JP3845173B2 - Endoscope for ligation treatment - Google Patents

Endoscope for ligation treatment Download PDF

Info

Publication number
JP3845173B2
JP3845173B2 JP09711197A JP9711197A JP3845173B2 JP 3845173 B2 JP3845173 B2 JP 3845173B2 JP 09711197 A JP09711197 A JP 09711197A JP 9711197 A JP9711197 A JP 9711197A JP 3845173 B2 JP3845173 B2 JP 3845173B2
Authority
JP
Japan
Prior art keywords
ligation
endoscope
distal end
loop
tip
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Fee Related
Application number
JP09711197A
Other languages
Japanese (ja)
Other versions
JPH10286224A (en
Inventor
輝雄 大内
Original Assignee
ペンタックス株式会社
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by ペンタックス株式会社 filed Critical ペンタックス株式会社
Priority to JP09711197A priority Critical patent/JP3845173B2/en
Publication of JPH10286224A publication Critical patent/JPH10286224A/en
Application granted granted Critical
Publication of JP3845173B2 publication Critical patent/JP3845173B2/en
Anticipated expiration legal-status Critical
Expired - Fee Related legal-status Critical Current

Links

Images

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12009—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
    • A61B17/12013—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot for use in minimally invasive surgery, e.g. endoscopic surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00071—Insertion part of the endoscope body
    • A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
    • A61B1/00087—Tools
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00071—Insertion part of the endoscope body
    • A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
    • A61B1/00089—Hoods
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/00296—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means mounted on an endoscope
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
    • A61B17/12009—Implements for ligaturing other than by clamps or clips, e.g. using a loop with a slip knot
    • A61B2017/12018—Elastic band ligators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1405—Electrodes having a specific shape
    • A61B2018/1407—Loop
    • A61B2018/141—Snare

Description

【０００１】
【発明の属する技術分野】
この発明は、体内の病変部などを結紮処置するために用いられる結紮処置用内視鏡に関する。
【０００２】
【従来の技術】
茎部を有するポリープ等に比べて結紮するのが難しい茎部のないポリープや平坦な腫瘍部分等を結紮処置する場合、二本の処置具挿通チャンネルを有する内視鏡を用いれば、一方の処置具挿通チャンネルに通した把持鉗子等で患部を引っ張り上げておき、他方の処置具挿通チャンネルに通した結紮具によって比較的確実に結紮処置を行うことができる。
【０００３】
しかし、処置具挿通チャンネルを二つ設けると内視鏡の径が非常に太くなって患者に与える苦痛が大きくなるので、なるべく一本の処置具挿通チャンネルだけで処置を行えることが望ましい。
【０００４】
そこで従来は、内視鏡の先端フード内に患部の粘膜を吸引により引き込んでおいてから、先端フードの内側又は外側に出口が設けられた処置具挿通チャンネルに通した結紮具を用いて、患部の根元部分を結紮するようにしていた（例えば、特開平８−１３１３９７号）。
【０００５】
【発明が解決しようとする課題】
しかし、図１９に示されるように、処置具挿通チャンネルの出口９１ａが先端フード９２の内側に設けられたものでは、結紮具のループ９３部分を先端フード９２の先端部分まで押し出す動作が、フード９２内に引き込まれた患部１００によって邪魔されるので、患部１００の根元部分を狙い通りに結紮するのが困難である。
【０００６】
また、図２０に示されるように、処置具挿通チャンネル９１の出口９１ａが先端フード９２の外側に設けられたものでは、処置具挿通チャンネル９１が先端フード９２から飛び出た形になるので、内視鏡の挿入性が非常に悪くなって、内視鏡が患者の体腔内粘膜を傷つける恐れがある。
【０００７】
そこで本発明は、茎部のないポリープや平坦な腫瘍部分等を、一本の処置具挿通チャンネルだけを用いて確実かつ安全に結紮することができる結紮処置用内視鏡を提供することを目的とする。
【０００８】
【課題を解決するための手段】
上記の目的を達成するため、本発明の結紮処置用内視鏡は、少なくとも処置具挿通チャンネルの出口と吸引口とが開口する内視鏡の先端部分を囲んで設けられた先端フードと、ループ部が上記先端フードの先端の縁部に沿って係脱自在に係止された縮径自在な結紮用ループワイヤと、先端部分が上記結紮用ループワイヤに対して係脱自在に設けられて上記処置具挿通チャンネルに挿通され、上記結紮用ループワイヤを縮径させて上記結紮用ループワイヤと分離される結紮操作具とを設けたことを特徴とする。
【０００９】
なお、上記処置具挿通チャンネルの出口と上記吸引口とが兼用されていてもよい。
また、上記結紮用ループワイヤのループ部分が、上記先端フードの先端外周面に形成された円周溝に係脱自在に係合してもよく、その場合、上記先端フードの先端部分に、上記結紮用ループワイヤの端部を上記先端フード内に案内するための案内溝が形成されていてもよい。
【００１０】
また、上記結紮用ループワイヤのループ部分が、上記先端フードの先端部分に貼着された粘着テープによって上記先端フードに係止されるようになっていてもよい。
【００１１】
或いは、上記結紮用ループワイヤのループ部分を上記先端フードの先端部分との間に軽く挟み付けて係止するためのループワイヤ係止補助部材が設けられていてもよい。
【００１２】
また、上記結紮用ループワイヤのループが、ワイヤ部材の一端側に形成された通し孔にそのワイヤの中間部分を通して形成されていてもよい。
そして、上記結紮操作具が、上記内視鏡の処置具挿通チャンネル内に挿脱されるシースとその中に挿通された操作ワイヤとを有しており、その操作ワイヤの先端が上記結紮用ループワイヤの自由端に係脱自在に連結され、上記シースの先端面が上記結紮用ループワイヤの締め付け部に当接するようになっていてもよい。
【００１３】
また、上記結紮用ループワイヤの自由端部分に瘤が形成され、上記操作ワイヤの先端部分には上記瘤が通る大きさのループが形成されていてもよい。
また、上記先端フードが上記内視鏡の先端部に対して着脱自在であってもよく、上記先端フードが透明であってもよい。
【００１４】
【発明の実施の形態】
図面を参照して本発明の実施の形態を説明する。
図１は、本発明の第１の実施の形態の結紮処置用内視鏡の先端部分を示している。１は、内視鏡の挿入部先端であり、その先端面には図２に示されるように、観察窓６、照明窓７及び処置具挿通チャンネル２の出口開口などが配置されている。
【００１５】
図１に戻って、３は、筒状に形成された先端フードであり、その後端部側の部分に内視鏡挿入部先端１が圧入され、先端フード３が内視鏡挿入部先端１に対して着脱自在に取り付けられている。
【００１６】
先端フード３は、内視鏡挿入部先端１の先端面から前方に突出した状態に取り付けられていて、観察窓６、照明窓７及び処置具挿通チャンネル２の出口開口などが先端フード３の内側に位置するようになっている。なお、処置具挿通チャンネル２は、吸引チャンネルも兼用している。
【００１７】
先端フード３は、透明な部材によって形成されている。したがって、先端フード３の内側に位置する観察窓６から、先端フード３を通して広い範囲の領域を観察することができる。
【００１８】
先端フード３の先端の外周部分には、図３にも示されるように、後述する結紮用ループワイヤ１０のループ部１２を嵌め込むための円周溝４が、全周に形成されている。
【００１９】
ただし、円周溝４からループ部１２が外れ易いようにするために、円周溝４の先端側（図において左側）の土手部分４ａは低く形成されている。５は、先端フード３の円周溝４に嵌め込まれた結紮用ループワイヤ１０の端部を先端フード３内に引き込むための案内溝である。
【００２０】
図２に示されるように、案内溝５の近傍では円周溝４の先端側の土手部分４ａが切除されていて、円周溝４からループ部１２が外れ易いようになっている。
【００２１】
図４は、結紮用ループワイヤ１０を示している。この結紮用ループワイヤ１０は、例えばナイロン糸などのように引っ張り力に対して強くて柔軟な材料によって形成されている。ただし、その他各種の材質の材料を用いることができる。
【００２２】
結紮用ループワイヤ１０の一端部側は、コイル状に複数回巻かれていて、その内側にワイヤの途中の部分を通すための通し孔１１が形成されている。そして他端側には、結び目によって瘤部１３が形成されている。
【００２３】
１４は、ワイヤが緩く通る孔が中央部に形成された円盤状の締め部材であり、通し孔形成部１１から引き出されたワイヤの途中の部分がその孔内に通されている。
【００２４】
したがって、瘤部１３部分を固定して締め部材１４で通し孔形成部１１をループ部１２側へ押せば、ループ部１２の径が小さくなって、結紮を行うことができる。なお、通し孔形成部１１部分の太さが大きい場合には、締め部材１４を省略して、通し孔形成部１１を直接押すようにしてもよい。
【００２５】
図１に戻って、２０は、結紮用ループワイヤ１０による結紮操作を行うための結紮操作具であり、図１には、その先端部分が示されている。
結紮操作具２０は、処置具挿通チャンネル２内に挿通自在な可撓性チューブからなるシース２１と、その内部に軸線方向に進退自在に挿通配置された操作ワイヤ２２とを有している。
【００２６】
操作ワイヤ２２の先端部分は曲げ戻されて止め管２４によってワイヤの途中に固定されており、それによって結紮用ループワイヤ１０の瘤部１３と係脱自在な大きさの環状部２３が形成されている。
【００２７】
図５は、結紮操作具２０の全体構成を示している。シース２１の基端部には操作部２５が連結されており、そこにスライド自在に取り付けられたスライドハンドル２５ａを矢印Ａ方向にスライド操作することによって、操作ワイヤ２２がシース２１内で軸線方向に進退し、先端環状部２３が矢印Ｂで示されるようにシース２１の先端から出入りする。
【００２８】
図６ないし図８は、上述のように構成された実施の形態の結紮処置用内視鏡の使用例を示しており、先端フード３の先端を体腔内粘膜表面の平らな患部に押しつけて処置具挿通チャンネル２を介して吸引をすることにより、図６に示されるように、患部１００が先端フード３内に吸い込まれて盛り上がる。
【００２９】
そこで、図７に示されるように、操作ワイヤ２２を手元側に引きつけながら、シース２１を前方に押し出して締め部材１４を先側に押すと、結紮用ループワイヤ１０のループ部１２が、縮径して先端フード３の円周溝４から外れて患部１００の根元部分を締めつける状態になる。
【００３０】
そのようにして、患部１００の根元部分を結紮用ループワイヤ１０でしっかり結紮したら、シース２１を手元側に引き戻して操作ワイヤ２２を先側に押し出し、図８に示されるように、結紮用ループワイヤ１０の瘤部１３から操作ワイヤ２２の先端環状部２３を外して結紮処置が完了する。
【００３１】
なお、先端フード３を柔軟性のある材料で形成しておけば、結紮用ループワイヤ１０のループ部１２を縮径させる際に、図９に示されるように、先端フード３が変形をして円周溝４から容易に外れるので、結紮動作をよりスムーズに行うことができる。
【００３２】
図１０は、本発明の第２の実施の形態を示しており、先端フード３の先端部分に貼着した粘着テープ３１によって、先端フード３の先端面にループ部１２を係止したものである。その状態からループ部１２を縮径させれば、先端フード３から粘着テープ３１が部分的に剥がれて、ループ部１２が先端フード３から離脱する。
【００３３】
図１１は、本発明の第３の実施の形態を示しており、弾力性のある部材からなる短筒状のループワイヤ係止補助部材３２を先端フード３の先端に取り付けて、先端フード３の先端面との間にループ部１２を挟み込むように係止したものである。
【００３４】
ループワイヤ係止補助部材３２は、先端フード３の先端外周面に嵌合して先側に少し突出しており、係合し合う凸部と凹部とからなるクリック部３３によって、先端フード３に対して係脱自在に固定されている。
【００３５】
ループ部１２が挟まれている先端フード３の先端面とループワイヤ係止補助部材３２との間の隙間は、ループ部１２を確実に係止できるように内面側が少し狭くなっているが、少し強い力でループ部１２を縮径させれば、その隙間部分を通ってループ部１２が係止部から内方に離脱する。
【００３６】
このように、結紮用ループワイヤ１０のループ部１２は、先端フード３の先端部分に係脱自在に係止できればよいので、第１の実施の形態の円周溝４による係止に代えて、各種の係止手段を用いることができる。
【００３７】
また結紮用ループワイヤ１０も、第１の実施の形態の構成に限定されるものではなく、例えば図１２に示されるように、全体を一つのループ状に形成して、締め部材１４をスライドさせることによりループが縮径する構造など、各種の構造をとることができる。
【００３８】
また本発明の臨床応用として、高周波切開具で茎部のないポリープや平らな患部等を切除する際に、本発明の結紮処置用内視鏡を補助的に用いることにより、安全かつ確実に切除を行うことができる。
【００３９】
図１３ないし図１８はその処置の状態を示しており、まず図１３に示されるような平らな患部１０１に対して、図１４に示されるように、内視鏡の処置具挿通チャンネルを介して注射具５１で粘膜下注射を行い、人工的にポリープ１０２を作る。
【００４０】
そして、図１５に示されるように、本発明の結紮処置用内視鏡の先端フード３内にポリープ１０２を入れて吸引をし、前述のようにして結紮処置を行うことにより、図１６に示されるように、人工ポリープ１０２の根元部分を結紮用ループワイヤ１０で結紮することができる。
【００４１】
そこで、図１７に示されるように、内視鏡の処置具挿通チャンネルを介して高周波スネア５２を導入し、人工ポリープ１０２の根元付近を緊縛してから高周波電流を流すことにより、図１８に示されるようにポリープ１０２が切除され、元々平面部にあった患部１０１を内視鏡的に安全に切除することができる。そして、切断端の近傍が結紮された状態を保つので、術後の出血のおそれがない。
【００４２】
【発明の効果】
本発明によれば、内視鏡の先端フードに係脱自在に係止された結紮用ループワイヤを、先端フード内に出口が配置された処置具挿通チャンネルに挿通される結紮操作具によって縮径させることができるので、一本の処置具挿通チャンネルだけを用いて、茎部のないポリープや平坦な腫瘍部分等を確実かつ安全に結紮することができる。
【図面の簡単な説明】
【図１】本発明の第１の実施の形態の結紮処置用内視鏡の先端部分の側面断面図である。
【図２】本発明の第１の実施の形態の結紮処置用内視鏡の先端部分の正面図である。
【図３】本発明の第１の実施の形態の先端フードの斜視図である。
【図４】本発明の第１の実施の形態の結紮用ループワイヤの平面図である。
【図５】本発明の第１の実施の形態の結紮用操作具の正面図である。
【図６】本発明の第１の実施の形態の結紮処置用内視鏡の使用状態の側面断面図である。
【図７】本発明の第１の実施の形態の結紮処置用内視鏡の使用状態の側面断面図である。
【図８】本発明の第１の実施の形態の結紮処置用内視鏡の使用状態の側面断面図である。
【図９】本発明の第１の実施の形態の先端フードの先端部分の側面断面図である。
【図１０】本発明の第２の実施の形態の結紮処置用内視鏡の先端部分の側面断面図である。
【図１１】本発明の第３の実施の形態の結紮処置用内視鏡の先端部分の側面断面図である。
【図１２】本発明の結紮用ループワイヤの他の構成例の平面断面図である。
【図１３】本発明の臨床応用例の手順を示す断面図である。
【図１４】本発明の臨床応用例の手順を示す断面図である。
【図１５】本発明の臨床応用例の手順を示す側面図である。
【図１６】本発明の臨床応用例の手順を示す断面図である。
【図１７】本発明の臨床応用例の手順を示す断面図である。
【図１８】本発明の臨床応用例の手順を示す断面図である。
【図１９】従来の結紮処置用内視鏡の先端部分の側面断面図である。
【図２０】従来の他の結紮処置用内視鏡の先端部分の側面断面図である。
【符号の説明】
１ 内視鏡挿入部先端
２ 処置具挿通チャンネル
３ 先端フード
４ 円周溝
１０ 結紮用ループワイヤ
１１ 通し孔形成部
１２ ループ部
１３ 瘤部
２０ 結紮操作具
２１ シース
２２ 操作ワイヤ
２３ 先端環状部
３１ 粘着テープ
３２ ループワイヤ係止補助部材[0001]
BACKGROUND OF THE INVENTION
The present invention relates to an endoscope for ligation treatment used for ligation treatment of a lesioned part or the like in the body.
[0002]
[Prior art]
When ligating a polyp without a stem or a flat tumor part that is difficult to ligate compared to a polyp with a stem, etc., if an endoscope with two treatment instrument insertion channels is used, one treatment The affected part can be pulled up with grasping forceps or the like passed through the instrument insertion channel, and the ligation treatment can be relatively reliably performed with the ligation instrument passed through the other treatment instrument insertion channel.
[0003]
However, if two treatment instrument insertion channels are provided, the diameter of the endoscope becomes very large and the pain given to the patient increases. Therefore, it is desirable to perform treatment with only one treatment instrument insertion channel as much as possible.
[0004]
Therefore, conventionally, the mucous membrane of the affected part is drawn into the distal end hood of the endoscope by suction, and then the affected part is used by using a ligation tool passed through a treatment instrument insertion channel provided with an outlet inside or outside the distal end hood. The root portion of the ligation was ligated (for example, Japanese Patent Laid-Open No. 8-131397).
[0005]
[Problems to be solved by the invention]
However, as shown in FIG. 19, in the case where the outlet 91 a of the treatment instrument insertion channel is provided inside the distal end hood 92, the operation of pushing the loop 93 portion of the ligation instrument to the distal end portion of the distal end hood 92 is performed. Since it is obstructed by the affected part 100 drawn in, it is difficult to ligate the root part of the affected part 100 as intended.
[0006]
Further, as shown in FIG. 20, when the outlet 91a of the treatment instrument insertion channel 91 is provided outside the distal end hood 92, the treatment instrument insertion channel 91 protrudes from the distal end hood 92. The insertion of the mirror becomes very bad and the endoscope may damage the mucous membrane in the body cavity of the patient.
[0007]
Accordingly, an object of the present invention is to provide a ligation treatment endoscope capable of ligating a polyp without a stem portion, a flat tumor portion, or the like reliably and safely using only one treatment instrument insertion channel. And
[0008]
[Means for Solving the Problems]
In order to achieve the above object, an endoscope for ligation treatment according to the present invention includes a distal end hood provided to surround at least an distal end portion of an endoscope where an outlet and a suction port of a treatment instrument insertion channel open, and a loop A diameter-reducing ligation loop wire that is detachably locked along the edge of the tip of the tip hood, and a tip portion that is detachably provided with respect to the ligation loop wire. A ligation operating tool that is inserted into the treatment instrument insertion channel and has a diameter reduced from the ligation loop wire to be separated from the ligation loop wire is provided.
[0009]
Note that the outlet of the treatment instrument insertion channel and the suction port may be combined.
Further, the loop portion of the ligation loop wire may be detachably engaged with a circumferential groove formed on the outer peripheral surface of the tip hood. In that case, the tip portion of the tip hood A guide groove for guiding the end of the ligation loop wire into the tip hood may be formed.
[0010]
The loop portion of the ligation loop wire may be locked to the tip hood with an adhesive tape attached to the tip portion of the tip hood.
[0011]
Alternatively, a loop wire locking auxiliary member may be provided for lightly pinching and locking the loop portion of the ligation loop wire with the tip portion of the tip hood.
[0012]
Further, the loop of the ligation loop wire may be formed through an intermediate portion of the wire in a through hole formed on one end side of the wire member.
The ligation operating tool has a sheath that is inserted into and removed from the treatment instrument insertion channel of the endoscope and an operation wire that is inserted through the sheath, and the distal end of the operation wire is the ligation loop. The free end of the wire may be detachably connected, and the distal end surface of the sheath may come into contact with the tightening portion of the ligation loop wire.
[0013]
Further, a knob may be formed at a free end portion of the ligation loop wire, and a loop having a size through which the knob is passed may be formed at a tip portion of the operation wire.
The tip hood may be detachable from the tip of the endoscope, and the tip hood may be transparent.
[0014]
DETAILED DESCRIPTION OF THE INVENTION
Embodiments of the present invention will be described with reference to the drawings.
FIG. 1 shows the distal end portion of the endoscope for ligation treatment according to the first embodiment of the present invention. Reference numeral 1 denotes a distal end of an insertion portion of an endoscope, and an observation window 6, an illumination window 7, an outlet opening of the treatment instrument insertion channel 2, and the like are arranged on the distal end surface thereof as shown in FIG.
[0015]
Returning to FIG. 1, reference numeral 3 denotes a cylindrical tip hood, the endoscope insertion portion tip 1 is press-fitted into a portion on the rear end side, and the tip hood 3 is inserted into the endoscope insertion portion tip 1. On the other hand, it is detachably attached.
[0016]
The distal end hood 3 is attached in a state of protruding forward from the distal end surface of the endoscope insertion portion distal end 1, and the observation window 6, the illumination window 7, the outlet opening of the treatment instrument insertion channel 2, and the like are inside the distal end hood 3. It is supposed to be located in. The treatment instrument insertion channel 2 also serves as a suction channel.
[0017]
The tip hood 3 is formed of a transparent member. Accordingly, a wide range of region can be observed through the tip hood 3 from the observation window 6 located inside the tip hood 3.
[0018]
As shown in FIG. 3, a circumferential groove 4 for fitting a loop portion 12 of a ligation loop wire 10, which will be described later, is formed on the entire outer periphery of the distal end hood 3.
[0019]
However, in order to make it easy for the loop portion 12 to be detached from the circumferential groove 4, the bank portion 4 a on the tip side (left side in the drawing) of the circumferential groove 4 is formed low. Reference numeral 5 denotes a guide groove for drawing the end of the ligation loop wire 10 fitted in the circumferential groove 4 of the tip hood 3 into the tip hood 3.
[0020]
As shown in FIG. 2, the bank portion 4 a on the tip side of the circumferential groove 4 is cut away in the vicinity of the guide groove 5, so that the loop portion 12 can be easily detached from the circumferential groove 4.
[0021]
FIG. 4 shows the ligation loop wire 10. The ligation loop wire 10 is made of a flexible material that is strong against tensile force, such as nylon thread. However, other various materials can be used.
[0022]
One end side of the ligation loop wire 10 is wound in a coil shape a plurality of times, and a through hole 11 is formed on the inner side of the ligation loop wire 10 for passing a middle portion of the wire. On the other end side, a knob portion 13 is formed by a knot.
[0023]
Reference numeral 14 denotes a disc-shaped fastening member in which a hole through which the wire passes is formed in the central portion, and a middle portion of the wire drawn from the through hole forming portion 11 is passed through the hole.
[0024]
Therefore, if the knob portion 13 is fixed and the through hole forming portion 11 is pushed to the loop portion 12 side by the fastening member 14, the diameter of the loop portion 12 becomes small and ligation can be performed. When the thickness of the through hole forming portion 11 is large, the fastening member 14 may be omitted and the through hole forming portion 11 may be pushed directly.
[0025]
Returning to FIG. 1, reference numeral 20 denotes a ligation operating tool for performing a ligation operation using the ligation loop wire 10, and FIG. 1 shows a tip portion thereof.
The ligation operating tool 20 includes a sheath 21 made of a flexible tube that can be inserted into the treatment instrument insertion channel 2 and an operation wire 22 that is inserted and disposed in the sheath 21 so as to be movable forward and backward in the axial direction.
[0026]
The distal end portion of the operation wire 22 is bent back and is fixed in the middle of the wire by a stop tube 24, thereby forming an annular portion 23 having a size that is detachable from the knob portion 13 of the ligation loop wire 10. Yes.
[0027]
FIG. 5 shows the overall configuration of the ligation operating tool 20. An operating portion 25 is connected to the proximal end portion of the sheath 21, and the operating wire 22 is moved in the axial direction in the sheath 21 by sliding the slide handle 25 a slidably attached thereto in the arrow A direction. The tip annular portion 23 moves in and out from the tip of the sheath 21 as indicated by an arrow B.
[0028]
6 to 8 show an example of use of the endoscope for ligation treatment according to the embodiment configured as described above, and treatment is performed by pressing the tip of the tip hood 3 against a flat affected area on the mucosal surface in the body cavity. By performing suction through the instrument insertion channel 2, the affected part 100 is sucked into the tip hood 3 and rises as shown in FIG. 6.
[0029]
Therefore, as shown in FIG. 7, when the sheath 21 is pushed forward and the fastening member 14 is pushed forward while pulling the operation wire 22 toward the hand side, the loop portion 12 of the ligation loop wire 10 is reduced in diameter. Then, the tip hood 3 is detached from the circumferential groove 4 and the root portion of the affected part 100 is tightened.
[0030]
When the root portion of the affected area 100 is firmly ligated with the ligation loop wire 10 as described above, the sheath 21 is pulled back to the proximal side and the operation wire 22 is pushed forward, and as shown in FIG. The distal end annular portion 23 of the operation wire 22 is removed from the ten knob portions 13 to complete the ligation treatment.
[0031]
If the tip hood 3 is formed of a flexible material, when the diameter of the loop portion 12 of the ligation loop wire 10 is reduced, the tip hood 3 is deformed as shown in FIG. Since it easily disengages from the circumferential groove 4, the ligation operation can be performed more smoothly.
[0032]
FIG. 10 shows a second embodiment of the present invention, in which the loop portion 12 is locked to the tip surface of the tip hood 3 by an adhesive tape 31 attached to the tip portion of the tip hood 3. . If the diameter of the loop portion 12 is reduced from this state, the adhesive tape 31 is partially peeled from the tip hood 3 and the loop portion 12 is detached from the tip hood 3.
[0033]
FIG. 11 shows a third embodiment of the present invention, in which a short cylindrical loop wire locking auxiliary member 32 made of a resilient member is attached to the tip of the tip hood 3, and The loop portion 12 is locked so as to be sandwiched between the front end surface.
[0034]
The loop wire locking auxiliary member 32 is fitted to the outer peripheral surface of the distal end of the distal end hood 3 and slightly protrudes toward the distal end. The click portion 33 including the projecting portion and the recessed portion engages with the distal end hood 3. It is fixed detachably.
[0035]
The gap between the front end surface of the front end hood 3 and the loop wire locking auxiliary member 32 between which the loop portion 12 is sandwiched is slightly narrower on the inner surface side so that the loop portion 12 can be securely locked. When the diameter of the loop portion 12 is reduced with a strong force, the loop portion 12 is detached from the locking portion inward through the gap portion.
[0036]
In this way, the loop portion 12 of the ligation loop wire 10 only needs to be detachably engageable with the distal end portion of the distal end hood 3, so that instead of the engagement by the circumferential groove 4 of the first embodiment, Various locking means can be used.
[0037]
Further, the ligation loop wire 10 is not limited to the configuration of the first embodiment. For example, as shown in FIG. 12, the entire ligation loop wire 10 is formed in a single loop shape and the fastening member 14 is slid. Accordingly, various structures such as a structure in which the loop diameter is reduced can be adopted.
[0038]
In addition, as a clinical application of the present invention, when a polyp without a stalk or a flat affected area is excised with a high-frequency incision tool, the ligation treatment endoscope of the present invention is used as an auxiliary, so that it can be safely and reliably excised. It can be performed.
[0039]
FIGS. 13 to 18 show the state of the treatment. First, a flat affected part 101 as shown in FIG. 13 is passed through the treatment instrument insertion channel of the endoscope as shown in FIG. Submucosal injection is performed with the injection tool 51 to artificially make the polyp 102.
[0040]
Then, as shown in FIG. 15, the polyp 102 is put into the distal end hood 3 of the endoscope for ligation treatment according to the present invention and suction is performed, and the ligation treatment is performed as described above. As described above, the root portion of the artificial polyp 102 can be ligated with the ligation loop wire 10.
[0041]
Therefore, as shown in FIG. 17, a high-frequency snare 52 is introduced through the treatment instrument insertion channel of the endoscope, and the vicinity of the root of the artificial polyp 102 is tied and then a high-frequency current is allowed to flow, as shown in FIG. Thus, the polyp 102 is excised, so that the affected part 101 originally in the plane part can be safely excised endoscopically. And since the vicinity of the cutting end is kept ligated, there is no fear of postoperative bleeding.
[0042]
【The invention's effect】
According to the present invention, the diameter of the ligation loop wire that is detachably locked to the distal end hood of the endoscope is reduced by the ligation operating tool that is inserted into the treatment instrument insertion channel in which the outlet is disposed in the distal end hood. Therefore, using only one treatment instrument insertion channel, a polyp without a stem portion, a flat tumor portion, or the like can be ligated reliably and safely.
[Brief description of the drawings]
FIG. 1 is a side sectional view of a distal end portion of an endoscope for ligation treatment according to a first embodiment of the present invention.
FIG. 2 is a front view of the distal end portion of the endoscope for ligation treatment according to the first embodiment of the present invention.
FIG. 3 is a perspective view of a tip hood according to the first embodiment of the present invention.
FIG. 4 is a plan view of the ligation loop wire according to the first embodiment of the present invention.
FIG. 5 is a front view of the ligation operating tool according to the first embodiment of the present invention.
FIG. 6 is a side cross-sectional view of the ligation treatment endoscope in use according to the first embodiment of the present invention.
FIG. 7 is a side cross-sectional view showing a state where the endoscope for ligation treatment according to the first embodiment of the present invention is in use.
FIG. 8 is a side cross-sectional view of the use state of the ligation treatment endoscope according to the first embodiment of the present invention.
FIG. 9 is a side sectional view of the distal end portion of the distal end hood according to the first embodiment of this invention.
FIG. 10 is a side sectional view of the distal end portion of the endoscope for ligation treatment according to the second embodiment of the present invention.
FIG. 11 is a side cross-sectional view of a distal end portion of a ligation treatment endoscope according to a third embodiment of the present invention.
FIG. 12 is a plan sectional view of another configuration example of the ligation loop wire of the present invention.
FIG. 13 is a cross-sectional view showing the procedure of a clinical application example of the present invention.
FIG. 14 is a cross-sectional view showing the procedure of a clinical application example of the present invention.
FIG. 15 is a side view showing the procedure of a clinical application example of the present invention.
FIG. 16 is a cross-sectional view showing the procedure of a clinical application example of the present invention.
FIG. 17 is a cross-sectional view showing the procedure of a clinical application example of the present invention.
FIG. 18 is a cross-sectional view showing the procedure of a clinical application example of the present invention.
FIG. 19 is a side cross-sectional view of a distal end portion of a conventional ligation treatment endoscope.
FIG. 20 is a side sectional view of a distal end portion of another conventional ligation treatment endoscope.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 Endoscope insertion part tip 2 Treatment tool insertion channel 3 Tip hood 4 Circumferential groove 10 Loop wire 11 for ligation 11 Through-hole formation part 12 Loop part 13 Knurl part 20 Ligation operation tool 21 Sheath 22 Operation wire 23 Tip annular part 31 Adhesion Tape 32 Loop wire locking auxiliary member

Claims (8)

少なくとも処置具挿通チャンネルの出口と吸引口とが開口する内視鏡の先端部分を囲んで設けられた先端フードと、ループ部が上記先端フードの先端部分の外縁部に沿って係脱自在に係止された縮径自在な結紮用ループワイヤと、上記結紮用ループワイヤが係脱自在に係合するように上記先端フードの先端外周面に形成された円周溝と、先端部分が上記結紮用ループワイヤに対して係脱自在に設けられて上記処置具挿通チャンネルに挿通され、上記結紮用ループワイヤを牽引することにより上記円周溝から離脱させて縮径させた状態にしてから上記結紮用ループワイヤと分離される結紮操作具とが設けられた結紮処置用内視鏡において、
上記円周溝の土手部のうち上記先端フードの先端寄り側の土手部を後寄り側の土手部より低く形成して、上記結紮用ループワイヤが上記円周溝から上記先端フードの後側に向かうより先端側に向かって外れ易くしたことを特徴とする結紮処置用内視鏡。A distal end hood provided to surround at least the distal end portion of the endoscope where the outlet and suction port of the treatment instrument insertion channel open, and a loop portion are detachably engaged along the outer edge portion of the distal end portion of the distal end hood. A ligature loop wire that can be reduced in diameter, a circumferential groove formed on the outer peripheral surface of the tip hood so that the ligation loop wire is detachably engaged, and a tip portion is used for the ligation. provided disengageably for the loop wire is inserted through the treatment instrument insertion channel, if we upper SL in the state of being reduced in diameter is disengaged from the circumferential groove by pulling the ligation loop wire In a ligation treatment endoscope provided with a ligation loop wire and a ligation operation tool separated ,
A bank portion closer to the tip of the tip hood of the bank portion of the circumferential groove is formed lower than a bank portion on the rear side, and the ligation loop wire extends from the circumferential groove to the rear side of the tip hood. Endoscope for ligation treatment, characterized in that it is easier to come off toward the tip side rather than toward . 上記処置具挿通チャンネルの出口と上記吸引口とが兼用されている請求項１記載の結紮処置用内視鏡。The endoscope for a ligation treatment according to claim 1, wherein an outlet of the treatment instrument insertion channel and the suction port are combined. 上記先端フードの先端部分に、上記結紮用ループワイヤの端部を上記先端フード内に案内するための案内溝が形成されている請求項１又は２記載の結紮処置用内視鏡。The endoscope for a ligation treatment according to claim 1 or 2, wherein a guide groove for guiding an end portion of the ligation loop wire into the tip hood is formed in a tip portion of the tip hood. 上記結紮用ループワイヤのループが、ワイヤ部材の一端側に形成された通し孔にそのワイヤの中間部分を通して形成されている請求項１ないし３のいずれかの項に記載の結紮処置用内視鏡。The ligation treatment endoscope according to any one of claims 1 to 3 , wherein a loop of the ligation loop wire is formed through an intermediate portion of the wire in a through hole formed on one end side of the wire member. . 上記結紮操作具が、上記内視鏡の処置具挿通チャンネル内に挿脱されるシースとその中に挿通された操作ワイヤとを有しており、その操作ワイヤの先端が上記結紮用ループワイヤの自由端に係脱自在に連結され、上記シースの先端面が上記結紮用ループワイヤの締め付け部に当接する請求項４記載の結紮処置用内視鏡。The ligation operating tool has a sheath that is inserted into and removed from the treatment instrument insertion channel of the endoscope, and an operation wire that is inserted into the sheath, and the distal end of the operation wire is the loop wire for the ligation. The ligation treatment endoscope according to claim 4 , wherein the ligation treatment endoscope is detachably connected to a free end, and a distal end surface of the sheath abuts against a tightening portion of the ligation loop wire. 上記結紮用ループワイヤの自由端部分に瘤が形成され、上記操作ワイヤの先端部分には上記瘤が通る大きさのループが形成されている請求項５記載の結紮処置用内視鏡。6. The endoscope for ligation treatment according to claim 5, wherein a loop is formed at a free end portion of the ligation loop wire, and a loop having a size through which the knob is passed is formed at a distal end portion of the operation wire. 上記先端フードが上記内視鏡の先端部に対して着脱自在である請求項１ないし６のいずれかの項記載の結紮処置用内視鏡。The endoscope for ligation treatment according to any one of claims 1 to 6 , wherein the distal end hood is detachable with respect to a distal end portion of the endoscope. 上記先端フードが透明である請求項１ないし７のいずれかの項記載の結紮処置用内視鏡。The endoscope for ligation treatment according to any one of claims 1 to 7 , wherein the tip hood is transparent.
JP09711197A 1997-04-15 1997-04-15 Endoscope for ligation treatment Expired - Fee Related JP3845173B2 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
JP09711197A JP3845173B2 (en) 1997-04-15 1997-04-15 Endoscope for ligation treatment

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
JP09711197A JP3845173B2 (en) 1997-04-15 1997-04-15 Endoscope for ligation treatment

Publications (2)

Publication Number Publication Date
JPH10286224A JPH10286224A (en) 1998-10-27
JP3845173B2 true JP3845173B2 (en) 2006-11-15

Family

ID=14183481

Family Applications (1)

Application Number Title Priority Date Filing Date
JP09711197A Expired - Fee Related JP3845173B2 (en) 1997-04-15 1997-04-15 Endoscope for ligation treatment

Country Status (1)

Country Link
JP (1) JP3845173B2 (en)

Families Citing this family (15)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2001275933A (en) * 2000-03-31 2001-10-09 Olympus Optical Co Ltd Hood for endoscope
JP4391765B2 (en) 2002-12-02 2009-12-24 オリンパス株式会社 Endoscopic mucosal resection tool
US7465308B2 (en) * 2003-04-10 2008-12-16 Smith & Nephew, Inc. Fixation device
JP4445736B2 (en) * 2003-10-01 2010-04-07 オリンパス株式会社 Insertion aid for treatment of full-thickness colorectal resection and its medical instrument system
JP2006276689A (en) * 2005-03-30 2006-10-12 Olympus Corp Objective lens unit, living body observation device and adaptor
US9155554B2 (en) 2011-10-27 2015-10-13 Boston Scientific Scimed, Inc. Tissue resection bander and related methods of use
WO2013063148A1 (en) 2011-10-27 2013-05-02 Boston Scientific Scimed, Inc Mucosal resection device and related methods of use
CN105232107B (en) * 2015-10-28 2017-10-27 湖南灵康医疗科技有限公司 The method to set up of elastic thread looping and binding device and elastic thread
WO2018001145A1 (en) * 2016-06-28 2018-01-04 张慧 Ligator setup method for automatically tightening elastic line and self-tightening elastic line ligator
CN106236178B (en) * 2016-08-29 2019-01-25 南京微创医学科技股份有限公司 A kind of lasso apparatus for ligating
WO2018191589A1 (en) * 2017-04-13 2018-10-18 The Cleveland Clinic Foundation Tissue ligation devices and methods for ligating tissue
US11957351B2 (en) 2020-11-09 2024-04-16 The Cleveland Clinic Foundation Tissue ligation systems and methods of ligating tissue
KR102296937B1 (en) * 2021-02-17 2021-09-02 (주)스코프로 Overtube
CN113729872B (en) * 2021-09-22 2024-03-26 微尔创（武汉）医疗科技有限公司 Automatic wire breaking device of ligature device
CN113712634B (en) * 2021-09-22 2024-03-26 微尔创（武汉）医疗科技有限公司 Elastic thread ligation gun with automatic thread breakage function

Also Published As

Publication number Publication date
JPH10286224A (en) 1998-10-27

Similar Documents

Publication Publication Date Title
JP3902290B2 (en) Endoscope ligature
JP3845173B2 (en) Endoscope for ligation treatment
US6071233A (en) Endoscope
JP4266743B2 (en) Endoscopic hood and endoscopic mucosal resection tool
US8298249B2 (en) Medical ligating apparatus
US5897487A (en) Front end hood for endoscope
JP4391765B2 (en) Endoscopic mucosal resection tool
EP2055247B1 (en) Ligation tool for endoscope and endoscopic ligation system
US8123763B2 (en) Suture securement apparatus
US20090259234A1 (en) Suture cutting method and device
KR20080079595A (en) Suture instrument
JP2004514530A (en) Ligation band delivery device
US20080015409A1 (en) Treatment device for endoscope
US20090234295A1 (en) Suture Securement Apparatus
JP2004230054A (en) Mucosal resection instrument for endoscope
WO2005032384A1 (en) Medical clipping device, medical instrument and method for cutting organism tissue utilizing the device
US8777964B2 (en) Suture and ligature device for medical treatment
JP2000210294A (en) Biopsy forceps for endoscope
JPWO2019066084A1 (en) Tow clip for endoscope
JPH06254101A (en) Clip device
JPH05212043A (en) Clipping device
JP3411782B2 (en) Endoscope for ligating
JP2001000440A (en) Clipping tool for endoscope
JP4105406B2 (en) Endoscopic clip device
JP2002253562A (en) Medical treatment instrument

Legal Events

Date Code Title Description
A521 Written amendment

Free format text: JAPANESE INTERMEDIATE CODE: A523

Effective date: 20040405

A621 Written request for application examination

Free format text: JAPANESE INTERMEDIATE CODE: A621

Effective date: 20040405

A977 Report on retrieval

Free format text: JAPANESE INTERMEDIATE CODE: A971007

Effective date: 20050805

A131 Notification of reasons for refusal

Free format text: JAPANESE INTERMEDIATE CODE: A131

Effective date: 20051215

A521 Written amendment

Free format text: JAPANESE INTERMEDIATE CODE: A523

Effective date: 20060203

TRDD Decision of grant or rejection written
A01 Written decision to grant a patent or to grant a registration (utility model)

Free format text: JAPANESE INTERMEDIATE CODE: A01

Effective date: 20060810

A61 First payment of annual fees (during grant procedure)

Free format text: JAPANESE INTERMEDIATE CODE: A61

Effective date: 20060818

R150 Certificate of patent or registration of utility model

Free format text: JAPANESE INTERMEDIATE CODE: R150

FPAY Renewal fee payment (event date is renewal date of database)

Free format text: PAYMENT UNTIL: 20090825

Year of fee payment: 3

FPAY Renewal fee payment (event date is renewal date of database)

Free format text: PAYMENT UNTIL: 20100825

Year of fee payment: 4

FPAY Renewal fee payment (event date is renewal date of database)

Free format text: PAYMENT UNTIL: 20100825

Year of fee payment: 4

FPAY Renewal fee payment (event date is renewal date of database)

Free format text: PAYMENT UNTIL: 20110825

Year of fee payment: 5

FPAY Renewal fee payment (event date is renewal date of database)

Free format text: PAYMENT UNTIL: 20120825

Year of fee payment: 6

LAPS Cancellation because of no payment of annual fees