JP5385079B2 - Detachable endoscopic treatment Food - Google Patents

Detachable endoscopic treatment Food Download PDF

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JP5385079B2
JP5385079B2 JP2009233378A JP2009233378A JP5385079B2 JP 5385079 B2 JP5385079 B2 JP 5385079B2 JP 2009233378 A JP2009233378 A JP 2009233378A JP 2009233378 A JP2009233378 A JP 2009233378A JP 5385079 B2 JP5385079 B2 JP 5385079B2
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endoscope
flexible tube
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JP2011078576A (en )
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内 弘 久 竹
部 展 次 阿
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学校法人杏林学園
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本発明は、内視鏡的粘膜下層剥離術(ESD)やNOTES関連手技において用いられる内視鏡の先端に取り付けられる、着脱可能な外付け多目的軟性チューブを備えた内視鏡用処置フードに関する。 The present invention is attached to the distal end of the endoscope to be used in endoscopic submucosal dissection (ESD) and NOTES related procedures relates to an endoscope treatment hood having a detachable external multi-purpose flexible tube.

近年、食道や胃等の早期胃癌に対して、開腹せずに内視鏡を用いて病変部の粘膜を切除する内視鏡的粘膜切除術が行われている。 Recently, with respect to early gastric cancer such as esophagus and stomach, endoscopic mucosal resection excising mucosal lesion using an endoscope without laparotomy it is performed. その方法の1つとして、高周波電気メスにて内視鏡的粘膜下層剥離術(ESD)が施すものが知られている。 One of the methods, which endoscopic submucosal dissection (ESD) is applied is known in the high frequency electric knife. ESDは、治療技術が難しく、そのため治療を容易にするために、様々な方法で病変部に対するカウンタートラクションの工夫がなされている。 ESD, the treatment technique is difficult, to facilitate treatment therefor, are devised to counter-traction against the lesion is made in various ways. しかし、従来、簡便にカウンタートラクションを行うことができる理想的な処置具が少ないという問題点があった。 However, conventionally, there is simply ideal treatment instrument problem is less capable of performing counter traction.

この種の従来の内視鏡用処置フードとして、内視鏡の先端に取り付けるキャップまたはフードに高周波電気メスもしくはナイフを装着して、鉗子孔に把持鉗子を挿入し、病変・切除面を把持鉗子により把持することにより、施術者の可視下の安定した視野で、病変部の切除・切開・剥離等の操作を可能にした内視鏡用フードナイフおよび多目的処置フードが提案されている(特許文献1及び2参照)。 As a conventional endoscope treatment hood of this kind, by mounting the high frequency electric knife or knives to the cap or hood attached to the distal end of the endoscope, to insert the grasping forceps into the forceps hole, gripping the lesion-resection surface Forceps by gripped by, a stable field of view observable practitioner, the endoscope hood knives and multipurpose treatment hood to allow resection, incision and operation of such separation of the lesion has been proposed (Patent documents see 1 and 2).

また、挙上鉗子用チューブでなく、洗浄液供給用チューブを備えた内視鏡用処置フードもある(特許文献3参照)。 Further, instead of tubes for elevation forceps is an endoscope treatment hood with a cleaning liquid supply tube (see Patent Document 3).

特開2005−192675号公報 JP 2005-192675 JP 特開2007−209534号公報 JP 2007-209534 JP 特開2008−55074号公報 JP 2008-55074 JP

しかしながら、上述した従来例の内視鏡用処置フードでは、処置用の鉗子チャンネルが内視鏡と一体型のため、処置方向と内視鏡が常に平行に同じ方向に動いてしまう。 However, treatment hood for an endoscope of the conventional example described above, since the forceps channel for treatment of the endoscope and integral treatment direction and the endoscope will always move parallel to the same direction. このため、内視鏡の自由度が極めて低いという問題点があった。 Therefore, flexibility of the endoscope there that the problem is extremely low.

本発明は、このような従来の内視鏡用処置フードが有する問題点を解決しようとするものであり、内視鏡の自由度が高く、かつ、内視鏡が自由に動けることが可能な内視鏡用処置フードを提供することを課題とする。 The present invention is intended to solve the problems of such a conventional endoscope treatment hood, high degree of freedom of the endoscope, and which can be an endoscope can move freely and to provide a endoscopic treatment hood.

上述した課題を解決するために、本発明は、内視鏡取り付け部の先端に設けられ周壁に突出して形成された空間形成部を有する内視鏡の先端に着脱自在に外嵌される筒状本体と、空間形成部に挿入して係止され患部を挙上する把持鉗子を挿入する多目的軟性チューブを備え、内視鏡とこの軟性チューブとを分離可能に形成して内視鏡用処置フードを構成する。 To solve the problems described above, the present invention is an endoscope endoscopic tubular to be freely fitted removably to the front end of which has a space forming portion that protrudes in the circumferential wall provided at the tip of the mounting portion body and, the affected part is locked by inserting the space forming portion comprises a multi-purpose flexible tube for inserting the grasping forceps for the upper elevation, endoscopic and treated hood for an endoscope and the flexible tube and separably formed constitute a.

本発明の多目的軟性チューブを着脱可能な内視鏡用処置フードにより、病変部に、鉗子で挙上することで得られるカウンタートラクションをかけつつ、内視鏡の自由度が高く、かつ、内視鏡が自由に動けることが可能となるため、あらゆる方向からの切開・剥離が可能となり、治療時間の短縮及び穿孔などの合併症を軽減することができるようになる。 Versatile flexible tube endoscopic hood removable of the present invention, the lesion, while applying a counter traction obtained by the upper elevation with forceps, high degree of freedom of the endoscope, and the endoscope since it is possible to mirror move freely, it is possible to incision and peeling from any direction, it is possible to reduce complications such as shortening and perforation treatment time.

また、空間形成部に挿入して係止され患部を挙上する把持鉗子を挿入する多目的軟性チューブを取り外さないで処置すること(筒状本体(フード)から多目的チューブを取り外さないで、一体型のままで治療に用いること)も可能であり、前記した従来例の内視鏡フードナイフと同様な使用も可能となる。 Furthermore, without removing the multipurpose tubing from treating not remove the multi-purpose flexible tube diseased locked by inserting the space forming portion inserts the grasping forceps for the upper elevation (tubular body (hood), integral while by using the therapy) is also possible, and can also be similar to using an endoscope hood knife in the conventional example described above.

さらに、多目的軟性チューブを利用して、多くのチャンネルを備える新たな内視鏡に買い換えることなく、現在使用している内視鏡を用いて低廉、かつ容易にチャンネル数を増加させることができる。 Further, by using a multi-purpose flexible tube, without get a new one in the new endoscope comprising a number of channels, can be inexpensive, and be easily increase the number of channels using an endoscope which is currently used.

さらに、病変・切除面を多目的軟性チューブに挿通させた把持鉗子で把持させ、多目的軟性チューブと内視鏡の先端に外嵌される筒状本体とを分離させた後、一旦、内視鏡を抜去し、再度、内視鏡の先端に外嵌される筒状本体に同様の多目的軟性チューブを装着させることで、病変・切除面の別の部位にカウンタートラクションをかけることが可能となり、容易に患部切除を行うことが出来るので、安全性の高い患部の切除が可能となる。 Furthermore, is gripped by the grasping forceps is inserted through the lesion-resection plane versatile flexible tube, after separating the tubular body to be fitted to the tip of the multi-purpose flexible tube and the endoscope, once the endoscope removal, and again, by the tubular body which is fitted on the distal end of the endoscope is fitted with a similar multipurpose flexible tube, it is possible to apply a counter-traction in other parts of the lesion-resection plane, easily it is possible to perform the affected area ablation, it is possible to cut a high safety affected area.

また、さらに、病変部を挙上させる把持鉗子や処置具が多目的軟性チューブに収納されて病変・切除面まで誘導できるため、病変部をもつ壁面や他の臓器を損傷させる恐れがない。 Still, since the grasping forceps or the treatment instrument to elevate the lesion is housed in multipurpose flexible tube can be induced to lesion-resection plane, there is no risk of damaging the walls and other organs with lesions.

上述したように、本発明は、このような従来の構成が有していた問題点を解決しようとするものであり、病変部に鉗子で挙上することで得られるカウンタートラクションをかけながら、内視鏡の自由度が高く、内視鏡が自由に動けることを可能とするため、あらゆる様々な方向からの切開・剥離が可能となり、治療時間の短縮や穿孔などの合併症を軽減することが可能となるとともに、容易に患部切除を行うことができ、安全性の高い患部の切除ができるようになる。 As described above, the present invention is intended to solve the problems the conventional configuration had, while applying a counter traction obtained by the upper elevation with forceps lesion, the inner freedom of endoscope is high, since the endoscope makes it possible to move freely, it is possible to incision and peeling from all different directions, it is possible to reduce complications, such as speed or perforation treatment time possible and with made, it can be easily performed diseased ablation, so that it is cut in the high safety affected area.

また、単純な構造で、生体に優しい柔らかいシリコン材料を用いて内視鏡用処置フードが作製可能で、装着も簡単なため実用性に優れている。 Further, a simple structure, the endoscope treatment hood with gentle soft silicon material in the living body can be produced at, is excellent in practicability for mounting simplest.

本発明の内視鏡用処置フードの筒状本体に、着脱自在な外付け多目的軟性チューブと内視鏡を取り付けた状態を示す側面図である。 The tubular body of the endoscope treatment hood of the present invention, is a side view showing a state of attaching the removable external multi-purpose flexible tube and the endoscope. 図1に示すA矢視部の部分拡大図である。 It is a partially enlarged view of the A arrow portion shown in FIG. 図1に示した本発明の内視鏡用処置フードの筒状本体に着脱自在な多目的軟性チューブを示し、図3(a)は、均一な直径をもつ多目的軟性チューブを、また、図3(b)は、鉗子等の挿入端がラッパ状に拡開した多目的軟性チューブの側面図を、それぞれ示す。 Shows the universal multi-purpose flexible tube detachably attached to the cylindrical body of the endoscope treatment hood of the present invention shown in FIG. 1, FIG. 3 (a), a multi-purpose flexible tube having a uniform diameter, and FIG. 3 ( b) is a side view of a multi-purpose flexible tube insertion end, such as forceps is expanded like a trumpet, respectively. 図1に示す本発明の内視鏡用処置フードの筒状本体を示し、図4(a)は、図1に示すI−I線矢視断面図、図4(b)は、同じくII−II線矢視断面図、図4(c)、図4(d)は、内視鏡用処置フードの他の実施例のI−I線矢視断面図である。 It shows the tubular body of the endoscope treatment hood of the present invention shown in FIG. 1, FIG. 4 (a), I-I sectional view taken along line shown in FIG. 1, FIG. 4 (b), likewise II- II cross-sectional view taken along line, FIG. 4 (c), the FIG. 4 (d), a II cross-sectional view taken along line of another embodiment of a treatment hood for an endoscope. 図1に示した本発明の内視鏡用処置フードの筒状本体のさらに他の実施例を示し、図5(a)は、その斜視図、図5(b)は、図5(a)に示した内視鏡用処置フードの筒状本体の係止部に嵌入される多目的軟性チューブの先端部の斜視図である。 Shows still another embodiment of the tubular body of the endoscope treatment hood of the present invention shown in FIG. 1, FIG. 5 (a), a perspective view thereof, FIG. 5 (b), FIGS. 5 (a) it is a perspective view of the tip of the multi-purpose flexible tube which is fitted into the locking portion of the cylindrical main body of the endoscope treatment hood shown in. また、図5(c)は、内視鏡の首を上下に振って、内視鏡用処置フードの筒状本体の係止部から多目的軟性チューブを外した状態の概略図である。 Further, FIG. 5 (c), shaking the head of the endoscope in a vertical, schematic view of a state in which remove the multi-purpose flexible tube from the locking portion of the cylindrical body of the endoscope treatment hood.

図1及び図2に示すように、本発明の実施例の内視鏡用処置フード1は、柔軟なシリコン材料からなる筒状本体1aと、内視鏡用処置フード1に一体に射出成形等で筒状本体1aの外周に突出して形成した把持部1aとからなり、筒状本体1aには、内視鏡の先端部が、また、把持部1aには、把持端子(鉗子)4等を内設したシリコン材料からなる外付け多目的軟性チューブ2の先端が、それぞれ嵌入されている。 As shown in FIGS. 1 and 2, the endoscopic treatment hood 1 embodiment of the present invention, a flexible and tubular body 1a made of silicon material, the endoscope treatment injection molding integrally with the hood 1 in consists of a gripping portion 1a which is formed to protrude to the outer periphery of the cylindrical main body 1a, the cylindrical main body 1a, the tip portion of the endoscope, also the grip portion 1a, the gripping pin (forceps) 4, etc. the tip of the external multi-purpose flexible tube 2 made internally provided silicon material, is fitted, respectively.

ここで、外付け多目的軟性チューブ2は、図3(a)に示すように同一直径をもつ鉗子等の挿入チューブとして構成してもよいが、図3(b)に示すように、鉗子等が挿入し易いように後端部を口が拡開したいわゆるラッパ状に構成してもよい。 Here, the external multi-purpose flexible tube 2 may be constructed as an insertion tube, such as a forceps having the same diameter as shown in FIG. 3 (a), as shown in FIG. 3 (b), forceps or the like the rear end portion mouth may be configured in a so-called trumpet shape that is flared so inserted easily.

本発明の内視鏡用処置フード1は、図4(a)及び図4(b)に、図1のI−I矢視断面図及びII−II矢視断面図に示すような、基本的構成を有する。 Endoscopic hood 1 of the present invention, in FIGS. 4 (a) and 4 (b), as shown in arrow II cross-sectional view and a II-II cross-sectional view taken along FIG. 1, the basic having the configuration. すなわち、そのI−I矢視断面(図4(a))に示すように、内視鏡用処置フード1は、内視鏡3が内装される筒状本体(チューブ)1aと、この筒状本体1aの外周面からその半径方向に突出した一対の把持部1b,1bと、該一対の把持部1b,1bの間に形成された多目的軟性チューブ2の直径よりも僅かに大きい巾寸法のスリット1cとからなり、柔軟性をもつ多目的軟性チューブ2をこのスリット1cを上方から押し開いて中空形成部C内に挿入し、内視鏡3に並列になるように外付けする。 That is, the I-I cross-sectional view taken along line as shown in (FIG. 4 (a)), the endoscope treatment hood 1 includes a cylindrical main body (tube) 1a of the endoscope 3 is furnished, the tubular a pair of gripping portions 1b projecting from the outer peripheral surface of the main body 1a in the radial direction, 1b and, the pair of gripping portions 1b, of slightly greater width dimension than the formed diameter of multipurpose flexible tube 2 between 1b slit consists of a 1c, pushes open the multi-purpose flexible tube 2 having flexibility the slit 1c from above was inserted into the hollow forming section C, and external to be parallel with the endoscope 3. ここで、図1に示すように、内視鏡用処置フード1の先端側には、突出部1b,1bが形成されず、図4(b)に示すように中空筒状断面になっている。 Here, as shown in FIG. 1, the distal end side of the endoscope treatment hood 1, the protruding portions 1b, 1b are not formed, has a hollow cylindrical cross-section as shown in FIG. 4 (b) .

ここで、突出部1b,1bの中空形成部C内に挿入した多目的軟性チューブ2を外して内視鏡3の動きに自由度をもたらすためには、病変周囲の組織部を鉗子で把持して挙上してからカウンタートラクションをかけながら、図5(c)に示すように、内視鏡3の首を振ってスリット1cから多目的軟性チューブ2が外れるようにする。 Here, in order to bring freedom of movement of the endoscope 3 to remove the protruding portion 1b, multipurpose flexible tube 2 inserted in 1b hollow forming section C of the tissue portion surrounding the lesion was grasped with forceps while over the counter traction from lifted, as shown in FIG. 5 (c), shaking the head of the endoscope 3 so as multipurpose flexible tube 2 is disengaged from the slit 1c.

また、多目的軟性チューブ2の外周面に突設した把持部1b,1bの形状としては、図4(c)に示すように、一対の把持部1b,1bの間に形成されるスリット1cを上下に交差するようにして中空形成部Cを形成してもよい。 Further, the grip portion 1b protruding from the outer circumferential surface of the multi-purpose flexible tube 2, the shape of 1b, as shown in FIG. 4 (c), the pair of gripping portions 1b, the slit 1c formed between 1b vertically it may form a hollow formed portion C so as to intersect.

また、図4(a)、図5(a)、(b)に示すように、多目的軟性チューブ2aの先端部に板状のスライド部材2bを一体に形成して、図5(a)に示す、把持部1b,1bの空間形成部C内にスライドさせて挿入して把持して係止し、また多目的軟性チューブ2aを内視鏡用処置フード1から多目的軟性チューブ2aの中心軸心方向にスライドさせて外すようにする。 Further, FIG. 4 (a), the FIG. 5 (a), formed as (b), the plate-shaped sliding member 2b integrally on the tip portion of the multi-purpose flexible tube 2a, shown in FIG. 5 (a) grip portion 1b, is slid into the space forming section C of 1b engaged by gripping and insertion, also a multi-purpose flexible tube 2a from the endoscope treatment hood 1 to the central axis direction of the multi-purpose flexible tube 2a slide to disengage with.

上述したように、本発明は、病変周囲の組織部に鉗子(把持端子)で挙上することで得られるカウンタートラクションをかけながら、鉗子等を内挿した多目的軟性チューブを内視鏡用処置フードから外して操作するから、内視鏡の自由度が高く、かつ、内視鏡が自由に動けることが可能となるため、あらゆる方向からの切開・剥離が可能となり、治療時間の短縮や穿孔などの合併症を軽減することが可能となるとともに、容易に患部切除を行うことができ、安全性の高い患部の切除ができるようになる。 As described above, the present invention is, while applying a counter traction obtained by the upper elevation to a tissue portion surrounding the lesion with forceps (gripping pin), the medical treatment endoscope multipurpose flexible tube with interpolation of a forceps or the like hood because operated removed from a high degree of freedom in the endoscope, and, since the endoscope is possible to move freely, it is possible to incision and peeling from any direction, speed and perforation treatment time it becomes possible to reduce the complications, it can be easily performed diseased ablation, so that it is cut in the high safety affected area.

1 内視鏡用処置フード1a 筒状本体1b 把持部1c スリット2 外付け多目的軟性チューブ3 内視鏡4 把持端子C 中空形成部 Within view 1 within endoscope treatment hood 1a cylindrical main body 1b grip portion 1c slits 2 external multipurpose flexible tube 3 Mirror 4 gripping terminal C hollow formed part

Claims (1)

  1. 内視鏡の先端部に嵌入された筒状本体と、該筒状本体の外周面に形成した一対の把持部と、前記一対の把持部に着脱自在に外付けされ、かつ、処置具が挿入される軟性チューブと、からなり、前記一対の把持部間にスリットを形成し、前記一対の把持部は、柔軟な材料からなり、病変部周囲の組織部を前記処置具で把持した後、前記スリットとは反対側に前記内視鏡の先端部を振って、前記スリットから前記軟性チューブを外すことが可能に形成されていることを特徴とする内視鏡用処置フード。 A cylindrical body that is fitted to the distal end of the endoscope, and a pair of gripping portions formed on the outer peripheral surface of the cylindrical body, removably mounted externally to the pair of gripping portions, and inserted treatment instrument a flexible tube which is made of, a slit is formed between the pair of gripping portions, the pair of gripping portions is made of a flexible material, after the tissue portion surrounding the lesion is grasped by the treatment instrument, wherein the slit waving tip of the endoscope to the opposite side, the endoscope treatment hood, characterized in that it is possible to form by removing the flexible tube from the slit.
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