JP4217334B2 - Endoscopic treatment device and high-frequency treatment tool thereof - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to an endoscopic treatment apparatus that performs treatment and excision of a lesion in a body cavity using an endoscope and a treatment tool, and a high-frequency treatment tool thereof.
[0002]
[Prior art]
As disclosed in Japanese Patent Laid-Open No. 9-203660, conventionally, treatment and excision of a lesion in a body cavity using an endoscope and a treatment tool introduced into the body cavity through a channel of the endoscope. Techniques for performing are known. The endoscope treatment apparatus described in Japanese Patent Laid-Open No. 9-203660 described above introduces a high-frequency snare into a body cavity through a channel of the endoscope, hangs on a lesioned part generated in the body cavity, and applies high-frequency to the snare wire. The lesion is excised by energization.
[0003]
[Problems to be solved by the invention]
The technique described in Japanese Patent Laid-Open No. 9-203660 described above can be applied only to a lesion having a size smaller than the opening of the snare wire. However, the size of the snare wire opening is limited. For this reason, the tissue may not be excised depending on the size of the lesion.
[0004]
Further, since the snare wire is relatively soft and has low waist strength, when the snare wire is put on the lesioned part, the state of the snare wire is likely to be unstable, and it is difficult to capture the lesioned part. In addition, the lesion generated in the body cavity does not stop in one place and often moves with the surrounding tissue, and it is easy to lose sight of the lesion to be captured. Capturing the lesion was generally a difficult procedure.
[0005]
In addition, mucosal resection is known in which a cap is attached to the distal end of the endoscope insertion section, the mucosa is sucked into the cap, and a snare wire is applied only to the raised mucosa. It is necessary to suck and draw the mucous membrane into the cap until it contacts the observation lens. For this reason, the state observed with the endoscope is a so-called “red ball state”. Therefore, the snare wire cannot be applied to the excision position while observing the state of the lesion, and the lesion is lost from the observation field of view. The technique was difficult.
[0006]
On the other hand, a technique for excising the mucous membrane with a needle-shaped electric knife is also known, but even in this case, it is very difficult to adjust the penetration depth to accurately excise only the mucosa, and it is quick and reliable. Treatment was difficult.
[0007]
The present invention has been made by paying attention to the above-mentioned problems, and an object of the present invention is an endoscope treatment apparatus capable of reliably and easily excising only a necessary part while observing a lesioned part and the like, and its The object is to provide a high-frequency treatment instrument.
[0008]
[Means and Actions for Solving the Problems]
The present invention can be attached to the distal end of the insertion portion of the endoscope, when mounted to the distal end portion, have a opening formed in a region that can be observed by the endoscope, and in the A hood capable of sucking the inside of the opening by an endoscope , and a conductive material for high-frequency treatment having a conductive wire disposed near the opening of the hood so as to cross the opening and observable with the endoscope A high-frequency treatment instrument for an endoscopic treatment apparatus, comprising: means; and high-frequency energization means for supplying a high-frequency current to the high-frequency treatment conductive means.
The present invention is the high-frequency treatment instrument for an endoscopic treatment device according to claim 1, wherein the hood is formed of a transparent electrically insulating material.
Furthermore, the present invention is an endoscopic treatment device characterized in that the high-frequency treatment instrument according to claim 1 or 2 is attached to a distal end portion of an insertion portion of an endoscope.
In the present invention , a conductive wire is provided in the vicinity of the opening of the hood so as to cross the opening, and only the necessary portion of the lesion that is sucked and taken in by the conductive wire is taken into the hood. Is treated.
[0009]
DETAILED DESCRIPTION OF THE INVENTION
(First embodiment)
A first embodiment of the present invention will be described with reference to FIGS. FIG. 1 shows a state in which an endoscope hood 2 is attached to the distal end portion of the endoscope 1.
[0010]
The endoscope 1 has a flexible insertion portion 3 as a whole, and the insertion portion 3 includes a flexible portion 4, a bending portion 5 that can be bent in a desired direction, and a distal end portion 6. Yes. An operation portion (not shown) provided with a mechanism for bending the bending portion 5 is connected to the base end of the insertion portion 3. A universal cord (not shown) is connected to the operation unit. The universal cord is connected to a light source device and a video processor (not shown), and the video processor is connected to a monitor.
[0011]
The distal end surface of the distal end portion 6 is provided with an observation lens 11, an illumination lens 12, an opening of a forceps channel 13 through which a treatment instrument is inserted and sucked, a nozzle 14 and the like. Here, a direct-view type endoscope 1 is constructed.
[0012]
Further, a transparent endoscope hood 2 is attached to the distal end portion of the insertion portion 3. The endoscope hood 2 includes a substantially cylindrical cap 21 and a conical cylindrical fixing member 22 for attaching the cap 21 to the distal end portion 6 of the endoscope 1. The cap 21 and the fixing member 22 are coaxially connected. As fixing means for the both, there are ultrasonic waves, a solvent, etc. in the case of press-fitting, fixing with an adhesive, coupling with a screw or the like, or a stronger fixing. Use the fixing method.
[0013]
The cap 21 is made of a hard and heat-resistant transparent synthetic resin, such as an acrylic resin, preferably a plastic material such as polycarbonate, or glass. The endoscope hood 2 has a hardness (rigidity) indicating a waist strength that does not deform when the tip edge is pressed against the mucous membrane or when the mucous membrane is sucked.
[0014]
A high-frequency wire 25 made of a metal wire is installed in the tip opening region of the cap 21 so as to be arranged over the position of the diameter line passing through the center of the opening circle. Both ends of the high-frequency wire 25 are fixed to the opening edge of the cap 21 by, for example, bonding. The tip opening area of the cap 21 is not limited to a perfect circle.
[0015]
The high-frequency wire 25 is electrically connected to a conductive wire 26 of a high-frequency current transmission means that is externally attached to the insertion portion 3 of the endoscope 1. Here, although not shown, the conductive wire 26 is disposed along the insertion portion 3 of the endoscope 1 to the hand side of the insertion portion 3 and connected to a high-frequency power supply device (not shown).
[0016]
The conductive wire 26 is formed of a conductive wire obtained by extending the high frequency wire 25 rearward as it is. The conductive wire 26 is in the form of a cord covered with a resin-coated tube 27 made of a tubular member so as to be electrically insulated from the outside.
[0017]
The fixing member 22 is made of synthetic resin, preferably soft plastic such as vinyl chloride, polyurethane, fluororesin, or elastic material, preferably rubber such as latex, silicon, isoprene, naoprene, etc. The tip portion 6 is configured to be detachable without damaging the tip portion 6. That is, the cap 21 is detachable from the distal end portion 6 of the endoscope 1, and the conductive wire 26 is detachable together with the cap 21.
[0018]
Next, the operation of the first embodiment will be described with reference to FIGS. The endoscope hood 2 is attached to the distal end portion 6 before the insertion portion 3 of the endoscope 1 is inserted into the body cavity of the patient. Then, the insertion part 3 of the endoscope 1 is inserted into the body cavity of the patient, and the lesion part to be excised is observed. Since the endoscope hood 2 is transparent, its periphery can also be observed. Therefore, orientation (positioning, guidance, etc.) is easy.
[0019]
Here, although not shown in advance, as in the usual endoscopic mucosal resection, physiological saline or the like is locally injected into the submucosal layer of the lesion using an injection needle inserted into the forceps channel 13. Raise the entire lesion. Then, while pressing the high-frequency wire 25 against the mucosa around the lesion, the inside of the cap 21 of the endoscope hood 2 is appropriately sucked through the forceps channel 13, and the mucous membrane is formed around the distal end opening of the cap 21. Adhere. At this time, the periphery of the distal end opening of the cap 21 avoids the lesioned part, and is positioned and fixed at the peripheral part of the lesioned part.
[0020]
At this time, as shown in FIG. 2, the mucous membrane layer and the muscle layer are peeled in advance with physiological saline or the like, and only the mucous membrane layer is sucked by the suction. The distal end opening of the endoscope hood 2 is located at a site to be excised in the peripheral region of the lesioned part. In this fixed state, a high-frequency current is passed through the high-frequency wire 25 to excise the mucous membrane.
[0021]
Further, since only the mucosal layer is separated from the muscle layer by suction and is slightly sucked into the hood 2, only the mucosal layer can be excised without the energized high-frequency wire 25 contacting the muscle layer.
[0022]
The above operation is performed in several times on the peripheral region surrounding the lesioned part, and as shown in FIG.
[0023]
The high-frequency wire 25 may have a function set so as to be appropriately bent depending on the amount of protrusion of the mucosa when the mucosa is sucked. For example, a configuration in which the high-frequency wire 25 itself is bent, a configuration in which the high-frequency wire 25 is elastically extended, a configuration in which the cap 21 is elastically deformed, or the like is conceivable. Further, it is desirable that the bending of the high-frequency wire 25 can be set so as to bend appropriately by adjusting the tension from the hand side.
[0024]
According to the present embodiment, it is possible to perform excision while fixing the excision portion at the distal end edge of the endoscope hood 2 and observing with the endoscope 1. Therefore, only the mucous membrane layer can be excised reliably and easily, and excision over a wide range can be performed accurately and promptly.
[0025]
As described above, by performing suction, the hood 2 provided with the high-frequency wire 25 can be fixed around the lesioned part, and the high-frequency wire 25 is positioned at the distal end of the hood 2, which is detected by the endoscope 1. It is visible. That is, a visible distance from the observation lens 11 of the endoscope 1 is maintained. For this reason, excision work can be reliably performed while observing a lesioned part. Therefore, there is no risk of damaging the muscle layer and the lesioned part, and the excision work can be performed quickly and easily.
[0026]
(Second Embodiment)
A second embodiment of the present invention will be described with reference to FIGS. In this 2nd Embodiment, the same code | symbol is attached | subjected to the same component as 1st Embodiment mentioned above, and the description is abbreviate | omitted.
[0027]
In this embodiment, means for rotating the endoscope hood 2 is provided. That is, the fixing member 22 of the endoscope hood 2 is made of rubber or the like so that it can rotate while being twisted. Further, as shown in FIG. 4, the high frequency wire 25 has a length corresponding to the amount of rotation of the hood 2 from the position of the tip of the covering tube 27 that guides the conductive wire 26, and the high frequency wire 25 of the endoscope hood 2. It arrange | positions in the site | part which passes along the position biased so that it may pass along an outer side.
[0028]
Then, by using the conductive wire 26 of the high-frequency current transmission means as a pulling operation member and pulling the high-frequency wire 25 toward the hand side, as shown in FIG. 5, the high-frequency wire 25 is linearly drawn and pulled as shown in FIG. The cap 21 rotates while the portion of the fixing member 22 of the endoscope hood 2 is twisted. That is, a means for rotating the cap 21 portion of the endoscope hood 2 is configured, and the direction (position) of the high-frequency wire 25 can be changed.
[0029]
When the high-frequency wire 25 is no longer pulled toward the hand side, the torsion of the portion returns due to the elasticity of the fixing member 22, and the high-frequency snare 25 returns to the original position shown in FIG.
[0030]
Next, when using this, as in the operation of the first embodiment, the endoscope hood 2 at the distal end portion 6 of the endoscope 1 is attached, and the insertion portion 2 is inserted into the body cavity. The lesion part to be excised is observed with the endoscope 1.
[0031]
Next, as in the case of endoscopic mucosal resection, physiological saline is locally injected into the submucosa to raise the entire lesion. Then, in the state where the mucosa layer and the muscle layer are separated, while pressing the tip of the endoscope hood 2 to the place where the mucosa around the lesion is to be excised, The mucous membrane is brought into close contact with the tip of the endoscope hood 2 and fixed. Then, a high-frequency current is passed through the high-frequency wire 25 to perform excision around the lesioned part.
[0032]
Here, the direction of the high-frequency wire 25 at the distal end of the endoscope transparent hood 2 is changed by pulling the conductive wire 26 of the high-frequency current transmitting means toward the proximal side in accordance with the angle to be excised, and surrounds the lesioned part. In this way, several excisions are performed, and the entire circumference of the lesion is excised.
[0033]
In addition, the high-frequency wire 25 can be continuously removed while rotating the high-frequency wire 25 together with the cap 21 portion of the endoscope hood 2.
[0034]
According to the present embodiment, since only the distal end portion having the high-frequency wire 25 can be rotated without rotating the endoscope 1, it is possible to easily set the movement and angle of the lesion to the portion to be excised. For this reason, excision in a fine range is possible.
[0035]
(Third embodiment)
A third embodiment of the present invention will be described with reference to FIG. In this 3rd Embodiment, the same code | symbol is attached | subjected to the same component as 1st Embodiment mentioned above, and the description is abbreviate | omitted.
[0036]
As shown in FIG. 6, the endoscope hood 2 of the present embodiment has a cap 21 formed with an obliquely distal end portion and an oblong end opening portion. The high frequency wire 25 is disposed along the major axis direction of the elliptical tip opening. The high-frequency wire 25 is disposed in the major axis direction at the oblique opening of the cap 21 of the endoscope hood 2. For this reason, even if the diameter of the cap 21 of the endoscope hood 2 shown in the first embodiment described above is the same, the excision function region of the high-frequency wire 25 becomes long in a long range.
[0037]
This excision operation is the same as the mucous membrane excision shown in the first embodiment. However, since the excision function area of the high-frequency wire 25 becomes longer, the excision operation can be performed in a longer range than that of the first embodiment. Therefore, excision over a wide range can be easily performed, and the treatment time can be shortened.
[0038]
In addition, by combining the function of rotating the cap 21 with the high-frequency wire 25 described in the second embodiment described above with the endoscope hood 2 whose tip opening is oblique as described above, the cut-out portion of the high-frequency wire 25 can be obtained. Since long and short adjustment selection is possible within a certain range, mucosal resection within a more accurate range can be performed.
[0039]
<Appendix>
1. A hood that can be attached to the distal end of an endoscope and has an opening formed in a region observed by the endoscope;
A conductive means for high frequency treatment, which is made of a conductive wire disposed in the diameter direction of the opening in the vicinity of the opening of the hood, and can be observed by the endoscope,
A high-frequency treatment instrument for an endoscopic treatment apparatus, comprising high-frequency energization means for supplying a high-frequency current to the high-frequency treatment conductive means.
2. The high-frequency treatment instrument for an endoscopic treatment device according to Additional Item 1, wherein the hood is formed of a transparent electrically insulating material.
3. An endoscopic treatment device, wherein the high-frequency treatment tool according to Additional Item 1 or Additional Item 2 is attached to a distal end portion of an endoscope.
[0040]
4). The hood has a cylindrical shape having an outer diameter substantially equal to or larger than the outer diameter of the endoscope insertion portion at the distal end of the insertion portion of the endoscope, and is made of a metal wire in the vicinity of the distal end opening of the hood. The endoscopic treatment device or the high-frequency treatment tool according to any one of items 1 to 3, wherein the conductive means for high-frequency treatment is arranged in a diameter direction of the distal end opening of the hood.
5. The endoscope treatment apparatus according to any one of claims 1 to 4, wherein the hood, the high-frequency treatment conductive means, and the high-frequency energization means are integrally detachable from the endoscope apparatus or the high-frequency wave thereof. Treatment tool.
[0041]
6). The hood includes a tip member made of a transparent, hard and heat-resistant resin material and a fixing member made of a soft elastic resin material connected to the rear of the tip member. The endoscopic treatment device according to appendix 5, or a high-frequency treatment tool thereof.
7). The endoscope according to any one of items 1 to 6, wherein means for rotating the distal end member of the hood about the endoscope insertion portion axis is configured using a metal wire constituting the high-frequency energizing means. Mirror therapy device or its high frequency treatment tool.
[0042]
8). The metal wire is embedded in a tubular member extending from the proximal side of the insertion portion of the endoscope, serves also as a traction member provided so as to be able to advance and retract by a traction operation from the proximal side, and is guided to the distal end member, and The endoscopic treatment device according to appendix 7, wherein the endoscopic treatment device is a high-frequency treatment conductive means disposed in the vicinity of the opening of the hood from the distal end of the tubular member on the outer periphery of the hood. Or its high frequency treatment tool.
[0043]
9. Endoscopic treatment according to any one of claims 1 to 8, wherein the hood communicates with an aspiration channel of an endoscope and a lesion is fixed to an open end of the hood by suction. The device or its high frequency treatment tool.
[0044]
【The invention's effect】
As described above, according to the present invention, it is possible to provide an endoscopic treatment apparatus capable of reliably and easily excising only a necessary part while observing a lesioned part or the like with an endoscope and a high-frequency treatment tool thereof. Can do.
[Brief description of the drawings]
FIG. 1 is a perspective view of a state where an endoscope hood is attached to a distal end portion of an endoscope according to a first embodiment.
FIG. 2 is an explanatory view showing an operating state when using the first embodiment.
FIG. 3 is an explanatory diagram of an operation state when the same embodiment is used.
FIG. 4 is a perspective view of a state in which an endoscope hood is attached to a distal end portion of an endoscope according to a second embodiment.
FIG. 5 is a perspective view showing a state where an endoscope hood is attached to the distal end portion of the endoscope in the second embodiment.
FIG. 6 is a perspective view showing a state in which an endoscope hood is attached to the distal end portion of the endoscope in the third embodiment.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 ... Endoscope, 2 ... Endoscope hood, 3 ... Endoscope insertion part, 4 ... Flexible part,
5 ... curved portion, 6 ... tip portion, 11 ... observation lens, 13 ... forceps channel,
21 ... Cap, 22 ... Fixing member, 25 ... High frequency wire,
26: Conductive wire of high-frequency current transmission means, 27: Covered tube, 28: Cutting line.

Claims (3)

Is attachable to the distal end of the insertion portion of the endoscope, when mounted to the distal end portion, have a opening formed in a region that can be observed by the endoscope, and the by the endoscope A hood capable of sucking inside the opening ,
In the vicinity of the opening of the hood, the conductive means for high-frequency treatment having a conductive wire disposed across the opening and observable with the endoscope,
High-frequency energizing means for supplying a high-frequency current to the high-frequency treatment conducting means;
A high-frequency treatment instrument for an endoscopic treatment apparatus, comprising:   The high-frequency treatment instrument for an endoscopic treatment device according to claim 1, wherein the hood is formed of a transparent electrically insulating material. An endoscope treatment apparatus comprising the high-frequency treatment tool according to claim 1 or 2 attached to a distal end portion of an insertion portion of an endoscope.

Images