JP5258609B2 - Treatment endoscope - Google Patents

Description

  The present invention relates to a treatment endoscope.

  In an endoscope, a bending portion that can be bent by remote operation is generally provided in the vicinity of the distal end of the insertion portion, and an observation window, a treatment instrument protrusion, and the like are disposed on the distal end side of the bending portion. However, some treatment endoscopes have an improved treatment capability by arranging observation windows and treatment tool protrusions on both the distal end side and the proximal end side of the bending portion (for example, Patent Documents 1 and 2). ).

JP 2004-223053 A JP-A-2005-95590

  Recent progress in surgery using endoscopes for treatment is remarkable, and mucosal dissection and mucosal dissection have been carried out as usual. Attempts have also been made to perform resection.

  However, if the entire wall of the living body is to be excised with a conventional endoscope for treatment as described in Patent Document 1, the incision electrode of the treatment tool is shaken during the excision, or the observation window position of the endoscope May swing to the excision site, and the excision procedure may not be performed in a stable state.

  Further, when excising the entire layer of the living body wall, it is necessary to perform excision not only in the state of the surface side of the living body wall but also in the running state of the blood vessel on the back side of the living body wall. Such a function cannot be obtained with this treatment endoscope.

  The present invention can perform a resection treatment and the like safely and smoothly without the high-frequency electrode and the observation window being shaken with respect to the resection object when performing resection of the entire layer of the living body wall. It is an object of the present invention to provide a treatment endoscope that can safely perform excision and the like while observing not only the surface side state but also the running state of blood vessels on the back side.

  In order to achieve the above object, the treatment endoscope of the present invention is provided with a flexible flat portion having a flat cross-sectional shape in a region in the vicinity of the distal end of the flexible insertion portion. An observation window is disposed on the flat surface side toward the side of the distal end of the lens, and a bending portion that can be bent by remote control is provided in the vicinity of the flexible flat portion, and is inserted into the insertion portion. An outlet opening of the conductive wire guide tube is arranged on the proximal end side of the flexible flat portion, and the conductive wire inserted into the conductive wire guide tube so as to advance and retract in the axial direction is flat from the outlet opening of the conductive wire guide tube. And extending to the distal end portion of the flexible flat portion as a high-frequency electrode, and the conductive wire distal end is connected to the vicinity of the distal end of the flexible flat portion to pull the conductive wire from the proximal end side. As a result, the flexible flat portion is curved in a bow shape and the high-frequency electrode becomes a string shape.

  Note that the flexible flat portion may be bent with a smaller radius of curvature than the bending portion. Moreover, the 2nd observation window may be provided in the base end part vicinity of the flexible flat part, and the 2nd observation window may be arrange | positioned toward diagonally forward.

  In addition, when a groove is formed in the lateral direction on the flat surface facing the high-frequency electrode of the flexible flat portion, the flexible flat portion is smoothly curved, and the region near the tip of the flexible flat portion May be a hard part with no flexibility. And the exit opening of a conductive wire guide tube may be arrange | positioned in the front-end | tip part of the half pipe part arrange | positioned along with the area | region of the base end vicinity of a flexible flat part.

  According to the present invention, when the conductive wire is pulled from the base end side, the flexible flat portion is bowed and the high frequency electrode becomes a string shape, so by applying a high frequency current to the high frequency electrode, When excising the entire layer of the living body wall, it is possible to perform the excision treatment safely and smoothly without the high-frequency electrode and the observation window being shaken with respect to the excision object, and the tip of the flexible flat part It is possible to safely perform excision treatment or the like while observing the running state of the blood vessel on the back side of the living body wall through the observation window arranged on the body.

It is a perspective view of the front end side part of the insertion part of the treatment endoscope which concerns on 1st Example of this invention. It is a side surface fragmentary sectional view of the front-end | tip part of the insertion part of the treatment endoscope which concerns on 1st Example of this invention. 1 is an overall configuration diagram of a treatment endoscope according to a first embodiment of the present invention. 1 is a schematic diagram of an apparatus on a video processor side used in a medical treatment endoscope according to a first embodiment of the present invention. It is a schematic diagram of the modification of the monitor screen by the side of the video processor used for the endoscope for treatment concerning the 1st example of the present invention. It is the schematic of the modification of the apparatus by the side of the video processor used for the treatment endoscope which concerns on 1st Example of this invention. It is a schematic diagram showing the use state of the endoscope for treatment concerning the 1st example of the present invention. It is a side view of the front end side part of the insertion part of the treatment endoscope which concerns on 2nd Example of this invention. It is a side view of the front end side part of the insertion part of the endoscope for treatment concerning the 3rd example of the present invention. It is a side view of the front end side part of the insertion part of the endoscope for treatment concerning the 4th example of the present invention.

Embodiments of the present invention will be described below with reference to the drawings.
FIG. 1 is a perspective view of a distal end side portion of a treatment endoscope according to a first embodiment of the present invention, and FIG. 2 is a side partial sectional view.

  A flexible flat portion 2 having a flat cross-sectional shape is provided in a region near the tip of the flexible insertion portion 1. An observation window 3 and an illumination window 4 are arranged on the side of the flat surface 2a toward the side (that is, the direction in which the flat surface 2a faces) at the distal end portion of the flexible flat portion 2. 2A shown in FIG. 2 is an emission end portion of the light guide fiber bundle disposed on the back side of the illumination window 4. FIG.

  The flexible flat portion 2 is formed in a cross-sectional shape obtained by cutting the insertion portion 1 having a circular cross-sectional shape into a substantially semicircular shape, and the length thereof is, for example, about several centimeters. The entire length of the insertion portion 1 is, for example, about 50 cm to 1.5 m.

  The flexible flat portion 2 can be formed, for example, by closing the distal end surface of a flexible multi-lumen tube, but may be formed from a molded product of a soft plastic material or the like.

  The area where the observation window 3 and the illumination window 4 near the tip of the flexible flat part 2 are arranged is a hard part having no flexibility, but the other areas of the flexible flat part 2 are flat. It is flexible enough to bend in the direction 2a.

  In the vicinity of the flexible flat portion 2, that is, in the region of the insertion portion 1 adjacent to the proximal end side of the flexible flat portion 2, it can be bent by remote operation from the proximal end side of the insertion portion 1. Part 5 is provided. The length of the bending portion 5 is, for example, about several centimeters to several tens of centimeters, and the flexible flat portion 2 can be bent with a smaller radius of curvature than the bending portion 5.

  A conductive wire guide tube 6 made of an electrically insulating tube or the like is inserted in the insertion portion 1 over the entire curved length, and an outlet opening 6a of the conductive wire guide tube 6 is formed as a flat surface of the flexible flat portion 2. It arrange | positions at the base end side of the flexible flat part 2 in the direction in alignment with 2a.

  The second observation window 13 and the illumination window 14 are aligned with the direction in which the flat surface 2a faces at a position adjacent to the base end of the flexible flat portion 2 along with the outlet opening 6a of the conductive wire guide tube 6. It is arranged diagonally forward.

  A conductive wire 7 is inserted into the conductive wire guide tube 6 so as to advance and retract in the axial direction. The conductive wire 7 extends from the outlet opening 6 a of the conductive wire guide tube 6 to the distal end portion of the flexible flat portion 2 along the flat surface 2 a of the flexible flat portion 2.

  The conductive wire 7 is applied to the linear high-frequency electrode 7A where the exposed portion (that is, the portion exposed to the outside of the endoscope) along the flat surface 2a of the flexible flat portion 2 is not provided with an electrical insulation coating or the like. Thus, the tip of the high-frequency electrode 7A (that is, the most distal portion of the conductive wire 7) is connected and fixed near the tip of the flexible flat portion 2.

  However, the tip of the high-frequency electrode 7A may be detachably connected to the tip of the flexible flat part 2, so that the high-frequency electrode 7A can be replaced when it deteriorates due to use for high-frequency treatment. Can be.

  With the configuration as described above, when the conductive wire 7 is pulled from the proximal end side, the flexible flat portion 2 has an arcuate shape in the direction in which the flat surface 2a faces as shown by a two-dot chain line in FIG. The high-frequency electrode 7A is bent and becomes like a bowstring, and the high-frequency electrode 7A can cut a living body wall or the like at high frequency. When the pulling operation of the conductive wire 7 is released, the flexible flat portion 2 returns to a state close to the original straight due to its own elasticity.

  FIG. 3 shows the overall configuration of the treatment endoscope. A bending operation knob 91 for remotely operating the bending portion 3 and an observation window are provided on the operation portion 90 connected to the proximal end of the insertion portion 1. An observation image control button 93 and the like for controlling the observation image picked up through the third and second observation windows 13 are arranged. Reference numeral 99 denotes a connector for connecting to a video processor described later.

  Reference numeral 95 denotes a conductive wire operating lever for moving the conductive wire 7 back and forth in the axial direction. Since the structure of the mechanism is the same as that of a known forceps raising operation mechanism or the like, a detailed description is omitted.

  Reference numeral 96 denotes a connection terminal for connecting a high-frequency power cord, not shown, and is always electrically connected to the conductive wire 7. Therefore, a high-frequency current can be arbitrarily supplied to the high-frequency electrode 7 </ b> A via the conductive wire 7.

  FIG. 4 shows a video processor 100 for controlling an endoscopic observation image and the like, a monitor 101 for displaying the endoscopic observation image, and the like, and an endoscopic observation image 121 obtained through the observation window 3. Is displayed large on the monitor 101, and an endoscopic observation image 141 obtained through the second observation window 13 is displayed in the endoscopic observation image. This is so-called picture-in-picture. Reference numeral 151 denotes a sub display area for displaying data relating to the image.

  However, as shown in FIG. 5, the endoscope observation image 121 obtained through the observation window 3 and the endoscope observation image 141 obtained through the second observation window 13 have the same size in one monitor 101. It can be displayed on the screen.

  Further, as shown in FIG. 6, the endoscope observation image 121 obtained through the observation window 3 and the endoscope observation image 141 obtained through the second observation window 13 are arranged on different monitors 101 and 201. It may be displayed.

  FIG. 7 shows an example of a full-thickness resection procedure for the stomach wall 500 performed using the treatment endoscope according to the present embodiment. The gastric wall 500 is formed to be small with a high-frequency scalpel for an endoscope (not shown). By inserting the flexible flat part 2 into the perforated 501 halfway and pulling the conductive wire 7 from the base end side, the high-frequency electrode 7A becomes a bow string, and the flexible flat part 2 is curved. It will be in the state.

  Therefore, by applying a high-frequency current to the high-frequency electrode 7A, the stomach wall 500 in contact with the high-frequency electrode 7A is cut by high-frequency cauterization, and the gastric wall 500 can be completely removed by moving the cut portion.

  At that time, the high-frequency electrode 7A does not shake while maintaining a bow-string shape, and the observation window 3 provided at the tip of the flexible flat portion 2 is also mechanically fixed to the high-frequency electrode 7A. By being in a state of being performed, it does not shake relative to the excision target site. Therefore, the resection can be performed safely and smoothly while always observing the resection site with certainty.

  The state of the surface side of the stomach wall 500 can be observed through the second observation window 13 provided at the base end of the flexible flat portion 2, and provided at the distal end of the flexible flat portion 2. Through the observation window 3, the excision treatment or the like can be performed safely while observing the running state of the blood vessel on the back side of the stomach wall 500.

  The present invention is not limited to the above-described embodiment. For example, as in the second embodiment shown in FIG. 8, the deflection on the side of the flexible flat portion 2 facing the high-frequency electrode 7A is not limited. An appropriate number of grooves 2g may be formed in the plane 2a in the lateral direction (that is, the direction orthogonal to the longitudinal direction of the flexible flat portion 2). By comprising in this way, the flexible flat part 2 curves more smoothly.

  Further, as in the third embodiment shown in FIG. 9, the region near the tip of the flexible flat portion 7 may be a hard portion 2H having no flexibility. With this configuration, the curved shape of the flexible flat portion 2 becomes a “<” shape, and as a result, the fluctuation of the high-frequency electrode 7 </ b> A becomes smaller.

  In addition, although the hard part which is not flexible will be made in the peripheral area | region of the observation window 3 of the front-end | tip part of the flexible flat part 2, in this Example, the hard part 2H was formed actively long. Therefore, the hard part 2H having an arbitrary length can be formed by appropriately installing a rigid member.

  Further, as in the fourth embodiment shown in FIG. 10, the insertion portion 1 is arranged so that the semi-tube portion 1x having a semicircular cross-sectional shape is arranged in parallel with the region near the base end of the flexible flat portion 2. The outlet opening 6a of the conductive wire guide tube 6 may be disposed at the distal end portion of the half tube portion 1x.

  By comprising in this way, the length of the high frequency electrode 7A with respect to the flexible flat part 2 can be formed short, and a stable incision can be performed according to a case etc. in some cases.

  The present invention can take various embodiments. For example, the flexible flat portion 2 of the third and fourth embodiments shown in FIGS. 9 and 10 can be replaced with the second embodiment shown in FIG. If a groove similar to the groove 2g of the embodiment is formed, the flexible flat portion 2 is smoothly curved in a stable state without shaking.

DESCRIPTION OF SYMBOLS 1 Insertion part 1x Semi-tube part 2 Flexible flat part 2a Flat surface 2g Groove 2H Hard part 3 Observation window 5 Curved part 6 Conductive line guide tube 6a Outlet opening 7 Conductive line 7A High frequency electrode 13 2nd observation window

Claims (7)

A flexible flat part having a flat cross-sectional shape is provided in a region near the tip of the flexible insertion part,
An observation window is arranged on the flat surface side toward the side at the tip of the flexible flat portion, and
A bending portion that can be bent by remote control is provided in the vicinity of the flexible flat portion at a rear position,
The outlet opening of the conductive wire guide tube inserted and disposed in the insertion portion is disposed on the proximal end side of the flexible flat portion,
A conductive wire inserted in the conductive wire guide tube so as to be able to advance and retreat in the axial direction extends from the outlet opening of the conductive wire guide tube to the distal end portion of the flexible flat portion as a high frequency electrode along the flat surface. Arranged,
The tip of the conductive wire is connected near the tip of the flexible flat part,
An endoscope for treatment, wherein the flexible flat portion is bent in a bow shape by pulling the conductive wire from the base end side, and the high-frequency electrode is formed in a string shape.   The treatment endoscope according to claim 1, wherein the flexible flat portion is curved with a smaller radius of curvature than the curved portion.   The treatment endoscope according to claim 1 or 2, wherein a second observation window is provided in the vicinity of a base end portion of the flexible flat portion.   The treatment endoscope according to claim 3, wherein the second observation window is disposed obliquely forward.   The treatment endoscope according to any one of claims 1 to 4, wherein a groove is formed in a lateral direction on a flat surface of the flexible flat portion facing the high-frequency electrode.   The treatment endoscope according to any one of claims 1 to 5, wherein a region in the vicinity of the distal end of the flexible flat portion is an inflexible hard portion.   The treatment according to claim 1 or 2, wherein an outlet opening of the conductive wire guide tube is arranged at a distal end portion of the half tube portion arranged in parallel with a region near the proximal end of the flexible flat portion. Endoscope.

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