JP4350472B2 - Insertion aid for treatment of full-thickness colorectal resection and its medical instrument system - Google Patents

Description

  The present invention relates to an insertion for treatment of full-thickness colorectal resection in which an endoscope and a treatment tool are inserted into an insertion assisting tool for full-thickness resection of a large intestine introduced into a body cavity to perform treatment such as full-thickness resection of the large intestine It is related with an auxiliary tool and its medical device system.

  2. Description of the Related Art Conventionally, a system has been developed in which an endoscope is inserted into the large intestine from the anus, and the entire large intestine including the mucous membrane layer and muscle layer is collectively removed. For example, in Patent Document 1, a tubular treatment insertion aid in the form of an overtube is attached in advance to an insertion portion of a first endoscope, and the treatment insertion aid is inserted into the large intestine by the first endoscope. Inserted into. Thereafter, the first endoscope is withdrawn from the treatment insertion aid, whereby only the treatment insertion aid is placed in the large intestine. In this state, the second endoscope, the ligation treatment tool, and the resection treatment tool are inserted into the large intestine through the inside of the treatment insertion aid.

  Then, in a state where the biological tissue to be treated is grasped by the grasping treatment tool such as grasping forceps inserted into the large intestine through the endoscope channel of the second endoscope, the biological tissue to be treated is pulled up. The biological tissue to be treated is lifted by moving the grasping treatment tool. Then, after ligating the base portion of the lifted living tissue with a ligation treatment tool, the upper portion of the ligated portion of the ligated biological tissue is excised with a resection treatment tool. As a result, the entire large intestine is excised. Here, in the device of the conventional configuration, the entire body of the large intestine can be obtained by penetrating, for example, a puncture needle from the side into the pulled up living tissue and placing a ligation tool such as T-BAR or ligating with a stapler. Is sutured.

Further, when the large intestine tissue is grasped / lifted by the grasping treatment tool inserted through the endoscope, a frame-like tissue pressing member is disposed around the large intestine tissue to be lifted. And, in the state where the large intestine tissue is grasped by the grasping treatment tool in the opening of the frame of the tissue pressing member, by suspending the large intestine tissue, the ligation process of the large intestine tissue by the ligation treatment tool in the next step, The excision process with the excision instrument is made easier.
JP 2000-37347 A

  Generally, the large intestine has a plurality of bent (curved) portions. Therefore, when inserting the treatment insertion assisting tool for full colorectal resection into the deep part of the large intestine, it is necessary to insert the treatment insertion assisting tool into such a bent (curved) portion of the large intestine. However, since the distal end portion of the treatment insertion assisting tool is formed with a relatively long hard portion in the axial direction, the operation of passing the distal end hard portion of the treatment insertion assisting tool through the bent (curved) portion of the large intestine There is a problem that the workability of inserting the treatment insertion aid into the deep part of the large intestine is difficult. Therefore, when performing the operation of inserting the treatment insertion aid into the deep part of the large intestine, there is a problem that it takes skill and takes time.

  The present invention has been made paying attention to the above circumstances, and the purpose thereof is to improve the workability of inserting the treatment insertion aid into the deep part of the large intestine and to reliably perform the work of excising the entire large intestine. It is an object of the present invention to provide a treatment tool insertion aid for full-color resection of the large intestine and its medical device system.

According to the first aspect of the present invention, there is provided a treatment side hole for inserting a living tissue to be treated into one side portion of the distal end portion outer peripheral surface of the large intestine insertion portion to be inserted into the large intestine, and the other end portion of the distal end portion outer peripheral surface. Each of the working space for full colorectal resection treatment is formed,
The biological tissue to be treated is pulled up into the working space through the treatment side hole, and the base portion of the biological tissue to be ligated is ligated by ligation means, and then the ligated biological tissue is ligated. Provide a treatment tool insertion aid main body for excision of the entire large intestine to remove the upper part from the part with the treatment tool for resection,
The treatment instrument insertion aid main body is formed by a frame-shaped arm member with a biological tissue pressing portion at the periphery of the treatment side hole,
While providing a folding means for supporting the arm member foldable in the front-rear direction along the axial direction of the insertion portion,
Opening and closing between a use position in which the arm member is moved in a direction to open in front of the insertion portion to form the treatment side hole and a closed position in which the arm member is folded to the rear side of the treatment side hole A treatment instrument insertion assisting tool for full-colorectal resection of the large intestine, characterized in that an operating means for operation is provided.
In the first aspect of the present invention, during the insertion operation of the treatment instrument insertion assisting tool main body, the frame-like arm member is folded by the folding means to the closed position where it is folded to the rear side of the treatment side hole. Further, when the living tissue is treated by the treatment instrument insertion assisting tool main body, the arm member is moved by the operation means in a direction to open in front of the insertion portion, and the opening operation is performed to the use position where the treatment side hole is formed. .

The invention according to claim 2 is characterized in that the treatment instrument insertion assisting instrument main body has an urging means that normally holds the arm member in the use position.
2. The large intestine according to claim 1, wherein the operation unit includes a slide type operation lever that pulls the arm member to the standby position against the urging force of the urging unit. This is a treatment tool insertion aid for full-thickness resection.
In the invention of claim 2, when the living tissue is treated by the treatment instrument insertion assisting tool main body, the urging means moves the arm member in the direction to open in front of the insertion portion to the use position where the treatment side hole is formed. It is held in the opened state. During the insertion operation of the treatment instrument insertion assisting tool main body, the arm member is pulled to the standby position against the urging force of the urging means by operating the slide type operating lever. As a result, the frame-like arm member is folded to the closed position folded to the rear side of the treatment side hole.

According to a third aspect of the present invention, the treatment instrument insertion assisting tool main body has a pressing member that suppresses the lifting of the distal end portion of the treatment tool for excision at an end portion of the insertion portion closer to the distal end portion than the treatment side hole. And
2. The pressing member is formed of an elastic member fixed to the arm member and elastically deformable so as to overlap with the arm member when the arm member is folded to the standby position. The treatment tool insertion aid for full-thickness excision of the large intestine as described in 1. above.
In the invention of claim 3, during the insertion operation of the treatment instrument insertion assisting tool main body, the frame-like arm member is folded to the closed position on the rear side of the treatment side hole by the folding means. When the arm member is folded, the elastic member of the pressing member is held in a state of being elastically deformed so as to overlap the arm member. Further, when the biological tissue is treated by the treatment instrument insertion assisting tool main body, the arm member is moved by the operation means in a direction to open in front of the insertion portion, and the opening operation is performed to the use position where the treatment side hole is formed. At this time, the pressing member is disposed at the end of the insertion portion closer to the distal end than the treatment side hole, and the pressing member suppresses the lifting of the distal end of the ablation treatment tool.

According to a fourth aspect of the present invention, there is provided a ligation channel in which at least an endoscope insertion channel and a ligation treatment tool for inserting a ligation tool for ligation of a living tissue are inserted into an insertion portion to be inserted into a body lumen. And an excision channel into which an excision treatment tool for excising the ligated portion of the living tissue ligated with the ligation instrument is formed, and is disposed at the distal end portion of the insertion portion, and the distal end of the insertion portion A treatment side hole for inserting a living tissue to be ligated into one side portion of the outer peripheral surface of the portion, and a pulling operation of the living tissue to be ligated from the treatment side hole formed on the other side portion of the outer peripheral surface of the distal end portion. A treatment instrument insertion aid comprising a working space,
The ligation treatment instrument set in a state of being inserted into the ligation channel and arranged at a position surrounding the treatment side hole;
An endoscope that is inserted to the working space through the endoscope insertion channel;
A grasping treatment tool provided with a grasping portion for grasping a living tissue at a distal end portion of an insertion portion inserted into the working space through the channel of the endoscope;
A tissue lifting means for pulling up the living tissue to be ligated through the treatment side hole by a bending operation of the endoscope in a state where the living tissue is gripped by the gripping portion of the gripping treatment tool;
Ligating means for ligating the living tissue to be ligated pulled up by the tissue lifting means with the ligation instrument;
An excision treatment tool that is inserted into the excision channel and excises the ligated portion of the living tissue ligated by the ligation means,
The treatment tool insertion assisting tool is formed by a frame-like arm member at a peripheral portion of the treatment side hole with a biological tissue pressing portion,
While providing a folding means for supporting the arm member foldable in the front-rear direction along the axial direction of the insertion portion,
Opening and closing between a use position where the arm member is moved in a direction to open in front of the insertion portion to form the treatment side hole and a closed position where the arm member is folded to the rear side of the treatment side hole A medical device system for excision of the entire large intestine, which is provided with operating means for operating.
In the invention of claim 4, during the entire colorectal resection treatment, the arm member is moved by the operation means in the direction to open in front of the insertion portion, and the opening operation is performed to the use position where the treatment side hole is formed. In this state, the biological tissue to be treated is pulled up to the working space through the treatment side hole, and the root portion of the biological tissue to be treated that has been pulled up is ligated by the ligating means. Furthermore, during the insertion operation of the treatment instrument insertion assisting tool main body, the frame-like arm member is folded by the folding means to the closed position where it is folded to the rear side of the treatment side hole.

The invention according to claim 5 is characterized in that the treatment instrument insertion assisting tool has an urging means that normally holds the arm member in the use position.
5. The large intestine according to claim 4, wherein the operating means has a slide type operating lever that pulls the arm member to the standby position against the urging force of the urging means. It is a medical instrument system for full thickness ablation.
In the invention of claim 5, when the living tissue is treated by the treatment instrument insertion assisting tool main body, the urging means moves the arm member in the direction to open in front of the insertion portion to the use position where the treatment side hole is formed. It is held in the opened state. During the insertion operation of the treatment instrument insertion assisting tool main body, the arm member is pulled to the standby position against the urging force of the urging means by operating the slide type operating lever. As a result, the frame-like arm member is folded to the closed position folded to the rear side of the treatment side hole.

According to a sixth aspect of the present invention, the treatment instrument insertion assisting tool protrudes forward from the resection channel at a position corresponding to the resection channel at an end portion of the insertion portion closer to the distal end than the treatment side hole. A holding member that suppresses lifting of the distal end of the treatment tool for excision,
The full-thickness colorectal resection according to claim 4, wherein the pressing member is formed by an elastic member fixed to the arm member and elastically deformable when the arm member is folded to the standby position. Is a medical instrument system.
In the invention of claim 6, during the operation of inserting the treatment instrument insertion aid main body, the frame-like arm member is folded to the closed position on the rear side of the treatment side hole by the folding means. When the arm member is folded, the elastic member of the pressing member is held in a state of being elastically deformed so as to overlap the arm member. Further, when the biological tissue is treated by the treatment instrument insertion assisting tool main body, the arm member is moved by the operation means in a direction to open in front of the insertion portion, and the opening operation is performed to the use position where the treatment side hole is formed. At this time, the pressing member is disposed at the end of the insertion portion closer to the distal end than the treatment side hole, and the pressing member suppresses the lifting of the distal end of the ablation treatment tool.

  ADVANTAGE OF THE INVENTION According to this invention, the workability | operativity which inserts the insertion assistance tool for treatment into the large intestine can be improved, and the operation | work which excises the entire large intestine can be performed reliably.

  Hereinafter, a first embodiment of the present invention will be described with reference to FIGS. 1 to 15A and 15B. FIG. 1 shows a schematic configuration of the entire medical instrument system 1 for excision of the entire large intestine of the present embodiment. The medical instrument system 1 according to the present embodiment includes an endoscope 2 and a treatment insertion aid 3.

  The endoscope 2 includes an elongated insertion portion 2a that is inserted into the body, and a proximal-side operation portion 2b that is connected to the proximal end of the insertion portion 2a. The insertion portion 2a has an elongated flexible tube portion 2c having flexibility, a hard distal end portion 2d disposed at the foremost position, and a bending portion 2e capable of bending deformation. Inside the insertion portion 2a, a plurality of operation wires, a control signal cable, a light guide cable, a water / water intake / air intake / intake tube, various probe channels, and the like are provided.

  The endoscope 2 according to the present embodiment is a side-view endoscope in which the visual field direction of the observation optical system at the distal end portion 2d is oriented in the direction orthogonal to or substantially rearward from the axial direction of the insertion portion 2a. An illumination window, an observation window, an air / water channel opening, a forceps channel opening that also serves as a suction port, and the like are provided on the side surface of the tip 2d. The exit end of the light guide cable is disposed opposite to the inner surface of the illumination window. On the inner surface of the observation window, an objective lens of the observation optical system, an electronic image pickup device (CCD) that images a subject observed by the objective lens, and the like are disposed. The illumination light is projected from the light emitting end of the light guide cable through the illumination window, and the subject illuminated with the projected illumination light is imaged by the electronic image sensor.

  The distal end portion 2d of the endoscope 2 is provided with a forceps raising base (not shown) in the forceps channel opening. This forceps raising base is operated by a forceps raising knob (not shown) provided in the operation section 2b. Then, the protruding direction of the tip gripping portion 4a (see FIG. 13) of the gripping forceps 4 to be described later inserted through the forceps channel is deflected by the lifting operation of the forceps lifting base.

  In addition, a base end portion of the universal cord 2f is connected to the operation portion 2b. The other end of the universal cord 2f is connected to the light source device via a connector (not shown). The illumination light from the light source device is supplied to the light guide cable in the universal cord 2f. An electrical cable is further connected to the connector. This electric cable is connected to a camera control unit (CCU) via an electric connector. Then, after the endoscopic image of the subject imaged by the observation optical system is converted into an electric signal by the electronic image sensor, this electric signal is transmitted to the camera control unit via the control signal cable, and is displayed on a display monitor (not shown). It is displayed.

  Further, the operation section 2b is provided with an operation knob 2g for bending operation, a forceps channel insertion port 2h, a forceps raising knob (not shown), and the like. Then, the operation wire in the insertion portion 2a is pulled by the operation of the operation knob 2g, and the bending portion 2e is bent, for example, up, down, left, and right to change the direction of the distal end portion 2d.

  Further, the grasping forceps 4 is inserted into the forceps channel insertion opening 2h, and the tip gripping portion 4a provided at the tip of the grasping forceps 4 is projected from the distal end portion 2d of the insertion portion 2a into the body cavity. It has become. At this time, by operating a forceps raising knob (not shown) of the operation portion 2b, the forceps raising base of the forceps channel opening of the tip portion 2d is raised, and the protruding direction of the tip gripping portion 4a inserted through the forceps channel is deflected. It is supposed to let you.

  As shown in FIG. 11, the treatment insertion aid 3 includes a sheath portion (treatment tool insertion aid main body) 5 to be inserted into the large intestine H <b> 1 and a grip portion 5 a connected to the proximal end portion of the sheath portion 5. And are provided. Furthermore, an endoscope insertion channel 8 (described later) into which the insertion portion 2a of the endoscope 2 is inserted is formed in the sheath portion 5 and the grip portion 5a of the treatment insertion assisting tool 3.

  The sheath portion 5 has flexibility to freely follow the bending of the insertion portion 2a of the endoscope 2, for example, polyurethane, vinyl chloride, polyurethane elastomer, polystyrene elastomer, polyolefin elastomer, polyester elastomer, polyamide It is made of a relatively flexible resin material such as a base elastomer, fluororesin (porous), and other various thermoplastic elastomers, and has the same length as the large intestine, preferably 600 mm or more and about 1700 mm.

  As shown in FIGS. 2A and 2B, the distal end portion of the sheath portion 5 has a treatment side hole 6 for inserting a living tissue to be treated into one side portion of the outer peripheral surface, and the other side of the outer peripheral surface of the distal end portion. Work space portions 7 for the entire colorectal resection treatment are formed in the respective portions. The work space 7 for the full-colorectal resection treatment is formed by a slit in which the upper half of the distal end portion of the sheath portion 5 is cut out in FIG. A distal end portion 2d of the insertion portion 2a of the endoscope 2 inserted from the grasping portion 5a of the treatment insertion assisting tool 3 projects into the working space portion 7 of the slit.

  The treatment side hole 6 is formed by a substantially rectangular opening that opens in the lower half of the distal end portion of the sheath portion 5 in FIG. Here, the opening shape of the treatment side hole 6 is formed in a horizontally long rectangular shape that is long in a direction orthogonal to the center line direction of the sheath portion 5 as shown in FIG. The rectangular shape of the horizontally long treatment side hole 6 is set so that the length in the direction orthogonal to the axial direction is longer than the length in the axial direction.

  Further, as shown in FIG. 3, the sheath portion 5 of the treatment insertion aid 3 includes at least one endoscope insertion channel 8, a plurality of, in this embodiment, four ligation channels 9, and one excision. It is formed by a multi-lumen tube having a channel 10. Here, the endoscope insertion channel 8 is disposed at a position corresponding to the working space portion 7 of the sheath portion 5. Then, four ligation channels 9 and one excision channel 10 are arranged at positions corresponding to the ligation and excision parts arranged below the working space portion 7.

  Further, the excision channel 10 is arranged at a position facing the substantially central portion of the ligation excision in FIG. Two ligation channels 9 are juxtaposed on both sides of this excision channel 10.

  A resection snare unit (resection treatment tool) 11 is inserted into the resection channel 10. The excision snare unit 11 includes an excision snare 12 and an excise snare introduction tube 13 through which the excise snare 12 is inserted. In the excision snare 12, an excision loop portion 15 having a spreading behavior in a loop shape is formed at the distal end portion of the elongated operation wire 14.

  The four ligation channels 9 are inserted with ligation treatment tools 17 for ligating a ligation tool 16 for ligation of living tissue (see FIG. 5) to the biological tissue to be treated. As shown in FIG. 5, the ligation tool 16 of the present embodiment has two substantially cylindrical T bars 16a and 16b, and a T bar sheath 16c that connects substantially central portions of the T bars 16a and 16b. The overall shape is formed in an H shape. The T-bar sheath 16c is thinner than the T-bars 16a and 16b, and has a length corresponding to approximately four layers of the large intestine to be ligated. The lengths of the T bars 16a and 16b are about the entire layer, and the length is about 5 to 15 mm, preferably about 10 mm.

  The ligature 16 is relatively flexible such as polyurethane, vinyl chloride, polyurethane elastomer, polystyrene elastomer, polyolefin elastomer, polyester elastomer, polyamide elastomer, fluororesin (porous), and other various thermoplastic elastomers. Made of resin material.

  Further, the ligation treatment instrument 17 is provided with four puncture needles 18 respectively inserted into the four ligation channels 9. As shown in FIG. 6, each puncture needle 18 is provided with a hollow needle member 19. The needle member 19 is formed of a metal pipe made of a material such as stainless steel or nitinol, and has an inner diameter of about 0.5 to 1.5 mm and an outer diameter of about 0.7 to 2.0 mm. The needle member 19 may be formed of a resin tube such as a fluororesin, polyethylene, polyamide, polyimide, polyurethane, various thermoplastic elastomers, or a metal coil. In addition, in order to make it difficult to buckle, a resin tube may be put on the outside of the metal coil, or a resin tube containing a metal mesh may be used.

  A sharp needle tip portion 19a having an inclined surface that is notched in a direction obliquely intersecting the axial direction is formed at the distal end portion of the needle member 19. Thereby, the needle tip portion 19a of the needle member 19 can puncture the tissue in the body cavity.

  Furthermore, a slit 19 b is provided along the axial direction on the outer peripheral surface of the distal end portion of the needle member 19. As shown in FIG. 4, a slit 9 a is formed at the tip of each ligation channel 9 at a position corresponding to the slit 19 b of the puncture needle 18.

  A substantially rod-shaped protruding member 20 is slidably inserted into the needle member 19 of the puncture needle 18. A distal end portion of a pusher wire 21 formed of a metal wire material such as a stainless steel member is connected to the base end of the protruding member 20.

  In addition, the grasping portion 5a of the treatment insertion assisting tool 3 is provided with a ligation / removal operation unit 22 for independently operating the resection snare unit 11 and the ligation treatment tool 17. The ligation and excision operation unit 22 includes an excision operation unit 23 that operates the excision snare unit 11 and a ligation operation unit 24 that operates the treatment tool 17 for ligation.

  The excision operation portion 23 includes a stopper 23a to which the proximal end portion of the excision snare introduction tube 13 is connected, and a handle 23b to which the proximal end portion of the operation wire 14 of the excision snare 12 is connected. Here, when the stopper 23a and the handle 23b are moved to the forward pushing position, the excision snare introduction tube 13 and the excision snare 12 are set to the set position for the excision operation as shown in FIG. The At this time, the distal end portion of the excision snare introduction tube 13 is moved to a position protruding from the excision channel 10, and the loop portion 15 of the excision snare 12 protrudes from the excision snare introduction tube 13 and has a treatment side hole. 6 is surrounded.

  In this state, by pulling out the handle 23b, the loop portion 15 of the excision snare 12 is drawn into the excision snare introduction tube 13 so as to hold the target portion.

  Further, the ligation operation unit 24 includes a needle introduction tube 25 into which the needle member 19 of the puncture needle 18 is inserted, a needle slider 26 to which the proximal end of the needle introduction tube 25 is connected and fixed, a needle introduction tube 25 and a needle. A puncture needle push-out stopper 27 to which the proximal end of the needle member 19 inserted in the slider 26 is connected and fixed, and a pusher wire stopper 28 to which the proximal end portion of the pusher wire 21 is connected and fixed are provided.

  In other words, the puncture needle 18 is pushed out by pushing the puncture needle push-out stopper 27 against the needle slider 26, and when the pusher wire 21 is pushed out by the pusher wire stopper 28, the protruding member 20 is pushed forward from the puncture needle 18. It has become.

  When the puncture needle push-out stopper 27 is completely pulled out from the needle slider 26, the tip of the puncture needle 18 is set so as to be located behind the treatment side hole 6 as shown in FIG. When the puncture needle push-out stopper 27 is completely pushed into the needle slider 26, the tip of the puncture needle 18 reaches a position beyond the tip side of the treatment side hole 6 as shown in FIG. Is set. At this time, if the length of the treatment side hole 6 protruding from the distal end side is 10 mm or more, the large intestine drawn into the treatment side hole 6 can be easily penetrated, preferably about 20 mm.

  Further, the ligation tool 16 is operated by pulling out the pusher wire stopper 28 of the ligation operation portion 24 and pulling the protruding member 20 to the proximal side of the puncture needle 18 via the pusher wire 21 as shown in FIG. It is attached to the slit 19b of the puncture needle 18. FIG. 4 shows a state in which the ligation tool 16 is set on the treatment insertion aid 3. Here, one ligation tool 16 is set in a state where two ligation channels 9 are used. In this embodiment, two ligation tools 16 are set in the four ligation channels 9.

  The set state of the two ligatures 16 is exactly the same. Therefore, here, the set state of one ligation tool 16 will be described. A puncture needle 18 is inserted into each ligation channel 9. Then, the T bars 16 a and 16 b of the ligation tool 16 are set in a state of being inserted into the slits 19 b of the puncture needles 18 of the two ligation channels 9. At this time, the T-bar sheath 16c of the ligation tool 16 is set in a state in which the slit 19b of each puncture needle 18 and the slit 9a of the ligation channel 9 are inserted from the distal end side of the needle member 19a.

  Here, the slit 19b of each puncture needle 18 has such a width that the T-bars 16a and 16b and the protruding member 20 cannot be inserted, and the length of the slit 19b is slit at the connecting portion between the T-bars 16a and 16b and the T-bar sheath 16c. When positioned on the proximal end side of 19b, the lengths of the T bars 16a and 16b are set so as not to be exposed from the distal end of the puncture needle 18. Then, when the puncture needle 18 is protruded from each ligation channel 9 and the distal end of the puncture needle 18 is positioned at the ligation position in front of the treatment side hole 6, the proximal end side of the slit 19b is the punctured colon tissue. It is set so as to be arranged at substantially the same position as the rear end position.

  Further, as shown in FIG. 7A, in the treatment insertion assisting tool 3 of the present embodiment, the living tissue pressing portion 31 at the periphery of the treatment side hole 6 disposed at the distal end portion of the sheath portion 5 is frame-shaped. The arm member 32 is formed. The arm member 32 is divided into two parts in the front-rear direction, and a front frame 32a and a rear frame 32b are provided. A joint portion (divided portion) between the front frame 32 a and the rear frame 32 b is disposed at a substantially central position in the front-rear direction of the treatment side hole 6.

  Further, as shown in FIG. 10, rotating shafts 33 arranged in a direction orthogonal to the center line direction of the sheath portion 5 are respectively attached to both sides of the front end portion of the rear frame 32b. A base end portion of the front frame 32a is rotatably connected to each rotation shaft 33. Thereby, the folding means 34 which supports the front side frame 32a of the arm member 32 so that it can fold in the front-back direction along the axial direction is formed. Then, as shown in FIG. 10, the front frame 32a of the arm member 32 is moved in the forward opening direction to form the treatment side hole 6, and the front frame 32a of the arm member 32 is moved as shown in FIG. It can move to the closed position folded to the rear side of the treatment side hole 6.

  Further, as shown in FIGS. 7A and 7B, the rotary shaft 33 is provided with a spring member 35 (biasing means) having a winding spring shape. One end of the spring member 35 is fixed to the rear frame 32b. The other end of the spring member 35 is fixed to the front frame 32a. The spring force of the spring member 35 urges the front frame 32a of the arm member 32 in a direction to hold it at the use position shown in FIG.

  Further, the grasping portion 5a of the treatment insertion assisting tool 3 is provided with a tissue pressing operation portion (operation means) 36 for opening and closing the front frame 32a of the arm member 32. As shown in FIG. 8, the tissue pressing operation portion 36 is formed with a guide groove 37 extending in the holding portion 5 a along the center line direction of the sheath portion 5. A proximal end portion of a wire guide member 38 disposed inside the sheath portion 5 is fixed inside the grip portion 5a. A similar guide groove 38a is formed in the wire guide member 38 at a position corresponding to the guide groove 37 of the grip portion 5a. The distal end portion of the wire guide member 38 extends to the distal end portion side of the sheath portion 5.

  Further, a slidable operation lever 39 that is slidable along the guide grooves 37 and 38a is attached to the grip portion 5a. One end of an operation wire 40 that is movably inserted in the axial direction inside the wire guide member 38 is fixed to the operation lever 39. The other end of the operation wire 40 extends forward from the tip of the wire guide member 38 and is fixed to the front end of the front frame 32a.

  The front frame 32a of the arm member 32 is opened and closed in accordance with the slide operation of the operation lever 39. Here, the front frame 32a of the arm member 32 is held in a use position where the front frame 32a is opened forward by the biasing force of the spring member 35 to form the treatment side hole 6 as shown in FIGS. Then, the operation lever 39 is held in a state of being moved to the front end positions of the guide grooves 37 and 38a as shown in FIG. When the operation lever 39 is slid rightward in FIG. 8 from this position, the operation wire 40 is pulled in the same direction. At this time, the front frame 32 a of the arm member 32 is pulled toward the hand side against the biasing force of the spring member 35 by the operation wire 40, so that the front frame 32 a of the arm member 32 is rotated around the rotation shaft 33. As shown in FIGS. 7B and 9, it can be moved to a closed position folded to the rear side of the treatment side hole 6.

  Next, the operation of the above configuration will be described. When the medical instrument system 1 of the present embodiment is used, first, after the treatment insertion aid 3 is extrapolated to the direct-viewing type colonoscope 29 shown in FIG. 11, the colonoscope 29 is first placed in the colon H1. Insert to the treatment target site. Subsequently, the treatment insertion aid 3 is inserted along the large intestine endoscope 29. At this time, the treatment insertion assisting tool 3 previously folds the front frame 32a of the arm member 32 to the rear side of the treatment side hole 6 as shown in FIG. 7B and FIG. It is inserted in the state moved to the closed position. After the treatment insertion assisting tool 3 is inserted to the treatment target site, the large intestine endoscope 29 is removed from the treatment insertion assisting tool 3.

  After removal of the large intestine endoscope 29, the operation lever 39 is returned to the original initial position, whereby the front frame 32a of the arm member 32 is moved forward as shown in FIGS. 7A and 10 by the urging force of the spring member 35. To the use position where the treatment side hole 6 is formed. In this state, the endoscope 2 is inserted into the treatment insertion aid 3. The distal end portion 2d of the insertion portion 2a of the endoscope 2 is inserted up to the affected portion of the large intestine H1 for treatment. In this state, with the endoscope 2 inserted into the treatment insertion aid 3, the treatment side hole 6 of the treatment insertion aid 3 is aligned with the treatment target site under the field of view of the endoscope 2. At this time, the insertion position of the sheath portion 5 of the treatment insertion assisting tool 3 is adjusted so that the center of the treatment target site coincides with the center of the treatment side hole 6. In this state, the stopper 23a and the handle 23b of the excision operation unit 23 are moved to the forward pushing position, and the excision snare introduction tube 13 and the excision snare 12 are set for excision operation as shown in FIG. Set to position. At this time, the loop portion 15 of the excision snare 12 is held in a state of surrounding the treatment side hole 6.

  Thereafter, the grasping forceps 4 is inserted into the forceps channel insertion opening 2 h of the endoscope 2. The tip gripping portion 4a of the gripping forceps 4 inserted into the forceps channel of the endoscope 2 is projected outward from the forceps channel opening of the tip portion 2d of the endoscope 2. In this state, the tip gripping portion 4 a of the gripping forceps 4 is moved toward the treatment side hole 6.

  Subsequently, the treatment target site of the large intestine H1 is gripped by the tip gripping portion 4a of the gripping forceps 4. In this state, the bending portion 2e of the endoscope 2 is bent to cause the distal end portion 2d of the insertion portion 2a to be raised as shown in FIG. The working space 7 is pulled up through.

  Thereafter, the puncture needle 18 is pushed out by pushing the puncture needle push-out stopper 27 against the needle slider 26 of the ligation operation unit 24. At this time, as shown in FIG. 13, the puncture needle 18 is punctured at the base of the tissue to be treated of the large intestine H1 that has been pulled up. In this state, the pusher wire 21 is then pushed in by the pusher wire stopper 28 of the ligation operation unit 24. At this time, the protruding member 20 is pushed out via the pusher wire 21, and the T bars 16 a and 16 b of the ligature 16 are pushed out by the protruding member 20. By the pushing operation of the projecting member 20, the T bars 16a and 16b penetrate the root portion of the tissue to be treated of the pulled large intestine H1, and penetrate to the front of the tissue to be treated of the pulled large intestine H1 (all layers of the large intestine H1). Pushed into position.

  In this state, the puncture needle push-out stopper 27 is pulled out with respect to the needle slider 26, and the puncture needle 18 is pulled out to the hand side. By this operation, the puncture needle 18 is pulled out from the treatment target tissue of the large intestine H1. At this time, since the T bars 16a and 16b of the ligation tool 16 are left at a position that penetrates to the front of the tissue to be treated of the pulled large intestine H1, the root portions of the tissue to be treated of the pulled large intestine H1 are T bars 16a and 16b. And ligated so as to be sandwiched between T-bar sheaths 16c (see FIG. 14).

  Thereafter, by pulling out the handle 23 b of the excision operation portion 23, the loop portion 15 of the excision snare 12 is drawn into the excision snare introduction tube 13. At this time, as shown in FIG. 14, the upper part of the ligation part of the tissue to be treated of the large intestine H1 ligated by the ligation tool 16 is excised by the loop part 15 of the snare 12 for excision. As a result, the entire layer of the large intestine H1 is excised.

  15A shows the excision hole H2 of the entire layer excision part of the large intestine H1 to be excised by the loop part 15 of the excision snare 12, and FIG. 15B shows the excision hole part H2 by the two ligatures 16. Indicates ligation status.

  Therefore, the above configuration has the following effects. In other words, in the treatment insertion assisting tool 3 of the medical instrument system 1 according to the present embodiment, the folding means 34 that supports the front frame 32a of the arm member 32 so as to be foldable by the living tissue pressing portion 31 at the periphery of the treatment side hole 6. Therefore, during insertion of the sheath portion 5, the front frame 32 a of the arm member 32 can be folded by the folding means 34 to the closed position where it is folded to the rear side of the treatment side hole 6. Therefore, since the length of the hard part of the distal end portion of the treatment insertion assisting tool 3 can be shortened as compared with the prior art, the distal end hard part of the treatment insertion assisting tool 3 is attached to the bent (curved) portion of the large intestine H1. The work to pass through can be easily performed, and the workability of inserting the treatment insertion aid 3 into the deep part of the large intestine can be improved. As a result, the operation of inserting the treatment insertion aid 3 into the deep part of the large intestine can be performed in a relatively short time.

  Furthermore, since the front frame 32a of the arm member 32 can be moved in the forward opening direction during the treatment of the living tissue with the treatment instrument insertion assisting tool 3, it can be opened to the use position where the treatment side hole 6 is formed. The work of cutting out all layers can be performed reliably.

  16 and 17 show a second embodiment of the present invention. In this embodiment, the configuration of the treatment insertion assisting tool 3 in the medical instrument system 1 for full-thickness resection of the large intestine according to the first embodiment (see FIGS. 1 to 15A and 15B) is as follows. It has been changed. The rest of the structure is the same as that of the medical device system 1 for full colorectal resection of the first embodiment, and the medical device system 1 for full thickness resection of the large colorectum of the first embodiment. The same parts are denoted by the same reference numerals, and the description thereof is omitted here.

  That is, in the treatment insertion assisting tool 3 of the medical instrument system 1 of the present embodiment, as shown in FIG. 17, the tip of the excision snare 12 is lifted to the living tissue pressing portion 31 at the periphery of the treatment side hole 6. A pressing member 41 for pressing is provided. The pressing member 41 is formed of an elastic member such as a plate-like rubber that is fixed in a state of being laid between both side portions of the front frame 32 a of the arm member 32. When the excision snare 12 is set at the excision operation set position as shown in FIG. 2B during treatment of the living tissue by the treatment instrument insertion aid 3, the distal end of the excision snare 12 is pressed down. It is inserted below the member 41 so that the lifting of the tip of the excision snare 12 is suppressed.

  Further, the rear frame 32b of the arm member 32 is formed with a front frame accommodation groove 42 for accommodating the front frame 32a. The front frame housing groove 42 is formed in a shape corresponding to the front frame 32a. As shown in FIG. 16, when the front frame 32a of the arm member 32 is folded to the rear side of the treatment side hole 6, the front frame 32a is accommodated in the front frame accommodation groove 42 of the rear frame 32b. It has become. Accordingly, when the front frame 32a of the arm member 32 is folded to the rear side of the treatment side hole 6, it is possible to prevent the front frame 32a from projecting to the outside of the rear frame 32b. Insertability of the auxiliary tool 3 can be improved.

  Further, when the front frame 32a of the arm member 32 is folded to the rear side of the treatment side hole 6, the pressing member 41 is elastically deformed while being sandwiched between the front frame 32a and the rear frame 32b. It has become.

  Therefore, the above configuration has the following effects. That is, in the treatment insertion assisting tool 3 of the medical instrument system 1 of the present embodiment, the living tissue pressing portion 31 is provided with the pressing member 41 that suppresses the lifting of the distal end portion of the excision snare 12. When the living tissue is treated by the treatment instrument insertion assisting tool 3, when the front frame 32 a of the arm member 32 is moved forward and the opening operation is performed to the use position where the treatment side hole 6 is formed, the pressing member 41 is operated. Is disposed at the end of the distal end side with respect to the treatment side hole 6, and the lifting of the distal end of the excision snare 12 can be suppressed by the pressing member 41. Therefore, since the work of excising the treatment target tissue of the large intestine H1 can be stably performed by the loop portion 15 of the excision snare 12, the workability of the work of excising the entire large intestine can be improved. The excision work can be performed reliably.

  Further, since the pressing member 41 is formed of a plate-like elastic member, in the state where the front frame 32a of the frame-like arm member 32 is folded to the closed position on the rear side of the treatment side hole 6 by the folding means 34. The pressing member 41 can be held in a state of being elastically deformed so as to overlap the front frame 32 a of the arm member 32. Therefore, when the front frame 32a of the arm member 32 is folded to the rear side of the treatment side hole 6, the pressing member 41 can be prevented from protruding outside the rear frame 32b, and the treatment insertion aid The insertion property of the tool 3 can be improved.

Furthermore, the present invention is not limited to the above-described embodiment, and various modifications can be made without departing from the scope of the present invention.
Next, other characteristic technical matters of the present application are appended as follows.
Record
(Additional Item 1) At least an endoscope insertion channel and an ligation channel into which a ligation treatment tool for inserting a ligation tool for ligation of biological tissue is inserted into an insertion portion to be inserted into a lumen in the body, A resection channel into which a resection treatment tool for resecting a ligation portion of a living tissue ligated with the ligation tool is formed and disposed at a distal end portion of the insertion portion, and an outer periphery of the distal end portion of the insertion portion An opening for inserting a living tissue to be ligated into one side portion of the surface, and a working space portion formed on the other side of the outer peripheral surface of the distal end portion for operating the living tissue to be ligated from the opening portion. A treatment insertion aid comprising:
The treatment instrument for ligation set in a state of being inserted into the ligation channel and arranged at a position surrounding the periphery of the opening;
An endoscope that is inserted to the working space through the endoscope insertion channel;
A grasping treatment tool provided with a grasping portion for grasping a living tissue at a distal end portion of an insertion portion inserted into the working space through the channel of the endoscope;
A tissue pulling means for pulling up the living tissue to be ligated through the opening by a bending operation of the endoscope in a state where the living tissue is gripped by the gripping portion of the grasping treatment tool;
Ligating means for ligating the living tissue to be ligated pulled up by the tissue lifting means with the ligation instrument;
An excision treatment tool that is inserted into the excision channel and excises the ligated portion of the living tissue ligated by the ligation means,
The treatment insertion aid is formed by a frame-shaped arm member at a peripheral portion of the opening of the living tissue holding portion,
While supporting the arm member foldable between a use position and a standby position on the rear side of the opening,
A medical instrument comprising an operating means for opening and closing the arm member between the use position and the standby position at a proximal end portion of an insertion portion of the treatment insertion aid.

(Additional Item 2) The treatment insertion assisting tool has a biasing means that normally holds the arm member in the use position,
The medical device according to claim 1, wherein the operation means includes a slide type operation lever that pulls the arm member to the standby position against the urging force of the urging means. Instruments.

(Additional Item 3) The resection insertion aid is protruded forward from the resection channel at a position corresponding to the resection channel at an end portion of the insertion portion closer to the distal end than the opening. A holding member that holds down the lifting of the tip of the treatment instrument for
The medical device according to claim 1, wherein the pressing member is formed of an elastic member that is fixed to the arm member and elastically deformable when the arm member is folded to the standby position.

  (Prior Art of Additional Items 1 to 3) The full-thickness resection system of the large intestine inserts a treatment system in the form of an Over Tube into the deep part of the large intestine along the conventional endoscope insertion part.

  (Problems to be solved by the supplementary items 1 to 3) However, when passing through the curved large intestine, the length of the hard part at the distal end of the treatment system has lowered its insertion property.

  (Object of Supplementary Items 1 to 3) In the present invention, the distal end of an endoscopic treatment system is provided that has a short hard part length when the system is inserted into the deep part of the large intestine and secures a sufficient area for work in the treatment site. It is to be.

  (Effects of Supplementary Items 1 to 3) The tissue pressing member protrudes at the time of treatment and is folded at the time of insertion of the large intestine, the length of the hard portion is shortened, and the insertability is improved.

  INDUSTRIAL APPLICABILITY The present invention is effective in a technical field that uses an insertion assisting tool for full colorectal resection treatment that performs a treatment such as full colorectal resection and a medical instrument system thereof.

The perspective view which shows the external appearance of the medical device system whole for large intestine excision of the 1st Embodiment of this invention. (A) is a side view which shows the front-end | tip part of the insertion aid for treatment in the medical device system of 1st Embodiment, (B) is a top view. III-III sectional view taken on the line of FIG. The top view which shows the state which set the T-bar ligation tool to the puncture needle in the medical device system of 1st Embodiment. The perspective view which shows the T-bar ligation tool in the medical device system of 1st Embodiment. The perspective view which shows the ligation unit pusher of the puncture needle in the medical device system of 1st Embodiment. The operation state of the holding member of the treatment insertion auxiliary tool of a 1st embodiment is shown, (A) is a longitudinal section of the important section showing the state where the holding member was moved in the direction of opening to a use position. B) is a longitudinal sectional view of the main part showing a state in which the pressing member is folded to the standby position. The longitudinal cross-sectional view of the principal part which shows the operation lever of the pressing member of the treatment insertion assistance tool in the medical device system of 1st Embodiment. The perspective view of the principal part which shows the state which folded the pressing member of the insertion aid for treatment in the medical device system of 1st Embodiment in the standby position. The perspective view of the principal part which shows the state which moved the holding member of the insertion assistance tool for treatment of 1st Embodiment to the use direction. Explanatory drawing for demonstrating the state which has inserted the medical device system of 1st Embodiment in the large intestine. The longitudinal cross-sectional view of the principal part which shows the state just before starting the pulling-up operation by arrange | positioning the opening part for tissue insertion of the medical device system of 1st Embodiment facing a treatment target tissue. The state which made the puncture needle puncture the biological tissue of ligation object pulled up in the state which pulled up the biological tissue of ligation object to the working space part through the opening part for tissue insertion of the medical device system of 1st Embodiment is shown. The longitudinal cross-sectional view of the principal part. The longitudinal cross-sectional view of the principal part which shows the state which excised the ligation part with the treatment tool for excision of the medical device system of 1st Embodiment. The large intestine suturing operation excised by the medical instrument system of the first embodiment will be described. (A) is a diagram showing the excised portion of the large intestine, and (B) is the excised portion of the large intestine with a T-bar ligature. The figure which shows the state ligated. The perspective view of the principal part which shows the state which folded down the pressing member of the treatment insertion assistance tool of the 2nd Embodiment of this invention in the standby position. The perspective view of the principal part which shows the state which moved the pressing member of the treatment insertion assistance tool of 2nd Embodiment to the use position.

Explanation of symbols

    DESCRIPTION OF SYMBOLS 5 ... Sheath part (procedure insertion auxiliary tool main body), 6 ... Treatment side hole, 31 ... Biological tissue pressing part, 32 ... Arm member, 32a ... Front side frame, 34 ... Folding means, 36 ... Tissue pressing operation part (operation Means), H1 ... large intestine.

Claims (6)

A side hole for treatment for inserting a living tissue to be treated into one side of the outer peripheral surface of the distal end portion of the insertion portion in the large intestine to be inserted into the large intestine, Each working space is formed,
The biological tissue to be treated is pulled up into the working space through the treatment side hole, and the base portion of the biological tissue to be ligated is ligated by a ligation means, and then the ligated biological tissue is ligated. Provide a treatment tool insertion aid main body for excision of the entire large intestine to remove the upper part from the part with the treatment tool for resection,
The treatment instrument insertion aid main body is formed by a frame-shaped arm member with a biological tissue pressing portion at the periphery of the treatment side hole,
While providing a folding means for supporting the arm member foldable in the front-rear direction along the axial direction of the insertion portion,
Opening and closing between a use position in which the arm member is moved in a direction to open in front of the insertion portion to form the treatment side hole and a closed position in which the arm member is folded to the rear side of the treatment side hole A treatment instrument insertion assisting tool for excision of the entire large intestine, which is provided with an operating means for operation. The treatment instrument insertion assisting instrument main body has an urging means that always holds the arm member in the use position,
2. The large intestine according to claim 1, wherein the operation unit includes a slide type operation lever that pulls the arm member to the standby position against the urging force of the urging unit. A treatment tool insertion aid for full thickness resection. The treatment instrument insertion assisting tool main body has a pressing member that suppresses lifting of the distal end portion of the excision treatment instrument at an end portion closer to the distal end portion than the treatment side hole of the insertion portion,
2. The pressing member is formed of an elastic member fixed to the arm member and elastically deformable so as to overlap with the arm member when the arm member is folded to the standby position. A treatment instrument insertion aid for full-color excision of the large intestine as described in 1. At least an endoscope insertion channel, a ligation channel into which a treatment tool for ligation for inserting a ligation tool for ligating biological tissue is inserted into an insertion portion to be inserted into a body lumen, and ligated by the ligation tool An excision channel into which a treatment tool for excision for excising a ligated portion of the living tissue formed is inserted and disposed at the distal end portion of the insertion portion, and one side portion of the outer peripheral surface of the distal end portion of the insertion portion A treatment side hole for inserting a living tissue to be ligated into the body, and a working space portion formed on the other side of the outer peripheral surface of the distal end portion for operating the living tissue to be ligated from the treatment side hole. A treatment instrument insertion aid,
The ligation treatment instrument set in a state of being inserted into the ligation channel and arranged at a position surrounding the treatment side hole;
An endoscope that is inserted to the working space through the endoscope insertion channel;
A grasping treatment tool provided with a grasping portion for grasping a living tissue at a distal end portion of an insertion portion inserted into the working space through the channel of the endoscope;
A tissue lifting means for pulling up the living tissue to be ligated through the treatment side hole by a bending operation of the endoscope in a state where the living tissue is gripped by the gripping portion of the gripping treatment tool;
Ligating means for ligating the living tissue to be ligated pulled up by the tissue lifting means with the ligation instrument;
An excision treatment tool that is inserted into the excision channel and excises the ligated portion of the living tissue ligated by the ligation means,
The treatment instrument insertion assisting tool is formed by forming a biological tissue pressing portion at the periphery of the treatment side hole with a frame-shaped arm member,
While providing a folding means for supporting the arm member foldable in the front-rear direction along the axial direction of the insertion portion,
Opening and closing between a use position in which the arm member is moved in a direction to open in front of the insertion portion to form the treatment side hole and a closed position in which the arm member is folded to the rear side of the treatment side hole A medical instrument system for excision of the entire large intestine, comprising operating means for operation. The treatment instrument insertion assisting tool has urging means that normally holds the arm member in the use position,
5. The large intestine according to claim 4, wherein the operation unit includes a slide type operation lever that pulls the arm member to the standby position against the urging force of the urging unit. Medical instrument system for full thickness resection. The treatment tool insertion assisting tool projects forward from the excision channel at a position corresponding to the excision channel at an end portion of the insertion portion closer to the distal end than the treatment side hole. It has a pressing member that suppresses the lifting of the tip of the tool,
The full-thickness colorectal resection according to claim 4, wherein the pressing member is formed by an elastic member fixed to the arm member and elastically deformable when the arm member is folded to the standby position. Medical instrument system for use.

Images