JP5777441B2 - Laser transmission path, laser treatment instrument, and laser treatment system - Google Patents

Description

  The present invention relates to, for example, a laser treatment system for performing laser treatment, a laser treatment instrument used in the laser treatment system, and a laser transmission path inserted through the laser treatment instrument.

  Conventionally, a treatment method using an endoscope has been implemented as a treatment method that can be treated with less burden on the patient. In the treatment using this endoscope, the endoscope tube is inserted into the body from the oral cavity or the like, and imaging and treatment are performed using the distal end configuration portion of the endoscope tube.

  The imaging is performed by irradiating illumination light from the tip component, receiving reflected light from the tissue in the body with a lens provided in the tip component, transmitting the light from the endoscope tube to the endoscope body device, This is executed by the endoscope main unit imaged and displayed on the display device. Alternatively, imaging is performed by an imaging element such as a CCD sensor provided at the distal end configuration portion of the endoscope tube, and an image signal configured by the distal end configuration portion is transmitted to the endoscope main body device through the endoscope tube. The image is displayed on the display device.

  The treatment is performed by a forceps tip that is inserted from a forceps insertion opening called a channel and comes out from the forceps outlet of the tip constituting portion. As the forceps, various instruments such as a gripping forceps and a knife are used.

As an instrument that is inserted from the forceps insertion opening and used for the treatment, an instrument that uses a laser transmission path for irradiating a therapeutic laser beam has been proposed (see Patent Document 1). The laser transmission path of Patent Document 1 describes that a gas such as carbon dioxide is conducted to a tubular waveguide having a hollow inside (hereinafter referred to as a hollow waveguide) together with a CO ₂ laser.
The gas passing through the hollow waveguide is supposed to function as a cooling fluid for cooling the hollow waveguide heated by the laser beam.

  As a laser treatment instrument, there has been proposed a gas treatment passage that allows passage of assist gas around a fiber of a laser irradiation probe that irradiates laser light (see Patent Document 2).

  In the cauterization operation with a therapeutic laser, especially in the submucosal dissection (ESD) and mucosal resection (EMR), the treatment space is expanded and the field of view is secured by removing the transpiration and smoke. The assist gas is required to be injected.

  On the other hand, when an assist gas with low bioabsorbability is used, it remains for a long time in the treatment target part, and there is a risk that postoperative bloating and pain may occur due to the assist gas filling the treatment target part. is there. Further, when air having low bioabsorbability is used as an assist gas, if air enters the blood vessel and air bubbles remain, there is a risk of causing vascular embolism. Therefore, it is preferable to use a bioabsorbable gas as the assist gas.

  When such a gas having bioabsorbability is used as an assist gas and the treatment target site is treated with laser light, the assist gas and the laser light are used as a hollow waveguide in the laser treatment instrument described in Patent Document 1. Can be assumed to be conducted.

  However, in this case, since the assist gas and the laser beam are conducted through the same hollow waveguide, the laser beam is absorbed by the assist gas depending on the type of assist gas and the type and wavelength of the laser beam. There is a possibility that the transmission efficiency is reduced and it is impossible to irradiate the treatment target site with a laser beam having a desired output.

Special table 2007-533374 JP 2001-309926 A

  In view of the above-described problems, an object of the present invention is to provide a laser transmission path, a laser treatment instrument, and a laser treatment system capable of conducting laser light and assist gas without reducing laser light transmission efficiency. And

The present invention also provides a laser oscillator that oscillates a laser beam, an assist gas generator that generates an assist gas having laser beam absorbability and bioabsorbability , and sub-assist gas generation that generates a sub-assist gas different from the assist gas. a device body with a vessel, the laser oscillator the laser beam oscillated from said assist gas generated from the assist gas generator, and treatment target the sub assist gas said generated from sub assist gas generator A laser transmission path for guiding to the site;
An operation unit for operating oscillation of the laser beam by the laser oscillator , generation of the assist gas by the assist gas generator , and generation of the sub-assist gas by the sub-assist gas generator , and a signal from the operation unit And a control unit for controlling the oscillation of the laser beam by the laser oscillator and the generation of the assist gas by the assist gas generator, and the laser transmission path is formed in a long hollow shape inside the laser beam. A gas waveguide that allows conduction of the assist gas between the hollow waveguide and the exterior tube, and a hollow waveguide that guides the hollow waveguide. JP it to form a, the laser beam and the sub assist gas, a laser treatment system for conducting the interior of the hollow waveguide To.

  The site to be treated can be an appropriate part of a living body including a human, such as the esophagus or stomach.
  As the laser beam, an appropriate laser beam such as a carbon dioxide laser can be used.

The hollow waveguide is formed of a tubular member made of a material having a smooth surface such as glass, a reflective film made of silver or the like is formed on the inner wall of the tubular member, and a cyclic olefin polymer or polyimide is formed on the inner surface of the reflective film. It can be set as the pipe line which forms the dielectric thin film by a material with high transmission efficiency.
The assist gas having the laser light absorbability and the bioabsorbability can be an appropriate gas such as carbon dioxide gas having a higher absorbability in the body than air.

According to the present invention, without reducing the transmission efficiency of the laser beam, the laser beam and the assist gas are conducted, and the assist gas is injected to a treatment target site such as an esophageal wall or a stomach wall in the body, thereby expanding the visual field by expanding the treatment space. Ensure the target site with laser light and assist gas generated and oscillated by control according to the treatment, while securing the field of view by removing smoke, ensuring the field of view, and preventing foreign matter from entering the hollow waveguide. Can be treated.

Further, in a laser transmission path formed of a hollow waveguide that is formed in an internal hollow long shape and guides laser light, and an outer tube that allows insertion of the hollow waveguide, the hollow waveguide, and The laser transmission path reduces the laser beam transmission efficiency by forming a gas transmission path that allows the conduction of assist gas that has laser light absorbability and bioabsorbability between the outer tube and the outer tube. Therefore, the laser beam and the assist gas can be conducted without causing the assist gas to be ejected to a treatment target site such as an esophageal wall or a stomach wall in the body. Thereby, the practitioner can surely treat the treatment target site with the laser beam while ensuring the visual field by expanding the treatment space and the visual field by removing the smoke.

  Specifically, the laser light is conducted inside the hollow waveguide, and the assist gas is conducted to the gas conduction path between the outer tube and the outer tube, that is, the laser light and the assist are respectively provided in separate conduction paths. Turn on the gas. For this reason, for example, when the laser beam and the assist gas are conducted through the same conduction path, the laser beam is absorbed by the assist gas, and a laser beam having a desired output cannot be irradiated to the treatment target site. A reduction in transmission efficiency can be prevented. That is, since the degree of freedom of the combination of the assist gas and the laser beam is increased, convenience is improved.

  In addition, since the assist gas is conducted to the gas conduction path between the outer tube and the outer tube, the hollow waveguide heated by the laser beam conducting inside can be efficiently cooled from the outside by the assist gas. it can. Specifically, the heated hollow waveguide is cooled more efficiently from the outside by the assist gas than when the assist gas that is the cooling medium is conducted inside the hollow waveguide together with the laser light that is the heating medium. Can do.

  Furthermore, it is possible to prevent foreign substances such as transpiration and blood from entering the inside of the hollow waveguide by the assist gas that is conducted through the gas conduction path outside the hollow waveguide and injected from the tip.

  In this way, the laser light is conducted inside the hollow waveguide, and the assist gas is conducted to the gas conduction path formed between the hollow waveguide and the outer tube, so that the assist gas is passed through the esophageal wall, stomach wall, etc. The target area is reliably treated with laser light while ensuring the field of view by expanding the treatment space, securing the field of view by removing smoke, and preventing foreign matter from entering the hollow waveguide. Can be treated.

As aspect of the invention, provided with a central through hole to permit passage of the pre-SL laser beam and the sub assist gas in front view the central, the exit portion having a peripheral through holes in the outer peripheral portion to permit passage of the assist gas The outer tube can be provided at the tip.

  More specifically, the sub-assist gas has neither laser light absorbability nor bioabsorbability in contrast to the assist gas having laser light absorbability and bioabsorbability. If the gas (gas) has no laser light absorbability and bioabsorbability, a large amount of gas can be conducted through the hollow waveguide without any problem. However, in practice, it is difficult to obtain a combination of such gas (gas) and laser light.

  Therefore, in the present invention, the assist gas that needs to be supplied in a certain amount takes into account the laser light absorptivity of the assist gas, makes the gas conduction path outside the hollow waveguide conductive, and the amount of supply is sufficient. Since the assist gas does not have laser light absorptivity, it is configured to conduct in the hollow waveguide.

  Therefore, by injecting both assist gas and sub-assist gas into the treatment target site such as the esophageal wall and stomach wall, it is possible to more reliably prevent invasion of the transpiration and the like into the hollow waveguide, and more reliably and efficiently the laser. The site to be treated can be treated with light.

In addition, the present invention is a laser treatment instrument in which the laser transmission path is inserted into an endoscope external hose and the distal end portion of the laser transmission path is disposed in the vicinity of the distal end opening of the endoscope external hose. It is characterized by that.
According to the present invention, the laser treatment instrument can inject the assist gas and reliably conduct the tip portion of the laser transmission path for irradiating the laser beam to the treatment target site.

  Specifically, the endoscope external hose is usually provided with a plurality of channels, one of which is equipped with an image fiber, and the end of the image fiber is equipped with a CCD camera, or the affected part of the channel Since the CCD camera is installed at the side tip, the tip of the endoscope external hose can reach the treatment site while confirming the image captured by the CCD camera.

  Therefore, the distal end portion of the laser transmission path disposed in the vicinity of the distal end opening portion of the endoscope external hose can be reliably conducted to the vicinity of the treatment target site while being inserted into the endoscope external hose. Therefore, the assist gas is injected into the esophageal wall, stomach wall, etc. in the body to secure the field of view by expanding the treatment space, securing the field of view by removing smoke, and preventing foreign substances from entering the hollow waveguide. The treatment target site can be more reliably treated with laser light while being planned.

  As an aspect of the present invention, a bending operation portion capable of bending operation is provided on the distal end side of the endoscope external hose, and a laser is provided at a position corresponding to the bending operation portion at the distal end of the hollow waveguide on the laser emission end side. A light mis-irradiation preventing member can be provided.

  The mis-irradiation prevention member is a member that absorbs laser light, such as a member that absorbs laser light or a metal member, in preparation for possible damage to the hollow waveguide in the bending operation portion. An elastic alloy, a shape memory alloy, or the like can be used.

  The portion corresponding to the bending operation portion at the tip of the hollow waveguide on the laser emission end side is a portion inserted into the bending operation portion in the hollow waveguide, and the outer peripheral side or inner peripheral side of the insertion portion. It can be. Alternatively, the hollow waveguide can be connected to the tip of the hollow waveguide up to the bending operation portion and can be a portion inserted through the bending operation portion.

According to the present invention, the bending operation section can be freely bent, and the practitioner can perform laser treatment safely and reliably in a good working environment.
Specifically, the erroneous irradiation preventing member can prevent leakage of the laser light from the hollow waveguide due to the bending operation in the bending operation unit that can freely perform the bending operation. That is, even if the hollow waveguide is broken or the coating of the reflective film is peeled off, even if the laser light leaks from the hollow waveguide, the leaked laser light, that is, laser light that has been mis-irradiated Can be absorbed or reflected. That is, the erroneous irradiation preventing member can prevent leakage of laser light (erroneous irradiation) from the hollow waveguide that may be caused by breakage of the hollow waveguide caused by the bending operation in the bending operation unit. Thereby, it is possible to prevent the outer tube, the endoscope external hose, or the optical system of the endoscope from being damaged due to the erroneous irradiation of the laser beam. Therefore, a laser treatment instrument with high safety and reliability can be configured.

  According to the present invention, it is possible to provide a laser transmission path, a laser treatment instrument, and a laser treatment system capable of conducting laser light and assist gas without reducing the transmission efficiency of laser light.

The schematic block diagram of the laser treatment system by an endoscope apparatus and a laser treatment apparatus. The block diagram which shows the structure of an endoscope apparatus and a laser treatment apparatus. Explanatory drawing by the perspective view for demonstrating the structure of an operator operation unit. Explanatory drawing by the perspective view for demonstrating the structure of a laser transmission path. Explanatory drawing by sectional drawing of a laser transmission path.

An embodiment of the present invention will be described below with reference to the drawings.
FIG. 1 is a configuration diagram illustrating a schematic configuration of a laser treatment system 1 including an endoscope apparatus 10 and a laser treatment apparatus 50, and FIG. 2 illustrates a configuration of the endoscope apparatus 10 and the laser treatment apparatus 50. FIG.

In the endoscope apparatus 10, as shown in FIG. 1, an operator operation unit 12 is connected to the apparatus main body 1 a by a connection cable 11.
The operator operation unit 12 mainly includes an operation unit 13 and an endoscope tube 21.

The operation unit 13 includes an eyepiece unit 15, an upper / lower angle knob 16, a left / right angle knob 17, an operation button 18, and a forceps insertion port 20.
The operation button 18 accepts operation inputs such as water supply, suction, zoom, or supply of assist gas or sub-assist gas described later.

  The endoscope tube 21 is provided with a flexible tube portion 22, a curved tube portion 23, and a distal end configuration portion 30 in this order from the base portion toward the distal end. In addition, a forceps insertion path 19 that communicates from the forceps insertion opening 20 to the forceps outlet 36 of the distal end component 30 is provided inside the endoscope tube 21. The forceps insertion path 19 functions as a treatment device insertion path for inserting a treatment device such as a forceps or a laser transmission path 70.

  In FIG. 1, the diameter is enlarged from the middle of the flexible tube portion 22 to the distal end of the bending tube portion 23, but this is for easy understanding of the configuration of the distal end configuration portion 30. Actually, it is formed in a shape having a constant diameter suitable for insertion into the living body such as the esophagus, stomach and intestine.

  The flexible tube portion 22 has a cylindrical shape that is appropriately curved, and can insert a therapeutic device such as an appropriate forceps inserted from the forceps insertion port 20 up to the distal end configuration portion 30. In this embodiment, a laser transmission path 70 of a laser treatment apparatus 50 is inserted as a treatment device.

The bending tube portion 23 is bent in the vertical direction by the operation of the vertical angle knob 16 and is bent in the horizontal direction by the left and right angle knob 17.
Specifically, the bending tube portion 23 is connected to the vertical angle knob 16 and the horizontal angle knob 17 by wires (not shown) inserted into the endoscope tube 21. For this reason, the rotation operation of the up-down angle knob 16 and the left-right angle knob 17 is transmitted to the bending tube portion 23 by the wire, and the bending tube portion 23 bends up, down, left and right. Thereby, the bending tube part 23 can be bent at an arbitrary angle in an arbitrary direction, and the distal end component part 30 can be directed in an appropriate direction toward the treatment target site.

The distal end configuration portion 30 is provided with light guides 31 and 35, a sub-water supply port 32, a lens 33, a nozzle 34, and a forceps outlet 36.
The light guides 31 and 35 are illumination parts that irradiate light serving as illumination for imaging. This enables the practitioner to observe and perform treatment while illuminating the body where light does not reach.

The auxiliary water supply port 32 is a water supply port that discharges a liquid such as a staining solution.
The lens 33 is a lens for collecting a reflected image of a living body by illumination of the light guides 31 and 35 and acquiring a captured image. A captured image can be obtained by appropriately processing the collected information, and the practitioner can check the state. An image sensor that converts light into an electrical signal may be provided in the vicinity of the distal-end component 30 and connected to the endoscope apparatus 10 with a conductive wire, or may be provided in the endoscope apparatus 10 by an image fiber. Light collected by the lens may be transmitted.

The nozzle 34 is a part that discharges a cleaning liquid or the like for cleaning the lens 33 toward the lens 33.
The forceps outlet 36 is an outlet of a treatment device such as the laser transmission path 70 of the laser treatment apparatus 50.
The laser transmission path 70 is formed longer than the forceps insertion path length which is also the entire length of the endoscope tube 21. Details of the laser transmission path 70 will be described later.

  As shown in FIG. 2, the laser treatment apparatus 50 includes an operation unit / display unit 51, a power supply unit 52, a signal processing unit 53, a central control unit 54, a detection unit 55, a guide light emission unit 56, a laser oscillation unit 57, a sub An assist gas injection unit 58 (hereinafter referred to as a SAG injection unit 58) and an assist gas injection unit 59 are provided.

The operation unit / display unit 51 receives an operation input such as a laser output setting or an operation mode change and transmits an input signal to the central control unit 54, and the laser output condition, the operation status of the apparatus, etc. from the central control unit 54 The display signal is received and appropriate information is displayed.
The power supply unit 52 supplies operating power to each unit such as the central control unit 54.

  The signal processing unit 53 processes the signal detected by the detection unit 55 and transmits it to the central control unit 54. In this embodiment, the signal processor 53 and the detector 55 constitute an OCT (Optical Coherence Tomography) apparatus.

  The detection unit 55 transmits, from the guide light emitting unit 56, the reflected guide light 55a (signal light) obtained by reflecting the low coherence guide light 56a irradiated from the guide light emitting unit 56 at the treatment target site. The received reference light is received to obtain interference light. The light received at this time is near infrared light in the vicinity of 800 nm to 1 μm.

  The detection unit 55 detects the light intensity of the beat signal generated by the interference between the reflection guide light 55a (signal light) and the reference light. The signal processing unit 53 performs heterodyne detection for obtaining the intensity of the signal light reflected from the predetermined surface of the treatment target site from the light intensity received from the detection unit 55, and acquires optical coherence tomographic information.

  By performing this while changing the treatment target site to be detected, optical coherence tomographic information of each treatment target site can be obtained. Thereby, optical coherence tomographic information including a tissue profile of a certain depth from the surface is obtained, and not only the surface mucosal layer but also the tissue profile to the submucosa and muscle layers are obtained. This optical coherence tomographic information is information before performing the imaging process. Then, the signal processing unit 53 transmits this optical coherence tomographic information to the central control unit 54.

The central control unit 54 performs various control operations on each unit. The central control unit 54 includes a laser output control unit 54a and a storage unit 54b.
The laser output control unit 54 a controls the output value of the therapeutic laser beam 57 a from the laser oscillation unit 57 in accordance with the output set by the operation unit / display unit 51 and the operation mode.
The storage unit 54b stores appropriate data in addition to control data such as output settings and operation mode settings.

As described above, the detection unit 55 receives the reflected guide light 55a (signal light) and the reference light, and detects the light intensity of the beat signal generated from the interference light.
The guide light emitting unit 56 emits near-infrared light with a low coherence having a wavelength in the vicinity of 800 nm to 1 μm. This guide light is for indicating the position where the therapeutic laser beam 57a for treatment is irradiated. Further, near-infrared light is invisible light, but it can be detected and imaged by an imaging device, so that it is converted into an image signal by an imaging unit 46 of the endoscope apparatus 10 to be described later, and an image display unit 48, the position where the therapeutic laser beam 57a for treatment is irradiated can be confirmed.

The laser oscillation unit 57 oscillates a treatment laser beam 57a used for treatment. In this embodiment, a carbon dioxide gas laser (hereinafter referred to as a CO ₂ laser) having a wavelength of 10.6 μm is used as the therapeutic laser beam 57a. Operations such as setting the irradiation intensity of the CO ₂ laser and starting and stopping irradiation are performed by manual operation by the operation unit / display unit 51 and control by the central control unit 54. Note that part or all of the manual operation can be replaced with a stepping operation using a foot controller (not shown) provided to be able to communicate and control the laser treatment apparatus 50.

  The SAG injection unit 58 injects air as a sub-assist gas 58a (hereinafter referred to as SAG 58a). The injection pressure of the SAG 58a injected by the SAG injection unit 58 is preferably grasped by an appropriate pressure acquisition means, but basically, the conduction space 82 of the hollow waveguide 80 that is conducted together with the therapeutic laser light 57a. Is sprayed at an appropriate pressure at which the pressure becomes positive.

  The guide light 56a irradiated by the guide light emitting unit 56 described above, the therapeutic laser light 57a oscillated by the laser oscillation unit 57, the SAG 58a ejected by the SAG ejection unit 58, and the reflection guide light 55a detected by the detection unit 55 are all. It is transmitted by one hollow waveguide 80. Therefore, these are all transmitted coaxially, and the site | part which acts on a treatment object, and the site | part to detect correspond as a treatment object site | part.

  The assist gas injection unit 59 injects carbon dioxide as the assist gas 59a. The injection pressure of the assist gas 59a that passes through an assist gas conduction path 77 of the laser transmission path 70 (to be described later) and is ejected from the tip of the laser transmission path 70 to the treatment target site is grasped by appropriate pressure acquisition means. It is desirable.

  The endoscope apparatus 10 includes an operation unit 41, a power supply unit 42, a central control unit 43, an affected part gas suction unit 44, an illumination unit 45, an imaging unit 46, a water ejection unit 47, and an image display unit 48.

  The operation unit 41 transmits an operation input by the operation unit 13 (see FIG. 1) to the central control unit 43. That is, the bending operation of the bending tube portion 23 by the operation of the vertical angle knob 16 and the left and right angle knob 17, the pressing operation by the operation button 18, and the like are transmitted. Alternatively, separately from the operation unit 12, for example, an operation unit is provided in a controller main body (not shown) of the endoscope apparatus 10, and operations such as illumination light quantity and still image shooting and storage are performed by the central control unit 43. To communicate.

The power supply unit 42 supplies operating power to each unit such as the central control unit 43.
The central control unit 43 executes various control operations on each unit.
The affected part gas inhalation part 44 inhales the affected part gas 44a filling the affected part through an inhalation conduction path 19b formed between a laser transmission path 70 described later and the forceps insertion path 19 of the endoscope tube 21.
The illumination unit 45 performs illumination from the light guides 31 and 35 (see FIG. 1).

The imaging unit 46 captures an image transmitted from the lens 33 (see FIG. 1) and obtains a captured image necessary for the treatment. By continuously acquiring these captured images in real time, the practitioner can perform the treatment smoothly. As described above, the imaging unit 46 may be provided in the vicinity of the distal end configuration unit 30 or may be provided in a controller main body (not shown) of the endoscope apparatus 10. is there.
The water ejection unit 47 ejects liquid from the auxiliary water supply port 32. In addition, liquid ejection from the nozzle 34 is also executed.

  The image display unit 48 displays an image based on a signal transmitted from the central control unit 43. This image includes a captured image acquired by the imaging unit 46. Therefore, the practitioner can perform the procedure while confirming the captured image displayed on the image display unit 48 in real time. Further, the pre-operative image is stored as a still image in, for example, the central control unit 43 or a communicable external storage device, and the pre-operative image is called and displayed after the operation. Can also be compared.

  Next, the laser transmission path 70 will be described with reference to FIGS. FIG. 3 is an explanatory diagram based on a perspective view for explaining the configuration of the operator operation unit 12. Specifically, FIG. 3 (a) shows a perspective view of the bending tube portion 23, and FIG. 3 (b) shows an enlarged view of a portion in FIG. 3 (a).

  4 is a perspective view for explaining the configuration of the laser transmission path 70, and FIG. 4 (a) is a perspective view of the laser transmission path 70 through the outer tube 71. FIG. (B) has shown the disassembled perspective view which decomposed | disassembled the laser transmission path 70 with the component.

  5 is an explanatory view of the laser transmission path 70 by a cross-sectional view, and FIG. 5 (a) is a longitudinal sectional view of the laser transmission path 70 in a state where it is attached to the forceps insertion path 19 of the endoscope tube 21. FIG.5 (b) has shown sectional drawing in the AA arrow in Fig.5 (a).

  As shown in FIGS. 3 and 4, the laser transmission path 70 includes an outer tube 71, a tip injection port 72, a protective metal tube 76, and a hollow waveguide 80, and as described above, the endoscope tube 21. It is formed longer.

  As shown in FIG. 5, the outer tube 71 is a flexible resin tube and is formed with a diameter that is slightly smaller than the forceps insertion path 19 of the endoscope tube 21. In the state of being inserted into the endoscope tube 21, the suction conduction path 19 b is formed by a gap formed between the outer peripheral surface 71 a of the outer tube 71 and the inner peripheral surface 19 a of the forceps insertion path 19.

  The inhalation conduction path 19b is connected to the affected part gas inhalation part 44 of the endoscope apparatus 10 as described above. Then, the above-mentioned affected part gas 44a is inhaled into the affected part gas inhalation part 44 through the inhalation conduction path 19b.

  As shown in FIGS. 4 and 5, the distal end injection port 72 is a substantially cylindrical body that press-fits the rear insertion flange 75 into the distal end portion of the outer tube 71. 72 has a central irradiation hole 73 penetrating in the length direction. Further, in the circumferential direction of the outer peripheral portion of the tip injection port 72, axial assist gas injection grooves 74 are formed at four equal intervals. Further, two stages of insertion hooks 75 that can be press-fitted into the distal end portion of the outer tube 71 are provided behind the distal end ejection port 72.

  As shown in FIGS. 4 and 5, the protective metal tube 76 is formed in a cylindrical body having an outer periphery with the same diameter as the central irradiation hole 73. In addition, the protective metal tube 76 is a material that is flexible and can be restored by its own elastic force even when it is bent. The protective metal tube 76 is an ultra-thick nickel titanium or the like that can reflect the therapeutic laser beam 57a on its inner peripheral surface. It is made of an elastic alloy or shape memory alloy.

  Since the protective metal tube 76 is formed with the same diameter so that the tip can be inserted into the central irradiation hole 73, the protective metal tube 76 is interposed between the inner peripheral surface 71 b of the outer tube 71 and the outer peripheral surface 76 a of the protective metal tube 76. A gap D1 is formed.

  As shown in the longitudinal cross-sectional view of FIG. 5A, the hollow waveguide 80 can be inserted into the protective metal tube 76 at the tip, and has an outer periphery having the same diameter as the inner periphery of the protective metal tube 76 and the outer tube 71. The inner hollow cylindrical body having the same length is formed. The hollow waveguide 80 has a smooth surface such as a glass tube, and is formed in a long shape from a material suitable for forming a reflective film such as silver and a dielectric thin film. The inner peripheral surface of the hollow waveguide 80 is covered with a dielectric thin film 81. The dielectric thin film 81 is formed of an appropriate material that efficiently reflects and transmits laser light, such as COP (cyclic olefin polymer) and polyimide.

  Thus, since the inner peripheral surface of the hollow waveguide 80 is covered with the reflective film such as silver and the dielectric thin film 81, the therapeutic laser light 57a that conducts the conduction space 82 inside the hollow waveguide 80, The guide light 56a or the reflected guide light 55a can be conducted with high transmission efficiency.

  Since the hollow waveguide 80 is formed of a cylindrical body having an outer periphery having the same diameter as the inner periphery of the protective metal tube 76 as described above, the inner peripheral surface 71b of the outer tube 71 and the hollow waveguide are formed. A gap D <b> 2 is formed between the outer peripheral surface 80 a of 80.

  As described above, the conduction of the assist gas 59a is established by the gaps D1 and D2 formed between the inner peripheral surface 71b of the outer tube 71, the outer peripheral surface 76a of the protective metal tube 76, and the outer peripheral surface 80a of the hollow waveguide 80. An assist gas conduction path 77 that allows the

  The distal end side of the assist gas conduction path 77 communicates with the assist gas ejection groove 74 of the distal end injection port 72 attached to the distal end of the outer tube 71, and the base portion of the assist gas conduction path 77 is the assist gas ejection section of the laser treatment apparatus 50. 59. Therefore, the assist gas 59a injected by the assist gas injection portion 59 is conducted from the base end side to the tip end through the assist gas conduction path 77 and is jetted forward from the assist gas jet groove 74 of the tip jet port 72. Can do.

Next, a method of use in submucosal dissection (ESD) using the laser treatment system 1 will be described.
As described above, in submucosal dissection (ESD) using the laser treatment system 1, the endoscope tube 21 of the operator operation unit 12 in which the laser transmission path 70 is inserted into the forceps insertion path 19 is inserted into the body. Then, based on the front image of the distal end configuration unit 30 captured by the imaging unit 46 displayed on the image display unit 48, the distal end configuration unit 30 of the operator operation unit 12 is inserted until it reaches the treatment target site. The site to be treated is a lumen such as the esophagus or stomach, and is an appropriate part of a living body including a human.

  Thereafter, the assist gas injection unit 59 is operated, and the assist gas 59a is ejected through the assist gas conduction path 77 and the assist gas injection groove 74 of the tip injection port 72 to enlarge the lumen as the treatment target site. Make it easy. Then, the practitioner confirms the image on the image display unit 48, and guides the guide light 56 a that conducts the conduction space 82 of the hollow waveguide 80, the treatment laser light 57 a, and the SAG 58 a to the central irradiation hole 73 of the tip ejection port 72. Irradiation / ejection is performed, and the treatment target site is treated with the therapeutic laser beam 57a.

  At this time, since the treatment target site is incised and separated by the therapeutic laser beam 57a, the lumen as the treatment target site is filled with smoke. Therefore, by injecting the assist gas 59a and operating the affected part gas suction part 44, the affected part gas 44a including smoke in the lumen can be absorbed by the affected part gas suction part 44 through the inhalation conduction path 19b. . Therefore, it is possible to keep the inside of the lumen that is the treatment target portion clear.

  Further, since SAG 58a is injected into the conducting space 82 of the hollow waveguide 80 together with the therapeutic laser beam 57a, the central irradiation hole 73 of the transpiration generated by the incision / separation of the treatment target site by the therapeutic laser beam 57a and the conduction are provided. Intrusion into the space 82 can be prevented.

  Then, after the treatment is completed, the endoscope tube 21 of the operator operation unit 12 is inserted from the body, and the submucosal dissection and exfoliation (ESD) is completed. In addition, even mucosal resection (EMR) can be performed by the same usage method.

  Since the laser treatment system 1 used in such a usage method has the above-described configuration, the treatment laser light 57a and the assist gas 59a are transmitted to the laser transmission path without reducing the transmission efficiency of the treatment laser light 57a. Conduction up to the tip of 70 is possible. Then, the laser treatment system 1 injects the assist gas 59a from the tip injection port 72 of the laser transmission path 70 to the treatment target site such as the esophageal wall and stomach wall in the body, thereby securing a visual field by expanding the treatment space and generating smoke. The treatment target site can be reliably treated with the treatment laser light 57a oscillated by the control according to the treatment while securing the visual field by the removal and cooling the hollow waveguide.

  More specifically, the laser transmission path 70 to be attached to the operator operation unit 12 is formed in a long hollow shape inside, and a hollow waveguide 80 that guides the therapeutic laser light 57a, and insertion of the hollow waveguide 80 is allowed. An assist gas conduction path 77 that allows conduction of an assist gas 59a having laser light absorbability and bioabsorbability is formed between the hollow waveguide 80 and the exterior tube 71. Thus, the therapeutic laser beam 57a is conducted to the conduction space 82 of the hollow waveguide 80, and the assist gas 59a is conducted to the assist gas conduction path 77 between the outer tube 71 and the outer tube 71, that is, respectively. The therapeutic laser beam 57a and the assist gas 59a are conducted through separate conduction paths.

  Therefore, for example, when the treatment laser beam 57a and the assist gas 59a are conducted through the same conduction path, the treatment laser beam 57a is absorbed by the assist gas 59a and the treatment laser beam 57a having a desired output is treated. Therefore, it is possible to prevent the transmission efficiency of the therapeutic laser beam 57a from being reduced.

Further, since CO ₂ gas having a bioabsorbability approximately 200 times higher than that of air is used as the assist gas 59a, the assist gas 59a filling the post-surgical site to be treated is quickly absorbed, and the postoperative The occurrence of fullness and pain can be suppressed. Also, even if the assist gas 59a is mixed into the blood vessel, there is no possibility of causing blood embolism due to the bioabsorbability of the assist gas 59a.

  Furthermore, the assist gas 59a is conducted to the assist gas conduction path 77 between the outer side of the hollow waveguide 80 and the outer tube 71, so that it is heated by the therapeutic laser light 57a that conducts the conduction space 82 of the hollow waveguide 80. The hollow waveguide 80 can be efficiently cooled from the outside. Specifically, the hollow waveguide heated by the assist gas 59a is compared with the case where the assist gas 59a serving as the cooling medium is conducted to the conduction space 82 of the hollow waveguide 80 together with the therapeutic laser light 57a serving as the heating medium. 80 can be cooled more efficiently from the outside.

  In this way, the therapeutic laser beam 57a is conducted to the hollow waveguide 80, and the assist gas 59a is conducted to the assist gas conduction passage 77 formed between the hollow waveguide 80 and the outer tube 71, thereby assist gas 59a. Is sprayed onto the esophageal wall, stomach wall, etc. in the body to secure the field of view by expanding the treatment space, secure the field of view by removing smoke, and prevent foreign substances from entering the hollow waveguide. The treatment target site can be reliably treated with the laser beam 57a for use.

Further, SAG 58a by air different from the assist gas 59a, which is highly bioabsorbable CO ₂ gas, is conducted to the conduction space 82 of the hollow waveguide 80, and the central irradiation that allows the treatment laser light 57a and the SAG 58a to pass therethrough. An esophageal wall of the assist gas 59a is provided at the distal end of the outer tube 71 by providing a distal end injection port 72 provided with a hole 73 in the center of the front view and an assist gas injection groove 74 that allows passage of the assist gas 59a in the outer periphery. Further, it is possible to more reliably prevent the transpiration from entering the hollow waveguide 80 by spraying on the treatment target site such as the stomach wall, and more reliably treat the treatment target site with the therapeutic laser beam 57a.

Note that air that is less bioabsorbable than the CO ₂ gas used as the assist gas 59a is used as the SAG 58a. The SAG 58a makes the conduction space 82 of the hollow waveguide 80 a positive pressure and the laser transmission path 70 Since the injection amount and the injection pressure are sufficient to prevent the invading material from entering the central irradiation hole 73, there is no influence on the feeling of fullness or pain after the operation. Furthermore, since the SAG 58a has the above-described injection amount and injection pressure, it is safe without causing a blood vessel embolism (air embolism) due to air entering the blood vessel and air bubbles remaining therein.

  Furthermore, in the operator operation unit 12 having a plurality of forceps insertion paths 19, the laser transmission path 70 is inserted into one forceps insertion path 19, and the distal end portion of the laser transmission path 70 is connected to the endoscope tube 21. Since the optical system including the illumination unit 45 is provided separately from the forceps insertion path 19, the practitioner operates the operator operation unit while checking the image captured by the illumination unit 45. It is possible to reliably reach the distal end constituting portion 30 of the twelve endoscope tubes 21 to the position closest to the treatment target site.

  Therefore, the assist gas 59a is sprayed to the site to be treated such as the esophageal wall and stomach wall in the body to secure the visual field by expanding the treatment space, secure the visual field by removing smoke, and prevent foreign substances from being mixed into the hollow waveguide. In addition, the practitioner can more reliably treat the treatment target site with the treatment laser beam 57a while confirming the captured image.

  In addition, a bending tube portion 23 that can be bent is provided at the distal end portion of the endoscope tube 21 of the operator operation unit 12, and a portion corresponding to the bending tube portion 23 at the distal end of the laser transmission path 70 on the laser emission end side. In addition, since the protective metal tube 76 for the treatment laser beam 57a is provided, the bending tube portion 23 can be freely bent so that the practitioner can perform laser treatment safely and reliably in a good working environment. Can do.

  Specifically, even if the hollow waveguide 80 is damaged by the bending operation in the bending tube portion 23 that can be freely bent, the protective metal tube 76 is erroneously irradiated with the therapeutic laser light 57a leaked from the hollow waveguide 80, that is, The therapeutic laser beam 57a can be reflected. That is, it is possible to prevent leakage (mis-irradiation) of the therapeutic laser beam 57a from the hollow waveguide 80, which may be caused by breakage of the hollow waveguide 80 caused by the bending operation in the bending tube portion 23. Thereby, it is possible to prevent the outer tube 71 and the endoscope tube 21 of the operator operation unit 12 from being damaged due to the erroneous irradiation of the therapeutic laser beam 57a. Therefore, the operator operation unit 12 with high safety and reliability can be configured.

In the above description, the CO ₂ laser is used as the therapeutic laser beam 57a. However, other appropriate therapeutic laser beam may be used.
Further, although CO ₂ gas is used as the assist gas 59a, an appropriate gas having laser light absorbability and bioabsorbability may be used. Furthermore, although air is used as the SAG 58a, an appropriate gas such as nitrogen that does not have laser light absorbability and bioabsorbability may be used.

  Furthermore, in the above description, the hollow waveguide 80 is inserted into the protective metal tube 76 and the outer side of the hollow waveguide 80 is surrounded by the protective metal tube 76 in the curved tube portion 23. Even if the protective metal tube 76 is inserted, the same effect can be obtained.

  Further, the hollow waveguide 80 is formed with the length of the flexible tube portion 22 up to the bending tube portion 23, the protective metal tube 76 is connected to the tip of the hollow waveguide 80, and only the protective metal tube 76 is bent. The same effect can be obtained even if the portion 23 is inserted.

In correspondence between the configuration of the present invention and the above-described embodiment,
The laser beam of the present invention corresponds to the therapeutic laser beam 57a,
Similarly,
Sub assist gas corresponds to SAG58a,
The central through hole corresponds to the central irradiation hole 73,
The outer peripheral through hole corresponds to the assist gas injection groove 74,
The emission part corresponds to the tip injection port 72,
The endoscope external hose corresponds to the endoscope tube 21,
The vicinity of the tip opening corresponds to the tip component 30,
The laser treatment instrument corresponds to the operator operation unit 12,
The bending operation portion corresponds to the bending tube portion 23,
The erroneous irradiation prevention member corresponds to the protective metal tube 76,
The laser oscillator corresponds to the laser oscillation unit 57,
The assist gas generator corresponds to the assist gas injection unit 59,
The apparatus body corresponds to the laser treatment apparatus 50,
The control unit corresponds to the central control unit 43,
The present invention is not limited only to the configuration of the above-described embodiment, and many embodiments can be obtained.

  For example, in the above description, a plurality of axial assist gas injection grooves 74 are provided on the outer periphery of the tip injection port 72, but the configuration of the assist gas injection groove 74 is not limited to this, and the outer peripheral surface of the tip injection port 72 is provided. A plurality of assist gas injection grooves 74 may be formed along the spiral. Alternatively, a plurality of concentric circles may be arranged on the outer peripheral side of the central irradiation hole 73, and the assist gas injection groove 74 may be configured by a through-hole penetrating in the axial direction as if in a lotus root in the wall of the tip injection port 72. Good. Further, the tip injection port 72 itself is formed in a frontal drum shape or a D shape, and an assist gas injection groove 74 is formed in a gap between the drum shape or the straight portion of the D shape and the inner peripheral surface 71 b of the outer tube 71. It may be configured.

  Moreover, the structure which detects the injection amount and jet pressure of SAG58a and the assist gas 59a, and stops the operation | movement of the laser treatment system 1 based on an abnormal detection result may be sufficient. Specifically, by detecting the injection amount and the ejection pressure of the SAG 58a and the assist gas 59a independently or relatively, the assist gas conduction path 77 through which the assist gas 59a passes, and the assist gas injection groove 74, Alternatively, blockage or breakage of the conduction space 82 through which the SAG 58a passes and the central irradiation hole 73 can be detected. In this case, since there is a possibility that accurate treatment cannot be performed, stop control for immediately stopping the operation of the laser treatment system 1 is performed. Thereby, the laser treatment system 1 with high safety and reliability can be configured.

  The present invention can be used in various devices that treat a living body using laser light. In particular, the present invention can be used for an apparatus such as an endoscope that transmits a laser beam in a limited space for treatment and treatment.

DESCRIPTION OF SYMBOLS 1 ... Laser treatment system 12 ... Operator operation unit 21 ... Endoscope tube 23 ... Curved tube part 30 ... Tip structure part 41 ... Operation part 43 ... Central control part 50 ... Laser treatment apparatus 57 ... Laser oscillation part 57a ... For treatment Laser beam 58a ... SAG
59 ... assist gas jetting section 59a ... CO ₂ assist gas 70 ... laser transmission channel 71 ... outer tube 72 ... tip ejection port 73 ... central exposure holes 74 ... assist gas injection grooves 76 ... protective metal tube 77 ... assist gas conduits 80 ... Hollow waveguide

Claims (4)

Laser oscillator that oscillates laser light, assist gas generator that generates assist gas having laser light absorbability and bioabsorbability , and apparatus including sub assist gas generator that generates sub assist gas different from the assist gas The body,
The laser oscillator the laser beam oscillated from the laser transmission path for guiding the assist gas generated from the assist gas generator, and the sub assist gas generated from the sub assist gas generator to treatment target site When,
An operation unit for operating oscillation of the laser beam by the laser oscillator , generation of the assist gas by the assist gas generator , and generation of the sub-assist gas by the sub-assist gas generator ;
A control unit that controls oscillation of laser light by the laser oscillator and generation of assist gas by the assist gas generator based on a signal from the operation unit;
The laser transmission path is formed of a hollow waveguide that is formed in an internal hollow long shape and guides the laser light, and an outer tube that allows the hollow waveguide to pass therethrough, and the hollow waveguide; A gas treatment path that allows conduction of the assist gas is formed between the outer tube and the laser treatment system that conducts the laser light and the sub-assist gas to the inside of the hollow waveguide. . A central through hole to permit passage of the pre-SL laser beam and the sub assist gas in front view the central, the exit portion having an outer peripheral portion of the peripheral through holes to permit passage of the assist gas, the outer tube distal end The laser treatment system according to claim 1 provided. While inserting the laser transmission path according to claim 1 or 2 through an endoscope external hose,
The tip of the laser transmission path is arranged near the tip opening of the endoscope external hose
A laser treatment instrument used in a laser treatment system . While providing a bending operation part capable of bending operation on the distal end side of the endoscope external hose,
The laser treatment instrument used for the laser treatment system according to claim 3, further comprising a laser beam misirradiation prevention member at a position corresponding to the bending operation portion at a tip of the hollow waveguide on the laser emission end side.

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