in a single-shot ligation device, the endoscope is taken out of the body cavity, a ligation ring is attached, and then again The treatment had to be performed by inserting it into a body cavity, and not only the labor of the operator was great, but also the burden on the patient was great. In order to solve such a problem, many ligature tools capable of performing ligation treatment continuously with an endoscope inserted into a body cavity have been proposed (for example, Japanese Patent Laid-Open No. 8-10217). No. 8-502198, No. 9-5000081, No. 2561223, No. 2657427, No. 2,398,844, No. 5,398,844, No. 5,462,559), these are ligated. Because the ligature ring is dropped by pulling the wire attached to the ring, the forceps hole of the endoscope becomes unusable by the wire, and when the endoscope is strongly inverted, the force is not pulled even if the wire is pulled In some cases, the ligation ring cannot be dropped without being well transmitted to the tip, and the operation is complicated such that the wire must be passed through the forceps hole.
[0004]
Japanese Patent No. 2958219 has been proposed as a ligation tool using fluid drive without using a wire, and these do not require a forceps hole and are easy to operate. Yes, even if multiple ligation rings are attached, in addition to frictional resistance during movement due to the contraction force of the ligation ring, pressure is applied by frictional resistance due to biting of the ligation ring into the gap between the inner cylinder and the slide cylinder. Not only is it difficult, but there is a problem that it is impossible to detach one piece at a time.
[0005]
[Problems to be solved by the invention]
An object of the present invention is to solve such a problem in a repetitive ligation device in which a plurality of ligation rings in a device attached to an endoscope are detached. An object of the present invention is to provide a continuous ligation device that improves the slidability under pressure and can be safely and reliably enforced.
[0006]
[Means for Solving the Problems]
That is, the present invention injects a fluid into a device attached to an endoscope by a fluid injection means and pressurizes it, thereby pushing out and detaching the ligature ring housed in the device, thereby ligating the affected area. In the medical ligature to be performed, the fluid injection means is connected to the ligation ring detachment detection means, while the device has an inner cylinder equipped with a plurality of ligation rings, an outer cylinder covering the ligation rings, and a rear part between the inner cylinder and the outer cylinder. It has a structure in which a seal ring is attached to the end and a slide cylinder that pushes out the ligature ring, and fluid injection means is connected to an airtight space formed by them, and a groove parallel to the central axis is provided on the outer periphery of the inner cylinder. A slide-type ligation device characterized in that the front end of the slide cylinder has a convex shape on the inside so as to fit into the groove shape of the inner cylinder, and the front end other than the convex is recessed toward the rear end. .
[0007]
DETAILED DESCRIPTION OF THE INVENTION
Hereinafter, the present invention will be described in detail with reference to the drawings. FIG. 1 is a cross-sectional view of a state in which a continuous ligation device according to an embodiment of the present invention is mounted on an endoscope (1), and FIG. 2 is a detailed cross-sectional view of a portion A in FIG. 3 and 4 are a front view and a side view of the inner cylinder of the continuous ligation device according to an embodiment of the present invention. FIG. 5 is a view showing a state in which the ligation ring is caught between the inner cylinder and the slide cylinder according to the prior art.
[0008]
As shown in FIG. 1, an embodiment of the device according to the present invention includes a ring-shaped slide cylinder (4) accommodated in a cylindrical outer cylinder (3), and a cylindrical inner cylinder (2 As shown in FIG. 3, a plurality of grooves are formed on the outer periphery of the inner cylinder (5) in parallel with the central axis. The slide cylinder (4) in FIG. 1 is movable in the axial direction, and the limit of movement in the direction toward the tip side is up to the tip of the inner cylinder. On the rear end side of the inner cylinder (2), a wearing cylinder (7) for fixing the device to the endoscope (1) is attached. An airtight space (8) in an airtight state is formed behind the seal ring (5) by the seal ring (5), the outer tube (3) and the inner tube (2) fixed to the rear end of the slide tube (4); One or more fluid tubes (9) for sending fluid are connected to the rear end of the hermetic space (8) and connected to fluid injection means (not shown).
[0009]
A plurality of ligation rings (6) are mounted in series on the outer periphery of the inner cylinder (2). There is no limitation on the number of ligating rings (6) attached, and it may be determined according to the application. For example, when considered for esophageal varices ligation treatment, since there are many cases where eight ligations are performed for one treatment, it is preferable to mount eight ligation rings (6).
[0010]
When using the continuous ligation kit of the present invention, the device is fixed on the tip of the endoscope (1), but the device is difficult to come off from the endoscope, and the varicose vein is sucked by negative pressure Sometimes it is necessary to have conditions that prevent air from leaking. The wearing cylinder (7) is for fitting and joining to the endoscope (1). However, if the fitting with the endoscope (1) is too tight, the endoscope (1) may break down. Therefore, it is preferable to use a material having appropriate flexibility and sealability. There is no particular limitation as long as the material satisfies this condition, and for example, soft plastic, rubber, and the like are particularly suitable.
[0011]
The material of the ligation ring (6) is not particularly limited as long as there is no problem in the elastic force for ligating the varicose veins and safety in placement in the esophagus, and natural rubber, isoprene rubber, etc. are suitable, for example. .
The inner cylinder (2), outer cylinder (3), and slide cylinder (4) are thin and have high dimensional accuracy and mechanical strength that can sufficiently withstand the internal pressure of the airtight space (8) that is reached when the slide cylinder (4) is moved. Therefore, a hard resin is suitable, and further, it is required to be transparent for improving operability. There are no particular limitations as long as these requirements are satisfied, but examples thereof include polycarbonate resin, polyvinyl chloride resin, polysulfone resin, acrylic resin, ABS resin, and PET resin.
[0012]
The seal ring (5) is required to be made of a material that maintains sufficient airtightness of the airtight space (8) even at the fluid circuit internal pressure that is reached, and that has good slidability. For such materials, for example, rubbers such as silicone rubber and isoprene rubber, soft plastics, and the like are suitable.
[0013]
The fluid tube (9) attached to the device is flexible and strong enough not to bend or bend when the endoscope is operated. Also, the fluid tube (9) is not damaged or significantly expanded when the fluid is fed and pressurized in the fluid circuit. The pressure resistance must be considered. The material is not particularly limited as long as it satisfies such conditions, but for example, nylon, soft vinyl chloride resin, polyurethane resin and the like are preferable.
[0014]
The shape and number of grooves (10) provided in the inner cylinder (2) are not limited, and may be determined in consideration of the strength of the inner cylinder (2) and the friction with the ligation ring (6), but at least three or more. Is desirable. In the embodiment of FIG. 3, circular grooves (10) having an outer diameter of 11.5 mm and an inner diameter of 9.5 mm (2) with a central angle of 30 degrees and a depth of 0.6 mm are equally spaced at 12 intervals. A book is provided. In the embodiment of FIG. 4, 24 square grooves having a depth of 0.5 mm are provided at equal intervals of a central angle of 15 degrees on the inner cylinder (2) having an outer diameter of 11.5 mm and an inner diameter of 9.5 mm. . The edge portion of the groove (10) is preferably a smooth R shape because it causes scratches or increased friction when the ligature ring (6) is pushed forward. In addition, the tip of the slide cylinder (4) has a convex shape (11) that matches the groove (10) of the inner cylinder (2), and it is necessary to provide clearance so that there is no friction with the groove (10). The inner diameter of the ligated ring (6) should not be exceeded. Further, the tip of the slide tube (4) other than the convex portion (11) is connected with a ligation ring (6) to prevent the ligation ring (6) from getting into the gap between the inner tube (2) and the slide tube (4). 6) A recess (12) is provided behind the tip of the projection so as not to come into contact with 6).
[0015]
By the way, the present invention is provided with ligation ring separation detecting means. This detecting means may be a pressure change in the airtight space generated when the ligation ring is detached, or a displacement amount of the ligation ring. In the example using the prior art tip device shown in FIG. 5, the friction due to the contraction of the ligature ring, and the ligature ring biting into the gap between the inner cylinder and the slide cylinder, the slidability is poor and the ligature ring is deformed. Due to variations, the detection means may not work effectively. Therefore, by providing a groove in the inner cylinder as described above, the contact area with the inner cylinder of the ligation ring is reduced to reduce the frictional resistance, and at the same time, only the portion with the groove is pressed. The bite between the tube and the slide tube can be completely eliminated, and the slidability is greatly improved. As a result, variation in deformation of the ligation ring is suppressed, and the ligation ring separation detection means works effectively.
[0016]
【The invention's effect】
If the continuous ligation device of the present invention is used, the slidability of the ligation ring is improved, the deformation variation of the ligation ring is small, and the ligation ring separation detection means works effectively, so that reliable and safe continuous The effect is that the affected part can be ligated.
[Brief description of the drawings]
FIG. 1 is a cross-sectional view of a state in which a continuous ligation device according to an embodiment of the present invention is attached to an endoscope.
FIG. 2 is a detailed cross-sectional view of the portion shown in FIG. 1A.
FIGS. 3A and 3B are a front view and a side view of an inner cylinder of a continuous ligation device according to an embodiment of the present invention. FIGS.
FIGS. 4A and 4B are a front view and a side view of an inner cylinder of a continuous ligation device according to an embodiment of the present invention. FIGS.
FIG. 5 is a diagram showing a state in which a ligation ring is caught between an inner cylinder and a slide cylinder in a continuous ligation device according to the prior art.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 Endoscope 2 Inner cylinder 3 Outer cylinder 4 Slide cylinder 5 Seal ring 6 Ligating ring 7 Wearing cylinder 8 Airtight space 9 Fluid tube 10 Inner cylinder groove part 11 Slide cylinder convex part 12 Slide cylinder hollow part

Claims (2)

A medical ligation tool that pushes and releases the ligation ring housed in the device by injecting fluid into the device attached to the endoscope by means of fluid injecting means to pressurize the ligation ring. The fluid injection means is connected to the ligation ring separation detection means, while the device has an inner cylinder fitted with a plurality of ligation rings, an outer cylinder covering the ligation rings, and a seal ring at the rear end between the inner cylinder and the outer cylinder. It consists of a slide cylinder attached and pushes out the ligature ring, and has a structure in which fluid injection means is connected to the airtight space formed by them, and a groove parallel to the central axis is provided on the outer periphery of the inner cylinder, and the tip of the slide cylinder is A repetitive ligation device characterized in that a convex shape is formed on the inner side so as to fit into the groove shape of the inner cylinder, and a tip portion other than the convex portion is recessed toward the rear end side. 2. The continuous ligation device according to claim 1, wherein there are at least three grooves provided on the outer periphery of the inner cylinder.

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