JP4360374B2 - Biological tissue resection aid - Google Patents

Description

  The present invention makes it possible to safely and efficiently remove a living tissue by applying tension to the separated living tissue when a living tissue such as a mucous membrane in a body cavity is excised with a high-frequency knife through an endoscope. It relates to a biological tissue resection aid.

  In body cavities such as the gastrointestinal tract, advancement of endoscopy makes it possible to detect mucosal tumors that are early tumors. Numerous mucosal resections have been performed to separate and remove the underlying muscle tissue. Endoscopic submucosal resection, which removes a wide range of mucous membranes at once, is one of the mucosal resections. Blind dissection is performed by covering the area where the mucosa separated during resection is separated from the muscular layer by a scalpel. It is necessary to injure the muscle layer with a scalpel and easily cause problems such as perforation of the digestive tract. In order to efficiently cut off a wide range of mucous membranes, it is desirable to place a knife at the boundary between the mucous membrane and the muscle layer while applying tension in the direction of peeling the separated mucosa from the muscle layer. In many cases, there is only one forceps hole in the endoscope, and the forceps hole in the endoscope has only a size that allows only a scalpel to pass through. At present, gripping forceps and the like for applying tension are inserted into the affected area and cannot be used.

In order to solve such problems, a method of fixing a magnetic body with a thread to a gripping tool, placing the gripping tool on a mucosal tissue, pulling the magnetic body magnetically from outside the body, and pulling the mucous membrane in an arbitrary direction (For example, Patent Document 1), a method of expanding a balloon at a separation interface between a mucosal tissue to be excised and a muscle tissue, and applying tension between the mucosal tissue and the muscle tissue (for example, Patent Document 2) are disclosed. . However, the former method requires not only a magnetic generator with a strong magnetic force, but also the tension and the pulling direction can be adjusted to some extent by adjusting the magnetic field. However, there is a problem that it is difficult to adjust and inefficient. In the method of expanding the balloon between the mucosal tissue and the muscular tissue, it is necessary to insert the balloon at the optimal position between the mucosal tissue layer and the muscular tissue layer that need to be separated. Therefore, it is necessary to change the position of the balloon with the progress of the separation, and it is still difficult to efficiently remove the living tissue, and the balloon is located very close to the high-frequency knife. There is a problem that the balloon is damaged and the balloon is easily ruptured.
JP 2002-268239 A JP 2004-146476 A

  The present invention has been made in view of the above circumstances, and the object of the present invention is that it does not require a device such as an extracorporeal magnetism generator, and is inserted into an affected part that requires excision of a living tissue such as a mucous membrane together with an endoscope. It is possible to place an arbitrary tension in any direction on a living tissue such as a mucous membrane that has been removed during excision by operating a tension transmitting member that can be placed from outside the body. It is possible to secure a clear visual field by covering the part to be covered, and to apply tension to the living tissue such as the mucous membrane being separated from the lower layer such as the muscle layer. Therefore, an object of the present invention is to provide a biological tissue resection aid that can increase the efficiency of resection and enables safe and efficient resection of biological tissue such as mucous membranes.

Such an object is achieved by the present invention described in the following (1) to (2).
・ When a living tissue in a body cavity is excised with a high-frequency knife etc. through an endoscope, the living tissue to be separated is tensioned, and the living tissue is separated safely and efficiently. A body tissue excision assisting tool that enables grasping of the living tissue, a grasping device that grasps the grasping portion with the living tissue, a tension transmitting member connected to the grasping portion, and the tension A handle portion that adjusts the tension applied to the transmission member, and a body cavity fixing portion that forms a fulcrum of the tension transmission member that applies the tension transmitted from the handle portion to the living tissue grasped by the grasping portion . The body cavity fixing portion has a cylindrical portion that is attached to the distal end portion of the endoscope and can be inserted into the body cavity together with the endoscope, and the endoscope can be removed from the body cavity fixing portion in the body cavity. biological tissue ablation aid, characterized in that is.
(2) The body cavity fixing portion has a substantially cylindrical shape having a plurality of lumens, and has an outer surface having a first balloon, an inner surface having a second balloon, and the outer surface. The body tissue resection aid according to claim 1, wherein a tension transmitting member is inserted between the inner surface and the inner surface.

  According to the present invention, when a living tissue is excised with a high-frequency knife or the like through an endoscope, a part of the living tissue being separated is grasped by the grasping member, and independent from the forceps hole of the endoscope. By operating the tension transmitting member connected to the gripping member through the route from outside the body and instantly applying tension in the intended direction to the living tissue being separated, the separated living tissue such as mucous membrane is separated by the scalpel. It is possible to secure a clear field of view by preventing the area to be covered from being covered, and it is efficient by applying tension to the living tissue such as the mucous membrane being separated from the lower layer such as the muscle layer. It is possible to cut a living tissue such as a mucous membrane safely and efficiently.

  Specifically, the endoscope is inserted into the first lumen of the body cavity fixing portion of the biological tissue resection aid according to the present invention, and the second balloon is expanded to fix the body tissue resection aid in the body cavity. The part is fixed to the endoscope. Next, the gripping device is inserted into the forceps hole of the endoscope, and the tip of the gripping device is protruded from the tip of the endoscope. Next, the gripping unit is mounted on the gripping device, and the gripping unit is housed in the endoscope forceps hole together with the gripping device. The body cavity fixing part of the biological tissue resection aid is inserted into the body cavity such as the digestive tract together with the endoscope, and is inserted from the affected part to be removed to the distal part. The first balloon is expanded to fix the body cavity fixing part of the tissue assisting tool to the body cavity wall.

  Next, the second balloon is deflated, the endoscope, the gripping portion, and the gripping device are removed from the first lumen of the body cavity fixing portion of the biological tissue excision assisting tool, and the affected portion is excised by the distal end of the endoscope Pull back until it is located on the proximal side. The grasping portion is protruded from the endoscope tip, and the grasping portion grasps the living tissue at the optimum position as a force point for applying tension at the proximal end of the portion to be excised of the living tissue, and then removes the grasping portion from the grasping device. Remove the grasping device from the endoscope forceps hole. The distal end portion of the endoscope is moved to the optimum position for starting the separation, and a high frequency knife for excision is inserted from the endoscope forceps hole. The handle of the tension transmitting member of the biological tissue resection aid is operated to give tension to the biological tissue to be resected through the gripping portion with the body cavity fixing portion of the biological tissue resection aid as a fulcrum, so that the view of the separated biological tissue is not obstructed The biological tissue is separated by a high-frequency knife or the like while being pulled to a position or to be pulled in the direction of peeling the separated biological tissue from the lower layer. When the separation of the biological tissue is completed, after removing the endoscope, the first balloon of the biological tissue resection aid is deflated, and the body cavity fixing part of the biological tissue resection aid is taken out of the body together with the separated biological tissue, It enables safe and efficient excision of living tissue such as mucous membranes.

  Hereinafter, a biological tissue resection aid according to the present invention will be described in detail based on a preferred embodiment shown in the accompanying drawings.

  FIG. 1 is a front view of a body cavity fixing part and a grasping device obtained by expanding a first balloon of a biological tissue resection aid according to the present invention. FIG. 2 is a left perspective view in which the first balloon and the second balloon of the body cavity fixing part of the biological tissue resection aid are expanded. FIG. 3 is a longitudinal sectional view of the handle portion for operating the tension transmitting portion of the body cavity fixing portion of the biological tissue resection aid. FIG. 4 is a side view of the handle portion for operating the tension transmitting portion of the body cavity fixing portion of the biological tissue resection aid. FIG. 5 is a cross-sectional view taken along the line A-A ′ of the body cavity fixing portion of the biological tissue resection aid. FIG. 6 is a left perspective view in which the first balloon and the second balloon of the body cavity fixing portion of the biological tissue resection aid are deflated. FIG. 7 is an enlarged front view of the grasping portion of the body cavity fixing portion of the biological tissue resection aid and the distal end portion of the grasping device. FIG. 8 is an enlarged side view of the grasping portion of the body cavity fixing portion of the biological tissue resection aid and the distal end portion of the grasping device. FIG. 9 is an enlarged front view in which the grasping portion of the body cavity fixing portion of the biological tissue resection aid is attached to the distal end portion of the grasping device. FIG. 10 is an enlarged cross-sectional view of the distal end portion of the grasping device in which the grasping portion of the body cavity fixing portion of the biological tissue resection aid is pulled into the grasping device. FIG. 11 is an enlarged sectional view of the gripping member showing the connection of the tension transmitting member to the gripping portion. FIG. 12 is an enlarged cross-sectional view of the gripping portion when the gripping portion is tightened with the gripping member fixing ring. FIG. 13 is a longitudinal sectional view of the handle portion of the gripping device. FIG. 14 is a side view of the handle portion of the gripping device. FIG. 15 is a left perspective view in which the endoscope is inserted into the first lumen of the body cavity fixing portion of the biological tissue resection aid and the gripping unit is attached to the gripping device inserted from the forceps hole of the endoscope. FIG. 16 is a diagram showing a state of separation of a biological tissue by an endoscope using a biological tissue resection aid.

The biological tissue resection assisting tool shown in FIG. 1 includes a body cavity fixing part (1) and a gripping device (18). The body cavity fixing part (1) includes a gripping part (2), a tension adjusting part (9), and a cylindrical part ( 6).
The grip portion (2) includes a grip member (2A) and a grip member fixing ring (2B).
The tension adjusting section (9) is configured such that the handle section (12) for adjusting the tension applied to the tension transmitting member (3) connected to the gripping member fixing ring (2B) and the tension transmitting member (3) directly contact the endoscope. The handle portion (12) is composed of a finger ring 1 (13) and a finger ring 2 (14).

  The gripping device (18) includes a claw portion (18A), an operation wire (18B), a gripping device mantle (18C), and a handle portion (12).

  As shown in FIG. 2, the cylindrical part (6) of the body cavity fixing part (1) has a first balloon (4) for fixing the cylindrical part (6) to the body cavity wall on the outer surface of the cylindrical part (6). Then, an endoscope insertion lumen (61) is formed in the lumen of the cylindrical portion (6), and a second balloon (5) for fixing the endoscope to the body cavity fixing portion (1) by expansion is provided. Have. Further, the cylindrical portion (6) has a tension adjusting portion lumen (91) communicating with the tension adjusting portion mantle (9A).

  The first balloon (4) and the second balloon (5) are each independently a first balloon expansion tube (injecting or discharging fluid to each balloon to enable expansion or contraction of each balloon). 7), a second balloon expansion tube (8), and a first balloon one valve (10) and a second balloon one valve (11) for temporarily preventing fluid from escaping from each balloon. The

  The tension fixing member (3) connected to the gripping member fixing ring (2B) can freely move within the tension adjusting portion lumen (91) and the tension adjusting portion outer jacket (9A) of the cylindrical portion (6). Is installed.

  As shown in FIG. 3, the handle portion (12) of the tension adjusting portion (9) is connected and fixed by inserting the tension adjusting portion mantle (9A) into the handle portion (12), and the tension transmitting member (3) is fixed. The member (15) is connected and fixed to the finger ring 1 (13), and the finger ring 2 (14) is rotatably fixed to the handle part (12) by the rotation cap (16).

  As shown in FIG. 4, the handle portion (12) is provided with a slide groove (12A), and is gripped by the grip portion (2) by moving the finger ring 1 (13) back and forth along the slide groove (12A). Adjust tension on living tissue.

  FIG. 5 shows the AA ′ cross section of FIG. 1 when the first balloon (4) and the second balloon (5) of the body cavity fixing part (1) of the biological tissue resection assisting tool are expanded. 6) has a second balloon expansion tube lumen (62) communicating with the second balloon expansion tube (8). The second balloon expansion tube lumen (62) is not necessarily required, and the second balloon expansion tube (8) is extended as it is below the expansion portion of the second balloon (5) to form the second balloon (5). In this case, the cylindrical portion (6) may have two lumens, and the second balloon expansion tube (8) has a lumen of the endoscope insertion lumen (61) having a two-lumen cylinder. It can be adhesively fixed to the surface.

  FIG. 6 is a view in which the first balloon (4) and the second balloon (5) are deflated. In this state, the endoscope is inserted into the body cavity fixing part (1) of the body tissue resection aid. It can be inserted into the lumen (61).

  As shown in FIG.7 and FIG.8, the front-end | tip part of a holding | gripping apparatus (18) has a nail | claw part (18A) which can hold | grip the rear-end part of a holding member (2A), and a nail | claw part (18A) is an operation wire ( 18B) is connected to the handle portion (12), and the claw portion (18A) can be taken in and out of the gripping device mantle (18C) by operating the handle portion. The claw portion (18A) is made of an elastic material, and the tip is open when protruding from the gripping device mantle (18C).

  As shown in FIGS. 9 and 10, the claw portion (18A) is hooked on the rear end portion of the gripping member (2A), and the operation wire (18B) is pulled to pull the claw portion (18A) into the gripping device mantle (18C). Thus, the tip of the claw portion (18A) is closed, and the grip portion (2) can be attached to the grip device (18) by firmly gripping the rear end of the grip portion (2).

  As shown in FIG. 10, by pulling the operating wire (18B) into the operating device mantle (18C), the rear end of the gripping member (2A) is drawn into the operating device mantle (18C), and the holding member fixing ring ( 2B) is fixed at the distal end portion of the operating device mantle (18C). Therefore, from the position of the gripping member fixing ring (2B) before tightening the gripping member (2A) shown in FIG. The gripping member fixing ring (2B) moves to the position of the gripping member fixing ring (2B) at the time of tightening of 2A), the gripping member fixing ring (2B) tightens the central portion of the gripping member (2A), and the gripping member (2A) The living tissue can be grasped with the tip of).

  After grasping the living tissue with the grasping portion (2), as shown in FIGS. 7, 8, and 9, the pulling by the operation wire (18B) is released, and the nail portion (18A) is moved to the tip of the grasping device mantle (18C). The tip of the claw portion (18A) is opened by protruding from the gripping portion, and the gripping portion (2) can be detached from the gripping device (19).

  As shown in FIGS. 11 and 12, the tension transmitting member (3) is connected to the grip portion (2) by providing a grip member fixing ring (2 B) with a hole through which the tension transmitting member (3) passes to fix the grip member. The tension transmission member (3) has its stumps fixed by the tension transmission member fixing portion (3A) on the lumen side of the ring (2B). The tension transmission member fixing portion (3A) is a tubular plastically deformable material, and after passing the tension transmission member (3) through the lumen, the lumen may be crushed to fix the tension transmission member (3). The tension transmitting member (3) may be fixed by passing the tension transmitting member (3) through a hole provided in advance in the tension transmitting member fixing portion (3A) and tightening with a screw or the like. Alternatively, the tension transmission member fixing portion (3A) can be simply ligated to the cut end of the tension transmission member (3) without using any new parts.

  As shown in FIGS. 13 and 14, the handle portion (12) of the gripping device (18) differs only in the operation wire (18B), and the structure of the handle portion (12) of the tension adjustment portion (9) shown in FIG. The same.

  As shown in FIG. 15, when the gripping part (2) is attached to the gripping device (18), the endoscope (17) is inserted into the endoscope insertion lumen (61) of the body cavity fixing part (1). Then, the second balloon (5) is expanded to fix the body cavity fixing portion (1) to the endoscope (17), and the grasping device (18) is inserted from the forceps hole of the endoscope (17). By projecting the distal end portion of the grasping device (18) from the distal end portion of the mirror (17), the tension transmitting member (3) is passed through the endoscope insertion lumen (61) of the body cavity fixing portion (1). Is attached to a gripping device (18).

As shown in FIG. 16, with the grasping part (2) attached to the grasping device (18), the body cavity fixing part (1) is inserted into an appropriate position of the body cavity together with the endoscope, and the first balloon (5) is inserted. After sufficiently expanding and fixing the body cavity fixing part (1) to the wall of the body cavity such as the digestive tract (23), the second balloon ( 5 ) is contracted, and the inside of the endoscope insertion lumen (61) The endoscope (17) is removed. At this time, the handle portion (12) of the tension adjusting portion (9) is made free so that the tension transmitting member (3) can be supplied into the body cavity with a sufficient length, thereby preventing the movement of the endoscope (17). Do not.

  The distal end of the endoscope (17) is moved to a position further forward than the proximal end of the biological tissue separation planned line (22), and the grasping device (18) is operated to operate the biological tissue separation planned line (22). The biological tissue at the optimum position as a force point for applying tension at the proximal end of the body is firmly grasped by the grasping portion (2).

Next, the handle portion (12) of the gripping device (18) is operated to push the claw portion (18A) outward from the tip of the gripping device outer trowel (18C), and the gripping portion (2) is detached from the gripping device (18). To do.
After removing the gripping part (2), the gripping device (18) is removed from the forceps hole of the endoscope (17).
Next, after moving the distal end of the endoscope to the site where the biological tissue is to be removed, a biological tissue excision tool such as a high-frequency knife (19) is inserted into the endoscope forceps hole, and the target biological tissue is started to be separated. To do.
At the same time as the separation of the living tissue starts, the handle of the grasping device (18) is operated to adjust the tension applied to the living tissue grasped by the grasping portion (2), and the separated end of the living tissue is adjusted to the target position. To do.

  The material of the grasping member (2A) and the grasping member fixing ring (2B) of the body cavity fixing portion (1) is inserted into the body cavity and directly grips the living tissue, so that it is difficult to be affected by digestive fluid and sufficient grip strength. Stainless steel, polyamide resin, polycarbonate resin, etc. can be used. The grip member (2A) having a thickness of 0.1 mm to 2 mm can be used as the thickness and the plate width. Although the length of the gripping member (2A) is not particularly limited, it is necessary to be able to pass through the endoscope insertion lumen (61) provided in the inner cylinder (6) of the body cavity fixing portion (1). -20 mm can be used. The opening degree of the distal end portion of the grasping member (2A) is desirably about 5 mm to 20 mm because it is necessary to easily and sufficiently grasp the living tissue under the endoscope. The inner diameter of the gripping member fixing ring (2B) requires a space in which the rear end portion of the gripping member (2A) can be inserted, so that the inner diameter of the gripping member fixing ring (2B) can be 1 to 5 mm. Since it needs to be fixed at the tip, it must be the same as or larger than the outer diameter of the gripping device mantle, and those of 1.3 mm to 6 mm can be used. The tension transmitting member (3) is provided with a sufficient force in the pulling direction on the grasping portion (2), and is used when the endoscope (17) is removed from the endoscope insertion lumen (61). And the gripping device (18) is not given great resistance, and it must be flexible and slippery as it is smoothly pulled out with the removal of the endoscope. A twisted wire or a suture thread such as silk thread can be used. If the outer diameter of the tension transmitting member (3) is too large, the tension adjusting portion mantle (9A) becomes too thick and difficult to insert into the body cavity together with the endoscope. 1.0 mm can be used.

  The body cavity fixing portion (1) is attached to the distal end portion of the endoscope and inserted into the body cavity together with the endoscope. Therefore, the outer diameter should be as small as possible, but the endoscope insertion lumen (61) Depending on the outer diameter of the endoscope to be used because it is necessary to easily fix and remove the endoscope by inserting and expanding and contracting the second balloon, considering easy insertion into the body cavity, A range of 9.0 mm to 26.0 mm can be used.

  The material of the cylindrical portion (6) is as thin as possible in consideration of making the outer diameter of the body cavity fixing portion (1) as small as possible without being deformed by the expansion of the first balloon (4) or the second balloon (5). A thick and strong material is desirable, and polycarbonate resin, polystyrene resin, hard polyvinyl chloride resin, acrylonitrile-styrene-butadiene copolymer resin, polyamide resin, polyurethane resin, and the like can be used. As the outer diameter of the cylindrical portion (6), a range of 9 mm to 25 mm can be used. The inner diameter of the balloon-expanding tube lumen (62) can be in the range of 0.5 mm to 2 mm. The material of the first balloon (4) and the second balloon (5) is not particularly limited, but it is preferably not bulky as much as possible when deflated and inserted into ten parts when dilated because it is inserted into the body cavity together with the endoscope. Since it is necessary to expand the body cavity wall such as the digestive tract and the outer surface of the endoscope to a size that can be compressed, silicone rubber, deproteinized natural rubber, synthetic rubber, etc. that have sufficient expandability can be used, especially Silicone rubber, isoprene rubber, styrene-ethylene-butadiene-styrene copolymer resin, and the like are preferable from the viewpoint of expandability and low reactivity to living bodies. The outer diameter of the first balloon (4) when it is expanded depends on the size of the body cavity to be fixed, but considering the size of a standard adult digestive tract, a range of 30 mm to 200 mm can be used. The thickness of the first balloon (4) can be used in the range of 0.1 mm to 1.0 mm considering the strength to withstand fixation in a body cavity such as the digestive tract, and the length is not particularly limited, but is bent. In order to easily insert a body cavity such as a digestive tract together with an endoscope, a range of 10 mm to 100 mm can be used.

  When the second balloon (5) is expanded, the inner diameter of the endoscope insertion lumen (61) is narrowed to fix the endoscope, but the second balloon (5) is expanded to expand the endoscope insertion inner space. An expanded diameter is available that reduces the range of 10% to 80% of the inner diameter of the cavity (61). The length of the second balloon (5) is not particularly limited as long as the endoscope can be fixed, but if it is too long, the resistance to removing the endoscope increases, so a range of 5 mm to 100 mm can be used. . The thickness of the second balloon (5) is preferably as thin as possible because it is desirable from the point of insertion and removal of the endoscope that the inner diameter of the endoscope insertion lumen (61) be as large as possible. Since it is necessary to have sufficient strength to withstand friction during insertion and removal of the endoscope and fixation of the endoscope, in consideration of these, a range of 0.1 mm to 1.0 mm can be used.

  The first balloon (4) can be fixed to the cylindrical part (6) by an adhesive or welding, and the second balloon (5) can be fixed to the cylindrical part (6) lumen similarly. If it is difficult to bond, prepare a cylindrical part that fits into the cylindrical part (6), sandwich the balloon between the cylindrical part and the inner surface of the cylindrical part (6), and bond the cylindrical part. You may adhere and fix to the lumen | bore surface of a cylindrical part (6) with an agent.

  The inner diameter of the endoscope insertion lumen (61) needs to be able to be easily inserted and removed by the endoscope, so that it depends on the outer diameter of the endoscope to be used. In consideration of the outer diameter size of an endoscope that is used at a relatively high frequency for excision, a range of 5.0 mm to 20.0 mm can be used.

  The first balloon expansion tube (7) and the second balloon expansion tube (8) are inserted into a body cavity such as a digestive tract together with the endoscope. Therefore, the first balloon expansion tube (7) and the second balloon expansion tube (8) are as thin as possible. A flexible material that does not become insertion resistance and does not damage tissue of the body cavity such as the digestive tract is desirable, but it must be a material that has the strength to withstand the expansion force of the balloon, such as silicone rubber, fluororesin, Polyamide resin, soft polyvinyl chloride resin, polyurethane resin, styrene-ethylene-butadiene-styrene copolymer resin and the like can be used. The inner diameters of the first balloon expansion tube (7) and the second balloon expansion tube (8) must be sized so that fluid can be easily injected into and discharged from the balloon, and a range of 0.1 mm to 1 mm is required. Available. The outer diameter of the first balloon expansion tube (7) and the second balloon expansion tube (8) is preferably as thin as possible, but considering the pressure resistance during balloon expansion, a range of 0.3 mm to 3 mm is used. it can. The lengths of the first balloon expansion tube (7) and the second balloon expansion tube (8) need to have a sufficient margin than the length of the endoscope, and a range of 1.0 m to 5.0 m can be used. .

  The outer diameter of the tension adjustment mantle (9A) is such that the tension transmitting member (3) can slide without resistance even if it is bent in the body cavity such as the digestive tract together with the endoscope, and it is highly resistant to insertion and operation of the endoscope. It is important that the size does not become, and a range of 0.1 mm to 3.0 mm can be used. The inner diameter of the tension adjusting portion mantle (9A) can be in the range of 0.05 mm to 2.0 mm in consideration of slidability with the tension transmitting member (3).

  The length of the tension adjusting portion mantle (9A) is not particularly limited, but it is necessary to be longer than the length of the endoscope. However, if the length is too long, the operability is lowered. A range is available.

  The tension adjusting portion mantle (9A) can be manufactured by extruding a thermoplastic resin into a tube shape or by molding a metal wire into a coil spring shape, and the material is slippery with the tension transmission member (3). It is important that the material has good properties and does not bend even when inserted into a body cavity such as a bent gastrointestinal tract. Fluorinated polyethylene resin, polyamide resin, soft polyvinyl chloride resin, polyurethane resin, stainless steel, nickel Titanium alloy wires and thin plate-like materials can be used.

  The tension adjustment mantle (9A) is inserted into a body cavity such as a bent gastrointestinal tract together with an endoscope. Therefore, considering the patient's uncomfortable feeling and damage to the body cavity such as the gastrointestinal tract, it should be as thin as possible. Since bending occurs in a body cavity such as a tube and the tension transmitting member (3) cannot be operated, the outer diameter range of 0.5 mm to 5 mm can be used. The inner diameter of the tension adjusting portion mantle (9A) depends on the outer diameter of the tension transmitting member (3) to be inserted and the material used for the force adjusting portion mantle (9A), but a range of 0.2 mm to 4 mm can be used.

  The tension transmitting part mantle (9A) is fixed to the body cavity fixing part (1) by being inserted into the tension adjusting part lumen (91) of the body cavity fixing part (1) and fixed by adhesion or welding. The

  The material of the finger ring 1 (13), the finger ring 2 (14), the fixing member (15), and the rotation cap (16) constituting the handle part (12) is the tension transmission member (3) and the operation wire (18B). The material must be able to withstand the tensile force, and acrylonitrile-styrene-butadiene copolymer resin, hard polyvinyl chloride resin, polycarbonate resin, polyethylene terephthalate resin, polyether ether ketone resin, polyimide resin, and the like can be used.

  The tension transmission member (3) or the operation wire (18B) and the fixing member (15) can be connected by directly injection-molding synthetic resin on the tension transmission member (3) or the operation wire (18B), or fixed in advance. The tension transmission member (3) or the operation wire (18B) may be inserted into the hole provided in the member (15) and fixed with an adhesive or a screw. For fixing the finger ring 1 (13) to the fixing member (15), the protrusion of the finger ring 1 (13) may be press-fitted into a hole provided in the fixing member (15), or may be fixed with an adhesive. good. The rotation cap (16) may be fixed to the handle portion (12) by cutting screws into the handle portion (12) and the rotation cap (16) and screwing them together, or by fixing with an adhesive. The finger ring 2 (14) and the rotation cap (16) are fixed by pressing the protrusion of the rotation cap (16) into a hole provided in advance in the finger ring 2 (14).

  The one-way valve for the first balloon (10) and the one-way valve for the second balloon (11) inject a fluid into the first balloon (4) and the second balloon (5) with a syringe, and the syringe is discharged from each one valve. Any one-way valve that can stop the back flow of fluid from each balloon when pulled out can be used.

  The claw portion (18A) of the gripping device (18) can be manufactured by cutting a plate-like metal and bending it into a substantially C shape as shown in FIG. 7, and making the synthetic resin into a substantially C shape. It can be produced by molding with a mold or the like, and may be produced by bending a linear metal into a substantially C shape. The tip of the claw portion (18A) is open in the natural state, and it is necessary to close the tip when it is pulled into the gripping device mantle (18C), and the gripping portion (2) is attached to the gripping device mantle (18C). ) It is necessary to be a material that can withstand the strength drawn into the material, and a material having spring elasticity is desirable, and stainless steel, titanium steel, polyamide resin, polycarbonate resin, nickel titanium alloy, etc. can be used.

  If the length of the nail portion (18A) is too long, the elasticity of the tip of the grasping device (18) increases, and the grasping device (18) is bent and passed through the forceps hole of the endoscope inserted into the body cavity. Since it is difficult to insert into the target affected part, it is better to be as short as possible. However, if it is too short, the deformation rate at the time of opening and closing the tip of the nail part (18A) becomes too large, and the material cannot withstand deformation and breaks. Therefore, a range of 5 mm to 20 mm can be used. Although the plate | board thickness of a nail | claw part (18A) is not specifically limited, In order to hold | grip and fix a holding | grip part (2) fully, a 0.2 mm-2 mm thing can be utilized. The opening width of the tip portion of the claw portion (18A) may be any size that allows the rear end portion of the grip portion (2) to be gripped / removed, and a range of 0.5 mm to 3 mm can be used. A range of 0.1 mm to 1.5 mm can be used as the wire diameter of the linear member when the claw portion (18A) is made of a linear member.

  The operation wire (18B) of the grasping device (18) can be moved without significant resistance in the grasping device mantle (18C) by operating the handle portion (12), and the grasping member (2A) grasping the living tissue can be moved to the nail portion. It must be strong enough to withstand the force of pulling (18A) and tightening the gripping member (2A) with the gripping member fixing ring (2B), and even if the gripping device (18) is inserted into the forceps hole of the bent endoscope Flexibility that does not hinder operations such as insertion and bending of the endoscope is required, and stainless steel wires, polyamide fibers, polypropylene fibers, and the like that are formed by twisting them into a rope shape can be used. The outer diameter of the operation wire (18B) is preferably as thin as possible from the viewpoint of flexibility. However, if it is too thin, the area of contact with the lumen of the gripping device mantle (18C) is reduced, and the outer diameter of the manipulating device mantle (18C) is reduced. Since resistance increases and operability decreases, a range of 0.1 mm to 2 mm can be used.

  As the gripping device mantle (18C), a thermoplastic resin extruded into a tube shape, a metal wire or a metal plate wound in a coil shape, or the like can be used. The material of the gripping device mantle (18C) should have good sliding resistance with the operation wire (18B), such as fluorinated polyethylene resin, polyamide resin, soft polyvinyl chloride resin, stainless steel wire, nickel titanium alloy wire, etc. it can. Since the outer diameter of the grasping device mantle (18C) must be a size that can be inserted into the forceps hole of the endoscope, a range of 1 mm to 3.5 mm can be used. The inner diameter of the gripping device mantle (18C) depends on the outer diameter of the operation wire (18B) to be inserted, but the inner diameter size into which the gripping part (2) can be inserted is required, so the range is 0.5 mm to 3.0 mm. Is available. Since the length of the grasping device mantle (18C) can project from 10 mm to 50 mm from the distal end of the endoscope and needs a sufficient length that allows the handle operation to be performed outside the body from the endoscope forceps hole, 1 A length in the range of 0 mm to 5 m can be used.

It is a front view of the body cavity fixing | fixed part which expanded the 1st balloon of the biological tissue excision assistance tool of this invention, and the holding | gripping apparatus. It is the left perspective view which expanded the 1st balloon and 2nd balloon of the body cavity fixing | fixed part of the biological tissue excision assistance tool of this invention. It is sectional drawing of the length direction of the handle | steering-wheel part which operates the tension transmission part of the body cavity fixing | fixed part of the biological tissue excision assistance tool of this invention. It is a side view of the handle | steering-wheel part which operates the tension transmission part of the body cavity fixing | fixed part of the biological tissue excision assistance tool of this invention. It is A-A 'sectional drawing of the body cavity fixing | fixed part of the biological tissue excision assistance tool of this invention. It is the left perspective view which showed the state which the 1st and 2nd balloon of the body cavity fixing | fixed part of the biological tissue excision assistance tool of this invention contracted. It is an enlarged front view of the holding part of the body cavity fixation part of the biological tissue resection aid of this invention, and the front-end | tip part of a holding apparatus. It is an expanded side view of the holding part of the body cavity fixing | fixed part of the biological tissue excision assistance tool of this invention, and the front-end | tip part of a holding | gripping apparatus. It is the enlarged front view which mounted | wore the front-end | tip part of the holding | grip apparatus with the holding part of the body cavity fixed part of the biological tissue excision assistance tool of this invention. FIG. 4 is a cross-sectional enlarged view of a grasping device tip portion in which a grasping portion of a body cavity fixing portion of a living tissue resection aid is pulled into a grasping device of a living tissue resection aid of the present invention. It is an expanded sectional view of a grasping member which shows connection of a tension transmission member to a grasping part of a body cavity fixation part of a living tissue resection auxiliary tool of the present invention. It is an expanded sectional view of a holding part when the holding part of the body cavity fixing part of the biological tissue resection aid of the present invention is fastened with a holding member fixing ring. It is length direction sectional drawing of the handle | steering-wheel part of the holding | grip apparatus of the biological tissue excision assistance tool of this invention. It is a side view of the handle | steering-wheel part of the holding | grip apparatus of the biological tissue excision assistance tool of this invention. FIG. 5 is a left perspective view in which an endoscope is inserted into the first lumen of the body cavity fixing portion of the biological tissue resection aid of the present invention, and a gripping unit is attached to a gripping device inserted through the forceps hole of the endoscope. It is a figure which shows the state of separation of the biological tissue by the endoscope using the biological tissue excision auxiliary tool of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Body cavity fixing part 2 Gripping part 2A Gripping member 2B Gripping member fixing ring 3 Tension transmission member 3A Tension transmission member fixing part 4 First balloon 5 Second balloon 6 Cylindrical part 61 Endoscope insertion lumen 62 Second balloon expansion Tube tube lumen 7 First balloon expansion tube 8 Second balloon expansion tube 9 Tension adjustment portion 9A Tension adjustment portion outer jacket 91 Tension adjustment portion lumen 10 First balloon one valve 11 Second balloon one valve 12 Handle Part 12A Slide groove 13 Finger ring 1
14 Finger Ring 2
DESCRIPTION OF SYMBOLS 15 Fixing member 16 Rotating cap 17 Endoscope 18 Grasping device 18A Claw part 18B Operation wire 18C Grasping device mantle 19 High frequency scalpel 20 Biological tissue excision trace 21 Detachment living tissue 22 Biological tissue separation planned line 23 Digestive tract

Claims (2)

When a living tissue in a body cavity is excised and separated with a high-frequency knife through an endoscope, tension is applied to the living tissue to be separated, and the living tissue can be safely and efficiently separated. A body tissue resection aid
A gripping part for gripping the living tissue;
A grasping device for grasping the grasping part on the living tissue;
A tension transmission member coupled to the gripping portion;
A handle portion for adjusting the tension applied to the tension transmitting member;
A body cavity fixing portion that forms a fulcrum of a tension transmitting member that applies the tension transmitted from the handle portion to the living tissue grasped by the grasping portion;
Consists of
The body cavity fixing portion has a cylindrical portion that is attached to the distal end portion of the endoscope and can be inserted into the body cavity together with the endoscope, and the endoscope can be removed from the body cavity fixing portion in the body cavity. biological tissue ablation aid, characterized in that is. The body cavity fixing portion has a substantially cylindrical shape having a plurality of lumens, and has a first balloon on an outer surface, a second balloon on a lumen surface, and the outer surface and the inner The biological tissue resection aid according to claim 1, wherein a tension transmitting member is inserted between the term surfaces.

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